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American Speech Language Hearing Association

Descriptive Analysis: Survey of Direct and Indirect Interventions for Persons With Dementia-Based Communication Disorders

Paul N., Mehrhoff J.

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2015, цитирований: 9, doi.org, Abstract

Results of a survey made available to SIG 2 and SIG 15 affiliates via the SIG listservs revealed information on direct and indirect interventions utilized for persons with dementia-based communication disorders. Fifty-eight practicing speech-language pathologists (SLPs) participated and reported using the following direct interventions most frequently: specific verbal instruction, cognitive stimulation, memory wallet, spaced retrieval, and errorless learning. The overwhelming majority of participants utilized caregiver training as the most frequent indirect technique. Barriers and facilitators to providing intervention for persons with dementia-related communication disorders were identified.

Dementia Management: A Practice Update for Speech-Language Pathologists

Mason-Baughman M.B., Kinder R.

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2015, цитирований: 1, doi.org, Abstract

Most clinicians working with older adults have assessed and treated patients with cognitive-communicative deficits associated with dementia. Dementia management can be challenging at times, even for the most seasoned clinician. This article will provide a framework for dementia management focusing on assessment, treatment, and documentation to ensure that speech-language pathology services are reimbursable by meeting Medicare's definition of reasonable and necessary services as set forth by the Medicare Benefit Policy Manual. The goal of sharing this information is to help clinicians shape management programs to meet the needs of their patients with dementia and ensure compliance with current healthcare regulations.

SIG 2 Perspectives Vol. 25, No. 4, October 2015

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2015, цитирований: 0, doi.org, Abstract

Download the CE Questions PDF from the toolbar, above. Use the questions to guide your Perspectives reading. When you're ready, purchase the activity from the ASHA Store and follow the instructions to take the exam in ASHA's Learning Center. Available September 19, 2018.

Guest Editor Column

Paul N.

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2015, цитирований: 0, doi.org

Direct and Indirect Interventions for Cognitive-Communication Disorders of Dementia

Hopper T., Douglas N., Khayum B.

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2015, цитирований: 2, doi.org, Abstract

The dementia syndrome is characterized by cognitive and behavioral deficits that affect daily life functioning, including communication. Speech-language pathologists (SLPs) will see increased numbers of adults with dementia in the coming years, as the incidence and prevalence of diseases that cause dementia continue to grow. In this article, the authors provide an update on the syndrome of dementia and its most common cause, Alzheimer's disease. A framework for interventions is provided, along with a discussion of research evidence for specific treatment techniques. The article concludes with case studies of person-centered assessment and intervention for individuals with mild and moderate dementia severity.

Patient Reported Outcome Measures in Neurologic Communication Disorders: An Update

de Riesthal M., Ross K.B.

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2015, цитирований: 16, doi.org, Abstract

In her seminal book on outcome measurement in the field of communication disorders, Carol Frattali (1998) set the path for outcomes research and clinical application in the field of speech-language pathology. In particular, she defined the many possible outcomes that can be measured to examine the influence of an intervention and the ways in which these measures can inform public policy. Of these, patient or client centered measures, which index outcome based on the patient's and family's or caregiver's perspective, have received increasing attention in recent research and clinical practice. These measures examine a variety of patient reported outcomes (PRO) associated with health. PRO measures are being used more commonly in clinical practice and as end points in medical and rehabilitation outcomes research. This perspective reflects the shift in medicine and rehabilitation toward patient-centered care. In this article, we will examine the rationale for using PRO measures, the advantages and challenges for using these tools, and current use of PRO measures in neurological communication disorders.

SIG 2 Perspectives Vol. 25, No. 3, June 2015

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2015, цитирований: 1, doi.org, Abstract

Active exams text: Download the CE Questions PDF from the toolbar, above. Use the questions to guide your Perspectives reading. When you're ready, purchase the activity from the ASHA Store and follow the instructions to take the exam in ASHA's Learning Center. Available until May 13, 2018.

Outcomes and Quality: Key Characteristics of a Successful SLP Value Journey

Rao P.R.

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2015, цитирований: 10, doi.org, Abstract

We are living in a challenging era of healthcare reform marked by dramatic change and unprecedented political and legal turmoil surrounding this reform. Healthcare reform in the name of the Patient Protection and Affordable Care Act (PPACA, 2010) is becoming “hardwired” over the five years since its inception, yet as recently as March of 2015, the Supreme Court of the United States heard arguments to roll back subsidies for the Federal Health Exchanges which if approved could increase insurance rates by nearly 75% on over 8 million subscribers. The national healthcare landscape including reforms, changes, wins, and losses to date will be described. The “secret sauce” for meeting these challenges is to embrace value in healthcare which can be defined as outcomes over cost. In the context of our current levels of care, an inexorable movement away from volume to value will be described focusing on outcomes. The challenges we face especially in reporting outcomes and shifting from volume to value are described. Finally, arguments and illustrations are provided for how speech-language pathologists (SLPs) can continue to espouse value in becoming critical players in the value-based healthcare economy.

The ICF, Relationship-Centred Care and Research Outcome Measurement: Carol Frattali's Impact on Aphasia Research

Worrall L., Wallace S.

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2015, цитирований: 4, doi.org, Abstract

Outcome measurement was a major focus of Carol Frattali's work. This article describes three aphasia research initiatives that have followed from her early publications. The first is the application of the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) to aphasia. The Living with Aphasia: A Framework for Outcome Measurement (A-FROM) is a reinterpretation of the ICF specifically as it applies to aphasia. The Assessment for Living with Aphasia (ALA) is an assessment that is derived from the A-FROM. The second initiative is the program of research that has described aphasia and aphasia rehabilitation from the patient perspective. Using qualitative methodologies, this research has highlighted the need for relationship-centred care in aphasia services. Finally, a current project is described that seeks to gain international consensus on a core outcome set for aphasia treatment research. This will help researchers combine data in effectiveness studies. To achieve the best outcomes for people with aphasia, there is a need to realize Carol Frattali's vision and ensure the continued use of unifying frameworks, relationship-centered practice, consumer-focused research, and consistent outcome measurement practices.

Guest Editor Column

de Riesthal M., Golper L.A.

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2015, цитирований: 0, doi.org

Seizure Disorders and the Effects of Antiepileptic Medications on Cognitive-Communicative Function

Abou-Khalil B., Abou-Khalil R.

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2015, цитирований: 4, doi.org, Abstract

Purpose Review effects of epilepsy and its treatment on cognitive-communicative function. Method We searched PubMed and extracted relevant information. Results Epilepsy is a disorder characterized by recurrent unprovoked seizures. Epilepsy is commonly associated with cognitive disturbances in between seizures, most commonly memory dysfunction. Other cognitive disturbances may be seen, particularly auditory naming when epilepsy starts in the dominant temporal lobe. While control of seizures is expected to improve the cognitive consequences, antiepileptic drugs themselves may be associated with cognitive dysfunction. Among the old generation of antiepileptic drugs, the sedating medications phenobarbital and benzodiazepines have the most negative impact on cognitive function. However, carbamazepine, phenytoin, and valproate may also adversely affect attention and memory. The newer antiepileptic drugs lamotrigine, gabapentin, and levetiracetam (LEV) are less likely to affect cognition than carbamazepine. Another new antiepileptic drug, topiramate, is associated with considerable adverse effects on attention, concentration, memory, executive function, and verbal fluency. Word finding difficulties are a common adverse effect, to the point that some patients can develop a nonfluent aphasia. Levetiracetam (LEV), on the other hand, has been reported to improve verbal fluency in patients with partial epilepsy and language dysfunction. Conclusions Both epilepsy and its treatment may adversely affect cognitive-communicative function.

Guest Editor's Column

Postman W.A.

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2015, цитирований: 0, doi.org

Evaluation and Treatment of Cognitive-Linguistic Deficits in Liver Disease Patients in the Acute Rehabilitative Phase

Maharay K., Salmon K.

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2015, цитирований: 0, doi.org, Abstract

Liver disease, which can range from mild liver dysfunction to End-Stage Liver Disease (ESLD), is a condition that may have potentially significant implications for cognitive-linguistic function and an individual's ability to participate in activities of daily living (ADLs). This article will outline the multiple, complex, and often interrelated factors that are present in this patient population and contributors to cognitive dysfunction. Pharmacological regimens specific to management of liver disease and their potential to cause cognitive-linguistic dysfunction are discussed. Case examples are included to highlight how the severity of liver disease, medication protocols, and the resulting cognitive impairment may impact an individual's disposition at the time of discharge from the acute rehabilitation setting. Therapy techniques, approaches, and compensatory strategies addressed in the acute rehabilitation environment identified and explained.

Pharmacology Issues Related to Dementia Syndrome of Depression in Elderly Residents of Long-Term Care Settings

Ball A.L., Gray A.S.

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2015, цитирований: 0, doi.org, Abstract

Pharmacological intervention for depressive symptoms in institutionalized elderly is higher than the population average. Among the patients on such medications are those with a puzzling mix of symptoms, diagnosed as “dementia syndrome of depression,” formerly termed “pseudodementia”. Cognitive-communicative changes, potentially due to medications, complicate the diagnosis even further. This discussion paper reviews the history of the terminology of “pseudodementia,” and examines the pharmacology given as treatment for depressive symptoms in the elderly population that can affect cognition and communication. Clinicians can reduce the risk of misdiagnosis or inappropriate treatment by having an awareness of potential side effects, including decreased attention, memory, and reasoning capacities, particularly due to some anticholinergic medications. A team approach to care should include a cohesive effort directed at caution against over-medication, informed management of polypharmacology, enhancement of environmental/communication supports and quality of life, and recognizing the typical nature of some depressive signs in elderly institutionalized individuals.

SIG 2 Perspectives Vol. 25, No. 2, April 2015

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2015, цитирований: 0, doi.org, Abstract

Active exams text: Download the CE Questions PDF from the toolbar, above. Use the questions to guide your Perspectives reading. When you're ready, purchase the activity from the ASHA Store and follow the instructions to take the exam in ASHA's Learning Center. Available until March 9, 2018.

Drug-Induced Movement Disorders

Lustig A., Ruiz C.

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2015, цитирований: 0, doi.org, Abstract

The purpose of this article is to present a general overview of the features of drug-induced movement disorders (DIMDs) comprised by Parkinsonism and extrapyramidal symptoms. Speech-language pathologists (SLPs) who work with patients presenting with these issues must have a broad understanding of the underlying disease process. This article will provide a brief introduction to the neuropathophysiology of DIMDs, a discussion of the associated symptomatology, the pharmacology implicated in causing DIMDs, and the medical management approaches currently in use.

Factors Influencing Risk and Recovery from Sport-Related Concussion: Reviewing the Evidence

Elbin R.J., Covassin T., Gallion C., Kontos A.P.

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2015, цитирований: 11, Обзор, doi.org, Abstract

Identifying factors that influence the risk and recovery from sport-related concussion (SRC) has become an important part of the clinical management of the injury. Consensus statements and clinical anecdotes have suggested several factors (i.e., history of migraine headaches) that may increase risk or lead to a protracted recovery from SRC. In the current paper, we will present evidence supporting primary and secondary risk factors listed in current consensus statements and relevant literature on emerging factors proposed to influence SRC risk and recovery.

Assessment of Cognitive-Communication Disorders in Adults with Mild Traumatic Brain Injury

Krug H., Turkstra L.S.

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2015, цитирований: 21, doi.org, Abstract

Mild traumatic brain injury (mTBI) has been in the news lately, particularly mTBI in school-aged children, professional athletes, and service members and veterans. College students have received less attention, but college students also are at high risk for mTBI, and lasting impairments can have major effects on academic performance. Speech-language pathologists (SLPs) can play an important role in supporting college students with mTBI, and several universities are developing concussion clinics directed by SLPs. In this paper, we describe our experience developing an SLP-run college concussion clinic in collaboration with peers and other team members. We present our protocol for assessment and guidelines for management and referral.

Sports Concussions (TBI), Imbalance, and Dizziness

Doettl S.M.

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2015, цитирований: 1, doi.org, Abstract

It has been widely accepted that the assessment of balance after concussion plays a large role in determining deficit. Qualitative balance assessments have been an established piece of the post-injury assessment as a clinical behavioral marker of concussion for many years. Recently more specific guidelines outlining the role of balance evaluation in concussion identification and management have been developed as part of concussion management tools. As part of the ongoing development of concussions protocols, quantitative assessment of balance function following concussion has also been identified to have an important role. Frequently imbalance and dizziness reported following concussion is assumed to be associated with post-concussion syndrome (PCS). While imbalance and dizziness are common complaints in PCS, they can also be a sign of additional underlying pathology. In cases of specific dizziness symptoms or limited balance recovery beyond the initial post-concussive period, a quantitative vestibular assessment may also be needed. Electronystagmography and videonystagmography (ENG/VNG), rotary chair testing (RCT), and vestibular evoked myogenic potentials (VEMPs) have all been identified as valid assessment tools for vestibular dysfunction following traumatic brain injury (TBI). The assessment of balance and dizziness following sports-related concussions is an integral piece of the puzzle for removal from play, assessment of severity, and management.

Guest Editor's Column

King K.

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2015, цитирований: 0, doi.org

SIG 2 Perspectives Vol. 25, No. 1, January 2015

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2015, цитирований: 0, doi.org, Abstract

Download the CE Questions PDF from the toolbar, above. Use the questions to guide your Perspectives reading. When you're ready, purchase the activity from the ASHA Store and follow the instructions to take the exam in ASHA's Learning Center. Available until December 21, 2017.

Right Temporal Variant of Frontotemporal Dementia: A Clinical Introduction

Babiak M.C.

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2014, цитирований: 2, doi.org, Abstract

Frontotemporal dementia (FTD) is a progressive, neurodegenerative syndrome that results in changes in personality, behavior, and language. The right temporal variant, a relatively under-studied and perhaps under-diagnosed clinical subtype of FTD, manifests as behavioral changes, loss of person-specific knowledge, and eventual deficits in word-finding and semantic knowledge. Thorough assessment is necessary in order to distinguish right temporal variant FTD from other dementias. Speech-language pathologists (SLPs) play an essential role in accurate diagnosis, provision of appropriate resources and referrals, and administration of effective treatments.

Treatment for Lexical Retrieval in Primary Progressive Aphasia

Rising K.

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2014, цитирований: 12, doi.org, Abstract

In recent years there has been an increase in research describing the behavioral characteristics and underlying pathology of primary progressive aphasia (PPA). One of the earliest and most prominent features of PPA, particularly for the logopenic and semantic variants, is anomia, and this is often the symptom that prompts individuals with PPA to seek treatment. However, speech-language pathologists who encounter individuals with PPA on their clinical caseloads often have questions about how best to manage progressive language decline in these patients. A small body of literature suggests that treatment for anomia in PPA is indeed warranted, and that item-specific improvement can be expected for a majority of individuals receiving treatment. Although generalization and maintenance of treatment gains are variable in the face of progressive decline, there are some emerging themes as to treatment approaches and patient characteristics that may promote more generalized and relatively durable treatment outcomes. Ultimately, treatment that engages residual semantic, phonologic and orthographic skills, using both strategic training and stimulation, may be appropriate for PPA patients with mild-moderate anomia.

Neuropsychological Assessment of Primary Progressive Aphasia (PPA)

Bettcher B.M., Sturm V.E.

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2014, цитирований: 10, doi.org, Abstract

The goal of this article is to outline the utility of both language and non-language testing in making a diagnosis of logopenic, nonfluent/agrammatic, and semantic variant primary progressive aphasias PPA as well as delineate important behavioral and speech features that can be detected via clinical observation. We review speech/language presentations, non-language cognitive domains, and behavioral manifestations associated with each disorder. Patients with logopenic variant PPA evidence non-language cognitive impairments that include acalculia, phonological working memory deficits, and mild/variable difficulties with memory and visuospatial functions. In contrast, patients with nonfluent/agrammatic variant PPA display non-language impairments in executive functions, and show relative preservation of memory and visuospatial functions. Finally, semantic variant patients display behavioral changes in social comportment as well as non-language difficulties with category fluency and arithmetic facts; they display relative preservation, if not enhancement, of visuospatial functions. In summary, broad neural networks that support both language and non-language functions are affected in PPA syndromes, thus a comprehensive assessment of additional neuropsychological domains may aid in solidifying and subtyping PPA diagnoses.

Neuroimaging in Primary Progressive Aphasia

Bonakdarpour B.

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 2014, цитирований: 1, doi.org, Abstract

Neuroimaging is a standard part of a primary progressive aphasia (PPA) diagnostic work-up and an important component of research investigating changes in the speech-language network in patients with PPA. In this paper, structural neuroimaging, including computed tomography (CT), magnetic resonance imaging (MRI), and diffusion tensor imaging (DTI), as well as functional neuroimaging, including single photon emission computed tomography (SPECT), positron emission tomography (PET), and functional MRI (fMRI), are discussed. Neuroimaging, in conjunction with meticulous clinical and neuropsychological evaluation, can increase diagnostic certainty for PPA subtyping and identification of underlying pathology, which is important for justification of potential pharmacological treatments, such as cholinesterase inhibitors. MRI and, more recently, DTI, have expanded our knowledge of structural brain changes in PPA, including gray matter abnormalities as well as alterations in neuronal tracts. SPECT and PET provide information regarding brain regional blood perfusion (SPECT) or metabolism (PET). Recently, thanks to PET ligands that bind to amyloid protein, it has become possible to diagnose or rule out Alzheimer pathology as a cause for PPA and tau imaging may be forthcoming. Finally, fMRI provides a unique window into brain-behavior relations for language as well as reorganization of the language network in disease. fMRI has also been used to gauge the effects of therapeutic interventions, including language treatment, and can be used for implementation of neuromodulatory mediations, such as repetitive transcranial magnetic stimulation (TMS).