The Acceptability of Relationship-Centered Communication Partner Training for Couples Impacted by Aphasia: A Mixed-Methods Pilot Investigation.

PURPOSE: This study explored the acceptability and impact of relationship-centered communication partner training (RC-CPT) in couples impacted by aphasia. In particular, couples considered whether discussing their relationship roles and responsibilities was important and relevant to the changes they desire. Preliminary quasi-experimental data regarding perceived communication confidence and the marriage relationship were also obtained. METHOD: Three couples participated in RC-CPT across two sessions. Surveys were used to measure communication confidence and the marital relationship before and after participation in RC-CPT. The quantitative findings were analyzed using descriptive statistics. Couples also participated in a semistructured interview about the acceptability of RC-CPT during a third session. The interviews were transcribed and analyzed using reflexive codebook analysis. RESULTS: Quantitative data indicated that participants generally maintained or improved self-rated accessibility, responsiveness, engagement, conflict resolution, and communication within their marriage after participating in RC-CPT. Additionally, individuals with aphasia demonstrated enhanced communication confidence scores. Qualitative analysis revealed three themes: (a) Impact on Communication, (b) Impact on Relationship, and (c) Impact on Psychosocial Well-Being. Feedback from participants regarding future development was also included. CONCLUSIONS: The convergence of quantitative and qualitative data supports the conclusion that couples experienced positive changes in their communication, relationship, and psychosocial well-being during the intervention, suggesting that RC-CPT has the potential to positively impact both communicative and psychosocial effects of aphasia on couples. Moreover, this study highlights the promise of RC-CPT as a relationship-centered counseling tool, warranting further exploratory and experimental research. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25937383.

Efficacy and Safety of Catheter Interventions for Postoperative Urinary Retention After Primary Hip and Knee Total Joint Arthroplasty.

INTRODUCTION: Postoperative urinary retention (POUR) is a common barrier to rapid-discharge hip and knee total joint arthroplasty (TJA). We evaluated the efficacy and safety of catheterization intervention methods for POUR before and after discharge. METHODS: A total of 1,659 primary TJAs were retrospectively reviewed. POUR resolutions before and after discharge were evaluated relative to catheterization type and other covariates. Complications before and within 90 days of discharge were quantified. A total of 113 POUR cases comprised the analysis sample of 76 hips and 37 knees in 51 women and 62 men with an average age and body mass index of 68.6 (range 22 to 92) years and 31.7 (range 16 to 49) kg/m2. RESULTS: POUR resolved before discharge for 82.3% (93/113) of patients, with equivalent resolution rates for intermittent catheterization alone (84.2%, 32/38) compared with indwelling catheterization with or without intermittent catheterization (82.6%, 57/69, P < 0.999), equivalent time to resolution (P = 0.319), and no difference in complication rates (P = 0.999). Complication rates within 90 days of discharge were higher for patients treated with indwelling catheters before discharge (P = 0.049). Resolution before discharge was more likely with increasing body mass index (P = 0.026) and less likely for patients with a history of urinary retention (P = 0.033). 60 percent (12/20) of patients with unresolved POUR were discharged with self-intermittent catheterization and 40% (8/20) with indwelling catheters, with no differences in efficacy and safety based on the catheterization type (P = 0.109). DISCUSSION: Before discharge, we observed equivalent resolution rates and equivalent time to resolution for indwelling and intermittent catheterization alone without compromising patient safety. Intermittent catheterization is favored, however, because in situ catheter exposure is dramatically reduced and postdischarge complication rates are lower. Additional research is needed to develop evidence-based POUR guidelines for outpatient TJA.

Examining cortical tracking of the speech envelope in post-stroke aphasia.

Introduction: People with aphasia have been shown to benefit from rhythmic elements for language production during aphasia rehabilitation. However, it is unknown whether rhythmic processing is associated with such benefits. Cortical tracking of the speech envelope (CTenv) may provide a measure of encoding of speech rhythmic properties and serve as a predictor of candidacy for rhythm-based aphasia interventions. Methods: Electroencephalography was used to capture electrophysiological responses while Spanish speakers with aphasia (n = 9) listened to a continuous speech narrative (audiobook). The Temporal Response Function was used to estimate CTenv in the delta (associated with word- and phrase-level properties), theta (syllable-level properties), and alpha bands (attention-related properties). CTenv estimates were used to predict aphasia severity, performance in rhythmic perception and production tasks, and treatment response in a sentence-level rhythm-based intervention. Results: CTenv in delta and theta, but not alpha, predicted aphasia severity. Neither CTenv in delta, alpha, or theta bands predicted performance in rhythmic perception or production tasks. Some evidence supported that CTenv in theta could predict sentence-level learning in aphasia, but alpha and delta did not. Conclusion: CTenv of the syllable-level properties was relatively preserved in individuals with less language impairment. In contrast, higher encoding of word- and phrase-level properties was relatively impaired and was predictive of more severe language impairments. CTenv and treatment response to sentence-level rhythm-based interventions need to be further investigated.

Race and sex differences in ROS production and SOD activity in HUVECs.

Black individuals and men are predisposed to an earlier onset and higher prevalence of hypertension, compared with White individuals and women, respectively. Therefore, the influence of race and sex on reactive oxygen species (ROS) production and superoxide dismutase (SOD) activity following induced inflammation was evaluated in female and male human umbilical vein endothelial cells (HUVECs) from Black and White individuals. It was hypothesized that HUVECs from Black individuals and male HUVECs would exhibit greater ROS production and impaired SOD activity. Inflammation was induced in HUVEC cell lines (n = 4/group) using tumor necrosis factor-alpha (TNF-α, 50ng/ml). There were no between group differences in ROS production or SOD activity in HUVECs from Black and White individuals, and HUVECs from Black individuals exhibited similar SOD activity at 24hr compared with 4hr of TNF-α treatment (p>0.05). However, HUVECs from White individuals exhibited significantly greater SOD Activity (p<0.05) at 24hr as compared to 4hr in the control condition but not with TNF-α treatment (p>0.05). Female HUVECs exhibited significantly lower ROS production than male HUVECs in the control condition and following TNF-α induced inflammation (p<0.05). Only female HUVECs exhibited significant increases in SOD activity with increased exposure time to TNF-α induced inflammation (p<0.05). HUVECs from White individuals alone exhibit blunted SOD activity when comparing control and TNF-α conditions. Further, compared to female HUVECs, male HUVECs exhibit a pro-inflammatory state.

Incorporating Metacognitive Strategy Training Into Semantic Treatment Promotes Restitutive and Substitutive Gains in Naming: A Single-Subject Investigation.

PURPOSE: This study tested the effectiveness of a modified semantic feature analysis (SFA) treatment protocol that incorporated metacognitive strategy training (MST). Regarding its restitutive component, SFA most reliably results in improved word retrieval for treated items and untreated, semantically related items, but evidence of response generalization is often small/inconsistent. Regarding its substitutive component, SFA is thought to facilitate successful communication via habituation of the SFA circumlocution strategy. However, repeated practice with SFA's strategy in the absence of direct MST may not result in independent strategy use and/or generalization. Furthermore, people with aphasia's independent use of the SFA strategy in moments of anomia is presently underreported. To address these limitations, we incorporated MST into SFA and directly measured substitutive outcomes. METHOD: Four people with aphasia participated in 24 treatment sessions of SFA + MST in a single-subject, A-B experimental design with repeated measurements. We measured word retrieval accuracy, strategy use, and explicit strategy knowledge. We calculated effect sizes to measure changes in word retrieval accuracy and strategy use and used visual inspection to assess gains in explicit strategy knowledge from pre- to posttreatment and retention. RESULTS: Participants achieved marginally small to medium effects in word retrieval accuracy for treated; untreated, semantically related; and untreated, semantically unrelated items and marginally small to large effects in independent strategy use. Explicit strategy knowledge was variable. CONCLUSIONS: Across participants, SFA + MST yielded positive changes in word retrieval accuracy or strategy use, or both. Positive changes in word retrieval accuracy were comparable to other SFA studies. Positive changes in strategy use demonstrate preliminary evidence of this treatment's ability to yield restitutive and substitutive gains. Overall, this study offers preliminary evidence of SFA + MST's effectiveness and highlights the importance of directly measuring SFA's substitutive outcomes, which showed that people with aphasia can respond to this treatment in multiple successful ways-not just improved target word production.

Reproducibility in Small-N Treatment Research: A Tutorial Using Examples From Aphasiology.

PURPOSE: Small-N studies are the dominant study design supporting evidence-based interventions in communication science and disorders, including treatments for aphasia and related disorders. However, there is little guidance for conducting reproducible analyses or selecting appropriate effect sizes in small-N studies, which has implications for scientific review, rigor, and replication. This tutorial aims to (a) demonstrate how to conduct reproducible analyses using effect sizes common to research in aphasia and related disorders and (b) provide a conceptual discussion to improve the reader's understanding of these effect sizes. METHOD: We provide a tutorial on reproducible analyses of small-N designs in the statistical programming language R using published data from Wambaugh et al. (2017). In addition, we discuss the strengths, weaknesses, reporting requirements, and impact of experimental design decisions on effect sizes common to this body of research. RESULTS: Reproducible code demonstrates implementation and comparison of within-case standardized mean difference, proportion of maximal gain, tau-U, and frequentist and Bayesian mixed-effects models. Data, code, and an interactive web application are available as a resource for researchers, clinicians, and students. CONCLUSIONS: Pursuing reproducible research is key to promoting transparency in small-N treatment research. Researchers and clinicians must understand the properties of common effect size measures to make informed decisions in order to select ideal effect size measures and act as informed consumers of small-N studies. Together, a commitment to reproducibility and a keen understanding of effect sizes can improve the scientific rigor and synthesis of the evidence supporting clinical services in aphasiology and in communication sciences and disorders more broadly. Supplemental Material and Open Science Form: https://doi.org/10.23641/asha.21699476.

Associations between cardiorespiratory fitness, monocyte polarization, and exercise-related changes in mnemonic discrimination performance in older adults.

Biological aging is accompanied by a chronic pro-inflammatory state that may facilitate losses in hippocampal-dependent mnemonic discrimination. Aerobic exercise training promotes adaptations that include improved immune competency, higher cardiorespiratory fitness, and maintenance of hippocampal function. However, it is poorly understood whether, in active older adults, baseline immune cell profiles and cardiorespiratory fitness are possible mechanisms that facilitate the long-term benefits to hippocampal dependent mnemonic discrimination performance. This within-subjects study with counterbalanced conditions aimed to investigate whether baseline monocyte polarization and cardiorespiratory fitness influenced performance in the mnemonic similarity task (MST) and related Lure Discrimination Index (LDI) score after an acute bout of exercise. Twenty-one active older adults (M = 68 ± 5 yrs) underwent baseline testing in which blood samples were collected and cardiorespiratory fitness measured. Participants then returned and completed a seated rest or moderate intensity aerobic exercise condition in which the MST was proctored prior to and 5 min after each condition. A linear mixed effects model was used in which Participant ID was a random effect and Condition (rest v. exercise), Time (pre- v post-), and order were fixed main effects. Simple linear regression models were used to determine the variance accounted for by monocyte phenotypes and cardiorespiratory fitness for LDI scores post-condition. Post-rest LDI scores were significantly lower than post-exercise LDI scores (t(20) = -2.65, p < 0.02, d = -0.57). Intermediate monocytes were significant predictors of the change in pre- to post-exercise LDI scores (F(1, 19) = 6.03, p = 0.024, R2 = 0.24) and cardiorespiratory fitness was a significant predictor of the difference between post-condition LDI scores (F(1, 19) = 6.71, p = 0.018, R2 = 0.26). Our results suggest baseline cardiorespiratory fitness and intermediate monocytes may relate to the integrity of hippocampal-dependent mnemonic discrimination performance, and possibly the degree of responsiveness to aerobic exercise interventions.

Applying adaptive distributed practice to self-managed computer-based anomia treatment: A single-case experimental design.

INTRODUCTION: There is a pressing need to improve computer-based treatments for aphasia to increase access to long-term effective evidence-based interventions. The current single case design incorporated two learning principles, adaptive distributed practice and stimuli variability, to promote acquisition, retention, and generalization of words in a self-managed computer-based anomia treatment. METHODS: Two participants with post-stroke aphasia completed a 12-week adaptive distributed practice naming intervention in a single-case experimental design. Stimuli variability was manipulated in three experimental conditions: high exemplar variability, low exemplar variability, and verbal description prompt balanced across 120 trained words. Outcomes were assessed at 1-week, 1-month, and 3-months post-treatment. Statistical comparisons and effect sizes measured in the number of words acquired, generalized, and retained were estimated using Bayesian generalized mixed-effect models. RESULTS: Participants showed large and robust acquisition, generalization, and retention effects. Out of 120 trained words, participant 1 acquired ∼77 words (trained picture exemplars) and ∼63 generalization words (untrained picture exemplars of treated words). Similarly, participant 2 acquired ∼57 trained words and ∼48 generalization words. There was no reliable change in untrained control words for either participant. Stimuli variability did not show practically meaningful effects. CONCLUSIONS: These case studies suggest that adaptive distributed practice is an effective method for re-training more words than typically targeted in anomia treatment research (∼47 words on average per Snell et al., 2010). Generalization across experimental conditions provided evidence for improved lexical access beyond what could be attributed to simple stimulus-response mapping. These effects were obtained using free, open-source flashcard software in a clinically feasible, asynchronous format, thereby minimizing clinical implementation barriers. Larger-scale clinical trials are required to replicate and extend these effects.

Get in Sync: Active Ingredients and Patient Profiles in Scripted-Sentence Learning in Spanish Speakers With Aphasia.

PURPOSE: Script training is a well-established treatment for aphasia, but its evidence comes almost exclusively from monolingual English speakers with aphasia. Furthermore, its active ingredients and profiles of people with aphasia (PWA) that respond to this treatment remain understudied. This study aimed to adapt a scripted-sentence learning protocol to Colombian Spanish speakers with aphasia, investigate speech entrainment (i.e., unison production of sentences) as an active ingredient for scripted-sentence learning, and identify patient profiles associated with better scripted-sentence learning. METHOD: Fourteen monolingual Spanish speakers with aphasia learned a set of 30 sentences. To examine speech entrainment as an active ingredient for scripted-sentence learning, we investigated whether sentences containing externally added rhythmic cues (involving stress-aligned vs. metronomic rhythmic cues) would result in better scripted-sentence learning compared with control sentences. Learning was measured via postsession probes and analyzed using mixed-effects logistic regression models. The relationship between scripted-sentence learning and baseline language and rhythmic processing measures was also examined. RESULTS: Significant scripted-sentence learning over time indicated a successful adaptation of a script-training protocol to Spanish. PWA learned significantly more scripted sentences in the rhythmically enhanced conditions compared with the control condition. There were no differences between rhythmically enhanced conditions (stress-aligned vs. metronomic). In terms of patient profiles, it was found that PWA with more severe aphasia demonstrated larger learning gains, but rhythmic processing showed little association with learning estimates. CONCLUSIONS: To our knowledge, this study provides the first adaptation of a scripted-sentence learning protocol for monolingual Spanish speakers with aphasia, demonstrating cross-linguistic benefits of script training interventions. Highlighting rhythmic features during speech entrainment facilitated scripted-sentence learning in Spanish speakers with aphasia, suggesting that speech entrainment may be an active ingredient for scripted-sentence learning. More severe aphasia was associated with better scripted-sentence learning, suggesting that more severely impaired individuals are likely to benefit most from this treatment. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19241847.

Practice-Related Predictors of Semantic Feature Verification Treatment for Aphasia.

PURPOSE: Specifying the active ingredients in aphasia interventions can inform treatment theory and improve clinical implementation. This secondary analysis examined three practice-related predictors of treatment response in semantic feature verification (SFV) treatment. We hypothesized that (a) successful feature verification practice would be associated with naming outcomes if SFV operates similarly to standard feature generation semantic feature analysis and (b) successful retrieval practice would be associated with naming outcomes for treated, but not semantically related, untreated words if SFV operates via a retrieval practice-oriented lexical activation mechanism. METHOD: Item-level data from nine participants with poststroke aphasia who received SFV treatment reported in the work of Evans, Cavanaugh, Quique, et al. (2021) were analyzed using Bayesian generalized linear mixed-effects models. Models evaluated whether performance on three treatment components (facilitated retrieval, feature verification, and effortful retrieval) moderated treatment response for treated and semantically related, untreated words. RESULTS: There was no evidence for or against a relationship between successful feature verification practice and treatment response. In contrast, there was a robust relationship between the two retrieval practice components and treatment response for treated words only. DISCUSSION: Findings were consistent with the second hypothesis: Retrieval practice, but not feature verification practice, appears to be a practice-related predictor of treatment response in SFV. However, treatment components are likely interdependent, and feature verification may still be an active ingredient in SFV. Further research is needed to evaluate the causal role of treatment components on treatment outcomes in aphasia.

Representation in Aphasia Research: An Examination of U.S. Treatment Studies Published Between 2009 and 2019.

PURPOSE: The external validity of aphasia treatment research relies on diverse and representative participants. The purposes of this study were (a) to examine whether reporting of patient-reported age, sex, and race/ethnicity has improved since Ellis (2009) and (b) to evaluate whether these demographic variables were consistent with population-level estimates of stroke survivor demographics in the United States. METHOD: A scoping review examined U.S.-based aphasia treatment studies published between 2009 and 2019 and characterized the percentage of studies reporting age, sex, and race/ethnicity. Summary statistics for these variables were calculated and compared statistically with a population-based study of stroke survivors. RESULTS: It was found out that 97.1% of studies reported age, 93.5% reported sex, and 28.1% reported race and/or ethnicity. Within reporting studies, participant mean age was 58.04 years, 61.6% of participants were men, and 38.4% were women; 86.5% of participants were White, 11.0% were Black, 2.0% were Hispanic/Latino, and 0.5% fell in other racial categories. All three variables were statistically different from the study of Kissela et al. (2012). DISCUSSION: Despite being highlighted as an issue by Ellis (2009), less than 30% of recent aphasia treatment studies reported race or ethnicity, and participants do not appear to be demographically representative compared with estimates of stroke survivors living in the United States. These issues may negatively impact the ecological validity of aphasia treatment research. Aphasia researchers should more consistently report participant race and ethnicity and follow current guidelines for increasing the demographic representation of women and minorities.

Exercise-induced modulation of monocytes in breast cancer survivors.

BACKGROUND: Exercise training reduces inflammation in breast cancer survivors; however, the mechanism is not fully understood. OBJECTIVES: The effects of acute and chronic exercise on monocyte toll-like receptor (TLR2 and 4) expression and intracellular cytokine production were examined in sedentary breast cancer survivors. METHODS: Eleven women with stage I, II, or III breast cancer within one year of treatment completion performed an acute, intermittent aerobic exercise trial. Blood samples were obtained before, immediately, and 1 h after a 45-min acute exercise trial that was performed before and after 16 weeks of combined aerobic and resistance. LPS-stimulated intracellular IL-1ß, TNF, and IL-6 production, and TLR2 and TLR4 expression were evaluated in CD14+CD16- and CD14+CD16+ monocytes using flow cytometry. RESULTS: Exercise training decreased IL-1ß+CD14+CD16- proportion (24.6%, p=0.016), IL-1ß+CD14+CD16- mean fluorescence intensity (MFI) (-9989, p=0.014), IL-1ß+CD14+CD16+ MFI (-11101, p=0.02), and IL-6+CD14+CD16- proportion (16.9%, P=0.04). TLR2 and TLR4 expression did not change following exercise training but decreased 1 h after acute exercise in CD14+CD16- (-63, p=0.002) and CD14+CD16+ (-18, p=0.006) monocytes, respectively. Immediately after the acute exercise, both monocyte subgroup cell concentration increased, with CD14+CD16+ concentrations being decreased at 1 h post without changes in intracellular cytokine production. CONCLUSIONS: Exercise training reduced monocyte intracellular pro-inflammatory cytokine production, especially IL-1ß, although these markers did not change acutely. While acute exercise downregulated the expression of TLR2 and TLR4 on monocytes, this was not sustained over the course of training. These results suggest that the anti-inflammatory effect of combined aerobic and resistance exercise training in breast cancer survivors may be, in part, due to reducing resting monocyte pro-inflammatory cytokine production.

Is There a Research-Practice Dosage Gap in Aphasia Rehabilitation?

Purpose Aphasia intervention research aims to improve communication and quality of life outcomes for people with aphasia. However, few studies have evaluated the translation and implementation of evidence-based aphasia interventions to clinical practice. Treatment dosage may be difficult to translate to clinical settings, and a mismatch between dosage in research and clinical practice threatens to attenuate intervention effectiveness. The purpose of this study is to quantify a potential research-practice dosage gap in outpatient aphasia rehabilitation. Method This study utilized a two-part approach. First, we estimated clinical treatment dosage in an episode of care (i.e., treatment provided from outpatient assessment to discharge) via utilization in a regional provider in the United States. Second, we undertook a scoping review of aphasia interventions published from 2009 to 2019 to estimate the typical dosage used in the current aphasia literature. Results Outpatient clinical episodes of care included a median of 10 treatment sessions and a mean of 14.8 sessions (interquartile range: 5-20 sessions). Sessions occurred 1-2 times a week over 4-14 weeks. The median total hours of treatment was 7.5 hr (interquartile range: 3.75-15 hr). In contrast, published interventions administered a greater treatment dosage, consisting of a median of 20 hr of treatment (interquartile range: 12-30 hr) over the course of 15 sessions (interquartile range: 10-24 sessions) approximately 3 times per week. Conclusions Results demonstrate a meaningful research-practice dosage gap, particularly in total treatment hours and weekly treatment intensity. This gap highlights the potential for attenuation of effectiveness from research to outpatient settings. Future translational research should consider clinical dosage constraints and take steps to facilitate intervention implementation, particularly with regard to dosage. Conversely, health care advocacy and continued development of alternative delivery methods are necessary for the successful implementation of treatments with dosage that is incompatible with current clinical contexts. Pragmatic, implementation-focused trials are recommended to evaluate and optimize treatment effectiveness in outpatient clinical settings. Supplemental Material https://doi.org/10.23641/asha.15161568.

Understanding Speed-Accuracy Processing Dynamics in Aphasia Using Response Time Modeling.

People with aphasia demonstrate language impairments evident in both performance accuracy and processing speed, but the direct relationship between accuracy and speed requires further consideration. This article describes two recent attempts to make quantitative progress in this domain using response time modeling: the diffusion model (Ratcliff, 1978) applied to two-choice tasks and a multinomial ex-Gaussian model applied to picture naming. The diffusion model may be used to characterize core linguistic processing efficiency and speed-accuracy tradeoffs independently, and research suggests that maladaptive speed-accuracy tradeoffs lead to performance impairments in at least some people with aphasia. The multinomial ex-Gaussian response time model of picture naming provides a simple and straightforward way to estimate the optimal response time cutoffs for individual people with aphasia (i.e., the cutoff where additional time is unlikely to lead to a correct response). While response time modeling applied to aphasia research is at an early stage of development, both the diffusion model and multinomial ex-Gaussian response time model of picture naming show promise and should be further developed in future work. This article also provides preliminary recommendations for clinicians regarding how to conceptualize, identify, and potentially address maladaptive speed-accuracy tradeoffs for people with aphasia.

Playing With BEARS: Balancing Effort, Accuracy, and Response Speed in a Semantic Feature Verification Anomia Treatment Game.

Purpose The purpose of this study was to develop and pilot a novel treatment framework called BEARS (Balancing Effort, Accuracy, and Response Speed). People with aphasia (PWA) have been shown to maladaptively balance speed and accuracy during language tasks. BEARS is designed to train PWA to balance speed-accuracy trade-offs and improve system calibration (i.e., to adaptively match system use with its current capability), which was hypothesized to improve treatment outcomes by maximizing retrieval practice and minimizing error learning. In this study, BEARS was applied in the context of a semantically oriented anomia treatment based on semantic feature verification (SFV). Method Nine PWA received 25 hr of treatment in a multiple-baseline single-case series design. BEARS + SFV combined computer-based SFV with clinician-provided BEARS metacognitive training. Naming probe accuracy, efficiency, and proportion of "pass" responses on inaccurate trials were analyzed using Bayesian generalized linear mixed-effects models. Generalization to discourse and correlations between practice efficiency and treatment outcomes were also assessed. Results Participants improved on naming probe accuracy and efficiency of treated and untreated items, although untreated item gains could not be distinguished from the effects of repeated exposure. There were no improvements on discourse performance, but participants demonstrated improved system calibration based on their performance on inaccurate treatment trials, with an increasing proportion of "pass" responses compared to paraphasia or timeout nonresponses. In addition, levels of practice efficiency during treatment were positively correlated with treatment outcomes, suggesting that improved practice efficiency promoted greater treatment generalization and improved naming efficiency. Conclusions BEARS is a promising, theoretically motivated treatment framework for addressing the interplay between effort, accuracy, and processing speed in aphasia. This study establishes the feasibility of BEARS + SFV and provides preliminary evidence for its efficacy. This study highlights the importance of considering processing efficiency in anomia treatment, in addition to performance accuracy. Supplemental Material https://doi.org/10.23641/asha.14935812.

Embedding Aphasia-Modified Cognitive Behavioral Therapy in Script Training for Primary Progressive Aphasia: A Single-Case Pilot Study.

Purpose This study sought to determine the initial feasibility and benefit of a novel intervention that combines speech-language treatment with counseling treatment for an individual with the nonfluent/agrammatic variant of primary progressive aphasia (PPA). Method Using a single-case experimental design, we evaluated the utility of modified script training paired with aphasia-modified cognitive behavioral therapy. The study employed a multiple baseline design across scripts for the primary linguistic outcome measure and a mixed methods approach for analyzing counseling outcomes. Psychosocial and communicative functioning scales were administered in conjunction with a phenomenological analysis of semi-structured interviews. Results The participant completed all study phases and participated in all treatment components. She met the criterion of 90% correct, intelligible scripted words on all trained scripts through 12 months post-treatment. Treatment outcomes were comparable to a comparison cohort that received script training without counseling (Henry et al., 2018). At post-treatment, the participant demonstrated stability or improvement on all measures of psychosocial and communicative functioning, with stability documented on seven out of 11 scales at follow-ups through 12 months post-treatment. A phenomenological analysis revealed pervasive themes of loss and resilience at both time points, and emerging themes of positive self-perception, sense of agency, and emotional attunement following treatment. Conclusions Results indicate that script training with aphasia-modified cognitive behavioral therapy is a feasible treatment for an individual with the nonfluent/agrammatic variant of PPA, with immediate and lasting benefits to speech-language production and psychosocial functioning. These findings are the first to support the integration of personal adjustment counseling techniques within a speech-language treatment paradigm for PPA. Supplemental Material https://doi.org/10.23641/asha.14925330.

Metacognitive Strategy Training Is Feasible for People With Aphasia.

Metacognitive strategy training shows promise for reducing disability following stroke, but previous trials have excluded people with aphasia. Considering the high incidence of poststroke aphasia, it is important to determine whether people with aphasia can benefit from strategy training. The purpose of this study was to determine the feasibility of an adapted strategy training protocol for people with aphasia. We recruited 16 adults with mild-moderate aphasia from inpatient stroke rehabilitation. We examined recruitment and retention, intervention delivery and fidelity, participant engagement and communication, participant strategy mastery, and change in disability. Therapists demonstrated good fidelity to intervention elements. Participants demonstrated good engagement and fair communication. The sample achieved a mean Functional Independence Measure change of 21.8 (SD = 16.2, Cohen's d = .95), similar to matched controls without aphasia from previous trials. An adapted strategy training protocol appears feasible for people with aphasia in inpatient stroke rehabilitation. Future studies should examine the efficacy of this approach in larger samples.

Circulating MicroRNA Responses to Postprandial Lipemia with or without Prior Exercise.

Repeated exposure to a high-fat meal triggers inflammation and oxidative stress, contributing to the onset of cardiometabolic diseases. Regular exercise prevents cardiometabolic diseases and a prior bout of acute endurance exercise can counteract the detrimental cardiovascular effects of a subsequent high-fat meal. Circulating microRNAs (ci-miRs) are potential mediators of these vascular effects through regulation of gene expression at the posttranscriptional level. Therefore, we investigated the expression of ci-miRs related to vascular function (miR-21, miR-92a, miR-126, miR-146a, miR-150, miR-155, miR-181b, miR-221, miR-222) in plasma from healthy, recreationally to highly active, Caucasian adult men after a high-fat meal with (EX) and without (CON) a preceding bout of cycling exercise. Ci-miR-155 was the only ci-miR for which there was a significant interaction effect of high-fat meal and exercise (p=0.050). Ci-miR-155 significantly increased in the CON group at two (p=0.007) and four hours (p=0.010) after the high-fat meal test, whereas it significantly increased in the EX group only four hours after the meal (p=0.0004). There were significant main effects of the high-fat meal on ci-miR-21 (p=0.01), ci-miR-126 (p=0.02), ci-miR-146a (p=0.02), ci-miR-181b (p=0.02), and ci-miR-221 (p=0.008). Collectively, our results suggest that prior exercise does not prevent high-fat meal-induced increases in vascular-related ci-miRs.

Effects of exercise training with weight loss on skeletal muscle expression of angiogenic factors in overweight and obese older men.

Low skeletal muscle capillarization is associated with impaired glucose tolerance (IGT); however, aerobic exercise training with weight loss (AEX + WL) increases skeletal muscle capillarization and improves glucose tolerance in adults with IGT. Given that the expression of angiogenic growth factors mediates skeletal muscle capillarization, we sought to determine whether angiogenic growth factor levels are associated with low capillarization in those with IGT versus normal glucose tolerance (NGT) or to the benefits of AEX + WL in both groups. Sixteen overweight or obese men 50-75 yr of age completed 6 mo of AEX + WL with oral glucose tolerance tests and vastus lateralis muscle biopsies for measurement of muscle vascular endothelial growth factor (VEGF), placental growth factor (PlGF), soluble fms-like tyrosine kinase receptor-1 (sFlt-1), and basic fibroblast growth factor (bFGF). At baseline, all growth factor levels were numerically lower in IGT than NGT, but these did not reach statistical significance (P = 0.06-0.33). Following AEX + WL, aerobic capacity [maximal oxygen consumption (V̇o2max)] increased by 16%, whereas body weight and 120-min postprandial glucose levels decreased by 10% and 15%, respectively (P ≤ 0.001 for all). There was a main effect of AEX + WL to increase VEGF (0.095 ± 0.016 vs. 0.114 ± 0.018 ng/µg, P < 0.05), PlGF (0.004 ± 0.001 vs. 0.005 ± 0.001 ng/µg, P < 0.05), and sFlt-1 (0.216 ± 0.029 vs. 0.264 ± 0.036 ng/µg, P < 0.01), with overall increases driven by the IGT group. These results suggest that 6 mo of AEX + WL increases skeletal muscle angiogenic growth factor levels in obese older adults with IGT and NGT, which may contribute to our previous findings that AEX + WL increases capillarization to improve glucose tolerance in those with IGT.NEW & NOTEWORTHY Skeletal muscle capillarization is lower in adults with impaired glucose tolerance than normal controls. This may, in part, be attributable to differential expression of angiogenic growth factors in skeletal muscle. Using a 6-mo aerobic exercise intervention with ∼10% body weight loss (AEX + WL), we show that the expression of angiogenic growth factors tends to be lower in adults with impaired glucose tolerance compared with normal controls and that AEX + WL increased expression of angiogenic growth factors in all participants.