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Background: The Western Aphasia Battery (WAB) (Kertesz, 1982) is one of the most frequently used tests of general language performance in aphasia, despite significant psychometric limitations. Item response theory (IRT) provides measurement models that may address some of these limitations. Aims: The purposes of this investigation were to evaluate whether the WAB can be productively fit to an IRT model, and to evaluate whether IRT modelling confers psychometric benefits. Methods & Procedures: An analysis of WAB data collected from a convenience sample of 101 individuals with chronic aphasia was undertaken. Exploratory factor analysis was conducted to evaluate the dimensionality of the WAB, and a Rasch Partial Credit Model was fit to the data. Item fit statistics and residual correlations were used to test key model assumptions. The distribution of traditional and Rasch-based person scores, and the relationship between ability level and test reliability were also examined. Outcomes & Results: Despite reasonable overall fit to the model, a small number of WAB items demonstrated significant misfit, suggesting that they do not productively contribute to the measurement of aphasia severity. A small but substantial minority of individuals also demonstrated inadequate fit to the measurement model. Rasch-based scores were more normally distributed than traditional scores, and score reliability varied substantially across the ability range. Conclusions: These results suggest that the WAB may be productively fit to an IRT-based measurement model, and that such models may be used to improve the psychometric properties of aphasia tests. Benefits include indices of severity and score reliability that are more valid than those currently in use, and the potential for improved efficiency of testing through adaptive administration. [ABSTRACT FROM AUTHOR]

A loss of speech can be related to disorders of the motor units (paresis), language deficits (aphasia), or speech programming deficits (apraxia of speech). Although apraxia of speech has been reported to be associated with degenerative diseases, we observed a patient with a unique constellation of signs that included apraxia of speech, oculo-orofacial apraxia and a supranuclear ophthalmoplegia in the absence of extrapyramidal (Parkinsonian) signs. Post-mortem examination revealed a loss of neurons in the frontal and temporal regions, but there was also a marked loss of neurons and astrogliosis in the caudate, claustrum, globus pallidus, substantia nigra, and loss of axons in the anterior cerebral peduncles. This patient's clinical presentation and the pathological correlates suggest that he might have suffered with a distinct disorder we call progressive oculo-orofacial-speech apraxia or POOSA. [ABSTRACT FROM AUTHOR]

Background : The purpose of this experiment was to investigate the underlying mechanisms responsible for the phonetic encoding of novel articulatory speech gestures (i.e., nonwords). Understanding these mechanisms is critical to gain a comprehensive realisation of normal speech production as well as insight into the nature of pathologic speech. Aims : The following research questions were addressed: (1) Is there a significant difference in the response latency among low, moderate, and high interphonemic transitional frequencies in nonwords? (2) Is there a significant difference in the response latency among low and high lexical frequencies in real words? (3) Is there a significant difference in total durations among low, moderate, and high interphonemic transitional frequencies in nonwords? Methods & Procedures : A total of 19 females between the ages of 50 and 79 repeated nonwords that were constructed in three interphonemic transitional frequency categories (low, moderate, high) and elicited in an immediate response condition. Outcomes & Results : The results showed an expected significant difference of shorter response latency for the high-frequency nonwords when compared to the moderate- and the low-frequency nonwords, and an unexpected significantly shorter duration for the low-frequency nonwords when compared to the moderate- and the high-frequency nonwords. Conclusions : Results are consistent with the interpretation that the high-frequency nonwords were initiated immediately (short response latency) and encoded phonetically on-line during production (longer nonwords duration), while the motor programs for the low-frequency nonwords were pre-loaded prior to initiation of production (longer response latency) and executed without update (shorter nonwords duration). [ABSTRACT FROM AUTHOR]

Background: Stimulus selection is important to anomia treatment because similarity between trained and untrained words in the mental lexicon may influence treatment generalization. We focused on phonological similarity between trained and untrained words from a clinical trial of Phonomotor Treatment (PMT) that showed gains in confrontation naming accuracy of untrained words post-treatment. One way to capture the amount of similarity between the trained and untrained words is to consider the phonological network path distance between words. We posited that the distance between trained and untrained words in a phonological network could account for the improvement in confrontation naming accuracy post-treatment., Aim: To define the phonological network distance between trained and untrained words that influences change in confrontation naming accuracy post-treatment., Methods and Procedures: We retrospectively analyzed data from 28 people with aphasia who received PMT as part of a clinical trial. Participants completed confrontation naming (baseline, post-treatment, and 3-months post-treatment) of words varying in phonological distance to the treatment stimuli. We used a phonological network to calculate the average shortest path length (ASPL), defined by number of phoneme differences, between an untrained word and all trained words. We used mixed effects regression models to predict change in confrontation naming accuracy of untrained words post-treatment from ASPL. Several post-hoc analyses were also conducted., Outcomes and Results: We found no effect of ASPL on change in confrontation naming accuracy of untrained words immediately post- and 3-months post-treatment. However, post-hoc analyses indicated significant subject heterogeneity and limitations in observable path distance between trained and untrained words., Conclusion: Despite the clinical trial report that confrontation naming of untrained words improved after PMT, we found no overall effect of ASPL on the amount of improvement. We discuss further investigation of the entire domain of phonological sequence knowledge (the phonological sequence knowledge landscape) and its influence on treatment generalization, and the potential importance of identifying predictors of treatment response to enhance the effects of treatment generalization.

Background Anomia treatments typically focus on single word retrieval, although the ultimate goal of treatment is to improve functional communication at the level of discourse in daily situations. Aims The focus of this study was to investigate the impact of two effective anomia treatments on discourse production as measured by a story retell task. Method and Procedure Fifty-seven people with aphasia were randomized to receive either a phoneme-based treatment, Phonomotor Therapy (PMT; 28 participants), or a lexical-semantic treatment, Semantic Feature Analysis (SFA; 29 participants). Groups were matched for age, aphasia severity, education, and years post onset. All received 56-60 hr of treatment in a massed treatment schedule. Therapy was delivered for a total of 8-10 hr/week over the course of 6-7 weeks. All participants completed testing 1 week prior to treatment (A1), immediately following treatment (A2), and again 3 months later (A3). Discourse was analyzed through the percentage of correct information units at each time point. Outcomes and Results Both groups showed nonsignificant improvements from pretreatment to immediately posttreatment. The PMT group showed significant improvement 3 months posttreatment, while the SFA group returned to near-baseline levels. Conclusion These results add to our understanding of the effects of both PMT and SFA. Future research should address understanding variability in discourse outcomes across studies and the effects of aphasia severity and individual participant and treatment factors on treatment outcomes for both of these approaches.

Purpose The ultimate goal of anomia treatment should be to achieve gains in exemplars trained in the therapy session, as well as generalization to untrained exemplars and contexts. The purpose of this study was to test the efficacy of phonomotor treatment, a treatment focusing on enhancement of phonological sequence knowledge, against semantic feature analysis (SFA), a lexical-semantic therapy that focuses on enhancement of semantic knowledge and is well known and commonly used to treat anomia in aphasia. Method In a between-groups randomized controlled trial, 58 persons with aphasia characterized by anomia and phonological dysfunction were randomized to receive 56-60 hr of intensively delivered treatment over 6 weeks with testing pretreatment, posttreatment, and 3 months posttreatment termination. Results There was no significant between-groups difference on the primary outcome measure (untrained nouns phonologically and semantically unrelated to each treatment) at 3 months posttreatment. Significant within-group immediately posttreatment acquisition effects for confrontation naming and response latency were observed for both groups. Treatment-specific generalization effects for confrontation naming were observed for both groups immediately and 3 months posttreatment; a significant decrease in response latency was observed at both time points for the SFA group only. Finally, significant within-group differences on the Comprehensive Aphasia Test-Disability Questionnaire (Swinburn, Porter, & Howard, 2004) were observed both immediately and 3 months posttreatment for the SFA group, and significant within-group differences on the Functional Outcome Questionnaire (Glueckauf et al., 2003) were found for both treatment groups 3 months posttreatment. Discussion Our results are consistent with those of prior studies that have shown that SFA treatment and phonomotor treatment generalize to untrained words that share features (semantic or phonological sequence, respectively) with the training set. However, they show that there is no significant generalization to untrained words that do not share semantic features or phonological sequence features.

Purpose An increasing number of anomia treatment studies have coupled traditional word retrieval accuracy outcome measures with more fine-grained analysis of word retrieval errors to allow for more comprehensive measurement of treatment-induced changes in word retrieval. The aim of this study was to examine changes in picture naming errors after phonomotor treatment. Method Twenty-eight individuals with aphasia received 60 hr of phonomotor treatment, an intensive, phoneme-based therapy for anomia. Confrontation naming was assessed pretreatment, immediately posttreatment, and 3 months posttreatment for trained and untrained nouns. Responses were scored for accuracy and coded for error type, and error proportions of each error type (e.g., semantic, phonological, omission) were compared: pre- versus posttreatment and pretreatment versus 3 months posttreatment. Results The group of treatment participants improved in whole-word naming accuracy on trained items and maintained their improvement. Treatment effects also generalized to untrained nouns at the maintenance testing phase. Additionally, participants demonstrated a decrease in proportions of omission and description errors on trained items immediately posttreatment. Conclusions Along with generalized improved whole-word naming accuracy, results of the error analysis suggest that a global (i.e., both lexical-semantic and phonological) change in lexical knowledge underlies the observed changes in confrontation naming accuracy following phonomotor treatment.

Purpose A significant relationship between verbal short-term memory (STM) and language performance in people with aphasia has been found across studies. However, very few studies have examined the predictive value of verbal STM in treatment outcomes. This study aims to determine if verbal STM can be used as a predictor of treatment success. Method Retrospective data from 25 people with aphasia in a larger randomized controlled trial of phonomotor treatment were analyzed. Digit and word spans from immediately pretreatment were run in multiple linear regression models to determine whether they predict magnitude of change from pre- to posttreatment and follow-up naming accuracy. Pretreatment, immediately posttreatment, and 3 months posttreatment digit and word span scores were compared to determine if they changed following a novel treatment approach. Results Verbal STM, as measured by digit and word spans, did not predict magnitude of change in naming accuracy from pre- to posttreatment nor from pretreatment to 3 months posttreatment. Furthermore, digit and word spans did not change from pre- to posttreatment or from pretreatment to 3 months posttreatment in the overall analysis. A post hoc analysis revealed that only the less impaired group showed significant changes in word span scores from pretreatment to 3 months posttreatment. Discussion The results suggest that digit and word spans do not predict treatment gains. In a less severe subsample of participants, digit and word span scores can change following phonomotor treatment; however, the overall results suggest that span scores may not change significantly. The implications of these findings are discussed within the broader purview of theoretical and empirical associations between aphasic language and verbal STM processing.

Background: Aphasia is an acquired language disorder that makes it difficult for people to produce and comprehend language, with every person with aphasia (PWA) demonstrating difficulty accessing and selecting words (anomia). While aphasia treatments typically focus on a single aspect of language, such as word retrieval, the ultimate goal of aphasia therapy is to improve communication, which is best seen at the level of discourse., Aims: This retrospective study investigated the effects of one effective anomia therapy, Phonomotor Treatment, on discourse production., Methods & Procedures: Twenty-six PWA participated in 60 hours of Phonomotor Treatment, which focuses on building a person's ability to recognise, produce, and manipulate phonemes in progressively longer non-word and real-word contexts. Language samples were collected prior to, immediately after, and three months after the treatment program. Percent Correct Information Units (CIUs) and CIUs per minute were calculated., Outcomes & Results: Overall, PWA showed significantly improved CIUs per minute, relative to baseline, immediately after treatment and three months later, as well as significantly improved percent CIUs, relative to baseline, three months following treatment., Conclusions: Phonomotor Treatment, which focuses on phonological processing, can lead to widespread improvement throughout the language system, including to the functionally critical level of discourse production., Competing Interests: Disclosure of Interest The authors report no conflict of interest.

Purpose: This study investigated the relationship between non-orthographic language abilities and reading in order to examine assumptions of the primary systems hypothesis and further our understanding of language processing poststroke., Method: Performance on non-orthographic semantic, phonologic, and syntactic tasks, as well as oral reading and reading comprehension tasks, was assessed in 43 individuals with aphasia. Correlation and regression analyses were conducted to determine the relationship between these measures. In addition, analyses of variance examined differences within and between reading groups (within normal limits, phonological, deep, or global alexia)., Results: Results showed that non-orthographic language abilities were significantly related to reading abilities. Semantics was most predictive of regular and irregular word reading, whereas phonology was most predictive of pseudohomophone and nonword reading. Written word and paragraph comprehension were primarily supported by semantics, whereas written sentence comprehension was related to semantic, phonologic, and syntactic performance. Finally, severity of alexia was found to reflect severity of semantic and phonologic impairment., Conclusions: Findings support the primary systems view of language by showing that non-orthographic language abilities and reading abilities are closely linked. This preliminary work requires replication and extension; however, current results highlight the importance of routine, integrated assessment and treatment of spoken and written language in aphasia., Supplemental Material: https://doi.org/10.23641/asha.7403963.

Purpose: This study explored the relationship between anomia and verbal short-term memory (STM) in the context of an interactive activation language processing model., Method: Twenty-four individuals with aphasia and reduced STM spans (i.e., impaired immediate serial recall of words) completed a picture-naming task and a word pair repetition task (a measure of verbal STM). Correlations between verbal STM and word retrieval errors made on the picture-naming task were examined., Results: A significant positive correlation between naming accuracy and verbal span length was found. More intricate verbal STM analyses examined the relationship between picture-naming error types (i.e., semantic vs. phonological) and 2 measures of verbal STM: (a) location of errors on the word pair repetition task and (b) imageability and frequency effects on the word pair repetition task. Results indicated that, as phonological word retrieval errors (relative to semantic) increase, bias toward correct repetition of high-imageability words increases., Conclusions: Results suggest that word retrieval and verbal STM tasks likely rely on a partially shared temporary linguistic activation process.

Purpose: The primary characteristics used to define acquired apraxia of speech (AOS) have evolved to better reflect a disorder of motor planning/programming. However, there is debate regarding the feature of relatively consistent error location and type., Method: Ten individuals with acquired AOS and aphasia and 11 individuals with aphasia without AOS participated in this study. In the context of a 2-group experimental design, error consistency was examined via 5 repetitions of 30 multisyllabic words. The influence of error rate, severity of impairment, and stimulus presentation condition (blocked vs. random) on error consistency was also explored, as well as between-groups differences in the types of errors produced., Results: Groups performed similarly on consistency of error location; however, adults with AOS demonstrated greater variability of error type in a blocked presentation condition only. Stimulus presentation condition, error rate, and severity of impairment did not influence error consistency in either group. Groups differed in the production of phonetic errors (e.g., sound distortions) but not phonemic errors., Conclusions: Overall, findings do not support relatively consistent errors as a differentiating characteristic of AOS.

Background and Objective: Children with attention-deficit hyperactivity disorder (ADHD) experience difficulty with expressive language, including form (e.g. grammatical construction) and content (e.g. coherence). The current study aimed to investigate the effect of methylphenidate-Osmotic Release Oral System® (MPH-OROS®) on the narrative ability of children with ADHD and language impairment, through the analysis of microstructure and macrostructure narrative elements., Method: In a single group off-on medication test design, narratives were obtained from 12 children with ADHD, aged 7-13 years, using wordless picture books. For microstructure, number of words, type-token ratio and mean length of utterance were derived from narrative samples using Systematic Analysis of Language Transcripts conventions. For macrostructure, the narratives were coded according to the Narrative Scoring Scheme, which includes seven narrative characteristics, as well as a composite score reflecting the child's overall narrative ability., Results: The administration of MPH-OROS® resulted in a significant difference in certain aspects of language macrostructure: cohesion and overall narrative ability. Little effect was noted in microstructure elements., Conclusion: We observed a positive effect of stimulant medication on the macrostructure, but not on the microstructure, of narrative production. Although stimulant medication improves attention and concentration, it does not improve all aspects of language abilities in children with ADHD. Language difficulties associated with ADHD related to language content and use may be more responsive to stimulant medication than language form, which is likely to be affected by cascading effects of inattention, hyperactivity and impulsivity beginning very early in life and to progress over a more protracted period. Therefore, a combination of treatments is advocated to ensure that children with ADHD are successful in reaching their full potential.

This article provides an overview of phonological treatment approaches for anomia in individuals with aphasia. The role of phonology in language processing, as well as the impact of phonological impairment on communication is initially discussed. Then, traditional phonologically based treatment approaches, including phonological, orthographic, indirect, guided, and mixed cueing methods, are described. Collectively, these cueing treatment approaches aim to facilitate word retrieval by stimulating residual phonological abilities. An alternative treatment approach, phonomotor treatment, is also examined. Phonomotor treatment aims to rebuild sublexical, phonological sequence knowledge and phonological awareness as a means to strengthen lexical processing and whole-word naming. This treatment is supported by a parallel-distributed processing model of phonology and therefore promotes multimodal training of individual phonemes and phoneme sequences in an effort to enhance the neural connectivity supporting underlying phonological processing mechanisms. The article concludes with suggestions for clinical application and implementation., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

The present study is an empirical investigation of cultural mistrust as a mediator in the association between racial microaggressions and mental health (anxiety, depression, and well-being) in a sample of Asian American college students. In addition, we explored the role of cultural mistrust as a mediator in the association between racial microaggressions and attitudes toward seeking professional help. Asian American participants (N = 156) were recruited from 2 institutions located in the Pacific Northwest region of the United States. Participants filled out an online survey consisting of measures assessing the study variables. Bootstrapped results indicated that cultural mistrust was a significant mediator in the relation between microaggressions and well-being, such that racial microaggressions was significantly and positively associated with cultural mistrust, which, in turn, was significantly and inversely related to well-being. Mediation models involving anxiety, depression, and help-seeking attitudes as outcome variables were nonsignificant. The significant mediation finding (microaggressions → mistrust → well-being) has implications for improved understanding of Asian American students' reactions to modern day racism and how it relates to their sense of well-being. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Epilepsy affects 1% of the general population and is highly prevalent among Veterans. The purpose of this phase I study was to investigate a presurgical linguistically distributed language treatment program that could potentially diminish effects of proper-name retrieval deficits following left anterior temporal lobe resection for intractable epilepsy. A single-subject multiple-baseline design was employed for three individuals with late-onset chronic left temporal lobe epilepsy. Word retrieval treatment was administered prior to anterior temporal lobe resection. The primary outcome measure was confrontation naming of proper nouns. Immediately posttreatment (before surgery), there was a positive effect for all trained stimuli in the form of improved naming as compared with pretreatment. In addition, trained stimuli were found to be better after surgery than they were at pretreatment baseline, which would not be expected had language treatment not been provided. This series of case studies introduces two fundamentally novel concept: that commonly occurring deficits associated with left temporal lobe epilepsy can be treated despite the presence of damaged neural tissue and that providing this treatment prior to surgery can lead to better preservation of language function after surgery than would be expected if the treatment were not provided.

Purpose: The ultimate goal of aphasia therapy should be to achieve gains in function that generalize to untrained exemplars and daily conversation. Anomia is one of the most disabling features of aphasia. The predominantly lexical/semantic approaches used to treat anomia have low potential for generalization due to the orthogonality of semantic and phonologic representations; this has been borne out in a meta-analysis of treatment studies. The intensive, neurally distributed, phonologic therapy reported here can, in principle, generalize to untrained phonologic sequences because of extant regularities in phonologic sequence knowledge and should, in principle, generalize to production of words trained as well as those untrained., Method: Twenty-six persons with chronic aphasia due to stroke were treated, in a staggered (immediate vs. delayed treatment) open trial design, with 60 hr of intensive, multimodal therapy designed to enhance access to and efficiency of phonemes and phonologic sequences., Results: There was an absolute increase of 5% in confrontation naming of "untrained" nouns at 3 months, and there were 9% to 10% increases on measures of generalization of phonologic processes., Conclusion: The results of this trial demonstrate generalization of training effects on laboratory measures, which were sustained at 3 months, and provide support for the theories that motivated the treatment.

Purpose: The integrity of selective attention in people with aphasia (PWA) is currently unknown. Selective attention is essential for everyday communication, and inhibition is an important part of selective attention. This study explored components of inhibition-both intentional and reactive inhibition-during spoken-word production in PWA and in controls who were neurologically healthy (HC). Intentional inhibition is the ability to suppress a response to interference, and reactive inhibition is the delayed reactivation of a previously suppressed item., Method: Nineteen PWA and 20 age- and education-matched HC participated in a Stroop spoken-word production task. This task allowed the examination of intentional and reactive inhibition by evoking and comparing interference, facilitation, and negative priming effects in different contexts., Results: Although both groups demonstrated intentional inhibition, PWA demonstrated significantly more interference effects. PWA demonstrated no significant facilitation effects. HC demonstrated significant reverse facilitation effects. Neither group showed significant evidence of reactive inhibition, though both groups showed similar individual variability., Conclusions: These results underscore the challenge interference presents for PWA during spoken-word production, indicating diminished intentional inhibition. Although reactive inhibition was not different between PWA and HC, PWA showed difficulty integrating and adapting to contextual information during language tasks.

To identify correlates of Asian American professional help-seeking, we tested a mediation model describing Asian American help-seeking (Asian value of emotional self-control → help-seeking attitudes → willingness to see a counselor; Hypothesis 1) in a sample of Asian American college students from the Pacific Northwest region of the United States (N = 232). We also examined biological and spiritual etiology beliefs as moderators of the mediation model (Hypotheses 2a and 2b). Our findings indicated that help-seeking attitudes significantly mediated the relation between emotional self-control and willingness to see a counselor, consistent with our mediation hypothesis. Furthermore, biological and spiritual etiology beliefs moderated this mediation model, providing partial support for our moderation hypotheses. Our findings suggest that researchers can contribute to the Asian American literature by investigating conditions in which established Asian American help-seeking models may or may not hold. In addition, the findings suggest additional nuanced ways for counselors to reach out to Asian American students to increase their mental health service utilization., ((c) 2015 APA, all rights reserved).)

The authors examined the moderating role of positive and negative religious coping in the relation between racism and psychological well-being in a sample of Catholic and Protestant Asian American college students (N = 107). On the basis of prior theorizing on the 2 types of religious coping, combined with some limited empirical evidence, they predicted that positive religious coping would have a buffering effect (Hypothesis 1) on the racism-mental health relation and that negative religious coping would have an exacerbating effect (Hypothesis 2). Participants completed an online survey containing measures corresponding to the study variables. Results indicated that the interaction between positive religious coping and racism was nonsignificant, so Hypothesis 1 was not supported. For Hypothesis 2, the negative religious coping and racism interaction term was statistically significant, but the moderating effect was in an unexpected direction, such that negative religious coping actually protected against the deleterious impact of racism on mental health. The findings suggest that the theorized deleterious influence of negative religious coping may need to be reconsidered in an Asian American setting. The findings have the potential to inform practitioners who work with Asian American college students to better cope with the detrimental consequences of racism., (PsycINFO Database Record (c) 2015 APA, all rights reserved.)

Purpose: The aim of this study was to investigate effects of a multimodal treatment of phonology, phonomotor treatment, on the reading abilities of persons with aphasia (PWA) with phonological alexia., Method: In a retrospective, single-group design, this study presents pre-, post-, and 3-months posttreatment data for 8 PWA with phonological alexia. Participants completed 60 hr of phonomotor treatment over 6 weeks. Wilcoxon signed-ranks tests and group effect sizes comparing pre-, immediately post-, and 3-months posttreatment performance on tests of phonological processing and reading were performed., Results: Group data showed phonological processing and oral reading of real words and nonwords improved significantly posttreatment; these gains were maintained 3 months later. No group improvement was found for reading comprehension; however, one individual did show improvement immediately post- and 3-months posttreatment., Conclusions: This study provides support that phonomotor treatment is a viable approach to improve phonological processing and oral reading for PWA with phonological alexia. The lack of improvement with comprehension is inconsistent with prior work using similar treatments (Conway et al., 1998; Kendall et al., 2003). However, this difference can, in part, be accounted for by differences in variables, such as treatment intensity and frequency, outcome measures, and alexia severity.

Metformin is the first-line treatment for type 2 diabetes (T2D) in adults, children and young people, particularly in obese or overweight patients. Many studies have demonstrated that metformin is associated with weight reduction in adults and in prevention or delay of T2D onset in those who are at increased risk. In 2012, metformin was recommended by the UK National Institute for Health and Care Excellence as a treatment option in adults aged 18 years or over, who remain at high risk of T2D, despite participation in an intensive lifestyle-change programme. Prevalence of childhood obesity is increasing and is associated with elevated long-term risk of T2D and other adverse cardio-metabolic events; however, consensus is lacking on intervention strategies aimed at reducing this risk. This article discusses the rationale and evidence for the use of metformin in obese children and young people at high risk of T2D.

Purpose: The aim of this study was to investigate the influence of phonomotor treatment on the types of errors produced during a confrontation naming task for people with aphasia (PWA)., Method: Ten PWA received 60 hr of phonomotor treatment across 6 weeks. Confrontation naming abilities were measured before and after treatment, and responses were coded as correct or incorrect. Incorrect responses were coded for error type. Paired t tests comparing pre-, post- and 3 months posttreatment naming accuracy and error type were performed., Results: Group data showed that naming accuracy on trained items improved significantly immediately post treatment, and gains were maintained 3 months later. Naming accuracy on untrained items did not show significant improvement immediately post treatment or 3 months later. Results of error type analysis were not significant. However, a decrease in omission errors and an increase in mixed errors were noted immediately post treatment for naming of untrained items., Conclusion: Results suggest that intensive phonomotor treatment improved lexical-retrieval abilities and may have triggered a shift in linguistic processing, as indicated by a decrease in omission errors on trained items and an increase in mixed errors on untrained items.

Purpose: Studies investigating language deficits in individuals with left temporal-lobe epilepsy have consistently demonstrated impairments in proper name retrieval. The aim of this Phase I rehabilitation study was to investigate the effects of a linguistically distributed word retrieval treatment on proper name retrieval in an individual with left temporal-lobe epilepsy., Method: A 61-year old right-handed male with left temporal-lobe epilepsy (clinical onset at the age of 50) and a deficit in proper name retrieval participated in this study. A single-subject, repeated-probe ABAA design with testing before, immediately after, and 3 months after treatment completion was employed. Proper name retrieval treatment was administered 2 hr per day for 5 days., Results: Results demonstrated improved naming on trained items and maintenance of trained items 3 months after treatment completion., Conclusion: Treatment, which took advantage of the individual's undamaged linguistic networks, promoted the reorganization of networks supporting proper naming, leading to improved proper name retrieval. Further research replicating these findings in individuals with varying degrees of proper name retrieval impairment is warranted. Additionally, the mechanism behind the observed improvements in proper name retrieval needs to be investigated further using functional neuroimaging.

Purpose: The purpose of this study was to develop a short form of the Boston Naming Test (BNT; Kaplan, Goodglass, & Weintraub, 2001) for individuals with aphasia and compare it with 2 existing short forms originally analyzed with responses from people with dementia and neurologically healthy adults., Method: Development of the new BNT-Aphasia Short Form and analysis of the other 2 forms were completed with archival data from 100 individuals with aphasia. The authors developed the BNT-Aphasia Short Form using items from the original 60-item instrument based on item response theory. Rasch analysis was computed on the short forms developed by Graves, Bezeau, Fogarty, and Blair (2004) and by Mack, Freed, Williams, and Henderson (1992)., Results: Analysis of the Graves et al. (2004) short form resulted in the smallest range of item difficulty and the largest floor effect compared with the Mack et al. (1992) short form and the BNT-Aphasia short form. The BNT-Aphasia Short Form showed an increase in information in the middle of the scale relative to both the Graves et al. and the Mack et al. forms., Conclusions: The new short form demonstrates good psychometric properties when used with individuals with aphasia. However, the Mack et al. form proved to be as psychometrically sound as the BNT-Aphasia Short Form and is also appropriate for individuals with aphasia.

Speech reaction time (SRT) was measured in a response priming protocol in 12 participants with Parkinson's disease (PD) and hypokinetic dysarthria "on" and "off" left-hemispheric deep brain stimulation (DBS). Speech preparation was measured during speech motor programming in two randomly ordered speech conditions: speech maintenance and switching. Double blind testing was completed in participants with DBS of globus pallidus pars interna (GPi) (n = 5) or subthalamic nucleus (STN) (n = 7). SRT was significantly faster in the maintenance vs switch task, regardless of DBS state. SRT was faster in the speech maintenance task "on" stimulation, while there was no difference in speech switching "on" and "off" DBS. These data suggest that left-hemispheric DBS may have differential effects on aspects of speech preparation in PD. It is hypothesized that speech maintenance improvements may result from DBS-induced cortical enhancements, while the lack of difference in switching may be related to inhibition deficits mediated by the right-hemisphere. Alternatively, DBS may have little influence on the higher level motor processes (i.e., motor planning) which it is believed the switch task engaged to a greater extent than the maintenance task.

Purpose: To provide preliminary evidence of the construct validity of the Communicative Effectiveness Survey (CES) for individuals with dysarthria and idiopathic Parkinson's disease (PD)., Method: In a prospective, quasi-experimental design, 25 participants each were assigned to 3 groups (N = 75): PD and dysarthria, non-PD and no dysarthria, and PD significant others (SOs). Mean CES ratings were used to test for significant differences between the PD and non-PD group, and PD and SO rating of PD's communicative effectiveness. Multiple linear regression tested for significant predictors of CES ratings for PD group only using sentence intelligibility and spontaneous speech intelligibility scores as predictor variables., Results: The PD group rated their CES significantly lower than did the non-PD group. The PD group rated their CES significantly higher than their SOs rated them. Neither speech intelligibility score was a significant predictor of CES ratings. In follow-up analysis, the Hoehn and Yahr PD staging accounted for 47% of the variability in CES ratings for the PD group participants., Conclusions: This study provides preliminary evidence of the CES's construct validity. Clinicians and researchers who assess and treat individuals with PD may consider adding an additional assessment to the traditional clinical measures (i.e., speech intelligibility) by obtaining a measure of communicative effectiveness.

This study investigated the effects of phonologic treatment for anomia in aphasia. We proposed that if treatment were directed at the level of the phonologic processor, opportunities for naming via a phonological route, as opposed to a strictly whole word route, would be enhanced, thereby improving naming. The participants, ten people with anomia and aphasia due to left hemisphere stroke, received 96 h of phoneme based treatment in 12 weeks. To learn if treatment improved naming, a single-subject, repeated probe design with replication was employed. The primary outcome measure was confrontation naming. Secondary outcome measures included phonologic production, nonword repetition and discourse production. Results suggest a positive treatment effect (confrontation naming), improvements in phonologic production and nonword repetition, and generalization to discourse production. When tested 3 months after the completion of treatment the effects appeared to be maintained.

Background: Up to 65% of individuals demonstrate poststroke cognitive impairments, which may increase hospital stay and caregiver burden. Randomized stroke clinical trials have emphasized physical recovery over cognition. Neuropsychological assessments have had limited utility in randomized clinical trials. These issues accentuate the need for a measure of functional cognition (the ability to accomplish everyday activities that rely on cognitive abilities, such as locating keys, conveying information, or planning activities)., Objective: The aim of the study was to present the process used to establish domains of functional cognition for development of computer adaptive measure of functional cognition for stroke., Methods: Functional cognitive domains involved in identifying relevant neuropsychological constructs from the literature were conceptualized and finalized after advisory panel feedback from experts in neurology, neuropsychology, aphasiology, clinical trials, and epidemiology., Results: The following 17 domains were proposed: receptive aphasia, expressive aphasia, agraphia, alexia, calculation, visuospatial, visuoperceptual, visuoconstruction, attention, language usage, executive functions, orientation, processing speed, memory, working memory, mood, awareness and abstract reasoning. The advisory panel recommended retaining the first 12 domains. Recommended changes included: to address only encoding and retrieval of recent information in the memory domain; to add domains for limb apraxia and poststroke depression; and to keep orientation as a separate domain or reclassify it under memory or attention. The final 10 domains included: language, reading and writing, numeric/calculation, limb praxis, visuospatial function, social use of language, emotional function, attention, executive function, and memory., Conclusion: Conceptualizing domains of functional cognition is the first step in developing a computer adaptive measure of functional cognition for stroke. Additional steps include developing, refining, and field-testing items, psychometric analysis, and computer adaptive test programming.

Twenty-three chronic nonfluent aphasia patients with moderate or severe word-finding impairments and 11 with profound word-finding impairments received two novel picture-naming treatments. The intention treatment initiated picture-naming trials with a complex left-hand movement and was designed to enhance right frontal participation during word retrieval. The attention treatment required patients to view visual stimuli for picture-naming trials in their left hemispace and was designed to enhance right posterior perisylvian participation during word retrieval. Because the intention treatment addressed action mechanisms and nonfluent aphasia reflects difficulty initiating or maintaining action (i.e., language output), it was hypothesized that intention component of the treatment would enhance re-acquisition of picture naming more than the attention component. Patients with moderate and severe word-finding impairment showed gains with both treatments but greater incremental improvement from one treatment phase to the next with the intention than the attention treatment. Thus, the hypothesis that intention component would be a more active constituent than the attention component was confirmed for these patients. Patients with profound word-finding impairment showed some improvement with both treatments but no differential effects for the intention treatment. Almost all patients who showed treatment gains on either treatment also demonstrated generalization from trained to untrained items.

The purpose of this case study was to examine the integrity of cognitive skills, language usage, and language structure components in a patient with corticobasal degeneration (CBD). CBD is a levadopa-nonresponsive, degenerative neurologic movement disorder that is generally accompanied by cognitive (frontal executive dysfunction, dementia) and linguistic (aphasia) disorders. However, no one has reported on social language usage deficits in cases of CBD. The reported frontal executive dysfunction found in CBD led us to expect social language usage deficits in the present case study. Consistent with the literature, the patient demonstrated motor, cognitive (severe apraxia, frontal executive deficits, dementia), and linguistic deficits (aphasia). However she also demonstrated significantly abnormal social language usage previously unreported in the literature.

In this phase I rehabilitation study, we investigated the effects of an intensive phonomotor rehabilitation program on verbal production in a 73-year-old male, 11 years postonset a left-hemisphere stroke, who exhibited apraxia of speech and aphasia. In the context of a single-subject design, we studied whether treatment would improve phoneme production and generalize to repetition of multisyllabic words, words of increasing length, discourse, and measures of self-report. We predicted that a predominant motor impairment would respond to intensive phonomotor rehabilitation. While able to learn to produce individual sounds, the subject did not exhibit generalization to other aspects of motor production. Discourse production was judged perceptually slower in rate and less effortful, but also less natural. Finally, self-report indicated less apprehension toward speaking with unfamiliar people, increased telephone use, and increased ease of communication.

In this phase I clinical rehabilitation study, we investigated the effects of phonological rehabilitation for alexia and aphasia in an individual 54 years after a left-hemisphere ischemic infarction. In the context of a single-subject design, we studied whether treatment would improve phonological processing, reading, and generalization to untreated behaviors. While results showed a lack of generalization to real-word reading aloud, improvement was present in phonological processing, language function (Western Aphasia Battery Aphasia Quotient, Boston Naming Test, Reading Comprehension Battery for Aphasia), and auditory processing (Revised Token Test). Improvement in the lexical-semantic system was attributed to informal forced-use language treatment. We concluded that phonological therapies are unlikely to be successful unless a minimum initial level of phonological sequence knowledge exists; therapies that pressure subjects to use verbal communication can achieve clinically important gains in communicative ability that generalize to untreated behaviors. This study also demonstrates the importance of a careful analysis of the patient's language ability before a therapeutic strategy is chosen.

Diffraction gratings having well-shaped rectangular profiles were fabricated by chemical etching of single-crystal silicon oriented in the ?110? direction. The grooves were 2.62 microm deep, 5.4 microm wide, and were separated by 10.2 microm. The diffraction behavior was measured near normal incidence using several laser wave-lengths. The specularly reflected (zero-order) beam varied by a factor of at least 140 at different visible wavelengths, thereby demonstrating the excellent geometric form of the structures.