Department of Speech-Language Pathology
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Item Description of connected speech across different elicitation tasks in the logopenic variant of primary progressive aphasia(2021-09) Lavoie, Monica; Black, Sandra E; Tang-Wai, David F; Graham, Naida L; Stewart, Steven; Leonard, Carol; Rochon, ElizabethBackground Despite its importance, in-depth analysis of connected speech is often neglected in the diagnosis of primary progressive aphasia (PPA) – especially for the logopenic variant (lvPPA) for which unreliable differential diagnosis has been documented. Only a few studies have been conducted on this topic in lvPPA. Aims The aim of this study was to describe and compare lexico-semantic and morphosyntactic features of connected speech in participants with lvPPA, in comparison with healthy controls, using three different elicitation tasks (i.e., picture description, story narration and semi-structured interviews). In addition to a number of discourse features, we were particularly interested in the presence or absence of syntactic deficits in this PPA variant in line with recent findings. Methods & Procedures A prospective group study was conducted to compare lvPPA participants (n = 13) to age- and education-matched healthy controls (n = 13). For each individual, connected speech was obtained using three tasks: (1) The Cookie Theft picture description; (2) Cinderella Story; (3) Topic-directed interview. Production on each task was recorded, transcribed and analysed according to the Quantitative Production Analysis (QPA) protocol, a tool developed by Berndt et al. (2000) for the analysis of sentence production in aphasia. Differences between lvPPA and healthy controls and among elicitation tasks were analysed using repeated measures multilevel mixed-effects regression, separately for each outcome. Outcomes & Results Four measures were significantly different between lvPPA participants and healthy controls across all elicitation tasks. Specifically, lvPPA participants produced a reduced proportion of open-class words, a higher proportion of verbs, a higher proportion of pronouns and fewer well-formed sentences. For these measures, the difference between lvPPA and healthy controls was consistent among elicitation tasks, except for the proportion of well-formed sentences, where the difference between the two groups was significantly greater in the story narration task than in the other tasks. Conclusions & Implications Across elicitation tasks that used the same analysis protocol (i.e., QPA), a similar pattern of deficits in connected speech emerged in lvPPA patients. Importantly, the findings replicate previous studies, which used different elicitation tasks and analysis protocols. Especially in relation to the documented syntactic deficits, these findings provide implications for differential diagnosis in PPA. What this paper adds What is already known on the subject Connected speech analysis can provide an important contribution to the language assessment for the logopenic variant of primary progressive aphasia (lvPPA). However, only a few studies have been conducted with this population. What this paper adds to existing knowledge This study highlights differences between patients with lvPPA and healthy controls regarding the proportion of open-class words, nouns, verbs and well-formed sentences. What are the potential or actual clinical implications of this work? Importantly, our results highlight syntactic deficits in the same group of individuals with lvPPA, using the same analysis protocol and across various elicitation tasks, which has implications for differential diagnosis.Item Analysing syntactic productions in semantic variant PPA and non-fluent variant PPA: how different are they?(2016-05) Cupit, Jennifer; Leonard, Carol; Graham, Naida L.; Seixas Lima, Bruna; Tang-Wai, David; Black, Sandra E.; Rochon, ElizabethBackground: It is commonly held that individuals with the nonfluent/agrammatic variant of primary progressive aphasia (nfvPPA) show difficulties with syntactic production, but that the production of individuals with the semantic variant of primary progressive aphasia (svPPA) is intact. Much of this evidence to date is derived from results of unconstrained language production tasks. There is emerging evidence however that the syntactic production of individuals with svPPA may not be as accurate as was previously thought. Aims: The goal of the current study was to investigate the sentence production abilities of participants with nfvPPA and svPPA (in comparison to matched control participants) using a constrained task eliciting syntactically complex utterances. Methods & Procedures: A constrained picture description task, which elicited active, passive, dative, and dative–passive sentences, was administered to three groups of participants (individuals with nfvPPA and svPPA and matched controls) on up to three occasions over a span of 2 years. Responses were scored andanalysed using analyses of variance, crossing group and sentence type, for each of the testing times. Outcomes & Results: Results show that both the nfvPPA and svPPA groups demonstrated more difficulty with the passive and dative– passive structures compared to the active and dative sentence structures and compared to control participants, although the difficulties were more severe and were observed earlier for the participants with nfvPPA. Both groups also demonstrated difficulty with noun production, although in this case the difficulty was more severe for the participants with svPPA. Conclusions: The current group study provides new evidence of a syntactic production difficulty in individuals with svPPA, notably when complex structures are elicited. The source of the difficulty, whether it is due to a primary syntactic impairment and/or as an extension of the impairment to their semantic system, remains unclear. However, the impairment appears to differ from that of participants with nfvPPA. Further clarification of this syntactic production impairment can yield potentially useful information for researchers and clinicians in this field.Item Longitudinal changes in connected speech over a one-year span in the nonfluent/agrammatic variant of Primary Progressive Aphasia(2022-05) Lavoie, M.; Black, S. E.; Tang-Wai, D. F.; Graham, N. L.; Stewart, S; Freedman, M.; Leonard, C.; Rochon, E.Background Connected speech assessment is essential to characterize the language features in primary progressive aphasia (PPA). This is especially true for the non-fluent/agrammatic variant (nfvPPA) in which one of the core features is agrammatism. Identification of agrammatism typically involves the analysis of sentence production, as in connected speech, in order to detect syntactic deficits. However, little is known about the longitudinal changes occurring in connected speech of individuals with non-fluent PPA. Aim The aim of this study was to assess changes in connected speech over a one-year span in participants with nfvPPA using semi-structured interviews. Methods and procedures We conducted a prospective group study including participants with nfvPPA (n=9) and age- and education-matched healthy controls (n=9). For each individual, connected speech was obtained using topic-directed interviews at two testing rounds, each approximately one year apart. Production on each task was recorded, transcribed and analyzed according to the Quantitative Production Analysis (QPA) protocol, a tool developed by Berndt and colleagues (2000) for the analysis of sentence production in aphasia. For each group, the probability of deterioration between the two testing rounds was estimated using Bayesian analysis. Results and outcomes For individuals with nfvPPA, statistical evidence of deterioration from the first testing round to the second was found for five variables, namely the proportion of pronouns, the proportion of verbs, the proportion of closed class words, the inflection index and the proportion of well-formed sentences. Conclusions Results from the present study suggest that variables relating to word-finding and morphology are more vulnerable to time and therefore may be relevant potential targets for intervention.Item Baseline executive control ability and its relationship to language therapy improvements in post-stroke aphasia: a systematic review(Taylor and Francis, 2019-04) Simic, Tijana; Rochon, Elizabeth; Greco, Elissa; Martino, RosemaryPurpose: To review current evidence on the relationship between executive control (EC) and post-treatment language gains in adults with post-stroke aphasia. Method: Electronic databases (CINAHL, Cochrane Trials, Embase, MEDLINE, MEDLINE-in-Process and PsycINFO) were systematically searched (year 2000 – present). Abstracts and full-text articles were reviewed by two independent raters against pre-specified criteria: original research with N > 2; at least 90% adults with stroke, all undergoing treatment for acquired aphasia; pre-treatment EC abilities were compared to language gains post-treatment across studies. Critical appraisal was conducted using the Cochrane group and Single-Case Experimental Design (SCED) methods. Data were extracted and summarised descriptively. Results: Search results yielded 2272 unique citations; ultimately 15 studies were accepted for review. Both pre-treatment EC and language abilities appear to be important indicators of treatment success, especially in moderate-severe aphasia. This relationship emerged when EC was measured using specific (e.g., divided attention), as opposed to broad (e.g., reasoning) tasks, and primarily when naming therapy was administered; intensive constraint-induced therapy did not correlate with treatment success. Conclusions: EC is a promising prognostic variable regarding language recovery, but further research is required using a-priori declared theoretical EC models, along with properly powered samples, standardised EC tasks and treatment protocols.Item The role of executive control in post-stroke aphasia treatment(Taylor and Francis, 2019-05-10) Simic, Tijana; Bitan, Tali; Turner, Gary; Chambers, Craig; Goldberg, Devora; Leonard, Carol; Rochon, ElizabethExecutive control (EC) ability is increasingly emerging as an important predictor of post-stroke aphasia recovery. This study examined whether EC predicted immediate treatment gains, treatment maintenance and generalization after naming therapy in ten adults with mild to severe chronic post-stroke aphasia. Performance on multiple EC tasks allowed for the creation of composite scores for common EC, and the EC processes of shifting, inhibition and working memory (WM) updating. Participants were treated three times a week for five weeks with a phonological naming therapy; difference scores in naming accuracy of treated and untreated words (assessed pre, post, four- and eight-weeks after therapy) served as the primary outcome measures. Results from simple and multiple linear regressions indicate that individuals with better shifting and WM updating abilities demonstrated better maintenance of treated words at four-week follow-up, and those with better common EC demonstrated better maintenance of treated words at both four- and eight-week follow-ups. Better shifting ability also predicted better generalization to untreated words post-therapy. Measures of EC were not indicative of improvements on treated words immediately post-treatment, nor of generalization to untreated words at follow-up. Findings suggest that immediate treatment gains, maintenance and generalization may be supported by different underlying mechanisms.Item A Usability Study of Internet-Based Therapy for Naming Deficits in Aphasia(American Speech-Language-Hearing Association, 2016-11-01) Simic, Tijana; Leonard, Carol; Laird, Laura; Cupit, Jennifer; Höbler, Fiona; Rochon, ElizabethPurpose: This study aimed to evaluate the usability of delivering the Phonological Components Analysis treatment for anomia (Leonard, Rochon, & Laird, 2008) remotely via the Internet to individuals with chronic poststroke aphasia. A secondary aim was to probe the experiences and satisfaction of clinicians in administering treatment at a distance. Method: Six individuals with mild–moderate aphasia and 2 trained clinicians participated in this usability study. Participants and clinicians underwent approximately 6 hr of treatment under observation by an independent observer. The usability characteristics of effectiveness, efficiency, and satisfaction were assessed. Results: Individuals with aphasia used the Internet-based Phonological Components Analysis therapy successfully, demonstrating independence and very few errors in completing online tasks. Overall, participant satisfaction was high, despite occasional difficulties with technical aspects of the system. Clinicians found the application easy to use but raised concerns about the participant–clinician interaction, perceiving rapport-building and communicating to be more difficult online than face-to-face. Conclusions: It is important to consider usability and the clinician's perspective in developing telepractice applications in speech-language pathology. Future directions include assessing the efficacy of remote treatment and collecting a larger sample of clinician data.Item Mechanisms underlying anomia treatment outcomes(Elsevier, 2020-09-29) Simic, Tijana; Chambers, Craig; Bitan, Tali; Stewart, Steven; Goldberg, Devora; Laird, Laura; Leonard, Carol; Rochon, ElizabethTreatments for anomia have demonstrated short- and long-term efficacy. However, individual outcomes can be variable, and evidence for treatment generalization is limited. We investigated whether treatment-related measures of access to- and learning of language, namely, a) responsiveness to cues, and b) during-treatment improvements in naming, are good predictors of treatment outcomes. In addition, we investigated mechanisms underlying treatment generalization. Ten adults with chronic, post-stroke aphasia received a phonological treatment for anomia three times a week for five weeks. Naming accuracy of treated and untreated words was assessed pre- and post-treatment and at four- and eight-week follow-ups. Generalization to an untrained naming task, which involved analyses of naming accuracy and speech errors, was also assessed; speech errors were analyzed according to the Interactive Activation (IA) model of word retrieval. Group analyses indicate significant improvements in naming treated compared to untreated words, at all timepoints after therapy. Additional analyses showed significant long-term improvements in naming untreated words. Initial responsiveness to cueing and early improvement emerged as significant predictors of overall pre- to post-treatment improvements in naming treated words; naming improvements made early-on in treatment were also predictive of improvements in naming of the untreated words at follow-up. Furthermore, our study is the first to demonstrate that generalization after a phonological treatment for anomia may be driven by a strengthening of lexical-phonological connections. This study provides novel insights regarding mechanisms driving anomia treatment outcomes. Understanding such mechanisms is critical to improving existing assessment practices, optimizing treatment selection and building treatment protocols that are more likely to generalize.Item The effects of intensity on a phonological treatment for anomia in post-stroke aphasia(Elsevier, 2021-06-02) Simic, Tijana; Leonard, Carol; Laird, Laura; Stewart, Steven; Rochon, ElizabethIntroduction: The evidence regarding optimal treatment intensity is mixed, and differing definitions have further confounded existing findings. The primary objective of this study was to compare the efficacy of Phonological Components Analysis (PCA) treatment for anomia delivered at intense and non-intense schedules, using a well-controlled design. The number of teaching episodes and active ingredients of therapy are important considerations when defining intensity. We hypothesized that an active ingredient of PCA is the self-generation of phonological components during therapy sessions. Our secondary aim was to examine whether component generation predicted treatment outcome. Methods: Sixteen adults (M = 52.63 years old, SD = 11.40) with chronic post-stroke aphasia (M = 4.52 years post-onset, SD = 5.55) were randomly assigned to intensive (IT) or standard (ST) PCA treatment conditions. Cumulative treatment intensity in both conditions was equivalent: ST participants received PCA 1 hour/day, 3 days/week for 10 weeks, whereas IT participants received PCA 3 hours/day, 4 days/week for 2.5 weeks. The primary outcome was naming accuracy on a set of treated and (matched) untreated words, measured pre- and post-treatment, and at four- and eight-week follow-ups. Results: IT and ST conditions were similarly efficacious. However, secondary analyses suggest an advantage for the IT condition in naming of the treated words immediately post-treatment, but not at follow-ups. The self-generation of phonological components emerged as a significant positive predictor of naming accuracy for both the treated and untreated words. However, this relationship did not reach significance once baseline anomia severity was accounted for. Conclusions: Although replication in a larger sample is warranted, results suggest that PCA treatment is similarly efficacious when delivered at different intensities. Other factors related to the quality of treatment (i.e., active ingredients such as cue-generation) may play an important role in determining treatment efficacy and must also be considered when comparing treatment intensities.Item Neural changes after phonological treatment for anomia: An fMRI study(Elsevier, 2010-09) Rochon, Elizabeth; Leonard, Carol; Burianova, Hana; Laird, Laura; Soros, Peter; Graham, Simon; Grady, CherylFunctional magnetic resonance imaging (fMRI) was used to investigate the neural processing characteristics associated with word retrieval abilities after a phonologically-based treatment for anomia in two stroke patients with aphasia. Neural activity associated with a phonological and a semantic task was compared before and after treatment with fMRI. In addition to the two patients who received treatment, two patients with aphasia who did not receive treatment and 10 healthy controls were also scanned twice. In the two patients who received treatment, both of whose naming improved after treatment, results showed that activation patterns changed after treatment on the semantic task in areas that would have been expected (e.g., left hemisphere frontal and temporal areas). For one control patient, there were no significant changes in brain activation at the second scan; a second control patient showed changes in brain activation at the second scan, on the semantic task, however, these changes were not accompanied with improved performance in naming. In addition, there appeared to be bilateral, or even more right than left hemisphere brain areas activated in this patient than in the treated patients. The healthy control group showed no changes in activation at the second scan. These findings are discussed with reference to the literature on the neural underpinnings of recovery after treatment for anomia in aphasia.Item Behavioural and neural changes after a “choice” therapy for naming deficits in aphasia: preliminary findings(Taylor & Francis, 2014) Leonard, Carol; Laird, Laura; Burianová, Hana; Graham, Simon; Grady, Cheryl; Simic, Tijana; Rochon, ElizabethBackground: Anomia, difficulty producing words, is a pervasive symptom of many individuals with aphasia. We have developed a treatment for naming deficits—the Phonological Components Analysis (PCA) protocol—that has proven efficacious in improving word-finding abilities for individuals with post-stroke aphasia. Aims: The aim of this investigation is to present preliminary findings exploring the potential influence of choice—that is the active engagement of a participant in therapy—on our PCA treatment. Methods & Procedures: Five individuals with aphasia were treated in one of two conditions—Choice or No Choice. Potential changes in neural activation as a function of the treatment were also investigated. Two individuals (one from each condition) underwent functional MRI (fMRI) pre- and post-therapy. Outcomes & Results: All the individuals demonstrated a significant treatment effect immediately post-treatment and at a 4-week follow-up and four of the five participants at an 8-week follow-up. Three also demonstrated generalisation to untrained items. Unfortunately, no clear-cut patterns emerged to allow us to make claims about the influence of choice, per se, on the behavioural manifestations of improved naming. Interestingly, the participant from the Choice condition showed neural activation changes post-treatment in frontal and parietal regions that were not evident for the participant in the No Choice condition. Moreover, these changes were accompanied by a larger treatment effect for that individual and generalisation to a novel naming task. Conclusion: The efficacy of PCA treatment for naming deficits is further supported. In addition, the neuroimaging data suggest the possibility that active engagement of an individual in his/her therapy (in this case choosing phonological attributes of a target word) may exercise executive functions important for success in treating anomia. Also, continued exploration of task factors that may promote even better treatment effects using this protocol is warranted, as is continued investigation of the neural underpinnings associated with treatment effects.Item Exploratory analysis of real personal emergency response call conversations: considerations for personal emergency response spoken dialogue systems(BioMed Central, 2016-11-14) Young, Victoria; Rochon, Elizabeth; Mihailidis, AlexThe purpose of this study was to derive data from real, recorded, personal emergency response call conversations to help improve the artificial intelligence and decision making capability of a spoken dialogue system in a smart personal emergency response system. The main study objectives were to: develop a model of personal emergency response; determine categories for the model's features; identify and calculate measures from call conversations (verbal ability, conversational structure, timing); and examine conversational patterns and relationships between measures and model features applicable for improving the system's ability to automatically identify call model categories and predict a target response.Item MRI-Based Neuroanatomical Predictors of Dysphagia, Dysarthria, and Aphasia in Patients with First Acute Ischemic Stroke(Karger Publishers, 2017-02-16) Flowers, Heather L; AlHarbi, Mohammed A; Mikulis, David; Silver, Frank L; Rochon, Elizabeth; Streiner, David; Martino, RosemaryDue to the high post-stroke frequency of dysphagia, dysarthria, and aphasia, we developed comprehensive neuroanatomical, clinical, and demographic models to predict their presence after acute ischemic stroke.Item Automated classification of primary progressive aphasia subtypes from narrative speech transcripts(Elsevier, 2014-06-01) Fraser, Kathleen C; Meltzer, Jed A; Graham, Naida L; Leonard, Carol; Hirst, Graeme; Black, Sandra E; Rochon, ElizabethIn the early stages of neurodegenerative disorders, individuals may exhibit a decline in language abilities that is difficult to quantify with standardized tests. Careful analysis of connected speech can provide valuable information about a patient's language capacities. To date, this type of analysis has been limited by its time-consuming nature. In this study, we present a method for evaluating and classifying connected speech in primary progressive aphasia using computational techniques. Syntactic and semantic features were automatically extracted from transcriptions of narrative speech for three groups: semantic dementia (SD), progressive nonfluent aphasia (PNFA), and healthy controls. Features that varied significantly between the groups were used to train machine learning classifiers, which were then tested on held-out data. We achieved accuracies well above baseline on the three binary classification tasks. An analysis of the influential features showed that in contrast with controls, both patient groups tended to use words which were higher in frequency (especially nouns for SD, and verbs for PNFA). The SD patients also tended to use words (especially nouns) that were higher in familiarity, and they produced fewer nouns, but more demonstratives and adverbs, than controls. The speech of the PNFA group tended to be slower and incorporate shorter words than controls. The patient groups were distinguished from each other by the SD patients' relatively increased use of words which are high in frequency and/or familiarity.Item Dysgraphia in primary progressive aphasia: Characterisation of impairments and therapy options(Taylor & Francis, 2014-01-03) Graham, Naida L.Background: Spelling impairment is common in primary progressive aphasia (PPA). Although behavioural interventions tend to focus on spoken language, remediation of written language may be desirable, either because an individual’s regular use of writing makes it a priority or because writing is needed for communication in cases where it is better preserved than spoken language. Aims: This paper has three aims: (1) to provide an up-to-date survey of spelling and handwriting impairments in each variant of PPA, (2) to provide guidance on characterisation of dysgraphia and identification of loci of impairment, and (3) to outline possible interventions. Because the number of studies which have specifically evaluated therapy for dysgraphia in PPA is small, this paper also reviews relevant studies of therapy in non-progressive dysgraphia. Main Contribution: Review of the literature indicated that the most common pattern of spelling impairment in the semantic variant of PPA is surface dysgraphia (impairment in lexical spelling). The profile is more variable in the non-fluent and logopenic variants of PPA, but most commonly there is impairment in lexical spelling and in phoneme-to-grapheme conversion. Review of the literature on therapy for dysgraphia indicated that four main types of therapy have been evaluated and shown to improve spelling performance: (1) training of spelling of specific target words (used to ameliorate lexical and graphemic buffer impairments), (2) training of sound-to-spelling correspondence rules (used to treat impairment in assembled spelling), (3) training in segmentation of stimulus words into smaller chunks (to make them manageable for a damaged graphemic buffer, or as a first stage in applying sound-to-spelling correspondence rules), and (4) learning to identify and self-correct errors (used in treatment of graphemic buffer disorder). Conclusions: It is likely that spelling impairment in PPA would be responsive to treatment, although this has only been demonstrated in the logopenic variant. Reported improvements following therapy for anomia demonstrate that relearning is possible in PPA, despite the progressive nature of the condition. This gives reason for optimism regarding a positive response to therapy for dysgraphia in all variants of PPA.Item White Matter Disruption and Connected Speech in Non-Fluent and Semantic Variants of Primary Progressive Aphasia(Karger Publishers, 2017-03-02) Marcotte, Karine; Graham, Naida L; Fraser, Kathleen C; Meltzer, Jed A; Tang-Wai, David F; Chow, Tiffany W; Freedman, Morris; Leonard, Carol; Black, Sandra E; Rochon, ElizabethDifferential patterns of white matter disruption have recently been reported in the non-fluent (nfvPPA) and semantic (svPPA) variants of primary progressive aphasia (PPA). No single measure is sufficient to distinguish between the PPA variants, but connected speech allows for the quantification of multiple measures. The aim of the present study was to further investigate the white matter correlates associated with connected speech features in PPA. We examined the relationship between white matter metrics and connected speech deficits using an automated analysis of transcriptions of connected speech and diffusion tensor imaging in language-related tracts. Syntactic, lexical, and semantic features were automatically extracted from transcriptions of topic-directed interviews conducted with groups of individuals with nfvPPA or svPPA as well as with a group of healthy controls. A principal component analysis was performed in order to reduce the number of language measures and yielded a five-factor solution. The results indicated that nfvPPA patients differed from healthy controls on a syntactic factor, and svPPA patients differed from controls on two semantic factors. However, the patient groups did not differ on any factor. Moreover, a correlational analysis revealed that the lexical richness factor was significantly correlated with radial diffusivity in the left inferior longitudinal fasciculus, which suggests that semantic deficits in connected speech reflect a disruption of this ventral pathway, and which is largely consistent with the results of previous studies. Using an automated approach for the analysis of connected speech combined with probabilistic tractography, the present findings demonstrate that nfvPPA patients are impaired relative to healthy controls on syntactic measures and have increased radial diffusivity in the left superior longitudinal fasciculus, whereas the svPPA group was impaired on lexico-semantic measures relative to controls and showed increased radial diffusivity in the uncinate and inferior longitudinal fasciculus bilaterally.Item Lack of Frank Agrammatism in the Nonfluent Agrammatic Variant of Primary Progressive Aphasia(2016-09-23) Graham, Naida L; Leonard, Carol; Tang-Wai, David F; Black, Sandra; Chow, Tiffany W; Scott, Chris J M; McNeely, Alicia A; Masellis, Mario; Rochon, ElizabethFrank agrammatism, defined as the omission and/or substitution of grammatical morphemes with associated grammatical errors, is variably reported in patients with nonfluent variant primary progressive aphasia (nfPPA). This study addressed whether frank agrammatism is typical in agrammatic nfPPA patients when this feature is not required for diagnosis.Item Methods to Enhance Verbal Communication between Individuals with Alzheimer's Disease and Their Formal and Informal Caregivers: A Systematic Review(Hindawi Publishing Corporation, 2010) Egan, Mary; Bérubé, Daniel; Racine, Geneviève; Leonard, Carol; Rochon, ElizabethAlzheimer's disease is the leading cause of dementia in older adults. Although memory problems are the most characteristic symptom of this disorder, many individuals also experience progressive problems with communication. This systematic review investigates the effectiveness of methods to improve the verbal communication of individuals with Alzheimer's disease with their caregivers. The following databases were reviewed: PsychINFO, CINAHL, EMBASE, MEDLINE, REHABDATA, and COMDIS. The inclusion criteria were: (i) experimentally based studies, (ii) quantitative results, (iii) intervention aimed at improving verbal communication of the affected individual with a caregiver, and (iv) at least 50% of the sample having a confirmed diagnosis of Alzheimer's disease. A total of 13 studies met all of the inclusion criteria. One technique emerged as potentially effective: the use of memory aids combined with specific caregiver training programs. The strength of this evidence was restricted by methodological limitations of the studies. Both adoption of and further research on these interventions are recommended.Item Patient-centred communication intervention study to evaluate nurse-patient interactions in complex continuing care(BioMed Central, 2012) McGilton, Katherine S.; Sorin-Peters, Riva; Sidani, Souraya; Boscart, Veronique; Fox, Mary; Rochon, ElizabethBackground: Communication impairment is a frequent consequence of stroke. Patients who cannot articulate their needs respond with frustration and agitation, resulting in poor optimization of post-stroke functions. A key component of patient-centred care is the ability of staff to communicate in a way that allows them to understand the patient’s needs. We developed a patient-centred communication intervention targeting registered and unregulated nursing staff caring for complex continuing care patients with communication impairments post stroke. Research objectives include 1) examining the effects of the intervention on patients’ quality of life, depression, satisfaction with care, and agitation; and (2) examining the extent to which the intervention improves staff’s attitudes and knowledge in caring for patients with communication impairments. The intervention builds on a previous pilot study. Methods/design: A quasi-experimental repeated measures non-equivalent control group design in a complex continuing care facility is being used. Patients with a communication impairment post-stroke admitted to the facility are eligible to participate. All staff nurses are eligible. Baseline data are collected from staff and patients. Follow-up will occur at 1 and 3 months post-intervention. Subject recruitment and data collection from 60 patients and 30 staff will take approximately 36 months. The Patient-Centred Communication Intervention consists of three components: (1) development of an individualized patient communication care plan; (2) a one-day workshop focused on communication and behavioural management strategies for nursing staff; and (3) a staff support system. The intervention takes comprehensive patient assessments into account to inform the development of communication and behavioural strategies specifically tailored to each patient. Discussion: The Patient-Centred Communication Intervention will provide staff with strategies to facilitate interactions with patients and to minimize agitation associated with considerable stress. The improvement of these interactions will lead to a reduction of agitation, which has the additional significance of increasing patients’ well-being, quality of life, and satisfaction with care. Trial registration: ClinicalTrials.gov Identifier NCT01654029Item An inpatient rehabilitation model of care targeting patients with cognitive impairment(BioMed Central, 2012) McGilton, Katherine S.; Davis, Aileen; Mahomed, Nizar; Flannery, John; Jaglal, Susan; Cott, Cheryl; Naglie, Gary; Rochon, ElizabethBackground: The course and outcomes of hip fracture patients are often complicated by the presence of dementia and delirium, referred to as cognitive impairment (CI), which limits access to in-patient rehabilitation. In response to this concern, members of our team developed and piloted an in-patient rehabilitation model of care (Patient-Centred Rehabilitation Model; PCRM) targeting patients with hip fracture and CI (PCRM-CI). We are now conducting a 3-year study comparing an inpatient rehabilitation model of care for community dwelling individuals with hip fracture and CI (PCRM-CI) to usual care to determine whether it results in improved mobility at the time of discharge from inpatient rehabilitation. Methods/Design: A non-equivalent pre-post design is being used to evaluate the PCRM-CI compared to usual care. All community dwelling (private home or retirement home) patients following a hip fracture are eligible to participate. Recruitment of both cohorts is taking place at two facilities. Target accrual is 70 hip fracture patients in the PCRM-CI cohort and 70 patients in the usual care cohort. We are also recruiting 70 health care providers (HCPs), who are being trained to implement the PCRM-CI, and their unit managers. Patient data are collected at baseline, discharge, and 6 months post-discharge from an inpatient rehabilitation program. Evaluations include mobility, physical function, and living arrangement. Additional outcome variables are being collected from medical records and from the patients via their proxies. Data on the prevalence and severity of dementia and delirium are being collected. Staff data are collected at baseline and one year after implementation of the model to determine change in staff knowledge and attitudes toward patients with hip fracture and CI. Bi-monthly semi-structured interviews with unit managers have been conducted to examine factors and barriers influencing the model implementation. Data collection began in 2009 and is expected to be completed in 2012. The control cohort of 70 patients has been recruited, and 45 patients have been accrued to the intervention group to date. Discussion: Evaluation of this model of care is timely given the increasing proportion of persons with cognitive impairment and hip fractures. Trial registration: The study is registered at http://clinicaltrials.gov, Identifier NCT01566136.Item Formal caregivers’ perceptions of effective communication strategies while assisting residents with Alzheimer’s disease during activities of daily living(Speech-Language and Audiology Canada, 2012) Wilson, Rozanne; Rochon, Elizabeth; Leonard, Carol; Mihailidis, AlexThis article describes caregivers’ perceptions of communication strategies that are useful in their care practice when assisting individuals with moderate and severe Alzheimer’s disease (AD) during the completion of activities of daily living (ADLs). A total of 10 formal caregivers participated in one-hour semi-structured focus group interviews (FGIs) conducted at two different long-term care (LTC) locations (n = 5 at each location). To identify the strategies caregivers perceived to be effective, content analysis was the primary method used to examine the FGI data. Particular attention was given to identifying the frequency and extensiveness in which caregivers made reference to communication strategies during the FGIs. Caregivers discussed a total of 33 strategies that they perceived to be useful when assisting residents with moderate and severe AD during the completion of ADLs. The majority of the communication strategies discussed (64%) were task-focused and the most frequently mentioned strategies included the use of negotiation and explaining one’s actions to the resident. Greeting the resident was the most frequently discussed social strategy. In addition, two emergent themes containing a total of 12 strategies were identified, with the most frequently mentioned being establishing eye contact, familiarity with the resident, and postponing the task. Caregivers’ perceived use of communication strategies indicates that person-centred dementia care is a central aspect to facilitating the completion of ADLs.