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PubMed2026

Diagnostic communication in functional neurological disorder: A systematic review and meta-analysis of patient acceptance and clinical outcomes.

OBJECTIVES: Diagnostic disclosure is a key therapeutic moment in Functional Neurological Disorder (FND). This systematic review aimed to evaluate quantitative evidence on diagnostic acceptance, understanding, satisfaction, symptom outcomes, and healthcare utilisation following diagnostic disclosure in FND, and to conduct a meta-analysis of diagnostic acceptance. METHODS: Systematic searches of PubMed, Scopus, PsycINFO, and Web of Science identified quantitative studies in adults with FND. Screening followed predefined inclusion criteria. Data were extracted using a structured template and risk of bias was assessed using the Newcastle-Ottawa Scale. A random-effects meta-analysis of proportions was conducted using the Freeman-Tukey transformation. RESULTS: Fifteen studies were included, four of which contributed to the meta-analysis (n = 481). Reported diagnostic acceptance rates ranged from 38.7% to 90%, although the timing and method of assessment varied across studies. Pooled acceptance was 0.68 (95% CI 0.44-0.88), with substantial heterogeneity. Structured or reinforced communication was frequently associated with improved understanding and satisfaction, although its superiority for diagnostic acceptance was not established. In some studies, diagnostic acceptance was associated with more favourable clinical outcomes, although findings were inconsistent. Some studies reported reductions in healthcare utilisation or costs following satisfactory diagnostic explanation, whereas others found no sustained overall reduction. CONCLUSIONS: Diagnostic communication in FND is associated with differences in acceptance, understanding, and downstream clinical and healthcare outcomes. Approximately two-thirds of patients were reported as accepting the diagnosis following disclosure, although the timing and method of assessment varied substantially across studies. Empathic and evidence-informed communication may enhance understanding and engagement, although its effects on healthcare use and recovery remain uncertain. PRACTICE IMPLICATIONS: Diagnostic disclosure should be delivered clearly, empathically, and with reinforcement over time. Written information, reputable educational resources, and opportunities for follow-up clarification may support patient understanding and engagement, although stronger comparative evidence is needed.

Humans↗
PubMed2001

Understanding the neuropsychological syndrome of dementia.

The syndrome of dementia is most commonly caused by Alzheimer's disease (AD), an age-related neurodegenerative process that primarily affects the cortex. Approximately 4 million Americans carry the diagnosis, and the number is expected to rise to 14 million by the year 2040. Affected individuals suffer multiple cognitive deficits that progressively affect the ability to communicate. Typically the earliest symptom is impairment of episodic memory, but other forms of declarative memory are ultimately impaired. To understand the communication problems of individuals with Alzheimer's, clinicians need to understand disease effects on knowledge stores and cognitive and memory processes. Using spared memory systems and less effortful cognitive processes to compensate for impaired stores and processes is the primary means by which optimal care can be provided. Recent advances in our understanding of disease effects on semantic memory suggest a greater potential for habilitation than previously thought. In this article, the neuropathology of AD is reviewed, effects on cognitive and communicative functions are specified, and principles for providing optimal patient care are discussed.

Aged↗
PubMed2004

Pain treatment and quality of life: reducing depression and improving cognitive impairment.

The purpose of this study was to identify implications for the care of nursing home residents based on exploration of the relationship of depression to pain, cognitive impairment, and communication impairment in this population. A descriptive, cross-sectional, post-hoc design was used. Methods of statistical analysis included bivariate correlation coefficient calculation, stepwise multiple regression, and analysis of variance. A complex triad of cognitive impairment, pain, and depression was identified. The strength of the relationship between depression and cognitive impairment increases as cognitive impairment increases and in the presence of pain. This relationship is strongest among residents with severe cognitive impairment, severe communication impairment, and advanced age. Nurses may be able to relieve symptoms of depression in nursing home residents by using strategies based on knowledge of the resident's cognitive, communication, and pain status. Treating pain may lead to improved cognitive performance in residents who are depressed or reduced depression in residents who are cognitively impaired. The most elderly adults and adults with severe communication impairment may benefit most from these interventions.

Age Distribution↗
PubMedDate not supplied

Observation scales for pain assessment in older adults with cognitive impairments or communication difficulties.

BACKGROUND: Several pain observation scales have been developed to accurately assess and manage pain in older adults with severe cognitive impairments, communication difficulties, or both. OBJECTIVE: To review relevant pain observation scales and the psychometric qualities of these scales. METHODS: The literature was searched for articles reporting the use of a pain observation scale in an empirical study and describing psychometric properties in older adults with cognitive impairments, communication difficulties, or both. RESULTS: Thirteen pain observation scales were included. Scales differed in numbers of items, types of categories, and psychometric properties. Facial expression, vocalization, motor behavior, and social behavior or mood are categories present in most of the scales. In terms of reliability and validity, however, most studies are too limited or incomplete to allow definite conclusions to be drawn about usefulness in daily practice. DISCUSSION: As different methods of evaluating reliability and validity were used, and different aims (e.g., type of pain) were pursued, the available scales cannot be compared easily. Nevertheless, a few are promising, given preliminary results. These should be examined further on psychometric properties and usefulness in different populations because optimal pain assessment is necessary for efficient and effective pain treatment.

Aged↗
PubMed1991

Relationship of family communication patterns to eating disorder inventory scores in adolescent girls.

This study attempted to identify risk factors for the development of the psychological and behavior traits associated with eating disorders. Subjects were 454 healthy, high school girls; their responses to the Eating Disorder Inventory (EDI) were correlated with information obtained through a personal-background questionnaire. Students who perceived their guardians as persons who always lectured them about their problems or discounted the importance of their problems scored significantly higher on the eight EDI subscales than did respondents who reported other perceptions. Students who perceived their guardians as unwilling to listen to their problems tended to score higher on all the EDI subscales; significant differences were found between the scores of those responding "always" and "never"/"rarely" willing to listen. Students who responded that they were always uncomfortable discussing problems with their guardians tended to have a higher mean score on all but the Drive for Thinness and Body Dissatisfaction subscales. The empirical data on the family interaction patterns support the theory that certain family relationships contribute to the development of the psychological and behavior traits assessed by the EDI.

Adolescent↗
PubMed2003

Pragmatic communication skills in patients with Parkinson's disease.

BACKGROUND: Pragmatic communication abilities may depend on intact frontal lobe systems. Independent evidence suggests that some persons with Parkinson's disease (PD) are impaired on measures of frontal lobe function. HYPOTHESIS: We therefore hypothesized in Study 1 that pragmatic communication skills would be impaired in some persons with PD and would be linked to frontal dysfunction in these patients. In Study 2 we hypothesized that PD patients would be unaware of their pragmatic communication deficits. METHODS: In Study 1 we administered tests of pragmatic abilities and frontal lobe functioning to twenty-two persons with Parkinson's disease (PD) and 10 healthy controls. In Study 2 we obtained self-ratings of pragmatic abilities from 11 PD patients and then checked these self-ratings against ratings of these same abilities by the patient's spouses. RESULTS: We found in Study 1 that patients with PD were: (a) significantly impaired on measures of pragmatic communication abilities, especially in the areas of conversational appropriateness, turn-taking, prosodics and proxemics, and that this impairment was significantly related to measures of frontal lobe function. In study 2 we found that PD patients overestimated their own abilities relative to spousal ratings of those abilities and thus were unaware of the extent of their problems with pragmatic social communication skills. CONCLUSION: We conclude that pragmatic social communication skills are impaired in PD and that this impairment may be related to frontal lobe dysfunction.

Aged↗
PubMed1998

Undetected communication problems in children with behavioural problems.

There is an increasing amount of evidence for links between emotional and behavioural problems and communication difficulties. Many children who hav emotional and behavioural problems also have communication difficulties (Cohen and Lipsett 1991, Benaisch et al. 1993) and children who have communication difficulties are more likely to develop psychiatric illness than their peers (Cantwell and Baker 1985). More importantly there are many children with emotional and behavioural problems who have undiagnosed speech and language difficulties. These have been found in child psychiatric populations (Cohen, et al 1993) and special educational settings (Burgess and Bransby 1990). This paper reports on a small-scale study which found undetected communication problems in children looked after by the local authority. The implications for these children are explored.

Adolescent↗
PubMed2005

Investigating the effects of communication problems on caregiver burden.

OBJECTIVE: The goal of this study was to explore the relationship between communication problems associated with dementia and caregiver burden, within the context of problem behaviors and cognitive and functional abilities of the care recipient. METHODS: A scale on communication problems associated with dementia was developed and administered to 89 family caregivers. Participants also completed measures of care-recipient cognitive and functional status, problem behavior, and caregiver burden (demand, stress, and objective burden). RESULT: Analyses using structural equation modeling showed that care-recipient cognitive and functional status indirectly predicted problem behaviors via communication problems. The status indicators also directly predicted demand burden. In addition, problem behaviors mediated the relationship between communication problems and all forms of burden. DISCUSSION: The study findings not only lend further support to the existing literature that has documented problem behaviors as strong predictors of burden but also emphasize the importance of communication problems in the caregiving process.

Adult↗
PubMed2006

Text chat as a tool for referential questioning in Asperger syndrome.

PURPOSE: This article reports a study in which referential communication in 11 individuals with Asperger syndrome (AS) and 11 controls was compared between text chat and telephone, using a route-solving task. METHOD: Participants deduced routes by asking closed questions, and the dependent variables were (a) accuracy in working out the route, (b) number of questions posed (turns taken), and (c) time taken to complete the task. RESULTS: Generally, individuals with AS were equally competent in solving the task in both media but less efficient than the typically developing comparison group. Individuals with AS who had higher measured executive ability adopted a similar approach to the comparison group, asking about landmarks on the map to deduce the route taken. In contrast, AS participants with lower executive ability used an inefficient left/right questioning strategy, which occupied more time, required more conversational turns, and was associated with a higher rate of error. CONCLUSION: Individuals with AS, who also have problems of executive functioning, may have difficulty communicating with others to use a route-solving task.

Adolescent↗
PubMedDate not supplied

The development of pragmatic communication skills in head injured children.

This study investigated the developmental levels of pragmatic language skills in children following head injury (HI), in comparison to their uninjured peers. Participants were 30 head-injured and 19 healthy controls, classified into a 'young' age group, 8-9 years, and an 'old' age group, 11-12 years. Participants were administered the WISC- III, a negotiating requests task and a hint task, the latter two assessing verbal reasoning skills and abilities to be indirect, respectively. It was found that negotiation and hinting strategies were rapidly developing in these age groups, where abilities to hint were less mature for all groups. Results found a main effect for injury on cognitive and functional language tasks, reflected by lower performance levels and inflexibility in reasoning for the head-injured group. Injury sustained at an earlier age consistently predicted poorer performance on the language tasks, complicating the ongoing development of generalized and higher-order communicative skills. Severity of injury did not predict performance on either language task.

Analysis of Variance↗
PubMed1996

Swallowing problems in adults with traumatic brain injury.

In patients with traumatic brain injury, the anatomic and physiologic status of the swallowing mechanism may be impaired. Patients typically compensate for these impairments by learning and using compensatory strategies to ensure safe and efficient food intake. However, when cognitive-communicative and behavioral impairments are also present, the rehabilitation of dysphagia is more complex and challenging. To facilitate maximum recovery from dysphagia, an interdisciplinary team approach is essential. Teams may include several medical and allied healthcare professionals such as the physician, nurse, speech-language pathologist, clinical dietitian, and physical and occupational therapist. The psychologist may be consulted to provide expertise in behavioral management strategies. The patient and caregiver also are integral members of this treatment team. Each team member needs to be aware of the food consistencies that are appropriate and the specific feeding techniques that are required. It is critical that all team members be consistent in their approach to feeding for the patient to learn and generalize the use of compensatory strategies. This article has presented a review of the literature on swallowing problems in traumatic brain injury. It is apparent that there are relatively few data-based studies that describe the impairments and even fewer that discuss the efficacy of treatment for dysphagia in these patients. In view of the frequency of oral intake problems in individuals with traumatic brain injury, and the added challenge of the cognitive-communicative problems, further studies are needed to increase our understanding of swallowing problems, their treatment, and recovery in this patient population.

Brain Injuries↗
PubMed2001

Retained neuropsychological abilities of individuals with Alzheimer's disease.

Individuals with Alzheimer's disease (AD) retain certain cognitive abilities over the course of the disease. In this article, we describe retained cognitive-linguistic abilities and the status of activities of daily living (ADLs) of individuals in the early, middle, and late stages of AD. Knowledge of preserved abilities in AD is necessary for clinicians to structure communication-stimulation programs and to train caregivers in the most effective ways to facilitate communication. Using the Global Deterioration Scale (GDS) for staging severity of AD, an outline of preserved abilities by disease stage is provided. Attention, memory, and communication abilities are discussed, and samples of discourse from patients at different stages are included.

Activities of Daily Living↗
PubMedDate not supplied

Vocalizations among cognitively impaired elders: what is your patient trying to tell you?

Unpleasant vocalizations are prevalent among cognitively impaired elders and often are considered disruptive and problematic by their families and caregivers. However, another way to perceive such challenging vocalizations is as a communication attempt by these patients to make their needs and feelings known. This article identifies possible meanings underlying these vocal behaviors and suggests strategies to help reduce their occurrence.

Aged↗
PubMed1984

Epidemiological study of psychiatric disorder in adolescent girls: preliminary communication.

A two-stage general population study of affective disorder and problems of eating control in 15-19-year-old girls is in progress, the sample being identified by the use of general practitioners' age-sex registers. So far, 244 girls and their mothers have been interviewed and have independently completed questionnaires relating to mood and appetite control. The girls completed questionnaires both on themselves and on their mothers, and their mothers on themselves and on their daughters. Significant correlations between self-rating and rating of the other person were obtained in all cases, with agreement on the daughters' mood being higher in non-manual couples.

Adolescent↗
PubMed1964

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Avitaminosis↗
PubMed2003

Findings from a multidisciplinary clinical case series of females with Rett syndrome.

Systematic data from a multidisciplinary clinical assessment of a large series of females with Rett syndrome (RS; n=87) is presented. Participants' ages ranged from 2 years 1 month to 44 years 10 months. Areas assessed included oromotor skills, feeding problems, growth, breathing abnormalities, mobility, postural abnormalities and joint deformities, epilepsy, hand use and stereotypies, self-care, and cognitive and communication skills. Many previously reported trends in the presentation of RS over time were confirmed, notably the increasingly poor growth and near pervasiveness of fixed joint deformities and scoliosis in adulthood. In contrast, there was a slight trend towards improved autonomic function in adulthood, whereas feeding difficulties increased into middle childhood and then reached a plateau. Improvements in mobility into adolescence were followed by a decline in those skills in adulthood. Levels of dependency were high, confirming findings from previous studies. Despite the presence of repetitive hand movements, a range of hand-use skills was seen in individuals of all ages. Cognitive and communication skills were limited, but there was little evidence of deterioration of these abilities with age. These findings confirm that RS is not a degenerative condition and indicate that intervention and support to maintain and increase motor skills, daily living skills, and cognitive and communicative functioning are appropriate targets for individuals with RS.

Activities of Daily Living↗
PubMed1993

Communication intervention for individuals with dual sensory and intellectual impairments.

For individuals with dual sensory and intellectual impairments, the lack of effective communication skills places severe limitations on their learning potential and sense of belonging. Educational intervention for this population has recognized the critical need to develop communication skills, yet the complexity of the individual's needs continues to plague progress. Unique needs and situations of individuals in this category, coupled with extremely limited numbers of trained and experienced professionals, challenge the field to develop creative means of addressing this vital issue. Documented case studies provide the field with examples of potential options to employ when addressing the communicative needs of individuals with dual sensory and intellectual impairments. However, these case studies provide partial communication systems that address partial communicative needs. Providing individuals having severe sensory, intellectual, and other disabilities with a true language that can meet all communication needs, both receptive and expressive, is still beyond our grasp. Future efforts with this focus will need to combine early intervention, creative technology, and principles of normalization in order to be successful.

Blindness↗