Translation and cross-cultural adaptation of the "Protocolo de Avaliação Miofuncional Orofacial MBGR" from Brazilian Portuguese into English.

In health-related research, an increasing number of clinical assessment tools are translated and cross-culturally adapted for cross-national and cross-cultural studies and comparisons. However, when translating and cross-culturally adapting clinical assessment tools for use across new countries, cultures, or languages, we must follow a thorough method to reach semantic, idiomatic, experiential, and conceptual equivalences between translated and original versions. Therefore, in this study, we translated and cross-culturally adapted the Protocolo MBGR (Marchesan, Berretin-Felix, Genaro, and Rehder) from Brazilian Portuguese into English, following international guidelines, and named it "MBGR Protocol." To verify its content validity, we used the Content Validity Index. Results indicated excellent content validity: a Scale-Content Validity Index of 0.96 and 97% of all translation units with an Item-Content Validity Index of 1.00. Also, to prove its face validity and confirm whether it worked in the target population's linguistic-cultural setting, we used it with 35 subjects. Again, results demonstrated excellent face validity: in the pretest, 91% of all translation units were considered comprehensible and clear; in the pilot test, 98% of all translation units were considered comprehensible and clear. Thus, we concluded that the MBGR Protocol is promising to enhance the uptake of studies in Orofacial Myology worldwide and support researchers and health professionals in assessing and diagnosing orofacial myofunctional disorders in children, adolescents, adults, and the elderly. Also, it may support evidence-based practice and assist in standardizing assessment and diagnostic criteria. The MBGR Protocol should have its psychometric properties tested before being used in clinical practice or scientific research. Therefore, future studies are needed, and collaborations among researchers from South and North American countries are encouraged to create an international network and advance with knowledge and skills in the Orofacial Myology discipline.

Developing a Memory and Communication App for Persons Living With Dementia: An 8-Step Process.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.3928/19404921-20210825-02.

The Functional External Memory Aid Tool Version 2.0: A How-To Clinical Guide.

PURPOSE: Although compensatory cognitive rehabilitation is a common treatment approach for adults with cognitive-communication disorders, there are few assessment tools available to support clinicians in developing person-centered treatment plans. In addition to understanding a client's cognitive and functional abilities, it is also important to understand how they compensate for their weaknesses, specifically with external aids (e.g., calendars, notes), in everyday life. The Functional External Memory Aid Tool (FEMAT) is a performance-based measure that quantifies and describes external aid use during task completion. METHOD: The purpose of this clinical focus article is to educate and equip clinicians to administer and interpretate the FEMAT with adult clients with cognitive-communication disorders. This clinical focus article describes the theoretical motivation for the FEMAT as well as the administration, scoring, and interpretation procedures for Version 2.0 of the measure. A hypothetical case example is included to illustrate how to use the FEMAT to develop person-centered goals and treatment plans. CONCLUSIONS: The FEMAT is psychometrically sound, clinically relevant, free, easily accessible, and quick to administer and provides data that are complementary to data obtained from traditional performance-based and/or patient-reported measures. This clinical focus article describes new resources that are available to help clinicians administer and interpret Version 2.0 of the FEMAT when serving adults with cognitive-communication disorders. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21651311.

A Seat at the Table: Supporting Persons with Severe Dementia in Communicating Their Preferences.

Objective: Persons with severe dementia are less likely to have a role in preference assessment due to communication challenges associated with the disease. Research is limited on how to support preference communication while using existing preference assessment tools (e.g., the Minimum Data Set 3.0).Methods: This study examined the effect of two assessment conditions (standard verbal; visual-and-text supported;) on residents' (N = 21) social and leisure preference consistency over 1-week and utterance types (acknowledgment, elaboration, off-topic, request for clarification) in response to preference questions. Residents with severe dementia were recruited from four nursing homes (n = 11) and three assisted living facilities (n = 10). As a preliminary measure of provider acceptability and social validity, a sample of 10 naïve judges (University students) listened to the interviews and rated residents' communication clarity and their confidence with understanding residents' preferences.Results: Neither assessment condition promoted significantly greater levels of consistency (i.e., the same preference rating at Time 1 and Time 2). Residents expressed significantly fewer requests for clarification in the visual-and-text supported condition. Naïve judges rated residents' communication positively, with no significant differences between conditions.Conclusions: This study addresses a gap in current research and holds important implications for enhancing care planning participation by residents with severe dementia.Clinical Implications: Residents with severe dementia can successfully participate in activity preference discussions without proxy participation. Residents may comprehend interview questions better when provided in a supported format.

Intergenerational Montessori Program for Adults With Memory Concerns.

Purpose This study evaluated the effects of an intergenerational Montessori after-school program on the engagement, affect, and quality of life of older adults with memory concerns and on the attitudes of children toward older adults. Method Eleven older adults were paired with 11 children to participate in a 45-min after-school activity program. Observations of engagement and affect during the interactions were collected 3 times a week for 4 weeks. The older adults' engagement and affect also were observed during 45-min planning/discussion sessions without the children present before their arrival to the program. Results Results revealed significant differences in older adults' engagement and positive affect when the children were present. Significant pre-post improvements in reported quality of life and maintenance of cognitive status were associated with program participation. Children demonstrated more active than passive engagement and more happy than neutral affect during activity sessions. Four of the seven children improved their positive ratings of older adults. Conclusions This program documented success in improving engagement and affect in older adults with mild memory concerns while engaging with children. Future studies with a larger sample of participants with varying degrees of memory impairment are needed to investigate the potential of this promising program.

Development and Initial Validation of the Functional External Memory Aid Tool.

Purpose The purpose of this study was to develop the item pool and investigate the structure and measurement properties of the Functional External Memory Aid Tool (FEMAT), a performance-based measure of everyday strategy use for persons with mild memory impairments. The FEMAT examines one's use of strategies to compensate for cognitive communication impairments that interfere with the completion of complex daily tasks. Method During Phase 1, six expert panel members reviewed the initial item pool and scoring rubric to assess item verification. Each item was developed to elicit strategy use and represent a complex daily task. During Phase 2, 99 participants with possible mild neurocognitive disorder (as determined by screening procedures) responded to 11 items. The factor structure of the data was analyzed using confirmatory factor analysis. Reliability and relationships between the FEMAT and additional factors were also examined. Results The process of development (Phase 1) resulted in 11 items distributed among three factors: (a) Medical Tasks, (b) Instrumental Daily Tasks, and (c) Retrieval-Based Tasks. Internal consistency (Phase 2), assessed with confirmatory factor analysis, confirmed the proposed three-factor model. Reliability analyses revealed at least 62%-84% of within-test score variance was due to true score variance. Correlation analyses indicated weak and strong relationships between the FEMAT and participant demographic variables and additional assessment measures. Conclusions The FEMAT provides reliable measurement of everyday external memory aid use in persons with possible mild neurocognitive disorder. The FEMAT was designed to be used in clinical settings and to provide better guidance to clinicians to design person-centered interventions than currently available cognitive communication measures.

Structured External Memory Aid Treatment for Mild Cognitive Impairment.

Purpose The aims of this study were (a) to examine the effects of a structured external memory aid (EMA) treatment for individuals with possible mild neurocognitive disorder on their use of EMAs to compensate for memory impairments, (b) to examine the extent that improved functional EMA use maintains following intervention, and (c) to measure the effects of treatment on participants' self-reported memory skills. Method The researchers employed a multiple-baseline design across subjects within dyads. Data were collected using the Roleplay Assessment. The graphed data were analyzed visually at baseline, treatment, and maintenance sessions. In addition, the researchers examined the participants' self-report of memory skills through an experimental pre-post design. Results Following intervention, a functional strategy use treatment effect was observed. All 6 participants' graphs revealed a large positive change in level, with no overlapping data. Statistical analyses also supported the positive effects of treatment. The participants maintained the use of strategies for 1-3 months. The participants self-reported a statistically significant increase in strategy use following intervention. Conclusions With treatment, individuals with mild memory impairments can learn to use EMAs to facilitate enhanced performance on functional activities. This study provides evidence for the importance of documenting individual treatment effects and using a functional measure to examine compensatory strategy use in everyday tasks.

Effects of Visual Aids for End-of-Life Care on Decisional Capacity of People With Dementia.

Purpose This study evaluated the decision-making capacity of persons with mild and moderate dementia on end-of-life care when using visual aids. A secondary purpose was to learn whether the judges naive to the experimental conditions would rate participants' decisional abilities as better when augmented by visual aids, thereby validating the behavioral changes due to the use of these external support. Method Twenty older adults with mild and moderate dementia demonstrated Understanding, Expressing a Choice, Reasoning, and Appreciation of 2 medical vignettes under 2 counterbalanced conditions: verbal alone or verbal with visual aids. Transcripts were analyzed and scored to measure decisional skills. Twelve judges rated participants' decisional abilities using a 7-point Likert scale. Results Participants demonstrated significantly better overall decisional capacity in Understanding, Reasoning, and Appreciation when supported by visual aids during the decision-making process. No significant differences between conditions were found in Expressing a Choice, the decisional skill Logical Sequence under Reasoning, and Acknowledgment under Appreciation. Overall, the judges' ratings validated these outcomes; the judges' ratings reflected greater agreement in the visual condition than in the verbal condition. Conclusions Findings indicated that visual aids (a) improved the decision-making capacity of individuals with dementia in comprehending medical information, employing supportive reasons, and relating this information to his or her own situation and (b) contain the potential for judges who majored or are majoring in speech-language pathology to reach a stronger consensus when determining the decision-making capacity of individuals with dementia.

External Memory Aid Preferences of Individuals with Mild Memory Impairments.

Individuals with mild memory impairments often rely on external memory aids (EMAs) to compensate for impaired cognitive abilities and to support independent completion of activities of daily living. These strategies are evidence based; however, professionals have limited knowledge regarding individual preferences and guidance on how to incorporate a person-centered approach into the EMA development phase. The purpose of the current study was to qualitatively investigate individuals' preferences and experiences as they relate to EMAs. Data analysis included (1) evaluation of a posttreatment questionnaire to explore individual strategy preferences following intervention and (2) evaluation of group intervention videos using thematic coding to investigate individuals' experiences with strategies during intervention. Results suggest that older adults with mild memory impairments have unique preferences and experiences, despite limited variability in demographic characteristics. Some themes that emerged included memory ability awareness and attitudes toward technology. Within a person-centered approach, skilled professionals must consider individuals' unique needs, preferences, and experiences when developing strategies throughout the continuum of care to promote sustained EMA use within everyday settings.

Person-Centered, Skilled Services Using a Montessori Approach for Persons with Dementia.

The current mandate for person-centered care throughout the health care system, and especially in the nursing home industry, requires that speech-language pathologists ensure that the services they provide to elders with dementia are skilled, person centered, and relevant to positive overall health outcomes. Guidelines developed by the Association Montessori International Advisory Board for Montessori for Aging and Dementia are one avenue toward such skilled and person-centered services. The purpose of this article is to provide clinicians with practical strategies for guiding their assessment, goal writing, and intervention plans to meet the expectations of a person-centered approach to services for elders with dementia, using the Montessori approach as a philosophical guide.

Anxious distress in depressed outpatients: Prevalence, comorbidity, and incremental validity.

The goals of this study were to estimate the prevalence of the DSM-5 anxious distress specifier (AD) among depressed outpatients, to examine associations of AD with comorbid diagnoses, and to test the incremental validity of AD over comorbidity in predicting functional impairment and severity of anxiety and depression symptoms. The sample was 237 outpatients diagnosed with major depressive disorder (MDD) or persistent depressive disorder (PDD), with and without AD, using the Anxiety and Related Disorders Interview Schedule for DSM-5. Outpatients also completed self-report questionnaires assessing functional impairment and anxiety, stress, and depression symptom severity. Two-by-two contingency tables were used to examine the associations of AD with comorbidity. Two-thirds (66.2%) of outpatients were assigned AD, with similar rates among those with MDD and PDD. Outpatients with AD were significantly more likely than those without AD to have a comorbid GAD diagnosis (OR = 2.47). Hierarchical multiple regressions were used to test the incremental validity of AD in predicting functional impairment and symptom outcomes beyond comorbid disorders. Controlling for comorbid disorders, AD was significantly associated with more severe functional impairment, autonomic arousal, stress, panic, generalized anxiety, and depression. The strongest incremental association were observed between AD and autonomic arousal (f2 = 0.12-0.18) and generalized anxiety (f2 = 0.17). These findings add to a growing literature that AD is common among outpatients and associated with important clinical outcomes, suggesting that AD should be routinely assessed in patients with mood disorders.

Using Spaced Retrieval With External Aids to Improve Use of Compensatory Strategies During Eating for Persons With Dementia.

PURPOSE: This study was designed to determine whether spaced retrieval (SR), when paired with an external memory aid, is an effective technique to teach persons with dementia to use compensatory swallowing strategies. A secondary purpose was to learn whether speech-language pathologists naive to the study aims would judge posttraining sessions as improved, or safer, in comparison to baseline sessions, thereby validating the changes in behavior due to SR training to use external aids during meals. METHOD: A multiple baseline design across behaviors was used to evaluate the effects of teaching compensatory swallowing behaviors (i.e., chin tuck, alternation of liquids and solids, lingual/finger sweep) to 5 nursing home residents diagnosed with dementia and coexisting dysphagia. RESULTS: SR training with the use of a visual aid was functionally related to improvements in 2-3 compensatory swallowing behaviors for each of the 5 participants. CONCLUSIONS: Study outcomes paired with social validation ratings demonstrated that persons with dementia could learn compensatory swallowing behaviors for perceived safety during intake. Because participants were eating in a quiet and controlled environment, generalization to the typical dining environment remains unknown, and further research is needed to investigate the long-term impact of this training protocol.

Will You Still Need Me When I'm 64, or 84, or 104? The Importance of Speech-Language Pathologists in Promoting the Quality of Life of Aging Adults in the United States into the Future.

In the next two decades, there will be advances in the diagnosis and treatment of the disorders of aging that have the potential to change the way speech-language pathologists (SLPs) are trained and provide services to individuals with a continuum of cognitive communication challenges. SLPs will address the needs of the aging adult who continues to reside in the community and desires to maintain an independent and meaningful life, as well as those who require a supportive residential setting to achieve a satisfying quality of life. Evidence-based strategies and intervention approaches for the range of goals that will address the desired functions of a meaningful life for individuals faced with cognitive communicative challenges are outlined. Institutional barriers to the implementation of documented evidence-based approaches will need to be reduced through a variety of organizational and systems changes. The projected outcome of these changes will be the creation of a person-centered culture of care that promotes dignity, choice, and engagement in meaningful activities through the end of life.

Perceived Emotion Control Moderates the Relationship between Neuroticism and Generalized Anxiety Disorder.

The relationships between neuroticism, perceived emotion control, and generalized anxiety disorder (GAD) severity were examined in 293 individuals diagnosed with GAD at a specialty anxiety disorders clinic. Hierarchical regression analyses performed within a structural equation modeling framework revealed that (1) neuroticism and perceived emotion control both predicted a latent variable of GAD in the expected direction, and (2) perceived emotion control moderated the relationship between neuroticism and GAD severity, such that lower levels of perceived emotion control were associated with a stronger relationship between neuroticism and GAD severity. The other dimensions of perceived control (i.e., stress and threat control) did not moderate the effect of neuroticism on GAD severity. The findings are discussed with regard to their implications to conceptual models of the psychopathology of GAD, and theory-based differential relationships between dimensions of vulnerability, perceived control, and anxiety disorders.

Join the Revolution: How Montessori for Aging and Dementia can Change Long-Term Care Culture.

Efforts to improve the quality of life of persons with dementia in long-term care through the implementation of various approaches to person-centered care have been underway for the past two decades. Studies have yielded conflicting reports evaluating the evidence for these approaches. The purpose of this article is to outline the findings of several systematic reviews of this literature, highlighting the areas of improvement needs, and to describe a new person-centered care model, DementiAbility Methods: The Montessori Way. This model focuses on the abilities, needs, interests, and strengths of the person and creating worthwhile and meaningful roles, routines, and activities for the person within a supportive physical environment. This is accomplished through gaining the commitment of the facility's leaders, training staff, and monitoring program implementation. The potential for a culture change in long-term care environments is dependent on the development and rigorous evaluation of person-centered care approaches.

Effects of Lingual Effort on Swallow Pressures Following Radiation Treatment.

PURPOSE: This article investigated the effects of increased oral lingual pressure on pharyngeal pressures during swallowing in patients who have undergone radiotherapy for head and neck cancer. It was hypothesized that increased oral lingual pressure would result in increased pharyngeal pressures. METHOD: A within-subject experimental design was used with 20 participants who were status post external beam radiotherapy for head and neck cancer. Participants completed typical swallows and swallows with increased lingual force during manofluoroscopic swallow studies. The swallow condition order was randomized across participants. RESULTS: Manometric data revealed significant differences in swallow pressure by condition at the base of tongue and upper esophageal sphincter sensor locations without significant pressure differences in the lower pharynx. The effortful lingual swallows resulted in higher mean pressures at all locations. CONCLUSIONS: The results of this study suggest that use of a maneuver designed to increase oral tongue effort can also increase pharyngeal tongue base pressure. Therefore, therapeutic activities used to generate greater pressure of the oral tongue may also alter pharyngeal response. Further research is needed to determine the direct clinical effect on swallow function for individuals with head and neck cancer.

The Relevance of Age of Onset to the Psychopathology of Social Phobia.

The present study aimed to examine the relevance of age of onset to the psychopathology of social phobia using a large clinical sample of 210 patients with social phobia. The two most common periods of onset were during adolescence (ages 14-17) and early childhood (prior to age 10). Structural regression modeling was used to test predictions that early onset social phobia would be associated with greater severity of the disorder, stronger current symptoms of depression and anxiety, greater functional impairment, and more pronounced levels of emotional disorder vulnerabilities (e.g., neuroticism/behavioral inhibition, extraversion, perceptions of control). Logistic regression was used to evaluate relationships between age of onset and the presence of acute and chronic stress at the time of onset. Results showed that earlier age of social phobia onset was associated with stronger current psychopathology, functional impairment, and emotional disorder vulnerabilities, and that later age of onset predicted the presence of an acutely stressful event around the time of disorder emergence. These results are discussed in regard to their clinical implications and congruence with prominent etiological models of the emotional disorders.

Agrammatism in Jordanian-Arabic speakers.

The studies of agrammatism show that not all morpho-syntactic elements are impaired to the same degree and that some of this variation may be due to language-specific differences. This study investigated the production of morpho-syntactic elements in 15 Jordanian-Arabic (JA) speaking individuals with agrammatism and 15 age-matched neurologically healthy individuals. Two experiments were conducted to examine the production of complementizer, tense, agreement and negation morphology in JA. The results indicated that the speakers of JA with agrammatism had marked dissociations in producing specific morpho-syntactic elements. The observed impairment patterns overlapped, in many respects, with those observed in other linguistic groups. The findings are discussed with respect to current theories of agrammatism, including both morpho-syntactic and computational accounts.

An evidence-based systematic review on cognitive interventions for individuals with dementia.

PURPOSE: To evaluate the current state of research evidence related to cognitive interventions for individuals with Alzheimer's disease or related dementias. METHOD: A systematic search of the literature was conducted across 27 electronic databases based on a set of a priori questions, inclusion/exclusion criteria, and search parameters. Studies were appraised for methodological quality and categorized according to intervention technique and outcome (e.g., cognitive-communication impairment or activity limitation/participation restriction). Results were summarized and, when possible, analyzed quantitatively using indicators of treatment effect size. RESULTS: Forty-three studies met criteria for inclusion in the review. The most commonly used cognitive intervention techniques used were errorless learning, spaced-retrieval training, vanishing cues, or verbal instruction/cueing. Most treatment outcomes were measured at the cognitive-communication impairment level of functioning and were generally positive. However, results should be interpreted cautiously because of methodological limitations across studies. CONCLUSIONS: Research evidence to support the use of cognitive interventions for individuals with dementia is accumulating. Researchers are beginning to evaluate treatment efficacy, yet the focus tends to be on discovery, specifically, refining intervention variables that will facilitate optimal outcomes. Implications for clinical practice and avenues for future research are discussed.