Pain assessment tools in adults with communication disorders: systematic review and meta-analysis.

BACKGROUND: Verbal communication is the "gold standard" for assessing pain. Consequently, individuals with communication disorders are particularly vulnerable to incomplete pain management. This review aims at identifying the current pain assessment instruments for adult patients with communication disorders. METHODS: A systematic review with meta-analysis was conducted on PubMed, PEDRO, EBSCOhost, VHL and Cochrane databases from 2011 to 2023 using MeSH terms "pain assessment, "nonverbal communication" and "communication disorders" in conjunction with additional inclusion criteria: studies limited to humans, interventions involving adult patients, and empirical investigations. RESULTS: Fifty articles were included in the review. Seven studies report sufficient data to perform the meta-analysis. Observational scales are the most common instruments to evaluate pain in individuals with communication disorders followed by physiological measures and facial recognition systems. While most pain assessments rely on observational scales, current evidence does not strongly endorse one scale over others for clinical practice. However, specific observational scales appear to be particularly suitable for identifying pain during certain potentially painful procedures, such as suctioning and mobilization, in these populations. Additionally, specific observational scales appear to be well-suited for certain conditions, such as mechanically ventilated patients. CONCLUSIONS: While observational scales dominate pain assessment, no universal tool exists for adults with communication disorders. Specific scales exhibit promise for distinct populations, yet the diverse landscape of tools hampers a one-size-fits-all solution. Crucially, further high-quality research, offering quantitative data like reliability findings, is needed to identify optimal tools for various contexts. Clinicians should be informed to select tools judiciously, recognizing the nuanced appropriateness of each in diverse clinical situations. TRIAL REGISTRATION: This systematic review is registered in PROSPERO (International prospective register of systematic reviews) with the ID: CRD42022323655 .

Relation of Speech-Language Profile and Communication Modality to Participation of Children With Cerebral Palsy.

PURPOSE: This study aimed to examine the contribution of speech motor impairment (SMI), language impairment, and communication modality to communicative and overall participation outcomes in school-age children with cerebral palsy (CP). METHOD: Eighty-one caregivers of children with CP provided information about their child's speech and language skills, communication modality, and participation through a web-based survey. Caregiver responses to two validated scales were used to quantify children's communicative participation and overall participation. Children were classified into four speech-language profile groups and three communication modality groups for comparison, based on caregiver-reported information regarding their child's communication skills. RESULTS: Children with CP who had co-occurring SMI and language impairment had significantly lower levels of communicative participation and involvement in activities overall, compared to children with SMI alone. Among children with SMI, augmentative and alternative communication (AAC) use was associated with greater overall frequency of participation and involvement in life activities. CONCLUSION: Children with CP who have both SMI and language impairment and those who are nonspeaking communicators should be prioritized early for communication interventions focused on maximizing participation, including consideration of AAC.

Influencia de la prematurez en el desarrollo de la comunicación / Prematurity influence in the development of communication / Influência da prematuridade no desenvolvimento da comunicação

Introducción: dentro de las alteraciones del neurodesarrollo, la prematurez es un factor de riesgo. Los niños prematuros tempranamente pueden presentar retraso en la comunicación y lenguaje, comparados con la población general. Objetivos: Dar a conocer la influencia de la prematurez en el desarrollo de la comunicación y el abordaje posible a realizar. Material y métodos: Análisis de 59 historias clínicas de niños prematuros que asistieron a control y seguimiento en el Gabinete de Intervención Temprana del Hospital Argerich, desde enero de 2011 hasta enero de 2017; y Escala Bayley del Desarrollo Infantil aplicada a cada niño, contemplando habilidades comunicativas y lingüísticas. Resultados: De las habilidades comunicativas esperadas para cada rango de edad, los diversos grupos (6, 9, 12, 18 meses de edad corregida) no alcanzaron a completar el 50% de las mismas. Analizando los resultados de cada grupo de prematuros (Extremo, Muy, Moderado y Tardío), se encontró que a medida que aumenta la edad gestacional existe un aumento de porcentaje de puntuación menor a dos desvíos estándar, visualizado a partir de los 9 meses de edad corregida, presentando compromiso cognitivo general y no sólo del lenguaje. Conclusiones: La prematurez afecta el desempeño comunicativo de los niños. La intervención fonoaudiológica temprana y el desarrollo de dispositivos de estimulación de comunicación y lenguaje contribuirían a disminuir el impacto que puede tener en el desarrollo global de los niños, favoreciendo la intra e intercomunicación, desde los primeros meses de vida.

Introduction: within neurodevelopmental disorders, prematurity is a risk factor. Also, premature infants, may have delays in language and communication acquisition compared to the general population. Objectives: Present the influence of prematurity in the development of communication and the possible approach to be performed. Material and methods: Analysis of 59 clinical records of premature infants, who attended control and follow-up at the Argerich Hospital Early Intervention Service, from January 2011 to January 2017; And Bayley's Scale of Child Development applied to each child, contemplating communicative and linguistic skills. Results: Of the communicative skills expected for each age range, the various groups (6, 9, 12, 18 months of age corrected) fail to complete 50% of the same. Analyzing the results of each group of premature infants (Extreme, Very, Moderate and Late), it was found that as gestational age increases, there is an increase in percentage of score less than two standard deviations observed after 9 months of age corrected, presenting general cognitive commitment and not just of the language. Conclusions: Prematurity affects the communicative performance of children. Early speech therapy and the development of language and communication stimulation devices, would contribute to reduce the impact that can have on the global development of children, favoring intra and intercommunication, from first months of life.

Introdução: dentro das alterações do neurodesenvolvimento a prematuridade é um fator de risco. Os prematuros podem ter atrasos na aprendizagem da linguagem, em comparação com a população em geral. Objetivos: Apresentar a influência da prematuridade no desenvolvimento da comunicação e sua possível abordagem. Material e métodos: Análise de 59 histórias clínicas de infantes prematuros que participaram do monitoramento e acompanhamento no gabinete de intervenção precoce do Hospital Argerich, de janeiro de 2011 à janeiro de 2017; a escala Bayley de crianças em desenvolvimento aplicada a cada criança, contemplando as habilidades comunicativas e lingüísticas. Resultados: Entre as habilidades comunicativas esperadas para cada facha de etária, os diversos grupos (6, 9, 12, 18 meses de idade corregida) não chegam a completar 50% dessas habilidades. Analisando os resultados de cada grupo de prematuros (extremo, muito, moderado e tarde), encontramos que a medida que aumenta a idade gestacional existe um aumento da porcentagem na pontuação menor a dois desvios estândar, observado a partir dos 9 meses, apresentando compromisso cognitivo general e não somente da linguagem. Conclusões: A prematuridade afeta o desempenho comunicativo de crianças. A intervenção fonoaudiológica precoce e o desenvolvimento de dispositivos de estimulação da linguagem, ajudaria a diminuir o impacto que pode ter sobre o desenvolvimento global das crianças, favorecendo a intra e intercomunicação a partir dos primeiros meses de vida.