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PubMed1996

A validated case study of facilitated communication.

The case of a 13-year-old boy with autism, severe mental retardation, and a seizure disorder who was able to demonstrate valid facilitated communication was described. In three independent trials, short stories were presented to him, followed by validation test procedures with an uninformed facilitator providing physical support to the subject's arm. In Trials 1 and 3, several specific answers were provided that clearly indicated that the young man, not the uninformed facilitator, was the source of the information. Moreover, some responses seemed to imply that the subject was employing simple inferential and abstract reasoning. This case study adds to the small, but growing number of demonstrations that facilitated communication can sometimes be a valid method for at least some individuals with developmental disabilities.

Adolescent↗
PubMed1996

Investigation of authorship in facilitated communication.

We examined whether facilitated communication users, under controlled conditions, could transmit rudimentary information to a naive facilitator. Forty-three students across 10 classrooms were shown a single randomly selected word with their facilitator out of the room. The facilitator then entered the room and asked the student to type the word, which was recorded exactly as typed and later evaluated; approximately 3,800 attempts were conducted over a 6-week period. Results showed that (a) under controlled conditions, some facilitated communication users can pass accurate information and (b) measurement of facilitated communication under test conditions may be significantly benefitted by extensive practice of the test protocol, which could partially account for the inability of several past studies to verify facilitated communication-user originated output.

Adolescent↗
PubMed1996

Investigation of the validity of facilitated communication through the disclosure of unknown information.

Three individuals (8, 10, and 24 years old with diagnoses of autism and mental retardation) participated in a message-passing format to determine whether they could disclose information previously unknown to their facilitators. Results showed valid facilitated communication from each participant. The facilitated speakers participated in 14 sessions, each lasting approximately 1 to 1.5 hours. A wide range of information was collected, coded, and analyzed for validity, consistency, language difficulties, behavioral compliance, and style of facilitation. Out of 720 communicative interactions, participants disclosed 77 incidents of unknown information. Each participant revealed unique behaviors and styles of responding, and all were able to demonstrate genuinely independent communication through disclosure of specific information previously unknown to a facilitator, although much inconsistency was noted. Results suggest that a phenomena as complex as facilitated communication eludes a cursory exploration.

Adolescent↗
PubMed1996

[Combined verbal and sign language for promoting communication development in non-verbal or or pre-verbal children and adolescents with mental retardation].

Conveying alternative and augmentative approaches to communication is becoming necessary for increasing numbers of persons with mental retardation with no or poor oral skills. The preverbal and nonverbal forms of communicating, hence, have special relevance in a developmental context. A natural extension of gestic messages, it in particular is the use of signing that is apt to enhance speech and language acquisition and bring about distinct improvement in understanding and making oneself understood. Exchanging messages by sign language can reveal to the child the significance of his/her own behaviour in the communicative situation, hence reduce passiveness and frustration. The extent to which they are able to support the child's communicative needs in concrete, everyday living is an important suitability criterion also for the various other alternative and augmentative communication devices available.

Adolescent↗
PubMed1995

Deafness in childhood: 2. Are deaf children getting the education they need?

Under the 1981 Education Act, deaf children should be assessed for a "Statement of Educational Needs". Deaf children under school age are supported by a peripatetic teacher for the deaf. There are different schools of thought about the best methods for teaching deaf children. Systems include the oral/aural, "Total Communication" and sign language methods Speech and language therapy is important but provision in schools is patchy and there may be disputes about whether it comes under the education or health budget. Ideally, each health district should have a District Children's Hearing Assessment Unit, which accepts self-referrals as well as referrals from professionals. The National Deaf Children's Society recommends that each child should have a key worker to co-ordinate the various services. At present the quality of schooling and support a deaf child receives is patchy and depends on the luck of where the parents happen to live.

Child↗
PubMedDate not supplied

Surgical and radiological effects upon the development of speech after total laryngectomy.

The data presented examine the relationship between postlaryngectomy communication method, and the extent of total laryngectomy and the use of radiation therapy. The expectations of speech therapy providers were also examined. The author interviewed 60 laryngectomy patients who were six months to 3 1/2 years postsurgery. Surgeries were grouped into four categories and correlated with communication method. The relationship was statistically significant with the most apparent deterrent effect exhibited only for the most extreme surgical excisions. There was no relationship with the use of radiation therapy. In many cases speech therapy providers' expectations were not supported by the data.

Humans↗
PubMed2005

The quality of communication between parents and adolescent children in the case of parental cancer.

BACKGROUND: This study was designed to investigate: (i) parent-adolescent communication in families of cancer patients; (ii) relationships between parent-adolescent communication and posttraumatic stress symptoms (PTSS) in adolescent children; and (iii) associations between parents' illness characteristics and parent-adolescent communication. PATIENTS AND METHODS: A total of 212 adolescents completed the Impact of Event Scale and Parent-Adolescent Communication Scale. RESULTS: Adolescents communicated less openly with mothers with cancer than controls with mothers; this was the only significant difference with the reference group. Daughters communicated more openly with ill parents than with healthy parents. More open communication with healthy parents was related to fewer PTSS in daughters. More problem communication with both parents was related to more PTSS in both sons and daughters. Sons reported more problems in communication with ill parents in case of more intensive treatment or recurrent disease. Daughters experienced less open communication with both parents when ill parents received more intensive treatment. Time since diagnosis was not related to parent-adolescent communication. Multivariate analyses showed that communication patterns specifically affected PTSS of daughters. Problem communication with the healthy parent was the strongest predictor of intrusion while problem communication with the ill parents was the strongest predictor of avoidance. CONCLUSIONS: Parent-adolescent communication in families of cancer patients differs little from that in families not confronted with parental cancer. Problem communication outweighed lack of openness with respect to development of PTSS. Recurrent disease and intensive treatment regimens affected parent-adolescent communication negatively.

Adolescent↗
PubMed2002

Complexities in ETS-domain transcription factor function and regulation: lessons from the TCF (ternary complex factor) subfamily. The Colworth Medal Lecture.

The ETS-domain transcription factor family can be divided into a series of subfamilies. Elk-1 represents the founding member of the ternary complex factor (TCF) subfamily. By focusing on the TCF subfamily, we can demonstrate the complexities that exist in the function and regulation of ETS-domain transcription factors. This article focuses on Elk-1 in detail and summarizes the functions of other TCFs. The key themes covered include the domain structure of the TCFs, the mechanisms of complex formation with serum response factor, regulation of TCFs by mitogen-activated protein kinase cascades, and transcriptional regulatory properties of the TCFs. Finally, the emerging role of the TCFs in vivo is discussed. A picture is developing indicating that, while these proteins exhibit significant sequence and functional conservation, key differences in their structure and regulation are being identified which may relate to unique functions of these proteins in vivo.

Amino Acid Sequence↗
PubMed2004

Communication ability, method, and content among nonspeaking nonsurviving patients treated with mechanical ventilation in the intensive care unit.

OBJECTIVE: To describe the communication ability, methods, and content among nonspeaking nonsurviving patients treated with mechanical ventilation in an intensive care unit. METHODS: Fifty patients who received mechanical ventilation and died during hospitalization were randomly selected from all adult patients (N = 396) treated in 8 ICUs in a tertiary medical center during a 12-month period. Clinicians' notes, use of physical restraints, and medication records were reviewed retrospectively. Data on communication method, use of sedation/analgesia (within 4 hours of communication event), and use of physical restraints were recorded on an investigator-developed communication event record for the first 10 communication episodes documented in each patient's record (n = 275). Message content and method were recorded for every documented communication episode (n = 694), resulting in a total of 812 content and 771 method data codes. RESULTS: Most charts (72%) had documentation of communication by patients at some time during mechanical ventilation. Most documented communication exchanges were between patients and nurses. Primary methods of communication were head nods, mouthing words, gesture, and writing. Physical restraints were used in half of the patients. However, most of the documented communication episodes (127/202, 62.9%) occurred when physical restraints were not in use. Communication content was primarily related to pain, symptoms, feelings, and physical needs. Patients also initiated communication about their homes, families, and conditions. CONCLUSIONS: A clinically significant proportion of nonsurviving patients treated with mechanical ventilation in the intensive care unit communicate to nurses, other clinicians, andfamily members primarily through gesture, head nods, and mouthing words.

Adult↗
PubMed2005

Interruptive communication patterns in the intensive care unit ward round.

OBJECTIVE: An exploratory study to examine interruptive communication patterns of healthcare staff within an intensive care unit (ICU) during ward rounds. METHODS: The study was conducted in a tertiary hospital in Sydney, Australia. Nine participants were observed individually, for a total of 24 h, using the communication observation method (COM). The amount of time spent in conversation, the number of conversation initiating and number of turn-taking interruptions were recorded. RESULTS: Participants averaged 75% [95% confidence interval 72.8-77.2] of their time in communication events during ward rounds. There were 345 conversation-initiating interruptions (C.I.I.) and 492 turn-taking interruptions (T.T.I.). C.I.I. accounted for 37% [95% CI 33.9-40.1] of total communication event time (5 h: 53 min). T.T.I. accounted for 5.3% of total communication event time (56 min). CONCLUSION: This is the first study to specifically examine turn-taking interruptions in a clinical setting. Staff in this intensive care unit spent the majority of their time in communication. Turn taking interruptions within conversations occurred at about the same frequency as conversation initiating interruptions, which have been the subject of earlier studies. These results suggest that the overall burden of interruptions in some settings may be significantly higher than previously suspected.

Communication↗
PubMed2004

Nonword repetition by children with cochlear implants: accuracy ratings from normal-hearing listeners.

Seventy-six children with cochlear implants completed a nonword repetition task. The children were presented with 20 nonword auditory patterns over a loud-speaker and were asked to repeat them aloud to the experimenter. The children's responses were recorded on digital audiotape and then played back to normal-hearing adult listeners to obtain accuracy ratings on a 7-point scale. The children's nonword repetition performance, as measured by these perceptual accuracy ratings, could be predicted in large part by their performance on independently collected measures of speech perception, verbal rehearsal speed, and speech production. The strongest contributing variable was speaking rate, which is widely argued to reflect verbal rehearsal speed in phonological working memory. Children who had become deaf at older ages received higher perceptual ratings. Children whose early linguistic experience and educational environments emphasized oral communication methods received higher perceptual ratings than children enrolled in total communication programs. The present findings suggest that individual differences in performance on nonword repetition are strongly related to variability observed in the component processes involved in language imitation tasks, including measures of speech perception, speech production, and especially verbal rehearsal speed in phonological working memory. In addition, onset of deafness at a later age and an educational environment emphasizing oral communication may be beneficial to the children's ability to develop the robust phonological processing skills necessary to accurately repeat novel, nonword sound patterns.

Child↗
PubMed1998

Speech recognition performance of older children with cochlear implants.

HYPOTHESIS: The primary purpose of this study was to determine if children, > or =5 years old, with onset of deafness before the acquisition of spoken language (i.e., prelingually deafened) derived more benefit from multichannel cochlear implants than from conventional hearing aids. It was hypothesized that children who used oral communication (speech plus listening) would demonstrate higher levels of performance after implantation than children who used total communication (English sign system plus speech and listening). BACKGROUND: Previous research suggests that prelingually deafened children given implants at an older age derive limited benefit from these devices. Changes in candidacy criteria and advances in technology, however, may make cochlear implants a more viable treatment option for this group of patients. METHODS: A repeated-measures design was to used to compare patients' preoperative performance with hearing aids to postoperative performance with the CLARION cochlear implant after 3 and 6 months of device use. Pre- and postoperative performance were analyzed separately for children who used oral and total communication. RESULTS: Both groups of children (oral and total communication) demonstrated significant postoperative improvement on all outcome measures over time. Postoperative scores of the children who used oral communication were significantly higher than those of the children who used total communication on four of the five outcome measures. CONCLUSIONS: Prelingually deafened children who do not receive cochlear implants until > or =5 years of age derive significant benefit from current implant devices compared with that obtained with conventional hearing aids. The greatest benefit is derived by children who use oral communication, with much more limited benefit demonstrated by children who use total communication.

Acoustic Stimulation↗
PubMed2006

A new method of evaluating the quality of radiology reports.

RATIONALE AND OBJECTIVES: The radiology report must provide the ordering physician relevant information in an understandable format. The objectives of this study were to develop and apply a method for the grading of the quality of radiology reports and to evaluate differences based on the reader's experience. This grading method permits evaluation of compliance with the American College of Radiology communication standards. MATERIALS AND METHODS: A total of 240 intensive care unit admission chest radiograph reports were retrieved from our hospital database. These were graded for quality. Our grading system is based on the concept that a radiology report must provide information relevant to the patient's known clinical status and thus is important to the ordering clinician. The best grade for a report is IV and the minimum grade assigned is I. Results were further analyzed based on the experience of the reader. RESULTS: A total of 436 grades from the 240 reports were generated: 374/436 (86%) grades were designated a III or IV, which we deemed as satisfactory reports. The scoring of the radiology reports evaluating the position of endotracheal tubes, catheters, and enteric feeding tubes scored significantly better than definitive diagnosis as the starting point on the clinical spectrum (P < .01). The scores from all other patients starting points on the clinical spectrum, when compared with one another, were nonsignificant. Using a one-way analysis of variance, when comparing reports based on the six different levels of reader experience, first-year residents up to staff radiologists reports showed no significant difference (P = .78). CONCLUSIONS: Ideally, 100% of radiology reports should receive a grade III or IV. Our study showed that only 86% of the reports met this standard.

Analysis of Variance↗
PubMed2002

[Oat cell carcinoma of the bladder].

Small cell carcinoma (CCP) of the urinary bladder is an uncommon tumor, having usually an aggressive behavior. We report a new case of CCP seen at our centre and we communicate the applied therapeutic method. Although total cystectomy followed by chemo and radiotherapy seems to be the most effective treatment, we have carried out radical RTU of the bladder accompanied by chemo and radiotherapy as conservative therapy obtaining complete remission after 2 year of diagnosis, without local and distant evidence of the disease.

Aged↗
PubMed1994

Self-esteem, family climate, and communication patterns in relation to deafness.

The purpose of the study presented in this article was to determine the effect that family communication patterns have on the self-esteem of deaf children. Deaf students at a southern residential school, ranging in age from 13 to 19, were administered the Modified Self-Esteem Inventory (MSEI) and the Subject Communication Questionnaire. The subjects' parents answered 10 questions about their communication patterns with their deaf child. The parents were not deaf themselves. Analysis of the data revealed that there is a positive relationship between the family's communication method and the deaf child's self-esteem such that parents who use total communication (speech, fingerspelling, and sign) have children whose self-esteem scores are higher than those of children whose parents use an oral-only method of communication (speech). The parents who were best able to communicate by using sign language had children whose self-esteem scores were higher than those of children whose parents were less skilled in sign language. Also, a positive relationship was found between student self-esteem and reading level.

Adolescent↗
PubMed2004

Examining multiple sources of influence on the reading comprehension skills of children who use cochlear implants.

Children with profound deafness are at risk for serious reading difficulties. Multiple factors affect their development of reading skills, including use of cochlear implants. Further, multiple factors influence the overall success that children experience with their cochlear implants. These factors include the age at which they receive an implant, method of communication, vocabulary skills, preoperative residual hearing, and socioeconomic status. Ninety-one children with prelingual and profound hearing impairments who received cochlear implants at varying ages participated in the study. Structural equation modeling confirmed that multiple factors affected young cochlear implant users' reading comprehension skills and that there were significant associations between the predictors of reading comprehension. Pre-implant vocabulary had an indirect positive effect on reading through postimplant vocabulary, which had a direct positive effect on reading. Overall, children with stronger language skills demonstrated stronger reading outcomes. Age at implantation both directly and indirectly, through postimplant vocabulary, affected reading outcomes, and the total effect was large. Children who were younger when they received their implants tended to have higher reading comprehension scores. Socioeconomic status negatively affected reading. Children who used total communication prior to implantation tended to have stronger pre-implant vocabulary scores, but the total effect of pre-implant communication method on children's reading skills was negligible. Research and educational implications are discussed.

Chi-Square Distribution↗