Identification of a know-do gap: An observational study of the assessment and treatment of dysphagia during inpatient stroke rehabilitation in primary healthcare in Norway.

PURPOSE: Oropharyngeal dysphagia is a common swallowing impairment post-stroke managed by speech language pathologists (SLP). This article aims to demonstrate a local know-do gap assessment for usual dysphagia care for patients undergoing inpatient stroke rehabilitation in primary healthcare in Norway, which included an assessment of the functional level of the patients and characteristics and outcomes of treatment. MATERIALS AND METHODS: In this observational study, we assessed the outcomes and interventions of patients admitted to inpatient rehabilitation following stroke. The patients received usual care from SLPs while the research team administered a dysphagia assessment protocol that included assessment of several swallowing domains including oral intake, swallowing, patient self-reported functional health status and health-related quality of life, and oral health. The treating SLPs documented the treatments provided in a treatment diary. RESULTS: Of 91 patients who consented, 27 were referred for SLP and 14 received treatment. During the median treatment period of 31.5 days (IQR = 8.8-57.0), patients received 7.0 treatment sessions (IQR = 3.8-13.5) of 60 minutes (IQR = 55-60). The patients who received SLP treatment demonstrated no/minor disorders (n = 7) and moderate/severe disorders (n = 7). Dysphagia treatments primarily included oromotor training and advice on bolus modification and were provided without association to dysphagia severity. Patients with moderate/severe swallowing impairments received slightly more SLP sessions over a longer time. CONCLUSIONS: This study identified gaps between current and best practices and opportunities to improve assessment, decision-making, and implement evidence-based practices.

Validation of Pain Assessment Checklist for Seniors with Limited Ability to Communicate-II (PACSLAC-II) in Iranian older adults with dementia living in nursing homes.

BACKGROUND: Some dementia patients can self-report pain although the reports are not valid in severe dementia. Observational scales have been developed for pain assessment in these patients. This study aimed to assess the psychometric properties of the Persian version of Pain Assessment Checklist for Seniors with Limited Ability to Communicate-II (PACSLAC-II). METHODS: This validation study was conducted on 138 older adults with dementia suffering from chronic pain who lived in nursing homes. The PACSLAC-II Persian version was applied through observations during activity and rest. Reliability of the PACSLAC-II was evaluated by Cronbach's alpha and intra-class correlation coefficients. Construct validity was determined by confirmatory factor analysis, divergent and convergent validity. The Spearman's rank correlation between PACSLAC-II scores and Faces Pain Scale was calculated for concurrent validity. Known-group validity during activity and rest was calculated by Wilcoxon signed ranks test. RESULTS: Cronbach's alpha coefficient for facial expression (0.82), verbalisation (0.72), and body movement (0.84) subscales indicated good internal consistency. The intra-class correlation coefficients between two raters was 0.76 and in three times evaluation, the value was 0.76. Convergent validity with Iranian Brief Pain Inventory and divergent validity with 15-item Geriatric Depression Scale confirmed the construct validity of PACSLAC-II. Three factors structure of PACSLAC-II was approved, and most of the variance was explained by facial expressions. The PACSLAC-II can discriminate between pain and non-pain events and has a moderate correlation with Faces Pain Scale (r = 0.33). CONCLUSIONS: PACSLAC-II Persian version is a valid and reliable scale for pain assessment in older adults with dementia.

Implementing Aided Augmentative Communication Systems With Persons Having Complex Communicative Needs.

Augmentative and alternative communication (AAC) systems can support communication skills for people with significant developmental disabilities who experience complex communication needs (CCNs). There is a need to tailor best practices in AAC assessment and intervention to create individualized communication systems with this population. In this article, we outline the important components of AAC systems that can be implemented in authentic settings. However, given the limited evidence on AAC interventions specific to people with CCNs, we also identify some priority areas for future inquiry. Among these involve strategies to enhance decision making regarding (a) matching communication mode(s) to learner skills and contextual demands, (b) identifying communicative opportunities and obligations, (c) individualizing aided communication display features, (d) selection of vocabulary specificity, and (e) considering dosage parameters needed to acquire and maintain a communicative repertoire. In addition, we briefly discuss the use of telehealth to enhance intervention capability.

New and emerging access technologies for adults with complex communication needs and severe motor impairments: State of the science.

Individuals with complex communication needs often use alternative access technologies to control their augmentative and alternative communication (AAC) devices, their computers, and mobile technologies. While a range of access devices is available, many challenges continue to exist, particularly for those with severe motor-control limitations. For some, access options may not be readily available or access itself may be inaccurate and frustrating. For others, access may be available but only under optimal conditions and support. There is an urgent need to develop new options for individuals with severe motor impairments and to leverage existing technology to improve efficiency, increase accuracy, and decrease fatigue of access. This paper describes person-centred research and development activities related to new and emerging access technologies, with a particular focus on adults with acquired neurological conditions.

Evidence-based development and initial validation of the pain assessment checklist for seniors with limited ability to communicate-II (PACSLAC-II).

OBJECTIVES: Our goal was to develop and validate, based on theoretical and empirical knowledge, the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-II), a shorter tool that would improve on the PACSLAC, while addressing limitations of the original version. METHODS: The PACSLAC was revised based on the relevant clinical and theoretical literature. Psychometric properties and clinical utility of the resulting 31-item PACSLAC-II were examined. Specifically, the PACSLAC-II was used to assess pain based on video footage of long-term care (LTC) residents with dementia undergoing painful procedures as part of routine care. Its ability to discriminate pain from non-pain-related states was compared with that of preexisting pain assessment tools using archival data. A second phase involved the use of the PACSLAC and PACSLAC-II by LTC staff to solicit feedback from health care providers. Mixed-methods analysis of this feedback was conducted. RESULTS: The PACSLAC-II demonstrated satisfactory reliability, excellent validity, and ability to differentiate between pain and nonpain states. The PACSLAC-II also accounted for unique variance in differentiating between pain and nonpain states, even after controlling for the preexisting tools combined, including the PACSLAC. The PACSLAC-II was also preferred by many LTC nurses and care aides, because of its length and condensed nature, which was thought to facilitate documentation and greater efficiency in pain management. DISCUSSION: Findings indicate that the empirical and theoretically driven revisions to the PACSLAC led to improved ability to differentiate between pain and nonpain states, while retaining its clinical utility.

Developmental delays and dental caries in low-income preschoolers in the USA: a pilot cross-sectional study and preliminary explanatory model.

BACKGROUND: Anecdotal evidence suggests that low-income preschoolers with developmental delays are at increased risk for dental caries and poor oral health, but there are no published studies based on empirical data. The purpose of this pilot study was two-fold: to examine the relationship between developmental delays and dental caries in low-income preschoolers and to present a preliminary explanatory model on the determinants of caries for enrollees in Head Start, a U.S. school readiness program for low-income preschool-aged children. METHODS: Data were collected on preschoolers ages 3-5 years at two Head Start centers in Washington, USA (N = 115). The predictor variable was developmental delay status (no/yes). The outcome variable was the prevalence of decayed, missing, and filled surfaces (dmfs) on primary teeth. We used multiple variable Poisson regression models to test the hypothesis that within a population of low-income preschoolers, those with developmental delays would have increased dmfs prevalence than those without developmental delays. RESULTS: Seventeen percent of preschoolers had a developmental delay and 51.3% of preschoolers had ≥1 dmfs. Preschoolers with developmental delays had a dmfs prevalence ratio that was 1.26 times as high as preschoolers without developmental delays (95% CI: 1.01, 1.58; P < .04). Other factors associated with increased dmfs prevalence ratios included: not having a dental home (P = .01); low caregiver education (P < .001); and living in a non-fluoridated community (P < .001). CONCLUSIONS: Our pilot data suggest that developmental delays among low-income preschoolers are associated with increased primary tooth dmfs. Additional research is needed to further examine this relationship. Future interventions and policies should focus on caries prevention strategies within settings like Head Start classrooms that serve low-income preschool-aged children with additional targeted home- and community-based interventions for those with developmental delays.

Developing and validating a Japanese version of the Assessment of Pain in Elderly People with Communication Impairment.

This study aimed to develop a Japanese version of the Assessment of Pain in Elderly People with Communication Impairment (PACSLAC-J) and evaluate the validity and reliability of the scale for use in older patients with dementia in Japan. All patients from 2 dementia wards at a geriatric hospital and 2 aged care facilities were asked to participate. Demographic data, medical prescriptions, Behavior Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD) score, and PACSLAC-J score were obtained from the patients or their medical charts. Researchers used the PACSLAC-J to assess pain behaviors while the patients walked or were transferred between a bed and a wheelchair. Intra-class correlation coefficients (ICC) for inter-rater and test-retest reliability, Cronbach's alpha, and correlations between PACSLAC-J score and other variables were examined. A total of 117 older patients participated. Dementia, including Alzheimer's disease (n=54) and/or vascular dementia (n=35), had been diagnosed in almost all of them. The ICC for inter-rater and test-retest reliability were 0.917 and 0.600, respectively. Internal consistency of the entire sample was 0.782. Patients who stated they were experienced pain during movement had higher scores than did patients who stated they had no pain during movement. PACSLAC-J total score was not associated with BEHAVE-AD score. Multiple regression analysis showed that total dependence on assistance during transfer (ß=0.32, p=0.001), and psychiatric medication prescription (ß=0.26, p=0.003) were independently associated with PACSLAC-J score. We found sufficient evidence of the validity and reliability of the PACSLAC-J.

Assessment of fluctuating decision-making capacity in individuals with communication barriers: a case study.

A current need exists for research to assist clinicians in the capacity evaluation process, especially in relation to assessment of clients with complex issues such as fluctuating capacity and communication barriers. The aim of this article is to promote knowledge and consideration of these issues through an examination of neuropsychological, ethical, and medical-legal factors associated with the assessment of capacity in an individual with both fluctuating capacity and communication impairments. The discussion includes a narrative case study of a complex individual case seen by the Regional Capacity Assessment Team (RCAT) for an assessment of decision-making capacity related to personal and financial matters. Relevant background information about this client, behavioral observations, neuropsychological test results, and the process and outcome of the RCAT targeted capacity interview are presented. Based on previous literature and the case study, a series of recommendations are provided to guide the clinician through the capacity evaluation process with individuals with complex issues. Common pitfalls, nuances, and dilemmas involved in capacity assessment are addressed.

A nationally representative study of the association between communication impairment at 4-5 years and children's life activities at 7-9 years.

PURPOSE: To examine the longitudinal association between communication impairment (primary or secondary diagnosis) and children's Activities and Participation (International Classification of Functioning, Disability and Health--Children and Youth [ICF-CY]; World Health Organization [WHO], 2007). METHOD: Participants were 4,329 children in the Longitudinal Study of Australian Children (LSAC; Australian Institute of Family Studies [AIFS], 2009): 1,041 (24.0%) of these children were identified with communication impairment at 4-5 years of age, and 3,288 (76.0%) of these children were not identified with a communication impairment. At age 7-9 years, Activities and Participation (WHO, 2007) outcomes across 5 ICF-CY domains were provided by (a) teachers (Academic Rating Scales [National Center for Education Statistics (NCES), 2002], Approach to Learning Scale [Gresham & Elliott, 1990], School Progress Scale (AIFS, 2009), Strengths and Difficulties Questionnaire [SDQ; Goodman, 1997], and Student-Teacher Relationship Scale [Pianta, 2001]); (b) parents (School-Age Inventory of Temperament [McClowry, 1995] and SDQ); (c) children (Marsh Self-Description Questionnaire-III [Marsh, 1992], School Liking [Ladd & Price, 1987], and Bullying [Kochenderfer & Ladd, 1997]); and (d) child assessment (Peabody Picture Vocabulary Test--III: Adapted; Rothman, 2003). RESULTS: Children identified with communication impairment at age 4-5 years performed significantly poorer at age 7-9 years on all outcomes. Parents and teachers reported slower progression in reading, writing, and overall school achievement than peers. Children reported more bullying, poorer peer relationships, and less enjoyment of school than did their peers. Analyses of covariance tests confirmed significant associations between communication impairment and outcomes, over and above the effects of sex, age, Indigenous status, and socioeconomic status. CONCLUSION: Consideration of the breadth and longevity of Activities and Participation outcomes reveals the potential extent and severity of communication impairment and directs future research and practice.

A tutorial on multiblock discriminant correspondence analysis (MUDICA): a new method for analyzing discourse data from clinical populations.

PURPOSE: In communication disorders research, clinical groups are frequently described based on patterns of performance, but researchers often study only a few participants described by many quantitative and qualitative variables. These data are difficult to handle with standard inferential tools (e.g., analysis of variance or factor analysis) whose assumptions are unfit for these data. This article presents multiblock discriminant correspondence analysis (MUDICA), which is a recent method that can handle datasets not suited for standard inferential techniques. METHOD: MUDICA is illustrated with clinical data examining conversational trouble-source repair and topic maintenance in dementia of the Alzheimer's type (DAT). Seventeen DAT participant/spouse dyads (6 controls, 5 participants with early DAT, 6 participants with moderate DAT) produced spontaneous conversations analyzed for co-occurrence of trouble-source repair and topic maintenance variables. RESULTS: MUDICA found that trouble-source repair sequences and topic transitions are associated and that patterns of performance in the DAT groups differed significantly from those in the control group. CONCLUSION: MUDICA is ideally suited to analyze language and discourse data in communication disorders because it (a) can identify and predict clinical group membership based on patterns of performance, (b) can accommodate few participants and many variables, (c) can be used with categorical data, and (d) adds the rigor of inferential statistics.

Chinese version of the Pain Assessment in Advanced Dementia Scale: initial psychometric evaluation.

AIM: This paper is a report of the validity and reliability testing of the Chinese version of the Pain Assessment in Advanced Dementia Scale (PAINAD-C). BACKGROUND: Pain is under-reported and under-treated for people with dementia, largely due to impairment of communication. An adequate instrument for assessment of pain in this population is essential to improving their quality of life and decreasing disability and behavioural disturbances, but none were found that were appropriate for these purposes. METHOD: The PAINAD-C was developed in three phases in 2006. First, back-translation was used to create the Chinese version, where five medical and nursing experts assessed content validity. Inter-rater reliability, internal consistency reliability and test-retest reliability were then examined. Finally, principal component analysis and known-group comparisons were used to test construct validity. Participants with dementia were selected from five licensed long-term care facilities in Taiwan. Direct observation was used to collect data. RESULTS: Inter-rater reliability showed an intra-class correlation coefficient of 0.80-0.86, and a test-retest reliability intra-class correlation coefficient of 0.71. The internal consistency reliability was 0.55-0.66. Factor analysis of the PAINAD-C showed two factors that explained 62.48% of variance. The PAINAD-C scores showed statistically significant differences between the non-dementia group and the advanced dementia group as well as significant differences between activities and rest groups. CONCLUSION: The PAINAD-C is useful in a clinical setting for people with advanced dementia for both research and practice. It is easy to use and is a comprehensive instrument.

Understanding distress in people with severe communication difficulties: developing and assessing the Disability Distress Assessment Tool (DisDAT).

BACKGROUND: Meaningful communication with people with profound communication difficulties depends on the ability of carers to recognize and translate many different verbal cues. Carers appear to be intuitively skilled at identifying distress cues, but have little confidence in their observations. To help in this process, a number of pain tools have been developed, but this sits uncomfortably with the lack of evidence that pain has any specific signs or behaviours. A palliative care team working with people with intellectual disabilities developed the Disability Distress Assessment Tool (DisDAT) to document a wide range of signs and behaviours of distress and when an individual is content. METHOD: The tool was piloted with 16 carers and 8 patients. It was then assessed using quantitative and qualitative methods, employing 56 carers in routine clinical situations with 25 patients, most with severe communication difficulties. Carers of 10 patients participated in semi-structured interviews exploring the signs and behaviours demonstrated by patients when distressed and when content. These same 10 patients were observed for distress cues during different activities. RESULTS: It became clear that distress did not have a common meaning among carers, but there was a clear understanding that distress did not just cover physical pain. The range of distress cues was wide, with no evidence that any cues were specific to particular causes. Although some distress cues were common between patients, each patient had a distinct pattern of distress cues. In addition, different carers identified a different range of distress cues, while the length of the relationship did not influence the number of cues identified. Most distress cues were a change from the norm, but some patients demonstrated distress as an absence of content cues. Carers found the DisDAT simple to use and useful, and several felt that DisDAT would have helped advocate for the patients in previous conflicts with clinical teams. CONCLUSIONS: There was no evidence that pain has any specific signs or behaviours. The preliminary and assessment phases showed that distress was a useful clinical construct in providing care. The DisDAT reflected patients' distress communication identified by a range of carers, and provided carers with evidence for their intuitive observations of distress.

Pain assessment in nonverbal older adults with advanced dementia.

TOPIC: Pain assessment is a particular challenge among individuals with advanced dementia who lack the ability to formulate and express their experience of discomfort. PURPOSE: Awareness of pain scales and methods specifically designed for use with nonverbal individuals with dementia is critical to expanded use and testing in clinical settings. SOURCES: Computerized literature searches using four databases revealed the five observational scales and two caregiver reports methods reviewed. CONCLUSIONS: A small number of valid, reliable, and sensitive scales are available for use by nurses and allied health personnel. Each has strengths and limitations and all would benefit from additional testing.

Development and preliminary validation of the pain assessment checklist for seniors with limited ability to communicate (PACSLAC).

The purpose of this study, conducted in three phases, was to develop a clinically useful observational tool (i.e., the Pain Assessment Checklist for Seniors With Limited Ability to Communicate [PACSLAC]) to assess pain in seniors with severe dementia. In Phase 1, professional caregivers of seniors with severe dementia were interviewed in order to generate a list of pain-related behaviors that are characteristic of care recipients living in long-term-care facilities. Based on a systematic examination of interview transcripts by experienced researchers and an independent coder, a behavioral checklist (i.e., the initial version of the PACSLAC) was developed. The checklist items were organized into conceptually based subscales (e.g., facial expressions, activity/body movement). Phase 2 focused on an assessment of the internal consistency of the checklist (alpha =.92). Following an item analysis, the subscales of the PACSLAC (Social/Personality/Mood Indicators, Facial Expressions, Activity/Body Movement, and Physiological Indicators/Eating/Sleeping Changes/Vocal Behaviors) were found to be internally consistent. Phase 3 focused on a preliminary validation of the PACSLAC. Analyses suggest that the PACSLAC discriminated among pain events (during which there was a clear and recognizable cause for the patients' pain), events during which patients were experiencing nonpainful distress, and situations during which patients were calm.

Selective mutism: how a successful speech and language assessment really is possible.

A speech and language assessment of children with selective mutism is often difficult because these children are silent in most situations. In Australia, a study was designed to assess the children in their homes, the place where they usually speak. Five children who met the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association 1994) criteria for selective mutism participated in the study. Assessment included audio-taping extracts of the children's conversations with members of their family and the administration of a number of standardised speech and language tests. The study found that four of the five children had a communication disorder. This paper outlines these communication disorders and describes how a successful speech and language assessment of children with selective mutism is possible.

Assessment of memory in neurogenic communication disorders.

The evaluation of memory in adults with neurogenic communication disorders is complicated by the fact that traditional memory assessment emphasizes verbal content. Also, standardized test procedures often include long and complex instructions that place heavy comprehension demands on clients. This article provides an overview of these and other issues to consider when assessing memory in adults with neurogenic communication disorders. Specifically, this article will include (1) a description of the concept of memory for clinical assessment and definitions of common terms; (2) a general review of assessment methods and selected tests; and (3) considerations for assessing adults with neurogenic communication disorders.

Cadê todo mundo?. O que a gente faz agora?

O vídeo apresenta dois filmes: 1º filme: Cadê todo mundo? Trata da comunicação dos adultos com as crianças. A comunicação é aprendida aos poucos e as crianças vão se colocando no mundo por meio dela. a criança é incentivada a falar e ser ouvida, começando assim a se construir como indivíduo inserido num contexto social. A socialização é percebida por meio da assimilação de regras que são estabelecidas por normas verbais e não verbais. 2º filme: O que a gente faz agora? Aprender a se cuidar desde quando se é pequeno, vai favorecer um desenvolvimento saudável e prazeroso. As crianças começam a perceber os riscos de ficarem doentes, as defesas do organismo e os medicamentos que são usados para o retorno da saúde. Por meio deste desenho animado os professores terão oportunidade de informarem às crianças sobre o que é saúde e doença

A case study: follow-up assessment of facilitated communication.

A 6-month follow-up of an individual reported to engage in validated facilitated communication (FC) is presented. Three main issues are addressed: the current status of the individual's FC use, the effect of food reinforcers on his communicative ability, and a comparison of FC to the Picture Exchange Communication System (PECS). Results indicated that the individual did not engage in any validated FC, that performance was equivalent on food and nonfood trials, and that PECS was the preferred mode of communication, yielding 100% accuracy in a message-passing, object identification task. Implications of these findings are discussed in the context of an individual's right to communicate by objectively validated methods.

Validity and reliability of the infant behavioral summarized evaluation (IBSE): a rating scale for the assessment of young children with autism and developmental disorders.

The Infant Behavioral Summarized Evaluation (IBSE) is a rating scale adapted from the Behavioral Summarized Evaluation (BSE) and specifically related to the assessment of behaviors of young children having autistic disorders. Content validity and reliability studies described in the paper were made from behavior ratings of videotapes for 89 children aged from 6 to 48 months. Results show a significant group of 19 items including some characteristic early autistic behaviors (communicative and social abnormalities) and some that are less commonly described in the syndrome (attentional, perceptive, and adaptive disorders). The value of the use of this scale for clinicians and professionals involved in behavioral evaluations and treatment of young children with developmental disorders and the necessity for further psychometric investigations are discussed.