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At least 1,603 records · Page 89Linked to original sources
PubMed1997

[Relation of asymptomatic myocardial ischemia to impaired communication, cerebrovascular disease, and lack of ability to perform activities of daily living in elderly patients].

Patient's reports of angina pectoris depend on cognition and communication, and on the patient's physical and mental activity. In elderly people, these functions are often impaired, and we therefore looked for evidence of myocardial ischemia in 770 consecutive autopsies. We defined the coronary stenosis index (CSI) as the sum of the stenosis scores of three coronary arteries: 0% = 1, 25% = 2, 50% = 3, 75% = 4, 90% = 4.5 95 or 100% = 5. A total score of more than 13.0 and a score of 5.0 in one vessel was assumed to have been associated with myocardial ischemia. Patients assumed to have had myocardial ischemia were classified according to the presence or absence of angina pectoris: 24 had angina pectoris and 92 were asymptomatic. As controls, 86 patients in whom the CSI was lower than 10.0 were studied. Death due to myocardial infarction was most frequent in patients with angina (67%). Acute myocardial infarction was more common in asymptomatic patients than in controls (27% vs. 1%). Small myocardial infarctions and inferior myocardial infarctions were more frequent in asymptomatic patients than in those with angina. Cerebrovascular disease, problems doing activities of daily living, and communication disturbance were more common in asymptomatic patients than in those with angina. Electrocardiographic evidence of an old myocardial infarction was found in 40.9%, 16.6%, and 2.3% of patients with angina, asymptomatic patients, and controls, respectively (p < 0.05). Morphologic details of the myocardial infarction, coexistence of cerebrovascular disease, inability to perform activities of daily living, and impaired communication are associated with asymptomatic myocardial ischemia. Patients with asymptomatic myocardial ischemia should be identified and treated because of their relatively poor prognosis. Ischemic events might be detected by careful observation and prevented by appropriate treatment.

Activities of Daily Living↗
PubMed1984

Engineering therapy: an approach to treatment of a patient with severe cognitive and physical handicaps.

"Engineering therapy" may be defined as therapeutic intervention based on technologic aids. The concept is illustrated by the case of a 63-year-old woman who sustained a traumatic brain injury that resulted in severely limited functional capabilities and inability to communicate or interact with her environment in any meaningful way. Although she participated in an intensive rehabilitation program, no significant improvement occurred and she was transferred to a nursing home. Two years postinjury a microcomputer and other technical aids were used to facilitate communication and interaction with her environment. During the course of the engineering therapy, voluntary motor skills and endurance significantly improved and communication skills markedly increased. Many secondary benefits were also noted such as increased participation by the nursing home staff in her therapy. It is concluded that engineering therapy can benefit severely handicapped patients even after many years of disability.

Brain Injuries↗
PubMedDate not supplied

Written communication in undifferentiated jargon aphasia: a therapy study.

A subject, R.M.M., with a 2-year history of jargon aphasia is described. At the beginning of this study she had minimal meaningful spoken output and showed little awareness of her speech despite having relatively well-preserved auditory comprehension. Her spoken output had proved resistant to earlier periods of therapy. In contrast, R.M.M.'s written output showed some ability to access orthographic information and monitoring of this modality was shown by an acute awareness of her errors. A 3-stage therapy programme is described. This was designed to improve R.M.M.'s writing of single words and to encourage use of writing as an alternative means of communication. The initial stage of therapy aimed to increase R.M.M.'s access to written word forms by use of picture stimuli. She showed significant improvement in writing treated items in response to pictures both immediately after therapy and at re-assessment 6 weeks later. Despite the acquisition of these skills, R.M.M. failed to use them in communicative contexts. A second stage of therapy replicated the results of the first and sought to facilitate R.M.M.'s functional use of her written vocabulary by asking her to write words to spoken questions. She again showed improved written naming of the treated items and could now produce written names appropriately in a questionnaire-type assessment. Generalization of this ability extended to items that had not been trained in this way. Functional use of writing in everyday communication remained absent, however. The final stage of therapy made explicit the potential links between items which R.M.M. could now write and functional messages which they might convey. She again showed significant changes in the acquisition of new vocabulary and, encouragingly, progress was also seen in her use of the strategy in functional communication. R.M.M.'s speech is almost entirely incomprehensible. It has remained unchanged for 2 years and has not responded to therapy. Relatively well-preserved auditory comprehension and good monitoring of written output allowed therapy to effectively target a small written vocabulary. Despite significant progress in the acquisition of new items, transfer of this skill to functional communication was initially absent. Further therapy which specifically targeted the impairment causing this failure was needed before functional use was seen. The potential for treating written output in cases of jargon aphasia which have been resistant to therapy for spoken language is discussed.

Aged↗
PubMed2005

Mindfulness and behavioral parent training: commentary.

We review the description of mindfulness-based parent training (MBPT) and the argument that mindfulness practice offers a way to bring behavioral parent training (BPT) in line with current empirical knowledge. The strength of the proposed MBPT model is the attention it draws to process issues in BPT. We suggest, however, that it may not be necessary to posit automatized transactional procedures in the parent-child interaction to justify the need for better delineation of therapist-parent communication in treatment. Empirically established behavioral processes may be used within BPT to accomplish parent-training goals similar to those proposed for mindfulness training. Yet, Dumas (2005) offers refreshing ideas for enhancing the therapeutic alliance and success with the parents of disruptive children.

Adult↗
PubMed1980

Tantrums: remediation through communication.

There is a high correlation between behaviour problems, and lack of receptive and expressive language communication. Multiply handicapped children, with varying degrees of physical, mental, emotional, and sensory handicaps, in addition to a communication deficit, can learn a sign language system. Progress in communication through the sign language also results in substantial emotional and behavioural improvements. This paper presents two case studies of such children, and describes in detail the 7 year programme used to develop language through the Paget-Gorman sign system, with a profoundly deaf, subnormal, athetoid, disturbed boy.

Adolescent↗
PubMed1998

Right hemisphere emotional perception: evidence across multiple channels.

Emotional perception was examined in stroke patients across 3 communication channels: facial, prosodic, and lexical. Hemispheric specialization for emotion was tested via right-hemisphere (RH) and valence hypotheses, and relationships among channels were determined. Participants were 11 right-brain-damaged (RBD), 10 left-brain-damaged (LBD), and 15 demographically matched normal control (NC) adults. Experimental measures, with analogous psychometric properties, were identification and discrimination tasks, including a range of positive and negative emotions. Nonemotional control tasks were used for each channel. For identification, RBDs were significantly impaired relative to LBDs and NCs across channels and valences, supporting the RH hypothesis. No group differences emerged for discrimination. Findings were not influenced by demographic, clinical, or control variables. Correlations among the channels were more prominent for normal than for brain-damaged groups.

Adult↗
PubMed1993

An experimental assessment of facilitated communication.

This report presents a quantitative study of facilitated communication. Participants were 12 people living at an institutional autism program and 9 people who provided them with facilitated communication support. These subjects were the 12 most competent producers of facilitated communication in the program. They were shown pictures of familiar objects and asked to type the names of the objects under three conditions: (a) assisted typing with facilitators unaware of the content of the stimulus picture, (b) unassisted typing, and (c) a condition in which the participants and facilitators were each shown pictures at the same time. In this last condition the paired pictures were either the same or different, and the participant's typing was facilitated to label or describe the picture. These participants were unable to succeed in the tasks without facilitator assistance. On trials when the facilitators and participants had different pictures, the only "correct" labels were for pictures shown to the facilitators and not shown to the participants. This finding demonstrates that the facilitators were unknowingly determining what was typed.

Adolescent↗
PubMed1985

Motor function after stroke.

Two hundred and eighty-seven patients who had survived an acute stroke for up to one week after admission to hospital were examined for loss of motor function in the arm and leg. There was a highly significant difference in problem-solving, spatial neglect, communication and postural function between those with significant motor loss and those without. There was no significant difference in memory impairment. Significant loss in motor power had a bad prognosis for functional outcome, length of stay in hospital and survival. If recovery was to occur, it had done so by eight weeks.

Cerebrovascular Disorders↗
PubMed1984

"Difficult" children as elicitors and targets of adult communication patterns: an attributional-behavioral transactional analysis.

A transactional model of adult-child interaction was proposed and tested. In determining the effects that caregivers and children have on each other, it was maintained that adult attributions act as important moderators in the interaction process. Specifically, it was predicted that adult beliefs about the causes of caregiving outcomes act as selective filters or sensitizers to child behavior--determining the nature and amount of adult reaction to different child behaviors. It was further predicted that adult attributions act in a self-fulfilling fashion, that is, the communication patterns that follow from caregiver beliefs act to elicit child behavior patterns that maintain those beliefs. In a synthetic family strategy, elementary-school-aged boys were paired with unrelated mothers (N = 96) for videotaped interactions. Children were either trained or preselected on two orthogonal dimensions: responsiveness and assertiveness. Mothers were premeasured on their self-perceived power as caregivers (S+) and the social power they attributed to children (C+). Videotapes were analyzed separately for adult facial expression and posture, voice intonation, and verbal communication. Each of these behavioral dimensions was measured on the dimensions of affect, assertion, and "maternal quality" (e.g., baby-talk). We expected low self-perceived power to sensitize the adult to variations in child responsiveness and high child-attributed power to sensitize the adult to variations in child assertiveness. Two transactional sequences were obtained (the same patterns were obtained for acted and dispositional enactments of child behavior): 1. Low S+ mothers (in comparison with high S+ mothers) were selectively reactive to child unresponsiveness. These adults reacted to unresponsive children with a communication pattern characterized by a "maternal" quality, negative affect, and positive affect that was unassertively inflected. Unresponsive children, in turn, reacted to low S+ mothers with continued unresponsiveness. 2. High C+ mothers (in contrast to low C+ mothers) were selectively reactive to child unassertiveness. These adults reacted to shy children with a "maternal," strong, and affectively positive communication style. Unassertive children, in turn, reacted to high C+ mothers with increased assertiveness. High S+ and low C+ mothers demonstrated no significant alterations in their behavior as a function of child behavior. This nonreactivity had positive consequences for child unresponsiveness (reduced) and negative consequences for child unassertiveness (maintained).(ABSTRACT TRUNCATED AT 400 WORDS)

Assertiveness↗
PubMed1999

Panic disorder in chest pain patients referred for cardiological outpatient investigation.

OBJECTIVES: The aims of the study were to: (i) determine the prevalence of panic disorder (PD) in patients referred to cardiological outpatient clinics for evaluation of chest pain; (ii) compare psychiatric comorbidity, psychological distress, pain characteristics and suicidal ideation in PD and non-PD patients: (iii) compare the prevalence of coronary risk factors and medical comorbidity in PD and non-PD patients; and (iv) describe current PD treatment and need for PD treatment as expressed by PD patients. DESIGN: A cross-sectional study based on psychiatric and cardiological investigation. SETTING: Four cardiological outpatient clinics in Oslo, Norway. SUBJECTS: One-hundred and ninety-nine consecutive patients without known heart disease referred to out-patient clinics for investigation of chest pain. MAIN OUTCOME MEASURES: Psychiatric state diagnosis (axis I); scores on self-assessment rating scales of psychological factors and pain modalities; cardiological diagnosis. RESULTS: Thirty-eight per cent of the patients met criteria for current panic disorder (PD). Panic disorder was associated with psychological distress, comorbid psychiatric disorders, medical disorders and significantly higher prevalence of coronary risk factors (P<0.05). Furthermore. the results suggest that these patients were not identified and appropriately treated for panic disorder prior to cardiological investigation. The results indicate that the patients are positive to screening for psychiatric disorder and communicate a need for treatment early in the investigation process. CONCLUSION: PD commonly occurs in this chest pain population. Thus, there is a need to educate physicians caring for these patients about PD identification and treatment.

Adult↗
PubMed2005

Cognitive ability, expertise, and age differences in following air-traffic control instructions.

Differences in cognitive ability and domain-specific expertise may help explain age differences in pilot performance. Pilots heard air-traffic controller messages and then executed them while "flying" in a simulator. Messages varied in length and speech rate. Age was associated with lower accuracy, but the expected Age x Message Difficulty interactions were not obtained. Expertise, as indexed by pilot ratings, was associated with higher accuracy; yet expertise did not reduce age differences in accuracy. The effect of age on communication task accuracy was largely explainable as an age-associated decrease in working memory span, which in turn was explainable as decreases in both speed and interference control. Results are discussed within frameworks of deliberate practice and cognitive mediation of age differences.

Age Distribution↗
PubMed1986

The influence of elderly patients' mental impairment on nurse-patient interaction.

The study investigates nurse-patient interaction on a geriatric ward. The Clifton Assessment Procedure for the Elderly was used to measure cognitive and behavioural functioning and the 23 subjects studied were divided into three groups: lucid; slightly confused; and confused or demented. Information relating to the subjects' activities and interactions with nursing staff was gained from time sampling by direct observation. One hundred and eighteen nurses also completed a questionnaire to elicit their priorities in care. The results reveal very low levels of staff-patient communication. Nurses interact significantly less with confused than lucid patients. Patients spent only 9.7% of observed time in self-care activities, and 5.9% eating and drinking; the remaining time they were inactive. Nursing staff, however, regarded their care priority as physical care rather than psychosocial interaction or restorative activities.

Activities of Daily Living↗
PubMedDate not supplied

What do we know about deaf clients after thirteen years of ambulatory mental health care? An analysis of the PsyDon database, 1987-1999.

Little is known about demographic, deafness-related, and diagnostic characteristics of deaf and partially hearing people with psychosocial or psychiatric problems. A study was conducted derived from data from intake assessment interviews of people with hearing loss treated at a Dutch ambulatory mental health center for the deaf between 1987 and 1999. Both sexes were equally represented. People who were postlingually deaf, hard of hearing, below age 22 years, or above age 65 years were less likely to ask for help than other groups in the study. Men presented more psychiatric disorders, and women more psychosocial problems, especially partially hearing women. The authors recommend stronger emphasis on mental health care for postlingually deaf people, severely hard of hearing people, adolescents, and retirement-age people. They also recommend development of skills for rational and emotional self-expression in the education and rearing of children with hearing loss.

Adolescent↗
PubMed1997

Postoperative pain management for the cognitively impaired older adult.

Communication difficulties associated with cognitive impairment pose a serious threat to effective pain management. The purpose of this study was to describe how pain behaviors and the use of pain relief measures differ between postoperative cognitively impaired and cognitively intact older adults. Findings showed that cognitively impaired patients may be at greatest risk for undertreatment of pain during the initial postoperative period.

Aged↗
PubMed1996

Pragmatics: right brain communication.

Neuroscience nurses as well as other health care providers are called upon to assess and implement intervention strategies to assist clients and family members and significant others to communicate in the presence of communication deficits. Language, high level language skills and speech are frequently addressed in presentations and in the literature but pragmatics which includes prosody, attitude, emotions and gestural behaviors is rarely addressed. Pragmatic competence mediated by the right hemisphere, is an equally important and essential component of human communication. An understanding of pragmatics permits the neuroscience nurse to identify and evaluate pragmatic deficits so interventions to facilitate communication can be undertaken. Specifically prosody, that is melody, pause, intonation, stresses and accents, affective tone, subtle grades of meaning and varied emphasis; its components; and aprosodia (lack of prosody) will be discussed. Kinesics, that is limb, body and facial movements, and referred to as pantomime and gestures, will be examined also as will facial expression. Suggestions for pragmatic assessment and therapeutic nursing interventions will be given.

Aged↗
PubMed2005

Autism: understanding conceptual processing deficits.

Autism is a behavioral diagnosis characterized by a triad of impairment, which includes impaired communication, impaired social skills, and impaired spontaneity. The outward behavior exhibited by people with autism represents a different cognitive processing style than that seen in typical development. Understanding the way people with autism process and store information is important for intervention. The majority of people diagnosed with autism do not have symptoms of mental retardation and need access to mainstream services to work on the problems presented by daily life.

Autistic Disorder↗
PubMed1995

Reliability of the Assessment of Communicative Effectiveness in Severe Aphasia.

The Assessment of Communicative Effectiveness in Severe Aphasia (ACESA) was developed to measure the communicative effectiveness of people with severe aphasia following a stroke. The reliability was evaluated. Ten patients with severe communication difficulties (particularly limited expression) were assessed and videoed. The videos were rated by three trained raters. Reliability was calculated to demonstrate intrarater and interrater reliability, and test-re-test reliability. Reliability was good but needed to be improved across raters. It was concluded that the ACESA has the potential to be a useful clinical and research tool.

Adult↗
PubMed2000

Adolescent and family predictors of physical aggression, communication, and satisfaction in young adult couples: a prospective analysis.

This study tested a model wherein the family conflict, depression, and antisocial behavior of 254 adolescents (mean age = 17 years; 63% female) are prospectively related to functioning within a marital (51%) or dating relationship in young adulthood (mean age = 23 years). Family aversive communication in adolescence and adolescent antisocial behavior predicted couple physical aggression. Family aversive communication predicted dyadic satisfaction and aversive couple communication for married women and dating men. Among those with partners who reported little antisocial behavior, adolescent antisocial behavior inversely predicted couple satisfaction and facilitative behavior. Partner antisocial behavior did not mediate the relation between adolescent characteristics and couple functioning. Findings emphasize the importance of the early family environment and psychopathology of the adolescent in the development of adaptive couple relationships.

Adolescent↗