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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↗
PubMedDate not supplied

Health communication takes on new dimensions at CDC.

Actions by the Centers for Disease Control and Prevention (CDC) to integrate health communication into overall prevention programs as a means of influencing individual behavior to reduce risks to health are described. These actions include a set of 5-year goals for the Agency; a proposal to establish an Office of Health Communication to provide leadership and support for accomplishing the goals; and establishment of a working group to create the proposed Office of Health Communication and to develop a framework for accomplishing the goals. Fundamental to the policy was development of a definition of health communication as the Agency would practice it. Steps taken to reach this definition are outlined as well as the 10 steps adopted as a framework for health communication. The article concludes with a statement describing communication as a part of CDC's overall mission. The hope is that the ultimate accomplishment will be increased awareness among Americans of the importance of good health and their ability to achieve it.

Centers for Disease Control and Prevention, U.S.↗
PubMed1995

Physician-patient communication in managed care.

The quality of physician-patient communication affects important health care outcomes. Managed care presents a number of challenges to physician-patient communication, including shorter visits, decreased continuity, and lower levels of trust. Good communication skills can help physicians create and maintain healthy relationships with patients in the face of these challenges. We describe 5 communication dilemmas that are common in managed care and review possible solutions suggested by recent literature on physician-patient communication. We also describe ways that managed care plans can promote more effective communication between physicians and patients.

Communication↗
PubMed1996

[Communication with intubated patients].

For critically ill patients on assisted respiration caring behavior is particularly important. In this paper we review the literature on patient satisfaction with medical care and with their communication with the nursing staff. Communication skills of staff of intensive respiratory care units were studied by direct observation, debriefing of hospitalized patients and by interview of discharged patients. Direct observation showed that nurses spent only a small proportion of their time talking to patients. The interactions dealt with technical rather than emotional matters and consisted mostly of negative and discouraging comments rather than positive and supporting messages. Debriefing of hospitalized intubated patients revealed a high degree of overall satisfaction with care on the one hand, and complaints of communication problems, anxiety and anger on the other. Lastly, interviews with discharged patients revealed that as many as a quarter of those who could remember their hospitalization reported feelings of anxiety, anger, distrust in the staff and difficulty in communication. These findings suggest that the nursing staff needs improved communication skills. There is evidence that the judicious use of communication techniques may improve patient satisfaction, reduce anxiety and reduce duration of treatment.

Anger↗
PubMed1995

Communication skills of biologically at-risk neonates.

Early communication intervention has advanced to include neonatal assessment and management. Currently, however, there are limited diagnostic tools developed from a speech-language pathology and audiology perspective. The purpose of the study was to design a comprehensive neonatal communication assessment protocol and use it to describe the communication skills of 50 biologically at-risk neonates (852 g-3060 g birthweight). The results indicated that the subjects' general development was within normal limits, but their communication abilities displayed a serious delay. A high risk register consisting of 13 factors predicting the subjects' communication abilities was compiled. The length of time before the subjects could successfully take bottle feeds was found to be the strongest predictor of their communication development. The study is of particular relevance to the present South African context which has an increased incidence of low birth weight, thus rendering an enlarged population of biologically at-risk neonates.

Child Language↗
PubMed1996

Identifying communication disorders in children.

Development of communication skills is an essential component of human growth. The ability to express oneself is crucial for social, emotional, educational, and vocational success in society. A popular theory of language development suggests that humans are social creatures who crave contact with one another. In view of this need to communicate and interact, it is apparent that people without adequate communication skills may face obstacles in many areas of life. As children grow and develop, there is an expectation that they will learn to talk. Numerous factors, from hearing loss to developmental delays, contribute to communication impairment. When the expectation of normal speech and language is not met, social and emotional problems can result, in addition to the communication disorder. Many problems secondary to communication disorders, such as isolation, ridicule, and academic failure, can be prevented with early identification and intervention.

Child↗
PubMed1997

Physician virtues and communicating with patients.

The growth of profit-driven medicine and managed care as well as the increasingly technologic focus of Western medicine have stimulated much reflection on the fundamental values of the medical profession and on the meaning of being a "good doctor." Many patients and many in the medical community have grown concerned about the fate of the doctor-patient relationship. In practicing medicine, physicians must be guided both by the basic principles of biomedical ethics and by Beauchamp's and Childress's four fundamental virtues: compassion, trustworthiness, discernment, and moral integrity. In addition, physicians must make the commitment to develop strong communication skills, for it is through communicating with patients that we forge a relationship with them and make them feel cared for. Good communication skills not only improve patient satisfaction and facilitate resolving the difficult ethical problems that arise in critical care but have also been shown to improve certain health outcomes. Unfortunately, studies have repeatedly shown physicians to have poor communication skills. In this article we identify key elements in preserving medicine's "covenant of trust" and in establishing good communication and rapport in critical care settings. We identify specific obstacles to good communication and propose strategies for overcoming them.

Clinical Competence↗
PubMed1995

Patient gender and communication with physicians: results of a community-based study.

An observational study of 648 routine medical visits with 69 physicians examined patient gender in relation to patient and physician communication, patient preference for the physician's communication style, patient satisfaction, and the physician's awareness of the patient's satisfaction. Data consisted of audiotapes as well as patient and physician questionnaires. Women appeared to be more actively engaged in the talk of medical visits--they sent and received more emotionally charged talk and were judged by independent raters as more anxious and interested both globally and in terms of voice quality than men. Consistent with the more emotional talk, women reported preferring a more "feeling-oriented" physician than male patients did. Mean levels of satisfaction with communication did not differ by gender, and communication predictors of satisfaction were similar for male and female patients, although they were stronger for male patients. Physicians were significantly less aware of some aspects of female patients' satisfaction compared to male patients' satisfaction. In light of the weaker correlations between patients' communication and their satisfaction for women, we suggest that women provided fewer obvious cues to their satisfaction. Training in communication skills may increase open discussion about feelings and emotions and may also produce greater physician sensitivity to patients' satisfaction, particularly with female patients.

Adult↗
PubMed1997

Comprehension of novel communicative signs by apes and human children.

Forty-eight young children (2.5 and 3.0 years old) and 9 great apes (6 chimpanzees and 3 orangutans) participated in a hiding-finding game. An adult human experimenter (the Hider) hid a reward in 1 of 3 opaque containers aligned on a wooden plank. Another adult experimenter (the Communicator) attempted to help the subject find the reward by giving 1 of 3 types of communicative sign: (1) Pointing, for which she placed her hand directly above the correct container with index finger oriented down; (2) Marker, for which she placed a small wooden block on top of the correct container; and (3) Replica, for which she held up a perceptually identical duplicate of the correct container. At both ages, children were above chance in this finding game with all 3 types of communicative sign, with Pointing being easiest (because they knew it prior to the experiment), Marker being next easiest, and Replica being most difficult. In contrast, no ape was above chance for any of the communicative signs that it did not know before the experiment (some had been trained in the use of the marker previously, and one knew pointing), nor was group performance above chance for any of the signs, despite the fact that apes experienced three times as many trials as children on each sign. Our explanation of these results is that young children understand the communicative intentions of other persons--although they may have more difficulty comprehending the exact nature of those intentions in some cases--whereas apes treat the behavioral signs of others as predictive cues only (signals). This may be because apes do not perceive and understand the communicative intentions of others, at least not in a human-like way.

Animals↗
PubMed1997

Rett syndrome (RS) and profound intellectual disability: cognitive and communicative similarities and differences.

The communicative and cognitive behaviours of a group of 10 girls with Rett syndrome (RS) were compared with those of a group of girls with non-Rett profound intellectual disability (NPID). The results suggest that the girls with RS were a comparatively homogenous group demonstrating similar cognitive patterns and fewer communicative behaviours, communicative functions, and total numbers of inferred communicative acts than the NPID group. Fewer girls with RS were intentionally communicating to communicative partners. Implications of these findings will be discussed in this paper.

Child↗
PubMed1994

Facilitated communication: a response by child protection.

Using a new technology called facilitated communication, a 7-year-old autistic child reported that she had been sexually abused. Because this method of reporting was the first of its kind at Hennepin County's (Minneapolis) Child Protection Agency, steps were taken not only to understand facilitated communication, but also to assess the reliability of the child's report. This article includes a description of the client's complaint, the subsequent referral process that it provoked, and a background description of the client and family situation. It also describes the client's method of communication, including the assessment procedure that was devised to examine her communication production. The article ends with a summary of results from implementation of the assessment procedures, and a discussion of the limitations of these procedures. What is evident is that facilitated communication cannot be ignored.

Adolescent↗
PubMed2005

Communication interaction in ICU--Patient and staff experiences and perceptions.

Patients on intensive care units (ICU) have difficulty with communication [Menzel LK. Factors related to the emotional responses of intubated patients to being unable to speak. Heart Lung 1998; 27(4):245-52]. Feelings of anger and low mood have been reported, which can lead to reduced participation in rehabilitation. For members of the multidisciplinary team breakdown in communication with patients may be frustrating and related to a limited knowledge of strategies and resources to facilitate communication. The NHS Modernisation Agency Critical Care Programme (2002) identified speech and language therapists (SLTs) as having a role in the assessment and management of patients with communication difficulties on ICU. This multi-centre pilot study aimed to investigate staff and patient perceptions and experiences of communication within ICUs. A short questionnaire was devised using semi-structured interviews to collect quantitative and qualitative information. Patterns were identified including insights into SLT service delivery and possible directions for future research and development.

Adaptation, Psychological↗
PubMedDate not supplied

Evaluating changes in the communication skills of deaf children using vibrotactile stimulation.

Results of a 9-mo longitudinal study designed to evaluate the efficacy of a vibrotactile aid, the SRA-10, with four profoundly deaf preschool children are reported. During the study the subjects were enrolled in 30-min triweekly language therapy sessions, and changes in communication skills in connected discourse (vocalization only, sign language only, and vocalization plus sign language) were measured using a computer-based observation system. Changes in structural and semantic aspects of language were also measured. The four subjects were evaluated during one 16-week phase in which the aid was used (aid-on condition) and another 8 weeks in duration in which the aid was not used (aid-off condition). Communication skills improved in the aid-on condition and decreased in the aid-off condition. The changes were found to be significant for the communication involving the vocalization plus sign language (Total Communication) measure, indicating that the vibrotactile stimulation was positively associated with the communicative act.

Child, Preschool↗
PubMedDate not supplied

[Adaptation of the picture exchange communication system in a school context].

BACKGROUND: Alternative communication. AIM: To evaluate the efficacy of the adapted Pecs and Picture Communication Symbols (PCS) in the communication of a child with cerebral palsy. METHOD: The participant of this study was a 9 year and 10 months old girl, with athetoid quadriplegia. All stages of the adapted Pecs were applied (Walter, 2000), using the PCS pictures (Johnson, 1998), associated with the functional curriculum proposed by LeBlanc (1991). An experimental AB Design was used in order to test the procedures. RESULTS: The subject was able to pass through all of the adapted Pecs phases and to use her communication board in school activities. CONCLUSION: The adapted Pecs proved to be effective in improving the subject's communication abilities.

Adaptation, Psychological↗
PubMed2001

PHLS overview of communicable diseases 1999.

Every other year since 1995 the Public Health Laboratory Service has undertaken a consultation exercise to identify communicable diseases of high public health priority. The purpose of identifying disease priorities is to guide rational and transparent service planning and resource allocation. Also, the process aims to ensure a customer sensitive service. This paper presents the results of the priority setting exercise undertaken in 1999. A postal questionnaire was sent to 1130 key professionals involved in communicable disease control in the United Kingdom. Respondents were asked to assess the relative priority of 61 communicable diseases and to identify priority areas of work associated with these diseases. Five criteria were used to assess relative priority. The five criteria were; present burden of ill-health, social and economic impact, potential threat to health, health gain opportunity and public concern and confidence. For each disease, respondents were asked to score the importance of each criterion. Forty six percent of participants (518/1130) returned completed questionnaires. There was no significant difference in response rate by professional group. Based on the scores assigned to each of the five criteria, the relative priority of 61 communicable diseases has been established. The top ten diseases in descending order of priority are, HIV/AIDS, meningococcal diseases, Chlamydia trachomatis, influenza, tuberculosis, E. coli O157, Methicillin resistant Staphylococcus aureus, salmonellosis, transmissible spongiform encephalopathies and Helicobacter pylori. The opinion of a large number of health care professionals has been used to establish a priority rank for a wide range of communicable diseases. This work provides planners and policy makers with a synthesis of current professional opinion that can be used as a foundation for making decisions on service developments.

Attitude of Health Personnel↗
PubMed2003

Improving the quality of communication in healthcare.

In this paper we present an assessment instrument for evaluating the quality of communication processes in health care. This instrument is based on communication theory, and does not only indicate the level of quality, but also explains it. This makes it also useful as a design tool in reorganising communication processes, in order to make them more effective. Such a tool is highly needed when Information and Communication Technology is applied in health care to support communication between professionals. The instrument is demonstrated for a case in multidisciplinary team care.

Computer Communication Networks↗
PubMed1999

Martin-Gruber communicating branch: anatomical and histological study.

We dissected 72 upper limbs of fresh cadavers and found 17 cases with a Martin-Gruber communicating branch (23.6%). These were classified into 4 types: type I (n = 5, 29.4%): communicating branch between the anterior interosseous and ulnar nn, type II (n = 3, 17.6%): Communicating branch between the median and ulnar nn., type III (n = 3, 17.6%): Communicating branch between the muscular branches to the flexor digitorum profundus m., type IV (n = 6, 35.3%): combination of type I or II and type III. At histologic examination the number and size of the nerve bundles each communicating branch contained proved to be very different. In one case of type II only a single nerve bundle was found. We suggest that the different numbers of nerve bundles innervate different amounts of the intrinsic hand musculature. The communicating branch with a single nerve bundle probably innervated only the first dorsal interosseous muscle.

Aged↗
PubMed1983

Learning disabilities with communicative disorders as related handicaps: a two-year study.

This study presents a demographic profile of learning-disabilities children with communicative disorders as related handicaps, and attempts to determine the analytical impact of including these children with children manifesting communicative disorders as primary handicaps. The purpose of this investigation emerged as a result of problems stemming from current definitions of learning disabilities as they relate to speech--language pathology and audiology, and from unavailable data on communicative disorders as related handicaps. The findings indicate that 0.35% of the school population were learning-disabled with communicative disorders as secondary handicaps; these children represented 30.2% of the service delivery for communicative disorders. The white: black ratio of 1.8: 1 did not coincide with the population ratio; this finding was unfavorable for blacks. Sex and race were confounding variables, with sex as the stronger one. Further, the study indicated that service delivery for language disorders and males were greater than in other communicative disordered populations.

Child↗