Maternal responsivity in mothers of young children with Down syndrome

Objective: The purpose of this study was to examine maternal responsivity and directive behaviors in mothers of children with Down syndrome (DS).

Methods: Participants included 22 mothers with a young child with DS compared to 22 mothers of chronologically age-matched typically developing (TD) children using a cross-sectional design. The dyads participated in videotaped structured activities that were coded for responsive and directive behaviors.

Results: Results indicated that the mothers of children with DS used a more facilitative style with the older children while these behaviors decreased with older children with TD; one directive behavior, request for behavioral comply, increased with the older children with DS.

Conclusion: The mothers of children with DS adapted their parenting style to be facilitative of their children's linguistic development.     

A pre–post intervention study investigating the confidence and knowledge of health professionals communicating with people with aphasia in a metropolitan hospital

Background: Communication partner training (CPT) is a social intervention approach that can be used to educate and train volunteers, family members, significant others and professionals, in addition to providing skills and strategies for people with aphasia (PWA). This body of CPT research extends the current research in the area by implementing CPT with health professionals (HPs) in using PWA as trainers in a sub-acute care setting, but some previous research in acute care setting has primarily focused on caregivers and volunteers in a community setting.

Aims: The aim of this study was to investigate implementing a CPT programme in an Australian metropolitan hospital by training professionals and utilising PWA as a key component of the training to facilitate “real-time” practical skill acquisition.

Method & Procedures: Fifty-two HPs from multidisciplinary teams (allied health assistants, audiology, dietetics, occupational therapy, pharmacy, physiotherapy, social work and nursing staff in a rehabilitation unit) participated in a pre–post intervention study. HPs completed a questionnaire to collect demographic information, identify current knowledge of aphasia-related communication strategies and ascertain their confidence levels (using a 100-mm visual analogue scale) related to interacting with people with communication impairments and list any strategies/resources that could be used as an adjunct to facilitate exchanges with PWA. These open-ended responses were categorised into four main groups using content analysis. The CPT component, adapted from two programmes run by “Connect—Communication Disability Network” in the United Kingdom, consisted of an educational lecture on communicating with PWA given by a speech-language pathologist and a practical conversation with a person with aphasia. The PWA provided “expert” practical feedback to the professionals participating in the training.

Outcomes & Results: HPs reported mean confidence levels of 46.56 mm (SD = 15.71) prior to training and 75.81 mm (SD = 12.16) post-training, t(51) = 12.479 (p < .001). More HPs were able to identify relevant strategies to assist with communication following the training (median total responses = 52, interquartile range [IQR] = 50–52), than prior to the training (median total responses = 15, IQR = 9–38).

Conclusions: The results provide preliminary evidence to suggest that a CPT programme may be an effective method to increase the confidence and knowledge of communication strategies of HPs, in an acute care setting, when interacting with PWA.     

Listener perceptions of simulated fluent speech in nonfluent aphasia

Background: People with aphasia (PWA) are frequently perceived less favourably by listeners than their peers. These perceptions include incorrect assumptions that can prevent successful social interactions. While communication partner training has been shown to improve social outcomes related to the listener, changing the verbal output of PWA may also yield more favourable listener perceptions about the speech, speaker, and their own affective response. We investigated the effects of artificially altered fluency (i.e., simulated fluency) on listeners’ subjective impressions.

Aims: The purpose of the study was to (1) confirm that listeners perceive PWA less favourably than their neurologically healthy peers and (2) determine the effects of simulated fluency on listener perceptions about PWA.

Methods & Procedures: Thirty-eight listeners heard nine narrative monologue language samples from three conditions (i.e., speakers with nonfluent aphasia, simulated fluent samples from the same speakers, and neurologically healthy speakers). Listeners responded to a nine-item questionnaire that probed perceptions about speech output, speaker attributes, and listener feelings.

Outcomes & Results: Listeners perceived PWA less favourably than their neurologically healthy peers. Simulated fluency yielded more positive listener perceptions for all questionnaire items except speech intelligibility, which was unchanged by simulated fluency.

Conclusions: Simulated fluency improved listener perceptions of PWA significantly, indicating that speech fluency may be a socially valid treatment target in aphasia. Beyond direct training of communication partners, changing the verbal output of aphasic speech can also yield more positive listener perceptions of PWA.     

Confidence of group home staff in supporting the health needs of older residents with intellectual disability

Background Increased life expectancy for people with intellectual disability is accompanied by increased age-related health concerns. People ageing with intellectual disability experience more health conditions and are relocated to aged care earlier than their age peers.

Method Group home staff were surveyed about their (a) training and confidence in 11 health conditions and 7 health procedures, and (b) attitude to relocating residents with health needs to aged care.

Results Staff training in each of 10 health conditions and 7 health procedures was positively associated with increased confidence in supporting residents with those health issues. Higher staff confidence in caring for residents with 9 conditions and requiring 4 procedures was negatively associated with a likelihood of recommending that a person with those health needs should relocate to aged care.

Conclusions Targeted training of staff in age-related health issues may contribute to better health care and delay residents relocating to aged care.     

Older adults’ influence in family care: how do daughters and aging parents navigate differences in care goals?

Objective: This study seeks to address how older adults influence their daily care when their preferences conflict with those of their adult daughter caregivers.

Method: Using a sample of 10 dyads (N = 20) of an older adult and adult daughter, we utilize content analysis strategies to analyze in-depth, semi-structured interview data with QSR NVIVO to investigate how older adults influence their care, how daughters respond to such efforts of influence, and how dyads navigate differences in care goals.

Results: When there is agreement in goals, dyads report tasks going well and both individuals’ requests are honored. When there are differences in care goals, daughters most frequently reason with their older parents, while parents walk away or ‘let go’ of their requests. Daughters report making decisions for their parents for health or safety-related needs. However, all dyads discuss differences in care goals, whereby parents are perceived as insisting, resisting, or persisting in care.

Conclusion: Findings illustrate complex patterns of responses by families when navigating differences in daily care goals that carry important implications for research and the development of dyadic-based family interventions.     

Toilet training in individuals with Angelman syndrome: A case series

Objective: To assess if adapted versions of the response restriction toilet training protocol, based on the behavioral phenotype of Angelman syndrome (AS), were successful in fostering urinary continence in seven individuals with AS.

Method: Data were collected in AB-designs during baseline, training, generalization and follow-up. The response restriction protocol was adapted: individuals were trained in their natural environment, were prompted to void and along with improving continence, the interval between voids was prolonged and time-on-toilet decreased.

Results: During generalization five individuals had less than two accidents and one to six correct voids per day; during baseline more accidents and/or less correct voids occurred. In two participants correct voids increased, but several accidents still occurred. Three participants maintained positive results after 3–18 months.

Conclusion: Despite their intellectual and behavioral challenges, urinary continence can be acquired in AS. Several indications of voiding dysfunctions were found; further research is indicated.     

Ethics and shared decision-making in paediatric occupational therapy practice

Background: Sharing information and decisions with children and their parents is critical in pediatric rehabilitation. Although the ethical significance and clinical benefits of sharing decisions are established, approaches for implementing shared decision-making in clinical practice are still developing.

Aim: To explore the ethical challenges of sharing information and decisions with one family in pediatric occupational therapy.

Method: We used a single qualitative in-depth interview with an occupational therapist to examine the ethical dimensions of sharing decisions.

Results: We found that asking what was ethically at stake in the information-sharing process, highlighted how timing and style of information sharing impacts on understanding and collaboration within the therapeutic relationship. Using ethics-based questions assisted in drawing out the complexity of implementing the ideals of sharing information and decisions in pediatric practice.

Conclusion: Reflecting on ethical dimensions of communication with families assists to identify approaches to shared decision-making in clinical practice.     

Training of goal directed arm movements with motion interactive video games in children with cerebral palsy – A kinematic evaluation

Objective: The main aim of this study was to evaluate the quality of goal-directed arm movements in 15 children with cerebral palsy (CP) following four weeks of home-based training with motion interactive video games. A further aim was to investigate the applicability and characteristics of kinematic parameters in a virtual context in comparison to a physical context.

Method: Kinematics and kinetics were captured while the children performed arm movements directed towards both virtual and physical targets.

Results: The children’s movement precision improved, their centre of pressure paths decreased, as did the variability in maximal shoulder angles when reaching for virtual objects. Transfer to a situation with physical targets was mainly indicated by increased movement smoothness.

Conclusion: Training with motion interactive games seems to improve arm motor control in children with CP. The results highlight the importance of considering both the context and the task itself when investigating kinematic parameters.     

Wii-habilitation as balance therapy for children with acquired brain injury

Purpose: To evaluate the effectiveness of the Nintendo Wii compared to traditional balance therapy in improving balance, motivation, and functional ability in children undergoing acute rehabilitation after brain injury.

Methods: A non-concurrent, randomized multiple baseline single-subject research design was used with three participants. Data were analyzed by visual inspection of trend lines.

Results: Daily Wii balance training was equally motivating to traditional balance therapy for two participants and more motivating for one participant. While improvements in dynamic balance were observed, the results for static balance remain inconclusive. All participants demonstrated improvements in functional ability.

Conclusion: Wii balance therapy is a safe, feasible, and motivating intervention for children undergoing acute rehabilitation after an acquired brain injury. Further research to examine the effectiveness of Wii balance therapy in this population is warranted.     

Perceptions and expectations of regular support meetings between staff and people with an intellectual disability

Background Client-centred models of care emphasise the importance of collaborative working between staff and clients with an intellectual disability (ID). How people with an ID perceive the nature of their engagement with staff is relatively unknown. This study investigated the perceptions of staff and people with an ID about the goals for their meetings and what aspects of the meetings they viewed as important.

Method Interviews were carried out with 9 client–staff dyads. Prior to their meeting, staff and clients were asked about their expectations. Afterwards, both parties were asked about what they believed happened during the interaction. The participants’ answers were subjected to a thematic analysis.

Results People with an ID appreciated the opportunity to tell their story and valued reliable, practical support and advice. A trusting relationship was important to both clients and staff. Only staff viewed promoting clients’ autonomy as important.

Conclusion Staff and people with an ID appear to differ in their expectations and perceptions regarding regular support meetings.     

The improvement in respiratory function by inspiratory muscle training is due to structural muscle changes in patients with stroke: a randomized controlled pilot trial

Background: The changes effected by the inspiratory muscle training (IMT) on the structure of inspiratory muscles such as on the diaphragm, in patients with stroke, is unclear.

Objective: To investigate the effect of IMT on inspiratory function, diaphragm thickness, walking endurance, and fatigue in patients with stroke.

Methods: A total of 30 patients with stroke were randomized to either the experimental group or the control group. The experimental group (n = 15) underwent inspiratory muscle training with resistance adjusted to 30% of maximal inspiratory pressure, 90 breaths a day, 5 times a week for 6 weeks. Both groups received regular physical therapy for the same amount of time. The primary outcome measure was the diaphragm thickness ratio. The secondary outcomes were inspiratory function; maximal inspiratory pressure and inspiratory muscle endurance; and gait endurance and fatigue.

Results: There were significant differences between the two groups in the thickness ratio on the affected diaphragm thickness (medium effect size), maximal inspiratory pressure (medium effect size), and inspiratory muscle endurance (large effect size; Bonferroni correction p < 0.005). The gait endurance (medium effect size) and fatigue (small effect size) showed no significant differences in the between group comparison.

Conclusion: Inspiratory muscle training was effective in improving respiratory function and inducing structural changes, especially in the affected diaphragm.     

Father involvement in the care,play, and education of children with autism

Background Despite general increased recognition of the importance of fathers, their role in the lives of children with autism remains underresearched.

Methods This study aimed to investigate the nature and extent of father involvement through an online survey of fathers of children with a diagnosis of autism in the UK.

Results Of the 306 fathers who completed the survey, half indicated that they were mainly or equally responsible for their children’s daily care routines, irrespective of the child’s age or diagnosis. More fathers spent time engaged in play than any other activity, although nearly half had received no relevant training. Many fathers supported their children’s education, especially helping with homework. The greatest obstacle to further engagement was the demands of employment.

Conclusions Findings are discussed within the context of the wider developmental literature. A more gender-differentiated approach to service provision is called for, alongside further research on enhancing father engagement in play and education.     

A metacognitive training pilot study for adolescents with autism spectrum disorder: Lessons learned from the preliminary stages of intervention development

Background Cognitive differences, including deficits in self-awareness, are common in high-functioning individuals with autism spectrum disorder (ASD) and represent a fruitful target for intervention. The current project presents the preliminary research undertaken in the development of metacognitive training (MCT), an intervention designed to increase knowledge about personal strengths and challenges in adolescents with ASD.

Method Two groups of 4 adolescents with ASD completed MCT, as well as measures to assess satisfaction and adverse effects. Visual inspection and thematic analysis were used to interpret the data.

Results Overall, both participants and their parents rated MCT favourably; the youth most enjoyed the interactive activities, whereas parents appreciated the opportunity for socialising and psychoeducation. There were no systematic changes on quantitative measures of adverse effects (i.e. self-esteem or depression).

Conclusion Although the results suggest further investigation of MCT may be warranted, certain modifications to the MCT protocol and research methodology are needed.     

Intensive multimodal communication treatment for people with chronic aphasia

Background: Clinicians often teach persons with aphasia (PWA) non-verbal strategies to compensate for reduced verbal communication. The manner in which they teach the strategies may have an impact on how well PWA generalise and use the strategies. Previously, multimodal communication treatment (MCT) taught multiple modalities simultaneously. While participants demonstrated some increase in the flexible use of strategies, many communication breakdowns continued to occur. Recent research suggests that intensive treatment protocols result in the greatest increase in skills.

Aims: The purpose of this study was to determine whether intensive (2–3 hours/day, 5 days/week, for 2 weeks) multimodality communication training for aphasia resulted in increased successful use of verbal and non-verbal communication modalities as well as increased successful communicative repairs during structured communication tasks.

Methods & Procedures: Three participants with chronic aphasia completed four baseline sessions, 10 treatment sessions across two phases (i.e., five sessions per phase), and three post-treatment sessions.

Outcomes & Results: Two of the three participants demonstrated gains in the acquisition of non-verbal strategies during training and increased use of strategies on a referential communication task.

Conclusions: Although MCT delivered intensely resulted in increased use of non-verbal modalities for two out of three participants, the results were similar to that achieved through the use of a non-intensive treatment protocol. Therefore, future research is needed to examine other potential modifications to maximise the gains people with aphasia receive from multimodal interventions.     

Do depressive symptoms predict mortality in older people?

Context: Depressive symptoms are common in older persons, and may predict mortality.

Objectives: To determine: (1) If depressive symptoms predict mortality; (2) If there is a gradient in this effect; and (3) Which depressive factors predict mortality.

Population: In 1991–1992, 1751 community-dwelling older persons, sampled from a population-based registry, were interviewed.

Measures: The Center for Epidemiologic Studies – Depression (CES-D), age, gender, the Modified Mini-Mental State Examination, self-rated health, and functional status.

Outcome measure: Time to death.

Analysis: Those scoring 16+ on the CES-D were considered depressed. To determine if a gradient was present, the CES-D was treated as a continuous variable. Four depressive factors from the CES-D (depressed affect, positive affect, somatic, and interpersonal) were analyzed. Cox regression models were constructed.

Results: The mortality in those with depressive symptoms was higher in those without depressive symptoms (Hazard Ratio of 1.71, p < 0.001, Log rank test). In multivariable models, this association was no longer significant after accounting for self-rated health and functional status. There was a gradient in risk of mortality across the range of the CES-D. Somatic factors, depressed affect, and positive affect were all associated with mortality in bivariate analyses, but not in multivariable models adjusting for functional status. Interpersonal factors were not associated with mortality.

Conclusions: Depressive symptoms predict mortality in older persons.     

Nerve root anomalies detected intra-operatively technical nuances towards achieving a successful surgical outcome: our experience of three case reports at a tertiary level centre

Objective: Analysis of three case reports of nerve root anomalies detected intra-operatively and its implications.

Design: Data collected during one year prospective non-randomised study using hospital records.

Setting: Single tertiary care centre.

Subjects: 3 patients in one year period.