Treatment of aphasia through family member training

Background: Studies describing communication between people with aphasia and family members have suggested that family members are not always skilled communication partners. For example, spouses or significant others sometimes adopt conversational strategies that do not facilitate communication with their aphasic loved one. Therefore, management of aphasia should address the communication skills of regular communication partners in order to maximize communication with individuals with aphasia.Aims: This study was designed to provide communication training to the wife of a man with aphasia in order to reduce the occurrence of her behaviors identified as “nonfacililative.” Nonfacilitative behaviors of the wife included spouse interruptions, convergent questions and negative teaching.Methods & Procedures: A single subject multiple baseline design examined the effects of training on the occurrence of three nonfacilitative behaviors across several conditions (spontaneous conversation in the clinic, discussion of television programs in the clinic and conversation at home).Outcomes & Results: Training the spouse resulted in reduced occurrence of the target behaviors (spouse interruptions, convergent questions) in probes of the training condition (news discussions). These improvements consistently generalized from the treatment situation to untrained conditions such as spontaneous conversations with her husband. In addition, this improvement was observed in an untrained behavior (negative teaching). Improvements in both trained and untrained behaviors were maintained on follow-up probes. Furthermore, this training resulted in improvements not only in the spouse's conversational interaction, but also in her aphasic husband's expressive communication during their conversations even though he was not included in the training.Conclusions: Direct training of interactive behaviors of a speaking partner might be an effective and efficient means of enhancing communication between family members and people with aphasia.     

An experimental analysis of acquisition,generalisation, and maintenance of naming behaviour in a patient with anomia

This paper examines the effects of a cueing hierarchy on naming in a patient with anomic aphasia. Using a single‐subject multiple baseline design across behaviors, the patient was trained to produce single inanimate nouns while generalization was tested to semantically related nouns matched for frequency of occurrence. Results showed successful acquisition and maintenance of trained words, but no generalization to untrained words. These data indicate that generalization does not occur as a natural by‐product of successful treatment and suggest, as pointed out by Baer, Wolf, and Risley (1968 Baer, D. M., Wolf, N. M. and Risley, T. R. 1968. Some current dimensions of applied behavior analysis.. Journal of Applied Behavior Analysis, 1: 91[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]), that “generalization should be programmed rather than expected or lamented”.     

Motor and cognitive assessment of infants and young boys with Duchenne Muscular Dystrophy: results from the Muscular Dystrophy Association DMD Clinical Research Network

Therapeutic trials in Duchenne Muscular Dystrophy (DMD) exclude young boys because traditional outcome measures rely on cooperation. The Bayley III Scales of Infant and Toddler Development (Bayley III) have been validated in developing children and those with developmental disorders but have not been studied in DMD. Expanded Hammersmith Functional Motor Scale (HFMSE) and North Star Ambulatory Assessment (NSAA) may also be useful in this young DMD population. Clinical evaluators from the MDA-DMD Clinical Research Network were trained in these assessment tools. Infants and boys with DMD (n = 24; 1.9 ± 0.7 years) were assessed. The mean Bayley III motor composite score was low (82.8 ± 8; p ? .0001) (normal = 100 ± 15). Mean gross motor and fine motor function scaled scores were low (both p ? .0001). The mean cognitive comprehensive (p = .0002), receptive language (p ? .0001), and expressive language (p = .0001) were also low compared to normal children. Age was negatively associated with Bayley III gross motor (r = ?0.44; p = .02) but not with fine motor, cognitive, or language scores. HFMSE (n = 23) showed a mean score of 31 ± 13. NSAA (n = 18 boys; 2.2 ± 0.4 years) showed a mean score of 12 ± 5. Outcome assessments of young boys with DMD are feasible and in this multicenter study were best demonstrated using the Bayley III.     

Spatial scale and place field stability in a grid‐to‐place cell model of the dorsoventral axis of the hippocampus

The rodent hippocampus and entorhinal cortex contain spatially modulated cells that serve as the basis for spatial coding. Both medial entorhinal grid cells and hippocampal place cells have been shown to encode spatial information across multiple spatial scales that increase along the dorsoventral axis of these structures. Place cells near the dorsal pole possess small, stable, and spatially selective firing fields, while ventral cells have larger, less stable, and less spatially selective firing fields. One possible explanation for these dorsoventral changes in place field properties is that they arise as a result of similar dorsoventral differences in the properties of the grid cell inputs to place cells. Here, we test the alternative hypothesis that dorsoventral place field differences are due to higher amounts of nonspatial inputs to ventral hippocampal cells. We use a computational model of the entorhinal‐hippocampal network to assess the relative contributions of grid scale and nonspatial inputs in determining place field size and stability. In addition, we assess the consequences of grid node firing rate heterogeneity on place field stability. Our results suggest that dorsoventral differences in place cell properties can be better explained by changes in the amount of nonspatial inputs, rather than by changes in the scale of grid cell inputs, and that grid node heterogeneity may have important functional consequences. The observed gradient in field size may reflect a shift from processing primarily spatial information in the dorsal hippocampus to processing more nonspatial, contextual, and emotional information near the ventral hippocampus. © 2013 Wiley Periodicals, Inc.     

Rater Characteristics Influencing Rating on the Checklist of Psychotherapy Transactions-Revised

Using Kiesler and Goldston's (1988) procedures for rating interpersonal therapy behavior on the Checklist of Psychotherapy Transactions-Revised (CLOPT-R), 25 untrained, clinically inexperienced raters judged therapist and client interpersonal behavior in 127 sessions of brief psychotherapy. Rater bias was examined by relating several individual difference variables (gender, age, grade-point average, perceived attitude similarity between the rater and ratee, scores on the Checklist of Interpersonal Transactions scales of Control and Affiliation, and scores on the California Personality Inventory scales of Dominance and Submission) to ratings of therapists and clients on the CLOPT-R scales of Control and Affiliation. Results indicated that (a) individual difference variables between raters predicted CLOPT-R scores, particularly on the Affiliation axis of the CLOPT-R for both therapist and client ratings; and (b) mean differences existed between the raters on their CLOPT-R ratings, even after adjustment for the individual differences variables. The importance of personality variables as sources of bias, the vulnerability of the Affiliation axis to rater bias, and recommendations for controlling the effects of rater variables are suggested for further study.     

Client resistance predicts outcomes in cognitive–behavioral therapy for panic disorder

Abstract

Objective: Little is known about how therapy processes relate to outcome in cognitive–behavioral therapy (CBT) for panic disorder (PD). This study examined whether client resistance predicts CBT for PD outcomes beyond the effects of established pre-treatment predictors. A secondary aim was to assess the consistency of resistance over treatment. Method: Data were from 71 adults participating in up to 24 biweekly sessions of CBT in a randomized controlled trial. Panic severity was assessed before, during (at Weeks 1, 5, and 9), and at termination of treatment (Week 12) using the Panic Disorder Severity Scale. Trained coders reliably rated resistance in videos of Sessions 2 and 10 using the Client Resistance Code. Results: Resistance was found to be moderately consistent (r?=?.64). Although overall resistance was unrelated to outcomes, hierarchical linear modeling revealed that openly hostile resistance at Session 10 predicted significantly diminished symptom change (r?=?.28, CI_95%?=?[.01, .51]), beyond the effects of pretreatment predictors. Hostile resistance at Session 2 predicted attrition (r_rb?=??.30, p?=?.001), even after established predictors were controlled. Conclusions: Although some forms of resistance may be benign, openly hostile resistance is an important therapy marker that warrants increased clinical and research attention.     

Meta‐Analysis of Therapist Effects in Psychotherapy Outcome Studies

In a meta-analysis, we examined factors that could account for the differences in therapist efficacy evidenced in psychotherapy outcome studies. The factors investigated were: (1) the use of a treatment manual, (2) the average level of therapist experience, (3) the length of treatment, and (4) the type of treatment (cognitive/behavioral versus psychodynamic). Data were obtained from fifteen psychotherapy outcome studies that produced 27 separate treatment groups. For each treatment group, the amount of outcome variance due to differences between therapists was calculated and served as the dependent variable for the meta-analysis. Each separate treatment group was coded on the above four variables, and multiple regression analyses related the independent variables to the size of therapist effects. Results indicated that the use of a treatment manual and more experienced therapists were associated with small differences between therapists, whereas more inexperienced therapists and no treatment manual were associated with larger therapist effects. The findings are discussed in terms of the design and the analysis of psychotherapy outcome research.