“It’s got to be more than that”. Parents and speech-language pathologists discuss training content for families with a new speech generating device

Purpose: Although parent-implemented interventions for children with a speech-generating device (SGD) have been well researched, little is known about parents’ or speech-language pathologists’ (SLPs) views around parent training content. In this project, we aimed to identify areas that parents and SLPs consider should be included in training for families with a new SGD. Methods: Seven parents of children with an SGD and three SLPs who were new to the SGD field, participated in individual semi-structured interviews. Ten SLPs experienced in SGD practice took part in two focus groups. Data were analysed using grounded theory methods. Results: Participants identified the following areas suitable for inclusion in a family SGD training package: (a) content aimed at improving acceptance and uptake of the SGD, including technical guidance, customisation and reassurance around SGD misconceptions; (b) content around aided language development and (c) home practice strategies, including responsivity, aided language stimulation and managing children’s motivation. Conclusions: Participants identified diverse training targets, many of which are unexplored in parent-training research to date. Their recounted experiences illustrate the diversity of family capacity, knowledge and training priorities, and highlight the need for collaborative planning between families and SLPs at all stages of SGD training.

• Implications for Rehabilitation

• Training needs for families with a new speech generating device (SGD) are diverse, ranging from technology-specific competencies to broader areas, such as advocacy, teamwork and goal-setting skills.

• Each family with a new SGD will have a unique profile of training needs, determined by individual learning capacity, priorities, prior knowledge and experience, as well as their child’s current communication skills and future support needs.

• Parents and speech-language pathologists (SLPs) may hold different priorities concerning family SGD training, necessitating ongoing team discussion.

     

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.

     

Clinicians’ management of young children with co-occurring stuttering and speech sound disorder

Abstract

Speech sound disorders reportedly co-occur in young children who stutter at a substantial rate. Despite this, there is a paucity of scientific research available to support a treatment approach when these disorders co-exist. Similarly, little is known about how clinicians are currently working with this caseload given that best practice for the treatment of both disorders in isolation has evolved in recent years. This study used a qualitative approach to explore current clinical management and rationales when working with children who have co-occurring stuttering and speech sound disorder. Thirteen participant SLPs engaged in semi-structured telephone interviews. Interview data were analysed based on principles derived from grounded theory. Several themes were identified including multi-faceted assessment, workplace challenges, weighing-up the evidence, and direct intervention. The core theme, clinical reasoning, highlighted the participants’ main concern, that not enough is known about this caseload on which to base decisions about intervention. There was consensus that little is available in the research literature to guide decisions relating to service delivery. These findings highlight the need for further research to provide evidence-based guidelines for clinical practice with this caseload.     

Development of a measure to assess effective listening and interactive communication skills in the delivery of children’s rehabilitation services

Purpose: Therapists’ listening and communication skills are fundamental to the delivery of children’s rehabilitation services but few measures comprehensively assess these skills. The 24-item Effective Listening and Interactive Communication Scale (ELICS) was developed to reflect a multifaceted conceptualization based on evidence in the literature. Method: Data from 41 pediatric rehabilitation therapists (occupational, physical, speech-language, recreation, and behavioural therapists; psychologists and social workers) were used to determine the factor structure, internal consistency, and construct validity of the subscales. Results: The measure contains four subscales with very good to excellent reliability: Consensus-oriented, Exploratory, Receptive, and Action-oriented Listening. Content validity was ensured by the development process. Conclusions: The ELICS portrays listening as a purposeful, goal-oriented, and relational activity. The measure allows clinicians to assess and reflect on their listening/communication skills, and can be used to evaluate professional development activities and interventions geared to improving these skills.

Implications for Rehabilitation

• Therapists’ listening and effective communication skills are essential to the successful delivery of children’s rehabilitation services, but few measures comprehensively assess these skills.

• Clinical encounters in pediatric rehabilitation involve various types of listening/communication skills: receptive listening, exploratory listening, consensus-oriented listening, and action-oriented listening.

• The ELICS is a valid and context-appropriate tool for the self-assessment of listening and communication skills in the context of pediatric rehabilitation practice.

• The ELICS allows clinicians (e.g., occupational, physical, and speech-language therapists) to assess and reflect on their listening/communication skills and may enhance the relationship-based practice of clinicians who provide therapy services to children with disabilities and their families.

     

Impact of communication partner familiarity and speech accuracy on parents’ ratings of their child for the Intelligibility in Context Scale: Dutch

Purpose: The aim of this study was to examine the role of familiarity of a communication partner on Dutch parents’ perception of their child’s intelligibility, for children with typically-developing speech (TD) or speech sound disorder (SSD).

Method: Participants were 67 Dutch-speaking children (48–84 months), 48 with TD and 19 with SSD. Item scores on the parent-rated Intelligibility in Context Scale: Dutch (ICS-NL) were compared between groups and related to naive listeners’ ratings of children’s intelligibility (IR), and a measure of speech accuracy (i.e. percentage of consonants correct-adjusted, PCC-A).

Result: Statistical analysis yielded a significant Group by Familiarity interaction on the ICS-NL. Parents rated the intelligibility of their child with SSD as higher with more familiar communication partners than less familiar, more so than parents of children with TD. In the SSD group, IR was more strongly correlated with ICS-NL item scores for less familiar partners. PCC-A was only correlated with ICS-NL item 7 (strangers).

Conclusion: Parents perceive their children as more intelligible with people in close relationships, likely due to their higher familiarity with the child’s speech. Children’s relationships should be considered with respect to communicative participation. PCC-A may be a less reliable predictor of participation in family and community life.     

Professionals’ views on the use of smartphone technology to support children and adolescents with memory impairment due to acquired brain injury

Purpose To identify from a health-care professionals’ perspective whether smartphones are used by children and adolescents with acquired brain injury as memory aids; what factors predict smartphone use and what barriers prevent the use of smartphones as memory aids by children and adolescents. Method A cross-sectional online survey was undertaken with 88 health-care professionals working with children and adolescents with brain injury. Results Children and adolescents with brain injury were reported to use smartphones as memory aids by 75% of professionals. However, only 42% of professionals helped their clients to use smartphones. The only factor that significantly predicted reported smartphone use was the professionals’ positive attitudes toward assistive technology. Several barriers to using smartphones as memory aids were identified, including the poor accessibility of devices and cost of devices. Conclusion Many children and adolescents with brain injury are already using smartphones as memory aids but this is often not facilitated by professionals. Improving the attitudes of professionals toward using smartphones as assistive technology could help to increase smartphone use in rehabilitation.

• Implications for Rehabilitation

• Smartphones could be incorporated into rehabilitation programs for young people with brain injury as socially acceptable compensatory aids.

• Further training and support for professionals on smartphones as compensatory aids could increase professionals’ confidence and attitudes in facilitating the use of smartphones as memory aids.

• Accessibility could be enhanced by the development of a smartphone application specifically designed to be used by young people with brain injury.

     

“… Trial and error …”: Speech-language pathologists’ perspectives of working with Indigenous Australian adults with acquired communication disorders

Purpose: This study explored speech-language pathologists' (SLPs) perspectives about factors that influence clinical management of Aboriginal and Torres Strait Islander adults with acquired communication disorders (e.g. aphasia, motor speech disorders).

Method: Using a qualitative phenomenological approach, seven SLPs working in North Queensland, Australia with experience working with this population participated in semi-structured in-depth interviews. Qualitative content analysis was used to identify categories and overarching themes within the data.

Result: Four categories, in relation to barriers and facilitators, were identified from participants’ responses: (1) The Practice Context; (2) Working Together; (3) Client Factors; and (4) Speech-Language Pathologist Factors. Three overarching themes were also found to influence effective speech pathology services: (1) Aboriginal and Torres Strait Islander Cultural Practices; (2) Information and Communication; and (3) Time.

Conclusion: This study identified many complex and inter-related factors which influenced SLPs’ effective clinical management of this caseload. The findings suggest that SLPs should employ a flexible, holistic and collaborative approach in order to facilitate effective clinical management with Aboriginal and Torres Strait Islander people with acquired communication disorders.     

Palliative care professional’s perceptions of barriers and challenges to accessing children’s hospice and palliative care services in South East London: A preliminary study

Objectives: Several barriers have been identified as preventing or delaying access to children’s palliative care services. The aim of this study is to further explore such barriers from palliative care professionals’ perspective from two London boroughs.

Methods: Qualitative-five children’s palliative care professionals’ perceptions were obtained from semi-structured interviews.

Results: Three themes emerged: availability and adequacy of child palliative care (e.g., unreliability of services), obstacles to accessing palliative care (e.g., logistical challenges), and cultural values and family priorities.

Conclusion: These findings contribute to the equal opportunities dialogue in this sector and the need for future research to address the challenges identified.     

Deep analysis of immune response and metabolic signature in children with food protein induced enterocolitis to cow’s milk

Background

Food Protein-Induced Enterocolitis Syndrome (FPIES) is considered to be a non-IgE mediated food allergy. However, its pathogenesis remains poorly understood and biomarkers are lacking. We aimed to perform in-depth characterization of humoral and cellular immune responses in children with cow’s milk (CM)-FPIES and investigated whether there is a FPIES metabolomic signature.

Methods

Children with CM-FPIES and control subjects with an IgE-mediated CM allergy (IgE-CMA), both avoiding CM, were recruited on the day of an oral food challenge. Blood samples were collected before the challenge. Total and specific levels of IgE, IgG1-4, IgA, IgM and IgD to various whey and casein allergens and to their gastroduodenal digestion products were measured in plasma, using plasma from CM-tolerant peanut allergic patients (IgE-PA, not avoiding CM) as additional controls. Cytokine secretion and cellular proliferation were analyzed after stimulation of PBMC with different CM allergens. Metabolomic profiles were obtained for plasma samples using liquid chromatography coupled to high-resolution mass spectrometry.

Results

Nine children with CM-FPIES and 12 control subjects (6 IgE-CMA and 6 IgE-PA) were included. In children with CM-FPIES, total Ig concentrations were lower than in control subjects, specific Ig against CM components were weak to undetectable, and no specific IgE against CM digestion products were detected. Moreover, in CM-FPIES patients, we did not find any Th cell proliferation or associated cytokine secretion after allergen reactivation, whereas such responses were clearly found in children with IgE-CMA. Plasma metabolic profiles were different between CM allergic patients, with significantly lower concentrations of various fatty acids and higher concentrations of primary metabolites such as amino acids in CM-FPIES compared to IgE-CMA patients.

Conclusions

In CM-FPIES, both humoral and cellular specific immune responses are weak or absent, and this is not related to CM avoidance. A metabolomic signature was identified in patients with CM-FPIES that may be useful for the diagnosis and management of this disease.

     

Gaze-controlled communication technology for children with severe multiple disabilities: Parents and professionals’ perception of gains,obstacles, and prerequisites

The aim of this study was to explore parents’ and professionals’ thoughts of how a gaze-controlled computer can be beneficial to children with severe multiple disabilities. All systems were provided primarily for symbol-based communication, but were also used for other purposes such as play, leisure and school activities. A further aim was to investigate factors affecting usability, specifically for communication.

The study used a qualitative approach, involving content analysis of semistructured interviews with the children’s key persons (N = 11). The analysis yielded three categories and twelve subcategories. There were gains for the children in terms of empowerment, social interaction, learning opportunities and efficient computer use. Inaccessibility, liability issues and technical failure were seen as obstacles, while the prerequisites included time, collaboration, stimulating content, know-how and opportunities. To sum up, this study suggests that gaze-controlled technology can provide children who have multiple disabilities involving severe motor dysfunction and communicative and cognitive problems with new opportunities to communicate, interact and perform activities independently, as long as conditions are right.     

Pre-registration nursing and occupational therapy students’ experience of interprofessional simulation training designed to develop communication and team-work skills: A mixed methods study

To bridge the gap between university and the clinical environment, the university where this study was conducted incorporated interprofessional simulation sessions into the curricula for pre-registration nursing and occupational therapy students. The purpose of the study was to evaluate the effectiveness of simulation training to support the development of students’ interprofessional communication and teamwork skills. Study participants were first-year students. A mixed methods study design was used that included: (1) a cross-sectional survey, (using the Interprofessional Education Collaborative Competency Self-Assessment tool), before and after the simulation session; and (2) two focus groups with students and one with academic staff. A total of 91 students and 5 staff participated. All students increased their self-perceived skills in interprofessional interactions. Two major themes were identified: ‘Communication and Teamwork’, with four sub-themes, (1) ‘Significance of Communication in teamwork’; (2) ‘Learning about, from and with each other’; (3) ‘Professional role identification and collaborative practice’; and (4) ‘Clinical leadership facilitated collaboration’ and ‘Lessons learnt from the simulation session’, with three subthemes: (1) ‘enhanced preparation for clinical placement’; (2) ‘the experience of interacting with a simulated patient’; and (3) ‘holistic patient care’. The results from the study demonstrated that interprofessional simulation sessions are an effective approach to introducing and developing collaborative clinical practice.     

Graduate nurses’ perceptions of mismatches between themselves and their jobs and association with intent to leave employment: a longitudinal survey

BackgroundGraduate nurses experience mismatches between themselves and their jobs. One of these is the demands–abilities misfit, which is a mismatch between the abilities of employees and those required by a job (demands). Another is the supplies–needs misfit, which occurs when employees’ work-specific needs are not fulfilled by opportunities (called environmental supplies) work can supply to reinforce them.ObjectivesThe aim of this study was to investigate how graduate nurses’ perceptions of the demands–abilities and supplies–needs misfits changed over time, and to examine how these misfits impact their intention to leave the jobs.DesignA longitudinal study design was used.SettingFive hospitals in the western region of Japan cooperated in the study.ParticipantsA total of 176 graduate nurses participated in the study one or more times. From among them, 150, 109, 102, and 96 graduates participated in the study conducted in the 3rd, 6th, 9th, and 12th months of the employment, respectively. In addition, 62 graduates participated in all studies.MethodsSurveys were distributed to the graduates 3, 6, 9 and 12 months after their employment commenced. The results were analysed using multiple regression analysis.ResultsThe results showed that the graduates perceived both demands–abilities and supplies–needs misfits, although the degree of the demands–abilities misfit became smaller towards the end of the graduate year. As for the impact on graduates’ turnover intention, the graduates’ abilities and their perception of the environmental supplies served as more significant predictors of their turnover intention, rather than the misfits per se. The variances of turnover intention explained by the supplies–needs variables were greater than those explained by the demands–abilities variables from the third to ninth months into the employment. On the other hand, the variance explained by the demands–abilities variables increased towards the end of the year, and finally exceeded that of the supplies–needs variables.ConclusionsThe graduates’ turnover intention is complex, and may not be explained by simple demands–abilities and supplies–needs misfits. Different factors influence their turnover intention at different times to different degrees.     

Effects of supervised slackline training on postural instability,freezing of gait,and falls efficacy in people with Parkinson’s disease

Purpose: The aim of this study was to assess whether supervised slackline training reduces the risk of falls in people with Parkinson’s disease (PD).

Methods: Twenty-two patients with idiopathic PD were randomized into experimental (EG, N?=?11) and control (CG, N?=?11) groups. Center of Pressure (CoP), Freezing of Gait (FOG), and Falls Efficacy Scale (FES) were assessed at pre-test, post-test and re-test. Rate perceived exertion (RPE, Borg’s 6–20 scale) and local muscle perceived exertion (LRPE) were also assessed at the end of the training sessions.

Results: The EG group showed significant improvements in FOG and FES scores from pre-test to post-test. Both decreased at re-test, though they did not return to pre-test levels. No significant differences were detected in CoP parameters. Analysis of RPE and LRPE scores revealed that slackline was associated with minimal fatigue and involved the major lower limb and lumbar muscles.

Conclusions: These findings suggest that slacklining is a simple, safe, and challenging training and rehabilitation tool for PD patients. It could be introduced into their physical activity routine to reduce the risk of falls and improve confidence related to fear of falling.

• Implications for Rehabilitation

• Individuals with Parkinson’s disease (PD) are twice as likely to have falls compared to patients with other neurological conditions.

• This study support slackline as a simple, safe, and challenging training and rehabilitation tool for people with PD, which reduce their risk of falls and improve confidence related to fear of falling.

• Slackline in people with PD yields a low tiredness or fatigue impact and involves the major lower limb and lumbar muscles.

     

What is it like to walk with the help of a robot? Children’s perspectives on robotic gait training technology

Abstract

Purpose: Robotic gait training is an emerging intervention that holds great therapeutic promise in the rehabilitation of children with neuromotor disorders such as cerebral palsy (CP). Little is known about children and parents’ views on this new technology. The purpose of this qualitative study was to investigate the expectations and experiences of children with CP in relation to robotic gait training using the Lokomat®Pro. Method: An interpretivist qualitative design was employed in which perspectives of children and parents were elicited through separate semi-structured interviews to examine expectations of and experiences with the Lokomat. Results: Four themes related to children’s expectations and experiences using the Lokomat were identified: (1) Not sure what to expect, but okay, I will do it; (2) It’s more than just the Lokomat, it’s the people that make the difference; (3) Having mixed impressions about the Lokomat; and (4) It’s probably helping me, but I don’t really know. Conclusions: Rehabilitation professionals, researchers and parents are encouraged to reflect on why and how one might engage children in gait-related rehabilitation in ways that appeal to children’s desires and expectations. This may shape how interventions are presented to children and how goals and outcomes are framed.

• Implications for Rehabilitation

• Children in this study did not consistently feel excited about, have a wish to use, or have a sustained interest in the use of a robotic technology, and at times experienced some anxiety in relation to their participation in the intervention.

• Contrary to assumptions that disabled children value walking “normally”, children in this study did not express a desire to walk in typical (non-disabled) gait patterns, and equated so-called “normal” walking with their usual walking styles.

• Thus, we encourage clinicians, researchers and parents to reflect on why, when and how best to engage children in gait-related rehabilitation in ways that appeal to and align with children’s desires and expectations.