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A considerable body of research supports the use of behavioral communication treatment as the standard of care for aphasia. In spite of robust progress in clinical aphasiology, many questions regarding optimal care remain unanswered. One of the major challenges to progress in the field is the lack of a common framework to adequately describe individual treatments, which, if available, would allow comparisons across studies as well as improved communication among researchers, clinicians, and other stakeholders. Here, we describe how aphasia treatment approaches can be systematically characterized using the Rehabilitation Treatment Specification System (RTSS). At the core of the RTSS is a tripartite structure that focuses on targets (the behavior that is expected to change as a result of treatment), ingredients (what a clinician does to affect change in the target), and mechanism(s) of action (why a given treatment works by linking the ingredients to the target). Three separate articles in the current issue specifically describe how the RTSS can be used to describe different kinds of aphasia treatment approaches: functional approaches, cognitive-linguistic approaches, and biological approaches. It is our hope that the application of the RTSS in clinical aphasiology will improve communication in published studies, grant proposals, and in the clinical care of persons with aphasia. [ABSTRACT FROM AUTHOR]

Abstract The purpose of this study was to characterize further the nature of sentence processing deficits in acquired aphasia. Adults with aphasia and age- and education-matched adults with no brain damage completed a battery of formal cognitive-linguistic tests and an experimental sentence judgment task, which was performed alone and during focused attention and divided attention or dual-task conditions. The specific aims were to determine whether (a) increased extra-linguistic cognitive demands (i.e., focused and divided conditions) differentially affected the sentence judgement performances of the aphasic and control groups, (b) increased extra-linguistic cognitive demands interact with stimulus parameters (i.e., syntactic complexity, number of propositions) known to influence sentence processing, and (c) syntactic- or material-specific resource limitations (e.g., sentence judgment in isolation), general cognitive abilities (e.g., short-term and working memory test scores), or both share a significant relationship with dual-task outcomes. Accuracy, grammatical sensitivity, and reaction time findings were consistent with resource models of aphasia and processing accounts of aphasic syntactic limitations, underscoring the theoretical and clinical importance of acknowledging and specifying the strength and nature of interactions between linguistic and extra-linguistic cognitive processes in not only individuals with aphasia, but also other patient and typical aging populations. Highlights • The sentence judgments of participants with aphasia were more vulnerable in complex attention conditions than those of control participants. • Participants with aphasia demonstrated resource allocation difficulties during the divided attention conditions. • Sentence type manipulations and correlations suggested sentence processing utilizes material-specific and general cognitive resources. • The findings accord well with resource accounts of not only aphasia but also sentence processing. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Many adults with aphasia demonstrate concomitant deficits in working memory (WM), but such deficits are difficult to quantify because of a lack of validated measures as well as the complex interdependence between language and WM. We examined the feasibility, reliability, and internal consistency of an n-back task for evaluating WM in aphasia, then explored the influence of domain-general (WM load, reaction time, age) and domain-specific (language) factors. Method: Fourteen adults with aphasia and 12 age-and education-matched controls completed n-back tasks varying in stimulus type (high-frequency, low-frequency, or non-nameable stimuli) and WM load (0-, 1-, and 2-back). Data analyses explored the impact of these variables within and across participants and groups. Results: n-Back scores were collectively reliable across conditions. Both groups performed similarly across stimulus types with significantly greater WM accuracy for nameable versus non-nameable stimuli. Compared to the controls, adults with aphasia were significantly more affected by increasing WM load. RT effects generally paralleled accuracy data, whereas age effects were inconsistent across tasks. Conclusions: These data are consistent with WM deficits in aphasia, for which the n-back task holds promise for clinical quantification. Learning outcomes: Readers will be able to: (a) define working memory, (b) discuss the difficulty inherent in removing language from a complex cognitive task, and (c) describe how the n-back task may contribute to measuring working memory capacity in individuals with aphasia. [Copyright &y& Elsevier]

Abstract: This study examined whether attention processing training-II [Sohlberg, M. M., Johnson, L., Paule, L., Raskin, S. A., & Mateer, C. A. (2001). Attention Process Training-II: A program to address attentional deficits for persons with mild cognitive dysfunction (2nd ed.). Wake Forest, NC: Lash & Associates.; APT-II], when applied in the context of a multiple baseline ABA design, would improve the attention abilities of RW, a patient with mild conduction aphasia and concomitant attention and working memory deficits. We also explored whether APT-II training would enhance RW''s auditory comprehension, other cognitive abilities such as memory, and his and his spouse''s perceptions of his daily attention and communication difficulties. With treatment, RW improved on trained attention tasks and made modest gains on standardized tests and probes that evaluated cognitive skills related to treatment activities. Nominal change in auditory comprehension and untrained attention and memory functions was observed, and neither RW nor his spouse reported noticeable improvements in his daily attention or communication abilities. These and previous findings indicate that structured attention retraining may enhance specific attention skills, but that positive changes in broader attention and untrained functions are less likely. Learning outcomes: As a result of reading this article, the participant will be able to: (1) summarize the previous literature regarding attention impairments and treatment approaches for patients with aphasia. (2) describe how Attention Processing Training-II affected the attention, auditory comprehension, and other cognitive abilities of the patient in this study. [Copyright &y& Elsevier]

Background: Medications can improve the functioning and health-related quality of life of patients with chronic heart failure (CHF) and reduce morbidity, mortality, and costs of treatment. However, patients may not adhere to therapy. Patients with complex medication regimens and low health literacy are at risk for nonadherence.Objective: The primary goal of this project is to develop and assess a multilevel pharmacy-based program to improve patient medication adherence and health outcomes for elderly CHF patients with low health literacy.Methods: In this 4-year, controlled trial, patients aged  50 years with a diagnosis of CHF who are being treated at Wishard Health Services (Indianapolis, Indiana) are randomly assigned to pharmacist intervention or usual care. Intervention patients receive 9 months of pharmacist support and 3 months of postintervention follow-up. The intervention involves a pharmacist providing verbal and written education, icon-based labeling of medication containers, and therapeutic monitoring. The pharmacist identifies patients'' barriers to appropriate drug use, coaches them on overcoming these barriers, and coordinates medication use issues with their primary care providers. Daily updates of relevant monitoring data are delivered via an electronic medical record system and stored in a personal computer system designed to support pharmacist monitoring and facilitate documentation of interventions. To measure medication adherence objectively, electronic monitoring lids are used on all CHF medications for patients in both study groups. Other assessments include self-reported medication adherence, results of echocardiography (eg, ejection fraction), brain natriuretic peptide concentrations, and health-related quality of life. Health services utilization, refill adherence, and cost data derive from electronic medical records. After completion of this study, the data can be used to assess the effectiveness and cost-effectiveness of our intervention.Results: One hundred twenty-two patients have been assigned to receive the intervention and 192 to receive usual care.Conclusions: Our study aims to improve patients'' knowledge and self-management of their medication and to improve medication monitoring in a multilevel pharmacy-based intervention. By doing so, we intend that the intervention will improve the health outcomes of elderly patients with CHF. [Copyright &y& Elsevier]

Although several clinical reports describe the benefits of toy stimulation for dementia patients, there is little empirical support for this sensory stimulation approach. The purpose of this investigation was to examine the effects of toy stimulation on the language, cognition, and emotional state of patients in the middle stages of Alzheimer’s disease (AD) during a formal testing situation. Eighteen patients completed a standardized test battery and picture description task twice, once with and once without a toy stimulus present. Three AD patients completed all tasks four times (twice with and twice without the toy) to examine performance consistency. Although some patients improved their performances in the presence of a toy, there were no significant group differences between the toy and no toy conditions for any experimental measure. Of the three patients who completed experimental tasks twice in the presence of a toy, two displayed some consistent improvements whereas the remaining patient’s response pattern was variable. Caregiver feedback regarding toy stimulation was positive. Methodological limitations of the current study and suggestions for future research are discussed.: Learning outcomesAs a result of reading this article, the participant will be able to: (1) summarize the previous literature regarding sensory stimulation treatment approaches for patients with Alzheimer’s disease or other dementing illnesses; and (2) describe the effects of toy stimulation on the linguistic and cognitive abilities, and emotional status of patients in the middle stages of Alzheimer’s disease. [Copyright &y& Elsevier]