A Visual Analog Scale for Self-Reported Quality of Life: A Comparison of VAS and QoL-AD in Older Adults.

PURPOSE: People with dementia (PWD) are one of the fastest-growing clinical populations for speech-language pathologists. Self-reported quality of life (QoL) assessments are critical patient-reported outcome measures that align with person-centered care principles. However, proxy-reporting is most often used due to assumptions that PWD cannot provide reliable self-report. Visual analog scales (VASs) have been successfully used with people with expressive and cognitive deficits to measure subjective constructs such as QoL, mood, and pain. The purpose of this project is to evaluate the feasibility and reliability of a VAS QoL assessment tool. METHODS: Twenty older adults free of cognitive impairment were assessed using the quality of life in Alzheimer's disease (QoL-AD) and the QoL-AD in combination with a VAS (VAS QoL-AD). The construct validity, internal consistency, and test-retest reliability of the VAS QoL-AD were assessed by performing both assessments twice, 4 weeks apart. RESULTS: Significant correlations between the overall VAS QoL-AD and the QoL-AD scale ratings, between most of the QoL-AD and VAS QoL-AD subtests, and between the first and second assessment scores were observed. CONCLUSIONS: Results indicated strong construct validity, internal consistency, and test-retest reliability of the VAS QoL-AD in people without dementia. These results warrant further research into the development of a dementia-specific, self-reported VAS QoL scale for PWD.

How Is Quality of Life Assessed in People With Dementia? A Systematic Literature Review and a Primer for Speech-Language Pathologists.

Purpose The purpose of this study was to determine how quality of life (QoL) is measured in people with dementia involved in interventions designed to improve well-being and to explore how those measures align with principles of person-centered care. Method A systematic literature review was conducted utilizing PsychInfo, CINAHL, and PubMed and combinations of the search terms: "dementia," "outcome measure," "creative engagement," "creative intervention," "TimeSlips," "art," "quality of life," and "well-being." The search was limited to studies published in peer-reviewed journals that reported outcomes for people with dementia in response to a creative intervention. Results Across the 24 reviewed studies, 30 different outcome measures were reported including eight self-reported, nine observational, and 13 proxy-reported measures. Self-report of QoL was elicited 16 times, observational measures were reported 17 times, and proxy-reported measures were used 28 times. All measures were used with participants across the dementia severity spectrum. Conclusion Current clinical practice of QoL evaluation does not align well with person-centered care principles of self-determination based on the low proportion of self-report. The previously reported limitations of proxy-report have been in part confirmed with this study. Implications of the findings for speech-language pathologists are discussed.

Service-Learning with older adults in care communities: Measures of attitude shifts in undergraduate students.

Background: Clinicians' attitudes toward older adults can influence the quality of the care they provide. The purpose of this study was to demonstrate how to measure the impact of service-learning on undergraduate healthcare students' attitudes toward elders and people with dementia using a theory-grounded qualitative and quantitative assessment, beyond the commonly used pre-test/post-test model. Methods: One-hundred forty-five undergraduate students across two midwestern universities participated in service-learning experiences in a long-term care or assisted living environment during one semester. Students completed the Dementia Attitudes Scale (DAS) before they began service-learning and at the end of the experience. Students also completed reflective journal entries throughout their experiences. Results: Significant, positive changes in knowledge and comfort were noted in ratings from pre-to post-assessment on the DAS. Of the 4165 sentences produced by students in three analyzed journal entries, 2045 (49%) reflected the Awareness-Application Attitude theoretical framework. For the first journal entry, the proportion of positive attitude statements was significantly lower than that for neutral and negative statements while the reversed effect was observed for the last journal entry. Conclusions: Service-learning is an evidence-based pedagogy associated with positive attitude shifts for undergraduate students.

Remote concussion history does not affect visually-guided reaching in young adult females.

AIM: We examined the long-term effects of concussions in young adult females on visuomotor behavior during a visually-guided reaching task of various complexities. MATERIALS & METHODS: 20 females with a history of longer than 6 months since a concussion and 20 healthy females quickly and accurately performed a delayed reach to a previously cued target. RESULTS: As both cognitive and motor load increased, task performance decreased for both groups (p < 0.05). However, contrary to our primary hypothesis, no differences in task performance were found between the two experimental groups (p > 0.05). CONCLUSION: The young adult females with a remote history of concussion demonstrated no deficits in visuomotor behavior on an attention-mediated reaching task as compared with control participants.

More Than the Verbal Stimulus Matters: Visual Attention in Language Assessment for People With Aphasia Using Multiple-Choice Image Displays.

Purpose: Language comprehension in people with aphasia (PWA) is frequently evaluated using multiple-choice displays: PWA are asked to choose the image that best corresponds to the verbal stimulus in a display. When a nontarget image is selected, comprehension failure is assumed. However, stimulus-driven factors unrelated to linguistic comprehension may influence performance. In this study we explore the influence of physical image characteristics of multiple-choice image displays on visual attention allocation by PWA. Method: Eye fixations of 41 PWA were recorded while they viewed 40 multiple-choice image sets presented with and without verbal stimuli. Within each display, 3 images (majority images) were the same and 1 (singleton image) differed in terms of 1 image characteristic. The mean proportion of fixation duration (PFD) allocated across majority images was compared against the PFD allocated to singleton images. Results: PWA allocated significantly greater PFD to the singleton than to the majority images in both nonverbal and verbal conditions. Those with greater severity of comprehension deficits allocated greater PFD to nontarget singleton images in the verbal condition. Conclusion: When using tasks that rely on multiple-choice displays and verbal stimuli, one cannot assume that verbal stimuli will override the effect of visual-stimulus characteristics.

Development of an eye-tracking method to assess mental set switching in people with aphasia.

BACKGROUND: Deficits in cognitive flexibility contribute to impaired functional communication in people with aphasia. Understanding the relationship between functional communication and cognitive flexibility in people with neurologic communication disorders is important. However, traditional methods to assess mental set switching pose significant linguistic, cognitive and motoric response confounds. Eye-tracking methods have great potential to address these challenges. AIMS: The goal of this study was to develop and validate an eye-tracking method to index mental set switching in individuals without neurological impairment based upon performance on a nonlinguistic switching task. METHODS: Eye movements of 20 adults without communication disorders were recorded as they completed a switching task, requiring participants to match stimuli to one or two search criteria (colour or shape) in single- and mixed-task conditions. Differences between single and mixed conditions were assessed with eye-tracking measures. Performance on the eye-tracking task was compared to standardized measures of cognitive flexibility. RESULTS: Eye-tracking measures indexed significant differences between nonswitch and switch trials within and between single- and mixed-task condition. Some standardized assessment measures correlated significantly with the eye movement measures. CONCLUSIONS: Results support the construct validity of the novel eye-tracking method for assessing cognitive switching in language-normal adults. Clinical and research implications are discussed.

A novel eye-tracking method to assess attention allocation in individuals with and without aphasia using a dual-task paradigm.

UNLABELLED: Numerous authors report that people with aphasia have greater difficulty allocating attention than people without neurological disorders. Studying how attention deficits contribute to language deficits is important. However, existing methods for indexing attention allocation in people with aphasia pose serious methodological challenges. Eye-tracking methods have great potential to address such challenges. We developed and assessed the validity of a new dual-task method incorporating eye tracking to assess attention allocation. Twenty-six adults with aphasia and 33 control participants completed auditory sentence comprehension and visual search tasks. To test whether the new method validly indexes well-documented patterns in attention allocation, demands were manipulated by varying task complexity in single- and dual-task conditions. Differences in attention allocation were indexed via eye-tracking measures. For all participants significant increases in attention allocation demands were observed from single- to dual-task conditions and from simple to complex stimuli. Individuals with aphasia had greater difficulty allocating attention with greater task demands. Relationships between eye-tracking indices of comprehension during single and dual tasks and standardized testing were examined. Results support the validity of the novel eye-tracking method for assessing attention allocation in people with and without aphasia. Clinical and research implications are discussed. LEARNING OUTCOMES: Readers will be able to: (1) summarize the nature of dual-task paradigms, (2) identify shortcomings of existing dual-task measures of attention allocation for application to people with aphasia, (3) describe how eye-tracking measures may be recorded and analyzed to reflect differences in attention allocation across conditions, and (4) summarize potential clinical applications for eye-tracking measures of attention allocation.