Exercise is Medicine on Campus: A Scoping Review of Evidence 2009 to 2021 and Call to Action.

ABSTRACT: The Exercise is Medicine On Campus (EIM-OC) program began in 2009 at Chatham University by Dr. Robert Sallis, Dr. Carena Winters, and ACSM leadership. The vision of EIM-OC is "to see all campus and community members across multiple disciplines discover, share, and adopt the principles of EIM that will help change the culture of physical activity and chronic disease prevention and management campus wide." Although EIM-OC maintains close track of programmatic details, such as the number of registered and recognized institutions, a comprehensive review of EIM-OC publications has not been previously reported. The purpose of this scoping review was to 1) identify and examine all peer-reviewed evidence of EIM-OC, including scholarly articles and published abstracts of presentations; 2) analyze the key themes of EIM-OC implementation and outcomes; and 3) identify gaps in the literature. The scoping review covered all peer-reviewed publications, including scholarly articles and published abstracts, from 2009 to December 2021. In total, 9 scholarly articles and 46 published abstracts were included in this review. The articles and abstracts covered a wide range of topics, including gold level (physical activity assessment and exercise referral), silver level (physical activity education), and bronze level (physical activity awareness and promotion) activities, as well as evaluation of EIM-OC programming. Now that EIM-OC programming is firmly established, we now call on campuses and leaders to strengthen their reporting of EIM-OC outcomes at all levels: gold, silver, and bronze. Publishing research evidence will strengthen EIM-OC programming and initiatives. Specifically, we encourage publishing scholarly articles and using broad means for increasing dissemination.

Comprehensive comparison of Apple Watch and Fitbit monitors in a free-living setting.

OBJECTIVES: The aim of this study was to evaluate the accuracy of three consumer-based activity monitors, Fitbit Charge 2, Fitbit Alta, and the Apple Watch 2, all worn on the wrist, in estimating step counts, moderate-to-vigorous minutes (MVPA), and heart rate in a free-living setting. METHODS: Forty-eight participants (31 females, 17 males; ages 18-59) were asked to wear the three consumer-based monitors mentioned above on the wrist, concurrently with a Yamax pedometer as the criterion for step count, an ActiGraph GT3X+ (ActiGraph) for MVPA, and a Polar H7 chest strap for heart rate. Participants wore the monitors for a 24-hour free-living condition without changing their usual active routine. MVPA was calculated in bouts of ≥10 minutes. Pearson correlation, mean absolute percent error (MAPE), and equivalence testing were used to evaluate the measurement agreement. RESULTS: The average step counts recorded for each device were as follows: 11,734 (Charge2), 11,922 (Alta), 11,550 (Apple2), and 10,906 (Yamax). The correlations in steps for the above monitors ranged from 0.84 to 0.95 and MAPE ranged from 17.1% to 35.5%. For MVPA minutes, the average were 76.3 (Charge2), 63.3 (Alta), 49.5 (Apple2), and 47.8 (ActiGraph) minutes accumulated in bouts of 10 or greater minutes. The correlation from MVPA estimation for above monitors were 0.77, 0.91, and 0.66. MAPE from MVPA estimation ranged from 44.7% to 55.4% compared to ActiGraph. For heart rate, correlation for Charge2 and Apple2 was higher for sedentary behavior and lower for MVPA. The MAPE ranged from 4% to 16%. CONCLUSION: All three consumer monitors estimated step counts fairly accurately, and both the Charge2 and Apple2 reported reasonable heart rate estimation. However, all monitors substantially underestimated MVPA in free-living settings.

Meeting a Physical Activity Guideline in Preschool and School Readiness: A Program Evaluation.

This study evaluates if the Kiddie Children and Teachers on the Move physical activity (PA) program improves the proportion of days meeting the Institute of Medicine (IOM) PA guideline, and whether meeting the guideline is correlated with improvement in school readiness. Thirteen Head Start-affiliated pre-kindergarten classrooms participated in this study. Minutes per hour of moderate-to-vigorous physical activity (MVPA) and proportion of days meeting the IOM PA guideline were examined across three types of intervention days: days during a non-intervention period, non-program days during the intervention period, and program days during the intervention period. Children displayed increasingly more MVPA and a greater proportion of days meeting the IOM guideline from non-intervention days to non-program days, and from non-program days to program days. Proportion of days meeting the guideline significantly predicted improvement in school readiness in five of six domains. Examination of program fidelity indicated the program was run with high fidelity.

Are we underestimating overweight and obesity prevalence in children?

OBJECTIVE: To objectively determine the prevalence of overweight and obesity in elementary school children in two rural counties in Vermont prior to implementing a community-based intervention. METHODS: School-based objective measures of body mass index (BMI) were obtained from 1,688 public school children in first, third, and fifth grades in two Northern Vermont counties in the Fall of 2017. RESULTS: Forty-one percentage of elementary school children were either overweight or obese, nearly double the estimated Vermont prevalence rate of 22.2%. Schools located in more rural areas showed higher levels of overweight and obesity in children than schools in less rural areas in these northern counties (p < .005). CONCLUSIONS: Indirect and self-reported measures of BMI may be underestimating the true prevalence of overweight and obesity particularly in more rural communities. POLICY IMPLICATIONS: Data presented here in which children were measured directly by trained study staff demonstrate that the prevalence of obesity among children in elementary school is alarmingly high. Accurate, ongoing BMI measurement surveillance is one tool to better understand both the current trends in childhood overweight and obesity and the effect of community and state interventions.

Moderate-to-vigorous physical activity and processing speed: predicting adaptive change in ADHD levels and related impairments in preschoolers.

BACKGROUND: Preschool ADHD symptoms have predictive utility for later presence of ADHD diagnoses (Harvey, Youngwirth, Thakar, & Errazuriz, 2009, Journal of Consulting and Clinical Psychology, 77, 349; Lahey et al., 2004, American Journal of Psychiatry, 161(11), 2014), yet some level of inattention, hyperactivity, and impulsivity are present even in typically developing preschoolers. Physical activity (PA) is known to have a broad spectrum of positive effects on the brain in school-age typically developing children (Centers for Disease Control and Prevention, 2010, The association between school based physical activity, including physical education, and academic performance. Atlanta, GA: U.S. Department of Health and Human Services), including functions impaired by ADHD (Halperin, Berwid, & O'Neill, 2014, Child and Adolescent Psychiatric Clinics of North America, 23, 899), yet links between PA and ADHD levels and impairments have rarely been studied in either typically developing or at-risk preschool children. Importantly, impaired processing speed (PS), though not a symptom of ADHD, is a robust neuropsychological correlate (Willcutt & Bidwell, 2011, Treating attention deficit hyperactivity disorder: Assessment and intervention in developmental context. Kingston, NJ: Civic Research Institute) that may indicate additional risk for ADHD. Hence, we examined whether baseline PS moderates the association between preschoolers' PA, specifically moderate-to-vigorous PA (MVPA), and changes in ADHD levels and related behaviors. METHOD: Eighty-five preschoolers (49.4% female; Mage  = 4.14, SDage  = .64) were drawn from a larger study of the effects of the Kiddie Children and Teachers (CATs) on the Move PA program on school readiness. The sample was largely Head Start eligible (68.2%) and ethnically diverse. Hierarchical regressions were utilized to examine links between MVPA, averaged over a school year, and changes in inattention (IA), hyperactivity/impulsivity (HI), oppositional behaviors, moodiness, and peer functioning, and whether these associations varied based on baseline PS. RESULTS: Results indicated that for IA, HI, and peer functioning, higher amounts of MVPA were associated with greater adaptive change for those with lower (but not higher) levels of PS. CONCLUSIONS: Preschool MVPA may be a viable method of reducing ADHD levels and impairments for those with lower PS.

Distinct Methods for Assessing Compliance With a Physical Activity Guideline for Children in Preschools.

BACKGROUND: According to the US Institute of Medicine guideline, preschool-aged children should participate in ≥15 minutes of physical activity (PA) per hour or 3 hours per day over 12 hours. Examinations of PA guideline compliance to date averaged time spent in PA over several days; however, children could exceed the guideline on some days and not on others. Therefore, this cross-sectional study examined PA guideline compliance in preschool children based on number of minutes per hour (average method) and percentage of days the guideline was met (everyday method). METHODS: PA was measured by accelerometry during the preschool day for up to 10 days in 177 children (59.3% males, Mage = 4.23). Minutes per hour and percentage of time in light, moderate to vigorous, and total PAs were calculated. Percentage of days in compliance was determined by number of days in compliance (defined as the child active on average ≥15 min/h) divided by total accelerometer days. RESULTS: Children engaged in PA, on average, 17.01 minutes per hour, suggesting that on average, children are meeting the guideline. However, children were only in compliance with the PA guideline 62.41% of assessment days. CONCLUSIONS: Findings demonstrate the importance of examining compliance with both the average and everyday methods to more accurately portray level of Institute of Medicine PA guideline compliance.

Consonant Age-of-Acquisition Effects in Nonword Repetition Are Not Articulatory in Nature.

Purpose: Most research examining long-term-memory effects on nonword repetition (NWR) has focused on lexical-level variables. Phoneme-level variables have received little attention, although there are reasons to expect significant sublexical effects in NWR. To further understand the underlying processes of NWR, this study examined effects of sublexical long-term phonological knowledge by testing whether performance differs when the stimuli comprise consonants acquired later versus earlier in speech development. Method: Thirty (Experiment 1) and 20 (Experiment 2) college students completed tasks that investigated whether an experimental phoneme-level variable (consonant age of acquisition) similarly affects NWR and lexical-access tasks designed to vary in articulatory, auditory-perceptual, and phonological short-term-memory demands. The lexical-access tasks were performed in silence or with concurrent articulation to explore whether consonant age-of-acquisition effects arise before or after articulatory planning. Results: NWR accuracy decreased on items comprising later- versus earlier-acquired phonemes. Similar consonant age-of-acquisition effects were observed in accuracy measures of nonword reading and lexical decision performed in silence or with concurrent articulation. Conclusion: Results indicate that NWR performance is sensitive to phoneme-level phonological knowledge in long-term memory. NWR, accordingly, should not be regarded as a diagnostic tool for pure impairment of phonological short-term memory. Supplemental Materials: https://doi.org/10.23641/asha.5435137.

Food Addiction: A Barrier for Effective Weight Management for Obese Adolescents.

BACKGROUND: Findings from studies of food addiction in adults suggest those with food addiction are less successful in weight-loss interventions. Little is known about food addiction in obesity treatment-seeking adolescents; therefore, the purpose of this study was to explore the prevalence of food addiction and correlates of food addiction symptoms in obese adolescents entering an outpatient, weight management program. METHODS: Obese adolescents (n = 26) were administered the Yale Food Addiction Scale for Children (YFAS-C), measures of appetitive responsiveness, and health-related quality of life (HRQOL) before and following a 12-week, outpatient, behavioral weight management program. Descriptive statistics and correlations between YFAS-C symptoms and study variables were performed and further examined with linear regression. Baseline differences were compared between those meeting criteria for food addiction to those who did not (independent t-tests) and pre-postweight management program changes were examined (paired t-tests). RESULTS: 30.7% met criteria for food addiction and 50% reported ≥3 symptoms. Number of YFAS-C symptoms was correlated with appetitive responsiveness (r = 0.57, p < 0.05) and inversely correlated with all domains of HRQOL (r = 0.47-0.53, p < 0.05). Attrition rate was higher in adolescents with food addiction compared to those without (62.5% vs. 44.4%, p < 0.05). CONCLUSIONS: Adolescents with food addiction or with a higher number of food addiction symptoms may warrant additional resources to support adherence to and retention with a weight management program. Implementing screening measures for food addiction before enrolling in a weight management program may be an effective strategy to identify adolescents who may benefit from adjunct modalities.

Making It Right? Some Thoughts about the Future of Treatment for Right Hemisphere Cognitive-Communication Disorders.

This article reflects on the future of intervention for language and communication disorders that follow unilateral damage to the right cerebral hemisphere. The author first introduces some of the challenges inherent in this task: a very small and preliminary evidence base and a limited number of investigators conducting treatment research for most of the consequences of these disorders, more general difficulties of translating evidence to practice, and limited graduate training in the area. The article then addresses some predictions and hopes for the future. The author foresees progress in defining the disorders and in clinicians' knowledge of the heterogeneity of the population, the multifaceted nature of complex impairments, and the expanding range of well-justified treatment options. The article next discusses the potential of noninvasive brain stimulation techniques, virtual reality-based approaches to intervention, and the promise of telerehabilitation. Finally, the author voices a concern that undeniably important new trends in health care, such as emphases on patient-reported outcomes and patient satisfaction measures, could penalize the subset of the client population that lacks awareness of or minimizes their deficits, and calls for vigilant clinician advocates in such cases.

The effect of speaking rate on serial-order sound-level errors in normal healthy controls and persons with aphasia.

BACKGROUND: Although many speech errors can be generated at either a linguistic or motoric level of production, phonetically well-formed sound-level serial-order errors are generally assumed to result from disruption of phonologic encoding (PE) processes. An influential model of PE (Dell, 1986; Dell, Burger & Svec, 1997) predicts that speaking rate should affect the relative proportion of these serial-order sound errors (anticipations, perseverations, exchanges). These predictions have been extended to, and have special relevance for persons with aphasia (PWA) because of the increased frequency with which speech errors occur and because their localization within the functional linguistic architecture may help in diagnosis and treatment. Supporting evidence regarding the effect of speaking rate on phonological encoding has been provided by studies using young normal language (NL) speakers and computer simulations. Limited data exist for older NL users and no group data exist for PWA. AIMS: This study tested the phonologic encoding properties of Dell's model of speech production (Dell, 1986; Dell,et al., 1997), which predicts that increasing speaking rate affects the relative proportion of serial-order sound errors (i.e., anticipations, perseverations, and exchanges). METHODS & PROCEDURES: The effects of speech rate on the error ratios of anticipation/exchange (AE), anticipation/perseveration (AP) and vocal reaction time (VRT) were examined in 16 normal healthy controls (NHC) and 16 PWA without concomitant motor speech disorders. The participants were recorded performing a phonologically challenging (tongue twister) speech production task at their typical and two faster speaking rates. OUTCOMES & RESULTS: A significant effect of increased rate was obtained for the AP but not the AE ratio. Significant effects of group and rate were obtained for VRT. CONCLUSION: Although the significant effect of rate for the AP ratio provided evidence that changes in speaking rate did affect PE, the results failed to support the model derived predictions regarding the direction of change for error type proportions. The current findings argued for an alternative concept of the role of activation and decay in influencing types of serial-order sound errors. Rather than a slow activation decay rate (Dell, 1986), the results of the current study were more compatible with an alternative explanation of rapid activation decay or slow build-up of residual activation.

Clinical Practice Guidelines From the Cystic Fibrosis Foundation for Preschoolers With Cystic Fibrosis.

Cystic fibrosis (CF) clinical care guidelines exist for the care of infants up to age 2 years and for individuals ≥6 years of age. An important gap exists for preschool children between the ages of 2 and 5 years. This period marks a time of growth and development that is critical to achieve optimal nutritional status and maintain lung health. Given that disease often progresses in a clinically silent manner, objective and sensitive tools that detect and track early disease are important in this age group. Several challenges exist that may impede the delivery of care for these children, including adherence to therapies. A multidisciplinary committee was convened by the CF Foundation to develop comprehensive evidence-based and consensus recommendations for the care of preschool children, ages 2 to 5 years, with CF. This document includes recommendations in the following areas: routine surveillance for pulmonary disease, therapeutics, and nutritional and gastrointestinal care.

The Health Care Provider's Experience With Fathers of Overweight and Obese Children: A Qualitative Analysis.

PURPOSE: The purpose of this study was to explore the experience of health care providers (HCPs) in the outpatient setting as they work with fathers of children who are overweight and obese. METHOD: Interpretative phenomenological analysis was used for data collection and analysis. Seven HCPs were interviewed about their experiences. RESULTS: Two major themes emerged from the experiences of these HCPs: "dad in the back seat" and "paternal resistance." DISCUSSION: The theme of "dad in the back seat" captured the HCPs' experiences and perceptions of parental roles and related stereotypes with respect to fathers' lack of presence in the health-care setting, family roles that relegate fathers to the back seat in dealing with this issue, and the tendency of fathers to take a passive role and defer to mothers in the management of their child's weight. "Paternal resistance" reflected the perceived tendency of the father to resist the acceptance of his child's weight as a problem and to resist change and even undermine family efforts to make healthier choices. CONCLUSION: HCPs' experiences of fathers as having a minimal role in the management of their child's overweight and obesity may lead them to neglect fathers as agents of change with regard to this important issue.

Voxel-Based Lesion Symptom Mapping of Coarse Coding and Suppression Deficits in Patients With Right Hemisphere Damage.

PURPOSE: This study examined right hemisphere (RH) neuroanatomical correlates of lexical-semantic deficits that predict narrative comprehension in adults with RH brain damage. Coarse semantic coding and suppression deficits were related to lesions by voxel-based lesion symptom mapping. METHOD: Participants were 20 adults with RH cerebrovascular accidents. Measures of coarse coding and suppression deficits were computed from lexical decision reaction times at short (175 ms) and long (1000 ms) prime-target intervals. Lesions were drawn on magnetic resonance imaging images and through normalization were registered on an age-matched brain template. Voxel-based lesion symptom mapping analysis was applied to build a general linear model at each voxel. Z score maps were generated for each deficit, and results were interpreted using automated anatomical labeling procedures. RESULTS: A deficit in coarse semantic activation was associated with lesions to the RH posterior middle temporal gyrus, dorsolateral prefrontal cortex, and lenticular nuclei. A maintenance deficit for coarsely coded representations involved the RH temporal pole and dorsolateral prefrontal cortex more medially. Ineffective suppression implicated lesions to the RH inferior frontal gyrus and subcortical regions, as hypothesized, along with the rostral temporal pole. CONCLUSION: Beyond their scientific implications, these lesion-deficit correspondences may help inform the clinical diagnosis and enhance decisions about candidacy for deficit-focused treatment to improve narrative comprehension in individuals with RH damage.

Negative Word Production in Adults With Right Hemisphere Brain Damage: Effects of Implicit Assessment and Contextual Bias.

PURPOSE: Both theory and evidence suggest that unilateral right hemisphere brain damage (RHD) should impair the processing of negative emotions. Typical metalinguistic assessments, however, may obscure processing strengths. This study investigated whether adults with RHD would produce proportionately fewer negative emotion words than control participants in an implicit assessment task and whether a negatively toned contextual bias would enhance performance. METHODS: Eleven participants with RHD and 10 control participants without brain damage watched a video in 2 parts and described each segment. Between segments, participants evaluated the emotion conveyed by sentences designed to induce the negative bias. RESULTS: The primary outcome measure, percentage of negative emotion words in video descriptions, did not differ between groups. After the contextual bias, this measure significantly increased for both groups, whereas production of motion words, a control variable, remained constant. CONCLUSIONS: Findings are consistent with a view that attributes some deficient RHD performances to the nature and/or demands of explicit metalinguistic assessment tasks. These results call for modulation of prevailing hypotheses that attribute negative emotion processing as an undifferentiated whole solely to the right cerebral hemisphere. The results also further substantiate the rationale of an experimental treatment that exploits contextual bias and priming for individuals with RHD.

Heart Rate and Perceived Exertion in Healthy Weight and Obese Children During a Self-Selected Physical Activity Program.

BACKGROUND: Compared with structured/organized activities, unstructured, self-selected physical activity (PA) may be more appealing for children in particular obese (OB) children. We examined whether both healthy-weight (HW) and OB children would engage in moderate to vigorous intensity PA during an unstructured PA program and compared heart rate (HR) and rate of perceived exertion (RPE) between the children. METHODS: Twenty-one children [9 OB (≥95th BMI percentile, 12 HW (5th - <85th), 8.6 ± 0.8 years; 9 males, 12 females] participated in before-school (7:30 AM to 8:15 AM) PA for 18 weeks, 3 consecutive days/week. Each child wore a Polar E600 HR monitor and was provided a vigorous, age-targeted heart rate (THR) of 70%. RESULTS: Mean HR ≥ vigorous THR for all children in 65.3% of the sessions and exceeded moderate intensity in 100%. Over the 18-weeks, no significant difference was observed in the overall mean HR between the HW (171.4 ± 12.0) and OB (169.3 ± 13.0), however the OB reported significantly lower RPEs than the HW (16.9 ± 2.6 vs. 17.6 ± 1.5, respectively; P < .05). CONCLUSIONS: Both the HW and OB children consistently sustained PA of moderate and vigorous intensity. The current study provides insight regarding the physiological capabilities and perceptual responses of HW and OB children participating in PA programs.

Contextual Constraint Treatment for coarse coding deficit in adults with right hemisphere brain damage: generalisation to narrative discourse comprehension.

Coarse coding is the activation of broad semantic fields that can include multiple word meanings and a variety of features, including those peripheral to a word's core meaning. It is a partially domain-general process related to general discourse comprehension and contributes to both literal and non-literal language processing. Adults with damage to the right cerebral hemisphere (RHD) and a coarse coding deficit are particularly slow to activate features of words that are relatively distant or peripheral. This manuscript reports a pre-efficacy study of Contextual Constraint Treatment (CCT), a novel, implicit treatment designed to increase the efficiency of coarse coding with the goal of improving narrative comprehension and other language performance that relies on coarse coding. Participants were four adults with RHD. The study used a single-subject controlled experimental design across subjects and behaviours. The treatment involved pre-stimulation, using a hierarchy of strong and moderately biased contexts, to prime the intended distantly related features of critical stimulus words. Three of the four participants exhibited gains in auditory narrative discourse comprehension, the primary outcome measure. All participants exhibited generalisation to untreated items. No strong generalisation to processing non-literal language was evident. The results indicate that CCT yields both improved efficiency of the coarse coding process and generalisation to narrative comprehension.

Suppression and narrative time shifts in adults with right-hemisphere brain damage.

PURPOSE: This study examined the functioning of a central comprehension mechanism, suppression, in adults with right-hemisphere damage (RHD) while they processed narratives that cued a shift in time frame. In normal language comprehension, mental activation of concepts from a prior time frame is suppressed. The (re)activation of information following a time frame shift was also assessed. METHOD: Twenty adults (12 RHD; 8 non brain-damaged) completed a speeded word recognition task while listening to narratives in 2 conditions: shift ("an hour later") and no shift ("a moment later"). RESULTS: There was no group difference in suppression for response time proportion data (shift/no shift), but cluster analyses identified a suppression deficit in 8 of the adults with RHD. There was overlap in suppression function at the narrative and lexical levels. The group with RHD was significantly delayed in mentally (re)activating new information after a time shift cue. CONCLUSION: Results underscore the generality of suppression functioning in adults with RHD. As such, treatment for a suppression deficit at one level may generalize to another level. An apparent independence of suppression and activation deficits suggests that each may need separate treatment. A better understanding of the nature and boundary conditions of suppression and activation deficits should better inform clinical decisions.

Substituting dietary monounsaturated fat for saturated fat is associated with increased daily physical activity and resting energy expenditure and with changes in mood.

BACKGROUND: The Western diet increases risk of metabolic disease. OBJECTIVE: We determined whether lowering the ratio of saturated fatty acids to monounsaturated fatty acids in the Western diet would affect physical activity and energy expenditure. DESIGN: With the use of a balanced design, 2 cohorts of 18 and 14 young adults were enrolled in separate randomized, double-masked, crossover trials that compared a 3-wk high-palmitic acid diet (HPA; similar to the Western diet fat composition) to a low-palmitic acid and high-oleic acid diet (HOA; similar to the Mediterranean diet fat composition). All foods were provided by the investigators, and the palmitic acid (PA):oleic acid (OA) ratio was manipulated by adding different oil blends to the same foods. In both cohorts, we assessed physical activity (monitored continuously by using accelerometry) and resting energy expenditure (REE). To gain insight into a possible mood disturbance that might explain changes in physical activity, the Profile of Mood States (POMS) was administered in cohort 2. RESULTS: Physical activity was higher during the HOA than during the HPA in 15 of 17 subjects in cohort 1 (P = 0.008) (mean: 12% higher; P = 0.003) and in 12 of 12 subjects in the second, confirmatory cohort (P = 0.005) (mean: 15% higher; P = 0.003). When the HOA was compared with the HPA, REE measured during the fed state was 3% higher for cohort 1 (P < 0.01), and REE was 4.5% higher in the fasted state for cohort 2 (P = 0.04). POMS testing showed that the anger-hostility score was significantly higher during the HPA (P = 0.007). CONCLUSIONS: The replacement of dietary PA with OA was associated with increased physical activity and REE and less anger. Besides presumed effects on mitochondrial function (increased REE), the dietary PA:OA ratio appears to affect behavior. The second cohort was derived from a study that was registered at clinicaltrials.gov as R01DK082803.

Generalization of a Novel, Implicit Treatment for Coarse Coding Deficit in Right Hemisphere Brain Damage: A Single Subject Experiment.

BACKGROUND: This manuscript reports generalization effects of Contextual Constraint Treatment for an adult with right hemisphere brain damage (RHD). Contextual Constraint Treatment is designed to stimulate inefficient language comprehension processes implicitly, by providing linguistic context to prime, or constrain, the intended interpretations of treatment stimuli. The study participant had a coarse coding deficit, defined as delayed mental activation of particularly distant semantic features of words (e.g., rotten as a feature of "apple"). Treatment effects were expected to generalize to auditory comprehension of narrative discourse, and perhaps to figurative language interpretation, because coarse coding has been hypothesized and/or demonstrated to support these abilities. AIMS: This treatment study aimed to induce generalization of Contextual Constraint Treatment in an adult with RHD with inefficient coarse coding. METHODS #ENTITYSTARTX00026; PROCEDURES: The participant in this study was a 75 year old man with RHD and a coarse coding deficit. A single subject experimental design across behaviors (stimulus lists) was used to document performance in baseline, treatment, and follow-up phases. Treatment consisted of providing brief, spoken context sentences to prestimulate, or constrain, intended interpretations of stimulus items. The participant made no explicit associations or metalinguistic judgments about the constraint sentences or stimulus words; rather, these contexts served only as implicit primes. Probe tasks were adapted from prior work on coarse coding in RHD. The dependent measure was the percentage of responses that met predetermined response time criteria. There were two levels of contextual constraint, Strong and Moderate. Treatment for each item began with the provision of the Strong constraint context, to minimize the production or reinforcement of erroneous or exceedingly slow responses. Generalization was assessed to a well-standardized measure of narrative discourse comprehension and to several metalinguistic tasks of figurative language interpretation. OUTCOMES #ENTITYSTARTX00026; RESULTS: Treatment-contingent gains, associated with respectable effect sizes, were evident after a brief period of treatment on one stimulus list. Generalization occurred to untrained items, suggesting that the treatment was facilitating the underlying coarse coding process. Most importantly, generalization was evident to narrative comprehension performance, for both overall accuracy and accuracy answering questions about implied information, and all of these gains maintained through three follow-up sessions. CONCLUSIONS: Though the results are still preliminary, this single-subject experimental design documents the potential for meaningful gains from a novel treatment that implicitly targets an underlying language comprehension process in an adult with RHD.