A systematic review of goal attainment scaling implementation practices by caregivers in randomized controlled trials.

BACKGROUND: Goal attainment scaling (GAS), an established individualized, patient-centred outcome measure, is used to capture the patient's voice. Although first introduced ~60 years ago, there are few published guidelines for implementing GAS, and almost none for its use when caregivers GAS is implemented with caregiver input. We conducted a systematic review of studies that implemented GAS with caregiver input; and examined variations in GAS implementation, analysis, and reporting. METHODS: Literature was retrieved from Medline, Embase, Cochrane, PsycInfo and CINAHL databases. We included randomized controlled trials (published between 1968 and November 2022) that used GAS as an outcome measure and involved caregiver input during goal setting. RESULTS: Of the 2610 studies imported for screening, 21 met the inclusion criteria. Most studies employed GAS as a primary outcome. The majority (76%) had children as study participants. The most common disorders represented were cerebral palsy, developmental disorders, and dementia/Alzheimer's disease. The traditional five-point GAS scale, with levels from -2 to +2, was most often implemented, with -1 level typically being the baseline. However, most studies omitted essential GAS details from their reports including the number of goals set, number of attainment levels and whether any training was given to GAS facilitators. CONCLUSIONS: GAS with caregiver input has been used in a limited number of randomized controlled trials, primarily in pediatric patients and adults with dementia. There is a variability in GAS implementation and many crucial details related to the specifics of GAS implementation are omitted from reports, which may limit reproducibility. Here we propose catalog that may be utilized when reporting research results pertaining to GAS with caregivers to enhance the application of this patient-centered outcome measure.

Reading and spelling profiles of adult poor readers: Phonological, orthographic and morphological considerations.

Reading and spelling skills are important to communicate in today's literate society, however, the underlying processes of spelling skills are under-researched compared to reading skills. Our goals were to (a) study how the component skills of phonological, orthographic and morphological awareness are different in adults with and without reading difficulties, and (b) characterize the relationship between the component skills and reading and spelling performance in both skilled and poor readers. Participants (N = 37, N = 15 with reading impairments and N = 22 skilled readers) took part in the study where they completed several literacy-based measures. We performed a series of mixed ANOVAs to study the between-group differences in performance and the relationship between different literacy outcomes, respectively. We found evidence for poor phonological and morphological awareness in the poor readers compared to the skilled readers. We also found differential relationships between the component skills and reading and spelling behavior. Specifically, sound awareness was significantly related to reading and spelling measures in the skilled readers, whereas morphological and sound awareness played an important role in the same skills in the poor readers. We discuss these findings in the context of potential remediation strategies for adults with persistent literacy impairments.

An investigation of white matter properties as they relate to spelling behaviour in skilled and impaired readers.

RESULTS: While the inferior longitudinal fasciculus was more strongly related to spelling behaviour in skilled adults, the uncinate fasciculus was more strongly related to spelling behaviour in impaired adults. We found strong left lateralization of the arcuate fasciculus and inferior longitudinal fasciculus in both groups. However, lateralization of the inferior frontal occipital fasciculus was more strongly related to spelling response time behaviour in skilled adults, whereas lateralization of the uncinate fasciculus was more strongly related to spelling accuracy behaviour in the impaired adults. CONCLUSION: This study provides some useful information for understanding the underlying white matter pathways that support spelling in skilled and impaired adults and underscore the advantage of adopting multiple spelling tasks and outcomes (i.e., response time and accuracy) to better characterize brain-behaviour relationships in skilled and impaired adults.

The Relationship between White Matter and Reading Acquisition, Refinement and Maintenance.

Reading requires efficient communication between brain regions that are situated all over the cortex. These brain areas are structurally connected by white-matter pathways that develop over the period of reading acquisition. Here, we conducted a cross-sectional study to assess the relationship between white-matter tracts and reading performance across the lifespan. METHODS: Behavioral (reading performance) and neuroimaging (diffusion tensor imaging [DTI]) data were collected from participants aged 3-21 years as a part of the multi-site project called the pediatric imaging neurocognition genetics study. DTI measures (fractional anisotropy [FA], mean diffusivity, radial diffusivity and axial diffusivity) of bilateral dorsal tracts (arcuate fasciculus, superior longitudinal fasciculus, and posterior superior longitudinal fasciculus) and ventral tracts (uncinate fasciculus, inferior fronto-occipital fasciculus, and inferior longitudinal fasciculus) were extracted. Reading performance was calculated as the number of items correctly read (words for older children and letters in the case of young children). Correlational and regression analyses were conducted between the DTI measures and reading scores. RESULTS: During the early stages of reading acquisition (ages 3-6), the dorsal tracts were positively related to reading performance (as FA goes up, reading performance goes up). For ages 6-10, the dorsal tracts remain positively associated with reading performance and a relationship between ventral tracts and reading performance emerges. From the age of 10 onwards, the dorsal tracts no longer correlate with reading performance, and a brain-behavior relationship in the right ventral tracts begins to shift, whereby higher FA is associated with lower reading performance. In addition to the involvement of left hemispheric tracts, this study revealed the initial engagement of right hemispheric tracts during the early stages of reading acquisition. CONCLUSION: We discuss these different associations of white-matter tracts with reading during development in the context of the biological processes model of myelination and pruning.

"To Name or Not to Name: That is the Question": The Role of Response Inhibition in Reading.

Reading is a complex process that includes the integration of information about letters (graphemes) and sounds (phonemes). In many circumstances, such as noisy environments, response inhibition is an additional factor that plays a marked role in successful oral reading. Response inhibition can take the form of task relevant inhibition (i.e., foils in a go/no-go task) and task irrelevant inhibition (i.e., distractor information). Here we investigated task relevant inhibition by having participants (N = 30) take part in two tasks: go/no-go naming with nonwords foils (GNG-NW) and go/no-go naming with pseudohomophones foils (GNG-PH). Also, we investigated the addition of task irrelevant inhibition by having participants (N = 28) take part in two tasks: GNG-NW + information masking and GNG-PH + information masking. We provide evidence that during a task relevant inhibition task, sub-word sound level information can be successfully inhibited, as evidenced by comparable response times for regular words and exception words, provided the foils do not contain familiar sound-based information (GNG-NW). In contrast, regular words were read aloud faster than exception words in a GNG-PH task, indicating that sub-word level interference occurs when the foils contain familiar sound-based information. The addition of task irrelevant inhibition (i.e., information masking at the phoneme level), served to increase response time overall, but did not impact the pattern of response times between regular words and exception words. Together these findings provide useful information regarding the role of response inhibition in word recognition and may be useful in computational models of word recognition and future work may benefit from accounting for the effects outlined in this paper.

Exploring the role of subcortical structures in developmental reading impairments: evidence for subgroups differentiated by caudate activity.

Although the role of cortical structures in skilled and impaired reading has been the topic of considerable investigation, the contribution of subcortical structures to reading performance is less well understood. Here, we assess the role of the caudate, putamen, and thalamus in adults with and without reading impairment. Thirty-three individuals (19 skilled readers and 14 reading impaired individuals) participated in two functional MRI tasks: (a) silent reading of real words and (b) silent reading of nonwords. Percent signal change was calculated for each of the three structures by evaluating the signal change relative to the baseline (i.e. no task or fixation crosses), and response time was measured for each reading condition. We found that for skilled readers, activity in the putamen predicted behavioral performance for both real words and nonwords. In contrast, we found evidence for two subgroups of impaired readers: a positive caudate activity group and a negative caudate activity group. Interestingly, brain activity differentially predicted reading performance depending on whether individuals had positive or negative caudate activity. We discuss our findings in the context of developmental reading impairments, print-to-speech networks, and language processing in general.

Pathways of the inferior frontal occipital fasciculus in overt speech and reading.

In this study, we examined the relationship between tractography-based measures of white matter integrity (ex. fractional anisotropy [FA]) from diffusion tensor imaging (DTI) and five reading-related tasks, including rapid automatized naming (RAN) of letters, digits, and objects, and reading of real words and nonwords. Twenty university students with no reported history of reading difficulties were tested on all five tasks and their performance was correlated with diffusion measures extracted through DTI tractography. A secondary analysis using whole-brain Tract-Based Spatial Statistics (TBSS) was also used to find clusters showing significant negative correlations between reaction time and FA. Results showed a significant relationship between the left inferior fronto-occipital fasciculus FA and performance on the RAN of objects task, as well as a strong relationship to nonword reading, which suggests a role for this tract in slower, non-automatic and/or resource-demanding speech tasks. There were no significant relationships between FA and the faster, more automatic speech tasks (RAN of letters and digits, and real word reading). These findings provide evidence for the role of the inferior fronto-occipital fasciculus in tasks that are highly demanding of orthography-phonology translation (e.g., nonword reading) and semantic processing (e.g., RAN object). This demonstrates the importance of the inferior fronto-occipital fasciculus in basic naming and suggests that this tract may be a sensitive predictor of rapid naming performance within the typical population. We discuss the findings in the context of current models of reading and speech production to further characterize the white matter pathways associated with basic reading processes.