Italian adaptation of the functional outcome questionnaire – aphasia: initial psychometric evaluation

Abstract

Purpose: To evaluate the psychometric properties of the Italian version of Functional Outcome Questionnaire – Aphasia.

Methods: Two hundred and five persons with stroke-related aphasia and right hemiparesis who received ongoing assistance from a family caregiver were assessed using the Functional Outcome Questionnaire – Aphasia, Aachener Aphasie Test, Token Test, Raven’s Coloured Progressive Matrices, Functional Independence Measure (FIM), Functional Assessment Measure (FAM), and Quality of Life Questionnaire for Aphasics (QLQA). The Functional Outcome Questionnaire – Aphasia was translated into the Italian language using a translation and back-translation method. Reliability and construct validity of the Functional Outcome Questionnaire – Aphasia were evaluated.

Results: The Italian version of the Functional Outcome Questionnaire – Aphasia showed good internal consistency and test–retest reliability for the overall scale (α?=?0.98; ICC?=?0.95) and subscales (α?=?0.89 for the communicating basic needs (CBN), α?=?0.92 for the making routine requests (MRR), α?=?0.96 for the communicating new information (CNI), α?=?0.93 for the attention/other communication skills (AO); ICC?=?0.95 for CBN, ICC?=?0.96 for MRR, ICC?=?0.97 for CNI and ICC?=?0.92 for AO). Significant correlations were found between the Functional Outcome Questionnaire – Aphasia and Token Test, QLQA, Aachener Aphasie Test scores, and FAM linguistic scores, indicating good convergent validity. Low correlations were found between Functional Outcome Questionnaire – Aphasia and Raven’s Coloured Progressive Matrices and FIM motor scores, showing good discriminant validity.

Conclusions: The overall findings of this study supported the reliability and construct validity of the Italian version of the Functional Outcome Questionnaire – Aphasia. This measure holds considerable promise in assessing the functional outcomes of aphasia rehabilitation in Italian-speaking persons with aphasia.

• Implications for Rehabilitation

• Functional Outcome Questionnaire – Aphasia is a reliable and valid questionnaire in assessing functional communication of Italian-speaking people with aphasia.

• This measure provides critical information about people with aphasia’s functional and pragmatic communication in home and community settings, contributing significantly to overall quality of life.

• Since the use of measures of functional communication is recommended in the clinical evaluation of language disease, the Italian version of Functional Outcome Questionnaire – Aphasia may be effective in tailoring rehabilitation treatment to the presenting communication problems of people with aphasia and their caregivers.

     

Development and evaluation of a mobile AAC: a virtual therapist and speech assistant for people with communication disabilities

Abstract

Purpose: The currently existing Augmentative and Alternative Communication (AAC) technologies have limitations to produce the best communication rehabilitation outcomes and therefore a better solution is needed.

Method: In this work, a mobile AAC app was developed based on results from research studies. Sophisticated AAC language programming, embedded training materials, and real-time communication performance reporting were integrated into the app. Two groups of study participants were recruited to participate a usability study and a preliminary feasibility study for the purpose of evaluating this mobile AAC app, respectively.

Results: A tablet-based AAC app was developed to support communication rehabilitation. User studies of the app were conducted and included able-bodied individuals and people with verbal communication disabilities. All study participants agreed that the app establishes a usable alternative treatment protocol for communication rehabilitation.

Conclusions: The app’s integrated features have great potential to maximize users’ communication effectiveness, enhance language skills, and ultimately improve users’ quality of life.

• Implications for rehabilitation

• We have developed and evaluated an integrated mobile AAC language-based app.

• This tablet-based app integrated AAC with embedded trainings and real-time performance report.

     

Communication partner training of enrolled nurses working in nursing homes with people with communication disorders caused by stroke or Parkinson’s disease

Purpose: To evaluate the effect of a communication partner training programme directed to enrolled nurses working with people with communication disorders in nursing homes, using an individualised approach. Method: Five dyads consisting of a person with stroke-induced aphasia (n?=?4) or Parkinson’s disease (PD) (n?=?1) living in different nursing homes and his/her enrolled nurse participated in the study, which had a replicated single-subject design with multiple baselines across individuals. The main element of the intervention was supervised analysis of video-recorded natural interaction in everyday nursing situations and the formulation of individual goals to change particular communicative strategies. Results: Outcome was measured via blinded assessments of filmed natural interaction obtained at baseline, intervention and follow-up and showed an increased use of the target communicative strategies. Subjective measures of goal attainment by the enrolled nurses were consistent with these results. Measures of perceived functional communication on behalf of the persons with communication disorders were mostly positive; four of five participants with communication disorders and two of five enrolled nurses reported improved functional communication after intervention. Conclusions: The use of an individualised communication partner training programme led to significant changes in natural interaction, which contributes importantly to a growing body of knowledge regarding communication partner training.

• Implications for rehabilitation

• Communication partner training can improve the communicative environment of people with communication disorders.

• For people with communication disorders who live in institutions, the main conversation partner is likely to be a professional caretaker.

• An individualised approach for communication partner training that focussed on specific communication patterns was successful in increasing the use of supportive strategies that enrolled nurses used in natural interaction with persons with communication disorders.

• The training also positively affected the perceived functional communication of the persons with communication disorders.

     

Effect of two layouts on high technology AAC navigation and content location by people with aphasia

Abstract

Purpose: Navigating high-technology augmentative and alternative communication (AAC) devices with dynamic displays can be challenging for people with aphasia. The purpose of this study was to determine which of two AAC interfaces two people with aphasia could use most efficiently and accurately. Method: The researchers used a BCB′C′ alternating treatment design to provide device-use instruction to two people with severe aphasia regarding two personalised AAC interfaces that had different navigation layouts but identical content. One interface had static buttons for homepage and go-back features, and the other interface had static buttons in a navigation ring layout. Throughout treatment, the researchers monitored participants’ mastery patterns regarding navigation efficiency and accuracy when locating target messages. Results: Participants’ accuracy and efficiency improved with both interfaces given intervention; however, the navigation ring layout appeared more transparent and better facilitated navigation than the homepage layout. Conclusions: People with aphasia can learn to navigate computerised devices; however, interface layout can substantially affect the efficiency and accuracy with which they locate messages.

• Implications for Rehabilitation

• Given intervention incorporating errorless learning principles, people with chronic aphasia can learn to navigate across multiple device levels to locate target sentences.

• Both navigation ring and homepage interfaces may be used by people with aphasia.

• Some people with aphasia may be more consistent and efficient in finding target sentences using the navigation ring interface than the homepage interface. Additionally, the navigation ring interface may be more transparent and easier for people with aphasia to master – that is, they may require fewer intervention sessions to learn to navigate the navigation ring interface.

• Generalisation of learning may result from use of the navigation ring interface. Specifically, people with aphasia may improve navigation with the homepage interface as a result of instruction on the navigation interface, but not vice versa.

     

Speech pathologists’ experience of involving people with stroke-induced aphasia in clinical decision making during rehabilitation

Purpose: Although client participation has been part of legislation and clinical guidelines for several years, the evidence of these recommendations being implemented into clinical practice is scarce, especially for people with communication disorders. The aim of this study was to investigate how speech pathologists experienced client participation during the process of goal-setting and clinical decision making for people with aphasia. Methods: Twenty speech pathologists participated in four focus group interviews. A qualitative analysis using Systematic Text Condensation was undertaken. Results: Analysis revealed three different approaches to client participation: (1) client-oriented, (2) next of kin-oriented and (3) professional-oriented participation. Participants perceived client-oriented participation as the gold standard. The three approaches were described as overlapping, with each having individual characteristics incorporating different facilitators and barriers. Conclusions: There is a need for greater emphasis on how to involve people with severe aphasia in goal setting and treatment planning, and frameworks made to enhance collaboration could preferably be used. Participants reported use of next of kin as proxies in goal-setting and clinical decision making for people with moderate-to-severe aphasia, indicating the need for awareness towards maintaining the clients’ autonomy and addressing the goals of next of kin.

• Implications for Rehabilitation

• Speech pathologists, and most likely other professionals, should place greater emphasis on client participation to ensure active involvement of people with severe aphasia.

• To achieve this, existing tools and techniques made to enhance collaborative goal setting and clinical decision making have to be better incorporated into clinical rehabilitation practice.

• To ensure the autonomy of the person with aphasia, as well as to respect next of kin's own goals, professionals need to make ethical considerations when next of kin are used as proxies in collaborative goal setting and clinical decision making.

     

A collaborative approach to supporting communication in the assessment of decision-making capacity

Purpose: This paper explores the clinical implications of acquired communication disorders in decisional capacity. Discipline-specific contributions are discussed in a multidisciplinary context, with a specific focus on the role of speech and language pathologists (SLPs). Method: Key rehabilitation issues in determining decisional capacity are identified. The impact of communication impairment on capacity is discussed in light of the research literature relating to supportive communication and collaborative practice that respects human rights. Results: Guidelines are presented for professionals involved in the assessment of the decisional capacity of individuals with communication disorders of neurological origin. They guide an assessor through: assessing cognition, language and speech; determining preferred communication domains; and practical strategies and considerations for maximising communication. Conclusion: There is a dearth of guidelines available that deal with augmenting and supporting communication of individuals with acquired communication disorders of neurological origin when it comes to assessing legal decision-making capacity. Capacity assessment is a multidisciplinary realm, and the involvement of SLPs is key to maximising the decision-making capacity of these individuals.

• Implications for rehabilitation

• All clinicians have an obligation to maximise client autonomy and participation in decision-making.

• Assessments of capacity should involve a general cognitive ability assessment, followed by a decision-specific assessment tool or question set for the decision facing the patient.

• The involvement of speech and language pathologists (SLPs) is key to assess and facilitate capacity determinations in instances of cognitive-communication disorder.

• Impairments in different aspects of auditory comprehension require different accommodations.

     

Speech pathology services for people with aphasia: what is the current practice in Singapore?

Abstract

Purpose: This study reports on current provision of aphasia services by speech pathologists in Singapore. Method: A 44-item web-based survey was conducted looking into areas of service delivery, assessment, cultural and linguistic adaptations, clinical approaches, education of clients, recovery, goal setting and discharge as well as scope and challenges to practice. Results: A total of 36 surveys were completed representing approximately 86% of the potential target population. The intensity of aphasia services provided was well below that recommended by the literature. Participants reported embracing approaches to aphasia rehabilitation that spanned across the ICF domains. Numerous challenges were reported in providing aphasia services. These included the lack of locally relevant resources for aphasia, lack of family support and patient motivation, manpower shortages as well as barriers such as transport and cost restricting access to services. Conclusions: This research reveals several findings with considerable implications for practice planning and future direction in aphasia rehabilitation. There is a need for the development of locally relevant aphasia resources to enable comprehensive provision of aphasia services. In addition, further investigation is required to tackle the resource challenges faced by the profession and improve community support for people with aphasia.

• Implications for Rehabilitation

• Speech pathology services for aphasia in Singapore

• This article has identified the challenges of providing aphasia services in the Singapore context.

• Further investigation is required to address the key issues to improve aphasia services in Singapore.

• This includes developing locally relevant resources, looking at means like telerehabilition to tackle resource challenges, and improving community support for people with aphasia.

     

Extending knowledge of the public awareness of aphasia in the Balkans: Serbia and Montenegro

Purpose: Public awareness of aphasia has been surveyed in a number of countries revealing that it is universally low. We report results of surveys in the Balkan countries Serbia and Montenegro and compare results with data from Croatia and Slovenia.

Methods: Convenience surveys of the general public were conducted in public places like shopping centers/malls and parks in Serbia (N?=?400) and Montenegro (N?=?500) using an adapted version of the public awareness of aphasia survey questionnaire. Respondents were asked whether they have heard of aphasia and tested with questions about aphasia. Information on gender, age, occupation and education was recorded.

Outcomes: Twelve percent (Serbia) and 11% (Montenegro) had heard of aphasia, but just 4% (Serbia) and 3.2% (Montenegro) had a basic knowledge of aphasia. Age, gender and occupation interacted variably with awareness. Between 16% (Slovenia) and 60% (Croatia) said they had heard of aphasia (10.5% overall mean for the four countries) and basic knowledge of aphasia across the four countries ranged between 3.2 and 7%.

Conclusions: Levels of awareness of aphasia in the Balkans are low and variably associated with age, gender, socio-economic and educational levels. Respondents with some knowledge of aphasia gained it through personal or professional interaction with aphasia or the media. The data provide a basis for awareness raising in Balkan countries to reduce stigmatization, improve community access and understanding.

• Implications for rehabilitation

• Awareness of aphasia is low universally, even among healthcare workers.

• Low public awareness of a condition, like aphasia, results in under-funded research and service provision.

• In order to raise public awareness of aphasia we need to know how many members of the general public know about it.

• Improvements in public awareness could positively affect funding, the quality of services, and the public understanding and acceptance of individuals with aphasia in the community.

• Improving awareness of aphasia in those who come into contact with aphasic people, like healthcare workers, could significantly improve the healthcare experience of people with aphasia and their families.

     

Towards a consumer-informed research agenda for aphasia: preliminary work

Abstract

Purpose: Person-centeredness in clinical practice incorporates the values of clients into a shared decision-making approach. The values of person-centeredness can be extended into the realm of research when the views of consumers towards relevant and important research topics are sought. Work in other health domains has shown the importance of gathering consumer views on health care research, which ultimately extends into health care policy and practice. The purpose of this paper is to report methods used successfully to gather the views of individuals living with aphasia on research topics they view as important. Methods: The project is founded on principles of community-based participatory research. Using a modified nominal group technique, members of an aphasia support group generated a list of research topics. Results: The Aphasia Support Group identified twenty-two potential research questions. Although a majority (59%) of the research questions generated by persons with aphasia could be addressed with accumulated scientific evidence, the remainder of the generated questions has not been addressed in the research literature. Conclusions: This project demonstrates that consumers with aphasia can participate as stakeholders in the discussion of research needs in aphasia. Additional work is needed to fully develop a consumer-informed research agenda for aphasia.

• Implications for Rehabilitation

• The perspectives of individuals with post-stroke aphasia on research needs can be successfully collected using nominal group techniques.

• Consumer input to research agendas and priorities can help to address potential research biases.

• Clinicians and researchers can use these techniques and other communication supports to foster collaborative, patient-centered care in their practice and work.

     

Using technology to overcome the language barrier: the Cognitive Assessment for Aphasia App

Purpose: We developed and explored the feasibility and user acceptance of the Cognitive Assessment for Aphasia App: a non-immersive virtual reality cognitive assessment for stroke survivors, designed to be inclusive of individuals with aphasia.

Methods: Participants were assessed on a battery of pen-and-paper cognitive tests and the Cognitive Assessment for Aphasia App. Feasibility was explored by quantifying missing data for test completion, determining user acceptance for the app by measuring participants’ preferred testing method, enjoyment and perceived task difficulty and time-taken to complete the test.

Results: Sixty-four stroke participants (35 with aphasia, 29 without aphasia) and 32 controls were recruited. Only one participant with aphasia was unable to complete all the Cognitive Assessment for Aphasia App tasks, whereas 13 participants were unable to complete all pen-and-paper tasks. Only 14% of participants preferred the pen-and-paper tests, and preference did not significantly differ between groups. Ninety-five per cent of participants were neutral or enjoyed the app and 4% perceived it to be very difficult. Higher age was negatively associated with user acceptance measures.

Conclusion: The study shows preliminary evidence for the Cognitive Assessment for Aphasia App to be a feasible cognitive assessment for stroke survivors with and without aphasia. The app is currently being validated in stroke.

• Implications for rehabilitation

• The Cognitive Assessment for Aphasia App is a feasible tool for assessing post-stroke cognition in acute, inpatient rehabilitation and community settings.

• In research trials examining cognition, individuals with aphasia are often excluded. The Cognitive Assessment for Aphasia App permits the inclusion of these individuals, enhancing generalizability.

• The Cognitive Assessment for Aphasia App provides an alternative method to assess cognition that is quicker and preferred over standard neuropsychological tests.

     

The lived experience of engaging in everyday occupations in persons with mild to moderate aphasia

Abstract

Purpose: Impairment of language ability, aphasia, can cause barriers to communication and hence impact on participation in many life situations. This study aimed to describe and explore how persons with aphasia following stroke experience engaging in everyday occupations. Method: Six persons from Southwest Finland who had aphasia due to stroke one to four years previously were interviewed for the study. A modified form of the empirical phenomenological psychological method was used for data analysis. Results: Three main characteristics of experiences of engaging in everyday occupations were identified: (1) encountering new experiences in everyday occupations, (2) striving to handle everyday occupations and (3) going ahead with life. The participants had experienced an altering life-world. Engagement in occupations affected their perceptions of competence and identity, and experiences of belonging and well-being. It was also through engagement in everyday occupations that they had discovered and learnt to handle changes in their everyday life. Conclusion: Aphasia can have a long-term impact on engagement in everyday occupations and participation in society, but conversely, engagement in meaningful occupations can also contribute to adaptation to disability and life changes.

• Implications for Rehabilitation

• Aphasia can have a long-term impact on engagement in everyday occupations and participation in society.

• Health care professionals need to determine what clients with aphasia think about their occupations and life situations in spite of difficulties they may have verbalizing their thoughts.

• Experiences of engaging in meaningful occupations can help clients with aphasia in reconstructing their life stories, thereby contributing to adaptation to disability and life changes.

     

Communication and well-being outcomes of a hybrid service delivery model of intensive impairment-based treatment for aphasia in the hospital setting: a pilot study

Purpose: This pilot study aimed to evaluate the effects of an intensive hybrid service delivery model (i.e., combining face-to-face individual, computer and group therapy) on communication and well-being for people with aphasia (PWA) in the hospital setting.

Materials and methods: The study explored two different intensities of the hybrid model, 4?h/week (Hybrid-4) and 8?h/week (Hybrid-8) both for 8 weeks. Participants ranging from 1?month to 5?years post-onset were allocated using matched-pair randomisation to receive either Hybrid-4 (n?=?5) or Hybrid-8 (n?=?4) and assessed using a comprehensive language battery by a blinded assessor, as well as selected activity, participation and well-being measures before, immediately after and 4-week post-treatment.

Results: All participants in Hybrid-4 and three out of four participants in Hybrid-8 demonstrated clinically significant improvement to measures of language impairment immediately post-treatment, with the majority also demonstrating maintenance effects 4-week post-treatment. Clinically significant improvements to activity, participation and well-being measures were also observed across participants in both groups.

Conclusions: Findings support the potential benefit of employing an intensive hybrid service model and suggest that both 4 and 8?h per week of impairment-based treatment for 8 weeks may result in improvements in communication and well-being for some PWA across different stages of recovery.

• Implications for rehabilitation

• The present findings help bridge the gap between what evidence suggests is effective intensity of rehabilitation for aphasia and what can be practically delivered in real-world hospital settings.

• Findings support the potential clinical value of employing a hybrid service model (using computer, group and individual therapy) to deliver intensive rehabilitation to people with aphasia in the hospital setting, and suggest that clinically significant improvements to communication and well-being can result when the model is delivered at either 4 or 8?h per week.

• The current study highlights that people with aphasia in the early stages of aphasia recovery can potentially benefit from intensive impairment-based hybrid models of intervention.

     

Accent on communication: the impact of regional and foreign accent on comprehension in adults with aphasia

Purpose: This study explored whether an unfamiliar non-native accent, differing in both segmental and prosodic features was more difficult for individuals with aphasia to understand than an unfamiliar native accent, which differed in segmental features only. Method: Comprehension, which was determined by accuracy judgments on true/false sentences, and speed of response were assessed in the following three conditions: a familiar Southern Standard British English (SSBE) accent, an unfamiliar native Grimsby accent, and an unfamiliar non-native Chinese accent. Thirty-four English speaking adults (17 people with and 17 people without aphasia) served as listeners for this study. Results: All listeners made significantly more errors in the unfamiliar non-native accent, although this difficulty was more marked for those with aphasia. While there was no affect of speaker accent on the response times of listeners with aphasia, listeners without aphasia were significantly slower with the unfamiliar non-native accent. Conclusion: The results indicate that non-native accented speech affects comprehension even on simple tasks in ideal listening conditions. The findings suggest that speaker accent, especially accents varying in both segmental and prosodic features, can be a barrier to successful interactions between non-native accented speakers and native listeners, particularly those with aphasia.

Implications for Rehabilitation

• Aphasia is an acquired language disorder, often occurring after stroke, which affects an individual’s understanding and use of language.

• People with and without aphasia find an unfamiliar accent more difficult to understand than a familiar accent, and these problems are more significant for those with aphasia.

• Problems are greater when the accent differs from the familiar accent by both individual sounds and prosody.

• Health professionals need to be aware that their accent is likely to affect an individual’s performance on assessments as well as their understanding of information, and could consider the use of other mediums to present information (e.g. drawing) and minimizing other variables that might compromise comprehension (e.g. background noise).

     

Third-party disability in family members of people with aphasia: a systematic review

Purpose: The WHO’s International Classification of Functioning, Disability, and Health (ICF) describes third-party disability as the disability experienced by significant others as a consequence of their family members’ health condition (WHO, 2001). A systematic review of the literature was conducted to summarize the current knowledge of third-party disability in aphasia. Method: PubMed, CINAHL and three other databases were searched for peer-reviewed studies reporting on how aphasia affects family members with no date restrictions. Findings from relevant studies that met the inclusion criteria were extracted and mapped to the ICF. Results: This paper summarizes what is known about the experience of family members of people with aphasia, describing negative outcomes in the body functions and activities and participation components of the ICF. However, due to the limited consensus between studies, this review reveals an incomplete understanding of the nature of third-party disability. Conclusion: While current literature suggests there is a broad range of consequences for family members of people with aphasia, the sequelae of disability for family members of people with aphasia are not well understood. Further research is needed to better describe the nature and degree of third-party disability in aphasia.

Implications for Rehabilitation

• Third-party disability occurs when family members experience changes to their functioning as a consequence of their significant other’s health condition (e.g. aphasia), even though they do not have the condition themselves.

• Aphasia has widespread impact on the family members of people with aphasia, including negative effects on their body functions, activities and participation.

• Future research using the International Classification of Functioning, Disability and Health is needed to guide rehabilitation professionals when providing family-centred care to people with aphasia and their family members.

     

Motivational interviewing: a novel intervention for translating rehabilitation research into practice

Purpose: Despite recent advances in rehabilitation research, moving evidence into clinical practice remains a challenge. This article explores a novel approach to knowledge translation (KT) – motivational interviewing (MI). MI is a style of communication that is typically used to facilitate health related behavior change in patients. Here we explore its potential use as a KT intervention aimed at clinicians. Methods: Commentary. Relevant literature on MI and KT is summarized and discussed by considering how MI could be used in a KT strategy aimed at rehabilitation clinicians. Results: Clinician motivation and readiness to change are key issues influencing implementation of evidence-based practice. We provide an argument suggesting that clinicians’ readiness to change clinical practices can potentially be enhanced through MI. The MI conceptual framework, principles, and strategies, typically used in patients, are discussed here in a novel context – enhancing clinician change in practice. Conclusions: MI is an effective intervention when the goal is to motivate individuals to change a current behavior. We suggest that MI is an evidence-based intervention that has been proven to be effective with patients and warrants study as a promising KT intervention.

Implications for Rehabilitation

• Despite recent advances in rehabilitation research, moving evidence into practice remains a challenge.

• Clinician motivation is one key issue influencing the implementation of evidence-based practice.

• Clinician motivation to implement evidence-based practice can potentially be enhanced through an approach called motivational interviewing (MI).

• Motivational interviewing is an evidence-based intervention that has proven to be effective in promoting behavioral change in patients, and warrants study in terms of its potential as a KT intervention.

     

Integrative intervention: a new perspective and brief review in aphasia

Purpose: While integrative treatment practices have become a popular treatment in different areas of study, its use in the field of aphasiology is still limited. The following paper is an attempt to address the different alternative practices that could potentially be used to remediate aphasia.

Method: A narrative review was completed regarding integrative intervention that could potentially apply to aphasia population.

Results: Through this article we have explored various treatment options for integrative health care in aphasiology. Integrative treatments including brain specific antioxidants, progesterone and estradiol therapy, nutrition, synbiotic treatment, exercise, yoga, meditation and positive mood states have demonstrated positive changes in health and behavior in healthy aging or disorders such as stroke and aphasia. Offering integrative treatment for people with aphasia allows potential for high impact gains when combined with current speech language therapeutic practices.

Conclusion: This paper highlights the rehabilitation possibilities for aphasia therapy. Combining complementary and traditional treatment approaches could be viewed as one of the contemporary approaches to clinical practice and research for practitioners and health care systems.

• Implications for Rehabilitation

• There has been very little research that explores the potential of various types of integrative treatment for individuals with aphasia.

• An integrative approach to the treatment of aphasia has potential for future clinical application.

• Combining treatment approaches could be viewed as a viable approach to clinical practice and in the health care system.

     

Osseointegrated dental implants in patients with intellectual disability: a pilot study

Purpose: The objective of this study was to investigate if intellectual disability (ID) itself constitutes an absolute contraindication to oral rehabilitation with osseointegrated implants, or if adequately selected patients can benefit from this dental treatment technique. Method: We report a series of eight patients with non-syndromic ID and no associated neuromuscular disorders, craniofacial abnormalities, or serious systemic complications, in whom oral rehabilitation was performed using implant-supported prostheses, with a follow-up of one to three years. Results: A total of 18 titanium implants were inserted and nine implant-supported prostheses were constructed. Follow-up examination showed that although the majority of implants presented a degree of peri-implant mucositis, all were osseointegrated and the prostheses were functional. Conclusions: Although there is very little literature on this subject, the results of this pilot study allow us to suggest that osseointegrated oral implants could constitute a therapeutic option for patients with ID. The success of oral rehabilitation depends fundamentally on appropriate patient selection.

Implications for Rehabilitation

• Apart from the obvious difficulties related to eating and communication, edentulism is of great cosmetic importance in patients with ID in terms of social acceptance.

• It has been suggested that patients with ID do not receive the same level of dental treatment as the general population.

• The results of this pilot study allow us to suggest that osseointegrated oral implants could constitute a therapeutic option for patients with ID.

     

The use of mobile devices as assistive technology in resource-limited environments: access for learners with visual impairments in Kenya

Purpose: In this paper, the authors explore the use of mobile devices as assistive technology for students with visual impairments in resource-limited environments. This paper provides initial data and analysis from an ongoing project in Kenya using tablet devices to provide access to education and independence for university students with visual impairments in Kenya. Method: The project is a design-based research project in which we have developed and are refining a theoretically grounded intervention – a model for developing communities of practice to support the use of mobile technology as an assistive technology. We are collecting data to assess the efficacy and improve the model as well as inform the literature that has guided the design of the intervention. Results: In examining the impact of the use of mobile devices for the students with visual impairments, we found that the devices provide the students with (a) access to education, (b) the means to participate in everyday life and (c) the opportunity to create a community of practice. Conclusions: Findings from this project suggest that communities of practice are both a viable and a valuable approach for facilitating the diffusion and support of mobile devices as assistive technology for students with visual impairments in resource-limited environments.

• Implications for Rehabilitation

• The use of mobile devices as assistive technology in resource-limited environments provides students with visual impairments access to education and enhanced means to participate in everyday life.

• Communities of practice are both a viable and a valuable approach for facilitating the diffusion and support of mobile devices as assistive technology for students with visual impairments in resource-limited environments.

• Providing access to assistive technology early and consistently throughout students’ schooling builds both their skill and confidence and also demonstrates the capabilities of people with visual impairments to the larger society.

     

Effectiveness of osteopathic manipulative treatment versus osteopathy in the cranial field in temporomandibular disorders – a pilot study

Purpose: Temporomandibular disorders are a common musculoskeletal condition causing severe pain, physical and psychological disability. The effect and evidence of osteopathic manipulative treatment and osteopathy in the cranial field is scarce and their use are controversial. The purpose of this pilot study was to evaluate the effectiveness of osteopathic manipulative treatment and osteopathy in the cranial field in temporomandibular disorders.

Methods: A randomized clinical trial in patients with temporomandibular disorders was performed. Forty female subjects with long-term temporomandibular disorders (>3 months) were included. At enrollment, subjects were randomly assigned into two groups: (1) osteopathic manipulative treatment group (20 female patients) and (2) osteopathy in the cranial field group (20 female patients). Examination was performed at baseline (E0) and at the end of the last treatment (E1), consisting of subjective pain intensity with the Visual Analog Scale, Helkimo Index and SF-36 Health Survey. Subjects had five treatments, once a week. 36 subjects completed the study (33.7?±?10.3 y).

Results: Patients in both groups showed significant reduction in Visual Analog Scale score (osteopathic manipulative treatment group: p?=?0.001; osteopathy in the cranial field group: pp?=?0.02; osteopathy in the cranial field group: p?=?0.003) and a significant improvement in the SF-36 Health Survey – subscale “Bodily Pain” (osteopathic manipulative treatment group: p?=?0.04; osteopathy in the cranial field group: p?= 0.007) after five treatments (E1). All subjects (n?=?36) also showed significant improvements in the above named parameters after five treatments (E1): Visual Analog Scale score (ppBodily Pain” (p?=?0.001). The differences between the two groups were not statistically significant for any of the three target parameters.

Conclusion: Both therapeutic modalities had similar clinical results. The findings of this pilot trial support the use of osteopathic manipulative treatment and osteopathy in the cranial field as an effective treatment modality in patients with temporomandibular disorders. The positive results in both treatment groups should encourage further research on osteopathic manipulative treatment and osteopathy in the cranial field and support the importance of an interdisciplinary collaboration in patients with temporomandibular disorders.

• Implications for rehabilitation

• Temporomandibular disorders are the second most prevalent musculoskeletal condition with a negative impact on physical and psychological factors.

• There are a variety of options to treat temporomandibular disorders.

• This pilot study demonstrates the reduction of pain, the improvement of temporomandibular joint dysfunction and the positive impact on quality of life after osteopathic manipulative treatment and osteopathy in the cranial field.

• Our findings support the use of osteopathic manipulative treatment and osteopathy in the cranial field and should encourage further research on osteopathic manipulative treatment and osteopathy in the cranial field in patients with temporomandibular disorders.

• Rehabilitation experts should consider osteopathic manipulative treatment and osteopathy in the cranial field as a beneficial treatment option for temporomandibular disorders.