Significant junctures on the way towards becoming a user of assistive technology in Alzheimer's disease

Abstract

Objective: The aim of this study was to describe how persons in the early stages of Alzheimer's disease (AD) became users of assistive technology (AT), and what the use of AT came to mean to these users and, when relevant, their significant others. Methods: Persons with AD were provided with individually chosen AT during a six-month period. Semi-structured interviews were conducted during the intervention period. The data were analysed with a constant comparative approach. Results: On the way towards becoming a user of AT, four junctures were identified, at which significant decisions were made by the participants. These decisions influenced whether to become a user or not and related to how the initial decision was made, how the routines to incorporate the AT were adjusted, whether the participant trusted the AT, and whether the participants felt an increased sense of capacity when using the AT. As users, the participants perceived how time and effort was saved, how worries and stress decreased, and how their sense of safety increased, which enabled them to perform valued activities, e.g. health-promoting and social activities, to a greater extent and in a more relaxed way than before. Conclusions: The findings support the view that AT can positively affect the activity performance of people with AD when the potential user can identify difficulties and needs and is motivated and able to make changes to overcome them, given that appropriate human support is available.     

Temporal arteritis

Abstract

Objective: To assess rates of diagnosis and antihyperglycemic dose adjustment in patients with moderate to end-stage renal impairment (RI) and type 2 diabetes mellitus (T2DM). Methods: Retrospective database analysis using GE Centricity Outpatient Electronic Medical Records. Patients aged ≥ 18 years with evidence of T2DM (International Classification of Diseases, Ninth Edition, Clinical Modification codes 250.x0 and 250.x2) between January 1, 2000 and June 30, 2009, and ≥ 12 months of data after identification were selected. Moderate to end-stage RI was evaluated using a formula-derived estimated glomerular filtration rate (eGFR) based on serum creatinine (SCr). Patients were classified as moderate (eGFR, 30–59 mL/min/1.73 m²), severe (eGFR, 15–29 mL/min/1.73 m²), or end-stage (eGFR, < 15 mL/min/1.73 m²), per the National Kidney Foundation guidelines, based on the first-observed SCr test. Among patients with a physician diagnosis, the time to diagnosis was reported. Dose adjustment was reported for patients receiving metformin and sitagliptin. Predictors of progression to end-stage RI based on logistic regressions were examined. Results: 35.2% of patients with T2DM had evidence of moderate to end-stage RI. Of these patients, 20% had a chart-documented physician diagnosis (range, 16% [moderate RI] to 66% [end-stage RI]). Patients with moderate or severe RI had a physician diagnosis mean of 253.4 (standard deviation [SD], 584.5) and 86.9 (SD, 417.4) days, respectively, after the eGFR calculation indicating RI. Patients with end-stage RI had a physician diagnosis mean of 83.6 (SD, 399.2) days before the eGFR calculation. After the eGFR calculation, 15.1% and 0.1% of patients with orders for sitagliptin and metformin, respectively, received doses of the drug appropriate for their degree of RI. Among patients with moderate or severe RI, appropriate diagnosis of RI was associated with significantly lower odds of progressing to end-stage RI (odds ratio, 0.200; 95% confidence interval, 0.188–0.213). Conclusions: Renal impairment is common but often undetected in patients with T2DM. Patients with a documented RI diagnosis have lower odds of progression to end-stage RI. Metformin and sitagliptin are frequently used at inappropriate doses in patients with RI. Further analyses to understand the clinical and economic consequences of these findings are needed.     

The Retirement Process in an Occupational Perspective:

The purpose of this study is to review and analyze the literature on retirement from an occupational perspective. Theories are compared and described; whether they have empirical support and whether they incorporate individual and environmental factors is discussed. The Model of Human Occupation is presented as one such model that is able to incorporate both individual and environmental factors when retirement issues are added to the model.     

Home Modifications for the Elderly

With society placing high positive value on independent living for the elderly, the need for home modification is growing. This paper will describe current information as well as psychosocial implications the occupational therapist should consider when collaborating with their elderly clients who wish to remain at home and “age in place.”     

Retraining of functional gait through the reduction of upper extremity weight-bearing in chronic cerebellar ataxia

Patients with chronic ataxia resulting from traumatic central nervous system (CNS) damage frequently attain a gait pattern dependent upon upper extremity weight-bearing (UEWB). Traditional attempts to train these patients may perpetuate UEWB dependency, by not allowing optimal facilitation of balance and associated movement control required for independent ambulation. In the present study an ambulation retraining approach designed to facilitate coordination and balance while minimizing UEWB was used. This approach can allow the patient to train outside of the clinic; only about 5% of the actual therapy hours involved a therapist.     

Two-year-olds' phonological acquisition: Normative data

The study reported evaluated an assessment of phonology for 2-year-olds to establish normative data and determine if early identification of children with speech difficulties is possible. The study evaluated 62 2-year-old children on the Toddler Phonology Test (TPT). Children produced 32 words, spontaneously or in imitation. Ten of the children were assessed three times, on the third occasion, when they had reached 3 years, on another phonological assessment. The data indicated that older children performed better than younger children on quantitative measures. Girls and boys performed equally well. Their phonetic repertoires were missing some fricatives and all affricates, as well as /r/. Consistently used error patterns identified included cluster reduction, final consonant deletion, stopping, fronting, weak syllable, deletion, gliding and deaffrication. Correlation analyses indicated that performance at the first assessment on the TPT indicated performance on subsequent assessments. While quantitative data was not a reliable predictive indicator of speech disorder, qualitative analysis of error types was predictive, with children who made many atypical errors at 2 years being diagnosed as phonologically disordered at 3 years. The findings provide initial evidence that direct formal assessment of 2-year-old phonology is possible.     

Core vocabulary in the narratives of bilingual children with and without language impairment

Abstract

Purpose: Children with primary language impairment (PLI) demonstrate deficits in morphosyntax and vocabulary. We studied how these deficits may manifest in the core vocabulary use of bilingual children with PLI.

Method: Thirty bilingual children with and without PLI who were matched pairwise (experimental group) narrated two Spanish and two English stories in kindergarten and first grade. Core vocabulary was derived from the 30 most frequently used words in the stories of 65 and 37 typically developing (TD) first graders (normative group) for Spanish and English, respectively. The number of words each child in the experimental group produced out of the 30 identified core vocabulary words and frequency of each of the core words produced each year were analysed.

Result: Children with PLI produced fewer core vocabulary words compared to their TD peers after controlling for total words produced. This difference was more pronounced in first grade. They produced core vocabulary words less frequently in kindergarten than their TD peers. Both groups produced core vocabulary words more frequently in English than Spanish.

Conclusions: Bilingual children with PLI demonstrate a less productive core vocabulary use compared to their TD peers in both their languages illustrating the nature of their grammatical and lexical-semantic deficits.     

Interpretation of compound nouns by adolescents with specific language impairment and autism spectrum disorders: An investigation of phenotypic overlap

Abstract

The study aimed to investigate (i) whether adolescents with Specific Language Impairment (SLI) and Autism plus Language Impairment (ALI) experience word-formation difficulties, and (ii) whether these two groups present with a similar language phenotype. The study investigated four groups using a 2 (language status) ×2 (autism status) design; adolescents with SLI (n =?14), ALI (n =?16), Autism Language-Typical (ALT; n =?14), and language matched controls (n =?17), with all groups presenting with typical non-verbal skills. Mean age was 14;10. Comprehension of conventional Noun–Noun lexical compounds (e.g., snowman), synthetic compounds (SCs, e.g., cat chaser), and novel root compounds (RCs, e.g., sheep socks), was assessed using a forced-choice picture selection task. The SLI and ALI participants frequently mis-parsed the SCs, interpreting the first noun as the agent. Those with poorer vocabularies and non-word repetition had greater difficulties. Reaction time (RT) profiles were flatter in the ASD groups, with similar RTs across different compounds. Language difficulties in the SLI and ALI groups extend to word-formation processes; for example, comprehension of SCs. This may reflect difficulties making analogies with stored lexical items. Overall the results support the hypothesis of a phenotypic overlap between SLI and ALI.