Therese M. O'NEil-Pirozzi

Purpose: This study serves as an extension of previous research on the effects of speech-generating device (SGD) use on the speech of autistic children, aiming to investigate the impact of SGD use on the speech of autistic adults. Method: A single-subject multiple-baseline design across behaviors was conducted with a minimally speaking, 21-year-old autistic man. The participant was an independent SGD user of the Accent 800 with LAMP Words for Life software. Differential reinforcement and echoic prompting were delivered concurrently to teach three new words on the SGD. Dependent variables included percentage of trials in which the participant vocally produced an independent target word, an independent target request using the SGD (a prompted full word or word approximation with SGD), or a novel word. Results: SGD use was consistent and accurate across all stimuli throughout the study. The participant mastered all three target words—“eat,” “drink,” and “music”—with an upward trend in independent words during treatment and strong maintenance during withdrawal. Novel words also emerged across phases. Conclusions: The results were consistent with those of previous studies indicating that SGD use can promote speech in autistic children. This study demonstrated that the adult participant increased speech production following intervention with an SGD. Limitations of the study include the single participant and participant experimenter familiarity. Further research is needed with autistic adults.

Background: Health perceptions affect health behaviors, engagement with healthcare providers and treatments, and health outcomes. However, tools to evaluate patient health perceptions are lacking. Therefore, we developed the Multidimensional Health Perceptions Questionnaire (MHPQ) as a comprehensive but brief self-reported measure of an individual’s health perceptions, agnostic to condition. This type of instrument is needed to help evaluate the effect of health perceptions on health-related outcomes in addition to informing adaptation of care to improve patient provider interactions. In a prior study, the MHPQ demonstrated excellent content validity (content validity index=98.1%) and conceptual equivalence in English and Spanish in the general population, with a reading grade level of th grade in both languages. We found a 7-factor structure in the general population (combined English and Spanish speakers), but limitations in the representativeness of the sample warranted further investigation into the factor structure of the MHPQ.¹ Additionally, validation in unique populations – like traumatic brain injury (TBI) – is consistent with best practice. Objective: To determine the factor structure of the MHPQ among adults with >1 year history of traumatic brain injury (TBI) that required inpatient rehabilitation. Participants: Participants (n=250) enrolled in the TBI Model Systems National Database across five participating centers who completed a follow-up assessment between September 1^st, 2023 and June 19^th, 2024. All participants had experienced a TBI requiring inpatient rehabilitation and ranged from 1-35 years post-injury. All were able to complete a self-reported survey. Methods: We administered the original 65-item MHPQ as an electronic survey (REDCap™) or via telephone interview (if preferred) to participants. All items are rated on a 1=Strongly disagree to 5=Strongly agree response scale. Results: N=250 participants with a history of TBI completed the MHPQ in English. The sample was 30.8% CIS-female (68.4% CIS-male, 0.8% Other gender), 18-90 years old (M=45.8, SD=16.2), 16.0% Hispanic/Latino, and predominantly White (68.0%), followed by Black (18%), and all other races (2.0-5.2%). Exploratory Factor Analysis resulted in 53 final items with a multidimensional structure and good internal consistency reliabilities, with the following eight health perceptions domains (% variance, Cronbach’s α): Anticipated Discrimination and Judgement (10 items; α=.90); Communication with Healthcare providers (9 items; α=.79); Spiritual Health Beliefs (8 items, α=.88), Health Self-Efficacy (5 items, α=.73), Trust in Social Health Advice (5 items, α=.78), Trust in Medicine (6 items, α=.76), How Health Affects My Life (5 items, α=.71), and How Others Affect My Health (5 items, α=.64) Conclusions: Results suggest that the MHPQ could be a valid and reliable measure for comprehensively characterizing health perceptions among individuals who have experienced TBI. It demonstrated an 8-factor structure, with 8 distinct subscales each yielding average scores (1-5). Further validation through Rasch analysis and for the Spanish-language version of the MHPQ are forthcoming.

Purpose: Cognitive exercise is an activity that people engage in to maximize brain health and function. A hybrid cognitive exercise group model creates an opportunity to potentially benefit adults with chronic moderate–severe (m-s) cognitive impairments post–acquired brain injury (ABI) in community residential settings. This article reports preliminary feasibility, enjoyment, and potential cognitive benefits of a 1-year hybrid cognitive exercise group from participant and trained in-person volunteer facilitator perspectives. Method: Ten adults residing in a community home participated in the group directed by a rehabilitation speech-language pathologist (SLP) via an internet-based videoconferencing platform and facilitated by three in-person trained volunteers in this mixed-methods single-group study. Attendance, retention, and postgroup satisfaction data were obtained from participants and facilitators. Pre−/postgroup cognitive testing data were obtained from participants. Results: Participants and facilitators attended more than 90% of sessions, with 100% retention. Eighty percent of participants reported that the group was extremely helpful, and 90% reported that it was extremely enjoyable, with 100% wanting to continue in the group. Episodic memory and processing speed were significantly improved postgroup. Facilitators reported that the group was extremely helpful and enjoyable to participants, with 100% wanting to continue helping run the group. Conclusions: Engagement in a hybrid cognitive exercise group led online by a rehabilitation SLP was perceived feasible by adults with chronic m-s cognitive impairments post-ABI residing in a community home and trained in-person volunteer facilitators. Cognitive benefits may be associated with this model of economical, time-efficient, and enjoyable group engagement. Further study is warranted. Supplemental Material: https://doi.org/10.23641/asha.29710805

Objective: To examine the association between environmental barriers and unmet rehabilitation needs during chronic recovery from traumatic brain injury (TBI) in persons discharged from inpatient rehabilitation. Setting: Five Veterans Affairs Polytrauma Rehabilitation Centers. Design: Cohort study of Veterans Affairs TBI Model Systems study participants who completed a 10 or 15 year follow up (N = 474). Main Measures: Craig Hospital Inventory of Environmental Factors, Short Form (CHIEF-SF); TBI Rehabilitation Needs Survey (RNS). Results: RNS scores ranged from 0 to 42 with an average score of 6.9 (SD = 7.7). The most frequent unmet needs endorsed included the need to improve memory, solve problems, and control physical symptoms. In the adjusted model, unmet rehabilitation needs (RNS total) was associated with overall environmental barriers (CHIEF-SF Total Score) and three of five CHIEF-SF subscales: Policy barriers, Attitudes/Support barriers, and Services/Assistance barriers. Conclusions: Results from this study suggest that rehabilitation needs persist for at least a decade after TBI and occur in areas that may be modifiable with intervention. Health care providers shoulder consider periodic screening for unmet needs and consider potential treatments to address them as medically indicated Also, results support the growing recognition of TBI as a dynamic and lifelong condition necessitating a chronic disease management model. Despite significant investment in healthcare infrastructure for Veterans and Service Members, knowledge gaps remain regarding understanding and addressing their long-term rehabilitation needs, as well as and how environmental barriers impact the ability to address those needs. Unmet needs among women and minority groups; as well as evaluation of systems interventions to ameliorate environmental barriers they face are important foci of future research.

Objective: To describe the self-reported needs of family caregivers of service members and veterans (SMVs) with traumatic brain injury (TBI) at 10 to 15 years post-injury and to identify unique predictors of unmet family needs. Setting: Five Department of Veterans Affairs Polytrauma Rehabilitation Centers. Participants: A total of 209 family caregivers of SMVs with TBI from the VA TBI Model Systems national database who completed a 10- or 15-year follow-up assessment. Design: Observational study. Main Outcome Measure: Family Needs Questionnaire-Revised (FNQ-R). Results: Item-, domain-, and total score-level descriptive analyses of FNQ-R responses were conducted. On average, 56.3% of the FNQ-R family caregiver needs were reported as met. Health information and involvement in care needs were the most often met, and emotional support and instrumental support needs were the least often met. Adjusted multivariable regression models demonstrated that urban-dwelling SMVs (compared to suburban) and spouses/significant others (compared to parents) were associated with more unmet family needs. Distinct associations were identified between the 6 FNQ-R domains and SMV environmental factors (ie, urbanicity, rurality, and being active duty at follow-up), SMV comorbidities (ie, receiving mental health treatment in the year prior to the follow-up), and caregiver factors (ie, spouses/significant others). Conclusion: Family caregivers of SMVs with TBI reported multiple unmet needs at 10 to 15 years post-injury, emphasizing the importance of ongoing caregiver support after TBI. Policy and programming to support military caregivers should consider the current findings to direct resources to address the identified unmet needs.

Background: Positive associations are reported between "cognitively stimulating" activities and cortical stimulation and between "cognitively challenging" activities and cortical stimulation. However, the basis for these has been largely subjective. One aim of this pilot study was to determine whether tabletop cognitive activities, believed to be cortically stimulating, are objectively based on left dorsolateral prefrontal cortex (LDLPFC) coherence measured by electroencephalography (EEG). A second aim was to compare LDLPFC coherence associated with Sudoku, perceived by most study participants to be the most cognitively challenging activity they completed, with LDLPFC coherence associated with the activity each perceived to be the least cognitively challenging. Methods: Participants engaged for five minutes in an "at rest" condition and each of five presumptively "cognitively stimulating" tabletop activity conditions. EEG data were collected throughout. Participants then ranked the cognitive challenge they experienced completing each tabletop activity. Results: Based on EEG LDLPFC coherence, not all activities were cortically stimulating. Sudoku, the activity rated "most cognitively challenging" by most participants (n = 13/25), was the most cortically stimulating condition in Beta, High Beta, Theta, Delta, and High Delta frequency bands. Conclusion: With a growing body of evidence supporting the benefits of ongoing engagement in challenging cognitive exercise for individuals across their lifespans, identifying cognitive activities that stimulate beneficial cortical activation and, ultimately, cognitive function is needed.

Purpose: Therapeutic alliance (TA) is critical to rehabilitation outcomes for adults with acquired brain injuries (ABIs). The purpose of this viewpoint article is to review factors that contribute to TA and to suggest ways speech-language pathologists (SLPs) can integrate these factors into their ABI rehabilitation practice. Method: We evaluated literature describing client and clinician factors shown to affect—or not affect—TA in ABI rehabilitation and mapped findings onto suggested practices that SLPs may use to actively promote TA with their clients. Informed by our findings and TA frameworks, we integrated findings into a novel clinician self-reflection tool: the Therapeutic Alliance Reflection Checklist. Conclusions: TA is a key ingredient in ABI rehabilitation. We contend that SLPs can, and should, actively facilitate TA with clients; the self-reflection checklist can assist. We advocate for continued TA research and improved measurement across rehabilitation settings. We further contend that training in active TA-promoting skills is a critical component of speech-language pathology education.

With human life expectancy and proportion of older adults increasing, global use of evidence-supported preventative methods to minimize risk of brain-related disabilities such as Alzheimer's disease and other dementias—as well as interventions to slow rate of disease progression—is important. Sustained engagement in cognitive and physical exercise programs may prevent or delay dementia onset as well as maximize health and function of those with dementia. Despite awareness of the importance of cognitive and physical exercise to brain health, exercise program adherence by older adults is extremely challenging. In this Perspective article, we summarize what is known about contributors to exercise program adherence and strategies to promote it. We discuss our viewpoint on knowledge gaps regarding exercise adherence and research that needs to be conducted. We conclude by proposing a multi-dimensional exercise adherence assessment framework that includes portable neurophysiologic technologies to inform initial design and updating of individualized exercise programs that optimize sustained exercise program engagement and, ultimately, maximize brain health in older adults with and without mild cognitive impairment and dementia.

Objective: To identify demographic, injury-related, and 1-year postinjury clinical and functional predictors of high and low life satisfaction at 10 years after moderate to severe traumatic brain injury (TBI) using an extreme phenotyping approach. Setting: Multicenter longitudinal database study. Participants: A total of 3040 people from the National Institute on Disability, Independent Living, and Rehabilitation Research TBI Model Systems database with life satisfaction data at 10 years post-TBI. Design: Multicenter, cross-sectional, observational design. Main Measures: Satisfaction With Life Scale (outcome), Glasgow Coma Scale, Disability Rating Scale, Functional Independence Measure, Participation Assessment with Recombined Tools-Objective, Patient Health Questionnaire-9, and General Anxiety Disorder-7 (standardized predictors). Results: Greater cognitive and motor independence, more frequent community participation, and less depressive symptoms 1 year post–moderate to severe TBI predicted extreme high life satisfaction 10 years later. Non-Hispanic White and Hispanic individuals were significantly more likely than Black individuals to have extreme high life satisfaction 10 years post-TBI. Conclusions: Extreme phenotyping analysis complements existing knowledge regarding life satisfaction post–moderate to severe TBI. From a chronic disease management perspective, future studies are needed to examine the feasibility and impact of early postinjury medical and rehabilitative interventions targeting cognitive and motor function, community participation, and mood on the maintenance/enhancement of long-term life satisfaction post-TBI.

In rehabilitation research and practice, participation is defined as involvement in life situations and most often measured as frequency of engaging in these life situations. This narrow measurement approach overlooks that individuals perceive importance of and satisfaction with participation in activities in various life areas differently. The purpose of this study was to determine differences in meaningful participation (perceived importance and satisfaction) after moderate to severe traumatic brain injury (TBI) across age groups and to identify predictors of participation satisfaction. Secondary data analysis of a TBI Model Systems substudy, including the Participation Assessment with Recombined Tools-Subjective (PART-S) that rates participation importance and satisfaction in 11 life areas that we grouped into three domains (i.e., productivity, social relations, out-and-about). We identified differences across age groups (i.e., 16 to 24 years, 25 to 44 years, 45 to 64 years, and 65 + years) and predictors of participation satisfaction. Participation satisfaction in and importance of the 11 life areas varied across age groups. In all age groups, participants rated relationships as being of medium or high importance more often than other life areas. Older adults reported the highest participation satisfaction across life areas, despite having the lowest participation frequency. Consistent predictors of participation satisfaction were cognitive functioning and frequency of participation in the domain examined. Participation importance, satisfaction, and frequency are related, yet distinct, dimensions of participation that should all be measured to adequately evaluate meaningful participation. Future research should explore interventions across the lifespan that target modifiable predictors, like functional cognition and access to frequent participation in important life activities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).