Publications by authors named "Jade Cartwright"

14 Publications

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Advocating the rights of people with dementia to contribute to research: Considerations for researchers and ethics committees.

Australas J Ageing 2021 Nov 25. Epub 2021 Nov 25.

Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia.

Objective: Research involving people with dementia is vital to appropriately inform policy and practice decisions affecting this population. As dementia-care researchers, we frequently advocate to Human Research Ethics Committees for the right of people with dementia to choose whether to participate in research. This brief report provides some considerations for researchers and ethics committees.

Method: Descriptive summary of principles that argue for inclusion of people with dementia in research studies.

Results: Specifically excluding people living with dementia from research because of perceived cognitive impairment is inappropriate in light of human rights principles and the right to contribute to evidence-based care.

Conclusion: There is a difference between capacity to provide informed consent and ability to provide perspectives that are valid for each individual. Providing the opportunity for a person with dementia to participate in research and offering support to do this is a matter of human rights.
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http://dx.doi.org/10.1111/ajag.13023DOI Listing
November 2021

Making the Right Connections: Maximizing Lexical Generalization in Lexical Impairments in Primary Progressive Aphasia and Alzheimer's Disease.

Am J Speech Lang Pathol 2021 03 22;30(2):697-712. Epub 2021 Mar 22.

School of Psychology, Curtin University, Perth, Western Australia, Australia.

Purpose Positive intervention effects following lexical retrieval interventions are increasingly reported with people with progressive language impairments; however, generalization of therapy gains are less frequently evident and less well understood. This study sought to explore the impact of specific therapy ingredients on generalization outcomes. Method Twelve participants with progressive lexical retrieval deficits (four each with semantic variant primary progressive aphasia, logopenic variant primary progressive aphasia, and Alzheimer's disease, amnestic presentation) and their family members participated in a 6-week intervention that aimed to increase access to different word classes (nouns, verbs, and adjectives) through a strategic self-cueing approach. Generalization was actively facilitated through strategy practice in connected speech. Repeated baselines of picture naming and connected speech were conducted prior to intervention and repeated immediately post and at 6 weeks following intervention. Results All three diagnostic groups showed significant improvements in naming performance post-intervention for all word classes and for both treated and untreated items, demonstrating consistent treatment effectiveness and generalization at the word level. No changes in the informativeness or efficiency of connected speech were found. Conclusions Despite heterogeneity across participants, widespread evidence of both treatment effects and generalization to untreated items was found for all diagnostic groups and word classes. The consistent within-level generalization across all groups is explored here in relation to optimization of strategy use through incorporation of cognitive scaffolds, strategic practice at the connected speech level, and the inclusion of family members. The absence of across-level generalization to connected speech is also explored. Supplemental Material https://doi.org/10.23641/asha.14219771.
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http://dx.doi.org/10.1044/2020_AJSLP-20-00019DOI Listing
March 2021

"I remember when … ": The impact of reminiscence therapy on discourse production in older adults with cognitive impairment.

Int J Speech Lang Pathol 2020 06 22;22(3):359-371. Epub 2020 Apr 22.

School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Australia.

Positive outcomes following reminiscence therapy have been reported for older adults with mild cognitive impairment and dementia in cognition and quality of life and, in a small number of studies, communication. Despite the close relationship between cognition and language, the impact on communication has received limited attention. This study aimed to investigate whether the spoken discourse of older adults with mild cognitive impairment or dementia could be improved within the genre of following group reminiscence therapy, and whether change generalised to everyday discourse. Four females (mean: 87 years, SD: 7.3) who lived in a residential aged care facility and were diagnosed with mild ( = 2) or major ( = 2) neurocognitive impairment were recruited to attend a group reminiscence programme delivered in eight one-hour treatment sessions over four weeks. Multiple baseline samples of discourse were obtained in the week prior to intervention to monitor stability. Macrostructure, rate, informativeness and efficiency of discourse production were measured to identify change within nostalgic recounts and monitor evidence of generalised change in everyday discourse genres. Cognitive performance and quality of life were also monitored. While variability was evident, significant increases in macrostructure and richness of nostalgic recounts were found for two participants, with significant generalisation to everyday discourse. Both participants had diagnoses of mild cognitive impairment. No significant improvements were seen in cognition or quality of life with all participants. This study provides promising evidence for the spoken recall of memories having the potential to improve the communication of people with neurocognitive disorders, with some indication that people with milder impairment may be more amenable to this form of intervention. Nostalgic recounts may provide an explicit context in which speech-language pathologists can facilitate the planning of spoken production in people with cognitive impairment, and influence speaking in everyday contexts.
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http://dx.doi.org/10.1080/17549507.2020.1747542DOI Listing
June 2020

Lost for words: Perspectives and experiences of people with primary progressive aphasia and Alzheimer's disease and their families of participation in a lexical retrieval intervention.

Int J Speech Lang Pathol 2019 10 17;21(5):483-492. Epub 2019 Jun 17.

School of Occupational Therapy, Social Work and Speech Pathology, Curtin University , Perth , Western Australia , Australia.

Previous qualitative research involving family members' experiences of living with a person with dementia has consistently revealed themes of reduced connectedness and reciprocity of communication, highlighting the importance of education, support and practical strategies to facilitate communication within families. This study aimed to evaluate the perspectives and experiences of both family members and people with dementia following participation in a targeted speech-language pathology intervention involving people with primary progressive aphasia (PPA) and Alzheimer's disease (AD) and their family members. Semi-structured interviews of eight people with dementia (six PPA, two AD) and 10 family members were conducted following an intervention to increase lexical retrieval within functional contexts. Thematic analysis was used to analyse the interview transcripts. Two themes common to participants with dementia and family members emerged: (1) perceived benefits of the intervention and (2) lack of previous information on communication difficulties. Two separate themes emerged for people with dementia, predominantly people with PPA, involving: (1) improved communication and (2) increased participation. Three separate themes emerged for family members: (1) increased awareness and knowledge, (2) increased value of interaction and engagement and (3) uncertainty of the future. The findings of this qualitative study revealed a range of perspectives on the experiences of client and family participants following a communication focussed intervention, examining both the nature of perceived direct gains and gaining insight into the issues faced by these client populations and their families. The provision of individualised information and education should be a fundamental human right for all people with communication impairment with greater attention given to people with progressive conditions where such needs are not currently met.
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http://dx.doi.org/10.1080/17549507.2019.1625439DOI Listing
October 2019

Profiling sentence repetition deficits in primary progressive aphasia and Alzheimer's disease: Error patterns and association with digit span.

Brain Lang 2019 07 3;194:1-11. Epub 2019 Apr 3.

School of Psychology, Curtin University, Perth, Western Australia, Australia.

The use of sentence repetition tasks to distinguish dementia syndromes, particularly variants of primary progressive aphasia (PPA), is receiving growing attention. Impaired sentence repetition is a core feature of logopenic variant PPA, although the underlying cognitive mechanisms of this impairment and its significance as a diagnostic criterion remain poorly understood. Sentence repetition abilities of 12 people with dementia, using an adapted error classification schema, were analyzed, along with digit span abilities, a measure frequently used to assess working memory capacity, to explore error patterns and correlations. Participants with semantic variant PPA showed the greatest performance on sentence repetition and digit span in comparison to the logopenic variant PPA and Alzheimer's disease participants. Sentence repetition errors were characterized by middle omissions for semantic variant PPA, ending omissions and phonological errors for logopenic variant PPA, and ending omissions and unrelated word substitutions for Alzheimer's disease. Significant correlations were found between sentence repetition and digit span abilities. Findings are discussed in relation to working memory capacity theories, specifically, the dual-component model.
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http://dx.doi.org/10.1016/j.bandl.2019.03.001DOI Listing
July 2019

Determining stability in connected speech in primary progressive aphasia and Alzheimer's disease.

Int J Speech Lang Pathol 2018 06 8;20(3):361-370. Epub 2018 Mar 8.

a School of Psychology and Speech Pathology , Curtin University , Perth , Australia and.

Purpose: Using connected speech to assess progressive language disorders is confounded by uncertainty around whether connected speech is stable over successive sampling, and therefore representative of an individual's performance, and whether some contexts and/or language behaviours show greater stability than others.

Method: A repeated measure, within groups, research design was used to investigate stability of a range of behaviours in the connected speech of six individuals with primary progressive aphasia and three individuals with Alzheimer's disease. Stability was evaluated, at a group and individual level, across three samples, collected over 3 weeks, involving everyday monologue, narrative and picture description, and analysed for lexical content, fluency and communicative informativeness and efficiency.

Result: Excellent and significant stability was found on the majority of measures, at a group and individual level, across all genres, with isolated measures (e.g. nouns use, communicative efficiency) showing good, but greater variability, within one of the three genres.

Conclusion: Findings provide evidence of stability on measures of lexical content, fluency and communicative informativeness and efficiency. While preliminary evidence suggests that task selection is influential when considering stability of particular connected speech measures, replication over a larger sample is necessary to reproduce findings.
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http://dx.doi.org/10.1080/17549507.2018.1442498DOI Listing
June 2018

Is the speech-language pathology profession prepared for an ageing population? An Australian survey.

Int J Speech Lang Pathol 2019 04 18;21(2):153-162. Epub 2017 Dec 18.

c College of Nursing and Health Sciences , Flinders University , Adelaide , Australia.

Purpose: This study profiled the demographic characteristics and practice patterns of speech-language pathologists working with older Australians to inform future workforce planning and service development in response to an ageing population and aged care sector reform.

Method: Data were collected through snowball distribution of an online survey comprising six sections: demographic details; caseload and service delivery practices, degree of inter-professional practice; engagement with professional development and support; and assessment and management of swallowing, mealtime and communication difficulties. All data were analysed using descriptive statistics and chi-square to determine the independence of key variables.

Result: Data from 145 speech-language pathologists highlight the need for increased numbers of clinicians working outside of metropolitan areas and greater workforce diversity, along with increased incentive, supervision and inter-professional support for new graduate and early career clinicians considering working outside of hospital settings. To ensure evidence-based practice, further research into the validity of current assessment and intervention methods used across aged care settings is needed.

Conclusion: The findings highlight the need for an extended scope of practice and improved models of support for speech-language pathologists working with older people to better respond to the needs of an ageing population and on-going aged care sector reform.
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http://dx.doi.org/10.1080/17549507.2017.1413135DOI Listing
April 2019

The health professionals' perspectives of support needs of adult head and neck cancer survivors and their families: a Delphi study.

Support Care Cancer 2017 08 3;25(8):2413-2420. Epub 2017 Mar 3.

School of Psychology and Speech Pathology, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.

Purpose: The aim was to identify the views of Australian and New Zealand health professionals regarding the support needs of people with head and neck cancer (HNC) and their families and current gaps in service delivery.

Methods: A modified Delphi process assessed support needs of people with HNC following acute medical management. A systematic review of the literature was used to develop items relevant to seven key concepts underpinning the psychological experience of living with HNC. A panel of 105 health professionals was invited to participate in two questionnaire rounds.

Results: Of the potential panellists, 50 (48%) completed round 1, and of these, 39 (78%) completed round 2. Following two rounds, there was consensus agreement on the concepts uncertainty and waiting, disruption to daily life and fear of recurrence. The concepts the diminished self, making sense of and managing the experience, sharing the burden and finding a path did not achieve consensus. There were no differences in responses according to gender, organization type or location. Medical professionals had significantly higher agreement for the concept uncertainty and waiting compared to allied health professionals, and professionals with five years' or more experience had significantly higher agreement than those with less experience.

Conclusions: Health professionals agreed that many psychosocial support needs of HNC survivors and families are not being met and that they experience difficulties in meeting these needs. Findings may inform evidence-based treatment programs for HNC survivors and their families to promote psychological resilience and quality of life in this vulnerable population.
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http://dx.doi.org/10.1007/s00520-017-3647-2DOI Listing
August 2017

Dysphagia therapy post stroke: An exploration of the practices and clinical decision-making of speech-language pathologists in Australia.

Int J Speech Lang Pathol 2018 04 12;20(2):226-237. Epub 2017 Jan 12.

a School of Psychology and Speech Pathology , Curtin University , Perth , Australia and.

Purpose: A variety of dysphagia management options are available for the treatment of dysphagia following a stroke, however, it is unknown which of these approaches are most commonly utilised by Australian speech-language pathologists (SLPs) and whether particular factors influence decision-making.

Method: The aim of this study was to investigate, through an online survey, the treatment practices of SLPs in Australia for the treatment of dysphagia post-stroke and identify the factors influencing treatment decisions.

Result: A total of 118 SLPs completed the online survey. Descriptive statistics identified large variability in the dysphagia treatments utilised, with all 24 therapies listed in the online survey reported as being routinely used. Compensatory therapies were ranked as being utilised more frequently than rehabilitative approaches, with six of the seven highly utilised therapies being compensatory in nature. A client's cognitive capacity was the most prominent factor influencing SLPs' treatment decisions.

Conclusion: This study provides insight into the practices of SLPs in Australia for the treatment of dysphagia following stroke and discusses potential for shifts in practice. It highlights the complexity involved in the decision-making process and that clinicians consider evidence, as well as client, clinician and service factors, when selecting between the range of options available.
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http://dx.doi.org/10.1080/17549507.2016.1265588DOI Listing
April 2018

Inhibitory control and traumatic brain injury: The association between executive control processes and social communication deficits.

Brain Inj 2016 24;30(13-14):1708-1717. Epub 2016 Oct 24.

a Department of Psychology and Speech Pathology , Curtin University , Perth , Australia.

Primary Objective: To further examine the proposed relationship between executive impairments in inhibitory control and social communication difficulties reflecting poor inhibition following TBI.

Method: Inhibitory control was assessed in 14 adults with TBI on the Hayling Sentence Completion Test (HSCT). Errors on Part B (failed inhibition) and Part B-Part A response latencies (delayed inhibition) were examined. A relative, friend or frequent communication partner of each participant with TBI completed the La Trobe Communication Questionnaire (LCQ) on the communication difficulties of the person with TBI. The Inhibitory Control Factor (ICF) score of the LCQ based on seven items relating to poor inhibition was specifically analysed against performance on the HSCT.

Results: Multiple regression analysis indicated that 58% (51% adjusted) of the variance in LCQ ICF scores was accounted for by measures on the HSCT. Only B-A response latencies on the HSCT explained a significant proportion of the variability in LCQ ICF scores.

Conclusions: Reduced inhibition speed may more strongly contribute to disinhibited communication behaviours than failures in inhibition. These findings contribute to understanding of the cognitive processes underlying social communication and have the potential to support and inform the use and development of management practices for individuals following TBI.
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http://dx.doi.org/10.1080/02699052.2016.1202450DOI Listing
January 2018

Exploring generalisation processes following lexical retrieval intervention in primary progressive aphasia.

Int J Speech Lang Pathol 2016 06 4;18(3):299-314. Epub 2016 Apr 4.

c Neurodegenerative Disorders Research , West Perth , Western Australia , Australia.

Purpose: Within the current literature, positive intervention effects demonstrate the significant potential for people with Primary Progressive Aphasia (PPA) to learn/relearn words. Generalisation of intervention effects to other words and/or other contexts, however, remains unclear.

Method: This multiple baseline, case-series design investigated the effects of a self-cueing lexical retrieval intervention across word classes (nouns, verbs and adjectives) on four individuals with PPA, three suggestive of the semantic variant and one of the logopenic variant. The intervention integrated semantic, phonological and orthographic levels of language production and drew on autobiographical memory. Changes in accuracy in retrieving treated and untreated items (pre-intervention, post-intervention and 4-weeks maintenance) were determined using the Cochran's Q test, with follow-up McNemar pairwise comparisons.

Result: All participants showed significant improvements in naming treated items, across all word classes. Different patterns of generalised improvement to untreated words were found for each participant. In discourse, the semantic variant participants demonstrated a significant increase in correct information units, in contrast to the participant with the logopenic variant who remained stable.

Conclusion: This study provides evidence that people with PPA can show improved lexical retrieval following intervention. The findings suggest possible differences in generalisation across word classes and according to underlying deficit.
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http://dx.doi.org/10.3109/17549507.2016.1151936DOI Listing
June 2016

The bedside assessment practices of speech-language pathologists in adult dysphagia.

Int J Speech Lang Pathol 2015 15;17(4):390-400. Epub 2014 Dec 15.

School of Psychology and Speech Pathology, Curtin University , Perth , Australia.

Purpose: The current study aimed to investigate what Australian speech-language pathologists frequently include in their bedside assessments in adult dysphagia, what factors influence these bedside assessments and whether they are consistent with the current evidence base.

Method: These aims were achieved via an online questionnaire and a series of semi-structured interviews. In the questionnaire, respondents were asked to rate how frequently they utilized bedside assessment components on a scale of five ranging from never to always.

Result: One hundred and forty practicing speech-language pathologists completed the online questionnaire in full. Eight interviews were then conducted. Respondents reported utilizing predominantly motor elements of their oro-motor examination with very few sensory elements being frequently utilized. Five main themes arose from the interviews including the influence of the individual patient and participant, the current evidence base, the participants' clinical practice and the participants' workplace.

Conclusion: The findings from this research have implications for current clinical and education practices, in particular the impact of education and training and caseload demands on current practice.
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http://dx.doi.org/10.3109/17549507.2014.979877DOI Listing
April 2016

A comparison of aphasia therapy outcomes before and after a Very Early Rehabilitation programme following stroke.

Int J Lang Commun Disord 2014 Mar-Apr;49(2):149-61

Faculty of Health, Engineering and Science, Edith Cowan University, Joondalup, WA, Australia; Clinical Centre of Research Excellence in Aphasia Rehabilitation, Brisbane, QLD, Australia.

Background: Very early aphasia rehabilitation studies have shown mixed results. Differences in therapy intensity and therapy type contribute significantly to the equivocal results.

Aims: To compare a standardized, prescribed very early aphasia therapy regimen with a historical usual care control group at therapy completion (4-5 weeks post-stroke) and again at follow-up (6 months).

Methods & Procedures: This study compared two cohorts from successive studies conducted in four Australian acute/sub-acute hospitals. The studies had near identical recruitment, blinded assessment and data-collection protocols. The Very Early Rehabilitation (VER) cohort (N = 20) had mild-severe aphasia and received up to 20 1-h sessions of impairment-based aphasia therapy, up to 5 weeks. The control cohort (n = 27) also had mild-severe aphasia and received usual care (UC) therapy for up to 4 weeks post-stroke. The primary outcome measure was the Aphasia Quotient (AQ) and a measure of communicative efficiency (DA) at therapy completion. Outcomes were measured at baseline, therapy completion and 6 months post-stroke and were compared using Generalised Estimating Equations (GEE) models.

Outcomes & Results: After controlling for initial aphasia and stroke disability, the GEE models demonstrated that at the primary end-point participants receiving VER achieved 18% greater recovery on the AQ and 1.5% higher DA scores than those in the control cohort. At 6 months, the VER participants maintained a 16% advantage in recovery on the AQ and 0.6% more on DA scores over the control cohort participants.

Conclusions & Implications: A prescribed, impairment-based aphasia therapy regimen, provided daily in very early post-stroke recovery, resulted in significantly greater communication gains in people with mild-severe aphasia at completion of therapy and at 6 months, when compared with a historical control cohort. Further research is required to demonstrate large-scale and long-term efficacy.
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http://dx.doi.org/10.1111/1460-6984.12074DOI Listing
November 2014

Promoting collaborative dementia care via online interprofessional education.

Australas J Ageing 2015 Jun 7;34(2):88-94. Epub 2013 Oct 7.

School of Pharmacy, Curtin University, Perth, Western Australia, Australia.

Aim: This study aimed to develop, implement and evaluate an online interprofessional education (IPE) dementia case study for health science students. The IPE initiative aimed to develop collaborative interprofessional capabilities and client-centred mindsets that underpin high-quality dementia care.

Method: A mixed methods research design was used to assess students' values, attitudes and learning outcomes using an interprofessional socialization and valuing scale (ISVS) completed pre and post the online case study and via thematic analysis of free text responses.

Results: Students' ISVS scores improved significantly following online participation, and the qualitative results support a shift towards interprofessional collaboration and client-centred care.

Conclusions: This online IPE case study was successful in developing the collaborative mindsets and interprofessional capabilities required by a future workforce to meet the complex, client-centred needs of people living with dementia.
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http://dx.doi.org/10.1111/ajag.12106DOI Listing
June 2015
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