The complexities of speaking for another

Background: While it is recognised that conversation partners of people with aphasia often speak for them, investigation of “speaking‐for” incidents has shown that these comprise a wide range of behaviours, leading Simmons‐Mackie, Kingston, and Schulz (2004 Simmons‐Mackie, N., Kingston, D. and Schultz, M. 2004. “Speaking for another”: The management of participant frames in aphasia.. American Journal of Speech‐Language Pathology, 13: 114–127. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) to identify a “fine interactive line” (p. 123) between “speaking for” and “speaking instead of”. To date, however, there has been little exploration of these behaviours in the context of everyday family conversation; furthermore, little is known about how family members themselves interpret the actions of speaking for their relative with aphasia.

Aims: The goal of this paper is to describe how the husband of a woman with progressive nonfluent aphasia (PNFA) and their adult children experienced and interpreted his ways of speaking for her.

Methods & Procedures: Findings are drawn from a qualitative case study exploring a family's experiences of progressive aphasia through analyses of their talk. Methodology included a thematic analysis of in‐depth interviews conducted with each of six family members and conversation analysis of their everyday conversations together, selected and audio recorded by the participants themselves over a 3‐month period.

Outcomes & Results: The husband's “speaking‐for” behaviours, which emerged as a significant theme in the interview data from him and all four adult children, were linked to long‐standing patterns of interaction but were described as problematic in the context of his wife's aphasia. Conversation analysis revealed that he used three patterns of “speaking‐for” behaviours, each with different interactional strategies and consequences.

Conclusions: Discussion highlights the nuances, challenges, and complexities of “speaking for” behaviours when considered in the historical context of relationship.     

Aphasia LIFT: Exploratory investigation of an intensive comprehensive aphasia programme

Background: Intensive comprehensive aphasia programs (ICAPs) are gaining popularity in the international aphasia rehabilitation community. ICAPs comprise at least three hours of treatment per day over at least two weeks, have definable start and end dates for one cohort and use a variety of formats including individual treatment, group therapy, education and technology to improve language and communication. While intensive treatment approaches have demonstrated equivocal results on impairment-based measures, positive changes on activity/participation measures provide support for ICAPs in rehabilitation of chronic aphasia. Aphasia Language Impairment and Functional Therapy (LIFT) is a research-based ICAP developed for the purpose of evaluating treatment outcomes across the International Classification of Functioning, Disability and Health (ICF) domains.

Aims: The aim of this study was to estimate the magnitude of treatment effects yielded by Aphasia Aphasia LIFT in the domains of language impairment, functional communication and communication-related quality of life (QOL).

Methods & Procedures: Eleven individuals with chronic post-stroke aphasia (mean = 26.9 months) completed Aphasia LIFT. The programme comprised individual impairment-based and functional treatment, group therapy, and computer-based treatment for 40 hours over two weeks (n = 4, LIFT 1) or 100 hours over four weeks (n = 7, LIFT 2). Assessments of confrontation naming, discourse production, functional communication and communication-related quality of life were completed at pre-treatment, immediately post-treatment and six to eight weeks following treatment termination.

Outcomes & Results: Group-level analyses revealed acquisition and maintenance of treatment effects, as evidenced by significant improvement on at least one outcome measure at follow-up in all domains. The most consistent pattern of improvement at an individual level was observed on measures of functional communication and communication-related QOL.

Conclusions: Aphasia LIFT yielded positive outcomes across ICF domains, and in many cases the treatment effect was enduring. These results demonstrate that Aphasia LIFT was successful in meeting the overarching goal of ICAPs, to maximise communication and enhance life participation in individuals with aphasia. Further research into ICAPs is warranted.     

Management of fingolimod in clinical practice

The efficacy of the innovative oral drug fingolimod has been proven in the largest study program in multiple sclerosis (MS) demonstrating reduced relapse and reduced disability progression in relapsing-remitting MS patients. Based on the extensive safety data of all clinical trials and the natural distribution pattern of fingolimod interacting receptors in organism, careful clinical monitoring is recommend and reviewed in this paper. Safety and tolerability data from clinical studies as well as current post-marketing experience present with high tolerability and easy-to-perform management of fingolimod. Here we present the recommended management of fingolimod in clinical practice starting with preparatory steps, first-dose application and long-term treatment period with fingolimod. This management of fingolimod in clinical practice ensure a safe treatment algorithm using fingolimod. We recommend documentation of fingolimod patients in clinical registries to generate postmarketing data on efficacy and safety of fingoilimod.     

Prescribing the System

This paper describes the treatment of a depressed, highly enmeshed intact family three years after the disclosure of incest between a father and his pre-adolescent daughter. Specifically, the effects of sequentially implemented paradoxical interventions are examined.     

Evidence-based practice: A quality indicator analysis of peer-tutoring in adapted physical education

The purpose of the research was to conduct a quality indicator analysis of studies investigating peer-tutoring for students with a disability in adapted physical education. An electronic search was conducted among English journals published from 1960 to November 2012. Databases included ERIC, PsycINFO, and SPORTDiscus. Fifteen research studies employing group-experimental (Gersten et al., 2005) or single-subject designs (Horner et al., 2005) met inclusion criteria. Each study was assessed for the presence and clarity of quality indicators. Group designs met an average of 62.5% essential and 69% desirable indicators. An average of 80% of indicators was present for single-subject designs. Results suggest claims of peer-tutoring being an evidence-based practice are premature. Recommendations for clarifying and applying the quality indicators are offered.     

Early socio-communicative forms and functions in typical Rett syndrome

Rett syndrome (RTT) is a severe neurological disorder characterized by a developmental regression in motor and speech-language domains. There is, however, limited research on socio-communicative development of affected children before the onset of regression. We analyzed audio–video recordings made by parents of six 9- to 12-month old girls later diagnosed with typical RTT, applying the Inventory of Potential Communicative Acts (IPCA) to identify early communicative forms and functions. Each girl used at least one communicative form (e.g., body movement, eye gaze, or vocalizations) to gain attention and answer, but none were observed to make choices or request information. Varying numbers of children were observed to perform other communicative functions according to the IPCA including social convention, rejecting or requesting an object. Non-verbal forms (e.g., reaching, moving closer, eye contact, smiling) were more common than non-linguistic verbal forms (e.g., unspecified vocalizations, pleasure vocalizations, crying). (Pre-)linguistic verbal forms (e.g., canonical or variegated babbling, proto-words) were not used for communicative purposes. These data suggest that atypical developmental patterns in the socio-communicative domain are evident prior to regression in young individuals later diagnosed with RTT.     

A Qualitative Study of Safety and Belongings Before and After the Communist Regime in Slovakia

ABSTRACT

This qualitative study examined the experience and perceptions of individuals’ immediate environment, family cohesion, safety and belongings during and after the communist regime in Slovakia. The aim of this exploratory study was to gain more understanding of the impact of political regime on individual’s perceptions and viewpoints. Purposeful sampling was used to select 12 participants who were divided based on specific criteria into 2 groups: “the younger” and “the older group.” Content analyses were used to analyze the data. Implications for future research and practice along with research limitation are discussed.