Severe Communication Deficits Research Articles

The Effect of Combined Intervention on Improvement of Early Lexical Development in Minimally Verbal Children with Autism Spectrum Disorder.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder defined by severe communication deficits and limited and repetitive behavioral tendencies. There are several treatment approaches and methods for minimally verbal children with ASD; nonetheless, there is inconclusive evidence about how early lexical development could be improved. The present study aimed to investigate the effect of combined intervention derived from the principles of different theories-including contemporary behaviorism, schemas, sociocultural, and event representation theories-to improve early lexical development in minimally verbal children with ASD. In this single-group pretest-posttest study, 10 children with ASD (mean age, 47.9 ± 8.3 months), including 7 boys and 3 girls, participated. Participants received 16 intervention sessions in 8 weeks. The combined intervention consisted of various methods derived from contemporary behaviorism, schemas, sociocultural, and event representation approaches. The MacArthur-Bates Communicative Development Inventory 1 (Infant form) assessed early lexical development before and after intervention and after a 2-month follow-up. The Friedman test was used to analyze the data, and pairwise comparisons were performed with the Will-Coxon test. Cohen's d was used to investigate the effect sizes. Significant increases in expressive vocabulary (P < 0.001) and receptive language (P < 0.001) were seen after the end of the intervention and at the follow-up (P = 0.005). Large effect sizes were found for expressive vocabulary (d = 3.7) and receptive vocabulary (d = 2.17). This study suggests that the combination of intervention based contemporary behaviorism, schemas, sociocultural, and event representation approaches improved receptive and expressive vocabulary in minimally verbal children with ASD.

Intestinal permeability correlates with behavioural severity in very young children with ASD: A preliminary study

Systemic inflammation is known to alter behaviour, and since it has been reported that individuals with autism spectrum disorder (ASD) have higher levels of circulating cytokines, it has been hypothesized that systemic inflammation may exacerbate behaviours characteristic of ASD. The acute phase proteins α-2-macroglobulin, C-reactive protein, haptoglobin, serum amyloid P, serum amyloid A, ferritin and tissue plasminogen activator, as well as markers of intestinal permeability (intestinal fatty acid binding protein and lipopolysaccharide) were quantitated in the plasma of very young children with ASD. Behaviour severity was measured using the Autism Diagnostic Interview-Revised (ADI-R), the Autism Diagnostic Observation Schedule (ADOS) and the Vineland Adaptive Behaviour Scale (VABS). An increase in circulating I-FABP correlated with more severe deficits in communication, communication + social interaction as well as maladaptive behaviour. The acute phase protein haptoglobin was associated with more severe social interaction and communication + social interaction. In summary, I-FABP, a marker of intestinal epithelial damage, was associated with more severe behavioural phenotypes in very young children with ASD. In addition, the acute phase protein, haptoglobin, was associated with behaviour.

Effects of Chronic Brain Injury on Quality of Life: A Study in Patients With Left- or Right-Sided Lesion

ObjectivesTo test the hypothesis that quality of life (QOL) is made up of different components, and each of these has different anatomic and demographic contributors. DesignQuestionnaire-based study. SettingCenter for Cognitive Neuroscience, University of Pennsylvania. ParticipantsPeople with chronic brain injury (N=52) volunteered for the study. After excluding patients with severe communication deficits, bilateral lesions, and incomplete data, 42 patients with focal lesions were included in the final study: 22 patients with left hemisphere injury (LHI) (9 women and 13 men; mean age ± SD, 60.6±11.2y [range: 36-83]; mean chronicity ± SD, 11.5±4.2y) and 20 patients with right hemisphere injury [RHI] (16 women and 4 men; mean age ± SD [62.7±12.8y] [range: 31-79]; mean chronicity ± SD 10.1±4.3y). InterventionsNot applicable. Main Outcome MeasuresWe administered the RAND36-Item Health Survey (RAND-Version-1.0), Stroke Impact Scale (version 3.0), Positive Affect and Negative Affect Scale, and Distress Thermometer to measure QOL in LHI and RHI patients. Exploratory factor analysis with principal component method reduced these measures to 5 factors, roughly categorized as—(1) physical functioning; (2) general health; (3) emotional health; (4) social functioning; and (5) cognitive functioning. Exploratory analyses attempted to relate these factor scores to demographic variables, neuroanatomical data, and neuropsychological measures. ResultsPhysical functioning was the biggest contributor to reduced QOL, explaining 32.5%, of the variance. Older age, less education, and larger lesion size predicted poorer physical functioning (P<.001). Age also affected emotional health. (P=.019). Younger patients reported poorer emotional health than older patients. LHI patients reported less satisfaction with their cognitive functioning (P=.009) and RHI patients with their physical functioning (P=.06). Exploratory neuroanatomical analyses hinted at brain areas that may be associated with the perception of disability in each QOL component. ConclusionsQOL is composed of 5 components. Clinical and demographic factors appear to differentially affect these aspects of patients’ perceived QOL, providing hypotheses for further testing and suggesting potential relations for therapeutic interventions to consider.

Predicting Speech Intelligibility Based on Spatial Tongue-Jaw Coupling in Persons With Amyotrophic Lateral Sclerosis: The Impact of Tongue Weakness and Jaw Adaptation.

Purpose Motor neuron diseases, such as amyotrophic lateral sclerosis (ALS), have a devastating effect on speech muscle function that often results in severe communication deficits. Over the course of bulbar disease, tongue and jaw movements are modified, but their impact on speech is poorly understood. The aim of this study was to determine the effect of disease-related changes in tongue-jaw movement coupling on speech intelligibility in persons at different stages of bulbar ALS. Method Parallel factor analysis was used to quantify the pattern of spatial coupling between 4 semi-independent regions of the tongue and the jaw in various vowels and consonants in 10 individuals with ALS and 10 healthy individuals, respectively, from the X-Ray Microbeam database (Westbury, 1994). The relation of spatial tongue-jaw coupling to speech intelligibility was examined in individuals at the early and late stages of bulbar ALS and healthy individuals. Results Tongue movement, independent of the jaw, decreased early and progressively, which negatively impacted speech intelligibility. Jaw contribution to tongue movement was increased during the early stages of bulbar ALS compared to that of the healthy subjects, which was followed by a decrease during the late stages of bulbar ALS. The early-stage increase of jaw contribution significantly improved speech intelligibility and is thus most likely to be an adaptive strategy to mitigate the negative impact of tongue movement reductions on speech intelligibility. This adaptive strategy became unavailable during the late stages of bulbar ALS, which might accelerate intelligibility decline. Conclusions The loss of functional tongue-jaw coupling may be the critical physiological factor leading to the eventual loss of functional speech in ALS. Monitoring changes in tongue-jaw coupling may improve the prediction about the timing of speech loss and guide clinical management of dysarthria in ALS.

Autism spectrum disorder in Say-Barber-Biesecker-Young-Simpson syndrome

Say-Barber-Biesecker-Young-Simpson syndrome (SBBYSS), also known as Ohdo syndrome SBBYS type, is a rare genetic disorder characterised by dysmorphic facial features and severe intellectual disability, as well as cardiac, dental and...

Augmentative And Alternative Communication Systems For Post-Stroke Patients With Severe Communication And Motor Impairment

Background and aims: Adults with acquired neurological disorders (stroke, Traumatic Brain Injury ...) develop their verbal communication and literacy capabilities as typical speakers and writers. They use these skills to participate academically, vocationally, recreationally, and socially. Depending upon their neurological condition, they gradually or suddenly lose their speech or language capabilities and are required to rely on Augmentative and Alternative Communication (AAC) systems to meet their communication needs. In addition to the loss of their spoken communication, the impact of their neurological condition on their participation patterns is potentially profound with reduced ability to care for themselves, a reduction or loss of employment, and usually a sudden or gradual restriction of their social networks. AAC is an umbrella term that encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language. During the past five decades, AAC technologies have been developed to compensate for these natural communication losses. Stroke is one of the main causes of disability in the world. About 20% of stroke patients experience aphasia, with 20-30% of these individuals exhibiting severe communication deficits for at least a portion of their recovery period. Augmentative and Alternative Communication (AAC) encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production of spoken or written language. Specifically designed Human Computer Interfaces (HCI), as an assistive technology, provides new channels of communication for patients with aphasia, dysarthria, and dyspraxia, when accompanied by movement impairments. In this workshop after stating a science review of the following types of issues: AAC acceptance (individually, culturally); AAC availability; AAC use patterns; AAC limitations are main issues, an AAC technology for post-stroke patients will be presented which developed by a knowledgebase company in Iran. The system allows patients with communication and motor impairment to state their intentions and feelings by a minimum movement in their body, or just by moving their eyes. Different sensors and switches are available to adopt based on the limited ability of the patients. For detecting eye movements, a novel wearable miniaturized system has been developed that is worn as a headband and detects eye movements based on processing electro-oculogram. A high performance graphical user interface has been developed to type letters and numbers in Persian language. The system also provides words prediction, text to speech conversion with natural voice, and sending/receiving messages in the mobile networks for a convenient communication experience. The developed system has been tested successfully by more than 20 patients with different disabilities, and is now commercially available.The proposed system can also help the severely disabled people with amyotrophic lateral sclerosis, quadriplegia, muscular dystrophy or cerebral palsy to communicate with others and mention their intentions, needs and feelings. This low-cost wearable device assures high level of comfort for the user without fatigue and do not need long time training. The system can also be adapted for the patients who can speak, but could not move their hands, to work with the computer and enjoy using the internet.

Occupational therapy for complex inpatients with stroke: identification of occupational needs in post-acute rehabilitation setting

Purpose: Inpatients admitted to rehabilitation express needs not linked to disease causing hospitalization.This observational cross-sectional study identifies features and occupational needs of complex inpatients during rehabilitation, focusing on function and ability, regardless of diagnosis.Method: This study included sixteen adult inpatients with stroke, deemed complex according to Rehabilitation Complexity Scale-Extended, at admission to Rehabilitation ward (from July 2014 to February 2015). Patients with primary psychiatric disorders, language barriers, cognitive or severe communication deficits were excluded. Upon admission, a multidisciplinary team collected data on general health, independence in daily activities (Modified Barthel Index), fatigue (Fatigue Severity Scale), resistance to sitting and ability to perform instrumental activities (Instrumental Activities of Daily Living). The occupational therapist identified occupational needs according to Canadian Occupational Performance Measure.Results: Inpatients enrolled in this study were dependent in basic ADL, limited in instrumental ADL and easily fatigable. Their occupational needs related to self-care (75%) and, to a lesser extent, productivity (15%) and leisure (10%). According to inpatients, rehabilitation process should firstly address self-care needs, followed by productivity and leisure problems.Conclusions: Despite small sample size, this study described patterns of occupational needs in complex inpatients with stroke. These results will be implemented in client-centered rehabilitation programs to be tested in a phase-two trial. [NCT02173197]Implications for RehabilitationPriority occupational needs of complex inpatients with stroke during rehabilitation are focused on self-care area.Productivity and leisure problems also arise in early post-acute phase.Client-centered rehabilitation programs should firstly address self-care needs and, later on, they should also focus on the recovery of family and social roles.

T7 - . CNS Patterning Gene Variants May Bridge The Gap Between Autistic Symptoms And Brain Cortical Structure

Background Abnormal cortical anatomy has been identified as a significant feature of the neuropathology of autism spectrum disorders (ASD). The CNS patterning gene, the wingless-type MMTV integration site family, member 2 (WNT2), has been shown to be associated with the risk for ASD and is essential for promoting cortical dendrite growth and dendritic spin formation. Whether the WNT2 variants are associated with clinical severity of autistic symptoms and cortical development is not yet studied. This study aims to investigate the genetic association between WNT2 variants and (1) clinical severity of ASD, and (2) the cortical thickness in individuals with ASD and typically-developing controls (TDC). Methods The genetic association study recruited 391 patients (males, 88.3%; mean age ± SD, 9.5 ± 4.4 years) diagnosed with ASD. Six tagging SNPs of WNT2 were genotyped and analyzed by their genetic association with the core symptoms of ASD. The candidate SNPs were selected for each linkage disequilibrium block across 5'-UTR to 3'-UTR. The neuroimage study included 122 patients with ASD (males, 95.8%; mean age 13.1 ± 6.4 years) and 118 TDC (males, 61.5%; man age 21.0 ± 9.7). Cortical thickness on MRI was analyzed by FreeSurfer software with 74 automatic parcellation. The main effect of each SNP and group*SNP interaction were examined for each region. Results In genetic association study, we found that the multi-locus markers of WNT2 were associated with communication problems and restricted/stereotyped behaviors in ASD. Patients who carry a specific haplotype showed more severe symptoms. In neuroimage study, we found that mean cortical thickness as well as nine cortical regions were reduced in ASD compared to TDC in a subsample with compatible sex and age (88 ASD and 51 TDC, mean age 13 years). Meanwhile, the WNT2 variants showed a main effect and an age interaction on the mean cortical thickness of bilateral hemispheres, as well as several brain regions including cingulate cortex and superior temporal cortex. Discussion In conclusion, our findings suggest that the variants of CNS patterning gene WNT2 may play a role in modulate the clinical severity and neuroimage phenotypes of ASD. Patients who carry specific WNT2 variants showed more severe communication deficits and severe stereotyped behaviors. Besides, WNT2 variants might contribute to the reduced cortical thickness found in ASD; subjects who carry specific genotype may experience accelerated cortical thinning during adolescence and early adulthood. These findings may be worth validation and further investigation.

Role of the speech-language pathologist: augmentative and alternative communication for acute care patients with severe communication impairments.

Severe communication deficits occur frequently in acute care. Augmentative and alternative communication (AAC) may improve patient-nurse communication, yet it remains underutilized. The objective of this study was to assess the impact of training student nurses (SNs) in acute and critical care on the use of AAC with regard to confidence levels and likelihood of implementation of AAC by SNs in acute care. Training in AAC techniques was provided to SNs. A pretraining and posttraining assessment was completed along with follow-up surveys conducted after the SNs had an opportunity to use AAC. A 6-fold increase in confidence (P < .01) was reported by the SNs after AAC training, as was an approximately 3-fold increase in likelihood of use (P < .01). The reliable yes/no was the most reported AAC technique (34.7% of the students). Providing SNs with AAC tools accompanied by brief training increases their confidence in the use of AAC and the likelihood that they will use them. Inclusion of AAC education in nursing curricula and nursing orientations could be an important step in risk reduction among patients with severe communication disorders. Further study is needed of the relationship between training student nurses in the use of AAC as a way to change practice and improve communication outcomes.

Motor imagery for severely motor-impaired patients: evidence for brain-computer interfacing as superior control solution.

Brain-Computer Interfaces (BCIs) strive to decode brain signals into control commands for severely handicapped people with no means of muscular control. These potential users of noninvasive BCIs display a large range of physical and mental conditions. Prior studies have shown the general applicability of BCI with patients, with the conflict of either using many training sessions or studying only moderately restricted patients. We present a BCI system designed to establish external control for severely motor-impaired patients within a very short time. Within only six experimental sessions, three out of four patients were able to gain significant control over the BCI, which was based on motor imagery or attempted execution. For the most affected patient, we found evidence that the BCI could outperform the best assistive technology (AT) of the patient in terms of control accuracy, reaction time and information transfer rate. We credit this success to the applied user-centered design approach and to a highly flexible technical setup. State-of-the art machine learning methods allowed the exploitation and combination of multiple relevant features contained in the EEG, which rapidly enabled the patients to gain substantial BCI control. Thus, we could show the feasibility of a flexible and tailorable BCI application in severely disabled users. This can be considered a significant success for two reasons: Firstly, the results were obtained within a short period of time, matching the tight clinical requirements. Secondly, the participating patients showed, compared to most other studies, very severe communication deficits. They were dependent on everyday use of AT and two patients were in a locked-in state. For the most affected patient a reliable communication was rarely possible with existing AT.

Genome‐wide association studies of severe communication processes and affectation of multiple prevalent pediatric communication disorders

Impairments in communication skills are commonly seen in schoolchildren, including in the prevalent disorders dyslexia or RD, language impairment (LI), and autism spectrum disorders (ASD). Children with these disorders are difficult to identify, frequently have academic underachievement, and have limited socioeconomic opportunities. Therefore, we performed a genome wide association study in the Avon Longitudinal Study of Parents and Children using two distinct strategies: (1) examining severe deficits in core communication processes and (2) dissecting the gene risk factors of having multiple impairments. For severe communication deficits, the strongest associations were seen within RD risk locus DYX2, within LI risk locus SLI2, and a novel locus on 4p15.1. We first examined disorders individually and then cases with multiple disorders. The strongest associations with LI were with the genes ZNF385D, IL26, and NDST4. Next, we examined cases with multiple disorders. With cases affected with both ASD and RD, the strongest associations were with HTRA1 and a locus on 1q31.3. For cases with both RD and LI, we saw the strongest associations with ZNF385D and COL4A2. For ASD and LI cases, the strongest associations were with SGMS2, CLDN10, and BTLA. Our results confirm the DYX2 and SLI2 loci in communication disorders and implicate genes previously associated with other neurobehavioral disorders.

The Picture-Exchange Communication System (PECS) increases functional communication of adults with intellectual disabilities

This review provides a summary and appraisal commentary on the treatment review by Conklin, C. G., & Mayer, R. G. (2011). Effects of implementing the Picture Exchange Communication System (PECS) with adults with developmental disabilities and severe communication deficits. Remedial and Special Education, 32, 155–166. Source of funding and disclosure of interest: No source of funding reported, and no conflicts of interest reported by the original authors of this research report.

Dynamic Duo Forges Smooth Relationship

Dynamic Duo Forges Smooth Relationship

Judgment of Intentionality and Moral Evaluation in Individuals with High Functioning Autism

In this study, we investigated the relationships between judgments of intentionality and moral evaluation in individuals with High Functioning Autism (HFA) or Asperger Syndrome (AS). HFA or AS are neurodevelopmental disorders characterised by severe deficits in communication and social functioning. Impairments in Theory of Mind (ToM), i.e., the ability to attribute mental states to oneself and to others, are thought to be the core features of autism. Of all mental states, the concept of ‘intentional action’ is particularly important. People normally distinguish between actions that are performed intentionally and those that are performed unintentionally and this distinction plays a crucial role in social understanding and moral judgment. Recently, Knobe (Analysis 63: 190–193, 2003a), (Philosophical Psychology 16: 309–324, 2003b) showed that people’s moral evaluations might serve as input to the process by which people intuitively arrive at the intentionality judgments. Here, by using two pairs of vignettes, the Knobe’s Harm/Help cases and Murder/Bull’s-eye cases, we showed that, as already observed in typical population, in individuals with HFA/AS judgment of intentional action is informed by the moral appreciation of the action outcome. However, the two groups differed on praise judgments and moral justifications, suggesting that these processes were poorly influenced by the agent’s psychological states. We concluded that, although under certain circumstances, individuals with HFA/AS and people with typical development have similar intuitive judgments of intentionality, over-assignment of praise judgments and the reduced use of folk-psychological concepts in moral judgment likely reflect difficulties using intentionality information for moral reasoning.

Effects of Implementing the Picture Exchange Communication System (PECS) With Adults With Developmental Disabilities and Severe Communication Deficits

The purpose of this study is to evaluate the effects of Picture Exchange Communication System (PECS) training, using a multiple baseline design on the independent initiations of three adults with developmental disabilities and severe communication deficits. All participants increased their independent initiations, although at different levels of quality and quantity throughout PECS training. Results demonstrate a functional relationship between the teaching of PECS and the increase of independent initiations, and these independent initiations continued to improve after initial training. In addition, problem behaviors (off-task and tantrum behaviors) were monitored to assess the collateral effects of PECS training. Results of data collection on untreated problem behaviors showed marked decreases, especially in the last half of PECS training, and remained below baseline levels during follow-up. The results of this study suggest that participants taught via PECS increased their initiation of requests, thereby increasing their independence and choice making, which also appears to have collateral effects on problem behaviors. This study extends the literature on PECS training with adults with developmental disabilities and severe communication deficits by demonstrating that at least one of the participants learned all six phases. This study also demonstrates collateral changes in untreated problem behaviors in this adult population.

Augmentative and Alternative Communication in the Geriatric Population: A Review of Literature

Abstract Speech-language pathologists working in the subacute rehabilitation setting often evaluate and treat patients with complex communication impairments. Many of these patients benefit from the use of Augmentative and Alternative Communication (AAC) to facilitate expression of basic wants and needs. When it comes to implementing an AAC system into a care plan, there are a vast number of options available. A thorough evaluation is crucial when determining the most appropriate AAC system to use. These systems can range from gesturing, to a static overlay board, to a more complex, dynamic high tech device. Implementation of AAC systems has been proven to assist people with severe communication deficits that have been caused by a variety of medical conditions. Numerous studies have documented the efficacy of the use of AAC systems with individuals with traumatic brain injury, Amyotrophic Lateral Sclerosis, and developmental disabilities. However, little has been documented regarding the use of AAC in the dementia, aphasia, and geriatric populations. This article will review the literature regarding the use of AAC with these populations.

Clinical application of speech intelligibility research: The River Street Autism Program at Coltsville.

Introduction Children with autism spectrum disorders (ASD) have severe deficits in communication. Because of this problem, behavioral researchers have sought to develop procedures to improve speech production in children with autism (cf. Koegel & Koegel, 1995; Lovaas, 1977; Lovaas, 2003). These researchers have developed powerful and effective strategies for teaching children to produce initial sounds, words, sentences, and conversational speech. Thus, many children have benefited from these procedures with the development of functional vocal repertoires. While some of these children have adequate intelligibility, there is a portion of this population with compromised intelligibility, due to a limited consonant inventory and less complex syllabic structure (National Research Council, 2001). To address this issue, this article will first review the research in this area and then discuss a model of intervention for children with ASD based on these research findings. Guidelines will be provided on how to: 1) assess intelligibility problems; 2) use the normal developmental model when selecting appropriate targets; 3) sequence treatment objectives; 4) improve intelligibility problems using behavioral interventions; 5) program for generalization; and 6) evaluate program success and troubleshooting. Finally, outcome data for five children on the autism spectrum who have received treatment within the context of this model will be provided. Review of the Research Assessment For children with intelligibility problems, speech language pathologists (SLPs) customarily assess sounds in initial, medial and final positions using picture cues with standardized articulation assessments (Newman & Creaghead, 1989). While this is effective in providing information that will guide treatment for the majority of children with intelligibility issues, these tests pose certain problems for children on the autism spectrum. Specifically, these children do not respond well to traditional assessment tools due to their characteristic language delays, excesses in problem behavior, and depressed motivation. Koegel, Koegel and Smith (1997) reported that modifications to the testing situation to respond to these problems will result in significantly higher test scores. Based on the success of this research, Dyer, Fitzgerald, Harris, and Harris (2005) developed an assessment tool that was designed to respond to these problems by: 1) decreasing demands on expressive language production that are often intrinsic to standardized articulation assessment; 2) providing external motivation with stimulus variation and child preferred items; 3) providing behavioral support through individual behavioral support plans and 4) presenting items in a discrete trial format (cf. Koegel & Schreibman, 1982). In addition, the assessment was delivered by a teacher who had stimulus control in a familiar setting, rather than an SLP who had limited contact with the child. The results of the study showed that this assessment method was more effective in providing information on the child's articulation ability than traditional assessment in the context of reversal designs for four children. This suggests that evaluators take steps to address deficits in motivation and language comprehension in the assessment process in order to gain a more representative sample of children's speech production. Treatment Accumulating studies have documented behavioral intervention techniques in the treatment of articulation for children with autism. Using discrete trial techniques described by Koegel and Schreibman (1982), Dyer, Santarcangelo, and Luce (1987) provided articulation treatment to two adolescents with ASD who had persistent articulation errors. After intervention, the first child met criterion on correct production of three separate sounds in less than 200 trials. The second child met criterion on seven sounds in less than 100 trials. …

Assessment and correlates of self-esteem following stroke using a pictorial measure

Objective: To describe the characteristics of a non-verbal measure of self-esteem in a sample of individuals in the acute phase following stroke. Design: Acute-phase stroke survivors (n=156) were administered measures of self-esteem, depression, anxiety, general emotional distress and cognitive functioning during admission to an inpatient stroke rehabilitation unit. Main measures: Visual Analogue Self-Esteem Scale (VASES), Geriatric Depression Scale, Adult Manifest Anxiety Scale, Visual Analog Mood Scales, measures of neuropsychological functioning. Results: VASES performance was not related to demographic variables, cognitive functioning, visual acuity, prior stroke or severe visuoperceptual impairment/left visual neglect. The VASES was most related to emotional functioning, with lower self-esteem ratings associated with higher levels of depressive symptoms and general emotional distress. Individuals with right hemisphere stroke tended to endorse lower self-esteem ratings, while aphasic individuals may have misunderstood the intent of the task. Conclusions: The non-verbal VASES appears to be minimally impacted by potentially invalidating patient factors (e.g. visual acuity, left visual neglect), although its use with patients with severe communication deficits is cautioned. The VASES may prove useful in identifying acute stroke survivors most at risk for emotional dysfunction, and may be useful as a research tool in this population.

Measurement of functional outcome in preschool children with neurogenic communication disorders.

Intervention programs for preschool children with neurogenic communication disorders are now being evaluated on their ability to achieve functional communication change. Documentation of functional gains in speech and language skills will likely determine who will deliver and receive intervention services in the future. However, few tools are available that measure functional gains in young children with severe communication deficits. This article discusses some of the issues that clinicians must consider when developing and using functional communication measures in a clinical service delivery setting.

A1-Year Longitudinal Study of Severe Traumatic Brain Injury in Australia Using the Sickness Impact Profile

Objective: To document outcome and to investigate patterns of physical and psychosocial recovery in the first year following severe traumatic brain Injury (TDI) In an Australian patient sample. Design: A longitudinal prospective study of a cohort of patients, with data collection at 3, 6,9, and 12 months post injury. Setting: A head injury rehabilitation unit in a large metropolitan public hospital. Patients: A sample of 55 patients selected from 120 consecutive admissions with severe TBI. Patients who were more than 3 months post injury on admission, who remained confused, or who had severe communication deficits or a previous neurologic disorder were excluded. Interventions: All subjects participated in a multidisciplinary inpatient rehabilitation program, followed by varied participation in outpatient rehabilitation and community-based services. Main Outcome Measures: The Sickness Impact Profile (SIP) provided physical, psychosocial, and total dysfunction scores at each follow-up. Outcome at 1 year was measured by the Disability Rating Scale. Results: Multivariate analysis of variance indicated that the linear trend of recovery over time was less for psychosocial dysfunction than for physical dysfunction (F(l, 51)=5.87, P<.02). One year post injury, 22% of subjects had returned to their previous level of employability, and 42% were able to live independently. Conclusions: Recovery from TBI in this Australian sample followed a pattern similar to that observed in other countries, with psychosocial dysfunction being more persistent. Self-report measures such as the SIP in TBI research are limited by problems of diminished self-awareness.