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PubMed2002

A dialogical approach to obsessions.

Cognitive conceptualizations of obsessions based on the information-processing metaphor are contrasted with a dialogical approach to understanding obsessive compulsive disorder (OCD). The dialogical approach views obsessions as one-sided conversations. The unit of analysis is the narrative or 'voice', which engages the person in the neutralizing behaviour. The dialogical approach accommodates well the apparent paradox that obsessions are both self and other generated, and that people can be positioned differently regarding the senselessness of their obsessions at different times. Also, people themselves characterize their obsessions in dialogical terms as: voice, conversation, or argument. The focus of therapy is the language and power of the narrative rather than discrete cognitive biases or representations, and dialogical therapy emphasizes role-play and narrative techniques. Cognitive therapy has already shown signs of adopting a narrative turn, and cognitive and dialogical conceptualizations of OCD are alternative perspectives rather than competing explanations.

Cognitive Behavioral Therapy↗
PubMed1991

[Rehabilitation of hemiplegic patients].

The multifactorial aspects of rehabilitation of hemiplegic patients are reported. Medical and neuropsychological aspects as well as the significance of therapies, such as occupational and language training, physiotherapy and recreation therapy, are discussed. The importance of the role of the family, the architectonic aspects, institutional placement, an early start to rehabilitation and the limits are emphasized.

Activities of Daily Living↗
PubMed1999

Psychotherapy process in the National Institute of Mental Health Treatment of Depression Collaborative Research Program.

This study examined psychotherapy process in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Transcripts of brief interpersonal and cognitive-behavioral therapies were rated using the Psychotherapy Process Q Set (PQS), an instrument designed to provide a standard language for describing therapy process. Results demonstrated that there were important areas of overlap and key differences in the process of the treatments. There were important differences in therapist stance, activity, and technique that were consistent with theoretical prescription, but patient characteristics within sessions were quite similar. Patient in-session characteristics as measured by the PQS were related to outcome across the treatment samples. These findings are linked to theoretical models, which may help explain the role of nonspecific factors associated with nondifferential treatment outcome in brief therapy.

Adult↗
PubMed2000

An analysis of managerial skills for the current and future health care environment.

A survey questioned 503 experienced practitioners about managerial tasks and responsibilities of senior professionals in four allied health fields: physiotherapy, speech-language pathology, occupational therapy, and medical radiation science. Participants worked in a range of settings, including the private and public sectors, small and large departments/units, and community and hospital-based work sites. Factor analysis identified eight managerial areas of functioning: department running, staff relations management, legislative knowledge, career path management, implementation and change, quality assurance, management of future planning, and prioritizing work. The professional field of the practitioner influenced the importances attached to these areas, while work setting and gender of practitioner had minimal impact. Level of involvement in managerial tasks had no bearing on the importance attached to competency areas. Open-ended comments added depth to the results of the factor analysis. The findings are discussed with respect to the changing requirements being placed upon health service personnel.

Administrative Personnel↗
PubMed2004

Therapy talk: analyzing therapeutic discourse.

Therapeutic discourse is the talk-in-interaction that represents the social practice between clinician and client. This article invites speech-language pathologists to apply their knowledge of language to analyzing therapy talk and to learn how talking practices shape clinical roles and identities. A range of qualitative research approaches, including ethnography of communication, conversation analysis, and frame theory, provides a background for the case presentation of a 13-year-old girl who stutters. Asymmetry is a feature of the therapeutic discourse presented , with evidence of recognition of the client's communicative competence emerging. Applications of analyzing therapy talk are discussed, illustrating the relevance of this approach for clinicians.

Adolescent↗
PubMed1991

Effects of an Asian client-therapist language, ethnicity and gender match on utilization and outcome of therapy.

The purpose of this study was to examine the relationship of Asian client-therapist ethnicity, language and gender match on two measures of utilization: number of sessions with primary therapist and dropout from therapy; and one measure of client outcome: admission-discharge difference in Global Assessment Scale (GAS) scores. The sample consisted of 1746 Asian client episodes in Los Angeles County mental health facilities between January 1983 and August 1988. Various types of multiple regression analyses were used to investigate the relationship of language, ethnicity, and gender match to the three dependent variables and to eight socio-demographic variables. Either client-therapist language match or ethnic match significantly increased the number of client sessions with the primary therapist. However, only ethnicity match had a significant effect on dropout rate. Gain in GAS admission-discharge score was not affected by either a client-therapist ethnicity or language match. Gender match had no consistent effect on the dependent variables. Of the covariates examined, only therapist discipline (social worker) had a consistent effect on the dependent variables. It was concluded that both client-therapist language and ethnicity match are important variables affecting the utilization of treatment. Further research will be needed to separate the effects of language and ethnicity on therapy utilization.

Adolescent↗
PubMed2003

Donepezil for the treatment of language deficits in adults with Down syndrome: a preliminary 24-week open trial.

At present, there is no proven pharmacologic treatment for cognitive or language impairments in Down syndrome (DS). Cholinergic deficits have been documented in DS and linked to cognitive deficits. This study is a 24-week open-label clinical trial of donepezil hydrochloride for the treatment of language deficits in adults with DS. To our knowledge, this is the first prospective study to evaluate systematically the effects of donepezil, a cholinesterase inhibitor, on specific language domains in DS. The main finding that emerged was an improvement in expressive language performance following donepezil therapy. Despite the multiple methodological limitations, the results raise important questions regarding the role of the cholinergic system in language function and the specific effect of cholinergic therapy in the treatment of language impairment in DS. The results support the need for large-scale controlled studies of the effects of donepezil treatment on language and on other cognitive domains in DS.

Adult↗
PubMed2006

The psychotherapist and the sign language interpreter.

Specialized psychotherapy for deaf people in the Dutch and Western European mental health systems is still a rather young specialism. A key policy principle in Dutch mental health care for the deaf is that they should receive treatment in the language most accessible to them, which is usually Dutch Sign Language (Nederlandse Gebarentaal or NGT). Although psychotherapists for the deaf are trained to use sign language, situations will always arise in which a sign language interpreter is needed. Most psychotherapists have the opinion that working with a sign language interpreter in therapy sessions can be a valuable alternative option but also see it as a second-best solution because of its impact on the therapeutic process. This paper describes our years of collaborationship as a therapist and a sign language interpreter. If this collaborationship is optimal, it can generate a certain "therapeutic power" in the therapy sessions. Achieving this depends largely on the interplay between the therapist and the interpreter, which in our case is the result of literature research and our experiences during the last 17 years. We analyze this special collaborative relationship, which has several dimensions and recurrent themes like, the role conception of the interpreter, situational interpreting, organizing the interpretation setting, or managing therapeutic phenomena during therapy sessions.

Adolescent↗
PubMed2006

The treatment of anomia using errorless learning.

In the contemporary literature, errorless learning is thought to have benefits over more traditional trial-and-error methods. The most prominent investigations of errorless learning are those designed for rehabilitation of severe memory impairments, including numerous demonstrations of effective amelioration of word-finding difficulties (Baddeley & Wilson, 1994; Clare, Wilson, Breen, & Hodges, 1999; Clare et al., 2000; Evans et al., 2000). Despite this, there are very few reports on the application of purely errorless learning to people with aphasia (Fillingham, Hodgson, Sage, & Lambon Ralph, 2003). The aim of this study was to compare directly the efficacy of errorless and errorful learning in a case series of 11 aphasic people with pronounced word-finding difficulties. Previous studies of errorless learning and, more recently, studies of rehabilitation have suggested that cognition is an important factor for determining outcome (Helm-Estabrooks, 2002; Robertson & Murre, 1999). Therefore, a thorough language and neuropsychological assessment battery was completed with each participant. Naming therapy was carried out to contrast errorless and errorful therapy in a case series analysis. Errorless learning proved to be as effective as the more traditional, errorful approach in the majority of cases in terms of both immediate improvement and at follow up assessment. Without exception, the patients preferred the errorless learning therapy. Strikingly, it was found that language skill did not predict therapy outcome. Participants who responded better overall, had better recognition memory, executive/problem solving skills and monitoring ability. This replicates recent findings that frontal executive skills are crucial for rehabilitation (Robertson & Murre, 1999). Also, participants who did better at errorful treatment were those with the best working and recall memory, and attention. It is probable that these factors are essential cognitive components for providing effective monitoring and feedback systems to a more general learning mechanism.

Adult↗
PubMed2003

Treating boys with low school achievement and behavior problems: comparison of two kinds of intervention.

Children with low school achievement frequently have behavior problems and interpersonal difficulties that pose a risk for psychosocial maladjustment. 39 boys were assessed and randomly assigned to one of two group treatment conditions: (a) interpersonal cognitive problem-solving for whom training was provided through oral and written language activities that met children's social and academic needs and (b) a language workshop, during which only academic difficulties were treated. Parents of children in both groups received group attention. Posttreatment assessments indicated that boys in both conditions showed significant improvements on school achievement and behavior problems, as they were measured by behavior scales reported by mothers and by an academic achievement test. Children in the problem-solving group improved significantly more than the other group on most measures. These results suggest that work with interpersonal cognitive problem-solving skills combined with reading and writing activities is a useful means to produce improvements in child behavior and school achievement.

Adolescent↗
PubMedDate not supplied

Is it possible for speech therapy to improve upon natural recovery rates in children who stutter?

BACKGROUND: Speech and language therapists treating children who stutter appear to be assigned a difficult task. Natural spontaneous remission accounts for approximately 60-80% of all children recovering from stuttering. Despite our best efforts, no protocol has ever shown its effectiveness separate from natural recovery rates (i.e. 60-80%). Although speech and language therapists have used a vast array of therapeutic protocols, the incidence and prevalence of childhood stuttering appears to have remained unchanged. Therefore, although in possession of multiple treatment tools, speech and language therapists might be ill-equipped to treat stuttering children effectively and efficiently to the point of recovery. AIM: To assess speech and language therapists' self-reported perceptions of their success in helping children 'completely recover from stuttering' (i.e. no longer exhibiting any overt or covert stuttering symptoms or using therapeutic strategies to modify speech and no longer being viewed by themselves or anyone else as a 'stutterer'). METHODS & PROCEDURES: A questionnaire was sent to 290 speech and language therapists providing stuttering therapy to children attending school in North Carolina, USA, in a system similar to what can be found in many other US states. It addressed therapeutic efficacy in the management of stuttering: the numbers of stuttering children treated and those perceived to be recovered, the therapeutic methods, the time spent in practice, therapy durations and schedules. OUTCOMES & RESULTS: Usable questionnaires were returned by 101 respondents who reported treating a total of 2036 children who stutter. They reported using a full array of techniques known to reduce stuttering. The median reported recovery rate among respondents was 13.9%. Twenty-eight respondents reported no recoveries whatsoever, and 81 reported five recoveries or fewer. The median time spent on a caseload was 3 years. In addition, longer practising therapists reported significantly higher recover rates than those with less time practising. CONCLUSIONS: Remission from stuttering in children being treated in the schools of North Carolina appears to be the exception rather than the rule. The reported recovery rates suggest that not much is being done therapeutically to help children recover from stuttering. The chance of recovery decreases with age, and speech therapy for children who stutter appears to do little to improve their odds of recovery. Speech and language therapists treating these children either do not possess the tools or the tools do not yet exist to change 'nature's recovery agendum' and put children who stutter on the path towards natural sounding, fluent and spontaneous in all situations. As such, the provision of therapy, in North Carolina at least, does not yet allow for stuttering children to shed the label of 'stutterer', in their own eyes and in the eyes of all others for the rest of their lives. In light of these data, the authors suggest re-examining the tools, policies and procedures used in the treatment of stuttering children.

Attitude of Health Personnel↗
PubMedDate not supplied

[An evaluation and comparison of the methodology of 2 otophoniatric screenings performed in the 1989-1990 biennium on a sample of 4-year-old children attending nursery schools].

The Pediatric Otophoniatric Department of U.S.L.75II, the Multicenter of Preventive Medicine in Via Cherasco, 5, Milan, carried out two otophoniatric screenings on about 70 four-year-old nursery school children. While this screening was considered experimental in four schools, the ultimate goal is to extend it to all the nursery schools in the same area. The primary aim of the screening was to individualize several pathologies of the upper respiratory tract in this age range. The second aim was to identify language pathologies in children under the age of six in order to treat them as soon as possible with adequate and preventive therapy and appropriate language re-education before their entrance into primary school. The materials and methods employed were as follows: O.R.L. examination: otoscopy, rhinoscopy, oropharyngoscopy, indirect laryngoscopy (after individualization of dysphonia); Audiometric test: peep show in free field with a 250 Hz-4000 Hz frequency range at 30 dB; Language evaluation through examination and interpretation of questionnaires formulated in order to evaluate language development filled in by the children's teachers. Two modifications in the method used in the 1989 study were made in the 1990 screening: The preventive use of an auditory duct cleaner and the distribution of the above-mentioned questionnaires at the very beginning of the study. These two changes improved screening planning as well as development. The results of the two screenings were compared and an increase in the percentage of children examined and subjected to the audiometric test was noted. In fact, in the 1989 study, only 77% of the children underwent the audiometric test (23% had ear wax), while in the 1990 study 100% underwent the test (ear cleaner had been used). With regard to the questionnaires, the data were gathered four months after screening in the 1989 study, whereas in the 1990 study this phase was carried out on the same day of the screening. The new methodology saved time in the screening.

Audiometry↗
PubMed1981

Influence of sensory integration procedures on language development.

The relationship between language development and sensory integration was explored through single case experimental studies of one female and three male aphasic children ranging in age from 4 years, 0 months to 5 years, 3 months. Other agencies had assessed all the children in the area of language development at least 6 months before the start of occupational therapy. Three of the four children had received either speech therapy, special education specific to aphasia, or both, before starting occupational therapy. Additional baseline data on language expression and comprehension, as well as on sensory integrative functioning, were gathered before beginning a year of occupational therapy that involved sensory integration procedures. Inspection of rate of language growth before and after starting occupational therapy showed a consistent increase in rate of growth in language comprehensive concomitant with occupational therapy compared to previous growth rate. The two children with depressed postrotary nystagmus demonstrated notable gains on expressive language measures.

Aphasia↗
PubMed1994

[Hearing capacity and speech production in 417 children with facial cleft abnormalities].

Children with cleft palates often suffer from chronic conductive hearing losses, delayed language acquisition and speech disorders. This study presents results of speech and language outcomes in relation to hearing function and types of palatal malformations found. 417 children with cleft palates were examined during followup evaluations that extended over several years. Disorders were studied as they affected the ears, nose and throat, audiometry and speech and language pathology. Children with isolated cleft lips were excluded. Among the total group, 8% had normal speech and language development while 92% had speech or language disorders. 80% of these latter children had hearing problems that predominantly consisted of fluctuating conductive hearing losses caused by otitis media with effusion. 5% had sensorineural hearing losses. Fifty-eight children (14%) with rhinolalia aperta were not improved by speech therapy and required velopharyngoplasties, using a cranial-based pharyngeal flap. Language skills did not depend on the type of cleft palate presents but on the frequency and amount of hearing loss found. Otomicroscopy and audiometric follow-ups with insertions of ventilation tubes were considered to be most important for language development in those children with repeated middle ear infections. Speech or language therapy was necessary in 49% of the children.

Articulation Disorders↗