Attention Process Training-3 to improve reading comprehension in mild aphasia: A single-case experimental design study.

People with aphasia frequently present with nonlinguistic deficits, in addition to their compromised language abilities, which may contribute to their problems with reading comprehension. Treatment of attention, working memory and executive control may improve reading comprehension in individuals with aphasia, particularly those with mild reading problems. This single-case experimental design study evaluated the efficacy of Attention Process Training-3, an intervention combining direct attention training and metacognitive facilitation, for improving reading comprehension in individuals with mild aphasia. A multiple baseline design across six participants was used to evaluate treatment effects. The primary outcome measure was a maze reading task. Cognitive measures were administered pre- and post-treatment. Visual inspection of graphed maze reading performance data indicated a basic effect between APT-3 and improved maze reading for three of the six participants. Quantitative analyses, using Tau-U, corroborated findings identified through visual analysis. The overall effect size was significant (Tau = .48, p = .01). Results suggest that APT-3 has the potential to improve reading in individuals with aphasia, but that it may be more efficacious under certain conditions. Treatment and participant variables, including intensity of treatment and metacognitive strategy usage, are discussed as potential influences on participants' responsiveness to APT-3.

Changes in Structural Connectivity Following a Cognitive Intervention in Children With Traumatic Brain Injury.

OBJECTIVE: Structural connectivity analysis based on graph theory and diffusion tensor imaging tractography is a novel method that quantifies the topological characteristics in the brain network. This study aimed to examine structural connectivity changes following the Attention Intervention and Management (AIM) program designed to improve attention and executive function (EF) in children with traumatic brain injury (TBI). METHODS: Seventeen children with complicated mild to severe TBI (13.66 ± 2.68 years; >12 months postinjury) completed magnetic resonance imaging (MRI) and neurobehavioral measures at time 1, 10 of whom completed AIM and assessment at time 2. Eleven matched healthy comparison (HC) children (13.37 ± 2.08 years) completed MRI and neurobehavioral assessment at both time points, but did not complete AIM. Network characteristics were analyzed to quantify the structural connectivity before and after the intervention. RESULTS: Mixed model analyses showed that small-worldness was significantly higher in the TBI group than the HC group at time 1, and both small-worldness and normalized clustering coefficient decreased significantly at time 2 in the TBI group whereas the HC group remained relatively unchanged. Reductions in mean local efficiency were significantly correlated with improvements in verbal inhibition and both parent- and child-reported EF. Increased normalized characteristic path length was significantly correlated with improved sustained attention. CONCLUSION: The results provide preliminary evidence suggesting that graph theoretical analysis may be a sensitive tool in pediatric TBI for detecting ( a) abnormalities of structural connectivity in brain network and ( b) structural neuroplasticity associated with neurobehavioral improvement following a short-term intervention for attention and EF.

Cognitive Intervention for Attention and Executive Function Impairments in Children With Traumatic Brain Injury: A Pilot Study.

OBJECTIVE: To test the effectiveness of the Attention Improvement and Management (AIM) program, a cognitive intervention for improving impairments in attention and executive functions (EFs) after pediatric traumatic brain injury (TBI). SETTING: Tertiary care children's hospital. PARTICIPANTS: A total of 13 children with complicated mild-to-severe TBI (average of 5 years postinjury) and 11 healthy comparison children aged 9 to 15 years completed the study. DESIGN: Open-label pilot study with a nontreated control group. MAIN MEASURES: Subtests from the Test of Everyday Attention-for Children (TEA-Ch) and the Delis-Kaplan Executive Function System (D-KEFS), the self- and parent-report from the Behavior Rating Inventory of Executive Function (BRIEF), and the Goal Attainment Scale (GAS). RESULTS: Relative to the healthy comparison group, children with TBI demonstrated significant improvement postintervention on a neuropsychological measure of sustained attention, as well as on parent-reported EFs. The majority of families also reported expected or more-than-expected personalized goal attainment. CONCLUSIONS: The study provides preliminary evidence for the effectiveness of AIM in improving parent-reported EFs and personalized real-world goal attainment in children with TBI.

Examining the role of attention and instruction in at-risk kindergarteners: electrophysiological measures of selective auditory attention before and after an early literacy intervention.

Several studies report that adults and adolescents with reading disabilities also experience difficulties with selective attention. In the present study, event-related brain potentials (ERPs) were used to examine the neural mechanisms of selective attention in kindergarten children at risk for reading disabilities (AR group, n = 8) or on track in early literacy skills (OT group, n = 6) across the first semester of kindergarten. The AR group also received supplemental instruction with the Early Reading Intervention (ERI). Following ERI, the AR group demonstrated improved skills on standardized early literacy measures such that there were no significant differences between the AR and OT groups at posttest or winter follow-up. Analysis of the ERP data revealed that at the start of kindergarten, the AR group displayed reduced effects of attention on sensorineural processing compared to the OT group. Following intervention, this difference between groups disappeared, with the AR group only showing improvements in the effect of attention on sensorineural processing. These data indicate that the neural mechanisms of selective attention are atypical in kindergarten children at risk for reading failure but can be improved by effective reading interventions.

Phase I evaluation of the television assisted prompting system to increase completion of home exercises among stroke survivors.

PURPOSE. Effective delivery of dysphagia exercises requires intensive repetition, yet many brain injury survivors demonstrate difficulty adhering to home programmes. The Television Assisted Prompting (TAP) system provides a novel method to deliver intensive in-home therapy prompts. Specific research questions compared the effectiveness of the TAP system to typical practice on programme adherence, satisfaction and caregiver burden. METHOD. A within-participant alternating treatment design with random assignment of treatment condition compared exercise programme adherence across TAP and typical practice delivery conditions, replicated across three participants. Data included quantitative programme completion rates, satisfaction survey reports and caregiver burden questionnaire results, as well as qualitative interview findings. RESULTS. A large treatment effect was demonstrated for two participants; exercise programme completion rates increased by 6-17 times typical practice levels with the TAP system. TAP supported sustained practice over the course of the experiment for the third participant despite minimal differences between conditions. Participants reported high satisfaction and endorsed the TAP system. There was no significant change in caregiver burden. CONCLUSION. The TAP system provided a novel assistive tool to support home programme completion of intensive exercise regimens for clients with cognitive impairment and care providers with significant burden. Future research must ensure continued development of a reliable and intuitive system.

Emergence of the neural network for reading in five-year-old beginning readers of different levels of pre-literacy abilities: an fMRI study.

The present study traced the emergence of the neural circuits for reading in five-year-old children of diverse pre-literacy ability. In the fall and winter of kindergarten, children performed a one-back task with letter versus false font stimuli during fMRI scanning. At the start of kindergarten, children with on-track pre-literacy skills (OT) recruited bilateral temporo-parietal regions for the letter > false font comparison. In contrast, children at-risk for reading difficulty (AR) showed no differential activation in this region. Following 3 months of kindergarten and, for AR children, supplemental reading instruction, OT children showed left-lateralized activation in the temporo-parietal region, whereas AR children showed bilateral activation and recruitment of frontal regions including the anterior cingulate cortex. These data suggest that typical reading development is associated with initial recruitment and subsequent disengagement of right hemisphere homologous regions while atypical reading development may be associated with compensatory recruitment of frontal regions.

Intensifying instruction: Does additional instructional time make a difference for the most at-risk first graders?

Research is clear on the benefit of early intervention efforts and the importance of intensive instructional supports; however, understanding which features to intensify is less clear. General intervention features of group size, instructional delivery, and time are areas schools can consider manipulating to intensify instruction. Also, each of these features can vary along a continuum making them easier or more challenging for schools to implement. What is unclear is if implementing very intensive interventions early in school (first grade), which require significantly more school resources, provides accordingly accelerated student learning. This article investigates the role of intensifying instructional time for the most at-risk first graders in schools implementing research-based instructional and assessment practices within multitiered instructional support systems. Results indicate that students receiving more intensive intervention made significantly more progress across a range of early reading measures. Intervention features, limitations, recommendations for practice, and implications for treatment resisters are discussed.

Predicting reading success in a multilevel schoolwide reading model: a retrospective analysis.

Despite recent research findings that implicate a long list of student variables that predict reading success or failure, these predictor variables have not been considered in the context of contemporary models of multitiered schoolwide reading intervention. This longitudinal, retrospective study follows 668 kindergarten and first-grade students identified as at risk for later reading difficulties through third grade. Key predictor variables were examined to determine their validity for predicting initial status and growth on oral reading fluency, third-grade oral reading fluency, and third-grade performance on a standardized test of reading. Results are provided in light of the instructional model provided. Implications for instruction and assessment are discussed.

Attributes of effective and efficient kindergarten reading intervention: an examination of instructional time and design specificity.

A randomized experimental design with three levels of intervention was used to compare the effects of beginning reading interventions on early phonemic, decoding, and spelling outcomes of 96 kindergartners identified as at risk for reading difficulty. The three instructional interventions varied systematically along two dimensions--time and design of instruction specificity--and consisted of (a) 30 min with high design specificity (30/H), (b) 15 min with high design specificity plus 15 min of non-code-based instruction (15/H+15), and (c) a commercial comparison condition that reflected 30 min of moderate design specificity instruction (30/M). With the exception of the second 15 min of the 15/H+15 condition, all instruction focused on phonemic, alphabetic, and orthographic skills and strategies. Students were randomly assigned to one of the three interventions and received 108 thirty-minute sessions of small-group instruction as a supplement to their typical half-day kindergarten experience. Planned comparisons indicated findings of statistical and practical significance that varied according to measure and students' entry-level performance. The results are discussed in terms of the pedagogical precision needed to design and provide effective and efficient instruction for students who are most at risk.

Beginning reading intervention as inoculation or insulin: first-grade reading performance of strong responders to kindergarten intervention.

This study examined the first-grade reading progress of children who participated in an intensive beginning reading intervention in kindergarten. Specifically, the study investigated whether kindergarten intervention could prevent first-grade reading difficulties, or produce an "inoculation" effect, for some children under certain instructional conditions. Participants included children at risk for developing reading difficulties who received a 7-month beginning reading intervention in kindergarten. In October of first grade, 59 children who had achieved criterion levels on measures of phonological awareness and alphabetic knowledge were randomly assigned to one of two types of first-grade reading instruction: (a) code-based classroom instruction and a supplemental maintenance intervention, or (b) only code-based classroom instruction. February posttest measures assessed oral reading fluency, word reading, nonword reading, and comprehension. Between-group analyses indicated that instructional groups did not differ on any posttest measure. The students' absolute levels of achievement were compared to national and local normative samples. These results indicated that between 75% and 100% of students in both conditions attained posttest levels and demonstrated growth comparable to their average-achieving peers. These results support the hypothesis that strong responders to kindergarten intervention can experience an inoculation effect through the middle of first grade with research-validated classroom reading instruction.