Active Music Therapy Following Acute Stroke: A Single-Arm Repeated Measures Study.

Experiencing a stroke can lead to difficulties with emotion regulation and mood disorders like depression. It is well documented that poststroke depression (PSD) affects a third of all stroke survivors. Higher levels of depression and depressive symptoms are associated with less efficient use of rehabilitation services, poor functional outcomes, negative impacts on social participation, and increased mortality. Mood in the acute phases of stroke recovery may be a key factor influencing the depression trajectory with early depression predicting poor longitudinal outcomes. The purpose of the study was to examine the effect of one active music therapy (AMT) treatment on mood following a first-time ischemic stroke during acute hospitalization. Forty-four adults received AMT defined as music-making interventions that elicit and encourage active participation. The Faces Scale was used to assess mood immediately prior to and following the treatment. A significant change in mood was found following one treatment. Comment analysis indicated that participants viewed music therapy as a positive experience. Findings here support the use of brief AMT to provide early psychological support to stroke survivors. Continued investigation into the role of music therapy in early stroke recovery is recommended.

Self-determined Occupational Performance Model for Children From Economically Disadvantaged Backgrounds.

Background. Children from low-income backgrounds have a higher incidence of handwriting challenges due to the unique social and environmental stressors associated with poverty. Additionally, children from economically disadvantaged households are at risk for motor, cognitive, and social deficits, which further impact their handwriting performance. Purpose. The purpose of this paper is to propose a theoretical model that provides a holistic perspective for addressing the handwriting needs of children from low-socioeconomic backgrounds. Key Issues. The presented conceptual model is derived from the person-environment-occupation model for occupational performance and self-determination theory. These theories reciprocally complement and enhance each other, providing a foundation from which clinicians can guide evaluation and intervention. Implications. Through the use of the proposed model, evaluation and intervention focus on intrinsic motivation while considering the physical, social, and cultural impacts on a child's occupational performance. The provider connects with the child's basic psychological needs, thus improving handwriting outcomes and facilitating improved academic performance.

Physical Therapists' Assessment of Patient Self-Efficacy for Home Exercise Programs.

BACKGROUND: Patient adherence to home exercise programs (HEPs) is low, and poor patient self-efficacy is a barrier clinicians can influence. However, little evidence suggests that clinicians assess level of patient self-efficacy before prescribing HEPs. PURPOSE: To determine the importance of patient self-efficacy to physical therapists (PTs) when addressing patient barriers, determine how PTs assess and use patient self-efficacy for HEPs, and describe the barriers facing PTs when assessing patient self-efficacy for HEPs. STUDY DESIGN: Survey. METHODS: Practicing PTs were recruited from the American Physical Therapy Association's Orthopedic Section and emailed the electronic survey. RESULTS: Email invitations were sent to 17730 potential participants, and 462 PTs completed the survey over one month. PTs rated self-efficacy as "very" to "extremely" important for patient adherence (58%, 265/454). Most (71%, 328/462) reported assessing self-efficacy before prescribing HEPs and did so through verbal discussion and observation of the patient (50% and 38% respectively). Half of respondents individualized HEPs through self-efficacy related themes. PTs not assessing self-efficacy reported not knowing how (51%, 68/134), being unsure what to do with the information (24%, 32/134), or reporting other barriers (21%, 28/134). CONCLUSIONS: Most PTs indicated that self-efficacy was important for patient adherence, but assessment strategies reported, such as verbal discussion and observation, may not be the most accurate. PTs who did not assess self-efficacy reported not knowing how or what to do with the information once collected. These findings suggest that there is a gap in knowledge related to how to evaluate self-efficacy for HEPs. Better assessment of self-efficacy may lead to more appropriate and effective implementation strategies. LEVEL OF EVIDENCE: Level II.

Comparison of Upper Extremity Function in Women With and Women Without a History of Breast Cancer.

BACKGROUND: Breast cancer treatments often result in upper extremity functional limitations in both the short and long term. Current evidence makes comparisons against a baseline or contralateral limb, but does not consider changes in function associated with aging. OBJECTIVE: The objective of this study was to compare upper extremity function between women treated for breast cancer more than 12 months in the past and women without cancer. DESIGN: This was an observational cross-sectional study. METHODS: Women who were diagnosed with breast cancer and had a mean post-surgical treatment time of 51 months (range = 12-336 months) were compared with women who did not have breast cancer (CTRL group). Self-reported upper extremity function using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and shoulder range of motion, strength, and muscular endurance were measured. Participants were divided into 3 groups: breast cancer involving the nondominant limb (BC-ND), breast cancer involving the dominant limb (BC-DOM), and CTRL. RESULTS: A total of 59 women in the CTRL group, 23 women in the BC-ND group, and 28 women in the BC-DOM group completed measures. Mean DASH scores in women with breast cancer were higher than those of women in the CTRL group, regardless of the limb on which cancer occurred (Cohen d = 1.13; 95% CI = 2.20 to 16.21) Range of motion for the BC-ND group was significantly less for flexion (Cohen d = 1.19, 95% CI = -13.08 to -0.11) and external rotation (Cohen d = 1.11, 95% CI = -18.62 to -1.98) compared with the CTRL group. Strength in the BC-ND group was 23% to 25% lower in the CTRL group for external (Cohen's d = 0.89, 95% CI = 0.09 to 0.12) and internal rotation (Cohen d = 0.92, 95% CI = 0.10 to 0.13). Endurance was not significantly different in the 3 groups. LIMITATIONS: Some participants had rehabilitation, which may have skewed results. The range of post-surgical treatment times was broad, making it difficult to determine when function returned. Muscular endurance measures demonstrated a ceiling effect and large variance, limiting the ability to distinguish differences among participants. These results may not be generalizable to the subset of women who were treated with lumpectomy, sentinel node biopsy, or chest wall radiation alone or who underwent a contralateral prophylactic mastectomy. CONCLUSION: In the long term, women with breast cancer have lower self-reported shoulder function than women without breast cancer. Motion and strength are lower among women who have experienced cancer on the nondominant limb.

Abnormal Nutritive Sucking as an Indicator of Neonatal Brain Injury.

A term neonate is born with the ability to suck; this neuronal network is already formed and functional by 28 weeks gestational age and continues to evolve into adulthood. Because of the necessity of acquiring nutrition, the complexity of the neuronal network needed to suck, and neuroplasticity in infancy, the skill of sucking has the unique ability to give insight into areas of the brain that may be damaged either during or before birth. Interpretation of the behaviors during sucking shows promise in guiding therapies and how to potentially repair the damage early in life, when neuroplasticity is high. Sucking requires coordinated suck-swallow-breathe actions and is classified into two basic types, nutritive and non-nutritive. Each type of suck has particular characteristics that can be measured and used to learn about the infant's neuronal circuitry. Basic sucking and swallowing are present in embryos and further develop to incorporate breathing ex utero. Due to the rhythmic nature of the suck-swallow-breathe process, these motor functions are controlled by central pattern generators. The coordination of swallowing, breathing, and sucking is an enormously complex sensorimotor process. Because of this complexity, brain injury before birth can have an effect on these sucking patterns. Clinical assessments allow evaluators to score the oral-motor pattern, however, they remain ultimately subjective. Thus, clinicians are in need of objective measures to identify the specific area of deficit in the sucking pattern of each infant to tailor therapies to their specific needs. Therapeutic approaches involve pacifiers, cheek/chin support, tactile, oral kinesthetic, auditory, vestibular, and/or visual sensorimotor inputs. These therapies are performed to train the infant to suck appropriately using these subjective assessments along with the experience of the therapist (usually a speech therapist), but newer, more objective measures are coming along. Recent studies have correlated pathological sucking patterns with neuroimaging data to get a map of the affected brain regions to better inform therapies. The purpose of this review is to provide a broad scope synopsis of the research field of infant nutritive and non-nutritive feeding, their underlying neurophysiology, and relationship of abnormal activity with brain injury in preterm and term infants.

Quantifying the Impact of Common Feeding Interventions on Nutritive Sucking Performance Using a Commercially Available Smart Bottle.

An estimated 25% to 40% of infants experience difficulties with learning to breast- or bottle-feed. Yet, guidelines and evidence-based support for common feeding practices are limited. The objective of this case report was to quantify the impact of feeding interventions on nutritive sucking performance after discharge in an outpatient setting. This observational case series involved 2 infants. To determine the impact of cumulative interventions, pre- and postintervention effect sizes were calculated. Sucking performance metrics of interest included nipple movement peak sucking amplitude, duration, frequency, and smoothness. Interventions included positional changes and changes in nipple flow rate, among others. For both infants, cumulative interventions had the greatest impact on suck frequency; postintervention, infants were able to increase their rate of nutritive sucking per burst. Other aspects of sucking performance were differentially impacted for each baby. Researchers agree that neonatal and infant feeding has been understudied and that the evidence for common interventions needs to be strengthened. We have demonstrated the implementation of readily available technology that can be used to quantify the direct impact of any intervention on actual sucking performance. In doing so, we can individualize care to support skill development and improve outcomes for infants at risk for ongoing feeding challenges.

The Self-Efficacy for Home Exercise Programs Scale: Development and Psychometric Properties.

BACKGROUND: The Self-Efficacy for Home Exercise Programs Scale (SEHEPS) was developed to help clinicians evaluate patients' self-efficacy for performing prescribed home exercise programs. Prior to clinical adoption, the scale's psychometric properties need to be examined. OBJECTIVE: To determine the psychometric properties of the SEHEPS. METHODS: Eighty-one patients (32 men, 49 women; mean ± SD age, 42 ± 17 years) with varying musculoskeletal conditions participated in this cohort study. Patients were given a home exercise program at the initial physical therapy visit and completed the SEHEPS and a modified Self-Efficacy for Exercise (SEE) scale. The SEHEPS is a 12-item patient-reported questionnaire designed to assess self-efficacy for prescribed home exercise. Patients rated their confidence on a 7-point scale that ranged from 0 (not confident) to 6 (very confident). Total scores ranged from 0 (low self-efficacy) to 72 (high self-efficacy). We assessed the internal consistency of the SEHEPS using Cronbach's alpha and its test-retest reliability using an intraclass correlation coefficient. Convergent validity between the SEHEPS and SEE scale was evaluated with a Spearman correlation. RESULTS: High internal consistency (α = .96) and good test-retest reliability (intraclass correlation coefficient = 0.88; SEM, 4; minimal detectable change at the 95% confidence level, 12) were demonstrated. The SEHEPS was strongly correlated with the SEE scale (ρ = 0.83, P<.01), indicating strong convergent validity. CONCLUSION: The SEHEPS demonstrates excellent internal consistency and convergent validity with the SEE scale. Overall, the SEHEPS is a clinically useful tool to evaluate a patient's self-efficacy in home-based musculoskeletal exercise programs. This scale can be used prior to prescribing a home exercise program for patients with musculoskeletal conditions. LEVEL OF EVIDENCE: Therapy, level 4. J Orthop Sports Phys Ther 2019;49(9):647-655. Epub 10 Jul 2019. doi:10.2519/jospt.2019.8779.

A comparison of the nutritive sucking performance of full term and preterm neonates at hospital discharge: A prospective study.

BACKGROUND: Studies show that 40% to 70% of premature infants exhibit both immature and atypical feeding ability. To establish thresholds of performance and develop efficacious treatments for initiating and advancing oral feedings, we must first identify the nutritive sucking performance measures impacted by preterm birth. AIMS: To compare objective measures of neonatal nutritive sucking between full term and preterm infants at hospital discharge. STUDY DESIGN AND METHODS: This was a prospective observational study including full term (FT; N = 32) and preterm (PT; N = 44) infants. Nutritive sucking performance at discharge was assessed. The outcome measures of interest were means and coefficients of variability of nutritive sucking peak amplitude, frequency, duration, and smoothness, and feeding-related length of stay. RESULTS: There was a significant difference in sucking performance between groups; FT infants demonstrated significantly lower mean suck frequency, with longer suck duration and greater suck smoothness as compared to PT. PT infants had significantly less variability in suck amplitude and frequency as compared to FT, while FT infants had significantly less variability in suck smoothness as compared to PT. Post hoc regression analyses found suck frequency alone accounted for 28% of the variance in feeding length of stay for PT; suck smoothness alone accounted for 34% of the variance in feeding length of stay for FT. CONCLUSIONS: Suck frequency may be an important intervention target for PT infants having difficulty transitioning to oral feeding. Suck smoothness may be a sensitive marker for identifying infants at high risk for feeding challenges.

Effects of Bronchopulmonary Dysplasia on Swallow:Breath Interaction and Phase of Respiration with Swallow During Non-nutritive Suck.

OBJECTIVES: The objective of this study is to describe swallow:breath interaction (SwBr) and phase of respiration incident to swallow (POR) during non-nutritive suck in infants with bronchopulmonary dysplasia and determine if speech-language intervention can modify the characteristics of non-nutritive suck in these infants. METHODS: Logistic regression models were used to describe SwBr and POR in 16 low-risk preterm (LRP) infants and 43 infants with bronchopulmonary dysplasia. Infants with bronchopulmonary dysplasia were randomized to receive individualized intervention from a speech-language pathologist (BPDwithTX) or standard care (BPDnoTX). RESULTS: No significant differences were noted between low-risk infants and either group of BPD infants for the distribution of SwBr types. Infants with bronchopulmonary dysplasia showed minor differences in the progression of POR. Speech-Language intervention did not change the progression of SwBr or POR in infants with bronchopulmonary dysplasia. CONCLUSION: Infants with bronchopulmonary dysplasia can improve the progression of SwBr through practice as effectively as low-risk preterm infants can. The minor differences in POR in infants with bronchopulmonary dysplasia are consistent with dysmature development as seen with other feeding studies of infants with this disease. Speech-Language intervention did not modify the developmental progression of swallow:breath interaction or phase of respiration incident to swallow.

Measurements of self-efficacy in musculoskeletal rehabilitation: A systematic review.

OBJECTIVES: Low self-efficacy is a barrier to rehabilitation adherence. Before an intervention can be implemented to improve self-efficacy, assessment is required. It is currently unknown if a standard measure of self-efficacy has been used to assess this in patients with musculoskeletal conditions, specifically for home exercise programmes (HEPs). The aim of the present study was to determine which self-efficacy scales are being used in conjunction with exercise adherence, identify if any scale has been developed to evaluate self-efficacy for HEPs and evaluate their psychometric properties. METHODS: Data sources included CINAHL, MEDLINE, Pubmed, PsycInfo, and Sport Discus. Studies had to include patients suffering from a musculoskeletal injury, pain or disorder; a measure of rehabilitation adherence; and patient's self-efficacy. The study population, self-efficacy measurement used, study quality as identified with the Modified Downs and Black checklist, results pertaining to self-efficacy, and level of evidence were extracted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and 29 articles were included. RESULTS: A total of 14 scales assessing self-efficacy were identified but no scale to assess self-efficacy for HEPs was found. Many scales report internal consistency but lack test-retest reliability and validity. CONCLUSIONS: The scales identified were specific to condition or tasks, and not applicable for all musculoskeletal patient populations. It is important, both for use in the clinic and for research, that outcome measures used are reliable and valid. Unfortunately, no scale was found to assess self-efficacy for HEPs, which is problematic as self-efficacy is task specific. As HEPs are essential to rehabilitation, there should be a scale designed specifically to assess self-efficacy for this task.

Quantifying Neonatal Sucking Performance: Promise of New Methods.

Neonatal feeding has been traditionally understudied so guidelines and evidence-based support for common feeding practices are limited. A major contributing factor to the paucity of evidence-based practice in this area has been the lack of simple-to-use, low-cost tools for monitoring sucking performance. We describe new methods for quantifying neonatal sucking performance that hold significant clinical and research promise. We present early results from an ongoing study investigating neonatal sucking as a marker of risk for adverse neurodevelopmental outcomes. We include quantitative measures of sucking performance to better understand how movement variability evolves during skill acquisition. Results showed the coefficient of variation of suck duration was significantly different between preterm neonates at high risk for developmental concerns (HRPT) and preterm neonates at low risk for developmental concerns (LRPT). For HRPT, results indicated the coefficient of variation of suck smoothness increased from initial feeding to discharge and remained significantly greater than healthy full-term newborns (FT) at discharge. There was no significant difference in our measures between FT and LRPT at discharge. Our findings highlight the need to include neonatal sucking assessment as part of routine clinical care in order to capture the relative risk of adverse neurodevelopmental outcomes at discharge.

Objective assessment of a preterm infant's nutritive sucking from initiation of feeding through hospitalization and discharge.

INTRODUCTION: In 2008, the American Academy of Pediatrics recommended that an infant's ability to feed independently be considered a primary consideration for discharge home. To date, NICU healthcare teams have relied on clinical experience as well as descriptive scales to determine a high risk infant's ability to transition safely from tube feeding to oral feeding. The aim of the current case study was to illustrate the clinical utility of nfant® Feeding Solution as a noninvasive and objective instrument for determining a neonate's readiness to begin and advance oral feeding. MATERIALS AND METHODS: We present the case of AC, a female infant born at 28.6 weeks, with an admitting diagnosis of respiratory distress syndrome. Data collection began when AC was declared medical stable by her attending physician and ready to begin oral feedings. Data was captured during hospitalization and at discharge as well as post discharge for a total of eleven (11) data collections. RESULTS: Results suggested that the subject progressed in all sucking metrics over time. Data analyses revealed three general amplitude and temporal patterns against the nipple: disorganized, hypervigilant, and then organized. Real time data was used to gain immediate feedback on the impact of interventions on sucking performance. CONCLUSIONS: Successful infant feeding is a complex process that requires integration of physiologic function and neurobehavioral ability. To model AC's feeding performance over time, we used nfant Feeding Solution which measures tongue movement against the nipple and streams the data to a mobile tablet so it is displayed in real time. Access to real-time data provides caregivers with objective information that can be used to guide bedside care, help clinicians avoid complications and navigate infants to faster oral feeds and subsequently earlier and safer hospital discharge with lowered expense.

Microlinguistic processes that contribute to the ability to relay main events: influence of age.

The purpose of the current study was to determine the microlinguistic processes that contribute to picture description in healthy adults across the life span. Two-hundred forty healthy adults were separated into three groups, young (n = 80; 20-39), middle (n = 80; 40-69), and older (n = 80; 70-89). Participants provided language samples in response to two single and two sequential pictures analyzed for total number of words, informativeness, lexical diversity, syntactic complexity, and main events. The older group produced a significantly lower proportion of main events for the single and sequential pictures compared to the other groups. Group differences on the microlinguistic measures varied depending on the measure and the stimulus type. Further, regardless of task, total number of words significantly related to main event production for the young and middle aged groups, but not the older group. Results of the current study extend previous findings by researchers who have investigated discourse production in cognitively healthy, older adults. Using a multi-level approach, we found that linguistic processes across different levels interact; however, the relationship is age-dependent. By including a middle-aged group we identify the potential course of documented change and our results indicate that the changes in language processes with age may not be linear.

Morphine versus clonidine for neonatal abstinence syndrome.

OBJECTIVE: The study goal was to determine whether clonidine treatment of neonatal abstinence syndrome (NAS) would result in a better neurobehavioral performance compared with morphine. METHODS: This pilot study prospectively enrolled infants ≥ 35 weeks' gestational age admitted for treatment of NAS. After informed consent was obtained, infants were randomized to receive morphine (0.4 mg/kg per day) or clonidine (5 µg/kg per day) divided into 8 doses. A 25% dose escalation every 24 hours was possible per protocol (maximum of 1 mg/kg per day for morphine and 12 µg/kg per day for clonidine). After control of symptoms, the dose was tapered by 10% every other day. Clinical staff monitored infants by using Finnegan scoring. Masked research staff administered the NICU Network Neurobehavioral Scale (NNNS) at 1 week and at 2 to 4 weeks after initiation of treatment and the Bayley Scales III, and Preschool Language Scale IV, at 1-year adjusted age. Analyses included descriptive statistics, repeated measures analysis of variance, and Wilcoxon tests. RESULTS: Infants treated with morphine (n = 15) versus clonidine (n = 16) did not differ in birth weight or age at treatment. Treatment duration was significantly longer for morphine (median 39 days) than for clonidine (median 28 days; P = .02). NNNS summary scores improved significantly with clonidine but not with morphine. On subsequent assessment, those receiving clonidine had lower height of arousal and excitability (P < .05). One-year motor, cognitive, and language scores did not differ between groups. CONCLUSIONS: Clonidine may be a favorable alternative to morphine as a single-drug therapy for NAS. A multicenter randomized trial is warranted.

Global coherence in younger and older adults: Influence of cognitive processes and discourse type.

The purpose of the present research was to examine the influence of cognitive processes on discourse global coherence ability measured across different discourse tasks and collected from younger (n = 40; 20-39 years) and older (n = 40; 70-87 years) cognitively healthy adults. Study participants produced oral language samples in response to five commonly used discourse elicitation tasks and they were analyzed for maintenance of global coherence. Participants also completed memory and attention measures. Group differences on the global coherence scale were found for only one type of discourse-recounts. Across discourse elicitation tasks the lowest global coherence scores were found for recounts compared to the other discourse elicitation tasks. The influence of cognitive processes on maintenance of global coherence differed for the two age groups. For the younger group, there were no observed significant relationships. For the older group, cognitive measures were related to global coherence of stories and procedures.

Evaluating measures of global coherence ability in stories in adults.

BACKGROUND: Discourse coherence is a reflection of the listener's ability to interpret the overall meaning conveyed by the speaker. Measuring global coherence (maintenance of thematic unity of the discourse) is useful for quantifying communication impairments at the discourse level in clinical populations and for measuring response to discourse-level treatments. AIMS: The aim was to determine feasibility of a four-point global coherence scale developed by the authors. Specifically, they were (1) to estimate measurement reliability of the four-point global coherence scale; and (2) to estimate construct validity for the four-point global coherence scale. METHOD & PROCEDURES: Fifty cognitively healthy adults aged between 28 and 58 years participated in the study. Participants viewed and then told the stories depicted in two wordless picture books. Participants' stories were orthographically transcribed and segmented into communication units (C-unit). Raters scored each participant's story for global coherence using two global coherence scales (four- and five-point scales). Each C-unit received an individual score, then the mean global coherence score was computed, resulting in two mean global coherence scores for each coherence scale, one for each story, for all participants. OUTCOMES & RESULTS: Results indicated high reliability estimates for the scale. In addition, construct validity, specifically face validity and convergent validity, was effectively estimated for using the four-point scale as a measure of maintenance of global coherence in stories told by cognitively healthy adults. Lastly, it was found that the wordless picture books elicited stories that are comparable and can be reliably interchanged as different forms to evaluate maintenance of global coherence. CONCLUSIONS & IMPLICATIONS: The assumptions that the measure is feasible were achieved and face and convergent validity were adequately estimated. Future investigations should consider estimating predictive validity, concurrent validity and discriminant validity of the measure.

Considering a multi-level approach to understanding maintenance of global coherence in adults with aphasia.

BACKGROUND: Discourse is a naturally occurring, dynamic form of communication. Coherence is one aspect of discourse and is a reflection of the listener's ability to interpret the overall meaning conveyed by the speaker. Adults with aphasia may present with impaired maintenance of global coherence, which, in turn, may contribute to their difficulties in overall communicative competence. AIMS: The aim of the study was to determine if microlinguistic processes contribute to maintenance of global coherence in adults with and without aphasia. METHOD AND PROCEDURES: Participants included 15 adults with aphasia (PWA) and 15 healthy controls (HC). Study participants told stories conveyed in wordless picture books. The discourse samples were transcribed and then analyzed for percent of information units produced, lexical diversity, syntactic complexity, and maintenance of global coherence. OUTCOMES AND RESULTS: Several linear regression models were carried out to investigate the relationship among the microlinguistic and macrolinguistic measures. For the control group, percent of information units conveyed was a significant predictor of maintenance of global coherence for stories told. For the aphasia group, percent of information units conveyed and lexical diversity were significant predictors of maintenance of global coherence for stories told. CONCLUSIONS: Results indicated that microlinguistic processes contribute to the maintenance of global coherence in stories told by adults with aphasia. These findings have important clinical implications for using a multi-level discourse model for analyzing discourse ability in adults with aphasia and measuring individual response to treatment.

Measurement of infant tongue thickness using ultrasound: a technical note.

Novel uses of ultrasound include obtaining images of intra-oral structures to further research in speech production and feeding. In this technical note we describe a noninvasive, cost-effective, and reliable method for measuring infant tongue muscle thickness. The current pilot study demonstrates high reliability of a trained ultrasonographer to obtain adequate images of the infant tongue and the ability to measure reliably between two anatomic landmarks to determine tongue thickness and investigate a potential relationship between tongue size and tongue force.

Attention and Off-Topic Speech in the Recounts of Middle-Age and Elderly Adults: A Pilot Investigation.

PURPOSE: The discourse of healthy older adults is commonly described as being lengthy and off-topic and is thought to be associated with a general cognitive decline that accompanies healthy aging. The purpose of this preliminary study was to investigate the overall decline in attention associated with healthy aging and its relationship to instances of off-topic speech (OTS). METHOD: Thirty cognitively healthy adults divided into 5 age cohorts (40-80) completed cognitive measures of attention and several discourse tasks that included recounting personal events. RESULTS: Cohorts differed significantly with respect to the measures of attention. However, no significant differences in the incidence of OTS were detected between the cohorts. Attention and the incidence of OTS were not significantly correlated within any of the cohorts. CONCLUSION: No significant differences in the incidence of OTS and its relation to attention measures were found. However, the relationship between age-related declines in attention and increased OTS approached significance, suggesting the need for further study.