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Purpose: The absence of culture- and language-specific aphasia assessment in Bangla underscores a critical problem in communication sciences and disorders. Aphasia occurs in ~41% of Bangla-speaking stroke survivors. In the past 40 years, stroke incidence has doubled in low- and middle-income countries, such as Bangladesh and India, where there are ~250 million native Bangla speakers. This study aims to initiate the first step toward identifying an appropriate picture stimulus for the Bangla picture description task (PDT) intended for inclusion in a Bangla aphasia assessment. Researchers have reported the importance of cultural relevance and three visuographic variables of a picture (high-context, color, and photograph vs. black-and-white line drawing) for faster comprehension and comprehensive language production in people with aphasia and neurologically healthy adults. Method: Ninety-six neurologically healthy native Bangla speakers of three age groups (young 19–30, middle age 40–55, and older 65–89 years) were recruited to compare spontaneous language production for four selected culturally related and nonrelated picture stimuli with and without the three visuographic variables. Five linguistic variables were used to analyze the language samples. Results: The results demonstrated a significant (a) picture type effect for moving-average type–token ratio, words per minute (WPM), and mean length of utterance in morphemes (MLU) and (b) age group effect for WPM, MLU, and complexity index. Conclusions: This study suggests that a culturally related high-context color photograph is the optimal choice for the Bangla PDT. This study also indicates reduced fluency, grammatical complexity, and syntactic complexity in healthy Bangla-speaking adults aged 65 years and above. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to explore receptiveness of people with poststroke aphasia to receiving transcranial direct current stimulation (tDCS), including preferences for the treatment setting and schedule of tDCS delivery. Method: An online survey was distributed via e-mail, flyers, social media, and online newsletters to reach people with aphasia. Fisher's exact test examined the relationship of self-reported tDCS receptiveness to demographic, clinical, and other factors. Results: Fifty-seven surveys were returned, and 50 complete surveys were analyzed. Twenty-eight percent of respondents had previously heard of tDCS. Sixty-six percent reported they would receive tDCS if it could help their aphasia, and only 6% reported that they definitely would not. There were statistically significant relationships between being receptive to tDCS and (a) not currently working, (b) being receptive to speech-language therapy, and (c) greater acceptance of potential temporary risks associated with tDCS. Most individuals (73%) who would consider tDCS were equivalently open to receiving it in the clinic or at home, yet the majority (64%) were open to more frequent sessions at home than in the clinic. Most respondents indicated that they would consider having tDCS "forever if it helped" (clinic: 51%; home: 68%). Conclusions: This is the first study to query individuals with aphasia about their receptiveness to tDCS outside the context of an intervention study. Responses suggest that a large majority of people with poststroke aphasia might be open to receiving tDCS if it can ameliorate their aphasia. Limitations include the small sample size, which does not adequately represent the broader population of people with aphasia, and that the survey did not provide the level of tDCS education crucial to inform shared decision making and person-centered care. However, future work may benefit from considering the practical implications of research designs (e.g., high intensity treatment outside the home) that may not, in application, be widely acceptable to primary stakeholders. [ABSTRACT FROM AUTHOR]

Background: In aphasia research, to improve a study's reliability, the aphasia journals compel their authors to report fidelity. Aphasia researchers are mostly concerned about Type I and Type II errors to maintain the level of confidence. However, the third type (Type III error) can significantly affect the study outcomes and question the research fidelity. Objective: This study explains the methodology of how investigators maintained research fidelity in the context of hiring and training remote data collectors and conducted a multi-site data collection. Methods: The present study used a descriptive analysis design to explicate the three-step process of remote data collection: (1) remotely selecting and training data collectors, (2) remotely supervising data collection and data management, and (3) optimizing and monitoring screening/assessment fidelity. At the initial step, investigators interviewed seven candidates and short-listed four of them, who were trained using a standard training protocol and participated in a mock data collection. For the next two steps, data collectors video-recorded each study session and e-shared the data with the investigator, who watched all the video-recordings and provided necessary feedback with a focus on the screening sections. The screenings were a part of the inclusion-exclusion criteria. Results: Two data collectors (both clinical psychologists) with the highest scores were selected and received final training. One-to-one e-supervision by the investigator resulted in significant improvement in data collectors' performance. Only 4% of the total collected sample size was excluded, and 99 participants' data were analyzed. Conclusion: The present study adds information on maintaining research fidelity for remote data collection, where limited studies exist. [ABSTRACT FROM AUTHOR]

Background: A comprehensive aphasia assessment is necessary to diagnose the type and severity of aphasia differentially and guide appropriate interventions. One component of an aphasia assessment is the picture description task (PDT), designed to probe spontaneous speech fluency and information content. Most aphasia assessments use black‐and‐white line drawings (LD) to elicit spontaneous language samples from people with aphasia (PWA). However, recent studies reported two visuographic variables: (1) colour (over black and white) and (2) photograph (over LD), that tended to encourage easier and faster comprehension and increased overall naturalistic language production from neurologically healthy individuals as well as PWA. Additionally, a suitable stimulus for a PDT should always be culturally relevant to the target population. Therefore, we suggest that a new PDT must include a culturally appropriate colour photograph (CP). Aims: To investigate if a culturally appropriate CP elicits longer and more complex utterances than a culturally appropriate black‐and‐white LD from neurologically healthy native Bangla speakers. Methods & Procedures: A total of 30 participants (mean age = 36.03 years) were recruited based on self‐reports of no known impairments in cognition, language, vision and hearing. All were of middle socioeconomic status with at least 12 years of formal education. A culturally appropriate CP was selected showing multiple characters performing various functions. Later, an artist prepared the black‐and‐white LD of that CP. The elicited language samples using these two pictures were transcribed and coded following preset transcription and coding guidelines. The transcribed samples were further analysed using the Bangla adaptation of Systematic Analysis of Language Transcripts (SALT) software. To identify the differences in language production between these two picture types, investigators used four measurement variables: mean length of utterances (MLU), complexity index (CI), total number of words (TNW) and words per minute (WPM). Outcomes & Results: Of the four measures, only MLU showed a statistically significant difference between the CP and the black‐and‐white LD. CI demonstrated a strong correlation with MLU for the CP, which indicates that the participants who produced higher MLU for the CP also produced a higher CI for the CP. There were no significant differences between the two picture types for CI, TNW and WPM. Conclusions & Implications: This study found that the grammatical complexity, as measured by MLU, of spontaneous language production of neurologically healthy adults was higher when a CP was used in a PDT. A CP may also be beneficial for PWA to produce complex language samples. What this paper addsWhat is already known on the subjectThere are studies on neurologically healthy individuals as well as on PWA that identified the impact of using different visuographic variables (colour and photograph) separately, which enhanced the picture comprehension and improved performances on associated language production tasks. To our knowledge, no studies have identified the combined impact of these two visuographic variables on spontaneous language production. Therefore, this initial study on neurologically healthy Bangla adults reports the impact of using a CP as a stimulus item for a PDT task to elicit spontaneous language samples.What this paper adds to existing knowledgeThis study reports that using a culturally appropriate CP for a PDT enhances the grammatical complexity of spontaneous language production of neurologically healthy adults. To our knowledge, this is the first study in Bangla that used the MLU as a measurement variable to analyse adults' spontaneous language production.What are the potential or actual clinical implications of this work?The development of future aphasia assessments should consider incorporating CPs as stimuli for PDTs, which may guide speech–language pathologists to provide accurate diagnoses for aphasia and related language disorders. [ABSTRACT FROM AUTHOR]

Purpose: We sought to examine interrater reliability in clinical assessment of apraxia of speech (AOS) in individuals with primary progressive aphasia and to identify speech characteristics predictive of AOS diagnosis. Method: Fifty-two individuals with primary progressive aphasia were recorded performing a variety of speech tasks. These recordings were viewed by 2 experienced speechlanguage pathologists, who independently rated them on the presence and severity of AOS as well as 14 associated speech characteristics. We calculated interrater reliability (percent agreement and Cohen’s kappa) for these ratings. For each rater, we used stepwise regression to identify speech characteristics significantly predictive of AOS diagnosis. We used the overlap between raters to create a more parsimonious model, which we evaluated with multiple linear regression. Results: Results yielded high agreement on the presence (90%) and severity of AOS (weighted Cohen’s κ = .834) but lower agreement for specific speech characteristics (weighted Cohen’s κ ranging from .036 to .582). Stepwise regression identified 2 speech characteristics predictive of AOS diagnosis for both raters (articulatory groping and increased errors with increased length/complexity). These alone accounted for ≥ 50% of the variance of AOS severity in the constrained model. Conclusions: Our study adds to a growing body of research that highlights the difficulty in objective clinical characterization of AOS and perceptual characterization of speech features. It further supports the need for consensus diagnostic criteria with standardized testing tools and for the identification and validation of objective markers of AOS. Additionally, these findings underscore the need for a training protocol if diagnostic tools are to be effective when shared beyond the research teams that develop and test them and disseminated to practicing speech-language pathologists, in order to ensure consistent application. [ABSTRACT FROM AUTHOR]

Many people with aphasia have inadequate language skills for functional communication thereby necessitating well-designed augmentative and alternative communication (AAC) interfaces. Using both a grid and a VSD interface with single word hotspots by neurologically healthy adults, across ages and with different technology experiences, this study examines the utility of these interfaces prior to investigating their use with people with aphasia in future studies. Participants include 18 young adults, 24 older adults with technology experience, and 20 older adults with limited technology experience. The older adult groups were matched for mean age and for sex. Participants described pictures with each interface, and performance was measured based on four dependent variables: (a) the total number of correct information units (CIUs), (b) the percentage of CIUs, (c) CIUs per minute, and (d) preferred interface. There was a significant difference between older adults and the young adult group for the total number of CIUs (p < 0.001) and CIUs per minute (p < 0.001). Despite the changes in technology experience between the two older groups, there was no significant difference in performance. Additionally, there was no significant difference in performance across the two interfaces in any of the groups. Findings suggest age does impact performance on AAC. However, the difference in technology experience in older adult groups did not affect performance. Furthermore, both interfaces used in the current study were equally beneficial when describing pictures by healthy adults. Augmentative and alternative communication (AAC) systems involve various interface designs. Consequently, the comparative utility of these interfaces must be examined across populations and communicative functions. Advancement in technology has given rise to numerous high-tech AAC interface designs. However, older adults with acquired language difficulties whose technology experience is limited may become reluctant to use high-tech AAC. Hence, the influence of technology experience on high-tech AAC performance should be investigated. Prior to examining interfaces with individuals with acquired language difficulties, the current study examined the use of a) grid display and b) visual scene display (VSD) with single word hotspots, by healthy adults of different ages and technology experiences. The study revealed that older adults with limited technology experience were equally competent in using high-tech AAC interfaces, as those with technology experience. Hence, an individual's technology experience should not be considered a deterrent to using high-tech AAC interfaces. Additionally, the study found no differences in performance between the two interfaces, making it essential to consider user's personal preference when adopting AAC interface designs. [ABSTRACT FROM AUTHOR]

Background Efficacy studies have demonstrated the benefit of group conversation therapy for a person with aphasia (PWA). However, a PWA typically participates in individual therapy prior to group therapy. Stimulation therapy (ST) is the most common type of individual aphasia therapy. Ultimately, the outcome of therapy is to enable the PWA to communicate effectively with others, which suggests the need for conversation therapy (CT). Little efficacy data exist to demonstrate the benefit of CT between a PWA and a clinician, in part because no clear treatment outcome measures have been established. More information is needed to identify optimal ways to measure CT outcomes. Aim To identify ways to measure CT outcomes and to determine if there is a change in linguistic complexity and total talk time during conversation, samples were taken during CT and ST in two PWAs. Methods & Procedures Seventeen 6-min conversational samples per PWA were analyzed from a prior single-subject AB1AB2A alternating treatment study with randomized ordering of interventions across participants. Data were analyzed for seven measures of linguistic complexity using Systematic Analysis of Language Transcripts (SALT). Efficiency was measured using correct information units (CIUs) per minute and total talk time. Outcomes & Results Per cent of complex utterances and propositional density were higher following CT. Four out of seven linguistic measures increased following ST. Total talk time was significantly greater for one PWA during CT compared with ST. No differences were found in CIUs/min across treatment types. Conclusion & Implications Linguistic complexity and efficiency appear to be conversational treatment outcome measures that are sensitive to change, which researchers might consider using. [ABSTRACT FROM AUTHOR]

Background: Few studies have investigated conversation therapy between a person with aphasia and a clinician. Furthermore, little information exists on generalisation of impairment-based stimulation treatment to conversational outcomes. Aim: The purpose of this preliminary study was to compare the effects of stimulation therapy and conversation therapy on conversational outcome measures in two cases. Method: We employed a single-subject AB1AB2A design with randomised ordering of interventions across two participants. Primary outcomes included 6-minute conversations coded for discourse functions of an utterance. Outcomes & Results: The participant who received stimulation therapy first demonstrated improved conversational outcomes after the first phase. The participant who received conversation therapy first demonstrated improved conversational outcomes after the first phase. Although improvements were made in each type of therapy, the highest gains in conversational production were during or following conversation therapy in either treatment order for both participants. Conclusion: Both types of therapy produced gains in conversational abilities. However, the small number of participants limits the generalisability of this study. Future research is needed to determine which participants may benefit most from conversation therapy and to improve the clinical feasibility of conducting and measuring conversational therapy. [ABSTRACT FROM AUTHOR]

Purpose: There is a pressing need for psychometrically sound naming materials for Spanish/English bilingual adults. To address this need, in this study the authors examined the psychometric properties of An Object and Action Naming Battery (An O&A Battery; Druks & Masterson, 2000) in bilingual speakers. Method: Ninety-one Spanish /English bilinguals named O&A Battery items in English and Spanish. Responses underwent a Rasch analysis. Using correlation and regression analyses, the authors evaluated the effect of psycholinguistic (e.g., imageability) and participant (e.g., proficiency ratings) variables on accuracy. Results: Rasch analysis determined unidimensionality across English and Spanish nouns and verbs and robust item-level psychometric properties, evidence for content validity. Few items did not fit the model, there were no ceiling or floor effects after uninformative and misfit items were removed, and items reflected a range of difficulty. Reliability coefficients were high, and the number of statistically different ability levels provided indices of sensitivity. Regression analyses revealed significant correlations between psycholinguistic variables and accuracy, providing preliminary construct validity. The participant variables that contributed most to accuracy were proficiency ratings and time of language use. Condusions: Results suggest adequate content and construct validity of O&A items retained in the analysis for Spanish/English bilingual adults and support future efforts to evaluate naming in older bilinguals and persons with bilingual aphasia. [ABSTRACT FROM AUTHOR]

Purpose: There is a pressing need for psychometrically sound naming materials for Spanish/English bilingual adults. To address this need, in this study the authors examined the psychometric properties of An Object and Action Naming Battery (An O&A Battery; Druks & Masterson, 2000) in bilingual speakers. Method: Ninety-one Spanish /English bilinguals named O&A Battery items in English and Spanish. Responses underwent a Rasch analysis. Using correlation and regression analyses, the authors evaluated the effect of psycholinguistic (e.g., imageability) and participant (e.g., proficiency ratings) variables on accuracy. Results: Rasch analysis determined unidimensionality across English and Spanish nouns and verbs and robust item-level psychometric properties, evidence for content validity. Few items did not fit the model, there were no ceiling or floor effects after uninformative and misfit items were removed, and items reflected a range of difficulty. Reliability coefficients were high, and the number of statistically different ability levels provided indices of sensitivity. Regression analyses revealed significant correlations between psycholinguistic variables and accuracy, providing preliminary construct validity. The participant variables that contributed most to accuracy were proficiency ratings and time of language use. Condusions: Results suggest adequate content and construct validity of O&A items retained in the analysis for Spanish/English bilingual adults and support future efforts to evaluate naming in older bilinguals and persons with bilingual aphasia. [ABSTRACT FROM AUTHOR]

Primary objective: To conceptualize functional cognitive constructs across the continuum of traumatic brain injury (TBI) recovery, to form the foundation for the Computer Adaptive Measure of Functional Cognition for TBI (CAMFC-TBI). Background: TBI often has a profound impact on a survivor's ability to return to previous level of functioning and significantly reduces the overall quality of life for survivors and caregivers. Few assessments are designed to evaluate TBI's impact on cognitive functioning in everyday life. Neuropsychological tests are time consuming and may have questionable ecological validity for predicting functional outcomes. Global functional assessments contain few cognitive items and may lack psychometric rigour. Presently there is a lack of efficient, precise, ecologically valid functional cognitive measures. Main outcome and results: Studies that used neuropsychological and global functional assessments were reviewed to direct conceptualization of functional cognitive constructs across TBI recovery stages. An advisory panel reviewed study methodology and functional cognitive constructs development. They validated the need for the CAMFC-TBI and the six functional cognitive constructs: attention, memory, processing speed, executive functioning, social communication and emotional management. Conclusion: Conceptualizing functional cognitive constructs is the first step in CAMFC-TBI development. Future project stages include item pool development, qualitative testing, field-testing, psychometric analysis and computerized adaptive test programming. [ABSTRACT FROM AUTHOR]

Purpose: To provide preliminary evidence of the construct validity of the Communicative Effectiveness Survey (CES) for individuals with dysarthria and idiopathic Parkinson's disease (PD). Method: In a prospective, quasi-experimental design, 25 participants each were assigned to 3 groups (N = 75): PD and dysarthria, non-PD and no dysarthria, and PD significant others (SOs). Mean CES ratings were used to test for significant differences between the PD and non-PD group, and PD and SO rating of PD's communicative effectiveness. Multiple linear regression tested for significant predictors of CES ratings for PD group only using sentence intelligibility and spontaneous speech intelligibility scores as predictor variables. Results: The PD group rated their CES significantly lower than did the non-PD group. The PD group rated their CES significantly higher than their SOs rated them. Neither speech intelligibility score was a significant predictor of CES ratings. In follow-up analysis, the Hoehn and Yahr PD staging accounted for 47% of the variability in CES ratings for the PD group participants. Conclusions: This study provides preliminary evidence of the CES's construct validity. Clinicians and researchers who assess and treat individuals with PD may consider adding an additional assessment to the traditional clinical measures (i.e., speech intelligibility) by obtaining a measure of communicative effectiveness. [ABSTRACT FROM AUTHOR]

The purpose of this case study was to examine the integrity of cognitive skills, language usage, and language structure components in a patient with corticobasal degeneration (CBD). CBD is a levadopa-nonresponsive, degenerative neurologic movement disorder that is generally accompanied by cognitive (frontal executive dysfunction, dementia) and linguistic (aphasia) disorders. However, no one has reported on social language usage deficits in cases of CBD. The reported frontal executive dysfunction found in CBD led us to expect social language usage deficits in the present case study. Consistent with the literature, the patient demonstrated motor, cognitive (severe apraxia, frontal executive deficits, dementia), and linguistic deficits (aphasia). However she also demonstrated significantly abnormal social language usage previously unreported in the literature. [ABSTRACT FROM AUTHOR]

Background: Communication of people with Parkinson's disease (PwPD) is negatively affected. For PwPD with communication difficulties, it is important to use self‐assessment tools as a primary assessment approach to evaluate their perspectives on communication. It is also important to evaluate PwPDs with self‐assessment scales in order to determine in which situations their communicative effectiveness is affected and to include them in the intervention plan. Aims: To create a Turkish version of the Communicative Effectiveness Survey‐Revised (CES‐R), to examine its validity and reliability, and to investigate its applicability in PwPD. Method: The study included 106 PwPD and 106 healthy participants. The original form of the CES‐R was adapted into Turkish according to international guidelines. Every participant completed the Turkish version of CES‐R and the Voice Handicap Index‐10 form. The adapted scale was retested 2 weeks later. Outcomes and Results: Because the Kaiser‐Meyer‐Olkin coefficient was 0.956 in the exploratory factor analysis of the CES‐R and p < 0.01 for Bartlett's Test, the data set is 'perfectly' suitable for factor analysis. In the explanatory factor analysis applied in the CES‐R scale, the total explanatory ratio of the two dimensions was determined as 63.5%, and the validity condition was met. Cronbach's alpha coefficient was 0.958 in the PwPD group and 0.955 in the control group and the scale was found to be at the 'high reliability' level. Conclusion: The CES‐R is a valid, reliable, and useable self‐assessment scale for Turkish PwPD. Furthermore, this adaptation research was developed to assess possible communication difficulties for PwPD. With this tool, difficulties in communication skills that can be identified by a comprehensive evaluation should also be studied in the intervention processes. What this paper adds: What is already known on the subject: Self‐assessment tools are suggested as a primary use when evaluating people with Parkinson's disease (PwPD) with communication difficulties. The CES‐R is one of these self‐assessment scales. However, the validity and reliability study of the Communicative Effectiveness Survey‐Revised (CES‐R) in Turkish has not been conducted. What this paper adds to existing knowledge: This study demonstrates the validity and reliability of the Turkish CES‐R scale and its applicability to PwPD. Furthermore, this scale can be used in assessment procedures for possible communication difficulties for PwPD. What are the potential or actual clinical implications of this work?: The scale, which is unidimensional in the literature, was found to have two dimensions with eigenvalues > 1 in the Discovery Factor analysis in this study. The first dimension was named communication in general situations (CGS) and the second dimension was named communication in difficult situations (CDS). It is thought that this scale will be useful in research and clinics for the comprehensive assessment of PwPD with communication difficulties before and after treatment. [ABSTRACT FROM AUTHOR]

Vocal expression reflects an integral component of communication that varies considerably within individuals across contexts and is disrupted in a range of neurological and psychiatric disorders. There is reason to suspect that variability in vocal expression reflects, in part, the availability of “on-line” resources (e.g., working memory, attention). Thus, understanding vocal expression is a potentially important biometric index of information processing, not only across but within individuals over time. A first step in this line of research involves establishing a link between vocal expression and information processing systems in healthy adults. The present study employed a dual attention experimental task where participants provided natural speech while simultaneously engaged in a baseline, medium or high nonverbal processing-load task. Objective, automated, and computerized analysis was employed to measure vocal expression in 226 adults. Increased processing load resulted in longer pauses, fewer utterances, greater silence overall and less variability in frequency and intensity levels. These results provide compelling evidence of a link between information processing resources and vocal expression, and provide important information for the development of an automated, inexpensive and uninvasive biometric measure of information processing. [ABSTRACT FROM AUTHOR]

Purpose: To present a primarily conceptual introduction to item response theory (IRT) and Rasch models for speechlanguage pathologists (SLPs). Method: This tutorial introduces SLPs to basic concepts and terminology related to IRT as well as the most common IRT models. The article then continues with an overview of how instruments are developed using IRT and some basic principles of adaptive testing. Conclusion: IRT is a set of statistical methods that are increasingly used for developing instruments in speechlanguage pathology. While IRT is not new, its application in speech-language pathology to date has been relatively limited in scope. Several new IRT-based instruments are currently emerging. IRT differs from traditional methods for test development, typically referred to as classical test theory (CTT), in several theoretical and practical ways. Administration, scoring, and interpretation of IRT instruments are different from methods used for most traditional CTT instruments. SLPs will need to understand the basic concepts of IRT instruments to use these tools in their clinical and research work. This article provides an introduction to IRT concepts drawing on examples from speech-language pathology. [ABSTRACT FROM AUTHOR]

Objective: To perform a psychometric evaluation of the Functional Outcome Questionnaire for Aphasia (FOQ-A), a 32-item instrument designed to assess the extent to which a person who has had a stroke performs several important functional communication behaviors. Research Design: The FOQ-A was administered to family caregivers of persons with a history of left hemisphere stroke (N = 91) undergoing a comprehensive screening assessment to determine their eligibility for participation in research trials for novel stroke rehabilitation interventions. Results: Statistical analyses provided strong support for the internal consistency reliability and the convergent and discriminant validity of the FOQ-A. An exploratory factor analysis revealed a two-factor solution, Basic Verbal Expression and Conversational Response Skills. Conclusions: The present findings build on earlier evidence indicating that the FOQ-A has good psychometric properties and considerable promise as a measure of functional communication in aphasia rehabilitation. Future research will focus on the test-retest reliability, criterion-oriented validity, and predictive validity of the instrument. [ABSTRACT FROM AUTHOR]

Primary objective: To determine whether the psychometrics of the BRIEF-A are adequate for individuals diagnosed with TBI. Research design: A prospective observational study in which the BRIEF-A was collected as part of a larger study. Methods and procedures: Informant ratings of the 75-item BRIEF-A on 89 individuals diagnosed with TBI were examined to determine items level psychometrics for each of the two BRIEF-A indexes: Behaviour Rating Index (BRI) and Metacognitive Index (MI). Patients were either outpatients or at least 1 year post-injury. Main outcomes and results: Each index measured a latent trait, separating individuals into five-to-six ability levels and demonstrated good reliability (0.94 and 0.96). Four items were identified that did not meet the infit criteria. Conclusions: The results provide support for the use of the BRIEF-A as a supplemental assessment of executive function in TBI populations. However, further validation is needed with other measures of executive function. Recommendations include use of the index scores over the Global Executive Composite score and use of the difficulty hierarchy for setting therapy goals. [ABSTRACT FROM AUTHOR]