Use and Perceived Effectiveness of Communication Modes Reported by Persons With Primary Progressive Aphasia.

PURPOSE: Primary progressive aphasia (PPA) is a clinical neurodegenerative dementia syndrome characterized by early, selective, and progressive language impairment. PPA onset is gradual, providing time to potentially identify additional or alternative expressive communication modes; however, reports of communication mode use and effectiveness by persons with PPA have not been described. This study characterized the use, frequency, and perceived effectiveness of communication modes reported by individuals with PPA. METHOD: Forty-one participants with mild-to-moderate PPA completed a structured interview detailing the type, frequency, and perceived effectiveness of 12 potential communication modes, categorized by technology required (no-tech, low-tech, and high-tech). The ratio of modes used was compared across technology categories with a repeated-measures generalized linear model assuming a binomial distribution with an overall Wald chi-square statistic, followed by pairwise post hoc t-test comparisons. RESULTS: Of the 12 communication modes assessed, participants reported using a median of eight (range: 5-10). All participants affirmed using speech, facial expressions, and talking on the phone. Frequency and perceived effectiveness ratings for these three modes were endorsed at the "some/most of the time" level for more than 80% of the participants. No-tech mode use was significantly higher than reported high-tech and low-tech modes (p = .004 and p < .0001, respectively). Even so, while some high-tech modes (apps) and some low-tech modes (nonelectronic augmentative and alternative communication) had fewer users, effectiveness ratings were moderate to high for all but one user. CONCLUSIONS: Persons with mild-to-moderate language impairment due to PPA report using a range of communication modes with moderate-to-high frequency and perceived effectiveness. These outcomes provide practical information when considering mode refinement or expansion during intervention to maximize communication participation. Barriers to modality use may include low awareness or access, which could be queried by future studies and supported by speech and language interventions. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21614262.

The Reliability of Telepractice Administration of the Western Aphasia Battery-Revised in Persons With Primary Progressive Aphasia.

PURPOSE: The use of telepractice in the field of communication disorders offers an opportunity to provide care for those with primary progressive aphasia (PPA). The Western Aphasia Battery-Revised (WAB-R) is used for differential diagnosis, to assess severity of aphasia, and to identify a language profile of strengths and challenges. Telehealth administration of the WAB-R is supported for those with chronic aphasia due to stroke but has not yet been systematically explored in neurodegenerative dementia syndromes. To fill this gap, in-person and telehealth performance on the WAB-R from participants with mild to moderate PPA was compared. METHOD: Nineteen participants with mild to moderate PPA were administered the WAB-R in person and over videoconferencing. Videoconferencing administration included modifications to the testing protocol to ensure smooth completion of the assessment. Subtest and Aphasia Quotient (WAB-AQ) summary scores were compared using concordance coefficients to measure the relationship between the administration modes. RESULTS: In-person and telehealth scores showed strong concordance for the WAB-AQ, Auditory Verbal Comprehension subtest, and Naming & Word Finding subtest. The Spontaneous Speech test summary score had slightly lower concordance, indicating the need for caution when comparing these scores across administration modes. CONCLUSION: These findings support extending the use of telehealth administration of the WAB-R via videoconferencing to those with mild to moderate PPA given appropriate modifications to testing protocol.

Clustering and Switching in Verbal Fluency Across Varying Degrees of Cognitive Control Demands: Evidence From Healthy Bilinguals and Bilingual Patients With Aphasia.

Different linguistic contexts place varying amounts of cognitive control on lexical retrieval in bilingual speakers, an issue that is complicated in bilingual patients with aphasia (BPWA) due to subsequent language and cognitive deficits. Verbal fluency tasks may offer insight into the interaction between executive and language control in healthy bilinguals and BPWA, by examining conditions with varying cognitive control demands. The present study examined switching and clustering in verbal fluency tasks in BPWA and healthy bilinguals across single- and dual-language conditions. We also examined the influence of language processing and language proficiency on switching and clustering performance across the dual-language conditions. Thirty-five Spanish-English BPWA and twenty-two Spanish-English healthy bilinguals completed a language use questionnaire, tests of language processing, and two verbal fluency tasks. The semantic category generation task included four conditions: two single-language conditions (No-Switch L1 and No-Switch L2) that required word production in each language separately; one dual-language condition that allowed switching between languages as desired (Self-Switch); and one dual-language condition that required switching between languages after each response (Forced-Switch). The letter fluency task required word production in single-language contexts. Overall, healthy bilinguals outperformed BPWA across all measures. Results indicate that switching is more sensitive to increased control demands than clustering, with this effect being more pronounced in BPWA, underscoring the interaction between semantic executive processes and language control in this group. Additionally, for BPWA switching performance relies on a combination of language abilities and language experience metrics.

Verbal fluency as a measure of lexical access and cognitive control in bilingual persons with aphasia.

BACKGROUND: Lexical access in bilinguals can be influenced by the demands that different interactional contexts pose on cognitive control processes (Green & Abutalebi, 2013: Adaptive Control Hypothesis; Green, 1998: Inhibitory Control Model). However, how varying cognitive control demands impact lexical access in bilingual persons with aphasia (BPWA) remains unclear. Verbal fluency tasks may provide valuable insights into the interplay between cognitive control and lexical access in BPWA by addressing word generation abilities in language contexts that exert varying degrees of cognitive control effort. AIMS: The present study aimed to examine the performance of BPWA on a semantic category generation task that required word retrieval in single and dual-language contexts under varying cognitive control demands and a traditional letter fluency task conducted in single-language contexts. We also examined the associations between verbal fluency performance and (i) bilingual language history, and (ii) performance on standardized language assessments in both BPWA and healthy bilinguals. METHODS AND PROCEDURES: Thirteen Spanish-English BPWA and twenty-two Spanish-English healthy bilinguals completed a language use questionnaire, verbal fluency testing and standardized language assessments in each language. The semantic category generation task included four conditions: two conditions examined word retrieval in the first-acquired (L1) and second-acquired language (L2) in single language contexts (No Switch-L1 and No Switch-L2) and two conditions elicited word retrieval in dual-language contexts (Self-Switch and Forced-Switch) with low and high cognitive control demands by allowing or restricting switching across languages. The letter fluency task was administered in single language contexts only (F, A, S for English and P, M, R for Spanish). Verbal fluency performance was compared across conditions and groups using multivariate analyses. Further, correlational analyses were used to examine associations between verbal fluency tasks and bilingual language history, language assessments, and cognitive function. OUTCOMES AND RESULTS: Overall, the healthy bilinguals produced a higher proportion of accurate words in both verbal fluency tasks relative to the BPWA. Results indicate that BPWA were more sensitive to the effects of increased cognitive control on lexical access relative to healthy bilinguals. BPWA and healthy bilinguals' performance on both verbal fluency tasks was associated with metrics of bilingual language history and standardized language assessments. Additionally, for BPWA, L2 letter fluency performance was associated with cognitive function. CONCLUSIONS: Our findings suggest that verbal fluency tasks can help characterize the impact of cognitive control on lexical access in BPWA in single and mixed language contexts with important clinical implications.

Print exposure predicts pronoun comprehension strategies in children.

Language development requires children to learn how to understand ambiguous pronouns, as in Panda Bear is having lunch with Puppy. He wants a pepperoni slice. Adults tend to link he with Puppy, the prior grammatical subject, but young children either fail to exhibit this bias (Arnold, Brown-Schmidt & Trueswell, 2007) or do so more slowly than adults (Hartshorne et al., 2015a; Song & Fisher, 2005). In the current study, we test whether language exposure affects this bias in elementary-school-age children. Children listened to stories like the one above, and answered questions like "Who wants a pepperoni slice?" which reveal their pronoun interpretation. Individual variation in the rate of selecting the subject character correlated with measures of print exposure, such that children who read more are more likely to follow the subject bias. This is the first study to establish that print exposure affects spoken pronoun comprehension in children.

Outcomes of pectoralis major myocutaneous flap in female patients for oral cavity defect reconstruction.

PURPOSE: Although much has been mentioned in the literature worldwide regarding the outcome of pectoralis major myocutaneous flaps (PMMFs), hardly any studies are available that mention the outcome of PMMFs in female patients. It has been presumed that complication rates after PMMF reconstruction in female patients are higher because of the presence of more adipose tissue in the flap. The objective of this study was to analyze our data regarding the outcomes of PMMFs in female patients with oral cancer undergoing reconstruction after tumor ablation. MATERIALS AND METHODS: In this retrospective study from January 2008 to May 2012, performed in a single institution in south India, we have analyzed our data on PMMFs in 140 female patients with oral cancer. The operative technique used was essentially the same as that described originally by Ariyan. However, to preserve the deltopectoral flap area, the incision was appropriately modified in a manner as described by Schuller. RESULTS: The mean age of the patients was 52.36 years, with a range from 30 to 76 years. They presented mostly with ulcers or ulceroproliferative lesions. Most of the patients had a history of tobacco and betel nut chewing. All of them underwent composite resection and reconstruction with PMMF under general anesthesia. Of the patients, 30 (21.4%) had complications, comprising infection (8), superficial flap necrosis (11), combined wound infection and superficial flap necrosis (3), total flap failure (2), and orocutaneous fistula (6). CONCLUSIONS: PMMF reconstruction is a reliable and cosmetically acceptable method of reconstruction in female patients for oral cavity defects after tumor ablation.

Determining the frequency of asbestos use in automotive brakes from a fleet of on-road California vehicles.

Asbestos is a known human carcinogen, and recent regulation in California limits asbestiform fibers in brakes to trace levels beginning in 2014, although there is no corresponding federal requirement. In order to gauge the current prevalence of asbestos use in automotive brake applications, the California Air Resources Board tested brake linings from 137 light- and medium-duty vehicles and 54 heavy-duty vehicles. Only about 3% of the light- and medium-duty vehicle brake linings contained chrysotile asbestos. All of those brake linings were drum-type shoes, which are generally being phased out. No asbestos was found in low mileage vehicles presumed to have their original stock linings from the vehicle manufacturer. Additionally, no asbestos was found in the heavy-duty vehicle brake shoe linings sampled. Given the small percentage of vehicle brake linings with asbestos observed, it appears that the prior federal ban that was subsequently overturned, in combination with a threat of litigation, has reduced asbestos use in brake linings. However, our study was limited in scope and without a national ban, the current and future prevalence of asbestos in brakes is uncertain, suggesting the need for continued monitoring of materials released as toxic air contaminants in normal braking operations.

Risk-based determination of critical nitrogen deposition loads for fire spread in southern California deserts.

Fire risk in deserts is increased by high production of annual forbs and invasive grasses that create a continuous fine fuel bed in the interspaces between shrubs. Interspace production is influenced by water, nitrogen (N) availability, and soil texture, and in some areas N availability is increasing due to anthropogenic N deposition. The DayCent model was used to investigate how production of herbaceous annuals changes along gradients of precipitation, N availability, and soil texture, and to develop risk-based critical N loads. DayCent was parameterized for two vegetation types within Joshua Tree National Park, California, USA: creosote bush (CB) and piñon-juniper (PJ). The model was successfully calibrated in both vegetation types, but validation showed that the model is sensitive to soil clay content. Despite this fact, DayCent (the daily version of the biogeochemical model CENTURY) performed well in predicting the relative response of production to N fertilization and was used to determine estimates of fire risk for these ecosystems. Fire risk, the probability that annual biomass exceeds the fire threshold of 1000 kg/ha, was determined for each vegetation type and began to increase when N deposition increased 0.05 g/m2 above background levels (0.1 g/m2). Critical loads were calculated as the amount of N deposition at the point when fire risk began to increase exponentially. Mean critical loads for all soil types and precipitation <21 cm/yr, representing the majority of our study region, were 0.32 +/- 0.07 and 0.39 +/- 0.09 g N/m2 for CB and PJ, respectively. Critical loads decreased with increasing soil clay content and increasing precipitation, such that the wettest areas with clay contents of 6-14% may have critical loads as low as 0.15 g N/m2. Mean fire risks approached their maximum at 0.93 +/- 0.21 and 0.87 +/- 0.17 g N/m2 in CB and PJ, indicating that precipitation is the driver of fire above these N deposition levels, which are currently observed in some areas of the Sonoran and Mojave Deserts. Overall, this analysis demonstrates the importance of considering both N deposition and precipitation when evaluating fire risk across arid landscapes.

Combined effects of precipitation and nitrogen deposition on native and invasive winter annual production in California deserts.

Primary production in deserts is limited by soil moisture and N availability, and thus is likely to be influenced by both anthropogenic N deposition and precipitation regimes altered as a consequence of climate change. Invasive annual grasses are particularly responsive to increases in N and water availabilities, which may result in competition with native forb communities. Additionally, conditions favoring increased invasive grass production in arid and semi-arid regions can increase fire risk, negatively impacting woody vegetation that is not adapted to fire. We conducted a seeded garden experiment and a 5-year field fertilization experiment to investigate how winter annual production is altered by increasing N supply under a range of water availabilities. The greatest production of invasive grasses and native forbs in the garden experiment occurred under the highest soil N (inorganic N after fertilization = 2.99 g m(-2)) and highest watering regime, indicating these species are limited by both water and N. A classification and regression tree (CART) analysis on the multi-year field fertilization study showed that winter annual biomass was primarily limited by November-December precipitation. Biomass exceeded the threshold capable of carrying fire when inorganic soil N availability was at least 3.2 g m(-2) in piñon-juniper woodland. Due to water limitation in creosote bush scrub, biomass exceeded the fire threshold only under very wet conditions regardless of soil N status. The CART analyses also revealed that percent cover of invasive grasses and native forbs is primarily dependent on the timing and amount of precipitation and secondarily dependent on soil N and site-specific characteristics. In total, our results indicate that areas of high N deposition will be susceptible to grass invasion, particularly in wet years, potentially reducing native species cover and increasing the risk of fire.

Patterns of understory diversity in mixed coniferous forests of southern California impacted by air pollution.

The forests of the San Bernardino Mountains have been subject to ozone and nitrogen (N) deposition for some 60 years. Much work has been done to assess the impacts of these pollutants on trees, but little is known about how the diverse understory flora has fared. Understory vegetation has declined in diversity in response to elevated N in the eastern U.S. and Europe. Six sites along an ozone and N deposition gradient that had been part of a long-term study on response of plants to air pollution beginning in 1973 were resampled in 2003. Historic ozone data and leaf injury scores confirmed the gradient. Present-day ozone levels were almost half of these, and recent atmospheric N pollution concentrations confirmed the continued air pollution gradient. Both total and extractable soil N were higher in sites on the western end of the gradient closer to the urban source of pollution, pH was lower, and soil carbon (C) and litter were higher. The gradient also had decreasing precipitation and increasing elevation from west to east. However, the dominant tree species were the same across the gradient. Tree basal area increased during the 30-year interval in five of the sites. The two westernmost sites had 30-45% cover divided equally between native and exotic understory herbaceous species, while the other sites had only 3-13% cover dominated by native species. The high production is likely related to higher precipitation at the western sites as well as elevated N. The species richness was in the range of 24 to 30 in four of the sites, but one site of intermediate N deposition had 42 species, while the easternmost, least polluted site had 57 species. These were primarily native species, as no site had more than one to three exotic species. In three of six sites, 20-40% of species were lost between 1973 and 2003, including the two westernmost sites. Two sites with intermediate pollution had little change in total species number over 30 years, and the easternmost site had more species in 2003. The easternmost site is also the driest and has the most sunlight filtering to the forest floor, possibly accounting for the higher species richness. The confounding effects of the precipitation gradient and possibly local disturbances do not show a simple correlation of air pollution with patterns of native and invasive species cover and richness. Nevertheless, the decline of native species and dominance by exotic species in the two westernmost polluted sites is cause for concern that air pollution is affecting the understory vegetation adversely.