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Message-encoding techniques for augmentative communication systems: the recall performances of adults with severe speech impairments.

This study investigated the cognitive and linguistic processing demands of message-encoding techniques used to retrieve prestored messages from computer-based augmentative communication systems. Twelve physically disabled adults with severe speech impairments participated in six counterbalanced experimental conditions, consisting of three encoding techniques (salient letter, letter category, and iconic codes), each in a personalized condition in which subjects selected their own codes and in a nonpersonalized condition in which codes were preselected by a clinician. In each of the experimental conditions, the subjects participated in five learning and testing sessions. During these sessions, the subjects learned the codes for lists of 80 messages, half of which involved concrete referents and half abstract concepts. Results indicated that the subjects were more accurate in recalling the codes to retrieve preprogrammed messages when using the two letter encoding techniques than when using the iconic technique. No reliable differences were found between recall performances with personalized codes and with nonpersonalized ones for any of the three encoding techniques. Code recall improved consistently across the series of learning sessions; there were no significant differences in the rates of learning across the encoding techniques. Subjects were found to be more accurate at recalling the codes to retrieve concrete messages than those to retrieve abstract messages.

Adult↗

Modifications in sign under conditions of impeded visibility.

This study investigated the effects of reduced visibility on the distance of signing hands from the bodies of adult signers who are deaf and on their rates of sign production. Subjects were videotaped as they signed with partners in each of three experimental conditions: unimpeded, moderately impeded, and severely impeded visibility. Visual impedance was created by placing screens between signing partners. The distance of a hand from the body, in terms of lateral, vertical, and forward-depth dimensions, was determined from digitized measurements of single video frames randomly selected from those in which the subject was actively signing. Sign rate was calculated as the number of signs produced in a given segment of time. Signs produced in the severely impeded visibility condition were found to be made at a slower rate and with a mean hand position further forward and vertically higher than signs produced in the unimpeded visibility condition.

Adult↗

Speech intelligibility of children with cochlear implants, tactile aids, or hearing aids.

Speech intelligibility was measured in 31 children who used the 3M/House single-channel implant (n = 12), the Nucleus 22-Channel Cochlear Implant System (n = 15), or the Tactaid II + two-channel vibrotactile aid (n = 4). The subjects were divided into subgroups based on age at onset of deafness (early or late). The speech intelligibility of the experimental subjects was compared to that of children who were profoundly hearing impaired who used conventional hearing aids (n = 12) or no sensory aid (n = 2). The subjects with early onset of deafness who received their single- or multichannel cochlear implant before age 10 demonstrated the highest speech intelligibility, whereas subjects who did not receive their device until after age 10 had the poorest speech intelligibility. There was no obvious difference in the speech intelligibility scores of these subjects as a function of type of device (implant or tactile aid). On the average, the postimplant or tactile aid speech intelligibility of the subjects with early onset of deafness was similar to that of hearing aid users with hearing levels between 100 and 110 dB HL and limited hearing in the high frequencies. The speech intelligibility of subjects with late onset of deafness showed marked deterioration after the onset of deafness with relatively large improvements by most subjects after they received a single- or multichannel implant. The one subject with late onset of deafness who used a tactile aid showed no improvement in speech intelligibility.

Age Factors↗

Facilitating prelinguistic communication skills in young children with developmental delay.

Very little research has focused on the development and evaluation of intervention strategies designed to facilitate the acquisition of prelinguistic communication skills. We conducted two experiments to determine the effects of a milieu teaching approach on the acquisition and generalization of specific prelinguistic communication skills. In the first experiment, we utilized this intervention approach within a multiple baseline design to teach prelinguistic requesting, commenting, and vocal imitation to a single subject with Down syndrome and language delay. The results indicated that the intervention approach was effective at facilitating the child's use of these skills within the treatment setting. Therefore, in the second experiment we conducted a more comprehensive analysis of this approach with 4 subjects with mental retardation. Three of these subjects were taught to request, and 1 subject was taught both to request and to comment. The effects were experimentally evaluated with multiple baseline across subjects design. The results indicated that the intervention was effective in eliciting the intervention targets within the training setting for all 4 subjects. All 4 subjects showed evidence of generalization across stimulus materials, setting, teachers, and interaction style. There was also evidence of reciprocal effects on how classroom teachers in the generalization setting interacted with the subjects as a result of changes in the child's communication behavior.

Child, Preschool↗

Initiation and repair of intentional communication acts by adults with severe to profound cognitive disabilities.

This study assessed the communication initiation and repair behaviors of 28 individuals with severe to profound mental retardation in a variety of experimental conditions. All of these individuals communicated through nonsymbolic gestures. The experimental procedures were devised to simulate the conditions that typically evoke two different types of initiations: comments and requests. Each subject initiation was followed by an experimenter response that indicated a communication breakdown to determine if and how these subjects would attempt to repair such breakdowns. Different indicators of communication breakdown were systematically varied in these scripted interactions, including explicit requests for repair (verbal and gestural) and implicit requests for repair (failure to respond or inappropriate response to the subject's communication act). All subjects initiated at least one communication act, and all but three subjects repaired at least one communication act following a breakdown. Significantly more subjects initiated protoimperative than protodeclarative communication acts, despite equal opportunities for both types of acts. Across all conditions, additions were observed to occur significantly less often than recasts or repetitions. There were no significant differences in the number of subjects repairing communication following the different types of communication breakdown.

Adult↗

Conversational repair by individuals with dementia of the Alzheimer's type.

Conversational repair was examined in videotaped samples of spontaneous mealtime talk of 6 normal elderly adults, 5 subjects with early stage dementia of the Alzheimer's type (EDAT) and 5 subjects with middle stage DAT (MDAT) with a family member who acted as a conversational partner. The overall percentage of utterances involved in communication breakdown and repair and the specific proportions of utterances related to conversation problems, signals identifying problems, and repairs, were evaluated. Using the normal dyads as a control group, results showed the differential effects of DAT onset and progression on the conversational repair behavior of both subjects with DAT and their conversational partner. The percentage of conversation involved in repair was significantly higher for MDAT versus control and EDAT dyads. Despite the increase of conversational troubles with DAT onset and progression, the difficulties were repaired successfully the majority of the time. Subjects with EDAT produced more requests for repair than did their conversational partners. However, conversational partners of EDAT subjects used more elaboration repairs than did EDAT subjects. The opposite pattern was observed in the MDAT group where subjects with MDAT created and repaired more conversational problems than did their conversational partner. MDAT subjects produced more discourse trouble sources than did EDAT subjects. It was also observed that MDAT subjects and conversational partners frequently used nonspecific terms to signal misunderstandings. The findings have important implications for developing family caregiver communication enhancement strategies that are specific to the clinical stage of DAT.

Adult↗

Interaction among preschoolers with and without disabilities: effects of across-the-day peer intervention.

We examined the effects of a peer-mediated intervention package that taught typically developing children to be more aware of communicative attempts to classmates with disabilities, to use a small set of facilitative strategies ("Stay, play, talk"), and to distribute strategy use across the school day. A multiple baseline design across subjects was instituted with two cohorts of preschool children. Following baseline observations, a total of 8 target children with moderate development disabilities were eventually paired with trained peers who received "buddy training." One trained peer were taught facilitative strategies and encouraged to use them during classroom activities, consistent improvements in social interaction on the part of the trained peers and target children were demonstrated. Similar or more frequent interactions were demonstrated when trained peers were reassigned to different target children during generalization probes. In addition, treatment effects were revealed when comparing sequential analyses applied to the specific communicative behaviors across experimental conditions, in changes in target children's sociometric ratings, and in social validity judgments of videotapes from before and after treatment. This peer intervention approach has promise for improving the communicative interaction and social integration of children with disabilities attending inclusive preschools.

Child↗

Age differences in the use of informative/heuristic communicative functions in young children with and without hearing loss who are learning spoken language.

Previous research has suggested that the normal development of communicative functions proceeds from the directing or "instrumental" types to the informative or "heuristic" types with age. This paper describes a cross-sectional study of communicative function in children with profound hearing loss and children with normal hearing, from ages 12-54 months. The children with hearing loss were learning spoken English as their primary means of communication. The primary purpose of the study was to evaluate whether the pattern of age differences seen in the two groups of children (those with and without normal hearing) are similar patterns that occur at differing chronological ages, or whether they are dissimilar patterns altogether. A second purpose was to examine the relationship between the use of informative/heuristic functions and the acquisition of vocabulary and syntax. The data suggested a somewhat different pattern of communicative function development in children with and without hearing loss. In addition, the use of language for social purposes was closely related to the achievement of traditional language milestones. In both normally hearing children and in those with hearing loss, the correlations between the use of informative-heuristic functions and various measures of language development indicated that the more mature uses of language co-occur with increased frequency of communication, larger vocabulary, and longer utterance length. These results document that when linguistic improvements such as increasing vocabulary size and sentence length occur in deaf children learning spoken English, they are used for appropriate and informative social purposes that are commensurate with their language age.

Age Factors↗

Nursing the patient with severe communication impairment.

BACKGROUND: Effective communication with patients is critical to effective nursing practice. Surprisingly, there is little information on nurses' experiences in caring for patients who are unable to speak. PURPOSE AND METHOD: This study provides descriptive information from interviews with 20 nurses who cared for patients with severe communication impairment. The interview protocol explored positive and negative experiences of nursing patients with severe communication impairment. Frequency counts and descriptive analyses were conducted to identify the major themes emerging from the interviews. RESULTS: The results suggest that nurse-patient communication is difficult when the patient has severe communication impairment, although some nurses discovered effective strategies to facilitate communication with such patients. Many of the difficulties could be viewed as a breakdown in understanding arising from the lack of a readily interpretable communication system that could be used by nurse and patient. CONCLUSIONS: The results suggest a need for training nurses in the use of alternative modes of communication. Nurses also need access to a variety of simple augmentative communication devices for use with patients who are unable to speak. Finally, nurses should collaborate with speech pathologists on the development of preadmission information and bedside training for people who are admitted to hospital with severe communication impairment.

Adult↗

Paediatricians: referral rates and speech pathology waiting lists.

OBJECTIVE: This study aimed to examine paediatricians' training in and understanding of communication development and disabilities and their attitudes to speech pathology waiting lists and management practices. The relationship between these factors and referral rates was also investigated. METHODOLOGY: A total of 229 paediatricians registered with the Australian College of Paediatrics participated in the study in November 1996. They answered 15 multiple-choice questions designed to collect demographic information and data pertaining to their training and understanding of communication development and disabilities. The survey also obtained data on referral rates to public and private speech pathology services and on paediatricians' perceptions of speech pathology waiting lists and possible management strategies. RESULTS: Referral rate to public and private speech pathology services was found to be associated with the quality of paediatricians' training in and knowledge of communication development and disabilities. Paediatricians who had regular contact with speech pathologists were also more likely to make more referrals. Waiting lists had a negative influence on referral rate. Treatment rather than assessment waiting lists were preferred. Paediatricians believed the best solution to speech pathology waiting lists was an increase in staffing levels particularly in community health centres. Respondents reported that 1-4 months was an acceptable time to wait for speech pathology care and indicated the order of importance of factors for prioritising children. CONCLUSIONS: The results have important implications for developing best practice models for improving referral processes and access to speech pathology services for children with communication disabilities.

Australia↗

Athetoid quadriplegia and literacy.

OBJECTIVE: To compare literacy levels in athetoid quadriplegic (AQ) patients born in the 1960s and 1970s with those born in the 1980s and 1990s. METHODOLOGY: Nine patients with AQ born between 1966 and 1972 were compared with eight patients born between 1983 and 1991. RESULTS: Reading difficulties were found in almost all patients with AQ, despite normal intellect. Those in the earlier period were for the most part functionally literate, while those in the later period were functionally illiterate. CONCLUSIONS: Specific and intensive reading education may be required in patients with AQ to obtain functional literacy.

Athetosis↗

Pain management in children with and without cognitive impairment following spine fusion surgery.

BACKGROUND: We compared pain assessment and management practices in children with and without cognitive impairment (CI) undergoing spine fusion surgery. METHODS: The medical records of 42 children (19 with CI and 23 without) were reviewed and data related to demographics, surgery, pain assessment and management, and side-effects were recorded. RESULTS: Fewer children with CI were assessed for pain on postoperative days (POD) 0-4 compared to those without CI (P < 0.002). Self-report was used for 81% of pain assessments in children without CI, while a behavioural tool was used for 75% of assessments in cognitively impaired children. Children with CI received smaller total opioid doses on POD 1-3 compared to those without CI (P < or = 0.02). Furthermore, children without CI received patient/nurse-controlled analgesia for more postoperative days than children with CI (P=0.02). CONCLUSION: Our data demonstrate a discrepancy in pain management practices in children with and without CI following spine fusion.

Analgesia, Patient-Controlled↗

The measurement properties of the Swedish version of the Assessment of Communication and Interaction Skills.

The purpose of this study was to validate the Swedish translation of the Assessment of Communication and Interaction Skills (ACIS-S) and its applicability in Sweden. The ACIS is an observational rating scale designed to capture, in detail, a person's social interactional ability, while he/she is participating in meaningful occupations. Eighteen occupational therapists trained in administering the ACIS-S, completed 157 ACIS-S assessments of 67 subjects with psychosocial and learning disabilities. Many-faceted Rasch analysis was used to analyse the data. The results supported internal, construct and person response validity of the ACIS-S, and rater validity and reliability. The scale effectively categorized subjects according to the levels of communication and interaction ability.

Adolescent↗

Development and assessment of school-age and adolescent children with human immunodeficiency virus.

This article presents a review of the literature regarding the communication problems of school-age children with HIV-infection and the impact of the psychosocial and emotional reactions of these children on their social relationships. An overview of the effects of HIV infection on the central nervous system is followed by descriptions of how hearing, oral motor function, speech, language, reading and written language may be affected.

Adaptation, Psychological↗

A CLN2 gene nonsense mutation is associated with severe caudate atrophy and dystonia in LINCL.

Clinical features and results of the blood DNA analysis are reported of a child affected with a distinct phenotype of the late infantile form of neuronal ceroid-lipofuscinosis (LINCL). He was affected by microcephaly and hypotonia since the fourth month of life; acquisition of motor and language abilities was severely impaired, and a disorder of communication with stereotyped movements followed. By age four, he developed signs and symptoms of progressive myoclonic encephalopathy along with motor and cognitive deterioration. Extrapyramidal signs were associated with neuroradiological findings of marked atrophy of the caudate nucleus. Specific curvilinear bodies were observed in blood lymphocytes and skin biopsy. Homozygous, nonsense mutation in the CLN2 gene was found giving origin to an Arg208stop, which produces an early transcription termination with loss of translation of about 50% of the gene product. Any relationship between the severe clinical features of our patient and the homozygous mutation here reported must be investigated on a larger number of LINCL patients bearing the same mutation.

Atrophy↗

Emergent and early literacy interventions for students with severe communication impairments.

Speech-language pathologists (SLPs) can play a pivotal role in fostering the acquisition of literacy skills in students using augmentative and alternative communication (AAC). SLPs have unique skills in the areas of vocabulary development, phonological processing, selection of graphical symbol systems, and knowledge of strategies for facilitating interactive communication. SLPs can support parents in providing meaningful emergent literacy activities, and they can extend or initiate classroom literacy learning with interventions. This article presents some of the literacy difficulties experienced by students with severe communication impairments and suggests strategies that SLPs can use to support emergent and early literacy in children who use AAC.

Adolescent↗

Indirect interventions to facilitate communication in Alzheimer's disease.

Indirect interventions are designed to maximize the functioning of individuals with Alzheimer's disease (AD) through training of caregivers, modifying the physical environment, and developing therapeutic routines and activities. In this article, characteristics of AD caregivers are described, caregiver communication strategies are discussed, and examples of caregiver communication training programs are provided. Environmental modifications and routines and activities to improve communication are detailed.

Adaptation, Psychological↗

Provision of speech-language services in the schools: working with the law.

Decisions regarding eligibility for speech-language services in the schools can be the most difficult decisions facing school-based speech-language pathologists. Clinicians and parents must be informed about the federal mandates for services in the schools for children with special needs in order to make appropriate decisions and to ensure that children with disabilities are receiving the services to which they are entitled. This article discusses the Individuals with Disabilities Education Act (IDEA), the federal law guaranteeing school-based services to children with disabilities, as an educational planning process that promotes meaningful access to the general curriculum for all students. Steps are then outlined for making eligibility decisions by following this established process and using IDEA's goals as the standard by which services are developed and implemented. Examples are given linking speech-language services to state learning standards.

Child↗

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