Community Engagement in Research: An Updated Systematic Review of Quantitative Engagement Measurement Scales for Health Studies.

Though the interest in community engagement in research (CEnR) protocols has increased, studies reporting on the findings of tested CEnR engagement measurement scales for health studies are sparse. A systematic review was conducted from January 1 to March 1, 2023, to identify validated, quantitative CEnR engagement measurement tools for health studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was employed. The rigor of scale development, testing, and implementation was explored, and a `best practices evaluation conducted. Themes on the readiness of scales for implementation in health research studies were narratively compiled. Nineteen studies met the search inclusion criteria-reporting on the development, testing, and implementation of seven CEnR engagement measurement scales for health studies. Scale implementation studies precipitated only two of the studies. None of the scales followed the rigorous process dictated in best practices; however, at this time, three scales have gone through the most robust testing processes. Advancement of the science of engagement measurement requires consensus on terminology, application of best practices for scale development and testing protocols, and consistency of reporting findings.

Developments in the application of Intensive Comprehensive Aphasia Programs: an international survey of practice.

PURPOSE: Intensive Comprehensive Aphasia Programs (ICAPs) were first described in 2013 with an international survey documenting 12 unique programs. ICAPs involve high dose intervention delivered in both group and individual settings, targeting communication across impairment, functioning, participation, and contextual domains. In this study, we aimed to investigate international growth in ICAPs. MATERIALS AND METHODS: We developed a 43-item questionnaire expanding on the original 2013 version to investigate program modifications, activities, protocolised therapies, software and apps, and family involvement. The survey was disseminated to aphasia clinicians and researchers internationally (November 2019-February 2020). RESULTS: Thirty-nine unique respondents completed the survey from nine countries. Twenty-one met the criteria for an ICAP or modified ICAP (mICAP): 14 ICAPs; 7 mICAPs, and 13 of these were new programs. ICAPs differed from mICAPs with greater emphasis on group sessions, use of technology, total communication, advocacy, and art activities. A large range of protocolised therapies were used across programs. An increased focus on mood and psychosocial well-being was observed compared to the 2013 survey. CONCLUSIONS: The number and comprehensiveness of ICAPs has grown since 2013 with development of modified versions. Future research should focus on comparative efficacy of ICAPs/mICAPs and other forms of aphasia interventions and factors underpinning growth and sustainability.Implications for RehabilitationClinicians who coordinate or are considering commencing an ICAP in future can use these results to consider the design of their program.Coordinators should carefully consider the components of their ICAPs and advise consumers whether they meet the definition of an ICAP or a mICAP.With the increasing number of ICAPs across the globe, clinicians commencing an ICAP may wish to contact existing ICAPs within their country for advice.Program sustainability may be challenging and these results provide an indication of some of the key challenges coordinators may face.

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.

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.

Activation and maintenance of peripheral semantic features of unambiguous words after right hemisphere brain damage in adults.

BACKGROUND: The right cerebral hemisphere (RH) sustains activation of subordinate, secondary, less common, and/or distantly related meanings of words. Much of the pertinent data come from studies of homonyms, but some evidence also suggests that the RH has a unique maintenance function in relation to unambiguous nouns. In a divided visual field priming study, Atchley, Burgess, and Keeney (1999) reported that only left visual field/RH presentation yielded evidence of continuing activation of peripheral semantic features that were incompatible with the most common image or representation of their corresponding nouns (e.g., rotten for "apple"). Activation for weakly related features that were compatible with the dominant representation (e.g., crunchy) was sustained over time regardless of the visual field/hemisphere of initial stimulus input. Several studies report that unilateral right hemisphere brain damage (RHD) in adults affects the RH's meaning maintenance function, but this work also has centred on homonyms, and/or more recently metonymic and metaphoric polysemous words. AIMS: The current investigation examined whether RHD deficits in processing secondary and/or distantly related meanings of words, typically observed in studies of homonyms, would extend to peripheral, weakly related semantic features of unambiguous nouns. METHODS #ENTITYSTARTX00026; PROCEDURES: Participants were 28 adults with unilateral RHD from cerebrovascular accident, and 38 adults without brain damage. Participants listened to spoken sentences that ended with an unambiguous noun. Each sentence was followed by a spoken target phoneme string. Targets included peripheral semantic features of the sentence-final noun that were either compatible or incompatible with the dominant mental images of the noun, and were presented at two intervals after that noun. A lexical decision task was used to gauge both the early activation and maintenance of activation for these weakly related semantic features. OUTCOMES #ENTITYSTARTX00026; RESULTS: Accuracy data demonstrated activation (priming) for both types of peripheral features, in both groups, shortly after presentation of the corresponding noun. Neither group evidenced continuing activation for either type of feature at a longer interval. These results are interpreted as reflecting rapid decay/poor maintenance of activation for distantly related features for both groups. The lack of a biasing context, however, did not provide an appropriate test for previously reported suppression deficits after RHD. Fast decay of activation of compatible semantic features was unexpected for the control group. Adults with RHD were less accurate than the control group at both test intervals for the features that are semantically more distant from their associated nouns (Related-incompatible features). Accordingly, it is argued that the RHD group's poor maintenance of activation for these features reflects a deficit, rather than normal performance. The interpretation of results from this study is complicated by the lack of RT priming for either type of semantic feature, and for either participant group. CONCLUSIONS: The right cerebral hemisphere appears to be necessary for activating semantic features that are particularly distantly related to their corresponding lexical items, and for sustaining activation of these features in the absence of a biasing context. Because lexical processing has been linked with discourse comprehension for adults with RHD, more work in this area should enhance clinical management in the future.

Coarse coding and discourse comprehension in adults with right hemisphere brain damage.

BACKGROUND: Various investigators suggest that some discourse-level comprehension difficulties in adults with right hemisphere brain damage (RHD) have a lexical-semantic basis. As words are processed, the intact right hemisphere arouses and sustains activation of a wide-ranging network of secondary or peripheral meanings and features-a phenomenon dubbed "coarse coding". Coarse coding impairment has been postulated to underpin some prototypical RHD comprehension deficits, such as difficulties with nonliteral language interpretation, discourse integration, some kinds of inference generation, and recovery when a reinterpretation is needed. To date, however, no studies have addressed the hypothesised link between coarse coding deficit and discourse comprehension in RHD. AIMS: The current investigation examined whether coarse coding was related to performance on two measures of narrative comprehension in adults with RHD. METHODS #ENTITYSTARTX00026; PROCEDURES: Participants were 32 adults with unilateral RHD from cerebrovascular accident, and 38 adults without brain damage. Coarse coding was operationalised as poor activation of peripheral/weakly related semantic features of words. For the coarse coding assessment, participants listened to spoken sentences that ended in a concrete noun. Each sentence was followed by a spoken target phoneme string. Targets were subordinate semantic features of the sentence-final nouns that were incompatible with their dominant mental representations (e.g., "rotten" for apple). Targets were presented at two post-noun intervals. A lexical decision task was used to gauge both early activation and maintenance of activation of these weakly related semantic features. One of the narrative tasks assessed comprehension of implied main ideas and details, while the other indexed high-level inferencing and integration. Both comprehension tasks were presented auditorily. For all tasks, accuracy of performance was the dependent measure. Correlations were computed within the RHD group between both the early and late coarse coding measures and the two discourse measures. Additionally, ANCOVA and independent t-tests were used to compare both early and sustained coarse coding in subgroups of good and poor RHD comprehenders. OUTCOMES #ENTITYSTARTX00026; RESULTS: The group with RHD was less accurate than the control group on all measures. The finding of coarse coding impairment (difficulty activating/sustaining activation of a word's peripheral features) may appear to contradict prior evidence of RHD suppression deficit (prolonged activation for context-inappropriate meanings of words). However, the sentence contexts in this study were unbiased and thus did not provide an appropriate test of suppression function. Correlations between coarse coding and the discourse measures were small and nonsignificant. There were no differences in coarse coding between RHD comprehension subgroups on the high-level inferencing task. There was also no distinction in early coarse coding for subgroups based on comprehension of implied main ideas and details. But for these same subgroups, there was a difference in sustained coarse coding. Poorer RHD comprehenders of implied information from discourse were also poorer at maintaining activation for semantically distant features of concrete nouns. CONCLUSIONS: This study provides evidence of a variant of the postulated link between coarse coding and discourse comprehension in RHD. Specifically, adults with RHD who were particularly poor at sustaining activation for peripheral semantic features of nouns were also relatively poor comprehenders of implied information from narratives.

A different story on "Theory of Mind" deficit in adults with right hemisphere brain damage.

BACKGROUND: Difficulties in social cognition and interaction can characterise adults with unilateral right hemisphere brain damage (RHD). Some pertinent evidence involves their apparently poor reasoning from a "Theory of Mind" perspective, which requires a capacity to attribute thoughts, beliefs, and intentions in order to understand other people's behaviour. Theory of Mind is typically assessed with tasks that induce conflicting mental representations. Prior research with a commonly used text task reported that adults with RHD were less accurate in drawing causal inferences about mental states than at making non-mental-state causal inferences from control texts. However, the Theory of Mind and control texts differed in the number and nature of competing discourse entity representations. This stimulus discrepancy, together with the explicit measure of causal inferencing, likely put the adults with RHD at a disadvantage on the Theory of Mind texts. AIMS: This study revisited the question of Theory of Mind deficit in adults with RHD. The aforementioned Theory of Mind texts were used but new control texts were written to address stimulus discrepancies, and causal inferencing was assessed relatively implicitly. Adults with RHD were hypothesised not to display a Theory of Mind deficit under these conditions. METHODS #ENTITYSTARTX00026; PROCEDURES: The participants were 22 adults with unilateral RHD from cerebrovascular accident, and 38 adults without brain damage. Participants listened to spoken texts that targeted either mental-state or non-mental-state causal inferences. Each text was followed by spoken True/False probe sentences, to gauge target inference comprehension. Both accuracy and RT data were recorded. Data were analysed with mixed, two-way Analyses of Variance (Group by Text Type). OUTCOMES #ENTITYSTARTX00026; RESULTS: There was a main effect of Text Type in both accuracy and RT analyses, with a performance advantage for the Theory of Mind/mental-state inference stimuli. The control group was faster at responding, and primed more for the target inferences, than the RHD group. The overall advantage for Theory of Mind texts was traceable to one highly conventional inference: someone tells a white lie to be polite. Particularly poor performance in mental-state causal inferencing was not related to neglect or lesion site for the group with RHD. CONCLUSIONS: With appropriate stimulus controls and a relatively implicit measure of causal inferencing, this study found no "Theory of Mind" deficit for adults with RHD. The utility of the "Theory of Mind" construct is questioned. A better understanding of the social communication difficulties of adults with RHD will enhance clinical management in the future.

Gesture and aphasia: Helping hands?

BACKGROUND: The study of communicative gestures is one of considerable interest for aphasia, in relation to theory, diagnosis, and treatment. Significant limitations currently permeate the general (psycho)linguistic literature on gesture production, and attention to these limitations is essential for both continued investigation and clinical application of gesture for people with aphasia. AIMS: The aims of this paper are to discuss issues imperative to advancing the gesture production literature and to provide specific suggestions for applying the material herein to studies in gesture production for people with aphasia. MAIN CONTRIBUTION: Two primary perspectives in the gesture production literature are distinct in their proposals about the function of gesture, and about where gesture arises in the communication stream. These two perspectives will be discussed, along with three elements considered to be prerequisites for advancing the research on gesture production. These include: operational definitions, coding systems, and the temporal synchrony characteristics of gesture. CONCLUSIONS: Addressing the specific elements discussed in this paper will provide essential information for both continued investigation and clinical application of gesture for people with aphasia.

Communicative value of self cues in aphasia: A re-evaluation.

BACKGROUND: Adults with aphasia often try mightily to produce specific words, but their word-finding attempts are frequently unsuccessful. However, the word retrieval process may contain rich information that communicates a desired message regardless of word-finding success. AIMS: The original article reprinted here reports an investigation that assessed whether patient-generated self cues inherent in the word retrieval process could be interpreted by listener/observers and improve on communicative effectiveness for adults with aphasia. The newly added commentary identifies and reports tentative conclusions from 18 investigations of self-generated cues in aphasia since the 1982 paper. It further provides a rationale for increasing research on self-generated cueing and notes a surprising lack of attention to the questions investigated in the original article. The original research is also connected with more recent qualitative investigations of interactional, as opposed to transactional, communicative exchange. METHODS #ENTITYSTARTX00026; PROCEDURES: While performing single-word production tasks, 10 adults with aphasia produced 107 utterances that contained spontaneous word retrieval behaviours. To determine the "communicative value" of these behaviours, herein designated self cues or self-generated cues, the utterance-final (potential target) word was edited out and the edited utterances were dubbed onto a videotape. Six naïve observers, three of whom received some context about the nature of word retrieval in aphasia and possible topics for the utterances, and three of whom got no information, predicted the target word of each utterance from the word-finding behaviours alone. The communicative value of the self-generated cues was determined for each individual with aphasia by summing percent correct word retrieval and percent correct observer prediction of target words, based on word retrieval behaviours. The newly added commentary describes some challenges of investigating a "communicative value" outcome, and indicates what would and would not change about the methods, if we did the study today. OUTCOMES #ENTITYSTARTX00026; RESULTS: The observer group that was given some context information appeared to be more successful at predicting target words than the group without any such information. Self-generated cues enhanced communication for the majority of individuals with aphasia, with some cues (e.g., descriptions/gestures of action or function) appearing to carry more communicative value than others (e.g., semantic associates). The commentary again indicates how and why we would change this portion of the investigation if conducting the study at this time. CONCLUSIONS: The results are consistent with Holland's (1977) premise that people with aphasia do well at communication, regardless of the words they produce. The finding that minimal context information may assist observers in understanding the communicative intent of people with aphasia has important implications for training family members to interpret self-generated cues. The new commentary reinforces these conclusions, highlights potential differences between self cues that improve word-finding success and those that enhance message transmission, and points to some additional research needs.

Effects of categorization training in patients with TBI during postacute rehabilitation: preliminary findings.

BACKGROUND: Previous research suggests that traumatic brain injury (TBI) interferes with the ability to extract and use attributes to describe objects. This study explored the effects of a systematic Categorization Program (CP) in participants with TBI and noninjured controls. PARTICIPANTS: Ten persons with moderate to severe TBI who received comprehensive postacute rehabilitation services and 13 matched noninjured controls participated in the study. INTERVENTION: All participants received CP training for 3 to 5 hours per week for 10 to 12 weeks that consisted of 8 levels and targeted concept formation, object categorization, and decision-making abilities. MAIN OUTCOME MEASURES: The Mayo-Portland Adaptability Inventory-3 (MPAI-3) and the Community Integration Questionnaire (CIQ). Two Categorization Tests (administered pretraining and posttraining) and 3 Probe Tasks (administered at specified intervals during training) assessed skills relating to categorization. RESULTS: Both groups showed significant improvement in categorization performance after the CP training on the 2 Categorization Tests related to the CP. They also were able to generalize and apply categorization and sorting skills in new situations (as measured by the Probe Tasks). Participants with TBI had improved functional outcome performance measured by the MPAI-3 and the CIQ. CONCLUSIONS: The systematic and hierarchical structure of the CP is beneficial to participants with TBI during postacute rehabilitation. This study contributes to the growing body of evidence supporting cognitive rehabilitation after moderate to severe TBI.