American Journal of Speech-Language Pathology, 2020
Purpose Macrostructural narrative analyses are important clinical measures, revealing age-related... more Purpose Macrostructural narrative analyses are important clinical measures, revealing age-related declines and disorder-related impairments in the accuracy, completeness, logical sequencing, and organization of content. The current study aims to provide preliminary data on typical aging and psychometric evidence supporting multilevel Main Concept, Sequencing, and Story Grammar (MSSG) analyses that capture these aspects of narratives. Method Transcripts of Cinderella narratives for 92 healthy control participants stratified across four age brackets from the online database AphasiaBank were coded by Richardson and Dalton (2016) for main concept (MC) analysis. In the current study, MSSG analyses were completed for (a) logical sequencing, independently and in combination with MC accuracy and completeness (MC + sequencing), and (b) story grammar organization (i.e., inclusion of episodic components and complexity of episodes). Interrater agreement (99%–100%) revealed highly reliable scori...
Neural substrates of fatigue in traumatic brain injury (TBI) are not well understood despite the ... more Neural substrates of fatigue in traumatic brain injury (TBI) are not well understood despite the considerable burden of fatigue on return to productivity. Fatigue is associated with diminishing performance under conditions of high cognitive demand, sense of effort, or need for motivation, all of which are associated with cognitive control brain network integrity. We hypothesize that the pathophysiology of TBI results in damage to diffuse cognitive control networks, disrupting coordination of moment-to-moment monitoring, prediction, and regulation of behavior. We investigate the cingulo-opercular (CO) and frontoparietal (FP) networks, which are engaged to sustain attention for task and maintain performance. A total of 61 individuals with mild TBI and 42 orthopedic control subjects participated in functional MRI during performance of a constant effort task requiring altering the amount of effort (25, 50, or 75% of maximum effort) utilized to manually squeeze a pneumostatic bulb across...
<b>Purpose:</b> Spoken discourse analysis is commonly employed in the assessment and ... more <b>Purpose:</b> Spoken discourse analysis is commonly employed in the assessment and treatment of people living with aphasia, yet there is no standardization in assessment, analysis, or reporting procedures, thereby precluding comparison/meta-analyses of data and hindering replication of findings. An important first step is to identify current practices in collecting and analyzing spoken discourse in aphasia. Thus, this study surveyed current practices, with the goal of working toward standardizing spoken discourse assessment first in research settings with subsequent implementation into clinical settings.<b>Method:</b> A mixed-methods (quantitative and qualitative) survey was publicized to researchers and clinicians around the globe who have collected and/or analyzed spoken discourse data in aphasia. The survey data were collected between September and November 2019.<b>Results: </b>Of the 201 individuals who consented to participate, 189 completed all mandatory questions in the survey (with fewer completing nonmandatory response questions). The majority of respondents reported barriers to utilizing discourse including transcription, coding, and analysis. The most common barrier was time (e.g., lack of time). Respondents also indicated that there was a lack of, and a need for, psychometric properties and normative data for spoken discourse use in the assessment and treatment of persons with aphasia. Quantitative and qualitative results are described in detail.<b>Conclusions:</b> The current survey study evaluated spoken discourse methods in aphasia across research and clinical settings. Findings from this study will be used to guide development of process standardization in spoken discourse and for the creation of a psychometric and normative property database.<b><br></b><b>Supplemental Material S1. </b>Survey. <br><b>Supplemental Material S2. </b>Response rates for quantitative questions (for all primary questions, e.g., not those that branched off).<br><b>Supplemental Material S3. </b>Response rates for qualita [...]
Supplemental Material for Reduced Salience and Enhanced Central Executive Connectivity Following ... more Supplemental Material for Reduced Salience and Enhanced Central Executive Connectivity Following PTSD Treatment by Chadi G. Abdallah, Christopher L. Averill, Amy E. Ramage, Lynnette A. Averill, Evelyn Alkin, Samaneh Nemati, John H. Krystal, John D. Roache, Patricia A. Resick, Stacey Young-McCaughan, Alan L. Peterson, Peter Fox and the STRONG STAR Consortium in Chronic Stress
BACKGROUND: In soldiers with posttraumatic stress disorder (PTSD), symptom provocation was found ... more BACKGROUND: In soldiers with posttraumatic stress disorder (PTSD), symptom provocation was found to induce increased connectivity within the salience network, as measured by functional magnetic resonance imaging (fMRI) and global brain connectivity with global signal regression (GBCr). However, it is unknown whether these GBCr disturbances would normalize following effective PTSD treatment. METHODS: 69 US Army soldiers with (n = 42) and without PTSD (n = 27) completed fMRI at rest and during symptom provocation using subject-specific script imagery. Then, participants with PTSD received 6 weeks (12 sessions) of group cognitive processing therapy (CPT) or present-centered therapy (PCT). At week 8, all participants repeated the fMRI scans. The primary analysis used a region-of-interest approach to determine the effect of treatment on salience GBCr. A secondary analysis was conducted to explore the pattern of GBCr alterations post-treatment in PTSD participants compared to controls. RE...
Social cognitive and affective neuroscience, Jan 15, 2015
Post-traumatic stress disorder (PTSD) is presumably the result of life threats and conditioned fe... more Post-traumatic stress disorder (PTSD) is presumably the result of life threats and conditioned fear. However, the neurobiology of fear fails to explain the impact of traumas that do not entail threats. Neuronal function, assessed as glucose metabolism with (18)fluoro-deoxyglucose positron emission tomography, was contrasted in active duty, treatment-seeking US Army Soldiers with PTSD endorsing either danger- (n = 19) or non-danger-based (n = 26) traumas, and was compared with soldiers without PTSD (Combat Controls, n = 26) and Civilian Controls (n = 24). Prior meta-analyses of regions associated with fear or trauma script imagery in PTSD were used to compare glucose metabolism across groups. Danger-based traumas were associated with higher metabolism in the right amygdala than the control groups, while non-danger-based traumas associated with heightened precuneus metabolism relative to the danger group. In the danger group, PTSD severity was associated with higher metabolism in prec...
Purpose: This paper describes the development of a working group and its initiatives, which have ... more Purpose: This paper describes the development of a working group and its initiatives, which have been designed to address major gaps in the spoken discourse aphasia literature, including a lack of standardization in methodology, analysis, and reporting, and nominal data regarding the psychometric properties of spoken discourse outcomes. Method: The working group includes task forces and initiatives to: 1) propose recommendations regarding standardization of spoken discourse collection, analysis, and reporting in aphasia, based on the results of an international survey and a systematic literature review; and, 2) create a database of test-retest spoken discourse data from individuals with and without aphasia. The survey of spoken discourse collection, analysis, and interpretation procedures will be distributed to clinicians and researchers involved in aphasia assessment and rehabilitation. A leadership team will discuss the survey results and recommend standards for collecting, analyz...
Organizing and finally assembling the chapters for this book has been one of life's more plea... more Organizing and finally assembling the chapters for this book has been one of life's more pleasurable education experiences for this editor. The impetus for the development of the book resides with the continuing far-sighted thinking of Dr. Sadanand Singh. He has been unflagging in helping the discipline of human communication sciences and disorders advance its knowledge base by publishing cutting-edge texts that help to define just what it is that our discipline can uniquely contribute to humanity—more specifically, just what that knowledge base can provide for our discipline's science and its quest for the alleviation of communication disorders. And that is precisely what this book aims to provide. Our discipline often has appeared to struggle to define a distinctive body of knowledge that constitutes the discipline of human communication disorders It also is rather puzzling, however, that our researchers and clini-cians would doubt that the discipline's search for the ...
OBJECTIVE: Active duty military members who had and had not sustained one or more mild traumatic ... more OBJECTIVE: Active duty military members who had and had not sustained one or more mild traumatic brain injuries (mTBI) were compared on an objective measure of sense of effort during functional MRI. BACKGROUND: Since the year 2000, over 333,000 military members have sustained traumatic brain injuries (TBI) [1]. Of these, 82.4[percnt] were mild. Mild traumatic brain injury (mTBI) refers to any injury to the brain resulting from external force that can cause confusion, loss of consciousness for up to 30 minutes, memory loss of up to 24 hours, and diffuse neuronal injury, which can result in cognitive problems [1]. Specifically, TBI often compromises the normal allocation of resources for attention and determination of effort. As service members who sustained brain injuries return from Iraq and Afghanistan, it is increasingly important to determine the relationship between effort and cognitive complaint in this population. DESIGN/METHODS: Active duty soldiers deployed to OIF/OEF/Endura...
It is well established that voice is disordered in nearly 90% of individuals with Parkinsons dise... more It is well established that voice is disordered in nearly 90% of individuals with Parkinsons disease (PD). Given the role of voice in language expression, we pose that optimizing vocal function may lead to improved language production. Verb production is an area of language deficit in PD, particularly for verbs associated with an individuals location of impairment (upper vs. lower limbs). It is thought that damage to the motor system, given its connection to action verbs, underlies this lexical effect. If this is the case, then treatment improving vocal motor function may also improve access to verbs. Nineteen participants with PD underwent Lee Silverman Voice Treatment (LSVT LOUD), a 4-week intensive voice treatment (TXPD), in an IRB-approved randomized controlled voice treatment trial. Language production was contrasted with 20 untreated PD (UNTXPD) and 20 age-matched neurotypical control participants. Each provided 1-minute picture description narratives at baseline and after 4-w...
Purpose Spoken discourse analysis is commonly employed in the assessment and treatment of people ... more Purpose Spoken discourse analysis is commonly employed in the assessment and treatment of people living with aphasia, yet there is no standardization in assessment, analysis, or reporting procedures, thereby precluding comparison/meta-analyses of data and hindering replication of findings. An important first step is to identify current practices in collecting and analyzing spoken discourse in aphasia. Thus, this study surveyed current practices, with the goal of working toward standardizing spoken discourse assessment first in research settings with subsequent implementation into clinical settings. Method A mixed-methods (quantitative and qualitative) survey was publicized to researchers and clinicians around the globe who have collected and/or analyzed spoken discourse data in aphasia. The survey data were collected between September and November 2019. Results Of the 201 individuals who consented to participate, 189 completed all mandatory questions in the survey (with fewer comple...
Purpose Severe acute respiratory syndrome coronavirus 2 is the virus resulting in COVID-19 infect... more Purpose Severe acute respiratory syndrome coronavirus 2 is the virus resulting in COVID-19 infections in nearly 4.3 million Americans with COVID-19 in the United States as of July 29, 2020, with nearly 150,000 deaths and hundreds of thousands of survivors ( https://www.coronavirus.jhu.edu/map.html ). This tutorial reviews (a) what has been reported about neurological insults in cases of COVID-19 infection, (b) what is known from similar conditions in other disorders, and (c) how that combined information can inform clinical decision making. Method PubMed and the Cochrane Central Register of Controlled Trials were searched for COVID-19 or other coronavirus infections, cognitive impairment observed following critical care, and disorders for which intermittent or chronic hypoxia is characteristic. These were combined with searches relating to cognition, brain, and communication. All searches were conducted between April 8 and May 23, 2020. Meta-analyses and randomized clinical trials a...
American Journal of Speech-Language Pathology, 2020
Purpose Macrostructural narrative analyses are important clinical measures, revealing age-related... more Purpose Macrostructural narrative analyses are important clinical measures, revealing age-related declines and disorder-related impairments in the accuracy, completeness, logical sequencing, and organization of content. The current study aims to provide preliminary data on typical aging and psychometric evidence supporting multilevel Main Concept, Sequencing, and Story Grammar (MSSG) analyses that capture these aspects of narratives. Method Transcripts of Cinderella narratives for 92 healthy control participants stratified across four age brackets from the online database AphasiaBank were coded by Richardson and Dalton (2016) for main concept (MC) analysis. In the current study, MSSG analyses were completed for (a) logical sequencing, independently and in combination with MC accuracy and completeness (MC + sequencing), and (b) story grammar organization (i.e., inclusion of episodic components and complexity of episodes). Interrater agreement (99%–100%) revealed highly reliable scori...
Neural substrates of fatigue in traumatic brain injury (TBI) are not well understood despite the ... more Neural substrates of fatigue in traumatic brain injury (TBI) are not well understood despite the considerable burden of fatigue on return to productivity. Fatigue is associated with diminishing performance under conditions of high cognitive demand, sense of effort, or need for motivation, all of which are associated with cognitive control brain network integrity. We hypothesize that the pathophysiology of TBI results in damage to diffuse cognitive control networks, disrupting coordination of moment-to-moment monitoring, prediction, and regulation of behavior. We investigate the cingulo-opercular (CO) and frontoparietal (FP) networks, which are engaged to sustain attention for task and maintain performance. A total of 61 individuals with mild TBI and 42 orthopedic control subjects participated in functional MRI during performance of a constant effort task requiring altering the amount of effort (25, 50, or 75% of maximum effort) utilized to manually squeeze a pneumostatic bulb across...
<b>Purpose:</b> Spoken discourse analysis is commonly employed in the assessment and ... more <b>Purpose:</b> Spoken discourse analysis is commonly employed in the assessment and treatment of people living with aphasia, yet there is no standardization in assessment, analysis, or reporting procedures, thereby precluding comparison/meta-analyses of data and hindering replication of findings. An important first step is to identify current practices in collecting and analyzing spoken discourse in aphasia. Thus, this study surveyed current practices, with the goal of working toward standardizing spoken discourse assessment first in research settings with subsequent implementation into clinical settings.<b>Method:</b> A mixed-methods (quantitative and qualitative) survey was publicized to researchers and clinicians around the globe who have collected and/or analyzed spoken discourse data in aphasia. The survey data were collected between September and November 2019.<b>Results: </b>Of the 201 individuals who consented to participate, 189 completed all mandatory questions in the survey (with fewer completing nonmandatory response questions). The majority of respondents reported barriers to utilizing discourse including transcription, coding, and analysis. The most common barrier was time (e.g., lack of time). Respondents also indicated that there was a lack of, and a need for, psychometric properties and normative data for spoken discourse use in the assessment and treatment of persons with aphasia. Quantitative and qualitative results are described in detail.<b>Conclusions:</b> The current survey study evaluated spoken discourse methods in aphasia across research and clinical settings. Findings from this study will be used to guide development of process standardization in spoken discourse and for the creation of a psychometric and normative property database.<b><br></b><b>Supplemental Material S1. </b>Survey. <br><b>Supplemental Material S2. </b>Response rates for quantitative questions (for all primary questions, e.g., not those that branched off).<br><b>Supplemental Material S3. </b>Response rates for qualita [...]
Supplemental Material for Reduced Salience and Enhanced Central Executive Connectivity Following ... more Supplemental Material for Reduced Salience and Enhanced Central Executive Connectivity Following PTSD Treatment by Chadi G. Abdallah, Christopher L. Averill, Amy E. Ramage, Lynnette A. Averill, Evelyn Alkin, Samaneh Nemati, John H. Krystal, John D. Roache, Patricia A. Resick, Stacey Young-McCaughan, Alan L. Peterson, Peter Fox and the STRONG STAR Consortium in Chronic Stress
BACKGROUND: In soldiers with posttraumatic stress disorder (PTSD), symptom provocation was found ... more BACKGROUND: In soldiers with posttraumatic stress disorder (PTSD), symptom provocation was found to induce increased connectivity within the salience network, as measured by functional magnetic resonance imaging (fMRI) and global brain connectivity with global signal regression (GBCr). However, it is unknown whether these GBCr disturbances would normalize following effective PTSD treatment. METHODS: 69 US Army soldiers with (n = 42) and without PTSD (n = 27) completed fMRI at rest and during symptom provocation using subject-specific script imagery. Then, participants with PTSD received 6 weeks (12 sessions) of group cognitive processing therapy (CPT) or present-centered therapy (PCT). At week 8, all participants repeated the fMRI scans. The primary analysis used a region-of-interest approach to determine the effect of treatment on salience GBCr. A secondary analysis was conducted to explore the pattern of GBCr alterations post-treatment in PTSD participants compared to controls. RE...
Social cognitive and affective neuroscience, Jan 15, 2015
Post-traumatic stress disorder (PTSD) is presumably the result of life threats and conditioned fe... more Post-traumatic stress disorder (PTSD) is presumably the result of life threats and conditioned fear. However, the neurobiology of fear fails to explain the impact of traumas that do not entail threats. Neuronal function, assessed as glucose metabolism with (18)fluoro-deoxyglucose positron emission tomography, was contrasted in active duty, treatment-seeking US Army Soldiers with PTSD endorsing either danger- (n = 19) or non-danger-based (n = 26) traumas, and was compared with soldiers without PTSD (Combat Controls, n = 26) and Civilian Controls (n = 24). Prior meta-analyses of regions associated with fear or trauma script imagery in PTSD were used to compare glucose metabolism across groups. Danger-based traumas were associated with higher metabolism in the right amygdala than the control groups, while non-danger-based traumas associated with heightened precuneus metabolism relative to the danger group. In the danger group, PTSD severity was associated with higher metabolism in prec...
Purpose: This paper describes the development of a working group and its initiatives, which have ... more Purpose: This paper describes the development of a working group and its initiatives, which have been designed to address major gaps in the spoken discourse aphasia literature, including a lack of standardization in methodology, analysis, and reporting, and nominal data regarding the psychometric properties of spoken discourse outcomes. Method: The working group includes task forces and initiatives to: 1) propose recommendations regarding standardization of spoken discourse collection, analysis, and reporting in aphasia, based on the results of an international survey and a systematic literature review; and, 2) create a database of test-retest spoken discourse data from individuals with and without aphasia. The survey of spoken discourse collection, analysis, and interpretation procedures will be distributed to clinicians and researchers involved in aphasia assessment and rehabilitation. A leadership team will discuss the survey results and recommend standards for collecting, analyz...
Organizing and finally assembling the chapters for this book has been one of life's more plea... more Organizing and finally assembling the chapters for this book has been one of life's more pleasurable education experiences for this editor. The impetus for the development of the book resides with the continuing far-sighted thinking of Dr. Sadanand Singh. He has been unflagging in helping the discipline of human communication sciences and disorders advance its knowledge base by publishing cutting-edge texts that help to define just what it is that our discipline can uniquely contribute to humanity—more specifically, just what that knowledge base can provide for our discipline's science and its quest for the alleviation of communication disorders. And that is precisely what this book aims to provide. Our discipline often has appeared to struggle to define a distinctive body of knowledge that constitutes the discipline of human communication disorders It also is rather puzzling, however, that our researchers and clini-cians would doubt that the discipline's search for the ...
OBJECTIVE: Active duty military members who had and had not sustained one or more mild traumatic ... more OBJECTIVE: Active duty military members who had and had not sustained one or more mild traumatic brain injuries (mTBI) were compared on an objective measure of sense of effort during functional MRI. BACKGROUND: Since the year 2000, over 333,000 military members have sustained traumatic brain injuries (TBI) [1]. Of these, 82.4[percnt] were mild. Mild traumatic brain injury (mTBI) refers to any injury to the brain resulting from external force that can cause confusion, loss of consciousness for up to 30 minutes, memory loss of up to 24 hours, and diffuse neuronal injury, which can result in cognitive problems [1]. Specifically, TBI often compromises the normal allocation of resources for attention and determination of effort. As service members who sustained brain injuries return from Iraq and Afghanistan, it is increasingly important to determine the relationship between effort and cognitive complaint in this population. DESIGN/METHODS: Active duty soldiers deployed to OIF/OEF/Endura...
It is well established that voice is disordered in nearly 90% of individuals with Parkinsons dise... more It is well established that voice is disordered in nearly 90% of individuals with Parkinsons disease (PD). Given the role of voice in language expression, we pose that optimizing vocal function may lead to improved language production. Verb production is an area of language deficit in PD, particularly for verbs associated with an individuals location of impairment (upper vs. lower limbs). It is thought that damage to the motor system, given its connection to action verbs, underlies this lexical effect. If this is the case, then treatment improving vocal motor function may also improve access to verbs. Nineteen participants with PD underwent Lee Silverman Voice Treatment (LSVT LOUD), a 4-week intensive voice treatment (TXPD), in an IRB-approved randomized controlled voice treatment trial. Language production was contrasted with 20 untreated PD (UNTXPD) and 20 age-matched neurotypical control participants. Each provided 1-minute picture description narratives at baseline and after 4-w...
Purpose Spoken discourse analysis is commonly employed in the assessment and treatment of people ... more Purpose Spoken discourse analysis is commonly employed in the assessment and treatment of people living with aphasia, yet there is no standardization in assessment, analysis, or reporting procedures, thereby precluding comparison/meta-analyses of data and hindering replication of findings. An important first step is to identify current practices in collecting and analyzing spoken discourse in aphasia. Thus, this study surveyed current practices, with the goal of working toward standardizing spoken discourse assessment first in research settings with subsequent implementation into clinical settings. Method A mixed-methods (quantitative and qualitative) survey was publicized to researchers and clinicians around the globe who have collected and/or analyzed spoken discourse data in aphasia. The survey data were collected between September and November 2019. Results Of the 201 individuals who consented to participate, 189 completed all mandatory questions in the survey (with fewer comple...
Purpose Severe acute respiratory syndrome coronavirus 2 is the virus resulting in COVID-19 infect... more Purpose Severe acute respiratory syndrome coronavirus 2 is the virus resulting in COVID-19 infections in nearly 4.3 million Americans with COVID-19 in the United States as of July 29, 2020, with nearly 150,000 deaths and hundreds of thousands of survivors ( https://www.coronavirus.jhu.edu/map.html ). This tutorial reviews (a) what has been reported about neurological insults in cases of COVID-19 infection, (b) what is known from similar conditions in other disorders, and (c) how that combined information can inform clinical decision making. Method PubMed and the Cochrane Central Register of Controlled Trials were searched for COVID-19 or other coronavirus infections, cognitive impairment observed following critical care, and disorders for which intermittent or chronic hypoxia is characteristic. These were combined with searches relating to cognition, brain, and communication. All searches were conducted between April 8 and May 23, 2020. Meta-analyses and randomized clinical trials a...
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Papers by Amy Ramage