Showing papers in "Seminars in Speech and Language in 2000"

Assessment of executive functions in clinical settings: problems and recommendations

Abstract: In this article we provide a tutorial review of various theoretical issues that surround executive function research from the perspective of cognitive psychology, focusing on issues that have important implications for clinical assessment of executive functioning. We first discuss theoretical and clinical reasons for the importance of understanding executive functions and then point out some serious problems with the common practice of relying exclusively on complex neuropsychological tests, such as the Wisconsin Card Sorting Test and the Tower of Hanoi, as general measures of executive functioning. We then briefly present a recent individual differences study of executive functions conducted in our laboratory that attempted to overcome certain limitations associated with the more typical approach. On the basis of the theoretical issues discussed and the results from our study, we offer some concrete suggestions and recommendations for the measurement and assessment of executive functions in clinical settings.

How should dysphagia care of older adults differ? Establishing optimal practice patterns.

Abstract: An unprecedented demographic transformation is occurring as our population ages. Those older than age 65 represent the fastest growing segment of the population. Within this older group, approximately 10% to 30% of adults are estimated to have dysphagia, but true incidence and prevalence are unknown. They make up a heterogeneous mix of both healthy and disabled individuals that reside across a spectrum of living settings. As clinicians approach older adults with dysphagia, general geriatric principles should be followed to optimize care for this diverse group. Likewise, practitioners need to appreciate the physiology that distinguishes a healthy old swallow from dysphagia and acknowledge the wide array of causes that contribute to dysphagia in older people. Clinicians need to recognize the heterogeneity in health, functional abilities, social supports, and resources among the elderly and understand how these factors may influence approaches to dysphagia in different care settings. Standard outcome measures of pneumonia, malnutrition, and mortality must be blended with other quality of life indices. Advanced directives are essential in caring for elderly patients with dysphagia irrespective of their health acuity or care setting. Ultimately, patient and family preferences should dictate the swallowing and feeding interventions offered.

Cognitive flexibility: theory, assessment, and treatment.

Abstract: Cognitive flexibility is often impaired in persons with neurogenic communication and cognition disorders. There is, however, little information to guide clinicians in assessing and treating this aspect of executive functioning. The purpose of this article is to provide a framework for clinicians who evaluate and treat persons with impaired cognitive flexibility. It (1) identifies basic definitions of flexibility, (2) discusses tests frequently used to assess flexibility, (3) provides a profile of characteristic patterns of inflexibility that persons with different communication and cognition disorders exhibit, and (4) discusses treatment options.

Management of swallowing disorders in head and neck cancer patients: optimal patterns of care.

Abstract: This article presents optimal patterns of care for management of head and neck cancer patients Discussion includes how the head and neck cancer multidisciplinary team makes decisions regarding treatment for head and neck cancer patients and the role of the speech pathologist as part of the team Specifically addressed issues are how speech pathologists can become team members, provide pretreatment intervention, and implement clinical and instrumental assessment of swallowing and swallowing treatment Types of treatments for head and neck cancer are described, including surgical and organ preservation (radiotherapy with or without chemotherapy) Types of surgeries are described, including surgical resection and surgical reconstruction with discussion of the effects of both resection and reconstruction on swallowing Management of swallowing disorders in the partial laryngectomy, total laryngectomy, partial pharyngectomy, and oral cancer patient are reviewed, as well as use of palatal prostheses and the speech pathologist's role in collaborative construction of the prosthesis and follow-up management of swallowing Types of radiotherapy and chemotherapy treatments and their side effects are discussed as are specific types of swallowing problems seen after these therapies and management of swallowing in this population Optimal care patterns, including timing and duration of swallow management specific to various head and neck cancer populations, are presented

Culturally sensitive assessment of narrative skills in children

Abstract: The clinical legacy of William Labov's narrative analysis framework is explored. In recent years, the importance of narration for children's developing literacy and discourse skills has been widely recognized. This article describes a three-step process for assessing children's narrative discourse: elicitation, coding, and scoring. The influences of cultural differences on narration are also presented, with implications and suggestions for culturally sensitive assessment.

All children are ready to learn: an emergent versus readiness perspective in early literacy assessment.

Abstract: Assessment of emergent literacy is relatively new to the field of communication disorders. Traditional approaches to reading assessment evaluated mastery of reading readiness skills. By contrast, emergent literacy assessment evaluates the increased awareness and understanding of print that begin early in development. One of the most influential figures in emergent literacy assessment has been Marie M. Clay. She has defined critical components of emergent literacy and, in so doing, has played an integral role in the paradigm shift from a reading readiness to an emergent literacy perspective. This article is intended to distinguish emergent literacy from reading readiness, explicate Marie Clay's contribution to our current understanding of effective emergent literacy assessment, and provide some guidance in using her assessment techniques with children with significant disabilities.

Optimal care patterns in pediatric patients with dysphagia.

Abstract: The pediatric population with dysphagia is diverse, ranging from premature infants to fully grown adolescents. A variety of medical conditions cause swallowing disorders in pediatric patients. Complications of swallowing disorders can have severe and even fatal consequences. Swallowing disorders have a direct impact on nutrition, and adequate nutrition is required for growth and development of all body systems in infants and children. Infants and children may not have the same symptoms and signs as adults with dysphagia do and learning to identify pediatric patients at risk for dysphagia is critical. The diagnosis must be thorough and accurate. Furthermore, management of swallowing disorders and nutrition must be aggressive and immediate because of the reduced nutritional reserve and high needs of the infant and child. This article discusses the following three areas for optimal care: identification of infants and children at risk for dysphagia, diagnostic procedures, and management.

Optimal patterns of care for dysphagic stroke patients.

Abstract: Dysphagia is a common poststroke occurrence. It is associated with aspiration, pneumonia, and malnutrition and can persist in some patients. Prompt evaluation and treatment are crucial to prevent ensuing medical problems. This article reviews the current best practices in clinical and dynamic deglutitive evaluations, including screening methods for identification of stroke patients at risk for dysphagia and aspiration. Optimal patterns of care in the management and treatment of the dysphagic stroke patient are also discussed.

Assessing the executive function abilities of adults with neurogenic communication disorders.

Abstract: Whereas it is known that executive function abilities are often impaired in clients having neurogenic communication disorders, few assessments of this cognitive domain are available that consider the speech and language deficits of this population. This article provides an overview of current procedures for assessing executive functions including a discussion of team approaches to assessment, a review of currently available neuropsychological and functional tests of executive function abilities, as well as a critique of those assessment procedures. In addition, suggestions are provided for how best to use or modify appropriately current tests of executive functioning for clients having acquired speech and language disorders as a result of brain damage.

Dynamic assessment: an approach to assessing children's language-learning potential.

Abstract: Dynamic assessment represents an alternative approach to traditional language assessments. In dynamic assessment, the examiner attempts to assess the child's potential for language change or modifiability. This article discusses the development of this approach from its early psychological applications to current models of dynamic assessment as they apply to the assessment of child language. Dynamic assessment is particularly useful in addressing cultural differences that may influence children's assessment performance. The approach involves a test-teach-retest paradigm that includes mediated learning experiences, measures of test score gains, ratings of modifiability and language-learning strategies, as well as analyses of qualitative changes in children's responses.

Optimal patterns of care in patients with chronic obstructive pulmonary disease.

Abstract: An intimate relationship exists between the physiological processes of respiration and swallowing at all levels of neuromotor control and peripheral function in healthy adults. Little is known regarding the potential alterations in these patterns in patients with chronic obstructive pulmonary disease (COPD), yet the impact of swallowing impairment and aspiration on the health outcomes of patients with COPD may be significant. COPD is a common comorbidity in patients with head and neck cancer and neurological disorders seen by swallowing clinicians, and warrants consideration during swallowing treatment. This article summarizes reports of alterations in the nutritional status, airway protective mechanisms, and swallowing efficiency that potentially contribute to or exacerbate the chronic and debilitating pulmonary condition. Care guidelines are given for modification of eating and swallowing behavior to optimize the health status of the patient with COPD. The need for controlled clinical trials for validation of the impact of these care guidelines on clinical outcomes is explained.

Clinical neurology and executive dysfunction.

Abstract: Executive function is a uniquely human ability that permits an individual to plan, carry out, and monitor a sequence of actions that is intended to accomplish a goal. This crucial neurobehavioral capacity depends on the integrity of the frontal lobes, most importantly the dorsolateral prefrontal cortices and their connections. Executive dysfunction is associated with a wide range of neurologic disorders that affect these regions. In this paper, executive dysfunction is considered from the perspective of behavioral neurology, and the lesion method is employed to illustrate this impairment in a diverse group of disorders. Frontal system damage leading to disturbed executive function is common and clinically significant. Recognition of this syndrome is critical for ensuring the correct diagnosis, accurate prognosis, and appropriate treatment of affected patients. Executive dysfunction also represents an intriguing aspect of brain-behavior relationships and offers important insights into one of the highest cerebral functions.

"Putting things in context": literal and discourse approaches to comprehension assessment.

Abstract: Research on receptive language development in typical children, especially as explicated in a classic paper by Robin Chapman, is reviewed. These findings raise three challenges for clinicians assessing comprehension in children with language disorders: (1) contrary to popular wisdom, comprehension does not always precede production in a simple step-by-step way; (2) comprehension is a private event; indicators of comprehension must be used to assess it, and these indicators can be misleading; and (3) children with subtle comprehension deficits may do well on standardized tests that are not sensitive to their difficulties with real-time discourse. Some strategies for addressing these challenges, as well as a framework for assessing comprehension, are offered.

Assessing and managing unawareness of self.

Abstract: Awareness deficits present challenges to recovery and barriers to the rehabilitation process. This paper provides a clinical framework for assessing and managing awareness deficits. It begins with a review of several theoretical and clinical models of awareness in order to identify important characteristics of awareness disorders. A variety of methods for measuring awareness are reviewed. Questions to guide the assessment process are described along with sources for answering the questions. Considerations for implementing three different intervention approaches are also detailed. These interventions include an Individual Awareness Enhancement Program, Procedural Training and Environmental Support, and Caregiver Training and Education. The associated awareness literature is reviewed. An actual case study illustrating the assessment and intervention approaches is provided at the end of the paper.

Working memory: a foundation for executive abilities and higher-order cognitive skills.

Abstract: This paper presents a discussion of working memory and the relationship between working memory and executive abilities. An overview of three prominent models of working memory is provided with experimental sup- port for each. The importance of assessing working memory in individuals with brain damage and related language disorders is discussed, as well as limita- tions of the currently available assessment tools. Lastly, future directions for the development of both theory and assessment tools are offered.

Assessing children's vocabulary skills: from word knowledge to word-learning potential.

Abstract: Knowledge of word meanings and the ability to use words are fundamental to nearly every interaction of every day. Beginning long before formal schooling, vocabulary skills underpin many aspects of communicative, social, and academic well-being. Thus, evaluation of vocabulary knowledge and use is central to any complete assessment of language proficiency. We have advanced in our use of vocabulary assessment significantly since Binet and Simon first used vocabulary tests to measure cognitive proficiency. We have a repertoire of informative tools and strategies from which vocabulary assessment protocols can be fashioned. Current assessment approaches integrate multiple sources of information. They also look beyond existing word knowledge toward word-learning potential. Integrated and dynamic approaches can provide a rich way to ascertain young children's vocabulary abilities and aptitudes.

Language and oral-motor development and disorders in infants and young toddlers with human immunodeficiency virus.

Abstract: There are only a few studies on the preverbal and language development of infants and toddlers with human immunodeficiency virus (HIV). However, the available literature indicates that HIV infection appears to compromise language development. No studies could be found on the oral-motor development of such children. This article reviews current research on the preverbal and language development of children with HIV from birth to 3 years of age and provides recommendations for future research. Information on several virus-related pathologies that can interfere with oral-motor integrity and development is also presented. Proper intervention to remediate language disorders and support oral-motor development of these children requires their comprehensive assessment, and a dynamic assessment strategy is recommended.

Patterns of Care for Dysphagic Patients with Degenerative Neurological Diseases

Abstract: Several of the most common neurodegenerative conditions associated with dysphagia are Parkinsons's disease, progressive supranuclear palsy, postpolio syndrome, and amyotrophic lateral sclerosis. The best clinical practices for treating dysphagic patients with these common conditions are discussed in relation to medication, surgery, diagnosis, and clinical management. Best practice patterns are explained as they relate to the following concepts of care, including comprehension and cognition; interaction with caregivers; dependence-independence during therapy; matching treatment plans to changes in physiology; and establishing realistic expectations including consideration of personal, cultural, and family needs for continuance or termination of care.

Assessing communicative intents: a situated pragmatics approach.

Abstract: The analysis of communicative intents is described as it has developed over time, beginning with J.L. Austin's work published in 1975. Recommendations for best practice are offered in which a situated approach is advocated. Key elements of this approach are a focus on contextual variables and open-ended, rather than list-oriented, assessments of range of intents. It is argued that intents must be assessed relative to the environment, with documentation of environmental variables such as barriers to communicative opportunity. Further, caution is urged in using lists of intents as the sole guide to analysis, because such lists serve to limit awareness of individual differences and multifunctionality of utterances.

Pediatric human immunodeficiency virus and acquired immunodeficiency syndrome: an overview.

Abstract: —This article covers the epidemiological manifestations of humanimmunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS)in children, demographic statistics, and information on the three modes of virustransmission. The various opportunistic diseases and neurological dysfunctionthat characterize pediatric HIV are described. The Center for Disease Controlpediatric HIV classification system is presented, and the developmental disor-ders often found in children with HIV are discussed. The Universal DiseasePrecautions of the American Speech and Hearing Association (ASHA) for clini-cians is also presented.KEY WORDS: pediatric HIV/AIDS, communication disorders in pediatricHIV/AIDS, developmental disorders in pediatric HIV/AIDS * Department of Communication Disorders, North Carolina Central University, Durham, NorthCarolina, † Communication Sciences and Disorders Program,Medical University of South Carolina, Charleston, South CarolinaReprint requests: Dr. Layton, Dept. of Communication Disorders, North Carolina CentralUniversity, Durham, NC 27707Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001,USA. Tel.: +1(212) 760-0888 x132. 0734-0478/2000/1098-9056(2000)21:01:7–18:SSL0032X

Language development and assessment in children with human immunodeficiency virus: 3 to 6 years.

Abstract: Young children infected or exposed, or both to the human immunodeficiency virus (HIV) present with a variety of speech, language, and communication problems. The purpose of this article is to provide an overview of the impact that HIV has on young children from 3 to 6 years of age. Issues concerning medically related problems are discussed, along with assessment criteria and descriptions of communication disorders among HIV-infected and -exposed children.

Communication intervention and therapeutic issues in pediatric human immunodeficiency virus.

Abstract: This article provides an overview of treatment strategies that target communicative disorders exhibited by children exposed to human immunodeficiency virus (HIV). The myriad of communicative disorders presented by these children is discussed in relationship to the complex needs of culturally diverse families. Rehabilitation considerations, the impact of health status on treatment outcomes, and the need to work collaboratively with other health care professionals in meeting children's needs from a family-focused perspective are further discussed.

Psychosocial issues in pediatric human immunodeficiency virus.

Abstract: -This article discusses the psychosocial issues associated with pediatric human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS). Using a psychosocial model instead of the usual medical or rehabilitation model will challenge speech-language pathologists to incorporate an understanding of the psychosocial stresses that affect a child's progression through HIV/AIDS and ensure that they receive adequate consideration in a total treatment model. A case study illustrates the relationship between communication disorders and HIV/AIDS.

Development and assessment of school-age and adolescent children with human immunodeficiency virus.

Abstract: This article presents a review of the literature regarding the communication problems of school-age children with HIV-infection and the impact of the psychosocial and emotional reactions of these children on their social relationships. An overview of the effects of HIV infection on the central nervous system is followed by descriptions of how hearing, oral motor function, speech, language, reading and written language may be affected.

Assessment of language structure: from syntax to event-based analysis.

Abstract: The last 70 years have seen much research and clinical attention devoted to the descriptions and assessment of children's developing language structures. From these efforts have evolved a number of ways to describe the kinds of structures children evidence at different stages of development, and thus the means to make comparisons across children or across time periods. This article reviews major trends that have emerged in syntactic descriptions and approaches to language habilitation, culminating in contemporary approaches that view syntactic structure in real life events rather than in artificial tasks or with arbitrary checklists. These new approaches allow us to determine the communication goals that are not being met rather than cataloging the syntactic structures that have not yet been mastered and provide us with the contexts for helping the children develop structures that will lead to clearer expression of meanings and fewer breakdowns in communication.

Assessing socially situated participation: a way of integrating communication and social assessment approaches.

Abstract: We have long treated communication and social assessment as related but separate domains. Theorizing by George Herbert Mead on "the social self" offers an alternative to this conceptual separation and a means of evaluating children's social interaction, social participation, and communication simultaneously. This article describes Mead's thinking and presents a framework for assessing children's social reciprocity, interactive stances, and role participation as they participate in everyday life contexts.