CAACC – CHARGE TO AND HOPE FOR THE CONFERENCE

1. CAACC – CHARGE TO AND HOPE FOR THE CONFERENCE Malcolm R. McNeil, Ph.D. Research Career Scientist VA Pittsburgh Healthcare System 7180 Highland Drive Pittsburgh, PA 15206 412-364-4951 AND Distinguished Service Professor & Chair Department of Communication Science and Disorders University of Pittsburgh 4033 Forbes Tower Pittsburgh, PA 15260 412=383-6541 mcneil@pitt.edu

2. Review of the paradigms that caused the development of the CAC What is a scientific paradigm? A set of principles and beliefs (both explicitly and implicitly stated) that govern the questions that are acceptable askandthe experimental methods that are acceptable to use in answering them An area of inquiry can operate without a paradigm, but once there is one, the discipline cannot operate without one It takes a scientific revolution to change a paradigm

3. Review of the paradigms that caused the development of the CAC • Why is it important to know if we have a paradigm? • It can explain why scientific methods and the communities that single-mindedly adhere to them are so impenetrable to change • It can give solace to pioneers and rebels who have revolutionary ideas about their science but remain outside of the mainstream and are even ostracized by its practitioners • But remember, not every new idea or rebellious practitioner brings enlightenment – there are a world of bad ideas and misguided (though well intentioned) pseudo-scientists • This is an “essential tension” in science

4. Review of the paradigms that caused the development of the CAC • How would we know if we have a paradigm? A paradigm exits when: • A majority of practitioners subscribe to it and • It dominates introductory text books Surprisingly, a paradigm can exist whether or not it is productive or even if it is demonstrated to be wrong

5. Review of the paradigms that caused the development of the CAC • It is important to evaluate whether we have a paradigm in aphasia because it explains why the CLINICAL APHASIOLOGY CONFERENCE was initiated • Without going through the evidence or the sequence of challenges to it, I will conclude that we do have a paradigm and we have some enduring but as yet unsuccessful challenges to it

6. Review of the paradigms that caused the development of the CAC • How do we characterize this paradigm? • Porch characterized the prevailing paradigm as “neurological aphasiology” • It was characterized by an antiquated and incorrect model of brain-behavior relationships and a preoccupation with “lesion-Lesion, where’s the lesion?” mentality and research on the classification of aphasia syndromes. • Centers and Pathways model of language and modalities based on Wernicke-Licthiem Model

7. Review of the paradigms that caused the development of the CAC • Bruce Porch perceived a need to have a forum that focused on clinical issues in aphasiology that the current paradigm did not address.

8. The Birth of CAC • In 1971, a small group of young like-minded aphasiologists with a special interest in clinical issues assembled with Bruce in the basement of the Albuquerque VA Hospital and debated clinical aphasiology in the tradition of Schuell • In 1972 the first solicitation of papers for presentation was advanced and the 2nd CAC was held at a hotel in Albuquerque • We have had 36 successful conferences in 36 different places with more than a thousand papers presented and published from it

9. A parenthetical about the paradigms that caused the development of the CAC • In my judgment, the paradigm that motivated the CAC has not changed • In spite of the fact that the dominant paradigm is untenable, the evidence has not been assembled that is strong enough to replace it (represented and formalized by a suitable “clinical classification” system) • Again, once we have a paradigm, we cannot be without one even if the current one is demonstrated to be wrong or untenable • The dominant paradigm is maintained until it is replaced with another (as evidenced by the majority of scientists in that field subscribing to it and as it is reflected in introductory text books) • Remember, a science can operate without a paradigm

10. About The Organization of CAC • CAC has a “Loose” organizational structure • There is no membership and no decisions about organization are left to the attendees of the meeting • Elected officers (by the steering committee) are: • Conference Chair • Program Chair (who appoints her own program committee) • Secretary • Treasure • Local arrangements chair (who appoints her own committee) • CAC is a 501-C3 organization so there is some structure

11. The Organization of CAC • CAC is run by a “Steering Committee” • Composed of all past Conference Chairs that handle written decisions - and those past chairs that are present for a meeting.

12. Structure of CAC • CAC has a mechanism for careful peer review of presentations (the program committee) • And a mechanism for the publication of papers in an established, scientific journal (Aphasiology).

13. Structure of CAC • My strong personal bias is NOT to publish papers in a “proceedings” or edited books. • CAC has ALL 1109 published manuscripts (from 1972 to the beginning of publication in Aphasiology) archived and accessible to the world scientific community at aphasiology.pitt.edu The Aphasiology Archive

14. Structure of CAC • Meeting attendance is restricted to: • first and second authors of papers that are accepted and to • first authors of rejected papers • Conference size is kept to about 100-120 (maximum) ensuring • Full engagement at a clinical-scientific level • Opportunities to participate fully

15. At the Meeting • Discussion is as prized as the presentation and given equal time • 15 minutes for presentation (strictly enforced) • 15 minutes for discussion • Debate and discussion is never pandering and can last until only one person is left standing (within the time limit). • Debate can be intense – but never personal.

16. Rules of CAC that have made it work and the model for several other conferences • Debate and discussion is designed to make our research and clinical practice the best that it can be for our science and for our patients – therefore it is always scientific. • Again, Debate and discussion is always civil, frequently leavened with humor and self-deprecation

17. Structure of CAC • The interpretation of one’s research is challenged for it’s adherence to scientific logic and shoddy research is kindly and gently exposed. • There is a fierce adherence to holding people to account for methodological rigor.

18. CAC is dedicated to attracting and raising the next generation • An NIH Training Grant supports a number of attendees each year (travel, registration, per diem)

19. Structure of CAC • NIH supported follows have several special sessions with an invited “fireman” that has lunch with them and talks to them as a group and individually (e.g. Ray Kent)

20. Structure of CAC • Trainees have special poster and discussion sessions for the presentation of their own work with a 1 min. oral summary of their poster to the whole conference

21. Structure of CAC • Attendees are given a mentor for the meetingfrom which doctoral student are often recruited{Chris Matthews}

22. Consequences of CAC • The venue for attracting our next generation of clinical scientists andfuture colleagues (Geoff Fredericks)

23. VENUE • CAC is always held in a place that people want to go. Springfield, Mo.

24. VENUE Winter Park, Utah

25. VENUE Ghent Belgium

26. VENUE Orcas Island, Washington

27. VENUE The Big Island Hawaii

28. CAC has introduced us to our mentors Fred Darley

29. We have “grown up” together

30. We have grown up together (Kevin Kearns and Marilyn Newhoff)

31. We have grown up together(Kevin Kearns and Sheila Pratt)

32. CAC has introduced colleagues that have become our best friends

33. CAC gave us the chance to procreate (professionally of course)

34. CAC has even brought the seriousness of the enterprise to our own children

35. Socialization • A banquet closes the conference and live dance- music is always included – including a CAC traveling band -“Ralph and the Dinosaurs” for a while • Featuring a cross dressing Ralph

36. Socialization • But we are not limited to local bands for our entertainment. • We have talent within the ranks and a group of hot dogs that love to perform Rick Peach and Chris Code

37. Socialization Talent Chick LaPointe Candice Quals Pagie Beeson Laura Murray Amy Ramage Chris Code Don Robin

38. Socialization Talent Rick Peach, Don Robin, Rich Katz

39. Socialization • Liberal attention to socialization has brought inter-institutional fraternization (recently lead to two marriages from a single conference). • UCSD & U. Pitt • UCSD & Boston U. Shannon Austermann and Will Hula

40. Socialization • It has led to unions many years after meeting at CAC Joe Duffy and Penny Meyers

41. Charge to and hope for CAACC • Challenge yourself by evaluating the paradigms by which you live and that brought us here today • Challenge each other with the single goal of finding the truths about the clinical science underlying the development and application of AAC systems • Adhere to rigorous scientific methods and allow for the presentation of goofy ideas as long as they are debated respectfully and evaluated with the tools of science

42. Charge to and hope for CAACC • Facilitate the integration of young scientists and develop a mechanism for mentoring them • Require the submission of papers for attendance (so that it does not turn into a forum for a handful of individuals that want to present clinical workshop quality material that is disguised as science)

43. Charge to and hope for CAACC • Provide as much time for discussion as for presentation • Make sure that ideas that are presented are appropriately challenged - though challenged respectfully • Develop a formal relationship with a peer-reviewed journal and publish the work that meets the rigors of scientific scrutiny • Eat, drink and play together

44. Charge to and hope for CAACC • Chose venues for the conference that make people want to attend (and I’d recommend keeping them fairly cloistered - in order to develop/maintain esprit de corps). • Present your work as though no-one is judging it and defend it as though nothing else matters so as to sidle up to the truth as much as one can

45. Thank YouAny ?’s

49. Topics in early conferences: • Dominated by measurement issues (1967 Porch) • Went to treatment with prevailing theories of behaviorism dominating (~1971; Holland, Brookshire) • Went Linguistics as an explanation and focus of assessment and treatment. ((~ 1975; Goodglass, Blumstein, Caplan, Caramazza, Zurif) • Went to Psychological mechanisms (attention and working memory) of the linguistic performance deficits (~1991 - McNeil) • Went to (resurrected) a strong “functionalist” approach that suggests that situational context is “the” relevant variable in treatment and assessment and treating in context is the correct approach (~ 1995; Holland, Simmons-Mackie, Byng, Elman) • Recognition that generally assessment and treatment approaches fall into two broad categories: impairment based treatments and participation/limitations based treatments – generally motivated by WHO categories (correctly applied to assessment but incorrectly applied to treatment). • Currently Neurological, psycholinguistic, linguistic and social (functional) approaches to aphasia are in a continuous battle but the Neurological remains the paradigm as reflected in the blind adherence to the need to classify aphasia according to the W-L model.

50. I would argue that we also has a paradigm in clinical aphasiology