Reconciling communication repertoires: navigating interactions involving persons with severe/profound intellectual disability, a classic grounded theory study.

BACKGROUND: A rights-based agenda, informed by the UNCRPD, that advocates person-centredness, inclusion, empowerment and self-determination is shaping service provision to people with intellectual disability (ID). Listening to their perspectives is fundamental to meeting these goals. However, communication with people with severe/profound ID is challenging and difficult. Therefore, this study aims to generate a theory that explains how people communicate with and understand each other in these interactions. METHODS: Classic grounded theory (CGT) methodology was used as it recognises that knowledge can be captured rather than interpreted. According to CGT, capturing rather than interpreting experiences strengthens findings, particularly in relation to participants with severe/profound ID. Concurrent theoretical sampling, data collection and analysis were undertaken. Twenty-two individuals participated in the study: 3 people with severe/profound ID and 19 people with whom they interact. Data were collected over a 9-month period and involved video recordings, field notes, individual and group interviews. Data were analysed using CGT methods of coding, constant comparison and memoing. RESULTS: The Theory of Reconciling Communication Repertoires was generated. Nurturing a sense of belonging emerged as the main concern and core category that is resolved by reconciling communication repertoires. A communication repertoire refers to the cache of communication skills a person has available to them. To reconcile repertoires is to harmonise or make them compatible with each other in order to communicate. Interactions are navigated through five stages: motivation to interact, connection establishment, reciprocally engaging, navigating understanding and confusion resolution. CONCLUSIONS: The Theory of Reconciling Communication Repertoires explains how interactions involving people with severe/profound ID are navigated. While this is a substantive rather than formal theory, it has the potential to inform practice, policy, management, education and research as it outlines how communication with people with severe/profound ID can take place to design, inform and plan person-centred care.

Exploring acupuncturists' perceptions of treating patients with rheumatoid arthritis.

AIMS: To outline acupuncturists' perceptions of treating patients with rheumatoid arthritis (RA), exploring the impact of practitioner affiliation to a traditional or western theoretical base. METHODS: Qualitative study utilising Grounded Theory Method. Nineteen acupuncturists were chosen via theoretical sampling. In-depth semi-structured interviews were tape-recorded and transcribed. Field notes were also taken. Emerging categories and themes were identified. RESULTS: Inter-affiliatory differences were identified in the treatments administered and the scope and emphasis of intended therapeutic effects. Limited divergence was found between acupuncturists' perceptions of treatment outcomes. Factors perceived as impacting on treatment outcomes were identified. CONCLUSIONS: Clinical trials of acupuncture in RA may have failed to administer a treatment which reflects that administered in clinical practice. Outcome measures employed in clinical trials of acupuncture in RA, as well as established outcome indices for RA, may lack the necessary breadth to accurately assess acupuncture's efficacy. Acupuncturist affiliation has demonstrable implications for the practice and research of acupuncture.

Speech and language therapy to improve the communication skills of children with cerebral palsy.

BACKGROUND: The production of speech, language and gesture for communication is often affected by cerebral palsy. Communication difficulties associated with cerebral palsy can be multifactorial, arising from motor, intellectual and / or sensory impairments, and children with this diagnosis can experience mild to severe difficulties in expressing themselves. They are often referred to speech and language therapy (SLT) services, to maximise their communication skills and help them to take an independent a role as possible in interaction. This can include introducing augmentative and alternative communication (AAC) systems, such as symbol charts or speech synthesizers, as well treating children's natural forms of communication. Various strategies have been used to treat the communication disorders associated with cerebral palsy but evidence of their effectiveness is limited. OBJECTIVES: To determine the effectiveness of SLT that focuses on the child or their familiar communication partners, as measured by change in interaction patterns. To determine if individual types of SLT intervention are more effective than others in changing interaction patterns. SEARCH STRATEGY: Searches were conducted of MEDLINE, CINAHL, EMBASE, PSYCH INFO, LLBA, ERIC, WEB of SCIENCE, NRR, BEI, SIGLE up to December 2002. References from identified studies were examined and relevant journals and conference reports were hand-searched. SELECTION CRITERIA: Any experimental study containing an element of control was included in this review. This includes non-randomised group studies and single case experimental designs in which two interventions were compared or two communication processes were examined. DATA COLLECTION AND ANALYSIS: L Pennington searched for and selected studies for inclusion. J Goldbart and J Marshall independently assessed separate random samples each comprising 25% of all identified studies. Two reviewers independently abstracted data from each selected study. Disagreements were settled by discussion between the three reviewers. MAIN RESULTS: Eleven studies were included in the review. Seven studies evaluated treatment given directly to children, four investigated the effects of training for communication partners. Subjects in the studies varied widely in age, type and severity of cerebral palsy, cognitive and linguistic skills. Studies focusing directly on children suggest that this model of therapy delivery has been associated with increases in treated communication skills by individual children. However, methodological flaws prevent firm conclusions being made about the effectiveness of therapy. In addition, maintenance of these skills was not investigated thoroughly. The studies targeting communication partners describe small exploratory group projects which contain insufficient detail to allow replication, have very low power and cannot provide evidence of effectiveness of this type of treatment. REVIEWERS' CONCLUSIONS: Firm evidence of the positive effects of SLT for children with cerebral palsy has not been demonstrated by this review. However, positive trends in communication change were shown. No change in practice is recommended from this review. Further research is needed to describe this client group, and its possible clinical subgroups, and the methods of treatment currently used in SLT. Research is also needed to investigate the effectiveness of new and established interventions and their acceptability to families. Rigour in research practice needs to be extended to enable firm associations between therapy and communication change to be made.

The UK education of overseas students in speech and language therapy.

Informal evidence suggests that many overseas speech and language therapists (SLTs) either do not return to their home country on qualification or do not work as SLTs in the public sector. Many factors may contribute to this situation. However, concern that it may result in part from a poor match between UK SLT education and the demands of the role in other countries, led the Royal College of Speech and Language Therapists (RCSLT) to fund a study of overseas SLT students' experiences of UK qualifying courses. The study involved questionnaires and interviews with current students and those qualifying since May 1994. The focus of this paper is the respondents' experiences of studying and working in the UK, their views of the advantages and disadvantages of working in their home countries and the UK and supportive strategies that UK universities and other agencies might adopt. Implications of the findings are discussed.

The appropriateness of western models of parent involvement in Calcutta, India. Part 1: Parents' views on teaching and child development.

As the initial stage of an evaluation of services offered to families at Shishu Sathi, West Bengal, by Spastics Society of Eastern India, a partial replication of a Guyanese study was undertaken. The results are presented in two papers. This paper (part 1) examines parents' beliefs concerning child development and the effectiveness of teaching. Part 2 explores roles and responsibilities within families in relation to the time available to parents for active participation in a parent involvement project. The aim is to find out in terms of the above issues whether, and to what extent, it is appropriate to apply Western models of Intervention with families in West Bengal. The findings suggest that strong similarities exist between parents' beliefs in this study, the Guyanese sample, and Western expectations, concerning child development and the effects of teaching, though with certain interesting exceptions. Possible reasons for these differences are discussed along with implications for the design and delivery of services.

The appropriateness of western models of parent involvement in Calcutta, India. Part 2: Implications of family roles and responsibilities.

As the initial stage of an evaluation of services offered to families at Shishu Sathi, West Bengal, by Spastics Society of Eastern India, a partial replication of a study from Guyana was undertaken. The overall aim was to examine the extent to which it is realistic and practicable to apply Western models of parental participation in intervention with families in West Bengal, in terms of the extent to which the project families meet requirements implicit in these Western models. The results are presented in two papers. Part 1 examined parents' beliefs concerning child development and the effects of teaching on children's development. This paper explores the division of roles and responsibilities within families in relation to demands on family members and the time available to parents for active participation in a parent involvement project. The results of the study demonstrate that, whilst mothers' domestic responsibilities are particularly onerous, their roles and those of other family members varied according to the type of family structure. Implications for service delivery and involvement of the wider family are discussed.