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PubMed2003

Predictors of outcome among high functioning children with autism and Asperger syndrome.

BACKGROUND: The objective of this paper is to assess the extent to which measures of cognitive abilities taken in an inception cohort of young high functioning children with autism and Asperger syndrome predict outcome roughly two and six years later. METHOD: Children who received a diagnosis of autism or Asperger syndrome (AS) and who had a nonverbal IQ score in the 'non-retarded' range were included in the inception cohort. Measures of language and nonverbal skills were taken when the children were 4-6 years of age and outcome assessments were completed when the children were 6-8 and 10-13 years of age. The three outcome measures consisted of scales of adaptive behaviours in socialisation and communication and a composite measure of autistic symptoms (abnormal language, abnormal body and object use, difficulties relating to others, sensory issues and social and self-help difficulties). RESULTS: The explanatory power of the predictor variables was greater for communication and social skills than for autistic symptoms. The power of prediction was stable over time but did differ by PDD subtype. In general, the association between language skills and outcome was stronger in the autism group than in the AS group. CONCLUSIONS: These results support the emphasis of early intervention programmes on language but more work needs to be done on understanding variables that influence outcome in social skills and autistic behaviours, particularly in those with AS.

Adaptation, Psychological↗
PubMed1998

Functional outcome assessment of adults with traumatic brain injury.

The treatment of cognitive communicative impairments that occur due to traumatic brain injury is a relatively new field. There is a need for more empirical evidence supporting the efficacy of cognitive rehabilitation. Fortunately, the number of studies in this area have continued to grow over the past few years. The purpose of this article is to provide current information regarding the assessment of functional outcomes after traumatic brain injury using the theoretical framework of the International Classification of Impairments, Disabilities, and Handicaps (ICIDH), which was developed by the World Health Organization (WHO).

Adult↗
PubMed1991

The aphasic isolate. A clinical-CT scan study of a particularly severe subgroup of global aphasics.

This paper outlines the clinical and CT scan features of a subtype of global aphasia, characterized by an extreme loss of communicative abilities, verbal as well as nonverbal. Three to four weeks after a left hemisphere stroke, 17 patients were completely unable to communicate with people addressing them. Though there were differences in their willingness to interact with the environment, they were characterized by complete loss of speech output and by inaccessibility to any kind of message, whether given verbally or through gestures. Patients who survived were reassessed 6 and 12 mos later and half of them were still found in a state of complete communicative isolation. The remainder had somewhat improved, but remained globally aphasic. The attempt to find a CT scan basis for this picture was disappointing. Only 35% of patients had a lesional pattern in agreement with the traditional view that ascribes global aphasia to the involvement of Broca's and Wernicke's areas. The location of lesion in the other cases spanned from anterior cortical damage, to posterior cortical damage, to deep nuclei damage and none of the lesions that have been proposed to account for subcortical global aphasia was consistently observed.

Aged↗
PubMed2006

Variation in vocal-motor development in infant siblings of children with autism.

In this study we examined early motor, vocal, and communicative development in a group of younger siblings of children diagnosed with autism (Infant Siblings). Infant Siblings and no-risk comparison later-born infants were videotaped at home with a primary caregiver each month from 5 to 14 months, with follow-up at 18 months. As a group, Infant Siblings were delayed in the onset of early developmental milestones and spent significantly less time in a greater number of postures, suggestive of relative postural instability. In addition, they demonstrated attenuated patterns of change in rhythmic arm activity around the time of reduplicated babble onset; and they were highly likely to exhibit delayed language development at 18 months.

Autistic Disorder↗
PubMed2002

The development and evaluation of the pain indicator for communicatively impaired children (PICIC).

A previous study found that parents of communicatively impaired children with severe cognitive impairments identified six core cues as indicating definite or severe pain in their child (J. Pediatr. Psychol. 27 (2002) 209). The frequency of each cue was assessed by 67 caregivers of communicatively impaired children, twice per day over a 1 week period. On each occasion the caregivers also rated whether they considered their child to be in pain and the severity of any pain. There was a statistically significant relationship between five of the cues and the presence and severity of pain. The single cue of screwed up or distressed looking face was the strongest predictor and on its own correctly classified 87% of pain and non-pain episodes. The study highlights the potential clinical utility of a short carer completed assessment to assess pain in this vulnerable group of children.

Adolescent↗
PubMed2001

Direct interventions for improving the performance of individuals with Alzheimer's disease.

Direct interventions are being used increasingly to maintain and improve the communicative and cognitive functioning of patients with Alzheimer's dementia. Speech-language pathologists can play an integral role in maximizing the functioning of dementia patients by selecting appropriate direct interventions that capitalize on spared neuropsychological abilities to compensate for impaired abilities. Successful direct interventions use techniques that facilitate learning and retention of information and skills. In this article, direct intervention techniques-repeated exposure via spaced retrieval training and quizzes; errorless learning; multisensory stimulation using music, toys, pets, and memory wallets; and other approaches to cognitive-linguistic stimulation such as the use of personal computers; the Montessori method; and activity programming-are reviewed. The rationale for use of these direct interventions and available efficacy data with Alzheimer's patients also are presented.

Aged↗
PubMed2005

Executive functions in children with communication impairments, in relation to autistic symptomatology. 2: Response inhibition.

Although impairment in executive functions has been described in autism, there has been debate as to whether response inhibition is specifically affected. We compared four groups: high-functioning autism; pragmatic language impairment; specific language impairment; and control. Inhibition was assessed using two subtests from the Test of Everyday Attention for Children, one requiring a verbal response and the other a non-verbal response. Although we found evidence of inhibitory deficits, these were neither specific to autism, nor linked to particular aspects of autistic symptomatology. Rather, they appeared to be associated with poor verbal skills and inattention. It is suggested that future studies need to control for structural language skills and attention deficit when evaluating cognitive deficits in autism. Reliance on control groups matched solely on vocabulary level or nonverbal mental age may obscure the important role played by language skills in executive functions.

Attention↗
PubMed2005

Foreign accents: suggested competencies for improving communicative pronunciation.

In the past 20 years, many speech-language pathologists (SLPs) have joined their English as a Second Language (ESL) colleagues to address the pronunciation skills of second language speakers of English. This paper introduces SLPs to the ESL term "communicative pronunciation" as the underpinning for the commonly accepted terms "accent modification" or "accent reduction." Initially, professionals in both speech pathology and ESL felt that accent intervention was outside the scope of speech pathology practice, though that stance is softening. If an essential part of our mission as speech pathologists is to improve communicative competence for all persons, then making pronunciation more intelligible falls under that heading. This article on foreign accents limits discussion to: (1) the rationale for intervening with foreign accented adults; (2) an outline of a broader scope and definition of effective instruction for this population; (3) suggestions for trainer preparation; (4) recommendations for productive literature searches; and (5) a brief discussion of principles guiding assessment and instruction planning. The article includes relevant research and references outside the field of speech pathology that should stimulate future productive research efforts as well as more in-depth papers on specific instruction and assessment issues. While this article is intended to stand alone, readers may benefit from the content and references in another article in this issue by the same author.

Adult↗
PubMed1996

Vision, cognition and developmental characteristics of girls and women with Rett syndrome.

Forty-two females with Rett syndrome, aged 2.5 to 47 years, were assessed with the Teller Acuity Cards and a new version of the Fagan test for age 2 years and above, and their parents were interviewed about the children's communication skills. The visual function of the subjects indicated arrested development, and they scored significantly lower on the Fagan test than a normal comparison group. Their visual processing and memory deteriorated somewhat with age, while those of the comparison group showed a slight increase. Both age at onset of Rett syndrome symptomatology and speech measures were inversely correlated with visual processing and memory, indicating that age at recession may have differential consequences for different functions. Among the subjects, persistent looking was associated with low cognitive function. The results have implications for intervention, and demonstrate that the paradigm of preferential looking may be useful in cognitive assessment of females with Rett syndrome.

Adolescent↗
PubMed2003

Screening for ability to complete a questionnaire: a preliminary evaluation of the AbilityQ and ShoulderQ for assessing shoulder pain in stroke patients.

OBJECTIVES: To assess the repeatability of the AbilityQ--a screening tool to assess technical ability to complete a questionnaire--in patients with complex disabilities following stroke. To evaluate the validity of the AbilityQ in predicting repeatability and consistency of response to verbal and visual analogue scale questions in the ShoulderQ in those with shoulder pain. DESIGN: In a cross-sectional study, the AbilityQ and 'ShoulderQ' were administered on two consecutive days by a single investigator. SETTING: Six regional rehabilitation centres in the UK managing patients with severe complex neurological disability. SUBJECTS: Forty-nine patients with anterior or posterior circulation strokes: 13 (63%) had cognitive deficits and 28 (57%) had communicative deficits. RESULTS: Thirty-one (63.3%) patients required some degree of help in completing the AbilityQ. Percentage agreement for individual questions between day 1 and day 2 ranged from 55 to 88% with kappa values from 0.07 to 0.79. Repeatability of ShoulderQ responses was 36-72% for the verbal questions (kappa values 0.16-0.56). For visual analogue scale (VAS) questions, agreement +/- 1 on a 10-point scale was 36-59% with intraclass correlation coefficients 0.50-0.60 (p < 0.01). High verbal (> or = 3/4) and VAS scores (3/3) on the AbilityQ had positive predictive values for good repeatability in the ShoulderQ of 80% and 58% respectively. Mismatched AbilityQ responses to verbal and VAS questions showed a positive predictive value of 92% for similar inconsistency in the ShoulderQ and a negative predictive value of 90%. CONCLUSIONS: In this preliminary evaluation the AbilityQ and the ShoulderQ each demonstrated a moderate level of repeatability in a group of patients expected to have difficulty in completing questionnaires. The AbilityQ appears to have some clinical usefulness in identifying those able to respond to the ShoulderQ and, where responses to verbal and VAS questions conflict, may offer some guidance as to which are most likely to be accurate in that individual. Further development is underway.

Adult↗
PubMedDate not supplied

Effects of toy stimulation on the cognitive, communicative, and emotional functioning of adults in the middle stages of Alzheimer's disease.

UNLABELLED: Although several clinical reports describe the benefits of toy stimulation for dementia patients, there is little empirical support for this sensory stimulation approach. The purpose of this investigation was to examine the effects of toy stimulation on the language, cognition, and emotional state of patients in the middle stages of Alzheimer's disease (AD) during a formal testing situation. Eighteen patients completed a standardized test battery and picture description task twice, once with and once without a toy stimulus present. Three AD patients completed all tasks four times (twice with and twice without the toy) to examine performance consistency. Although some patients improved their performances in the presence of a toy, there were no significant group differences between the toy and no toy conditions for any experimental measure. Of the three patients who completed experimental tasks twice in the presence of a toy, two displayed some consistent improvements whereas the remaining patient's response pattern was variable. Caregiver feedback regarding toy stimulation was positive. Methodological limitations of the current study and suggestions for future research are discussed. LEARNING OUTCOMES: As a result of reading this article, the participant will be able to: (1) summarize the previous literature regarding sensory stimulation treatment approaches for patients with Alzheimer's disease or other dementing illnesses; and (2) describe the effects of toy stimulation on the linguistic and cognitive abilities, and emotional status of patients in the middle stages of Alzheimer's disease.

Affect↗
PubMed1981

Population study of hearing disorders in adults: preliminary communication.

The Institute of Hearing Research is embarked upon a study of the prevalence, characteristics and determinants of hearing problems and tinnitus in the adult population of the UK. One of its objectives is to ascertain the size of the problem in terms both of numbers of people affected and the degrees to which they are affected. Such knowledge is highly relevant to any consideration of the services needed for the adult hearing impaired. The overall plan for the study and the results of its pilot study are outlined. In Tier A, a questionnaire on hearing difficulties and tinnitus was sent to 6804 persons living in Cardiff, Glasgow, Nottingham and Southampton. This enabled stratification of respondents by age groups and reported impairments, and thereby permitted appropriate sampling ratios from those strata to be invited to attend the clinics for the Tier B clinical and audiological investigations. Response rates were around 80% at Tier A and 50% at Tier B; domiciliary follow up showed the biases in non-responders and non-attenders to be minimal. About 25% of the sample reported some hearing difficulty, and about 17% reported an experience of tinnitus that was more than transitory or temporary noise-induced. Taking a criterion of over 25 dB hearing level in the better ear, averaged across 0.5, 1, 2 and 4 kHz, a prevalence estimate for the UK population is that 19.9 +/- 4.4% of adults are so affected. About 0.5-1% of adults appear to be severely affected by tinnitus; this amounts to about 200 000 persons in the UK. The scale of the problem has not been fully appreciated before and points to an urgent need to develop further the clinical services and research effort in the field of tinnitus.

Adolescent↗
PubMed2007

Experimental manipulation of cognitive control processes causes an increase in communication disturbances in healthy volunteers.

BACKGROUND: Although communication disturbances (CD) have been associated with poor cognitive control, it is unclear whether they are associated specifically with poor cognitive control or with poor cognition in general. The current research examined whether (a) two specific components of cognitive control, working memory and interference resolution, were associated with CD, and (b) associations between CD and cognitive control could be accounted for by generalized poor cognitive performance. METHOD: In this study, as healthy volunteers spoke, the level of cognitive demands was experimentally increased, thereby simulating cognitive deficits (i.e. a reduction in the degree to which certain types of cognitive processes could be used for speech). Hence, this research examined whether simulated cognitive deficits would cause an increase in CD. Participants also completed separate cognitive tasks that assessed working memory, interference resolution and general cognitive ability. RESULTS: An increase in working memory demands caused an increase in CD. Moreover, working memory demands interacted with interference resolution demands, with the greatest amount of CD caused by both high working memory and high interference resolution demands. By contrast, increasing another cognitive demand, sustained attention, did not increase CD. Furthermore, performance on separate working memory and interference resolution tasks interacted to predict CD on the experimental speech task. However, performance on a psychometrically matched cognitive task did not predict CD. CONCLUSION: Overall, the current study provides evidence that working memory and interference resolution may be specifically associated with CD and that manipulations of these cognitive control processes can cause an increase in CD.

Adolescent↗
PubMed2004

The impact of cognitive impairment on the rehabilitation process in geriatrics.

A study has been carried out in our geriatric rehabilitation wards, to know better the role of cognitive dysfunction in treatment outcome and processing, mainly functional recovery and comorbidity. We analyzed 478 frail inpatients, 2/3 of them were females, aged 78.7 + 9.2 years, consecutively admitted to the unit. Assessment of cognitive function was performed by the mini mental state examination (MMSE), of functional status by Barthel index (BI), of co-morbidity by cumulative illness rating scale (CIRS) both at the admission and discharge for each patient, together with the usual clinical parameters and social outcome. More than one people in three lived alone and showed some communication problems; one in seven needed modifications in food preparation or nutritional system;more than one in five had pressure sore >/= 2 (EPUAP = European Pressure Ulcers Advisory Panel classification). The mean (+/- SD) levels of the admitted were: MMSE = 20 +/- 7.2; BI total score = 45.5 +/- 28.9; CIRS class = 4 +/- 2, CIRS severity score = 1.9 +/- 0.4. Of the patients, 74.5% were discharged to home. Mean functional gain was 20 points at BI: 65.6 +/-30.7; MMSE improved to 21.6 +/- 7.1 (p = 0.00005 for both comparisons, by Wilcoxon test).MMSE was positively correlated to BI (r = 0.6, p = 0.0005) and negatively correlated (p =0.0005) to CIRS comorbidity (r = -0.33) and severity (r = -0.26), and to age (r = -0.38, p =0.0005) both at admission and at discharge. MMSE at admission was correlated neither to functional gain, nor to improvement of clinical indicators, nor to measures of functional and clinical efficiency. MMSE at discharge showed similar results. In a stepwise multiple correlation analysis, taking the gain in BI as the dependent variable, while BI, serum albumin level, MMSE, CIRS severity and comorbidity indexes at admission as independent variables, MMSE together with BI admission total score and CIRS severity index retained a strong association with functional gain, whilst admission serum albumin levels and CIRSindex lost it. Consistently with some literary data, we showed the actual possibility of functional and clinical gains for people cared in a geriatric rehabilitation ward, all through a wide range of MMSE score, including subnormal scores. Poor cognitive status bears heavily on frailty, but does not hamper the outcomes of genuine rehabilitative efforts in geriatrics.

Aged↗
PubMed1998

Environmental supports to enhance social-communication.

"Environmental support" is a general term used to define the systematic use of explicit visual and/or social cues to clarify meaning for children with autism. Environmental supports can serve as a compensatory means to structure and enhance language understanding, social engagement, and social-communicative interactions. The unique and atypical developmental patterns associated with autism provide the rationale for the use of two environmental supports: visually cued instruction and modified sociolinguistic input. Using empirical research, multiple examples of environmental supports to enhance social-communication are provided.

Autistic Disorder↗
PubMed1996

Diagnosis and classification in autism.

This study compared four systems for the diagnosis of autism (DSM-III, DSM-III-R, DSM-IV, and ICD-10) with two empirically derived taxa of autism, and with three social subgroups of autism (Aloof, Passive, and Active-but-Odd) in 194 preschool children with salient social impairment. There were significant behavior and IQ differences between autistic and other-PDD groups for all four diagnostic systems, and a significant association was found (a) for Taxon B, diagnoses of autism, and the Aloof subgroup, and (b) for Taxon A, other-PDD, and the Active-but-Odd subgroup. Findings offer support for two major overlapping continua within idiopathic Pervasive Developmental Disorder.

Algorithms↗
PubMed1976

Perseveration in brain-injured adults.

Despite the acceptance of perseveration as a characteristic sign of disturbed CNS functioning, objective data relative to its nature and occurrence are noticeably lacking. Data obtained in this study, not unexpectedly, indicate that perseverative responses occur more often in brain-injured than in normal subjects. The brain-injured subject most likely to evidence perseveration appeared to be one who (1) had suffered a CVA (2) less than 6 months ago that (3) resulted in aphasia. Two types of perseveration, repetitious and continuous, were noted in the responses of the brain-injured with higher incidences of the repetitious type occurring. It was felt that the behavioral definitions used to differentiate between repetitious and continuous perseveration allowed for reliable judgments between observers.

Adult↗