Are Nursing Faculty Future-Ready? The Effects of Emerging Technologies on Nursing Education.

BACKGROUND: Preparing the next generation of nurses requires consideration for the integration of emerging technologies. This refers specifically to technologies that will shape and affect how care is delivered-not in today's health care facilities but in facilities 20 years from now and beyond. METHOD: A cross-sectional survey examining how seven emerging technologies were integrated into nursing curricula was developed and distributed to nursing faculty. A multiple linear regression model was used to analyze the data for the level of integration. The model was adjusted for all demographic measures, and the independent variables of interest were developed from unified theory of acceptance and use of technology (UTAUT) constructs. RESULTS: Performance, attitude, social influence, and effort were insignificant. Education and training, costs, and complexity were noted as top barriers to adoption. CONCLUSION: A literature gap regarding integrating emerging technologies in nursing curricula exists. Further research is warranted to understand factors influencing integration. [J Nurs Educ. 2023;62(12):689-700.].

How well does the discrepancy between semantic and letter verbal fluency performance distinguish Alzheimer's dementia from typical aging?

In Alzheimer's dementia (AD), greater declines in semantic fluency (SF) relative to letter fluency (LF) have been assumed to reflect semantic disintegration. However, the same pattern is observed in typical aging and neurodegenerative disorders besides AD. We examined this assumption by comparing different aspects of SF and LF performance in older adults with and without dementia, and identifying which verbal fluency measures most clearly distinguish AD from typical aging. Verbal fluency data were compared from 109 individuals with AD and 66 typically aging adults. Correct items, clusters, and errors were analyzed using both raw counts and proportions. Regression analyses examined Task-by-Group interactions and the impact of demographic variables on verbal fluency measures. ROC analyses examined the sensitivity and specificity of the different outcome measures. In regressions, interactions were found for raw but not proportional data, indicating that different group patterns were driven largely by the number of correct items produced. Similarly, in ROC analyses, raw SF totals showed stronger discriminability between groups than either raw discrepancy scores (SF-LF) or discrepancy ratios (SF/LF). Age and cognitive status (MMSE) were the strongest individual predictors of performance. Findings suggest that AD entails quantitative declines in verbal fluency, but qualitatively similar patterns of performance relative to typically aging adults. Thus, SF declines in AD seem to be at least partially attributable to an exaggeration of the underlying mechanisms common to typical aging, and do not necessarily implicate semantic disintegration.

Elderspeak communication and pain severity as modifiable factors to rejection of care in hospital dementia care.

BACKGROUND: Rejection of care (RoC) occurs when persons living with dementia (PLWD) withstand or oppose the efforts of their caregiver. Improvements in hospital dementia care are needed, and one way to address this need is by identifying factors that lead to RoC, particularly those that are modifiable. Elderspeak communication is an established antecedent to RoC among PLWD in nursing homes. The purpose of this study was to extend these results to acute care settings by determining the impact of elderspeak communication by nursing staff on RoC by hospitalized PLWD. METHODS: Care encounters between nursing staff and PLWD were audio-recorded, transcribed verbatim, and coded for semantic, pragmatic, and prosodic features of elderspeak. RoC behaviors was scored in real-time using the Resistiveness to Care Scale. A Bayesian repeated-measures hurdle model was used to evaluate the association between elderspeak and both the presence and severity of RoC. RESULTS: Eighty-eight care encounters between 16 PLWD and 53 nursing staff were audio-recorded for elderspeak and scored for RoC. Nearly all (96.6%) of the encounters included some form of elderspeak. Almost half of the care encounters (48.9%) included RoC behaviors. A 10% decrease in elderspeak was associated with a 77% decrease in odds of RoC (OR = 0.23, 95% CI = 0.03, 0.68) and a 16% decrease ( e ß =  0.84, CI = 0.73, 0.96) in the severity of RoC. A one-unit decrease in pain severity was associated with 73% reduced odds of RoC (OR = 0.27, CI = 0.12, 0.45) and a 28% decrease ( e ß =  0.72, CI = 0.64, 0.80) in the severity of RoC. CONCLUSIONS: Both elderspeak by nursing staff and RoC by PLWD are present and pervasive in acute care. Pain and elderspeak are two modifiable factors of RoC in hospitalized PLWD. Person-centered interventions are needed that address communication practices and pain management for hospitalized PLWD.

Characteristics of elderspeak communication in hospital dementia care: Findings from The Nurse Talk observational study.

BACKGROUND: Elderspeak communication is typically viewed as patronizing and infantilizing by older adults and can lead to resistive behaviors in persons living with dementia. Little is known about the presence of elderspeak communication in hospitals in the United States. Understanding this phenomenon in the hospital setting is needed in order to improve hospital dementia care. OBJECTIVES: The purpose of the Nurse Talk study was to (1) describe attributes of elderspeak use in hospital dementia care and to (2) determine what characteristics are associated with nursing staff use of elderspeak communication with hospitalized patients with dementia. DESIGN: A cross-sectional observational study design was used to collect and analyze audio-recordings of nursing staff during care for hospitalized patients with dementia. SETTING: Three hospital units in one Midwestern university hospital in the United States. PARTICIPANTS: A convenience sample of 53 staff nurses and nursing assistants that provided direct care to 16 patients with mild or more severe dementia recruited from October 2019 through mid-March 2020. METHODS: Eighty-eight care encounters were audio-recorded and coded for elderspeak communication using the Iowa Coding of Elderspeak scheme to determine the frequency and characteristics of elderspeak communication. A linear mixed effects model was used to determine what characteristics were associated with elderspeak and the frequency of elderspeak use by nursing staff to hospitalized patients with dementia. RESULTS: Over a quarter (28.7%) of all nursing staff speech directed towards patients with dementia constituted elderspeak and nearly all (96.6%) care encounters included some elderspeak. Particularly common attributes of elderspeak were minimizing words and mitigating expressions, childish terms and phrases, and collective pronoun substitution. A statistically significant interaction was identified between staff role and age (95% CI: -0.02, -0.00, p = .008) in predicting the frequency of elderspeak use, indicating that elderspeak was used more often by older staff nurses, whereas the age of nursing assistants remained constant across elderspeak use. Statically significant effects for delirium and length of stay were also demonstrated. Elderspeak use was 12.5% higher with patients with delirium (95% CI: 0.02, 0.23, p = .025) and increased 1.5% for each additional day the patient with dementia was hospitalized (95% CI: 0.00, 0.03, p = .035). CONCLUSIONS: Elderspeak is present and pervasive in the acute care setting. Interventions targeted towards older staff nurses and nursing staff from hospital units that care for patients with delirium and longer lengths of stay are needed. TWEETABLE ABSTRACT: This study identified that nursing staff are frequently using elderspeak (infantilizing speech) with hospitalized patients with dementia. @claireshaw_phd @IowaNursing.

How Do Clinicians Judge Fluency in Aphasia?

PURPOSE: Aphasia fluency is multiply determined by underlying impairments in lexical retrieval, grammatical formulation, and speech production. This poses challenges for establishing a reliable and feasible tool to measure fluency in the clinic. We examine the reliability and validity of perceptual ratings and clinical perspectives on the utility and relevance of methods used to assess fluency. METHOD: In an online survey, 112 speech-language pathologists rated spontaneous speech samples from 181 people with aphasia (PwA) on eight perceptual rating scales (overall fluency, speech rate, pausing, effort, melody, phrase length, grammaticality, and lexical retrieval) and answered questions about their current practices for assessing fluency in the clinic. RESULTS: Interrater reliability for the eight perceptual rating scales ranged from fair to good. The most reliable scales were speech rate, pausing, and phrase length. Similarly, clinicians' perceived fluency ratings were most strongly correlated to objective measures of speech rate and utterance length but were also related to grammatical complexity, lexical diversity, and phonological errors. Clinicians' ratings reflected expected aphasia subtype patterns: Individuals with Broca's and transcortical motor aphasia were rated below average on fluency, whereas those with anomic, conduction, and Wernicke's aphasia were rated above average. Most respondents reported using multiple methods in the clinic to measure fluency but relying most frequently on subjective judgments. CONCLUSIONS: This study lends support for the use of perceptual rating scales as valid assessments of speech-language production but highlights the need for a more reliable method for clinical use. We describe next steps for developing such a tool that is clinically feasible and helps to identify the underlying deficits disrupting fluency to inform treatment targets. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19326419.

Demystifying the Complexity of Aphasia Treatment: Application of the Rehabilitation Treatment Specification Systemx.

A considerable body of research supports the use of behavioral communication treatment as the standard of care for aphasia. In spite of robust progress in clinical aphasiology, many questions regarding optimal care remain unanswered. One of the major challenges to progress in the field is the lack of a common framework to adequately describe individual treatments, which, if available, would allow comparisons across studies as well as improved communication among researchers, clinicians, and other stakeholders. Here, we describe how aphasia treatment approaches can be systematically characterized using the Rehabilitation Treatment Specification System (RTSS). At the core of the RTSS is a tripartite structure that focuses on targets (the behavior that is expected to change as a result of treatment), ingredients (what a clinician does to affect change in the target), and mechanism(s) of action (why a given treatment works by linking the ingredients to the target). Three separate articles in the current issue specifically describe how the RTSS can be used to describe different kinds of aphasia treatment approaches: functional approaches, cognitive-linguistic approaches, and biological approaches. It is our hope that the application of the RTSS in clinical aphasiology will improve communication in published studies, grant proposals, and in the clinical care of persons with aphasia.

Evaluating Cognitive-Linguistic Approaches to Interventions for Aphasia Within the Rehabilitation Treatment Specification System.

The Rehabilitation Treatment Specification System (RTSS) provides a framework to identify specific components of treatments developed within various rehabilitation disciplines (eg, physical, occupational, or speech-language therapy). Furthermore, this framework offers the opportunity to identify the target and active ingredients of a therapy approach as well as the mechanism of action by which it is hypothesized to effect change in abilities or functions. In this article, we apply the RTSS framework to the characterization of a sample of treatments for aphasia that are based on cognitive-linguistic models of language processing. Our discussion of these applications centers on the benefits of this classification system and additional criteria to consider when evaluating cognitive-linguistic treatments for aphasia.

Understanding Elderspeak: An Evolutionary Concept Analysis.

BACKGROUND AND OBJECTIVES: Elderspeak is an inappropriate simplified speech register that sounds like baby talk and is used with older adults, especially in health care settings. Understanding the concept of elderspeak is challenging due to varying views about which communicative components constitute elderspeak and whether elderspeak is beneficial or harmful for older adults. RESEARCH DESIGN AND METHODS: Rodgers' evolutionary concept analysis method was used to evaluate the concept of elderspeak through identification of elderspeak's attributes, antecedents, and consequences. A systematic search using the PubMed, CINAHL, PsycINFO, and Embase databases was completed. RESULTS: Eighty-three theoretical or research articles from 1981 to 2020 were identified. Elderspeak characteristics were categorized by semantic, syntactic, pragmatic, paralinguistic, and nonverbal attributes. The primary antecedent to elderspeak is implicit ageism, in which old age cues and signs of functional or cognitive impairment led to simplified communication, usually from a younger caregiver. Research studies varied in reporting whether elderspeak facilitated or interfered with comprehension by older adults, in part depending on the operational definition of elderspeak and experimental manipulations. Exaggerated prosody, a key feature of elderspeak, was found to reduce comprehension. Elderspeak was generally perceived as patronizing by older adults and speakers were perceived as less respectful. In persons with dementia, elderspeak also increases the probability of resistiveness to care, which is an important correlate of behavioral and psychological symptoms of dementia. DISCUSSION AND IMPLICATIONS: Based on this concept analysis, a new definition of elderspeak is proposed, in which attributes that have been found to enhance comprehension are differentiated from those that do not. Recommendations for consistent operationalization of elderspeak in future research are made.

The effects of age and verbal ability on word predictability in reading.

Increased predictability effects in older compared to younger adults have been mostly observed in late eye-movement measures during reading. However, it is unclear whether and how these effects may be related to verbal ability, which typically improves with age. Past studies have shown that verbal abilities modulate the predictability effect. Here, we aimed to replicate predictability effects in younger and older adults in a sentence reading paradigm and to investigate how verbal ability modulates the predictability effect. We monitored 26 younger and 27 older adults' eye movements as they read sentences with target words varying in predictability and examined the impact of age and verbal ability, as reflected in vocabulary and print exposure measures. Replicating previous studies, we found that older adults relied more heavily on contextual information in their anticipation of upcoming input in one late measure. In one early measure (first-fixation duration), participants with higher scores in verbal ability showed greater predictability effects, whereas the predictability effect was virtually absent in those with low scores. In one late measure (regression-path duration), age interacted with predictability. However, verbal ability, when included as a covariate in this model, could not account for the age-related increases in predictability effects. Collectively, our findings indicate that verbal ability influences predictability effects in early processing stages, suggesting facilitation of initial word processing and that some aspect of aging other than verbal ability influences predictability effects in late measures. The latter finding most likely reflects a shift toward integrative controlled processes with age. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Factor Analysis of Spontaneous Speech in Aphasia.

Purpose Spontaneous speech tasks are critically important for characterizing spoken language production deficits in aphasia and for assessing the impact of therapy. The utility of such tasks arises from the complex interaction of linguistic demands (word retrieval, sentence formulation, articulation). However, this complexity also makes spontaneous speech hugely variable and difficult to assess. The current study aimed to simplify the problem by identifying latent factors underlying performance in spontaneous speech in aphasia. The ecological validity of the factors was examined by examining how well the factor structures corresponded to traditionally defined aphasia subtypes. Method A factor analysis was conducted on 17 microlinguistic measures of narratives from 274 individuals with aphasia in AphasiaBank. The resulting factor scores were compared across aphasia subtypes. Supervised (linear discriminant analysis) and unsupervised (latent profile analysis) classification techniques were then conducted on the factor scores and the solutions compared to traditional aphasia subtypes. Results Six factors were identified. Two reflected aspects of fluency, one at the phrase level (Phrase Building) and one at the narrative level (Narrative Productivity). Two other factors reflected the accuracy of productions, one at the word level (Semantic Anomaly) and one at the utterance level (Grammatical Error). The other two factors reflected the complexity of sentence structures (Grammatical Complexity) and the use of repair behaviors (Repair), respectively. Linear discriminant analyses showed that only about two thirds of speakers were classified correctly and that misclassifications were similar to disagreements between clinical diagnoses. The most accurately diagnosed syndromes were the largest groups-Broca's and anomic aphasia. The latent profile analysis also generated profiles similar to Broca's and anomic aphasia but separated some subtypes according to severity. Conclusions The factor solution and the classification analyses reflected broad patterns of spontaneous speech performance in a large and representative sample of individuals with aphasia. However, such data-driven approaches present a simplified picture of aphasia patterns, much as traditional syndrome categories do. To ensure ecological validity, a hybrid approach is recommended, balancing population-level analyses with examination of performance at the level of theoretically specified subgroups or individuals. Supplemental Material https://doi.org/10.23641/asha.13232354.

How Old Do You Think I Am? Speech-Language Predictors of Perceived Age and Communicative Competence.

Purpose Spoken language serves as a primary means of social interaction, but speech and language skills change with age, a potential source of age-related stereotyping. The goals of this study were to examine how accurately age could be estimated from language samples, to determine which speech and language cues were most informative, and to assess the impact of perceived age on judgments of the speakers' communication skills. Method We analyzed narratives from 84 speakers aged 30-89 years to identify age-related differences and compared these differences to factors affecting perceptions of age and communicative competence. Three groups of raters estimated the speakers' ages and judged the quality of their communication: 44 listeners listened to audio-recorded narratives, 51 readers read transcripts of the narratives, and 24 voice raters listened to 10-s samples of speech extracted from one of the narratives. Results Older speakers spoke more slowly but showed minimal linguistic differences compared to younger speakers. Speakers' ages were estimated quite accurately, even from 10-s samples. Estimates were largely based on cues available in the acoustic signal-speech rate and vocal characteristics-so listeners were more accurate than readers. However, an overreliance on these cues also contributed to overestimates of speakers' ages. Communication ratings were not strongly related to perceived age but were influenced by various aspects of speech and language. In particular, speakers who produced longer narratives and spoke more quickly were judged to be better communicators. Conclusion Speakers tend to be judged on relatively superficial aspects of spoken language, in part because age-related change is most evident at these levels. Implications of these findings for age-related theories of stereotyping and speech-language intervention are discussed.

Lexical prediction in the aging brain: The effects of predictiveness and congruency on the N400 ERP component.

Although the N400 ERP component has been extensively studied in younger adults, the underlying mechanisms are still unclear. In older adults, N400 ERP studies have shown less efficient use of context compared to younger adults. Here, we asked whether the mechanisms underlying the N400 effect are the same in terms of predictiveness and congruency in younger and older adults. We used a simple picture-word matching task in which we crossed predictiveness and congruency. Our results indicate a three-way interaction between predictiveness, congruency, and age, in that, younger adults showed an N400 effect only in strongly constrained conditions; whereas, older adults showed an effect in both strongly- and weakly constrained conditions. This interaction was not modulated by language experience or cognitive decline. Our results support either two separate mechanisms (lexical access and integration) that run in parallel and are modulated by age or a common prediction error mechanism that changes with age.

Why do older adults have difficulty with semantic fluency?

Aging involves many cognitive declines, particularly in fluid intelligence, with relative maintenance of crystallized intelligence. This paradox is evident in the language domain: lexical retrieval becomes slower and less accurate, despite well preserved vocabularies. Verbal fluency assesses both crystallized and fluid aspects of language. Semantic fluency hypothetically reflects semantic knowledge, while letter fluency putatively reflects executive functioning, which would predict a greater impact of aging on the latter. However, the opposite is typically observed. To investigate factors contributing to such asymmetries, we examined verbal fluency in 86 adults (30-89 years). Multiple regression analyses indicated that semantic fluency depends largely on lexical retrieval speed, as well as visualization strategies to support controlled retrieval, skills which may disproportionately decline with age. By contrast, letter fluency relies heavily on vocabulary knowledge, providing some protection against age-related declines. These findings contribute to our understanding of the mechanisms of typical age-related declines in word retrieval.

Older is wiser? It depends who you ask and how you ask.

Interacting with older adults can trigger a number of stereotypes. Negative stereotypes tend to dominate, but a persistent positive perception of aging in the popular psyche is that age brings wisdom. Despite this common belief, previous research suggests that the relationship between age and wisdom is weak and inconsistent. We propose that this is due to opposing perceptions of aging - gains in life experience and socioemotional skills, counteracted by declines in cognitive skill - that also vary with characteristics of the perceiver and the context. We investigated these paradoxical perceptions of aging by asking younger (aged 20-40) and older (aged 60-80) adult judges to rate adult speakers (aged 30-89) on the basis of their responses to three narrative prompts. Several aspects of wisdom were judged, including those related to cognitive skills, and those related to socioemotional aspects of wisdom. We examined the impact on ratings of speaker and rater characteristics, as well as the interaction of these characteristics with the dimension being rated. Findings showed that the wisdom ratings were higher for speakers with better verbal fluency, and that the relationship between age and perceived wisdom was moderated by the speaker's gender. Consistent with prior work, speaker age (relative to rater's age) had a negative effect on cognitive aspects of wisdom, but a positive effect on socio-affective aspects of wisdom. Implications for understanding age-related stereotypes and conceptions of wisdom are discussed.

Finding Meaning in Written Emotional Expression by Family Caregivers of Persons With Dementia.

This study tested the effect of written emotional expression on the ability to find meaning in caregiving and the effects of finding meaning on emotional state and psychological burden in 91 dementia family caregivers. In a pretest-posttest design, participants were randomly assigned to either an experimental or a comparison group. Experimental caregivers (n = 57) wrote about their deepest thoughts and feelings about caring for a family member with dementia, whereas those in the comparison group (n = 34) wrote about nonemotional topics. Results showed enhanced meaning-making abilities in experimental participants relative to comparison participants, particularly for those who used more positive emotion words. Improved meaning-making ability was in turn associated with psychological benefits at posttest, but experimental participants did not show significantly more benefit than comparison participants. We explore the mediating roles of the meaning-making process as well as some of the background characteristics of the individual caregivers and their caregiving environments.

The Aging Neighborhood: Phonological Density in Naming.

Aging affects the ability to retrieve words for production, despite maintainence of lexical knowledge. In this study, we investigate the influence of lexical variables on picture naming accuracy and latency in adults ranging in age from 22 to 86 years. In particular, we explored the influence of phonological neighborhood density, which has been shown to exert competitive effects on word recognition, but to facilitate word production, a finding with implications for models of the lexicon. Naming responses were slower and less accurate for older participants, as expected. Target frequency also played a strong role, with facilitative frequency effects becoming stronger with age. Neighborhood density interacted with age, such that naming was slower for high-density than low-density items, but only for older subjects. Explaining this finding within an interactive activation model suggests that, as we age, the ability of activated neighbors to facilitate target production diminishes, while their activation puts them in competition with the target.

Semantic interference in a randomized naming task: effects of age, order, and category.

Lexical retrieval in production is a competitive process, requiring activation of a target word from semantic input and its selection from amongst coactivated items. Competitors are automatically primed through spreading activation within the lexicon, but competition may be increased by the prior presentation of related items: the semantic interference effect. This has been demonstrated in tasks in which pictures grouped by semantic category are compared to unrelated pictures (blocked naming) and in tasks involving successive naming of items from the same semantic category (continuous naming). Such highly structured tasks may not be representative of the processes at work under more natural word retrieval conditions. Therefore, we conducted a retrospective examination of naming latencies from a randomized picture naming task containing a wide variety of items and categories. Our large sample of adults, ranging in age from 22 to 89 years, also allowed us to test the hypothesis that older adults, who are particularly susceptible to word-retrieval problems, experience increased difficulty resolving competition among lexical items. Semantic interference effects were evident in the interaction between semantic category and order of presentation within a block-miscellaneous items were named more quickly, whereas related items were named more slowly. This interference effect did not vary with participant age, contrary to the hypothesis that older adults are more susceptible to semantic interference.

Measuring the lexical semantics of picture description in aphasia.

BACKGROUND: Individuals with non-fluent aphasia have difficulty producing syntactically laden words, such as function words, whereas individuals with fluent aphasia often have difficulty producing semantically specific words. It is hypothesised that such dissociations arise, at least in part, from a trade-off between syntactic and semantic sources of input to lexical retrieval. AIMS: The aims of this study were (a) to identify quantitative measures of the semantic content of narrative for people with aphasia that are reliable indicators of semantic competence, independent of overall aphasia severity; (b) to determine whether these measures distinguish between fluent and non-fluent aphasia; and (c) to assess whether individuals with fluent and non-fluent aphasia show a trade-off between measures of syntactic and semantic production. METHODS #ENTITYSTARTX00026; PROCEDURES: Connected speech samples were elicited from 16 participants with aphasia, 8 fluent and 8 non-fluent. The semantic sufficiency of the samples was analysed by measuring the proportion of correct information units (CIUs), the type-token ratios (TTRs) of content words, and the proportion of semantically specific ("heavy") to semantically general ("light") verbs produced. These measures were then correlated with syntactic measures from the QPA (Berndt, Wayland, Rochon, Saffran, & Schwartz, 2000) across and within participant groups. OUTCOMES #ENTITYSTARTX00026; RESULTS: CIUs were found to reflect primarily aphasia severity, and not to differentiate between fluent and non-fluent groups. TTRs were also strongly influenced by severity among fluent, but not non-fluent, participants. The ratio of heavy to light verbs reliably distinguished the groups, and showed different patterns of correlation with the syntactic measures. CONCLUSIONS: Results show some evidence for a trade-off between syntactic and semantic inputs to word retrieval, at least among non-fluent participants. The heavy-light verb ratio provides information about semantic specificity, beyond what is provided by the CIU or TTR measures.

A neural signature of phonological access: distinguishing the effects of word frequency from familiarity and length in overt picture naming.

Cognitive models of word production correlate the word frequency effect (i.e., the fact that words which appear with less frequency take longer to produce) with an increased processing cost to activate the whole-word (lexical) phonological representation. We performed functional magnetic resonance imaging (fMRI) while subjects produced overt naming responses to photographs of animals and manipulable objects that had high name agreement but were of varying frequency, with the purpose of identifying neural structures participating specifically in activating whole-word phonological representations, as opposed to activating lexical semantic representations or articulatory-motor routines. Blood oxygen level-dependent responses were analyzed using a parametric approach based on the frequency with which each word produced appears in the language. Parallel analyses were performed for concept familiarity and word length, which provided indices of semantic and articulatory loads. These analyses permitted us to identify regions related to word frequency alone, and therefore, likely to be related specifically to activation of phonological word forms. We hypothesized that the increased processing cost of producing lower-frequency words would correlate with activation of the left posterior inferotemporal (IT) cortex, the left posterior superior temporal gyrus (pSTG), and the left inferior frontal gyrus (IFG). Scan-time response latencies demonstrated the expected word frequency effect. Analysis of the fMRI data revealed that activity in the pSTG was modulated by frequency but not word length or concept familiarity. In contrast, parts of IT and IFG demonstrated conjoint frequency and familiarity effects, and parts of both primary motor regions demonstrated conjoint effects of frequency and word length. The results are consistent with a model of word production in which lexical-semantic and lexical-phonological information are accessed by overlapping neural systems within posterior and anterior language-related cortices, with pSTG specifically involved in accessing lexical phonology.