Background - Boston University
The Intensive Cognitive-Communication Rehabilitation (ICCR) Program for Young Adults with Acquired Brain Injury (ABI)Gilmore, N., Ross, K., & Kiran, S.Natalie Gilmore *Aphasia Research LaboratorySpeech and Hearing Sciences, Boston University, Boston, MAngilmore@bu.edu*Corresponding AuthorKatrina RossAphasia Research LaboratorySpeech and Hearing Sciences, Boston University, Boston, MAkatrinajross@Swathi KiranAphasia Research LaboratorySpeech and Hearing Sciences, Boston University, Boston, MAkirans@bu.eduAbstractPurpose: This study investigated the effects of an intensive cognitive-communication rehabilitation (ICCR) program for young individuals with chronic Acquired Brain Injury (ABI).Methods: ICCR included classroom lectures; metacognitive instruction, modeling, and application; technology skills training; and individual cognitive-linguistic therapy. Four individuals participated in the intensive program (6 hours with 1 hour lunch break x 4 days x 12-weeks of treatment); three participants completed three consecutive semesters; the fourth completed one. Two controls did not receive treatment and completed assessments before and after the 12-week treatment interval only. Results: All four experimental participants demonstrated significant improvements on at least one standardized cognitive-linguistic measure, whereas controls did not. Furthermore, timepoint significantly predicted participants’ scores on two of the four standardized outcome measures, indicating that as duration in ICCR increased, scores increased. Participants who completed multiple semesters of ICCR also showed gains in their therapy and personal goals, classroom behavior, life participation, and QOL.Conclusion: After ICCR, participants showed gains in their cognitive-linguistic functioning, classroom participation, and individual therapy. They also demonstrated improvements outside of the classroom and in their overall well-being. There is a gap between the large population of young adults with ABI who wish to return to higher education and a lack of rehabilitation programs supporting re-entry into academic environments; ICCR is a first step in reducing that gap. BackgroundIndividuals with Acquired Brain Injury (ABI) as a result of traumatic brain injury (TBI) or stroke (CVA) typically experience cognitive and/or language deficits that persist for years post-onset ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"GLATd1ht","properties":{"formattedCitation":"(Chapey, 2008; Cicerone et al., 2011; Kennedy, Coelho, et al., 2008; Sohlberg & Mateer, 1989)","plainCitation":"(Chapey, 2008; Cicerone et al., 2011; Kennedy, Coelho, et al., 2008; Sohlberg & Mateer, 1989)","noteIndex":0},"citationItems":[{"id":33005,"uris":[""],"uri":[""],"itemData":{"id":33005,"type":"book","title":"Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders","publisher":"Lippincott Williams & Wilkins","publisher-place":"Baltimore, MD","number-of-pages":"1091","edition":"Fifth Edition","event-place":"Baltimore, MD","abstract":"A book discussing strategies and approaches to helping clients with stroke or brain damage related injuries/disorders.","ISBN":"978-0-7817-6981-5","language":"English","author":[{"family":"Chapey","given":"Roberta"}],"issued":{"date-parts":[["2008"]]}}},{"id":"lgPqHwOs/wLGnyoSv","uris":[""],"uri":[""],"itemData":{"id":"goGfe1NI/HIBfryfB","type":"article-journal","title":"Evidence-Based Cognitive Rehabilitation: Updated Review of the Literature From 2003 Through 2008","container-title":"Archives of Physical Medicine and Rehabilitation","page":"519-530","volume":"92","issue":"4","source":"CrossRef","DOI":"10.1016/j.apmr.2010.11.015","ISSN":"00039993","shortTitle":"Evidence-Based Cognitive Rehabilitation","language":"en","author":[{"family":"Cicerone","given":"Keith D."},{"family":"Langenbahn","given":"Donna M."},{"family":"Braden","given":"Cynthia"},{"family":"Malec","given":"James F."},{"family":"Kalmar","given":"Kathleen"},{"family":"Fraas","given":"Michael"},{"family":"Felicetti","given":"Thomas"},{"family":"Laatsch","given":"Linda"},{"family":"Harley","given":"J. 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The first section presents basic principles and general issues; the second section, which comprises the bulk of the text, i","ISBN":"978-0-89862-738-1","shortTitle":"Introduction to Cognitive Rehabilitation","language":"English","author":[{"family":"Sohlberg","given":"McKay Moore"},{"family":"Mateer","given":"Catherine A."}],"issued":{"date-parts":[["1989"]]}}}],"schema":""} (Chapey, 2008; Cicerone et al., 2011; Kennedy, Coelho, et al., 2008; Sohlberg & Mateer, 1989). Young adults are a frequently affected and growing population (i.e., age 18-36) within ABI ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a1k4oqatcjg","properties":{"formattedCitation":"(\\uc0\\u8220{}TBI: Get the Facts,\\uc0\\u8221{} 2017; \\uc0\\u8220{}Young Stroke Survivors,\\uc0\\u8221{} 2016)","plainCitation":"(“TBI: Get the Facts,” 2017; “Young Stroke Survivors,” 2016)","noteIndex":0},"citationItems":[{"id":"lgPqHwOs/PEaq3J7P","uris":[""],"uri":[""],"itemData":{"id":727,"type":"article","title":"TBI: Get the Facts","publisher":"Centers for Disease Control and Prevention","URL":"","language":"English","issued":{"date-parts":[["2017",4,6]]},"accessed":{"date-parts":[["2017",2,13]]}}},{"id":"lgPqHwOs/iLIRdKgd","uris":[""],"uri":[""],"itemData":{"id":728,"type":"article","title":"Young Stroke Survivors","URL":"","issued":{"date-parts":[["2016",12,19]]},"accessed":{"date-parts":[["2017",3,17]]}}}],"schema":""} (“TBI: Get the Facts,” 2017; “Young Stroke Survivors,” 2016). Unfortunately, when a young adult has a brain injury during high school or college, essential aspects of the college experience (e.g., following a schedule, taking notes, studying, writing papers, giving presentations) become challenging due to deficits in executive function, attention, memory, and language skills. Post-secondary education may be challenging for individuals with ABI, but has the potential to be quite valuable for them as it would tax their problem-solving skills; provide opportunities to interact with peers ( ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"tsgj3K8H","properties":{"formattedCitation":"(Cicerone, 2004; Lyon, 1992)","plainCitation":"(Cicerone, 2004; Lyon, 1992)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":33222,"uris":[""],"uri":[""],"itemData":{"id":33222,"type":"article-journal","title":"Participation as an outcome of traumatic brain injury rehabilitation","container-title":"The Journal of Head Trauma Rehabilitation","page":"494–501","volume":"19","issue":"6","source":"Google Scholar","author":[{"family":"Cicerone","given":"Keith D."}],"issued":{"date-parts":[["2004"]]}}},{"id":33224,"uris":[""],"uri":[""],"itemData":{"id":33224,"type":"article-journal","title":"Communication use and participation in life for adults with aphasia in natural settings: The scope of the problem","container-title":"American Journal of Speech-Language Pathology","page":"7–14","volume":"1","issue":"3","source":"Google Scholar","shortTitle":"Communication use and participation in life for adults with aphasia in natural settings","author":[{"family":"Lyon","given":"Jon G."}],"issued":{"date-parts":[["1992"]]}}}],"schema":""} Cicerone, 2004; Lyon, 1992); and build independence ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"x8ajnn94","properties":{"formattedCitation":"(Kennedy, O\\uc0\\u8217{}Brien, & Krause, 2012)","plainCitation":"(Kennedy, O’Brien, & Krause, 2012)","noteIndex":0},"citationItems":[{"id":33227,"uris":[""],"uri":[""],"itemData":{"id":33227,"type":"article-journal","title":"Bridging person-centered outcomes and therapeutic processes for college students with traumatic brain injury","container-title":"SIG 2 Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders","page":"143–151","volume":"22","issue":"4","source":"Google Scholar","author":[{"family":"Kennedy","given":"M.R."},{"family":"O’Brien","given":"K.H."},{"family":"Krause","given":"Miriam O."}],"issued":{"date-parts":[["2012"]]}}}],"schema":""} (Kennedy, O’Brien, & Krause, 2012). Regrettably, individuals with ABI are typically offered transition services that prepare them for employment or independent living rather than a college/university setting ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a1iilfispq0","properties":{"formattedCitation":"(Todis & Glang, 2008)","plainCitation":"(Todis & Glang, 2008)","noteIndex":0},"citationItems":[{"id":32272,"uris":[""],"uri":[""],"itemData":{"id":32272,"type":"article-journal","title":"Redefining success: Results of a qualitative study of postsecondary transition outcomes for youth with traumatic brain injury","container-title":"The Journal of head trauma rehabilitation","page":"252–263","volume":"23","issue":"4","source":"Google Scholar","shortTitle":"Redefining success","author":[{"family":"Todis","given":"Bonnie"},{"family":"Glang","given":"Ann"}],"issued":{"date-parts":[["2008"]]}}}],"schema":""} (Todis & Glang, 2008). When individuals with ABI do pursue post-secondary education, they often do not seek out available support services (e.g., note-takers, counselors; ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a34841oreb","properties":{"formattedCitation":"(Kennedy, Krause, & Turkstra, 2008)","plainCitation":"(Kennedy, Krause, & Turkstra, 2008)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":32267,"uris":[""],"uri":[""],"itemData":{"id":32267,"type":"article-journal","title":"An electronic survey about college experiences after traumatic brain injury","container-title":"NeuroRehabilitation","page":"511–520","volume":"23","issue":"6","source":"Google Scholar","author":[{"family":"Kennedy","given":"M.R."},{"family":"Krause","given":"Miriam O."},{"family":"Turkstra","given":"Lyn S."}],"issued":{"date-parts":[["2008"]]}}}],"schema":""} Kennedy, Krause, & Turkstra, 2008). Not surprisingly then, degree completion is rare for this population; and requires extensive support and extraordinary personal motivation ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a5lgc3jo8r","properties":{"formattedCitation":"(Todis & Glang, 2008)","plainCitation":"(Todis & Glang, 2008)","noteIndex":0},"citationItems":[{"id":32272,"uris":[""],"uri":[""],"itemData":{"id":32272,"type":"article-journal","title":"Redefining success: Results of a qualitative study of postsecondary transition outcomes for youth with traumatic brain injury","container-title":"The Journal of head trauma rehabilitation","page":"252–263","volume":"23","issue":"4","source":"Google Scholar","shortTitle":"Redefining success","author":[{"family":"Todis","given":"Bonnie"},{"family":"Glang","given":"Ann"}],"issued":{"date-parts":[["2008"]]}}}],"schema":""} (Todis & Glang, 2008). Currently, Cognitive Rehabilitation (CR; ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a1o6u292hnc","properties":{"formattedCitation":"(Cicerone et al., 2000)","plainCitation":"(Cicerone et al., 2000)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":227,"uris":[""],"uri":[""],"itemData":{"id":227,"type":"article-journal","title":"Evidence-based cognitive rehabilitation: Recommendations for clinical practice","container-title":"Archives of Physical Medicine and Rehabilitation","page":"1596-1615","volume":"81","issue":"12","source":"ScienceDirect","abstract":"Cicerone KD, Dahlberg C, Kalmar K, Langenbahn DM, Malec JF, Bergquist TF, Felicetti T, Giacino JT, Harley JP, Harrington DE, Herzog J, Kneipp S, Laatsch L, Morse PA. Evidence-based cognitive rehabilitation: recommendations for clinical practice. Arch Phys Med Rehabil 2000;81:1596-615. Objective: To establish evidence-based recommendations for the clinical practice of cognitive rehabilitation, derived from a methodical review of the scientific literature concerning the effectiveness of cognitive rehabilitation for persons with traumatic brain injury (TBI) or stroke. Data Sources: A MEDLINE literature search using combinations of these key words as search terms: attention, awareness, cognition, communication, executive, language, memory, perception, problem solving, reasoning, rehabilitation, remediation, and training. Reference lists from identified articles also were reviewed; a total bibliography of 655 published articles was compiled. Study Selection: Studies were initially reviewed according to the following exclusion criteria: nonintervention studies; theoretical, descriptive, or review papers; papers without adequate specification of interventions; subjects other than persons with TBI or stroke; pediatric subjects; pharmacologic interventions; and non-English language papers. After screening, 232 articles were eligible for inclusion. After detailed review, 61 of these were excluded as single case reports without data, subjects other than TBI and stroke, and nontreatment studies. This screening yielded 171 articles to be evaluated. Data Extraction: Articles were assigned to 1 of 7 categories according to their primary area of intervention: attention, visual perception and constructional abilities, language and communication, memory, problem solving and executive functioning, multi-modal interventions, and comprehensive-holistic cognitive rehabilitation. All articles were independently reviewed by at least 2 committee members and abstracted according to specified criteria. The 171 studies that passed initial review were classified according to the strength of their methods. Class I studies were defined as prospective, randomized controlled trials. Class II studies were defined as prospective cohort studies, retrospective case-control studies, or clinical series with well-designed controls. Class III studies were defined as clinical series without concurrent controls, or studies with appropriate single-subject methodology. Data Synthesis: Of the 171 studies evaluated, 29 were rated as Class I, 35 as Class II, and 107 as Class III. The overall evidence within each predefined area of intervention was then synthesized and recommendations were derived based on consideration of the relative strengths of the evidence. The resulting practice parameters were organized into 3 types of recommendations: Practice Standards, Practice Guidelines, and Practice Options. Conclusions: Overall, support exists for the effectiveness of several forms of cognitive rehabilitation for persons with stroke and TBI. Specific recommendations can be made for remediation of language and perception after left and right hemisphere stroke, respectively, and for the remediation of attention, memory, functional communication, and executive functioning after TBI. These recommendations may help to establish parameters of effective treatment, which should be of assistance to practicing clinicians. ? 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation","DOI":"10.1053/apmr.2000.19240","ISSN":"0003-9993","note":"00000","shortTitle":"Evidence-based cognitive rehabilitation","journalAbbreviation":"Archives of Physical Medicine and Rehabilitation","author":[{"family":"Cicerone","given":"Keith D."},{"family":"Dahlberg","given":"Cynthia"},{"family":"Kalmar","given":"Kathleen"},{"family":"Langenbahn","given":"Donna M."},{"family":"Malec","given":"James F."},{"family":"Bergquist","given":"Thomas F."},{"family":"Felicetti","given":"Thomas"},{"family":"Giacino","given":"Joseph T."},{"family":"Harley","given":"J. Preston"},{"family":"Harrington","given":"Douglas E."},{"family":"Herzog","given":"Jean"},{"family":"Kneipp","given":"Sally"},{"family":"Laatsch","given":"Linda"},{"family":"Morse","given":"Philip A."}],"issued":{"date-parts":[["2000",12]]}}}],"schema":""} Cicerone et al., 2000) is the gold standard treatment for individuals with ABI. Most CR can be organized into two broad categories: impairment-based therapy (e.g., Attention Process Training (APT); ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"2fqsk39fq0","properties":{"formattedCitation":"(Sohlberg, McLaughlin, Pavese, Heidrich, & Posner, 2000)","plainCitation":"(Sohlberg, McLaughlin, Pavese, Heidrich, & Posner, 2000)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":"lgPqHwOs/AfZpq2QJ","uris":[""],"uri":[""],"itemData":{"id":563,"type":"article-journal","title":"Evaluation of attention process training and brain injury education in persons with acquired brain injury","container-title":"Journal of clinical and experimental neuropsychology","page":"656–676","volume":"22","issue":"5","source":"Google Scholar","author":[{"family":"Sohlberg","given":"McKay Moore"},{"family":"McLaughlin","given":"Karen A."},{"family":"Pavese","given":"Antonella"},{"family":"Heidrich","given":"Anke"},{"family":"Posner","given":"Michael I."}],"issued":{"date-parts":[["2000"]]}}}],"schema":""} Sohlberg, McLaughlin, Pavese, Heidrich, & Posner, 2000) and functional therapy (e.g., training on the use of external memory aids, Promoting Aphasics’ Communicative Effectiveness (PACE); ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"LuWjTf1z","properties":{"formattedCitation":"(Cicerone et al., 2011; Davis, 2005)","plainCitation":"(Cicerone et al., 2011; Davis, 2005)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":"lgPqHwOs/wLGnyoSv","uris":[""],"uri":[""],"itemData":{"id":"9zPX2b5J/N8HBrAFB","type":"article-journal","title":"Evidence-Based Cognitive Rehabilitation: Updated Review of the Literature From 2003 Through 2008","container-title":"Archives of Physical Medicine and Rehabilitation","page":"519-530","volume":"92","issue":"4","source":"CrossRef","DOI":"10.1016/j.apmr.2010.11.015","ISSN":"00039993","shortTitle":"Evidence-Based Cognitive Rehabilitation","language":"en","author":[{"family":"Cicerone","given":"Keith D."},{"family":"Langenbahn","given":"Donna M."},{"family":"Braden","given":"Cynthia"},{"family":"Malec","given":"James F."},{"family":"Kalmar","given":"Kathleen"},{"family":"Fraas","given":"Michael"},{"family":"Felicetti","given":"Thomas"},{"family":"Laatsch","given":"Linda"},{"family":"Harley","given":"J. 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Main Contribution: The article provides a description and history of the procedure and then proceeds with discussions of conceptualisation, modifications, and efficacy. Responses to several concerns about PACE should clarify many aspects of the procedure. These concerns include the procedure's naturalness, applicability to a variety of patients, and absence of corrective feedback. Conclusions: PACE has an uncertain place in the healthcare environment of the United States. Because of its mixed reviews and unsettled efficacy, it may still be considered to be an experimental treatment.","DOI":"10.1080/02687030444000598","ISSN":"0268-7038","note":"WOS:000227089600002","journalAbbreviation":"Aphasiology","language":"English","author":[{"family":"Davis","given":"G. A."}],"issued":{"date-parts":[["2005",1]]}}}],"schema":""} Cicerone et al., 2011; Davis, 2005). Ideally, a comprehensive CR program would employ a holistic approach: targeting the body structure/function, or impairment level, and the activity/participation, or functional level ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ae86aa4ptj","properties":{"formattedCitation":"(World Health Organization, 2002)","plainCitation":"(World Health Organization, 2002)","noteIndex":0},"citationItems":[{"id":33103,"uris":[""],"uri":[""],"itemData":{"id":33103,"type":"article","title":"Towards a common language for functioning, disability and health: ICF","URL":"","author":[{"family":"World Health Organization","given":""}],"issued":{"date-parts":[["2002"]]},"accessed":{"date-parts":[["2017",9,23]]}}}],"schema":""} (World Health Organization, 2002). Furthermore, it would consider psychosocial, environmental, and personal factors ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"pQ41VXIT","properties":{"formattedCitation":"(Bayley et al., 2014; Cicerone et al., 2011; Corrigan & Hammond, 2013; Kennedy, Coelho, et al., 2008; Kennedy & Coelho, 2005; Scottish Intercollegiate Guidelines Network (SIGN), 2013)","plainCitation":"(Bayley et al., 2014; Cicerone et al., 2011; Corrigan & Hammond, 2013; Kennedy, Coelho, et al., 2008; Kennedy & Coelho, 2005; Scottish Intercollegiate Guidelines Network (SIGN), 2013)","noteIndex":0},"citationItems":[{"id":33004,"uris":[""],"uri":[""],"itemData":{"id":33004,"type":"article-journal","title":"INCOG Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: Methods and Overview","container-title":"Journal of Head Trauma Rehabilitation","page":"290-306","volume":"29","issue":"4","source":"CrossRef","DOI":"10.1097/HTR.0000000000000070","ISSN":"0885-9701","shortTitle":"INCOG Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury","language":"en","author":[{"family":"Bayley","given":"Mark Theodore"},{"family":"Tate","given":"Robyn"},{"family":"Douglas","given":"Jacinta Mary"},{"family":"Turkstra","given":"Lyn S."},{"family":"Ponsford","given":"Jennie"},{"family":"Stergiou-Kita","given":"Mary"},{"family":"Kua","given":"Ailene"},{"family":"Bragge","given":"Peter"}],"issued":{"date-parts":[["2014"]]}}},{"id":"lgPqHwOs/wLGnyoSv","uris":[""],"uri":[""],"itemData":{"id":"goGfe1NI/HIBfryfB","type":"article-journal","title":"Evidence-Based Cognitive Rehabilitation: Updated Review of the Literature From 2003 Through 2008","container-title":"Archives of Physical Medicine and Rehabilitation","page":"519-530","volume":"92","issue":"4","source":"CrossRef","DOI":"10.1016/j.apmr.2010.11.015","ISSN":"00039993","shortTitle":"Evidence-Based Cognitive Rehabilitation","language":"en","author":[{"family":"Cicerone","given":"Keith D."},{"family":"Langenbahn","given":"Donna M."},{"family":"Braden","given":"Cynthia"},{"family":"Malec","given":"James F."},{"family":"Kalmar","given":"Kathleen"},{"family":"Fraas","given":"Michael"},{"family":"Felicetti","given":"Thomas"},{"family":"Laatsch","given":"Linda"},{"family":"Harley","given":"J. 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R."},{"family":"Coelho","given":"C."}],"issued":{"date-parts":[["2005"]]}}},{"id":33007,"uris":[""],"uri":[""],"itemData":{"id":33007,"type":"book","title":"Brain injury rehabilitation in adults a national clinical guideline.","publisher":"Scottish Intercollegiate Guidelines Network","publisher-place":"Edinburgh","source":"Open WorldCat","event-place":"Edinburgh","URL":"","ISBN":"978-1-905813-98-8","language":"English","author":[{"literal":"Scottish Intercollegiate Guidelines Network (SIGN)"}],"editor":[{"family":"McMillan","given":"Ailsa"}],"issued":{"date-parts":[["2013"]]},"accessed":{"date-parts":[["2017",4,14]]}}}],"schema":""} (Bayley et al., 2014; Cicerone et al., 2011; Corrigan & Hammond, 2013; Kennedy, Coelho, et al., 2008; Kennedy & Coelho, 2005; Scottish Intercollegiate Guidelines Network (SIGN), 2013). One could further argue that CR service delivery models for young individuals with ABI should include academic instruction, vocational counseling/rehabilitation, opportunities for community re-entry with typical peers, and/or programming for age-appropriate social and leisure activities. Yet, few programs currently exist for young individuals with ABI who wish to enroll in college that include all of these components.There is a wealth of literature demonstrating that individuals with ABI respond variably to rehabilitation ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a2k0clre6gt","properties":{"formattedCitation":"(Brady, Kelly, Godwin, Enderby, & Campbell, 2016; Cicerone et al., 2011)","plainCitation":"(Brady, Kelly, Godwin, Enderby, & Campbell, 2016; Cicerone et al., 2011)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":9588,"uris":[""],"uri":[""],"itemData":{"id":9588,"type":"chapter","title":"Speech and language therapy for aphasia following stroke","container-title":"Cochrane Database of Systematic Reviews","publisher":"John Wiley & Sons, Ltd","publisher-place":"Chichester, UK","source":"CrossRef","event-place":"Chichester, UK","URL":"","language":"en","editor":[{"literal":"The Cochrane Collaboration"}],"author":[{"family":"Brady","given":"Marian C"},{"family":"Kelly","given":"Helen"},{"family":"Godwin","given":"Jon"},{"family":"Enderby","given":"Pam"},{"family":"Campbell","given":"Pauline"}],"issued":{"date-parts":[["2016",6,1]]},"accessed":{"date-parts":[["2016",7,22]]}}},{"id":"lgPqHwOs/wLGnyoSv","uris":[""],"uri":[""],"itemData":{"id":83,"type":"article-journal","title":"Evidence-Based Cognitive Rehabilitation: Updated Review of the Literature From 2003 Through 2008","container-title":"Archives of Physical Medicine and Rehabilitation","page":"519-530","volume":"92","issue":"4","source":"CrossRef","DOI":"10.1016/j.apmr.2010.11.015","ISSN":"00039993","shortTitle":"Evidence-Based Cognitive Rehabilitation","language":"en","author":[{"family":"Cicerone","given":"Keith D."},{"family":"Langenbahn","given":"Donna M."},{"family":"Braden","given":"Cynthia"},{"family":"Malec","given":"James F."},{"family":"Kalmar","given":"Kathleen"},{"family":"Fraas","given":"Michael"},{"family":"Felicetti","given":"Thomas"},{"family":"Laatsch","given":"Linda"},{"family":"Harley","given":"J. Preston"},{"family":"Bergquist","given":"Thomas"},{"family":"Azulay","given":"Joanne"},{"family":"Cantor","given":"Joshua"},{"family":"Ashman","given":"Teresa"}],"issued":{"date-parts":[["2011",4]]}}}],"schema":""} (e.g., Brady, Kelly, Godwin, Enderby, & Campbell, 2016; Cicerone et al., 2011). One individual may respond well to a particular treatment, but then, that same treatment approach may be less effective for another individual, despite similar clinical profiles ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"mEMVVCoU","properties":{"formattedCitation":"(Coelho, DeRuyter, & Stein, 1996; Holland, Fromm, DeRuyter, & Stein, 1996)","plainCitation":"(Coelho, DeRuyter, & Stein, 1996; Holland, Fromm, DeRuyter, & Stein, 1996)","noteIndex":0},"citationItems":[{"id":32235,"uris":[""],"uri":[""],"itemData":{"id":32235,"type":"article-journal","title":"Treatment Efficacy: Cognitive-Communicative Disorders Resulting From Traumatic Brain Injury in Adults","container-title":"Journal of Speech Language and Hearing Research","page":"S5","volume":"39","issue":"5","source":"CrossRef","DOI":"10.1044/jshr.3905.s5","ISSN":"1092-4388","shortTitle":"Treatment Efficacy","language":"en","author":[{"family":"Coelho","given":"Carl A."},{"family":"DeRuyter","given":"Frank"},{"family":"Stein","given":"Margo"}],"issued":{"date-parts":[["1996",10,1]]}}},{"id":32236,"uris":[""],"uri":[""],"itemData":{"id":32236,"type":"article-journal","title":"Treatment Efficacy: Aphasia","container-title":"Journal of Speech and Hearing Research","page":"S27-S36","volume":"39","author":[{"family":"Holland","given":"Audrey L."},{"family":"Fromm","given":"Davida S."},{"family":"DeRuyter","given":"Frank"},{"family":"Stein","given":"Margo"}],"issued":{"date-parts":[["1996"]]}}}],"schema":""} (Coelho, DeRuyter, & Stein, 1996; Holland, Fromm, DeRuyter, & Stein, 1996). Many behavioral, neurological, and psychosocial factors influence treatment recovery in ABI ( ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"apmcl3chug","properties":{"formattedCitation":"(Bonilha, Gleichgerrcht, Nesland, Rorden, & Fridriksson, 2016; Leininger, Strong, & Donders, 2014)","plainCitation":"(Bonilha, Gleichgerrcht, Nesland, Rorden, & Fridriksson, 2016; Leininger, Strong, & Donders, 2014)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":9029,"uris":[""],"uri":[""],"itemData":{"id":9029,"type":"article-journal","title":"Success of anomia treatment in aphasia is associated with preserved architecture of global and left temporal lobe structural networks.","container-title":"Neurorehabilitation and Neural Repair","page":"266-279","volume":"30","issue":"3","source":"EBSCOhost","archive":"psyh","archive_location":"2016-08048-008","abstract":"Background and Objective: Targeted speech therapy can lead to substantial naming improvement in some subjects with anomia following dominant-hemisphere stroke. We investigated whether treatment-induced improvement in naming is associated with poststroke preservation of structural neural network architecture. Methods: Twenty-four patients with poststroke chronic aphasia underwent 30 hours of speech therapy over a 2-week period and were assessed at baseline and after therapy. Whole brain maps of neural architecture were constructed from pretreatment diffusion tensor magnetic resonance imaging to derive measures of global brain network architecture (network small-worldness) and regional network influence (nodal betweenness centrality). Their relationship with naming recovery was evaluated with multiple linear regressions. Results: Treatment-induced improvement in correct naming was associated with poststroke preservation of global network small worldness and of betweenness centrality in temporal lobe cortical regions. Together with baseline aphasia severity, these measures explained 78% of the variability in treatment response. Conclusions: Preservation of global and left temporal structural connectivity broadly explains the variability in treatment-related naming improvement in aphasia. These findings corroborate and expand on previous classical lesion-symptom mapping studies by elucidating some of the mechanisms by which brain damage may relate to treated aphasia recovery. Favorable naming outcomes may result from the intact connections between spared cortical areas that are functionally responsive to treatment. (PsycINFO Database Record (c) 2016 APA, all rights reserved). (journal abstract)","DOI":"10.1177/1545968315593808","ISSN":"1545-9683","journalAbbreviation":"Neurorehabilitation and Neural Repair","author":[{"family":"Bonilha","given":"Leonardo"},{"family":"Gleichgerrcht","given":"Ezequiel"},{"family":"Nesland","given":"Travis"},{"family":"Rorden","given":"Chris"},{"family":"Fridriksson","given":"Julius"}],"issued":{"date-parts":[["2016",3]]}}},{"id":32252,"uris":[""],"uri":[""],"itemData":{"id":32252,"type":"article-journal","title":"Predictors of Outcome After Treatment of Mild Traumatic Brain Injury: A Pilot Study","container-title":"Journal of Head Trauma Rehabilitation","page":"109-116","volume":"29","issue":"2","source":"CrossRef","DOI":"10.1097/HTR.0b013e3182860506","ISSN":"0885-9701","shortTitle":"Predictors of Outcome After Treatment of Mild Traumatic Brain Injury","language":"en","author":[{"family":"Leininger","given":"Shelley"},{"family":"Strong","given":"Carrie-Ann H."},{"family":"Donders","given":"Jacobus"}],"issued":{"date-parts":[["2014"]]}}}],"schema":""} Bonilha, Gleichgerrcht, Nesland, Rorden, & Fridriksson, 2016; Leininger, Strong, & Donders, 2014). Thus, one underlying driver of rehabilitation is how the brain reorganizes as a response to specific training (i.e., experience-dependent neural plasticity; ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Gzpe9oM6","properties":{"formattedCitation":"(Kerr, Cheng, & Jones, 2011; Kleim, 2011; Kleim & Jones, 2008; Power & Schlaggar, 2017; Warraich & Kleim, 2010)","plainCitation":"(Kerr, Cheng, & Jones, 2011; Kleim, 2011; Kleim & Jones, 2008; Power & Schlaggar, 2017; Warraich & Kleim, 2010)","noteIndex":0},"citationItems":[{"id":33269,"uris":[""],"uri":[""],"itemData":{"id":33269,"type":"article-journal","title":"Experience-dependent neural plasticity in the adult damaged brain","container-title":"Journal of Communication Disorders","source":"CrossRef","URL":"","DOI":"10.1016/j.jcomdis.2011.04.011","ISSN":"00219924","language":"en","author":[{"family":"Kerr","given":"Abigail L."},{"family":"Cheng","given":"Shao-Ying"},{"family":"Jones","given":"Theresa A."}],"issued":{"date-parts":[["2011",5]]},"accessed":{"date-parts":[["2018",1,9]]}}},{"id":33268,"uris":[""],"uri":[""],"itemData":{"id":33268,"type":"article-journal","title":"Neural plasticity and neurorehabilitation: Teaching the new brain old tricks","container-title":"Journal of Communication Disorders","page":"521-528","volume":"44","issue":"5","source":"CrossRef","DOI":"10.1016/j.jcomdis.2011.04.006","ISSN":"00219924","shortTitle":"Neural plasticity and neurorehabilitation","language":"en","author":[{"family":"Kleim","given":"Jeffrey A."}],"issued":{"date-parts":[["2011",9]]}}},{"id":32239,"uris":[""],"uri":[""],"itemData":{"id":32239,"type":"article-journal","title":"Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage","container-title":"Journal of speech, language, and hearing research","page":"S225–S239","volume":"51","issue":"1","source":"Google Scholar","shortTitle":"Principles of experience-dependent neural plasticity","author":[{"family":"Kleim","given":"Jeffrey A."},{"family":"Jones","given":"Theresa A."}],"issued":{"date-parts":[["2008"]]}}},{"id":33267,"uris":[""],"uri":[""],"itemData":{"id":33267,"type":"article-journal","title":"Neural plasticity across the lifespan: Neural plasticity across the lifespan","container-title":"Wiley Interdisciplinary Reviews: Developmental Biology","page":"e216","volume":"6","issue":"1","source":"CrossRef","DOI":"10.1002/wdev.216","ISSN":"17597684","shortTitle":"Neural plasticity across the lifespan","language":"en","author":[{"family":"Power","given":"Jonathan D."},{"family":"Schlaggar","given":"Bradley L."}],"issued":{"date-parts":[["2017",1]]}}},{"id":33271,"uris":[""],"uri":[""],"itemData":{"id":33271,"type":"article-journal","title":"Neural plasticity: the biological substrate for neurorehabilitation","container-title":"PM&R","page":"S208–S219","volume":"2","issue":"12","source":"Google Scholar","shortTitle":"Neural plasticity","author":[{"family":"Warraich","given":"Zuha"},{"family":"Kleim","given":"Jeffrey A."}],"issued":{"date-parts":[["2010"]]}}}],"schema":""} (Kerr, Cheng, & Jones, 2011; Kleim, 2011; Kleim & Jones, 2008; Power & Schlaggar, 2017; Warraich & Kleim, 2010). Based on this research, brain reorganization occurs according to behavioral, sensory, and cognitive experiences that encourage specific skill use, and repetitive, intensive practice. These tenets have since been implemented in effective rehabilitation techniques for neurogenic populations (e.g., constraint induced language therapy (CILT); ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"jgekKLmT","properties":{"formattedCitation":"{\\rtf (Pulverm\\uc0\\u252{}ller et al., 2001)}","plainCitation":"(Pulvermüller et al., 2001)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":5337,"uris":[""],"uri":[""],"itemData":{"id":5337,"type":"article-journal","title":"Constraint-induced therapy for chronic aphasia after stroke.","container-title":"Stroke (00392499)","page":"1621-1626 6p","volume":"32","issue":"7","source":"EBSCOhost","archive":"cin20","abstract":"Patients with chronic aphasia were assigned randomly to a group to receive either conventional aphasia therapy or constraint-induced (CI) aphasia therapy, a new therapeutic technique requiring intense practice over a relatively short period of consecutive days. CI aphasia therapy is realized in a communicative therapeutic environment constraining patients to practice systematically speech acts with which they have difficulty. Patients in both groups received the same amount of treatment (30 to 35 hours) as 10 days of massed-practice language exercises for the CI aphasia therapy group (3 hours per day minimum; 10 patients) or over a longer period of approximately 4 weeks for the conventional therapy group (7 patients). CI aphasia therapy led to significant and pronounced improvements on several standard clinical tests, on self-ratings, and on blinded-observer ratings of the patients' communicative effectiveness in everyday life. Patients who received the control intervention failed to achieve comparable improvements. Data suggest that the language skills of patients with chronic aphasia can be improved in a short period by use of an appropriate massed-practice technique that focuses on the patients' communicative needs.","ISSN":"0039-2499","journalAbbreviation":"Stroke (00392499)","author":[{"family":"Pulvermüller","given":"F."},{"family":"Neininger","given":"B."},{"family":"Elbert","given":"T."},{"family":"Mohr","given":"B."},{"family":"Rockstroh","given":"B."},{"family":"Koebbel","given":"P."},{"family":"Taub","given":""}],"issued":{"date-parts":[["2001",7]]}}}],"schema":""} Pulvermüller et al., 2001).The following principles of neural plasticity are particularly relevant to CR for young individuals with ABI interested in pursuing higher education: age (i.e., Younger brains may change more and faster than aging brains, although both are responsive to experience); intensity (i.e., increased length and frequency of treatment); salience (i.e. stimuli must be sufficiently interesting and engaging); and repetition (i.e., skill is elicited a sufficient number of times for learning). However, to our knowledge, no CR programs to date incorporate all of these principles into one design to optimize the potential for neural plasticity. The following sections detail programs that incorporate some, but not all of these principles. Currently, most CR is provided in a hospital or clinic setting (e.g., TBI Model System Centers). While this intervention may include academic support and training, it may not be formal and is unlikely to involve real-time clinician support in the classroom setting. In recent years, Intensive Comprehensive Aphasia Programs (ICAPs) have also become a popular option for individuals with aphasia as a result of ABI. ICAPs are efficacious treatments that are generally hosted at an aphasia center, or in a university clinic ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"gELSt4Yq","properties":{"formattedCitation":"(Babbitt, Cherney, & Worrall, 2016; Hoover, Caplan, Waters, & Carney, 2017; Persad, Wozniak, & Kostopoulos, 2013; Rodriguez et al., 2013; Rose, Cherney, & Worrall, 2013; Winans-Mitrik et al., 2014)","plainCitation":"(Babbitt, Cherney, & Worrall, 2016; Hoover, Caplan, Waters, & Carney, 2017; Persad, Wozniak, & Kostopoulos, 2013; Rodriguez et al., 2013; Rose, Cherney, & Worrall, 2013; Winans-Mitrik et al., 2014)","noteIndex":0},"citationItems":[{"id":2057,"uris":[""],"uri":[""],"itemData":{"id":2057,"type":"article-journal","title":"Who benefits from an intensive comprehensive aphasia program?","container-title":"Top. Lang. Disord. Topics in Language Disorders","page":"168-184","volume":"36","issue":"2","source":"","archive":"/z-wcorg/","ISSN":"0271-8294","language":"English","author":[{"family":"Babbitt","given":"E.M."},{"family":"Cherney","given":"L.R."},{"family":"Worrall","given":""}],"issued":{"date-parts":[["2016"]]}}},{"id":32289,"uris":[""],"uri":[""],"itemData":{"id":32289,"type":"article-journal","title":"Communication and quality of life outcomes from an interprofessional intensive, comprehensive, aphasia program (ICAP)","container-title":"Topics in Stroke Rehabilitation","page":"82-90","volume":"24","issue":"2","author":[{"family":"Hoover","given":"E.L."},{"family":"Caplan","given":"D.N."},{"family":"Waters","given":"G.S."},{"family":"Carney","given":"A."}],"issued":{"date-parts":[["2017"]]}}},{"id":8086,"uris":[""],"uri":[""],"itemData":{"id":8086,"type":"article-journal","title":"Retrospective analysis of outcomes from two intensive comprehensive aphasia programs.","container-title":"Topics in Stroke Rehabilitation","page":"388-397","volume":"20","issue":"5","source":"EBSCOhost","archive":"psyh","archive_location":"2013-36099-002","abstract":"Positive outcomes from intensive therapy for individuals with aphasia have been reported in the literature. Little Is known about the characteristics of individuals who attend intensive comprehensive aphasia programs (ICAPs) and what factors may predict who makes clinically significant changes when attending such programs. Demographic data on participants from 6 ICAPs showed that individuals who attend these programs spanned the entire age range (from adolescence to late adulthood), but they generally tended to be middle-aged and predominantly male. Analysis of outcome data from 2 of these ICAPs found that age and gender were not significant predictors of improved outcome on measures of language ability or functional communication. However, time post onset was related to clinical improvement in functional communication as measured by the Communication Activities of Daily Living, second edition (CADL-2). In addition, for one sample, initial severity of aphasia was related to outcome on the Western Aphasia Battery-Revised, such that individuals with more severe aphasia tended to show greater recovery compared to those with mild aphasia. Initial severity of aphasia also was highly correlated with changes in CADL-2 scores. These results suggest that adults of all ages with aphasia in either the acute or chronic phase of recovery can continue to show positive improvements in language ability and functional communication with intensive treatment. (PsycINFO Database Record (c) 2016 APA, all rights reserved). (journal abstract)","DOI":"10.1310/tsr2005-388","ISSN":"1074-9357","journalAbbreviation":"Topics in Stroke Rehabilitation","author":[{"family":"Persad","given":"Carol"},{"family":"Wozniak","given":"Linda"},{"family":"Kostopoulos","given":"Ellina"}],"issued":{"date-parts":[["2013",9]]}}},{"id":7219,"uris":[""],"uri":[""],"itemData":{"id":7219,"type":"article-journal","title":"Aphasia LIFT: Exploratory investigation of an intensive comprehensive aphasia programme.","container-title":"Aphasiology","page":"1339-1361","volume":"27","issue":"11","source":"EBSCOhost","archive":"psyh","archive_location":"2013-36332-004","abstract":"Background: Intensive comprehensive aphasia programs (ICAPs) are gaining popularity in the international aphasia rehabilitation community. ICAPs comprise at least three hours of treatment per day over at least two weeks, have definable start and end dates for one cohort and use a variety of formats including individual treatment, group therapy, education and technology to improve language and communication. While intensive treatment approaches have demonstrated equivocal results on impairment-based measures, positive changes on activity/participation measures provide support for ICAPs in rehabilitation of chronic aphasia. Aphasia Language Impairment and Functional Therapy (LIFT) is a research-based ICAP developed for the purpose of evaluating treatment outcomes across the International Classification of Functioning, Disability and Health (ICF) domains. Aims: The aim of this study was to estimate the magnitude of treatment effects yielded by Aphasia Aphasia LIFT in the domains of language impairment, functional communication and communication-related quality of life (QOL). Methods & Procedures: Eleven individuals with chronic post-stroke aphasia (mean = 26.9 months) completed Aphasia LIFT. The programme comprised individual impairment-based and functional treatment, group therapy, and computer-based treatment for 40 hours over two weeks (n = 4, LIFT 1) or 100 hours over four weeks (n = 7, LIFT 2). Assessments of confrontation naming, discourse production, functional communication and communication-related quality of life were completed at pre-treatment, immediately post-treatment and six to eight weeks following treatment termination.Outcomes & Results: Group-level analyses revealed acquisition and maintenance of treatment effects, as evidenced by significant improvement on at least one outcome measure at follow-up in all domains. The most consistent pattern of improvement at an individual level was observed on measures of functional communication and communication-related QOL. Conclusions: Aphasia LIFT yielded positive outcomes across ICF domains, and in many cases the treatment effect was enduring. These results demonstrate that Aphasia LIFT was successful in meeting the overarching goal of ICAPs, to maximise communication and enhance life participation in individuals with aphasia. Further research into ICAPs is warranted. (PsycINFO Database Record (c) 2014 APA, all rights reserved). (journal abstract)","DOI":"10.1080/02687038.2013.825759","ISSN":"0268-7038","journalAbbreviation":"Aphasiology","author":[{"family":"Rodriguez","given":"Amy D."},{"family":"Worrall","given":"Linda"},{"family":"Brown","given":"Kyla"},{"family":"Grohn","given":"Brooke"},{"family":"McKinnon","given":"Eril"},{"family":"Pearson","given":"Charlene"},{"family":"Van Hees","given":"Sophia"},{"family":"Roxbury","given":"Tracy"},{"family":"Cornwell","given":"Petrea"},{"family":"MacDonald","given":"Anna"},{"family":"Angwin","given":"Anthony"},{"family":"Cardell","given":"Elizabeth"},{"family":"Davidson","given":"Bronwyn"},{"family":"Copland","given":"David A."}],"issued":{"date-parts":[["2013",11]]}}},{"id":32242,"uris":[""],"uri":[""],"itemData":{"id":32242,"type":"article-journal","title":"Intensive Comprehensive Aphasia Programs: An International Survey of Practice","container-title":"Topics in Stroke Rehabilitation","page":"379-387","volume":"20","issue":"5","author":[{"family":"Rose","given":"Miranda L."},{"family":"Cherney","given":"Leora R."},{"family":"Worrall","given":"Linda E."}],"issued":{"date-parts":[["2013"]]}}},{"id":7678,"uris":[""],"uri":[""],"itemData":{"id":7678,"type":"article-journal","title":"Description of an intensive residential aphasia treatment program: Rationale, clinical processes, and outcomes.","container-title":"American Journal of Speech-Language Pathology","page":"S330-S342","volume":"23","issue":"2","source":"EBSCOhost","archive":"psyh","archive_location":"2014-30874-019","abstract":"Purpose: The purpose of this article is to describe the rationale, clinical processes, and outcomes of an intensive comprehensive aphasia program (ICAP). Method: Seventy-three community-dwelling adults with aphasia completed a residentially based ICAP. Participants received 5 hr of daily 1:1 evidence-based cognitive-linguistically oriented aphasia therapy, supplemented with weekly socially oriented and therapeutic group activities over a 23-day treatment course. Standardized measures of aphasia severity and communicative functioning were obtained at baseline, program entry, program exit, and follow-up. Results were analyzed using a Bayesian latent growth curve model with 2 factors representing (a) the initial level and (b) change over time, respectively, for each outcome measure. Results: Model parameter estimates showed reliable improvement on all outcome measures between the initial and final assessments. Improvement during the treatment interval was greater than change observed across the baseline interval, and gains were maintained at follow-up on all measures. Conclusions: The rationale, clinical processes, and outcomes of a residentially based ICAP have been described. ICAPs differ with respect to treatments delivered, dosing parameters, and outcomes measured. Specifying the defining components of complex interventions, establishing their feasibility, and describing their outcomes are necessary to guide the development of controlled clinical trials. (PsycINFO Database Record (c) 2014 APA, all rights reserved). (journal abstract)","DOI":"10.1044/2014_AJSLP-13-0102","ISSN":"1058-0360","journalAbbreviation":"American Journal of Speech-Language Pathology","author":[{"family":"Winans-Mitrik","given":"Ronda L."},{"family":"Hula","given":"William D."},{"family":"Dickey","given":"Michael W."},{"family":"Schumacher","given":"James G."},{"family":"Swoyer","given":"Brooke"},{"family":"Doyle","given":"Patrick J."}],"issued":{"date-parts":[["2014",5]]}}}],"schema":""} (Babbitt, Cherney, & Worrall, 2016; Hoover, Caplan, Waters, & Carney, 2017; Persad, Wozniak, & Kostopoulos, 2013; Rodriguez et al., 2013; Rose, Cherney, & Worrall, 2013; Winans-Mitrik et al., 2014). While these treatment programs were built using principles of neural plasticity (e.g., intensity, salience) and target both the impairment and activity/participation levels, they do not appear to be the most appropriate CR choice for young individuals with ABI interested in enrolling in higher education for a number of reasons. First, although younger individuals have participated in ICAPs, they were primarily surrounded by much older individuals (Mean (M) =53; Range 16-86; Persad et al., 2013). Second, most ICAP participants have already graduated from college and/or worked in professional careers (Persad et al. 2013). Third, caregivers are heavily involved in ICAPs, which is at odds with typical goals for college-age individuals (i.e., to increase their independence from their guardians). Most importantly, while ICAPs provide intensive treatment (≥3 hours of daily therapy, 2-4.5 weeks; ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a1rofqplndc","properties":{"formattedCitation":"(Rose, Cherney, & Worrall, 2013)","plainCitation":"(Rose, Cherney, & Worrall, 2013)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":32242,"uris":[""],"uri":[""],"itemData":{"id":32242,"type":"article-journal","title":"Intensive Comprehensive Aphasia Programs: An International Survey of Practice","container-title":"Topics in Stroke Rehabilitation","page":"379-387","volume":"20","issue":"5","author":[{"family":"Rose","given":"Miranda L."},{"family":"Cherney","given":"Leora R."},{"family":"Worrall","given":"Linda E."}],"issued":{"date-parts":[["2013"]]}}}],"schema":""} Rose, Cherney, & Worrall, 2013), cognitive-linguistic skills are not specifically targeted in an academic context.In addition to the efficacy of ICAPs, recent work in CR for TBI has investigated its effect on military service members. Although differences in TBI etiology and their subsequent sequelae exist between civilians and service members, a brief discussion of the approaches used in a few of these studies is relevant to the present study. As veterans often pursue academic goals upon deployment, ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"aocfrt1f5v","properties":{"formattedCitation":"(MacLennan & MacLennan, 2008)","plainCitation":"(MacLennan & MacLennan, 2008)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":32284,"uris":[""],"uri":[""],"itemData":{"id":32284,"type":"article-journal","title":"Assessing readiness for post-secondary education after traumatic brain injury using a simulated college experience","container-title":"NeuroRehabilitation","page":"521–528","volume":"23","issue":"6","source":"Google Scholar","author":[{"family":"MacLennan","given":"Don L."},{"family":"MacLennan","given":"Diane C."}],"issued":{"date-parts":[["2008"]]}}}],"schema":""} MacLennan & MacLennan, (2008) investigated the readiness of three veterans with TBI to enter the post-secondary setting via a simulated college experience. The intervention involved sixteen 60-minute sessions and consisted of twelve lectures, seven of which focused on the effects of brain injury (e.g., Pathophysiology of Brain Injury) and five on study skills (e.g., Study Skills: Reading College Textbooks). The benefit of compensatory strategies (i.e., note takers, extra time for tests, video-recorded lectures, and audio-recorded textbooks) were assessed for each student. They were quizzed using short-answer, multiple-choice, and true/false questions to capture both their recall and recognition memory function. Following the intervention, two students decided not to enroll in school due to the severity of their impairments, and the third student was similarly encouraged to pursue vocation rather than school. Although referred to as a simulated college experience, this program was used primarily as an assessment. It did not provide students with academic content, nor did it provide support for those who wanted to return to school, but did not possess the necessary skills. Additionally, the Study of Cognitive Rehabilitation Effectiveness (SCORE; ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a2fk67kn4rg","properties":{"formattedCitation":"(Cooper et al., 2017)","plainCitation":"(Cooper et al., 2017)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":32286,"uris":[""],"uri":[""],"itemData":{"id":32286,"type":"article-journal","title":"Cognitive Rehabilitation for Military Service Members With Mild Traumatic Brain Injury: A Randomized Clinical Trial","container-title":"Journal of Head Trauma Rehabilitation","page":"E1-E15","volume":"32","issue":"3","source":"CrossRef","DOI":"10.1097/HTR.0000000000000254","ISSN":"0885-9701","shortTitle":"Cognitive Rehabilitation for Military Service Members With Mild Traumatic Brain Injury","language":"en","author":[{"family":"Cooper","given":"Douglas B."},{"family":"Bowles","given":"Amy O."},{"family":"Kennedy","given":"Jan E."},{"family":"Curtiss","given":"Glenn"},{"family":"French","given":"Louis M."},{"family":"Tate","given":"David F."},{"family":"Vanderploeg","given":"Rodney D."}],"issued":{"date-parts":[["2017"]]}}}],"schema":""} Cooper et al., 2017), consisting of four treatment arms: (1) psychoeducation, (2) computer-based CR, (3) therapist-directed CR, and (4) integrated therapist-directed CR, combined with cognitive-behavioral psychotherapy (CBT), was recently completed. The fourth arm was the most comprehensive, holistic, and intensive, providing 10 hours total of individual CR, metacognitive group therapy, psychoeducational counseling, and computerized therapy, and thus would be hypothesized to be the most effective. Yet, all four arms resulted in significant cognitive, psychological, and behavioral improvements, suggesting that no particular treatment arm was significantly more effective than any other arm. Furthermore, the SCORE program was tested with individuals with mild TBI only and did not focus on transition to an academic environment. Some treatments have in fact been developed to support individuals with TBI in the academic environment, but these are offered to students who are already actively enrolled. The College Program for Students with Brain Injury ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ae7r9v8gdu","properties":{"formattedCitation":"(Kennedy & Krause, 2011)","plainCitation":"(Kennedy & Krause, 2011)","noteIndex":0},"citationItems":[{"id":32288,"uris":[""],"uri":[""],"itemData":{"id":32288,"type":"article-journal","title":"Self-Regulated Learning in a Dynamic Coaching Model for Supporting College Students With Traumatic Brain Injury: Two Case Reports","container-title":"Journal of Head Trauma Rehabilitation","page":"212-223","volume":"26","issue":"3","source":"CrossRef","DOI":"10.1097/HTR.0b013e318218dd0e","ISSN":"0885-9701","shortTitle":"Self-Regulated Learning in a Dynamic Coaching Model for Supporting College Students With Traumatic Brain Injury","language":"en","author":[{"family":"Kennedy","given":"M.R."},{"family":"Krause","given":"Miriam O."}],"issued":{"date-parts":[["2011"]]}}}],"schema":""} (Kennedy & Krause, 2011), at the University of Minnesota, is one such opportunity (eligibility criteria: completed rehabilitation, accepted to a two or four-year college, and need to have return to college as a “realistic” goal). While providing a valuable service to students with ABI in the academic setting, such programs are not available to individuals who have not yet been accepted to a university due to the severity of their cognitive-linguistic impairments. Furthermore, this program teaches strategies to cope in the classroom, not the academic material. Some community colleges also provide opportunities for individuals with ABI (e.g., Coastline Community College’s Acquired Brain Injury (ABI) program), although the efficacy of these programs has not been established through experimental means. While some of the aforementioned programs incorporated intensity (e.g., SCORE, ICAPs) and others implemented specificity of training (e.g., MacLennan & MacLennan, 2008), age (e.g., College Program for Students with Brain Injury), and/or repetition (e.g., TBI Model Systems of Care), none of them included all the key principles of neural plasticity in one program (i.e., repetition, salience, specificity of training, intensity, age). Given this literature, it appears rare for individuals with ABI to receive post-acute CR that focuses directly on the necessary skills for a successful transition to higher education ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"6dqqi8uf5","properties":{"formattedCitation":"(Masel & DeWitt, 2010)","plainCitation":"(Masel & DeWitt, 2010)","noteIndex":0},"citationItems":[{"id":"lgPqHwOs/p97xwkuc","uris":[""],"uri":[""],"itemData":{"id":353,"type":"article-journal","title":"Traumatic Brain Injury: A Disease Process, Not an Event","container-title":"Journal of Neurotrauma","page":"1529-1540","volume":"27","issue":"8","source":"CrossRef","DOI":"10.1089/neu.2010.1358","ISSN":"0897-7151, 1557-9042","shortTitle":"Traumatic Brain Injury","language":"en","author":[{"family":"Masel","given":"Brent E."},{"family":"DeWitt","given":"Douglas S."}],"issued":{"date-parts":[["2010",8]]}}}],"schema":""} (Masel & DeWitt, 2010). Therefore, in the present study, we developed a comprehensive CR program, entitled Intensive Cognitive-Communication Rehabilitation (ICCR), to address the rehabilitation needs of young individuals with ABI interested in enrolling in higher education with full inclusion. To determine the initial efficacy of this novel treatment approach, we investigated the following research questions (RQs): Do participants demonstrate changes in cognitive-linguistic skills as a result of this novel intervention program?Hypothesis: ICCR incorporated key aspects of evidence-based cognitive rehabilitation (i.e., targeting impairment, function, and psychosocial aspects of ABI within individual and group settings) and principles of experience-dependent neural plasticity (i.e., age, repetition, salience, and intensity). Therefore, we hypothesized that participants with chronic ABI would improve in their cognitive-linguistic skills as measured by standardized outcome measures after treatment. Do participants improve in their classroom participation over time?Hypothesis: In this program, participants were provided instructional material at a reduced pace with repetition and instructed to use metacognitive strategies in the academic context. Given this design, we hypothesized that they would answer questions, make comments, and ask questions at an increased frequency and with greater accuracy and appropriateness over the course of treatment. Do participants progress toward therapy and personal goals over the course of treatment?Hypothesis: Participants received intensive speech-language and cognitive therapy (one - four times/week), targeting both therapy (e.g., improve auditory comprehension of complex questions) and personal goals (e.g., self-transportation) throughout the program. Therefore, we hypothesized that they would show improvements in these areas.Do participants demonstrate changes at the activity and participation levels, as well as changes to their quality of life, as a result of this program?Hypothesis: Individuals in ICCR participated in a semester-long academic program within a real university setting. They engaged in a college experience with a cohort of age-matched peers and used academic facilities with other university students. They became part of the college milieu, an opportunity otherwise unavailable to them because of the severity of their brain injuries. We hypothesized that treatment in the group setting, in a college environment, would increase not only their life participation, but also their quality of life, as assessed via standardized measures and subjective reports. MethodsParticipantsSix individuals with ABI (Male = 4) as the result of a TBI (n = 4) or CVA were recruited from the New England region of the US through referral from physicians, speech-language pathologists, neuropsychologists, and word of mouth. Recruitment materials were emailed to professionals (e.g., physicians, speech-language pathologists) working with this population in the greater Boston area and nationally (e.g., hospitals, rehabilitation clinics, community colleges). Fliers were also posted on various academic and clinical listservs. Interested individuals who were not within commuting distance of Boston University temporarily relocated to participate in the program, as dormitory housing was not available. Participants ranged in age from 21-34 years (M = 27.17, SD = 4.99), months post onset (MPO) from 38-97 months (M = 68.17, SD = 24.38), and education from 12-16 years (M = 13.5, SD = 1.76). The study utilized a quasi-experimental design, with treatment administered to four experimental participants (P1, P2, P3, and P4) and deferred for two control participants (C1 and C2). It should be noted that P1, P2, and P3 participated in three consecutive semesters, C1 participated in the first two semesters, and P4 and C2 participated in the spring semester only (displayed in Figure 1). Participants met several inclusion criteria: (a) between the ages of 18 and 36; (b) ABI after the onset of adolescence (age 13 or older); (c) interest in post-secondary education; (d) cognitive and/or linguistic deficits that precluded enrollment in post-secondary education; and (e) adequate vision and hearing for functional reading and conversation. Participants with cognitive and/or linguistic deficits solely as the result of a congenital or developmental disorder and/or concomitant neurological disease were excluded. Participants consented in writing before any assessments were administered in accordance with the Boston University Institutional Review Board protocol. The diagnosis of cognitive-linguistic impairment was made using the battery of standardized assessments reviewed below. Medical records were also reviewed to determine the nature and etiology of their ABI. See Table 1 for relevant demographic information and treatment assignment. Notably, P4 had severe language deficits and mild-to-moderate cognitive deficits secondary to TBI. As we hypothesized that young individuals with any severity of ABI would improve in their cognitive-linguistic skills as a function of ICCR and he met the selection criteria for the study, he was not excluded based on his initial test scores, but rather was enrolled with support in the classroom to augment his auditory comprehension (i.e., supported communication techniques). Standardized AssessmentsThe following assessments were administered: (a) Western Aphasia Battery - Revised ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"aloihs9r56","properties":{"formattedCitation":"(Kertesz, 2006)","plainCitation":"(Kertesz, 2006)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":"lgPqHwOs/P33qLenb","uris":[""],"uri":[""],"itemData":{"id":738,"type":"book","title":"Western Aphasia Battery-Revised","publisher":"PsychCorp","URL":"","shortTitle":"WAB-R","author":[{"family":"Kertesz","given":"Andrew"}],"issued":{"date-parts":[["2006"]]},"accessed":{"date-parts":[["2017",4,24]]}}}],"schema":""} (WAB-R; Kertesz, 2006) to assess broad language function, (b) Repeatable Battery for the Assessment of Neuropsychological Status (RBANS ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a24anrbm6ob","properties":{"formattedCitation":"(Randolph, 2012)","plainCitation":"(Randolph, 2012)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":"lgPqHwOs/m8hHdZ6K","uris":[""],"uri":[""],"itemData":{"id":811,"type":"book","title":"Repeatable Battery for the Assessment of Neuropsychological Status Update (RBANS)","publisher":"Pearson Clinical","URL":"","author":[{"family":"Randolph","given":"Christopher"}],"issued":{"date-parts":[["2012"]]}}}],"schema":""} ; Randolph, 2012) to measure cognitive function, (c) Scales of Cognitive and Communicative Ability for Neurorehabilitation ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"aka6j4h6hh","properties":{"formattedCitation":"(Holland & Milman, 2012)","plainCitation":"(Holland & Milman, 2012)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":"lgPqHwOs/6nST1WUf","uris":[""],"uri":[""],"itemData":{"id":760,"type":"book","title":"Scales of Cognitive and Communicative Ability for Neurorehabilitation (SCCAN)","publisher":"Pro-Ed","language":"English","author":[{"family":"Holland","given":"Audrey L."},{"family":"Milman","given":"Lisa"}],"issued":{"date-parts":[["2012"]]}}}],"schema":""} (SCCAN; Holland & Milman, 2012) to evaluate cognitive and linguistic skills, (d) Discourse Comprehension Test (DCT; ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a7lbuqj82d","properties":{"formattedCitation":"(Brookshire & Nicholas, 1993)","plainCitation":"(Brookshire & Nicholas, 1993)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":"lgPqHwOs/vPrYQOOg","uris":[""],"uri":[""],"itemData":{"id":766,"type":"book","title":"Discourse Comprehension Test","publisher":"BRK Publishers","shortTitle":"DCT","language":"English","author":[{"family":"Brookshire","given":"Robert H."},{"family":"Nicholas","given":"Linda E."}],"issued":{"date-parts":[["1993"]]}}}],"schema":""} Brookshire & Nicholas, 1993) to examine listening and reading comprehension at the narrative level, (e) Child and Adolescent Scale of Participation (CASP; ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a18evcrj138","properties":{"formattedCitation":"(McDougall, Bedell, & Wright, 2013)","plainCitation":"(McDougall, Bedell, & Wright, 2013)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":"lgPqHwOs/wmOhjy89","uris":[""],"uri":[""],"itemData":{"id":770,"type":"article-journal","title":"The youth report version of the Child and Adolescent Scale of Participation (CASP): assessment of psychometric properties and comparison with parent report","container-title":"Child: Care, Health and Development","page":"512-522","volume":"39","issue":"4","source":"Wiley Online Library","abstract":"Objective\n\nThe Child and Adolescent Scale of Participation (CASP) parent report is a brief and valid measure for use with children and youth with chronic conditions/disabilities that has been shown to have good coverage at the chapter level of the ‘Activities and Participation’ component of the International Classification of Functioning, Disability and Health. The purpose of this research was to assess the psychometric properties of a CASP youth self-report version, to further validate the parent report, and to compare parent and youth reports of youths' activity and participation.\n\n\nMethods\n\nBaseline data from a longitudinal study examining predictors of changes in quality of life for youth with chronic conditions/disabilities were used. CASP data were collected on 409 youth aged 11–17 with various conditions/disabilities using youth and parent reports. Internal consistency and factor structure were examined for both versions using Cronbach's alpha and exploratory factor analyses. Inter-rater agreement and magnitude of differences between youth and parent report were evaluated using intraclass correlation coefficients and paired t-tests respectively. Gender, age and condition/disability group differences in youth report CASP scores were examined using independent t-tests or analyses of variance.\n\n\nResults\n\nStrong internal consistency and internal structure validity was demonstrated for the CASP youth and parent report. The youth report factor structure was similar to the parent report in this and other studies. Youth reported their activity/participation to be significantly higher than did their parents. Significant differences in CASP scores were found among condition/disability groups.\n\n\nConclusions\n\nFindings show that, from a psychometric standpoint, the youth version of the CASP is a promising new self-report measure of activity and participation. As youth perceive their activity and participation levels differently than their parents, it is important to collect data from both sources to obtain a more comprehensive understanding of this aspect of youths' lives.","DOI":"10.1111/cch.12050","ISSN":"1365-2214","shortTitle":"The youth report version of the Child and Adolescent Scale of Participation (CASP)","journalAbbreviation":"Child Care Health Dev","language":"en","author":[{"family":"McDougall","given":"J."},{"family":"Bedell","given":"G."},{"family":"Wright","given":"V."}],"issued":{"date-parts":[["2013",7,1]]}}}],"schema":""} McDougall, Bedell, & Wright, 2013) to assess participation at home, school, and in the community, and (f) subtests of the TBI Quality-of-Life (QOL) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a1bn5plv68c","properties":{"formattedCitation":"(Tulsky et al., 2016)","plainCitation":"(Tulsky et al., 2016)","noteIndex":0},"citationItems":[{"id":"lgPqHwOs/PP4HyxPB","uris":[""],"uri":[""],"itemData":{"id":757,"type":"article-journal","title":"TBI-QOL: Development and Calibration of Item Banks to Measure Patient Reported Outcomes Following Traumatic Brain Injury","container-title":"Journal of Head Trauma Rehabilitation","page":"40-51","volume":"31","issue":"1","source":"CrossRef","DOI":"10.1097/HTR.0000000000000131","ISSN":"0885-9701","shortTitle":"TBI-QOL","language":"en","author":[{"family":"Tulsky","given":"David S."},{"family":"Kisala","given":"Pamela A."},{"family":"Victorson","given":"David"},{"family":"Carlozzi","given":"Noelle"},{"family":"Bushnik","given":"Tamara"},{"family":"Sherer","given":"Mark"},{"family":"Choi","given":"Seung W."},{"family":"Heinemann","given":"Allen W."},{"family":"Chiaravalloti","given":"Nancy"},{"family":"Sander","given":"Angelle M."},{"family":"Englander","given":"Jeffrey"},{"family":"Hanks","given":"Robin"},{"family":"Kolakowsky-Hayner","given":"Stephanie"},{"family":"Roth","given":"Elliot"},{"family":"Gershon","given":"Richard"},{"family":"Rosenthal","given":"Mitchell"},{"family":"Cella","given":"David"}],"issued":{"date-parts":[["2016"]]}}}],"schema":""} (Tulsky et al., 2016) or Neurologic Quality of Life?(Neuro-QOL) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a10qpkm4gvu","properties":{"formattedCitation":"(Gershon et al., 2012)","plainCitation":"(Gershon et al., 2012)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":"lgPqHwOs/bKav0uEk","uris":[""],"uri":[""],"itemData":{"id":809,"type":"article-journal","title":"Neuro-QOL: quality of life item banks for adults with neurological disorders: item development and calibrations based upon clinical and general population testing","container-title":"Quality of Life Research","page":"475-486","volume":"21","issue":"3","source":"CrossRef","DOI":"10.1007/s11136-011-9958-8","ISSN":"0962-9343, 1573-2649","shortTitle":"Neuro-QOL","language":"en","author":[{"family":"Gershon","given":"Richard C."},{"family":"Lai","given":"Jin Shei"},{"family":"Bode","given":"Rita"},{"family":"Choi","given":"Seung"},{"family":"Moy","given":"Claudia"},{"family":"Bleck","given":"Tom"},{"family":"Miller","given":"Deborah"},{"family":"Peterman","given":"Amy"},{"family":"Cella","given":"David"}],"issued":{"date-parts":[["2012",4]]}}}],"schema":""} (Gershon et al., 2012; i.e., communication, anxiety, depression, positive affect and well-being, and cognitive function), depending on etiology, to evaluate health-related QOL. Goal Attainment Scaling (GAS; ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a1l37ituog2","properties":{"formattedCitation":"(King, McDougall, Palisano, Gritzan, & Tucker, 2000)","plainCitation":"(King, McDougall, Palisano, Gritzan, & Tucker, 2000)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":"lgPqHwOs/DdzWJeHJ","uris":[""],"uri":[""],"itemData":{"id":814,"type":"article-journal","title":"Goal Attainment Scaling: Its Use in Evaluating Pediatric Therapy Programs","container-title":"Physical & Occupational Therapy In Pediatrics","page":"31-52","volume":"19","issue":"2","source":"CrossRef","DOI":"10.1080/J006v19n02_03","ISSN":"0194-2638, 1541-3144","shortTitle":"Goal Attainment Scaling","language":"en","author":[{"family":"King","given":"Gillian A."},{"family":"McDougall","given":"Janette"},{"family":"Palisano","given":"Robert J."},{"family":"Gritzan","given":"Janet"},{"family":"Tucker","given":"Mary Ann"}],"issued":{"date-parts":[["2000",1]]}}}],"schema":""} King, McDougall, Palisano, Gritzan, & Tucker, 2000) was also incorporated to allow patients to develop personal goals for the semester. All participants were assessed with this battery both before and after each semester of the intervention. For all individuals who participated in multiple semesters of ICCR, the post-intervention scores from the first semester were used as the pre-intervention scores for the next semester. Figure 1 depicts the schedule of assessments for each participant. TreatmentSimilar to a typical undergraduate student, ICCR students took four classes per semester; were administered weekly quizzes and final exams; prepared presentations and wrote papers; asked and answered questions requiring both memorization and critical thinking; discussed course content with the lecture facilitator and their peers; accessed course content online (i.e., video lectures to review later and class notes); asked the lecture facilitator to meet with them to review course content outside of class as needed; traveled from one classroom to another; took certain courses on one day and others on a different day; and stayed in an apartment near campus and/or commuted from home. One possible difference from a traditional liberal arts education was that students in ICCR reviewed video-recorded lectures, which were facilitated by an SLP. However, online courses have increased in prevalence in the last twenty years ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"hv3bKydK","properties":{"formattedCitation":"(Miller et al., 2013)","plainCitation":"(Miller et al., 2013)","noteIndex":0},"citationItems":[{"id":33294,"uris":[""],"uri":[""],"itemData":{"id":33294,"type":"book","title":"Leading the e-learning transformation of higher education: Meeting the challenges of technology and distance education","publisher":"Stylus Publishing, LLC.","author":[{"family":"Miller","given":"G."},{"family":"Benke","given":"M."},{"family":"Chaloux","given":"B."},{"family":"Ragan","given":"L.C."},{"family":"Schroeder","given":"R."},{"family":"Smutz","given":"W."},{"family":"Swan","given":"K."}],"issued":{"date-parts":[["2013"]]}}}],"schema":""} (Miller et al., 2013), and therefore, watching lectures on a screen may actually be reflective of some typical students’ experiences. ICCR further diverged from a typical college environment in that students were not regularly expected to complete assignments outside of class and were reminded of assignments/course topics by the clinician as opposed to having to follow a syllabus only. According to the principle of intensity, each treatment phase consisted of a 12-week semester, during which participants received treatment four days per week, six hours per day with a one hour lunch break. The only restriction for control subjects was that they not engage in other intensive rehabilitation during the deferred treatment phase. In each day of ICCR, students participated in academic classes and metacognitive therapy, individual speech-language-cognitive therapy, and technology skill training. Lecture content was repeated throughout the day and the schedule of activities did not vary, which allowed for specificity and repetition of training. Each of these elements is described below.Academic coursework consisted of open source academic material (e.g., ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a6kdij9109","properties":{"formattedCitation":"(\\uc0\\u8220{}Khan Academy,\\uc0\\u8221{} 2017)","plainCitation":"(“Khan Academy,” 2017)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":"lgPqHwOs/mo1w9mGX","uris":[""],"uri":[""],"itemData":{"id":771,"type":"article","title":"Khan Academy","URL":"","issued":{"date-parts":[["2017"]]},"accessed":{"date-parts":[["2016",9,1]]}}}],"schema":""} “Khan Academy,” 2017); Open Yale Courses, Bloom, ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"2pbbcrhhb","properties":{"formattedCitation":"(2012)","plainCitation":"(2012)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":"lgPqHwOs/uGxVeWuJ","uris":[""],"uri":[""],"itemData":{"id":784,"type":"webpage","title":"Psych 110 Introduction to Psychology","container-title":"Open Yale Courses","abstract":"What do your dreams mean? Do men and women differ in the nature and intensity of their sexual desires? Can apes learn sign language? Why can’t we tickle ourselves? This course tries to answer these questions and many others, providing a comprehensive overview of the scientific study of thought and behavior.","URL":"","language":"English","author":[{"family":"Bloom","given":"Paul"}],"issued":{"date-parts":[["2012",4,5]]},"accessed":{"date-parts":[["2016",9,1]]}},"suppress-author":true}],"schema":""} 2012) spanning subjects from psychology to personal finance. Each semester was designed to simulate a liberal arts curriculum, thus comprising the functional component of ICCR, wherein students applied discretely trained skills in the relevant, salient classroom environment. Academic content was presented through video-recorded lectures moderated by a trained research assistant (RA) or clinical fellow in speech-language pathology (CF-SLP) (e.g., stopping the lecture to ask discussion questions, review information). Classes included lecture material, academic projects, and training and application of strategies. Course subjects were selected based on the complexity of the material and with consideration of participants’ interests to align with the principle of salience. The reader is referred to Appendix 1 for more details on the academic component of ICCR. Speech-language-cognitive therapy served as the impairment-based complement to the functional classroom. Short- and long-term goals were developed according to the participants’ individual profiles, as determined from case histories, client and caregiver report, and formal testing, which also supported salience. Therapy could address the following goal areas: attention, memory, executive functioning, auditory comprehension, verbal expression, reading comprehension, written expression, motor speech, social-pragmatics, and/or augmentative-alternative communication (AAC). Metacognitive strategy training and supported practice were provided at the individual and group levels.Participants targeted their cognitive-linguistic functioning during a technology-skills session, which included various programs (e.g., ICCR website, Microsoft Office, Google Suite, Constant Therapy). During this time, they could access previously-watched lectures to review content about which they were confused; enter information into Google sheets related to a class activity; write a paragraph/essay/paper for a class assignment; work on a presentation for finance or public speaking and/or target impairment-based cognitive-linguistic skills using application-based therapy. In terms of the clinician’s role, during class, the clinician targeted ICCR students’ attention (e.g., redirected students during lecture preview), memory (e.g., asked students to recall lecture content immediately and after a delay), problem-solving (e.g., during moments of confusion, irritability, hypersensitivity, and within academic tasks), executive function skills (e.g., promoted students to self-monitor, self-correct, self-advocate), auditory comprehension (e.g., repeated information on request), verbal expression (e.g., facilitated lexical retrieval with semantic, phonologic, orthographic cueing and/or encouraged self-cueing), reading (e.g., supported students’ oral reading), writing (e.g., assisted students’ note writing), metacognitive (e.g., provided strategy instruction and modeling; facilitated application in a natural context), and pragmatic skills (e.g., targeted appropriateness, such as turn taking, topic, and timing; extinguished negative behaviors; increased social communication). The clinician was also responsible for creating the weekly quizzes and lecture notes and keeping the website current for students. During the technology skills training, the clinician supported students with application-based therapy as indicated, encouraged students to maintain attention to the tasks, and provided assistance to students reviewing classroom material, as needed. Treatment Data Classroom performanceStudents’ classroom behavioral performance was measured by on-line tracking of the frequency of “positive” behaviors (i.e., answering questions accurately (i.e., cued and uncued), asking appropriate questions, and making appropriate comments) and “negative” behaviors (i.e., answering questions inaccurately, asking inappropriate questions, making inappropriate comments) exhibited during coursework on a daily basis. The instructor would tally each time the participants performed one of the previously described behaviors on a paper datasheet, which was then entered into Research Electronic Data Capture (REDCap) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a2nq9v6loo7","properties":{"formattedCitation":"(Harris et al., 2009)","plainCitation":"(Harris et al., 2009)","noteIndex":0},"citationItems":[{"id":33215,"uris":[""],"uri":[""],"itemData":{"id":33215,"type":"article-journal","title":"Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support","container-title":"J Biomed Inform","page":"377-81","volume":"42","issue":"2","author":[{"family":"Harris","given":"P.A."},{"family":"Taylor","given":"R."},{"family":"Thielke","given":"R."},{"family":"Payne","given":"J."},{"family":"Gonzalez","given":"N."},{"family":"Conde","given":"J.G."}],"issued":{"date-parts":[["2009"]]}}}],"schema":""} (Harris et al., 2009) for later analysis. The reader is referred to Appendix 2 for more information regarding the classroom performance data collection process. Progress in SLP sessions was measured across different cognitive-linguistic domains (e.g., attention, auditory comprehension, etc.) with specific metrics for the task at hand (e.g., accuracy, duration, frequency). Weekly QuizzesParticipants were administered quizzes in two courses each week. Quizzes consisted of five questions (i.e., four multiple-choice and 1 true/false) pertaining to academic content that had been repeated multiple times during the lecture and was provided in supplemental lecture notes. Quizzes were administered to 1) hold the students accountable for the material they were learning each day, 2) provide a context for them to apply metacognitive strategies; and 3) facilitate retention of information in line with the testing effect (i.e., more likely to recall information later when you have been tested on it ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Po5gbrh2","properties":{"formattedCitation":"(Batsell, Perry, Hanley, & Hostetter, 2017)","plainCitation":"(Batsell, Perry, Hanley, & Hostetter, 2017)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":33319,"uris":[""],"uri":[""],"itemData":{"id":33319,"type":"article-journal","title":"Ecological Validity of the Testing Effect: The Use of Daily Quizzes in Introductory Psychology","container-title":"Teaching of Psychology","page":"18-23","volume":"44","issue":"1","source":"Crossref","DOI":"10.1177/0098628316677492","ISSN":"0098-6283, 1532-8023","shortTitle":"Ecological Validity of the Testing Effect","language":"en","author":[{"family":"Batsell","given":"W. Robert"},{"family":"Perry","given":"Jennifer L."},{"family":"Hanley","given":"Elizabeth"},{"family":"Hostetter","given":"Autumn B."}],"issued":{"date-parts":[["2017",1]]}}}],"schema":""} ; Batsell, Perry, Hanley, & Hostetter, 2017).Data AnalysisFirst, a group level analysis was performed using logistic mixed-effect regression models to determine if timepoint significantly predicted item score on the standardized measures. Fixed effects included timepoint as a numerical predictor (Pre=”0”, Post1=”1”, Post2=”2”, Post3=”3”). Random effects included random intercepts for subjects and items with by-subject random slopes for timepoint. Second, to supplement the group level analysis, data from four experimental patients and two controls were analyzed on an individual basis. McNemar’s tests were performed comparing item-level accuracy between different time periods: 1) before treatment/no-treatment to the final treatment/no-treatment timepoint (P1-P3: Pre to Post3; P4 and C2: Pre to Post1; C1: Pre to Post2); and 2) between each treatment/no-treatment timepoint (i.e., P1-P3 and C2: Post1 to Post2; P1-P3: Post2 to Post3) to assess for statistical improvements on standardized measures (i.e., WAB-R, RBANS, SCCAN, and DCT). For items with gradient scoring (e.g., WAB-R object naming scores range 0 – 3), responses that received full credit were assigned a 1; responses below this threshold were assigned a 0. This type of analysis summed all of the incorrect responses (0) and correct responses (1), then, compared the proportion to see if there were significantly more positive or negative responses at between two timepoints. Linear mixed-effects regression models were used to analyze classroom participation (i.e., summed frequency of classroom behaviors) as the dependent variable and time (i.e., weeks), behavior type (i.e., positive/negative), and their interaction as independent variables. These data were collected for each semester. However, only the data for semester three could be analyzed because the same coding system was employed throughout the entire semester by the same clinician, which was not the case for the other two semesters. While gains in individual speech-language-cognitive therapy were measured during each therapy session by the treating clinician, qualitative improvements were noted through inspection for changes in the complexity of short-term goals across the duration of the program, which are available in Table 6. Improvements in participation and quality of life were determined by visual inspection for increases in T-scores on the TBI- and Neuro-QOLs and CASP summary and domain scores, which are available in Table 2. ResultsStandardized Assessments Logistic mixed-effects regression analyses accounting for differences in baseline performance across participants/items and different rates of improvement showed a positive effect of treatment on cognitive-linguistic functioning. Timepoint significantly predicted participants’ scores on the WAB (?=.45, SE=.12, t=3.88, p <.001) and the SCCAN (?=.44, SE=.16, t=2.74, p=.01), indicating that participants’ scores increased as the number of semesters they spent in ICCR increased, as depicted in Figure 2. Follow-up analyses conducted at the individual participant level support the results reported above. All four experimental participants made statistically significant gains on at least one standardized assessment by the third semester of intervention. The reader is referred to Table 2 for subtest and total scores on these measures and Table 3 for statistical results of the McNemar’s tests. On the WAB, P1 made statistically significant gains from the second to third timepoint (i.e., semester) and from pre-treatment to the final semester; P2 showed statistically significant gains from the first to the second semester and from pre-treatment to the final semester; and P3 demonstrated statistically significant gains from pre-treatment to the first semester and from pre-treatment to the final semester. On the RBANS, P1 made statistically significant improvements from the second to the third semester and from pre-treatment to the final semester. On the SCCAN, P1 exhibited statistically significant gains after the first semester and from pre-treatment to the final semester; and P2 showed statistically significant increases from the second to third semester and from pre-treatment to the final semester. On the DCT, only P4 demonstrated statistically significant improvements from pre-treatment to the final semester. Importantly, none of the control participants exhibited statistically significant gains on any of the standardized assessments after a period without intervention, suggesting that the gains seen in the experimental group were not due to practice effects. Furthermore, the experimental participants did not demonstrate steady gains on each subtest each semester, as would have been if their improvements were due to repeated exposure to the tests.Classroom PerformanceAttendanceOverall, participants who committed to the program (i.e., P1, P2, P3, P4) attended consistently (see Table 4). In the first semester, P1 and P3 attended ICCR very regularly, as evidenced by attendance records of 98% and 95%, respectively. P2 committed at the start of the first semester to a less intensive schedule (i.e., three days/week), thus he attended 68% of the four-day week. Of note, he attended 86% of his 3-day week schedule. In the Spring Semester, attendance ranged from 93 – 98% for all four participants. In the Summer Semester, attendance ranged from 93 – 100%. In-class participationTo capture changes in the classroom over time, participation (i.e., summed frequency of tracked behaviors) for each week of the third semester served as the dependent variable in a linear mixed-effects model. Fixed effects in this model included time (i.e., weeks), behavior type (i.e., positive/negative), and their interaction. To account for individual variability, participant was used as a random effect in the model. The first finding was a main effect of time (F (1, 51) =37.75, p < 0.001), suggesting that classroom behavior increased significantly as the third semester progressed. Secondly, and more importantly, as depicted in Figure 3, there was a significant time-by-behavior type interaction effect, (F (1, 51) =11.249, p = 0.002), such that the effect of time was significantly less for negative behaviors than positive behaviors (? = -5.850, SE = 1.744, t(1,51) = -3.34, p = 0.002). In other words, the frequency of positive behaviors (e.g., asking appropriate questions) increased at a greater rate over time than negative behaviors (e.g., asking inappropriate questions), suggesting that participants’ were more positively engaged in the classroom with the duration of the third semester. It is important to note that while these results reflect the data that was collected in the third semester, they may have been influenced by the classroom experience of previous semesters. Furthermore, reliability checks could not be completed for the classroom data. Thus, these findings should be interpreted with caution.Quiz performance Participants demonstrated variable accuracy on the weekly quizzes, as reflected in Table 5. Anecdotally, P1 consistently studied for his quizzes across all semesters; P2 started consistently studying for quizzes in the Spring semester; and P3 did not regularly study for quizzes outside of ICCR, as he needs support to do so and that was not available through his group home. These observations are relatively consistent with their performance. Notably, one may not expect to see a linear upward trend in accuracy on the quizzes across the semester(s) as the complexity of the test varied each week. SLP PerformanceThree to five impairment-level cognitive-linguistic goals per semester were generated for each participant and targeted during individual SLP sessions via drills and structured exercises. Participants’ performance in these goal areas was regularly monitored, and once the established criterion was achieved, the goal was revised. All participants who committed to at least one full semester of ICCR targeted more complex goals in their SLP sessions at the end of the treatment than at baseline. At the time of enrollment, P1 exhibited moderate-severe cognitive deficits, moderate anomic aphasia, and mild-moderate apraxia of speech (AOS). After three semesters, he demonstrated improvements across goal areas, and now exhibits moderate impairments. P2 initially exhibited mild-moderate anomic aphasia, and mild cognitive deficits, particularly in executive function. P2 also demonstrated broad gains across goal areas, ultimately presenting with only mild cognitive-linguistic deficits. Furthermore, after completing his third semester, P2 discharged from ICCR and re-enrolled at a local community college to finish his Associate’s Degree, a goal he had abandoned prior to ICCR. P3 initially was classified as having moderate-to-severe cognitive-linguistic deficits, particularly in attention and memory, as well as a severe spastic dysarthria. At the end of Semester 3, he continued to demonstrate moderate-to-severe cognitive-communication deficits, though he demonstrated incremental gains across goal areas. Finally, P4 demonstrated Broca’s aphasia, mild-to-moderate cognitive deficits of attention and executive function, and moderate AOS. Following his one semester of treatment, his profile also remained generally stable, though incremental progress was noted in his goals as well.GAS was used to allow participants to generate specific goals that they wanted to prioritize in therapy. P1 improved in his immediate/delayed memory in the first semester (+ 20) and ability to navigate a city in the third semester (+ 3.10). P2 was interested in securing alternative transportation (i.e., wanted to begin driving lessons, take public transportation, etc.) and made gains on that goal in the third semester (+30). P3 made gains in reducing his use of a maladaptive speech intelligibility strategy (i.e., reduce finger occlusion of nose) and ability to make a daily schedule in the Fall (+ 10) and Spring (+ 12.40) semesters. P4 was interested in obtaining employment and did not make gains toward that goal, which may not be surprising given that ICCR is focused on furthering academic versus vocational goals specifically. These results are also available in Table 2. Participation and Quality of LifeIn order to measure participation, CASP responses from pre-treatment and the final available time-point were compared. All experimental participants transitioned from a score of 0 (“unable to participate”) in the School domain to a score of 65 or greater. P1, P2, and P4 all exhibited increases in their total CASP scores (+17.5, +2.9, +5.7), as did C1 (+5.0), though P3 exhibited a decrease (-12.7).Responses from the TBI- and Neuro-QOL were compared for all patients who completed the measure more than once (i.e., P1, P2, and P3). All values refer to t-scores, with the exception of Communication on the Neuro-QOL, which does not provide a t-score so raw scores were used. P1 demonstrated an improvement in Cognitive Function (+0.8), Depression (-7.3; lower scores indicate fewer symptoms of depression), and Positive Affect and Well-Being (+4.7). He also showed an increase in Anxiety (+2.7; higher scores indicate more symptoms of anxiety). Positively, P2 demonstrated a reduction in his anxiety levels (i.e., Anxiety: -5.8), but slight decreases in the remaining QOL domains (Cognitive Function = -1; Communication = -1; Depression = +1.5; Positive Affect and Well-Being = -1). Finally, P3 demonstrated improved Anxiety levels (-5.2); decreased Cognitive Function (-8.7) and Communication (-9.9); and stable report in the remaining domains. Treatment Fidelity A speech-language pathologist on the project who was not directly involved in the day-to-day treatment administration documented observation of approximately 10% of the classroom instruction across the Fall, Spring, and Summer semesters. No gross deviations from the treatment protocol (see Appendix 1) were noted during those times. Treatment protocols detailing procedures for different aspects of the project were written before the start of the semester for the speech-language pathologist and/or classroom facilitators to follow. DiscussionThe results of this study provide initial evidence that an intensive cognitive-communication rehabilitation (ICCR) program resulted in improved cognitive-linguistic skills for young adults with chronic ABI. Following ICCR, all four experimental participants demonstrated statistically significant gains on at least one standardized measure of cognitive-linguistic functioning, while control participants did not. Furthermore, there was a significant linear effect of timepoint for the WAB and SCCAN, such that as the number of semesters students were in the program increased, their assessment scores increased. Extending those results, all three participants who completed multiple semesters of ICCR demonstrated significantly more positive classroom behaviors than negative behaviors over time; more complex individual SLP goals; and made gains on their personal (GAS) goals across at least one semester. Finally, those same three participants improved in their school participation and on at least one aspect of their health-related quality of life. This study’s findings support growing evidence that principles of experience-dependent neural plasticity are indeed advantageous for rehabilitation (Persad et al. 2013). ICCR deliberately incorporated many of these principles into its design (i.e., age, intensity, repetition, specificity of training, and salience). The benefits of CR for individuals with ABI are well-known, and during ICCR, the classroom setting provided a much-needed context for learning and generalization four days a week ( ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a2pot6o0m81","properties":{"formattedCitation":"(Peach, Nathan, & Beck, 2017)","plainCitation":"(Peach, Nathan, & Beck, 2017)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":32177,"uris":[""],"uri":[""],"itemData":{"id":32177,"type":"article-journal","title":"Language-Specific Attention Treatment for Aphasia: Description and Preliminary Findings","container-title":"Seminars in Speech and Language","page":"005-016","volume":"38","issue":"01","source":"CrossRef","DOI":"10.1055/s-0036-1597260","ISSN":"0734-0478, 1098-9056","shortTitle":"Language-Specific Attention Treatment for Aphasia","language":"en","author":[{"family":"Peach","given":"Richard"},{"family":"Nathan","given":"Meghana"},{"family":"Beck","given":"Katherine"}],"issued":{"date-parts":[["2017",2,15]]}}}],"schema":""} Peach, Nathan, & Beck, 2017; i.e., intensity, repetition, age). Behaviors and metacognitive strategies targeted during individual therapy, group therapy, and technology-skills training could be immediately applied within the functional setting of the classroom, as also seen by Kennedy and Krause (2011) with their coaching intervention. These results indicate that a systematic, structured, and intensive rehabilitation program that includes both impairment and activity-level components in its treatment approach has the potential to improve functional skills in young adults with chronic TBI. While the key component of ICCR cannot be determined without future carefully-designed research, it is likely that the intensive, repetitive training of discrete skills, while providing a natural context for their application, is driving the improvements seen in ICCR students. By participating in ICCR, students also became aware of strategies and accommodations that were specifically beneficial to them. Of note, P2 has returned to community college to complete an Associate’s Degree and is an excellent example of a student utilizing the skills and services promoted in ICCR. He and his family met with disability services prior to re-enrolling, they utilized SLP progress notes to ensure appropriate accommodations, and they petitioned for one ICCR class to fill an educational maintenance requirement during his absence from school. Outside of cognitive gains, students also expressed changes in their participation, social engagement, and well-being after the program. It would seem that ICCR supported the students’ ability to increase their involvement in activities in their home (e.g., caregivers reported anecdotally that one participant initiated more conversation over the weekends with family), school (e.g., all students asked/answered more questions, and made more comments in class), and community (e.g., one student invited another to go to an amusement park together to celebrate their birthday). Social communication was encouraged in the program (i.e., Clinicians suggested that students eat lunch together), but not targeted directly to allow conversation and friendships to develop organically. In the future, this aspect of the program will be investigated objectively to determine the advantages/disadvantages of this approach. The above-described reports are supported objectively in that three out of four experimental participants made gains on the CASP total participation scale by their final semester. These improvements may be partly attributable to the cognitive-communication gains they made in the program, which may have allowed them to engage more frequently and successfully in their homes and communities. Additionally, as ICCR courses took place in Sargent College of Rehabilitation Sciences, ICCR students attended classes on the same semester schedule as BU students and thus, had the opportunity to observe and interact with them on a regular basis in the building. The positive effects of this environment on ICCR students’ psychosocial gains cannot be understated, particularly given the propensity for individuals with ABI to experience social isolation post-injury ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"lPtnraEu","properties":{"formattedCitation":"(McLean, Jarus, Hubley, & Jongbloed, 2012; Northcott & Hilari, 2011)","plainCitation":"(McLean, Jarus, Hubley, & Jongbloed, 2012; Northcott & Hilari, 2011)","noteIndex":0},"citationItems":[{"id":33058,"uris":[""],"uri":[""],"itemData":{"id":33058,"type":"article-journal","title":"Differences in social participation between individuals who do and do not attend brain injury drop-in centres: A preliminary study","container-title":"Brain Injury","page":"83-94","volume":"26","issue":"1","source":"CrossRef","DOI":"10.3109/02699052.2011.635353","ISSN":"0269-9052, 1362-301X","shortTitle":"Differences in social participation between individuals who do and do not attend brain injury drop-in centres","language":"en","author":[{"family":"McLean","given":"A. M."},{"family":"Jarus","given":"T."},{"family":"Hubley","given":"A. M."},{"family":"Jongbloed","given":"L."}],"issued":{"date-parts":[["2012",1]]}}},{"id":6943,"uris":[""],"uri":[""],"itemData":{"id":6943,"type":"article-journal","title":"Why do people lose their friends after a stroke?","container-title":"International Journal of Language & Communication Disorders","page":"524-534","volume":"46","issue":"5","source":"EBSCOhost","archive":"psyh","archive_location":"2012-26263-003","abstract":"Background: It is well‐known that people lose friends after a stroke; what is less well understood is why this occurs. Aims: This study explored why people lose contact with their friends, and whether there are any protective factors. It also examined how friendship loss and change is perceived by the individual. Methods and Procedures: Participants with a first stroke were recruited from one acute stroke unit in the UK. In‐depth qualitative interviews took place between 8 and 15 months post stroke. Outcomes and Results: 29 participants were recruited of whom 10 had aphasia. The main reasons given for losing friends were: loss of shared activities, reduced energy levels, physical disability, aphasia, unhelpful responses of others, environmental barriers, and changing social desires. The subset of participants who experienced the most extensive loss of friends were those who described a sense that they were ‘closing in’ on themselves leading to a withdrawal from social contact and a new preference for meeting only close friends and family. Those with aphasia experienced the most hurtful negative responses from others and found it more difficult to retain their friends unless they had strong supportive friendship patterns prior to the stroke. The factors which helped to protect friendships included: having a shared history, friends who showed concern, who lived locally, where the friendship was not activity‐based, and where the participant had a ‘friends‐based’ social network prior to the stroke. Conclusions and Implications: Given the link between depression and loss of friends post stroke, supporting an individual in maintaining a social network is likely to be beneficial. For intervention to be effective, however, it may need to take into account not only the impact of new physical and language disabilities, but also changing social desires. (PsycINFO Database Record (c) 2012 APA, all rights reserved). (journal abstract)","DOI":"10.1111/j.1460-6984.2011.00079.x","ISSN":"1368-2822","journalAbbreviation":"International Journal of Language & Communication Disorders","author":[{"family":"Northcott","given":"Sarah"},{"family":"Hilari","given":"Katerina"}],"issued":{"date-parts":[["2011",9]]}}}],"schema":""} (McLean, Jarus, Hubley, & Jongbloed, 2012; Northcott & Hilari, 2011). Gains in quality of life were expected as a result of ICCR for both individuals with cognitive-linguistic impairments secondary to TBI and/or stroke. According to the literature, social integration, a key component of ICCR, has been shown to be related to better QOL in both of these populations ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"5NXCfD83","properties":{"formattedCitation":"(Hilari, Cruice, Sorin-Peters, & Worrall, 2016; Johnston & Miklos, 2002)","plainCitation":"(Hilari, Cruice, Sorin-Peters, & Worrall, 2016; Johnston & Miklos, 2002)","noteIndex":0},"citationItems":[{"id":9591,"uris":[""],"uri":[""],"itemData":{"id":9591,"type":"article-journal","title":"Quality of Life in Aphasia: State of the Art","container-title":"Folia Phoniatrica et Logopaedica","page":"114-118","volume":"67","issue":"3","source":"CrossRef","DOI":"10.1159/000440997","ISSN":"1021-7762, 1421-9972","shortTitle":"Quality of Life in Aphasia","language":"en","author":[{"family":"Hilari","given":"Katerina"},{"family":"Cruice","given":"Madeline"},{"family":"Sorin-Peters","given":"Riva"},{"family":"Worrall","given":"Linda"}],"issued":{"date-parts":[["2016",1,21]]}}},{"id":33296,"uris":[""],"uri":[""],"itemData":{"id":33296,"type":"article-journal","title":"Activity-related quality of life in rehabilitation and traumatic brain injury","container-title":"Archives of Physical Medicine and Rehabilitation","page":"S26-S38","volume":"83","source":"Crossref","abstract":"Johnston MV, Miklos CS. Activity-related quality of life in rehabilitation and traumatic brain injury. Arch Phys Med Rehabil 2002;83 Suppl 2:S26-38.","DOI":"10.1053/apmr.2002.37100","ISSN":"00039993","language":"en","author":[{"family":"Johnston","given":"Mark V."},{"family":"Miklos","given":"Carol S."}],"issued":{"date-parts":[["2002",12]]}}}],"schema":""} (Hilari, Cruice, Sorin-Peters, & Worrall, 2016; Johnston & Miklos, 2002). Furthermore, in PWA, participation in ICAPs and group therapy, have also been associated with gains in QOL, again suggesting that QOL should improve with ICCR. Interestingly, post-ICCR, participants who had completed multiple semesters of ICCR reported improvements in at least one domain, as well as decreases in at least one domain. The decreases are likely attributable to two factors: 1) increased insight into deficits; and 2) response shift, a change in self-evaluation due to improved understanding of QOL on follow-up test administration ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"agh4ooq39j","properties":{"formattedCitation":"(Megari, 2013)","plainCitation":"(Megari, 2013)","noteIndex":0},"citationItems":[{"id":32256,"uris":[""],"uri":[""],"itemData":{"id":32256,"type":"article-journal","title":"Quality of life in chronic disease patients","container-title":"Health psychology research","volume":"1","issue":"3","source":"Google Scholar","URL":"","author":[{"family":"Megari","given":"Kalliopi"}],"issued":{"date-parts":[["2013"]]},"accessed":{"date-parts":[["2017",9,8]]}}}],"schema":""} (Megari, 2013). Although ICCR resulted in consistent positive gains on standardized assessment measures for participants who enrolled in consecutive semesters, not all participants responded similarly to the treatment. This responsiveness primarily appeared to be due to severity, insight, and motivation, which will be described in some detail below. P4 had high levels of family/caregiver support and initial motivation to attend, and so he was enrolled with accommodations for his language impairments. Despite these adaptations, he struggled to attend, comprehend, and participate. While he demonstrated the smallest objective gains in ICCR, he did initiate use of total communication in the classroom, which was a therapy goal for him. Nonetheless, he elected to seek vocational employment upon completion of one semester, which in certain cases may be more appropriate for some young individuals with ABI ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a14440leccp","properties":{"formattedCitation":"(MacLennan & MacLennan, 2008)","plainCitation":"(MacLennan & MacLennan, 2008)","noteIndex":0},"citationItems":[{"id":32284,"uris":[""],"uri":[""],"itemData":{"id":32284,"type":"article-journal","title":"Assessing readiness for post-secondary education after traumatic brain injury using a simulated college experience","container-title":"NeuroRehabilitation","page":"521–528","volume":"23","issue":"6","source":"Google Scholar","author":[{"family":"MacLennan","given":"Don L."},{"family":"MacLennan","given":"Diane C."}],"issued":{"date-parts":[["2008"]]}}}],"schema":""} (MacLennan & MacLennan, 2008). In regards to the control subjects, both C1 and C2 were invited to enroll as experimental participants after deferring for one semester. However, neither decided to do so after re-evaluating their current levels of functioning and/or educational goals. C2 agreed to continue as a control subject for one additional semester. Notably, neither C1 nor C2 demonstrated statistically significant gains during their involvement in the study. There are many ongoing and future avenues available for ICCR’s improvement. First, although this study demonstrated preliminary evidence of efficacy, it needs to be studied with a larger, more diverse patient sample. Thus, these results, as well as any limitations, should be interpreted with caution, especially given the small sample size. Second, time post onset ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a21hfbomd9s","properties":{"formattedCitation":"(Moss & Nicholas, 2006)","plainCitation":"(Moss & Nicholas, 2006)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":9766,"uris":[""],"uri":[""],"itemData":{"id":9766,"type":"article-journal","title":"Language rehabilitation in chronic aphasia and time postonset - A review of single-subject data","container-title":"Stroke","page":"3043-3051","volume":"37","issue":"12","source":"Web of Science","abstract":"Background and Purpose - This article is a comprehensive review of aphasia treatment studies for the purpose of investigating the relationship between time postonset of aphasia and response to treatment for aphasia in chronic patients at >= 1 year after symptom onset. Methods - Studies that demonstrated treatment response (defined as a measurable change in task performance compared with a control task performance) through the use of single-subject design methodologies on measures of verbal output or auditory comprehension were selected. Individual subject data were extracted from the 23 studies that met criteria identifying the subjects as those who received direct continuous therapy for spoken language deficits and whose changes in response to therapy were measurable. Percent of maximum possible change was used as a measurement of outcome. Results - Nonparametric correlation statistics (Spearman rho) and comparisons of group means (Kruskal - Wallis) were used to compare the relationship between time postonset and improvement. Time postonset at which treatment was initiated did not correlate with response to treatment. No significant differences in response to treatment were found between groups of patients according to times postonset. Conclusions - Time postonset is not related to response to treatment for aphasia in patients > 1 year postonset of aphasia.","DOI":"10.1161/01.STR.0000249427.74970.15","ISSN":"0039-2499","note":"00066 \nWOS:000243411500042","journalAbbreviation":"Stroke","language":"English","author":[{"family":"Moss","given":"Aviva"},{"family":"Nicholas","given":"Marjorie"}],"issued":{"date-parts":[["2006",12]]}}}],"schema":""} (i.e., All participants were in the chronic phase of recovery; Moss & Nicholas, 2006) and etiology (i.e., Participants with TBI and stroke significantly improved) did not appear to influence treatment outcome. Yet, severity did seem to play a role (i.e., P1 and P2: less severe; robust treatment responses; P3 and P4: more severe; less favorable treatment responses). Thus, ICCR does look to be a better fit for individuals with chronic ABI with deficits in the mild and moderate range. Third, it would be ideal if ICCR could be scaled to other colleges and rehabilitation clinics and partnerships with the local community and state may be useful in meeting that goal. Fourth, it may also be beneficial to explore the effects of neuromodulation (e.g., TDCS) concurrent with behavioral intervention to enhance ongoing treatment. Finally, although no participants thus far have been safe to undergo magnetic resonance imaging (MRI), we hope to explore the effects of ICCR on brain reorganization (i.e. functional near-infrared spectroscopy (fNIRS); electroencephalography (EEG); functional MRI (fMRI); diffusion tensor imaging (DTI)) if possible. ConclusionCurrently, there exists a gap in rehabilitation services for young individuals with chronic ABI, who want to continue their education but are not yet able to do so. ICCR is a first step in filling that gap. This program was designed using principles of experience-dependent neural plasticity and cognitive rehabilitation to support young adults with ABI to build the skills necessary to enroll in post-secondary education. Following ICCR, participants demonstrated improved cognitive-linguistic skills, more appropriate classroom behavior, and increased complexity of targeted SLP goals. Beyond these improvements, participants reported increased life participation and QOL. They enjoyed ICCR and found it beneficial; they learned from one another, supported each other, and even became friends. Overall, these findings demonstrate initial effectiveness of the ICCR program and support its use with this population.AcknowledgmentsThis project was supported by an internal grant through Boston University and T32DC0130170. There are no financial conflicts of interest for Natalie Gilmore or Katrina Ross. Dr. Swathi Kiran discloses that she is a Scientific Advisor and Consultant for Constant Therapy/The Learning Corporation. The authors thank the participants, families, and caregivers for their support and belief in the program. Additionally, they extend their gratitude to Natalie Albrittain-Ross for developing course content and serving as a course instructor for two semesters. The authors thank Rachel Ryskin for her assistance with data analysis and plotting using R and R Studio. Finally, they appreciate Carrie Des Roches, Deirdre McLaughlin, Heather Wolfe, Shreya Chaturvedi, and Lindsey Foo for their assistance with data collection, classroom support, and program development. References ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Babbitt, E. M., Cherney, L. R., & Worrall. (2016). Who benefits from an intensive comprehensive aphasia program? Top. Lang. Disord. Topics in Language Disorders, 36(2), 168–184.Batsell, W. R., Perry, J. 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The Journal of Head Trauma Rehabilitation, 23(4), 252–263.Tulsky, D. S., Kisala, P. A., Victorson, D., Carlozzi, N., Bushnik, T., Sherer, M., … Cella, D. (2016). TBI-QOL: Development and Calibration of Item Banks to Measure Patient Reported Outcomes Following Traumatic Brain Injury. Journal of Head Trauma Rehabilitation, 31(1), 40–51. , Z., & Kleim, J. A. (2010). Neural plasticity: the biological substrate for neurorehabilitation. PM&R, 2(12), S208–S219.Winans-Mitrik, R. L., Hula, W. D., Dickey, M. W., Schumacher, J. G., Swoyer, B., & Doyle, P. J. (2014). Description of an intensive residential aphasia treatment program: Rationale, clinical processes, and outcomes. American Journal of Speech-Language Pathology, 23(2), S330–S342. Health Organization. (2002). Towards a common language for functioning, disability and health: ICF. Retrieved from Stroke Survivors. (2016, December 19). Retrieved from 1: ICCR Treatment ProtocolSemester 1 classes: Psychology, Economics, US History, Personal Finance, Public SpeakingSemester 2 classes: Biology, Psychology, US History, Finance, CommunicationsSemester 3 classes: Biology, Psychology, Finance, US HistoryPre-semester preparationDetermine semester schedule Decide on courses from content available on Khan Academy, Open Yale Courses, other on-line sources and students’ interestsChoose units/sub-topic videos with 30-40 minutes lecture content/hourAdminister pre-treatment test battery unless student is returning for a consecutive semester, in which case use previous post-treatment scoresCreate the following documents for each classSemester Tracker - plan and track completion of video lecturesSyllabus – instructor information, class description, dates/schedules, lecture topics, and grading rubric Weekly PowerPoints – presentations with linked videos for core and elective classesGenerate materials for individual treatment sessions to target:Impairment-based cognitive-linguistic goals based on pre-testing for 1:1 sessions and classroom Functional GAS goal(s) developed with clients in pre-testingDuring the semesterClassesCore classes: “Preview, Review/Discuss, Quiz Review” ModelFirst hour (preview): watch lecture with no distractions, pause only for student questions. Second hour (review/discussion): re-watch content presented in the first hour; introduce metacognitive strategies (e.g., RITA: Rehearse, Imagine, Take Time, Activate; STEP BACK: Self-care, Take Breaks, Exercise, Pace yourself, Be open to help, Avoid interruptions, Cut distractions, Keep it simple) and mnemonics while providing rationale for their use; provide visual aids, written support, and repetition to support memory and auditory comprehension; facilitate conversation between the students to recap what they have learned and generate connections between new and old content. Third hour (quiz review): answer sample quiz questions that have been prepared by the clinician and apply metacognitive strategies they learned in the previous hour to encode salient information from the lecture that they may be quizzed on later in the weekElective classes: Option 160 minutes (discussion): watch the lecture and clinician stops it and asks students to recall salient information that was just presented taxing their immediate recall. Then, they discuss the meaning/significance/relevance and relate it to current events and their environmentOption 2Find an article relevant to the subjectRead as a group with participants taking turnsDiscuss main ideas following each paragraph/sectionGenerate a slide presentation as a group to be presented by students on final day of article discussionICCR WebsiteStudent “Lecture notes” – Clinician posts notes in basic outline format on academic content in CORE subject Research Assistants (RAs) create these outside of classVideos – post lecture content for all classes at the end of each dayIndividual sessions 60 minute cognitive-linguistic therapy Technology Time 60 minutes of Constant Therapy, individual or supported lecture review, or classroom assignment completion (i.e., may involve use of internet, Google Docs, Microsoft Word)RA provides ICCR students support during this hour Testing Quizzes – 5 question multiple choice (1 True/False) questions regarding content from that week’s lecture materialAdministered Mondays/Tuesdays prior to lecture in CORE classes ONLYHand back to students for guided self-correction during “Quiz Review” hour Final exam – compilation of quizzes; CORE classes ONLYAppendix 2: Additional details regarding classroom dataOperational definitions used for coding classroom participation behaviors: Accurately answered question: Student gave an accurate response reflecting comprehension of the materialAccurately answered question cued: Clinician provided support for the student to answer the question accurately (i.e., choices, phonemic (first sound of the word), semantic (related word), orthographic (wrote part of the word)) or, if the clinician asked the student to elaborate.Inaccurately answered question: Clinician explicitly stated that the student was incorrect and asked them to try again, or asked another student to answer. Also, relevant if the student replied “I don’t know” when asked a questionAppropriate question: Student generated a question that was on topic, relevant, and added value to the conversation (e.g. While discussing addictive food product, a student asked if cigarettes have similar addictive properties? Although class is currently discussing food, student connected addictive properties to another known source). Inappropriate question: When the student produced questions that were directed at discontinuing a productive academic activity such as, “Why do we have to do this?” or questions that were irrelevant to the current topic?, “Did you know last summer I scraped my knee and got a bruise?” Appropriate comment: When the student’s response was relevant to the current topic, and/or added value to the subject, or when students made comments that related information in the current class to information they were learning in another class.Inappropriate comment: Student produced a comment that was not irrelevant to the current topic, was distracting to other students, or included information that should be discussed individually (if at all) and not with the group during class Sample datasheet used to collect classroom participation dataClasses_________________Date_________Clinician________________ICCR Day_____P1?P2?P3?Answered QuestionAsked QuestionMade Comment NotesKey: accurate/appropriate = +, accurate/appropriate cued = (+), inaccurate/inappropriate = -Table 1. Demographic Information P1P2P3P4C1C2EtiologyTBICVATBITBICVATBIAge212925343123SexMMMMFFEducation (years)121512161412Months Post Onset497096975938Cognitive-Linguistic ProfileModerate-severe cognitive deficits, moderate aphasia, mild-moderate AOSMild-moderate aphasia, mild cognitive deficitsSevere cognitive deficits, severe spastic dysarthriaSevere Broca’s aphasia, mild-to-moderate cognitive deficits, moderate AOSMild aphasia, mild AOSModerate cognitive deficits, moderate-to-severe hypokinetic dysarthriaNote: TBI – Traumatic Brain Injury; CVA – Cerebrovascular Accident; M - Male; F - Female; AOS – Apraxia of speechTable 2. Standardized tests scores at each time point for each participant P1P2P3P4C1C2PrePost1Post2Post3PrePost1Post2Post3PrePost1Post2Post3PrePostPrePost1Post2PrePostWAB-RLanguage Quotient56.860.465.964.572.580.382.485.369.978.981.082.824.125.185.084.587.090.691.3Cortical Quotient65.266.573.973.276.481.886.389.171.681.083.684.834.032.988.089.491.090.389.8Aphasia Quotient61.966.678.374.978.885.888.193.362.576.383.083.018.817.584.391.091.891.392.8RBANSImm. Mem.44.044.044.061.069.076.083.073.044.040.040.044.040.040.073.076.073.069.087.0V/C69.072.072.069.072.087.087.0100.066.075.069.072.096.084.084.092.084.060.053.0Language40.044.040.047.082.087.078.074.047.074.047.074.040.040.087.078.054.074.085.0Attention43.049.040.043.040.040.043.046.053.064.053.043.043.046.049.040.056.056.043.0Del. Mem.44.044.048.052.094.088.097.094.040.044.044.040.040.040.094.083.097.044.044.0Total45.046.045.049.064.069.072.071.046.052.046.049.047.046.071.067.066.052.054.0SCCANOral Expr.42.147.457.957.978.978.973.789.547.447.457.952.615.85.389.584.294.7100.0100.0Orient.58.383.391.7100.0100.0100.0100.0100.058.391.766.766.750.091.7100.0100.0100.0100.083.3Memory42.136.847.457.942.152.684.284.221.126.331.642.121.121.157.968.489.531.626.3Speech61.569.269.269.269.2100.092.3100.084.6100.092.3100.030.846.276.9100.092.3100.092.3Reading Comp.33.383.366.783.383.383.383.391.758.366.758.341.766.733.383.391.783.375.066.7Writing57.157.157.157.157.157.157.157.185.771.485.785.742.942.957.171.457.171.471.4Attention43.856.362.581.375.075.081.393.843.850.056.350.050.056.387.5100.093.868.875.0Prob. Solv.47.869.682.687.087.082.678.3100.056.552.256.556.547.860.995.795.791.369.682.6Total46.060.063.071.070.075.080.086.054.059.058.058.037.041.064.068.072.063.055.0DCTList. + Read. Total45.051.054.048.060.053.060.057.038.041.043.046.00.040.064.068.072.063.055.0CASPHome79.2100.079.2100.091.783.387.583.387.583.379.279.279.270.891.7100.0100.087.5Neigh. and Comm.50.068.850.081.375.062.575.093.881.375.068.875.068.868.893.893.8100.0100.0School0.075.080.090.00.085.085.085.00.075.075.085.00.065.00.00.00.0100.0Home and Comm.100.050.058.395.080.068.868.885.081.362.562.545.037.575.0100.0100.0100.087.5Total75.076.369.492.583.376.380.386.383.975.072.471.364.370.095.098.3100.093.8Neuro- and TBI-QOLAnxiety41.243.954.248.441.23649.442.152.0Cog. Fxn.43.043.843.942.932.824.147.544.938.2Communication45.445.420.019.057.547.640.31949.9Depression68.361.045.346.838.338.370.536.963.0Pos. Aff.33.738.457.856.867.867.843.168.041.5GASChange20.00.03.10.00.030.010.012.40.0Note Western Aphasia Battery- Revised (WAB-R; ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a29tnc45s31","properties":{"formattedCitation":"(Kertesz, 2006)","plainCitation":"(KERTESZ, 2006)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":"lgPqHwOs/P33qLenb","uris":[""],"uri":[""],"itemData":{"id":"agMx92dm/8xHaekqZ","type":"book","title":"Western Aphasia Battery-Revised","publisher":"PsychCorp","URL":"","shortTitle":"WAB-R","author":[{"family":"Kertesz","given":"Andrew"}],"issued":{"date-parts":[["2006"]]},"accessed":{"date-parts":[["2017",4,24]]}}}],"schema":""} Kertesz, 2006); Repeatable Battery for the Assessment of Neuropsychological Status Update (RBANS Update; ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a1h4kd97qm9","properties":{"formattedCitation":"(Randolph, 2012)","plainCitation":"(RANDOLPH, 2012)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":"lgPqHwOs/m8hHdZ6K","uris":[""],"uri":[""],"itemData":{"id":"agMx92dm/alDyaoBy","type":"book","title":"Repeatable Battery for the Assessment of Neuropsychological Status Update (RBANS)","publisher":"Pearson Clinical","URL":"","author":[{"family":"Randolph","given":"Christopher"}],"issued":{"date-parts":[["2012"]]}}}],"schema":""} Randolph, 2012); Scales of Cognitive and Communicative Ability for Neurorehabilitation (SCCAN; ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a2jh76vnldc","properties":{"formattedCitation":"(Holland & Milman, 2012)","plainCitation":"(HOLLAND & MILMAN, 2012)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":"lgPqHwOs/6nST1WUf","uris":[""],"uri":[""],"itemData":{"id":"agMx92dm/oNZNW2tq","type":"book","title":"Scales of Cognitive and Communicative Ability for Neurorehabilitation (SCCAN)","publisher":"Pro-Ed","language":"English","author":[{"family":"Holland","given":"Audrey L."},{"family":"Milman","given":"Lisa"}],"issued":{"date-parts":[["2012"]]}}}],"schema":""} Holland & Milman, 2012); Discourse Comprehension Test ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"agpfg5hmh8","properties":{"formattedCitation":"(Brookshire & Nicholas, 1993)","plainCitation":"(BROOKSHIRE & NICHOLAS, 1993)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":"lgPqHwOs/vPrYQOOg","uris":[""],"uri":[""],"itemData":{"id":"JOtfSvqo/CqxzcUFf","type":"book","title":"Discourse Comprehension Test","publisher":"BRK Publishers","shortTitle":"DCT","language":"English","author":[{"family":"Brookshire","given":"Robert H."},{"family":"Nicholas","given":"Linda E."}],"issued":{"date-parts":[["1993"]]}}}],"schema":""} (Brookshire & Nicholas, 1993); Child and Adolescent Scale of Participation (CASP) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a26v0aac46q","properties":{"formattedCitation":"(McDougall et al., 2013)","plainCitation":"(MCDOUGALL ET AL., 2013)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":"lgPqHwOs/wmOhjy89","uris":[""],"uri":[""],"itemData":{"id":"JOtfSvqo/5l1byG1A","type":"article-journal","title":"The youth report version of the Child and Adolescent Scale of Participation (CASP): assessment of psychometric properties and comparison with parent report","container-title":"Child: Care, Health and Development","page":"512-522","volume":"39","issue":"4","source":"Wiley Online Library","abstract":"Objective\n\nThe Child and Adolescent Scale of Participation (CASP) parent report is a brief and valid measure for use with children and youth with chronic conditions/disabilities that has been shown to have good coverage at the chapter level of the ‘Activities and Participation’ component of the International Classification of Functioning, Disability and Health. The purpose of this research was to assess the psychometric properties of a CASP youth self-report version, to further validate the parent report, and to compare parent and youth reports of youths' activity and participation.\n\n\nMethods\n\nBaseline data from a longitudinal study examining predictors of changes in quality of life for youth with chronic conditions/disabilities were used. CASP data were collected on 409 youth aged 11–17 with various conditions/disabilities using youth and parent reports. Internal consistency and factor structure were examined for both versions using Cronbach's alpha and exploratory factor analyses. Inter-rater agreement and magnitude of differences between youth and parent report were evaluated using intraclass correlation coefficients and paired t-tests respectively. Gender, age and condition/disability group differences in youth report CASP scores were examined using independent t-tests or analyses of variance.\n\n\nResults\n\nStrong internal consistency and internal structure validity was demonstrated for the CASP youth and parent report. The youth report factor structure was similar to the parent report in this and other studies. Youth reported their activity/participation to be significantly higher than did their parents. Significant differences in CASP scores were found among condition/disability groups.\n\n\nConclusions\n\nFindings show that, from a psychometric standpoint, the youth version of the CASP is a promising new self-report measure of activity and participation. As youth perceive their activity and participation levels differently than their parents, it is important to collect data from both sources to obtain a more comprehensive understanding of this aspect of youths' lives.","DOI":"10.1111/cch.12050","ISSN":"1365-2214","shortTitle":"The youth report version of the Child and Adolescent Scale of Participation (CASP)","journalAbbreviation":"Child Care Health Dev","language":"en","author":[{"family":"McDougall","given":"J."},{"family":"Bedell","given":"G."},{"family":"Wright","given":"V."}],"issued":{"date-parts":[["2013",7,1]]}}}],"schema":""} (McDougall et al., 2013); TBI Quality-Of-Life (QOL; ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"gblVxOSx","properties":{"formattedCitation":"(Tulsky et al., 2016)","plainCitation":"(Tulsky et al., 2016)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":"lgPqHwOs/PP4HyxPB","uris":[""],"uri":[""],"itemData":{"id":757,"type":"article-journal","title":"TBI-QOL: Development and Calibration of Item Banks to Measure Patient Reported Outcomes Following Traumatic Brain Injury","container-title":"Journal of Head Trauma Rehabilitation","page":"40-51","volume":"31","issue":"1","source":"CrossRef","DOI":"10.1097/HTR.0000000000000131","ISSN":"0885-9701","shortTitle":"TBI-QOL","language":"en","author":[{"family":"Tulsky","given":"David S."},{"family":"Kisala","given":"Pamela A."},{"family":"Victorson","given":"David"},{"family":"Carlozzi","given":"Noelle"},{"family":"Bushnik","given":"Tamara"},{"family":"Sherer","given":"Mark"},{"family":"Choi","given":"Seung W."},{"family":"Heinemann","given":"Allen W."},{"family":"Chiaravalloti","given":"Nancy"},{"family":"Sander","given":"Angelle M."},{"family":"Englander","given":"Jeffrey"},{"family":"Hanks","given":"Robin"},{"family":"Kolakowsky-Hayner","given":"Stephanie"},{"family":"Roth","given":"Elliot"},{"family":"Gershon","given":"Richard"},{"family":"Rosenthal","given":"Mitchell"},{"family":"Cella","given":"David"}],"issued":{"date-parts":[["2016"]]}}}],"schema":""} Tulsky et al., 2016), or Neurologic Quality Of Life?(Neuro-QOL; ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"RDwTfqME","properties":{"formattedCitation":"(Gershon et al., 2012)","plainCitation":"(Gershon et al., 2012)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":"lgPqHwOs/bKav0uEk","uris":[""],"uri":[""],"itemData":{"id":809,"type":"article-journal","title":"Neuro-QOL: quality of life item banks for adults with neurological disorders: item development and calibrations based upon clinical and general population testing","container-title":"Quality of Life Research","page":"475-486","volume":"21","issue":"3","source":"CrossRef","DOI":"10.1007/s11136-011-9958-8","ISSN":"0962-9343, 1573-2649","shortTitle":"Neuro-QOL","language":"en","author":[{"family":"Gershon","given":"Richard C."},{"family":"Lai","given":"Jin Shei"},{"family":"Bode","given":"Rita"},{"family":"Choi","given":"Seung"},{"family":"Moy","given":"Claudia"},{"family":"Bleck","given":"Tom"},{"family":"Miller","given":"Deborah"},{"family":"Peterman","given":"Amy"},{"family":"Cella","given":"David"}],"issued":{"date-parts":[["2012",4]]}}}],"schema":""} Gershon et al., 2012); Goal Attainment Scaling (GAS; ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"iss0mzaA","properties":{"formattedCitation":"(King et al., 2000)","plainCitation":"(KING ET AL., 2000)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":"lgPqHwOs/DdzWJeHJ","uris":[""],"uri":[""],"itemData":{"id":814,"type":"article-journal","title":"Goal Attainment Scaling: Its Use in Evaluating Pediatric Therapy Programs","container-title":"Physical & Occupational Therapy In Pediatrics","page":"31-52","volume":"19","issue":"2","source":"CrossRef","DOI":"10.1080/J006v19n02_03","ISSN":"0194-2638, 1541-3144","shortTitle":"Goal Attainment Scaling","language":"en","author":[{"family":"King","given":"Gillian A."},{"family":"McDougall","given":"Janette"},{"family":"Palisano","given":"Robert J."},{"family":"Gritzan","given":"Janet"},{"family":"Tucker","given":"Mary Ann"}],"issued":{"date-parts":[["2000",1]]}}}],"schema":""} King et al., 2000); Imm. Mem. = Immediate Memory; V/C = Visuospatial Constructional; Del. Mem. = Delayed Memory; Oral Expr. = Oral Expression; Orient. = Orientation; Prob. Solv. = Problem Solving; List. + Read. Total = Listening And Reading; Neigh. and Comm. = Neighborhood and Community, Home and Comm. = Home and Community Living Cog. Fxn. = Cognitive Function; Pos. Aff. = Positive Affect and Well-Being; Table 3. Statistical results of McNemar’s tests used to test for item-level gains in standardized measures after each assessment timepoint P1P2P3P4C1C2Time pointPre-Post1Post1-Post2Post2-Post3Pre-Post3Pre-Post1Post1-Post2Post2-Post3Pre-Post3Pre-Post1Post1-Post2Post2-Post3Pre-Post3Pre-Post1Pre-Post1Post1-Post2Pre-Post2Pre-Post1WAB-Rχ2 :5.0; p=.025χ2 :10.1; p=.001χ2 :15.6; p <.001χ2 :8.0; p <.01p=.007χ2 :9.6; p <.01RBANSχ2 : 8.5; p=0.004χ2 :18.3; p< .001SCCANp< .001χ2 :19.9; p< .001p=.031p<.01DCTχ2 :38.0; p<.01Note: Blank cell = Change was non-significant; Bold value = Gains were statistically significant, according to McNemar’s Test, p < 0.05; Timepoint: Pre = Baseline testing, Post1 = Semester 1, Post2=Semester 2, Post3 = Semester 3/final timepoint; Western Aphasia Battery- Revised (WAB-R; Kertesz, 2006); Repeatable Battery for the Assessment of Neuropsychological Status Update (RBANS Update; Randolph, 2012); Scales of Cognitive and Communicative Ability for Neurorehabilitation (SCCAN; Holland & Milman, 2012); Discourse Comprehension Test Table 4. ICCR Attendance (% of days attended) SemesterFallSpringSummerP198.095.0100.0P268.098.0100.0P395.098.095P4n/a93.0n/aNote: P2 elected to attend only 3/4 days of ICCR for his first semester. He attended 86 % of the days that he committed to attending the first semester of ICCR. Table 5. Participant's quiz data (i.e., Proportion of correct items/total items represented as a percent correct)?P1P2P3P4FallSpringSummerFallSpringSummerFallSpringSummerFallSpringSummerQuiz #C1C2C3C4C5C6C1C2C3C4C5C6C1C2C3C4C5C6C1C2C3C4C5C61806080606060n/a801001008080204060804040n/an/a6060n/an/a240408010010010060201001004060606080806060n/an/a80n/an/an/a350100601004040100100100100408083401001004040n/an/a6060n/an/a44040100100808060608080401004060801004040n/an/a2020n/an/a58040604060608080100100201004060801006060n/an/a6040n/an/a68069804060601003180408080403880602020n/an/a8060n/an/a7100606080808080801006060608060100806060n/an/a6080n/an/a880808080404060801008040604080100602020n/an/a8020n/an/a9100100??00100100??80408080??2020??????1080???606080???6040100???6060??????Note:C1=Psychology I, C2=Economics I, C3=Psychology II, C4=Biology I, C5=Psychology III, C6=Biology II All quizzes were 5 questions (i.e., 4 multiple-choice and 1 True/False), with the exception of Quiz 6 in C2, which was out of 16 points.Table 6. SLP treatment goal areasInitial Goal AreasFinal Goal AreasP1(August 2016 - August 2017)? Selective attention in a non-distracting environment with minimal cues? Concrete problem solving with moderate cues and extra time? 1-paragraph auditory comprehension? Alternating/divided attention in a mildly distracting environment with minimal cues? Mixed concrete-abstract problem solving with minimal-moderate cues and extra time? Word-to-phrase level reading and writingP2(August 2016 - August 2017)? 1-2 paragraph auditory comprehension with moderate cues and extra time? Concrete problem solving? Organization and cognitive flexibility in concrete, discrete scenarios with maximal cues? Multi-step functional problem solving with moderate cues? Organization and cognitive flexibility in functional situations with moderate-maximal cuesP3(August 2016 - August 2017)? 1-5 minute sustained attention in a minimally distracting environment with moderate-maximal cues? Basic concrete problem solving with maximal cues and extra time? <15 automatic utterances per session with maximum cues? 10 minute sustained and selective attention in a classroom environment with minimal cues? Minimally-moderately complex concrete problem solving with moderate-maximal cues and extra time? <10 automatic, inappropriate utterances per session with minimal cuesP4(January - May 2016)? Use total communication on 3 occasions to repair breakdowns given maximal cues? Identify basic familiar pictures by name from a field of 3 ? Use total communication on 4-5 occasions to repair breakdowns given moderate cues? Identify basic familiar pictures by name from a field of 4Note: P = Participant; Date ranges refer to the time periods during which the participant was enrolled in ICCRSchedule of standardized assessment testing for experimental participants and controlsNumber of correct responses on each standardized test for experimental participants at each timepoint. Timepoint significantly predicted participants’ scores on the WAB and SCCAN, indicating that as the number of semesters in ICCR increased, participants’ scores on those tests increased. Note: * indicates that timepoint was a significant predictor of scoreResults of linear mixed effects regression revealed that time (i.e., weeks) had a significantly greater effect on the positive classroom behaviors (solid line) than the negative classroom behaviors (dotted line), supporting that ICCR students demonstrated more accurate and appropriate classroom participation with the duration of the third semester. ................
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