Read, Understand, Learn, & Excel: Development and Testing of an Automated Reading Strategy Detection Algorithm for Postsecondary Students.

Purpose An important predictor of postsecondary academic success is an individual's reading comprehension skills. Postsecondary readers apply a wide range of behavioral strategies to process text for learning purposes. Currently, no tools exist to detect a reader's use of strategies. The primary aim of this study was to develop Read, Understand, Learn, & Excel, an automated tool designed to detect reading strategy use and explore its accuracy in detecting strategies when students read digital, expository text. Method An iterative design was used to develop the computer algorithm for detecting 9 reading strategies. Twelve undergraduate students read 2 expository texts that were equated for length and complexity. A human observer documented the strategies employed by each reader, whereas the computer used digital sequences to detect the same strategies. Data were then coded and analyzed to determine agreement between the 2 sources of strategy detection (i.e., the computer and the observer). Results Agreement between the computer- and human-coded strategies was 75% or higher for 6 out of the 9 strategies. Only 3 out of the 9 strategies-previewing content, evaluating amount of remaining text, and periodic review and/or iterative summarizing-had less than 60% agreement. Conclusion Read, Understand, Learn, & Excel provides proof of concept that a reader's approach to engaging with academic text can be objectively and automatically captured. Clinical implications and suggestions to improve the sensitivity of the code are discussed. Supplemental Material https://doi.org/10.23641/asha.8204786.

Evaluation of a computer-based prompting intervention to improve essay writing in undergraduates with cognitive impairment after acquired brain injury.

This study evaluated a computer-based prompting intervention for improving expository essay writing after acquired brain injury (ABI). Four undergraduate participants aged 18-21 with mild-moderate ABI and impaired fluid cognition at least 6 months post-injury reported difficulty with the writing process after injury. The study employed a non-concurrent multiple probe across participants, in a single-case design. Outcome measures included essay quality scores and number of revisions to writing counted then coded by type using a revision taxonomy. An inter-scorer agreement procedure was completed for quality scores for 50% of essays, with data indicating that agreement exceeded a goal of 85%. Visual analysis of results showed increased essay quality for all participants in intervention phase compared with baseline, maintained 1 week after. Statistical analyses showed statistically significant results for two of the four participants. The authors discuss external cuing for self-monitoring and tapping of existing writing knowledge as possible explanations for improvement. The study provides preliminary evidence that computer-based prompting has potential to improve writing quality for undergraduates with ABI.

Read, Understand, Learn, & Excel (RULE): Development and Feasibility of a Reading Comprehension Measure for Postsecondary Learners.

Purpose: There is a lack of quick, reliable, and valid standardized reading comprehension assessments appropriate for postsecondary readers. We attempted to address this gap by designing Read, Understand, Learn, & Excel (RULE), a reading comprehension measure that employs sentence verification and recall tasks to assess reading comprehension. This article describes the exploratory study undertaken to construct RULE and then examines the preliminary concurrent validity and alternate form reliability of this measure. Method: The RULE measure was first developed by designing reading stimuli, test items for the sentence verification task, and directions for the recall test for 2 forms based on previous work (Griffiths, Sohlberg, Kirk, Fickas, & Biancarosa, 2016). Thirty undergraduate students who identified themselves as typical readers were administered the RULE measure as well as the Nelson-Denny Reading Test (Brown, Fishco, & Hanna, 1993). Students also completed questionnaires and participated in informal interviews to provide information regarding study and learning habits and academic background. Results: There was preliminary evidence of alternate form reliability between the sentence verification task sets of 2 chapters of RULE (r = .38, p < .05). Preliminary evidence for concurrent validity between RULE and the Nelson-Denny Reading Test was provided by correlation coefficients in the low to moderate range (.03-.38). Conclusion: RULE design and preliminary findings of concurrent validity and alternate form reliability provide "proof of concept" for an ecologically valid testing format that assesses comprehension skills appropriate for the postsecondary level. Suggestions for strengthening validity and reliability of the tool are provided, and clinical contributions of RULE are discussed. Supplemental Material: https://doi.org/10.23641/asha.6987371.

Evaluation of use of reading comprehension strategies to improve reading comprehension of adult college students with acquired brain injury.

Adults with mild to moderate acquired brain injury (ABI) often pursue post-secondary or professional education after their injuries in order to enter or re-enter the job market. An increasing number of these adults report problems with reading-to-learn. The problem is particularly concerning given the growing population of adult survivors of ABI. Despite the rising need, empirical evaluation of reading comprehension interventions for adults with ABI is scarce. This study used a within-subject design to evaluate whether adult college students with ABI with no more than moderate cognitive impairments benefited from using reading comprehension strategies to improve comprehension of expository text. Integrating empirical support from the cognitive rehabilitation and special education literature, the researchers designed a multi-component reading comprehension strategy package. Participants read chapters from an introductory-level college anthropology textbook in two different conditions: strategy and no-strategy. The results indicated that reading comprehension strategy use was associated with recall of more correct information units in immediate and delayed free recall tasks; more efficient recall in the delayed free recall task; and increased accuracy recognising statements from a sentence verification task designed to reflect the local and global coherence of the text. The findings support further research into using reading comprehension strategies as an intervention approach for the adult ABI population. Future research needs include identifying how to match particular reading comprehension strategies to individuals, examining whether reading comprehension performance improves further through the incorporation of systematic training, and evaluating texts from a range of disciplines and genres.

Developing Brain Injury Interventions on Both Ends of the Treatment Continuum Depends Upon Early Research Partnerships and Feasibility Studies.

PURPOSE: The purpose of this research article is to describe two very different lines of brain injury treatment research, both of which illuminate the benefits of implementation science. METHOD: The article first describes the development and pilot of a computerized cognitive intervention and highlights how adherence to implementation science principles improved the design of the intervention. Second, the article describes the application of implementation science to the development of assistive technology for cognition. RESULTS: The Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009) and the menu of implementation research strategies by Powell et al. (2012) provide a roadmap for cognitive rehabilitation researchers to attend to factors in the implementation climate that can improve the development, usability, and adoptability of new treatment methods. CONCLUSION: Attention to implementation science research principles has increased the feasibility and efficacy of both impairment-based cognitive rehabilitation programs and assistive technology for cognition.

An Exploratory Study of Reading Comprehension in College Students After Acquired Brain Injury.

PURPOSE: This exploratory study builds on the small body of existing research investigating reading comprehension deficits in college students with acquired brain injury (ABI). METHOD: Twenty-four community college students with ABI completed a battery of questionnaires and standardized tests to characterize self-perceptions of academic reading ability, performance on a standardized reading comprehension measure, and a variety of cognitive functions of this population. Half of the participants in the sample reported traumatic brain injury (n = 12) and half reported nontraumatic ABI (n = 12). RESULTS: College students with both traumatic and nontraumatic ABI cite problems with reading comprehension and academic performance postinjury. Mean performance on a standardized reading measure, the Nelson-Denny Reading Test (Brown, Fischo, & Hanna, 1993), was low to below average and was significantly correlated with performance on the Speed and Capacity of Language Processing Test (Baddeley, Emslie, & Nimmo-Smith, 1992). Injury status of traumatic versus nontraumatic ABI did not differentiate results. Regression analysis showed that measures of verbal attention and suppression obtained from the California Verbal Language Test-II (Delis, Kramer, Kaplan, & Ober, 2000) predicted total scores on the Nelson-Denny Reading Test. CONCLUSIONS: College students with ABI are vulnerable to reading comprehension problems. Results align with other research suggesting that verbal attention and suppression problems may be contributing factors.

An evaluation of reading comprehension of expository text in adults with traumatic brain injury.

PURPOSE: This project was conducted to obtain information about reading problems of adults with traumatic brain injury (TBI) with mild-to-moderate cognitive impairments and to investigate how these readers respond to reading comprehension strategy prompts integrated into digital versions of text. METHOD: Participants from 2 groups, adults with TBI (n = 15) and matched controls (n = 15), read 4 different 500-word expository science passages linked to either a strategy prompt condition or a no-strategy prompt condition. The participants' reading comprehension was evaluated using sentence verification and free recall tasks. RESULTS: The TBI and control groups exhibited significant differences on 2 of the 5 reading comprehension measures: paraphrase statements on a sentence verification task and communication units on a free recall task. Unexpected group differences were noted on the participants' prerequisite reading skills. For the within-group comparison, participants showed significantly higher reading comprehension scores on 2 free recall measures: words per communication unit and type-token ratio. There were no significant interactions. CONCLUSION: The results help to elucidate the nature of reading comprehension in adults with TBI with mild-to-moderate cognitive impairments and endorse further evaluation of reading comprehension strategies as a potential intervention option for these individuals. Future research is needed to better understand how individual differences influence a person's reading and response to intervention.

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.

When directions fail: Investigation of getting lost behaviour in adults with acquired brain injury.

PRIMARY OBJECTIVE: To investigate and describe getting lost behaviour and wayfinding strategies among acquired brain injury (ABI) survivors and matched controls. RESEARCH DESIGN: Matched control group comparison design. METHODS AND PROCEDURES: This study compared wayfinding performance of 18 adults with acquired brain injury to controls matched for gender, age and education. Participants followed written directions along an eight-step route in an unfamiliar neighbourhood, with three intentionally challenging choice-points. They used a cellular phone to request assistance if they became lost. Dependent measures included accuracy, directness and wayfinding strategy. Statistical and qualitative analyses explored group themes and differences. MAIN RESULTS: Participants with ABI demonstrated significantly greater on-route wayfinding errors and hesitancy than matched controls. The ABI group requested assistance over the cell phone more frequently than controls and required more attempts at re-orientation with concrete, salient directions in order to re-orient in the field. Participants in the control group anticipated errors with greater frequency than those with ABI. CONCLUSIONS: ABI survivors demonstrated greater challenges with wayfinding than matched controls. Re-orientation required concrete, explicit redirection with reference to salient landmarks. Implications for clinical practice and assistive technology are discussed.

How best to orient travellers with acquired brain injury: A comparison of three directional prompts.

PRIMARY OBJECTIVE: To compare the effects of written landmark, cardinal and left/right street directions on navigational success at the beginning of a walking route. RESEARCH DESIGN: Matched control group comparison design. METHODS AND PROCEDURES: This study compared navigational performance of 18 adults with acquired brain injury (ABI) to controls matched for gender, age and education. Participants followed written directions with landmark, cardinal or left/right directions at each of four locations. Dependent measures included accuracy, directness, stated confidence and preference. MAIN RESULTS: Participants with ABI demonstrated greater errors and hesitancy than controls when presented with cardinal and left/right directions. Both groups performed equally well with landmark directions. All participants stated preference for landmark directions. Participants with ABI were more likely to guess or become confused when following cardinal or left/right directions. CONCLUSIONS: Landmarks served as a performance equalizer between groups for navigational performance at the start of a walking route. Implications for the design of navigational assistive tools and future research are discussed.

Public computing options for individuals with cognitive impairments: survey outcomes.

PURPOSE: To examine availability and accessibility of public computing for individuals with cognitive impairment (CI) who reside in the USA. METHOD: A telephone survey was administered as a semi-structured interview to 145 informants representing seven types of public facilities across three geographically distinct regions using a snowball sampling technique. An Internet search of wireless (Wi-Fi) hotspots supplemented the survey. RESULTS: Survey results showed the availability of public computer terminals and Internet hotspots was greatest in the urban sample, followed by the mid-sized and rural cities. Across seven facility types surveyed, libraries had the highest percentage of access barriers, including complex queue procedures, login and password requirements, and limited technical support. University assistive technology centres and facilities with a restricted user policy, such as brain injury centres, had the lowest incidence of access barriers. CONCLUSION: Findings suggest optimal outcomes for people with CI will result from a careful match of technology and the user that takes into account potential barriers and opportunities to computing in an individual's preferred public environments. Trends in public computing, including the emergence of widespread Wi-Fi and limited access to terminals that permit auto-launch applications, should guide development of technology designed for use in public computing environments.

Validation of the Activities of Community Transportation model for individuals with cognitive impairments.

PURPOSE: To develop a theoretical, functional model of community navigation for individuals with cognitive impairments: the Activities of Community Transportation (ACTs). METHODS: Iterative design using qualitative methods (i.e. document review, focus groups and observations). Four agencies providing travel training to adults with cognitive impairments in the USA participated in the validation study. RESULTS: A thorough document review and series of focus groups led to the development of a comprehensive model (ACTs Wheels) delineating the requisite steps and skills for community navigation. The model was validated and updated based on observations of 395 actual trips by travellers with navigational challenges from the four participating agencies. Results revealed that the 'ACTs Wheel' models were complete and comprehensive. CONCLUSIONS: The 'ACTs Wheels' represent a comprehensive model of the steps needed to navigate to destinations using paratransit and fixed-route public transportation systems for travellers with cognitive impairments. Suggestions are made for future investigations of community transportation for this population.

A comparison of four prompt modes for route finding for community travellers with severe cognitive impairments.

PRIMARY OBJECTIVE: Navigational skills are fundamental to community travel and, hence, personal independence and are often disrupted in people with cognitive impairments. Navigation devices are being developed that can support community navigation by delivering directional information. Selecting an effective mode to provide route-prompts is a critical design issue. This study evaluated the differential effects on pedestrian route finding using different modes of prompting delivered via a handheld electronic device for travellers with severe cognitive impairments. RESEARCH DESIGN: A within-subject comparison study was used to evaluate potential differences in route navigation performance when travellers received directions using four different prompt modes: (1) aerial map image, (2) point of view map image, (3) text based instructions/no image and (4) audio direction/no image. METHODS AND PROCEDURES: Twenty travellers with severe cognitive impairments due to acquired brain injury walked four equivalent routes using four different prompting modes delivered via a wrist-worn navigation device. Navigation scores were computed that captured accuracy and confidence during navigation. MAIN OUTCOME: Results of the repeated measures Analysis of Variance suggested that participants performed best when given prompts via speech-based audio directions. The majority of the participants also preferred this prompting mode. Findings are interpreted in the context of cognitive resource allocation theory.

A profile of community navigation in adults with chronic cognitive impairments.

PRIMARY OBJECTIVE: This study sought to identify navigation patterns and illuminate the barriers to and possible solutions for independent community travel in people with chronic cognitive impairments as a result of acquired brain injury. RESEARCH DESIGN: Two investigative methods were used to explore navigation in the population of interest: Study 1 was a field study and study 2 convened a series of focus groups with relevant stakeholders. METHODS AND PROCEDURES: For study 1, each week during a 4 month period, researchers administered a navigational survey and structured interview to a typical case sample of six participants in order to catalogue all trips taken outside the assistive living facility. Study 2 convened six focus groups to access perspectives on navigational issues for individuals with cognitive impairments (CI) from a number of stakeholder groups including individuals with CI, care providers for this population and public transportation workers. CONCLUSIONS: The results of both studies were consistent and indicated that community access is severely restricted for individuals with CI. The majority of trips that were taken tended to be routine and assisted. The variety of travel was limited; participants ventured to the same set places with the same people. Participants described barriers accounting for these problems and suggested a number of strategies to minimize problems.

A pilot study exploring electronic (or e-mail) mail in users with acquired cognitive-linguistic impairments.

This paper reports the results of an exploratory study into the usability of a simplified e-mail interface for eight individuals with acquired cognitive-linguistic impairments. Participatory Action Research, a qualitative research method, was used to capture the range of performance variables and to emphasize a 'user-centred' approach to the research process. The participants were asked to read and reply to e-mails across four writing prompt conditions. An analysis of errors and participant preferences for the prototype e-mail system was conducted. Errors fell into two general categories: (1) computer usability (e.g. conceptual understanding of mouse/cursor operation) and (2) message composition (e.g. generating ideas for a message). Participant preferences for the writing prompt conditions varied considerably. All participants endorsed the use of customized e-mail interfaces as a means of connecting with friends and family, thereby reducing social isolation. Implications for interface design, rehabilitation and future research into assistive technology are discussed.