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PubMed2001

Measuring communication and social skills in a high security forensic setting using the behavioural status index.

Assessing patient functioning in the areas of communication and social skills is a core area of practice within psychiatric nursing. Difficulties within these areas can often represent the root of a number of presenting problems. Objective assessment can be difficult without a validated assessment schema. The Behavioural Status Index (BSI) offers such a system of baseline assessment and longitudinal monitoring as a basis for treatment, further specialised assessment, or measurement of outcome during and after interventions. This paper introduces some basic theory and describes the function and purpose of the BSI. This is followed by data analysis for the BSI communications and social skills sub-scale. Data were collected, using a repeated measures method by primary nurses, from a sample of 503 individual patients in two high security mental health hospitals. Results are reported for descriptive statistics, and factor analysis; and differences between the independent groups of Mental Health Act 1983 classification, ward dependency and gender. Data trends are indicative of clinically interesting relationships. A distinct factorial structure emerged suggesting groupings of assertive-interpersonal, non-verbal, social-perceptive and para-linguistic behaviours. Results are reported to be underpinning current European studies.

Adult↗

PubMed2006

The MMR vaccination and autism controversy in United Kingdom 1998-2005: inevitable community outrage or a failure of risk communication?

BACKGROUND: The report of an hypothesised link between measles-mumps-rubella (MMR) vaccination and autism in 1998 became a major public health issue in the United Kingdom (UK), leaving most experts surprised by the overwhelming influence it had on public opinion about MMR vaccination. Coverage rates fell dramatically, and did not start to recover until 2004. Could this public reaction have been predicted? METHODS: We used Sandman's model of components predicting community outrage to assess the MMR controversy. RESULTS: The controversy fulfilled all of Sandman's 12 primary components and six of the eight additional components. CONCLUSIONS: The Sandman model provided a useful framework to analyse this controversy and explained a significant portion of the community reaction and subsequent fall in vaccination coverage rates.

Autistic Disorder↗

PubMed1997

Delay versus deviance in autistic social behavior.

The pattern of acquisition of social, communication, and daily living skills was examined for autistic children, compared to retarded and normal controls, by quantifying intradomain scatter on the Vineland Adaptive Behavior Scales. Autistic children were matched to normal children and mentally retarded children on Vineland raw scores; group differences in scatter were examined for each domain of adaptive behavior. Autistic children had significantly more scatter on Communication and Socialization than both control groups. Item analyses showed that the autistic children had particular weaknesses on items reflecting attention to and pragmatic use of language, as well as play and reciprocal social interaction; the autistic children had particular strengths on items reflecting written language and rote language skills, and rule-governed social behavior. The number of items showing consistent group differences, however, was small, suggesting that although autistic development appears sequentially deviant and not merely delayed, individual autistic children derive their scatter from different items, and are a developmentally heterogeneous group.

Activities of Daily Living↗

PubMed2006

Communication with patients during the prenatal testing procedure: an explorative qualitative study.

OBJECTIVE: While generally two phases of prenatal genetic counseling are distinguished, i.e. pre- and post-test counseling, we revealed a third form of communication during the testing procedure. The content of this intermediate communication was explored. METHODS: A secondary analysis was performed on data obtained in another observational study, which was focussed on how indefinite testing results are clarified. Thirteen testing trajectories in which communication with parents took place during the testing procedure were further analysed. RESULTS: In the majority of cases the content of intermediate communication was similar to the content of pre-test counseling. In four cases the content was different, because the communication involved the parents in decision-making about a testing result, which was still being processed. CONCLUSION: Communication in (prenatal) genetic testing is not always restricted to separate phases, but can be an ongoing process occurring parallel to, and sometimes even intertwined with, the testing process. The advocated model of shared decision-making might work better once it is determined if the decision concerns the area wherein the provider is the expert, or the patient. PRACTICE IMPLICATIONS: Further research into the process of continuing decision-making could clarify how providers' and patients' responsibilities regarding the diagnostic process are distributed. Meanwhile, the possible occurrence of continuous decision-making should be mentioned in (prenatal) genetic counseling.

Adaptation, Psychological↗

PubMed1987

Patient versus clinician item generation for quality-of-life measures. The case of language-disabled adults.

Using nominal group process to develop a measure of quality of life, two groups of aphasic patients and a group of rehabilitation clinicians generated separate lists of important functional communication situations. Comparison of the lists by raters who were blind to their source revealed that the two patient lists were more similar to each other than were either of the patient lists to the clinician list; clinicians underestimate the patients' focus on social needs; patients, rather than clinicians, generated the more specific and concrete situations, which are of use in a quality-of-life measure. The study demonstrates that language-disabled adults can generate items for a quality-of-life measure (hence, this should be possible in almost any other disease group), and that clinician-generated items are not fully representative of patient values.

Aphasia↗

PubMed1992

Preliminary findings in a study of age, linguistic evolution and quality of life in recovery from aphasia.

Age has been reported as both a decisive and weak variable in recovery from aphasia. A middle aged group of aphasic subjects (50-64) are compared with an older group (65-80) on linguistic task performance, functional communication and quality of life measures administered at 3, 6, 9, and 12 months post stroke. Preliminary findings do not suggest any age based recovery discrepancies for middle aged versus older aphasic subjects on these measures in the first post stroke year. An hierarchical pattern of severity across aphasia type emerged, with fluent aphasic subjects being the least and global aphasia subjects the most impaired both at the beginning and end of the first post stroke year. There appear to be differences in the schedule of improvement on different measures, which remain to be confirmed in the final analysis of the data.

Activities of Daily Living↗

PubMed1995

Working with anger in groups: a modern analytic approach.

The development of Modern Psychoanalytic psychotherapy with schizophrenic and borderline patients is briefly traced, and the major themes of the treatment approach that derived from that early work are discussed with attention to their application in group therapy. These themes include the concepts of the narcissistic defense, narcissistic transference, joining or reinforcing defenses, emotional communication, and a shift away from the classical psychoanalytic emphasis on interpretation and insight to a strategy of helping the patient put all his or her thoughts and feelings into language in a constructive manner. These principles are discussed in connection with three kinds of problems involving anger in therapy groups: members' anger destructively turned against their own egos, anger expressed toward the leader within a negative transference, and anger destructively expressed toward others in the group. Lastly, consideration is given to the group leader's anger and its expression within the group. Some contrasts are made between the Modern Analytic approach and the classical Freudian position as well as Kohut's self psychology.

Anger↗

PubMed2004

Language reactivity and work functioning in schizophrenia.

Some studies have found that the speech of certain schizophrenia patients becomes more disordered in stressful laboratory situations. It is unknown, however, whether affective reactivity of speech is associated with stress responsiveness of symptoms in the real world. This study examines whether language-reactive patients report more stress-related impairments in work functioning than language-nonreactive patients. Forty-six patients provided speech samples and completed a work history interview. It was found that the language-reactive patients were more likely than the language-nonreactive patients to endorse items pertaining to social anxiety and difficulty relating to others as reasons for their work difficulties. This suggests that language-reactive patients are more sensitive to social stressors than language-nonreactive patients.

Adult↗

PubMed2005

Making electronic mail accessible: perspectives of people with acquired cognitive impairments, caregivers and professionals.

The primary objective of this study was to better understand the technology needs, barriers and strategies of individuals with acquired cognitive impairments (ACI) in order to design and modify technologies with potential for alleviating the diminished independence and social isolation common in this population. The authors hypothesized that (1) higher rates of computer use would be reported by younger, more highly educated individuals with ACI, those with less severe injuries and those with previous computer experience; (2) A low percentage of survey respondents would own their own computers; and (3) People with ACI would experience social isolation and report low frequency of connecting with important people who live far away. A total of 133 individuals with ACI, professionals and care providers completed the survey. To gain more specific information, seven focus groups were conducted with 66 individuals with ACI and 20 care providers. Finally, 10 current email users participated in structured conversations, detailing their strategies for using email. The survey revealed that 80% of subjects with ACI reported owning a computer. Age and education were not predictors of computer use, but individuals whose ACI was the result of more severe injuries were less likely to use computers. As expected, respondents reported that maintaining contact with distant loved ones is problematic. The focus groups and conversations provided more detail about the communication needs of the population and the relative advantages and disadvantages of email compared with telephone and mail. Participants also identified barriers to email use they had encountered or feared they would encounter when using email. A number of accommodations to overcome these barriers were suggested. The results of the survey, focus groups and conversations confirmed the utility of email and other technologies for people with ACI and the need to make these technologies more accessible. The results and suggestions provided by the focus groups and interviews are being used in the design of Think and Link, an email interface for use by individuals with ACI.

Adult↗

PubMed2002

'What did you say'?: understanding conversational breakdowns in children with speech and language impairments.

The study examined the types of mistakes children make during conversations with a familiar partner. The current investigation differs from previous studies because it asked what it is about the language of children with specific language impairment and phonological disorder (SLI:PD) that causes mothers to ask for clarification. Videotaped interactions were coded with the Breakdown Coding System to describe breakdowns. Not surprisingly, results indicated that children with SLI:PD were more difficult to understand than peers because of phonological errors and reduced intelligibility, supporting long-held beliefs about the functional impact of phonological impairments. Less predictable, however, was the finding that when children with SLI:PD were intelligible, mothers had more difficulty understanding them because of ambiguous utterances and underspecified pronouns, or because of semantically inappropriate or inaccurate information. Implications are discussed, and breakdown descriptions are presented as a useful supplement to current assessment methods and intervention planning.

Child↗

PubMedDate not supplied

Origins of theory of mind, cognition and communication.

There has been a revolution in our understanding of infant and toddler cognition that promises to have far-reaching implications for our understanding of communicative and linguistic development. Four empirical findings that helped to prompt this change in theory are analyzed: (a) Intermodal coordination--newborns operate with multimodal information, recognizing equivalences in information across sensory-modalities; (b) Imitation--newborns imitate the lip and tongue movements they see others perform; (c) Memory--young infants form long-lasting representations of perceived events and use these memories to generate motor productions after lengthy delays in novel contexts; (d) Theory of mind--by 18 months of age toddlers have adopted a theory of mind, reading below surface behavior to the goals and intentions in people's actions. This paper examines three views currently being offered in the literature to replace the classical framework of early cognitive development: modularity-nativism, connectionism, and theory-theory. Arguments are marshaled to support the "theory-theory" view. This view emphasizes a combination of innate structure and qualitative reorganization in children's thought based on input from the people and things in their culture. It is suggested that preverbal cognition forms a substrate for language acquisition and that analyzing cognition may enhance our understanding of certain disorders of communication.

Age Factors↗

PubMed2002

Written discourse of adolescents with closed head injury.

Written discourse of adolescents with closed head injury (CHI) was compared to that of normal controls. It was expected that the writing of adolescents with CHI would be disordered on one or more of the eight measurements used (productivity, efficiency, lexical, incomplete, or elliptic cohesion, global or local coherence, and maze use). Eight adolescents with closed head injury and matched controls provided written descriptions of a pictured activity. Analysis using t-tests indicated that adolescents with CHI used fewer words to express each idea in writing (p = 0.05), and that the relationship between successive ideas was rated as less than that of controls (p = 0.002). Implications are that written as well as oral discourse should be assessed after CHI. Writing is a more controlled process than speaking; and, therefore, may be used clinically to structure the development of ideas after CHI.

Adolescent↗

PubMed2005

Osteoarthritic knee or hip pain: possible indicators in elderly adults with cognitive impairment.

Many elderly individuals with cognitive impairment (CI) suffer from chronic pain resulting from osteoarthritis (OA). They have diminished ability to communicate their pain to health care providers, and when pain is undetected, it may be untreated. A method of detecting chronic OA pain in elderly individuals with Cl and measuring treatment outcomes is thus urgently needed. This article examines indicators of chronic OA pain in cognitively intact elderly individuals that could be used to identify pain in elderly individuals with Cl. The review suggests that patients with severe knee or hip OA pain tend to show specific motor patterns, disturbances of gait patterns, and reduction of activity level. Therefore, these behaviors could serve as alternatives to verbal report of chronic pain in elderly individuals with Cl and knee or hip OA.

Activities of Daily Living↗

PubMed1987

Interhemispheric suppression: a test of central auditory function.

Two groups of brain damaged adults, those with cerebrocranial injury (CCI) and victims of cerebrovascular accident (CVA) were tested with the competing sentences test of Willeford (In: Central Auditory Dysfunction. New York: Grune and Stratton, 1977: Chap 2). The main purpose was the exposure of functional disorders of communication in such patients who test within normal or near-normal limits on routine audiological testing and also on tests for aphasia. Of 142 serially admitted CCI patients, 43%, many with diffuse lesions, gave abnormal responses, mostly at the left ear, with 19 of them showing total extinction at that ear. On two sound field competing message tests the CCI patients were significantly poorer than normal controls. CVA patients with confirmed right hemisphere lesions tended strongly toward left ear suppression, while left hemisphere damaged patients often showed bilateral drop in scores. It is clear that brain damaged patients can have central dysfunction of auditory processing despite normal findings on routine audiological tests and tests for aphasia. The implications for activities of daily living and for habilitation are discussed.

Adult↗

PubMed1998

Extensive apoptotic death of rat colonic cells deprived of crypt habitat.

Apoptosis in cells of different lineages is restrained by survival signals which depend upon cell-to-cell communication. The aim of this study was to determine whether colonic cells deprived of crypt ambient are doomed to die prior to their normal chronological demise. Apoptosis was studied in rat whole colonic tissue, in isolated intact crypts, and in colonic cell populations collected from the crypt axis at different stages of proliferation and differentiation. In a number of experiments, cell harvest was performed in the presence of either a tetrapeptide (YVAD-CMK) inhibitor of interleukin-1beta-converting enzyme (ICE), or tyrphostin A25, a protein tyrosine kinase inhibitor, or sodium-orthovanadate, a phosphatase inhibitor. DNA fragmentation was assessed by electrophoretic and nonisotopic-labeling procedures. The ultrastructure of colonic tissue specimens and isolated cells was examined by transmission electron microscopy. Apoptosis in whole colonic tissue and in isolated crypts was confined predominantly to cells resident in the upper crypt regions. In contrast, extensive apoptotic death was observed in isolated colonic cells, irrespective of their developmental stage and positional hierarchy within the crypt continuum at harvest time. An apoptotic gradient, however, was evident. Exposure to YVAD-CMK resulted in a marked decrease in the number of apoptotic cells. Treatment with tyrphostin A25 caused a sharp rise in the apoptotic index; conversely, vanadate significantly impeded apoptosis. Cumulatively, these results indicate that disordered intercellular communication provokes unscheduled ICE-mediated apoptosis of colonocytes, and that local signals along the crypt continuum control both the reprieve from death and the timely demise of distinct colonic cell populations. Attenuation of tyrosine phosphorylation may be a contributory event in the acquisition of the apoptotic phenotype.

Amino Acid Chloromethyl Ketones↗

PubMed2005

Ineffective communication of mental status information during care transfer of older adults.

BACKGROUND: Monitoring and documenting the mental status of older patients transferred between providers or facilities is important because mental status change can be a sign of acute disease and mental status abnormalities necessitate specific approaches to care. OBJECTIVES: To identify patient and illness factors associated with presence of a mental status description in inter-facility transfer documents and to describe the content and concurrent validity of transfer mental status descriptions when they occur. DESIGN: Retrospective study. PARTICIPANTS: Individuals transferred between 5 long-term and 2 acute care facilities in an urban setting. MEASUREMENTS: Trained research personnel reviewed hospital and nursing home medical records and inter-facility transfer documents. Mental status descriptions in transfer documents were coded as abnormal or normal within 5 domains: alertness, communication, orientation/memory, behavior, and mood. Descriptions were compared with mental status items in the nursing home Minimum Data Set and in a transfer communication checklist. RESULTS: In all, 123 nursing home residents experienced 174 hospital admissions. Mental status descriptions were present in 69% of transfer documents. A total of 67% of patients missing a transfer mental status description upon nursing home-to-hospital transfer had dementia. Factors associated with presence of a transfer mental status description were urgent transfer, nursing home of origin, and among patients without dementia, greater cognitive impairment. When present, a mean of 1.47 (SD=0.81) cognitive domains were documented in transfer mental status descriptions. Agreement between transfer mental status descriptions and comparison sources was fair to good (kappa=.31 to .73). CONCLUSION: Mental status documentation during transfer of older adults between nursing home and hospital did not identify all patients with dementia and did not completely characterize patients' cognitive status.

Age Factors↗

PubMedDate not supplied

Caregivers' beliefs regarding pain in children with cognitive impairment: relation between pain sensation and reaction increases with severity of impairment.

OBJECTIVES: To determine whether caregivers of children with cognitive impairment (CI) have systematic beliefs regarding the pain of this special group of children and whether these beliefs are related to their general attitudes towards people with mental challenges, or their experience with, or knowledge about, children with CI . PARTICIPANTS: Sixty-five caregivers (52 parents and 13 health care providers) of children with significant CI. MEASURES: Caregivers completed the Mental Retardation Attitude Inventory-Revised and provided information regarding their previous experience and learning about children with CI. They also completed the Pain Opinion Questionnaire, indicating the percentage of children with mild, moderate, or severe/profound CI that they believe experience 5 facets of pain "less than", "the same as", or "more than" children without CI: sensation, emotional reaction, behavioral reaction, communication, and frequency. RESULTS: Caregivers believed children's pain Sensation becomes greater, relative to children without CI, as severity of CI increases and that pain reaction is most consistent with pain sensation for children with severe CI. They also believed children with mild CI may over-react to pain. Caregivers' beliefs regarding pain were not influenced by their general attitudes about people with mental challenges or by their experience with children with CI, but those with more learning regarding children with CI believed that they experience pain less than children without CI. CONCLUSIONS: Caregivers have a priori beliefs regarding pain in children with CI that vary with level of cognitive impairment and pain facet. These beliefs could impact children's care.

Adolescent↗

PubMed1983

Prognostic indicators and the pattern of recovery of communication in aphasic stroke patients.

Communication abilities were assessed on a wide range of tests in 56 aphasic stroke patients, 33 classified as "moderate" and 23 as "severe". Thirty-six of the patients had received language treatment. The biographical variables of age, months post-onset and handedness were shown to be differentially correlated with improvements. In particular, there were some significant trends of decreasing improvement with increasing months post-onset on expressive verbal tasks in treated moderate aphasics and on comprehension tasks in treated severe aphasics. Untreated patients did not show the same clear pattern of trends; however, these patients were reassessed after a shorter period and covered a smaller range of months post-onset. The role of treatment deserves further clarification. The results also indicate that language recovery is relatively independent of age and of handedness.

Adolescent↗