Referential interactions of Turkish-learning children with their caregivers about non-absent objects: integration of non-verbal devices and prior discourse

This paper examines the way children younger than two use non-verbal devices (i.e., deictic gestures and communicative functional acts) and pay attention to discourse status (i.e., prior mention vs. newness) of referents in interactions with caregivers. Data based on semi-naturalistic interactions with caregivers of four children, at ages 1;00, 1;05, and 1;09, are analyzed. We report that children employ different types of non-verbal devices to supplement their inadequate referential forms before gaining mastery in language. By age 1;09, children show sensitivity to discourse status by using deictic gestures to accompany their non-lexical forms for new referents. A comparison of children's patterns with those in the input they receive reveals that caregivers choose their referential forms in accordance with discourse status information and tend to use different types of non-verbal devices to accompany their lexical and non-lexical referential forms. These results show that non-verbal devices play an important role in early referential discourse.

Exploring Expressive Communication Skills in a Cross-Sectional Sample of Children and Young Adults With Angelman Syndrome

PURPOSE

This study explores data on expressive communication skills of 300 individuals aged 0.0-21.11 years with Angelman syndrome (AS). These data provide a composite portrait of communication skills in a large sample of children and young adults with this rare disorder, specifying new detailed information about expressive communication.

METHOD

The database associated with the Communication Matrix assessment (Rowland, 2004, 2011; Rowland & Fried-Oken, 2010) was mined for data regarding individuals with AS. We extracted data on the reasons for communicating, level of communication achieved, and use of various expressive communication modes to convey 24 specific messages. The performance of children and young adults in 5 age groups in the cross-sectional sample were contrasted.

RESULTS

Results confirmed earlier studies showing that few individuals with AS use natural speech. However, in addition to using presymbolic modes, many children used alternative symbolic modes such as picture symbols, object symbols, and manual signs. Assessment scores increased slightly with age, F(4, 295) = 2.416, p = .049.

CONCLUSIONS

Aggregating data on a large sample of individuals with AS provides a reference point for practitioners and family members and a basis for future investigations.

How Much Information Do People With Aphasia Convey via Gesture?

PURPOSE

People with aphasia (PWA) face significant challenges in verbally expressing their communicative intentions. Different types of gestures are produced spontaneously by PWA, and a potentially compensatory function of these gestures has been discussed. The current study aimed to investigate how much information PWA communicate through 3 types of gesture and the communicative effectiveness of such gestures.

METHOD

Listeners without language impairment rated the information content of short video clips taken from PWA in conversation. Listeners were asked to rate communication within a speech-only condition and a gesture + speech condition.

RESULTS

The results revealed that the participants' interpretations of the communicative intentions expressed in the clips of PWA were significantly more accurate in the gesture + speech condition for all tested gesture types.

CONCLUSION

It was concluded that all 3 gesture types under investigation contributed to the expression of semantic meaning communicated by PWA. Gestures are an important communicative means for PWA and should be regarded as such by their interlocutors. Gestures have been shown to enhance listeners' interpretation of PWA's overall communication.

The Trifocus Framework and Interprofessional Collaborative Practice in Severe Disabilities

PURPOSE

Individuals with severe disabilities are a diverse group of learners with complex communication needs. This article presents a synthesis of the literature addressing the five strategies of the trifocus framework, with its triadic structure of learner with disability, communication partner, and environment. The application of interprofessional collaborative practice (IPCP) to the implementation of trifocus framework communication strategies is emphasized.

METHOD

A literature search was conducted using Google Scholar and EBSCO to identify literature and research studies on IPCP and communication intervention for learners with severe disabilities, published 1994-2015, and then organized within the trifocus framework. The trifocus strategies are enhancing sensitivity, utilizing routines, increasing communication opportunities, modifying the communication environment, and augmenting input. Studies that included at least one participant with severe disabilities and their communication partners were considered. A secondary search was then conducted by reviewing the articles referenced in the original articles.

CONCLUSION

Effective IPCP in communication intervention considers the learner's characteristics, the knowledge and skills required of communication partners, and effective environmental arrangements to support communication. Future research should include clear participant descriptions, documentation of fidelity measures, and evidence of generalization to support professionals to know when findings are relevant to the individuals they serve.

Paediatric cochlear implantation factors that affect outcomes

Cochlear implantation is an established surgical intervention for individuals with bilateral severe to profound sensorineural hearing loss. The aim of the interevention is to provide the individual with a sensation of sound which they can learn to interpret with meaning. Outcomes vary considerably and the factors that impact on outcomes will be discussed.

Exploratory investigation of communication management in residential-aged care: a comparison of staff knowledge, documentation and observed resident-staff communication

BACKGROUND

There is a high prevalence of communication difficulty among older people living in residential-aged care. Such functional deficits can have a negative impact on resident quality of life, staff workplace satisfaction and the provision of quality care. Systematic research investigating the nature of communication management in residential-aged care and factors impacting optimal communication management is lacking.

AIMS

To use data triangulation across multiple sources to describe resident-staff communication and communication management in residential-aged care.

METHODS & PROCEDURES

Participants included a sample of 14 residents and 29 staff directly involved in communication interactions with residents. Data were obtained from: (1) resident file review (n = 14), (2) observation of resident-staff communication (n = 14), (3) resident surveys (n = 14) and (4) staff surveys (n = 29). Data from each source were examined separately then triangulated.

OUTCOMES & RESULTS

All residents had limited opportunity for meaningful communication with staff. Documentation of residents' communication needs and strategies to facilitate resident-staff communication was insufficient to provide individualized recommendations. Although staff were observed to use various strategies to facilitate communication with residents, staff agreement about the applicability of these strategies to individual residents was inconsistent. Differences in resident-staff communication for residents who experience nil/mild versus moderate/severe communication difficulty were also found.

CONCLUSIONS & IMPLICATIONS

Resident-staff communication and communication management in residential-aged care is limited in scope and challenged in meeting residents' individual communication needs. Improvements in both documentation and staff knowledge of residents' communication needs are necessary. Strategies to facilitate communication with individual residents must be tailored, evidence based, documented in care plans and delivered to staff through ongoing education. Increased involvement of specialist providers such as speech pathologists to support better communication management in residential-aged care may provide one way of facilitating such change.

An enhanced protocol for constraint-induced aphasia therapy II: a case series

PURPOSE

The initial version of Constraint-Induced Aphasia Therapy (CIAT I) consisted of a single exercise. This study sought to evaluate the feasibility for future trials of an expanded and restructured protocol designed to increase the efficacy of CIAT I.

METHOD

The subjects were 4 native English speakers with chronic stroke who exhibited characteristics of moderate Broca's aphasia. Treatment was carried out for 3.5 hr/day for 15 consecutive weekdays. It consisted of 3 components: (a) intensive training by a behavioral method termed shaping using a number of expressive language exercises in addition to the single original language card game, (b) strong discouragement of attempts to use gesture or other nonverbal means of communication, and (c) a transfer package of behavioral techniques to promote transfer of treatment gains from the laboratory to real-life situations.

RESULTS

Participation in speech in the life situation improved significantly after treatment. The effect sizes (i.e., d') in this domain were ≥ 2.2; d' values ≥ 0.8 are considered large. Improvement in language ability on a laboratory test, the Western Aphasia Battery-Revised (Kertesz, 2006), did not achieve statistical significance, although the effect size was large--that is, 1.3 (13.1 points).

CONCLUSION

These pilot results suggest in preliminary fashion that CIAT II may produce significant improvements in everyday speech.

Predicting progress in Picture Exchange Communication System (PECS) use by children with autism

BACKGROUND

The Picture Exchange Communication System (PECS) is a widely used communication intervention for non-verbal children with autism spectrum disorder. Findings for the benefits of PECS have almost universally been positive, although there is very limited information about the characteristics of PECS users that determine the amount of progress that they are likely to make.

AIMS

To explore the utility of using children's developmental age to predict the subsequent degree of progress using PECS.

METHODS & PROCEDURES

In a retrospective study, 23 non-verbal 5- and 6-year-old children with autism spectrum disorder attending a special school were assessed to determine their highest level of PECS ability. They were then allocated to one of two groups depending on whether or not they had mastered PECS phase III. All participants had been assessed using the Psycho-Educational Profile-Revised (PEP-R) on entry to the school and before being introduced to PECS. Total developmental age scores were examined to determine whether they accurately predicted membership of the two PECS ability groups.

OUTCOMES & RESULTS

All the 16 children who had mastered PECS phase III had total developmental age scores of 16 months or above, whilst six of the seven children who had not progressed beyond phase III scored below 16 months--the other child had a score of 16 months.

CONCLUSIONS & IMPLICATIONS

The assessment of the developmental level of potential PECS users may provide valuable predictive information for speech-and-language therapists and other professionals in relation to the likely degree of progress and in setting realistic and achievable targets.

Do group audiologic rehabilitation activities influence psychosocial outcomes?

PURPOSE

To attempt to determine whether group audiologic rehabilitation (AR) content affected psychosocial outcomes.

METHOD

A randomized controlled trial with at least 17 participants per group was completed. The 3 treatment groups included a communication strategies training group, a communication strategies training plus psychosocial exercise group, and an informational lecture plus psychosocial exercise group. Evaluations were conducted preclass, postclass, and 6-months postclass; they included hearing loss-related and generic quality of life scales, and a class evaluation form.

RESULTS

All treatment groups demonstrated short- and long-term improvement on the hearing loss-related quality of life scale. Minimal differences were measured across treatment groups. A significant difference was observed between the lecture plus psychosocial exercise group and the communication strategies training group for 1 hearing loss-related quality of life subscale. Better outcomes were measured for the 2 groups with psychosocial exercises versus the communication strategies training group on 1 generic quality of life subscale. The results for the class evaluation did not discriminate among the treatment groups.

CONCLUSIONS

Class content had only a minimal influence on treatment outcomes. Recommended AR class content includes a mix of interventions including information, training, and psychosocial exercises.

The impact of partner training on the communicative involvement of students with multiple and severe disability in special schools

BACKGROUND

The outcomes of a pilot program of staff development in communication support in the context of observed changes in student behaviour states and interactive abilities are reported. Participant reports about the impact of the program on their professional practices are included.

METHOD

Six teachers and six teacher aides in special (segregated) schools were provided with a short, intensive training program designed to improve their communicative interactions with students with multiple and severe disability (MSD) in their classes. Behaviour state assessment was used for pre- and post-testing of six students. Teachers and aides completed self-report scales related to their communication skills, knowledge and concerns prior to and at the conclusion of the training program.

RESULTS

While staff reported improved skills and knowledge, this was not reflected in improvements in the communicative interactions of the students as observed in their classrooms.

CONCLUSIONS

The training provided may not have been sufficient to change well-established teaching and interaction processes. Further research using in-school collaborative mentors is planned.

"Please listen, it's my turn": instructional approaches, curricula and contexts for supporting communication and increasing access to inclusion

BACKGROUND

Four elementary (primary) school students with severe speech and physical impairments (SSPI) who used augmentative and alternative communication (AAC) aids were selected to take part in an intensive, 4-week summer intervention program. The program was designed to explore effective approaches, content and contexts for supporting communication (including oral language, literacy, and technology skills) among young people who require AAC.

METHOD

Features of the intervention included (i) using an integrated approach to provide language and literacy opportunities intended to elicit the students' active involvement in meaningful, productive and expressive tasks in everyday contexts; (ii) constant modelling of AAC usage; (iii) requiring family involvement as a criterion for participation in the program; and (iv) follow-up visits to schools during which effective instructional strategies were shared with staff.

RESULTS

Formative and summative assessment measures revealed that all four participants made progress during intervention. However two of the students maintained these gains into the follow-up period, whereas the other two did not. Each pair seemed to share certain characteristics, which are illustrated in this paper by two case study synopses. One relates the story of a child whose successes continued into the follow-up period, and the other chronicles the experiences of the child whose successes quickly waned.

CONCLUSIONS

This study provides a range of instructional approaches, curricula and contexts to promote communication for children with complex communication needs. These instructional supports are more likely to improve access to inclusion in schools that seek to work in partnership with parents, plan educational transitions, and implement adequate training and awareness-raising among their staff.

Presumed competence reflected in the educational programs of students with IDD before and after the Beyond Access professional development intervention

BACKGROUND

Judgements about students' competence influence the goals of their individualised education programs (IEPs), the location of service delivery, and their placement in general education (GE) as opposed to special education (SE) classes. The purpose of this study was to describe how presumed competence to learn the GE curriculum was reflected in the IEPs of students with intellectual and developmental disabilities (IDD), and in the reported percentage of time that these students spent in GE classes prior to and following the Beyond Access professional development intervention.

METHOD

Five educational teams of students with IDD participated in a professional development intervention that emphasised students' presumed competence to learn grade-level GE curriculum. Students' pre- and post-intervention IEPs were qualitatively analysed and team member reports of percentage time spent in GE classes were averaged.

RESULTS

Five categories of presumed competence were identified. Following intervention, emphasis on learning the GE curriculum, a shift in location of service delivery from outside to within the GE classroom, and increased time spent in GE classes were reported.

CONCLUSIONS

The Beyond Access intervention shows promise for enhancing views of the competence of students with IDD to learn the GE curriculum and for increasing their inclusion in GE classrooms.

Pediatric cochlear implantation in Taiwan: long-term communication outcomes

OBJECTIVES/HYPOTHESIS

Cochlear implantation is an established method of auditory rehabilitation for severely and profoundly hearing impaired individuals. Although numerous studies have examined communication outcomes in pediatric cochlear implant (CI) recipients, data concerning the benefits of cochlear implantation in children who speak Mandarin Chinese are lacking. This study examined communication outcomes in 29 Mandarin-speaking children implanted at Chung Gung Memorial Hospital.

DESIGN

A prospective between-groups design was used to compare communication outcomes as a function of age at time of implantation.

METHODS

Children in the Younger group were implanted before 3 years of age, whereas children in the Older group were implanted after 3 years of age. Outcome measures assessed auditory thresholds, speech perception, speech intelligibility, receptive and expressive language skills, communication barriers, and communication mode. Correlation analysis was used to examine the relationship between communication outcome and age at implantation.

RESULTS

Children in the Younger group demonstrated a significant level of difference on Mandarin vowels, consonants, tones, and open-set speech perception compared with the children in the Older group. Between-group differences were also shown on receptive and expressive language skills. But, no significant differences were noted on speech intelligibility or in self-ratings of communication barriers. A larger proportion of children in the Younger group used oral communication and were educated in mainstream classrooms. Communication mode change of the Younger group reached a significant level after cochlear implant. Speech perception performance was negatively correlated with age at implantation as well as chronological age. Mandarin-speaking children can obtain substantial communication benefits from cochlear implantation, with earlier implantation yielding superior results.

Communication strategies for nurses interacting with deaf patients

Nurses play a pivotal role in promoting access to culturally competent health care services for those who experience linguistic and cultural barriers. Nursing strategies to facilitate and enhance the deaf community's access to health care services are provided.

Contriving transitive conditioned establishing operations to establish derived manding skills in adults with severe developmental disabilities

The purpose of this study was to demonstrate derived manding skills in 2 adults with severe developmental disabilities and language deficits by contriving transitive conditioned establishing operations. Specifically, we evaluated whether a history of reinforced conditional discrimination learning would ultimately result in a derived mand repertoire, in which participants manded for items that were needed to complete chained tasks. After mastering the first three phases of the picture exchange communication system (PECS), participants were taught to mand for the needed items by exchanging pictures of the items for the items themselves. They were then taught to conditionally relate the dictated names of the items to the corresponding pictures of the items and to relate the dictated names to the corresponding printed words. We then tested, in the absence of reinforcement, whether participants would mand for the items needed to complete the chained tasks using text rather than pictures. Both participants showed the emergence of derived mands and some derived stimulus relations as a result of this instruction. Some of the derived relations were shown to be intact at 1-month follow-up, and scores on derived mand probes were higher at follow-up than before training. In addition, the 2 participants vocally requested the needed items on maintenance test probes, a skill that was never trained and was not previously in their repertoires. These results suggest that a history of reinforced relational responding may facilitate the expansion of a number of verbal skills and emphasize the possibility of a synthesis of Skinner's (1957) analysis of verbal behavior and derived stimulus relations into language-training efforts for persons with significant disabilities.

Asking well-built questions for evidence-based practice in augmentative and alternative communication

Evidence-based practice (EBP) is increasingly being advocated as the preferred approach to practice in augmentative and alternative communication (AAC). The EBP process involves multiple steps. The asking of a well-built question is the first step in the quest for answers. At the same time it is also often the first stumbling block for practitioners. To facilitate the asking of well-built questions it may be helpful to follow a template. The most frequently used template is PICO, which stands for patient, intervention, comparison, and outcome [Richardson, W., Wilson, M., Nishikawa, J., & Hayward, R. (1995). The well-built clinical question: A key to evidence-based decisions. ACP Journal Club, 123, A12-A13]. In this article, we examine the suitability of the PICO template for AAC in terms of the representativeness of the components, and the appropriateness of its subcomponents, and their terminology. Based on this analysis, we propose the PESICO template, which stands for person, environments, stakeholders, intervention, comparison, and outcome. This template is then illustrated with examples representing a range of decision-making areas in AAC. Finally, directions for future research are provided.

LEARNING OUTCOMES

The reader will be able to: (1) appreciate the importance of asking well-built questions, (2) name the shortcomings of the PICO template, and (3) describe the components of the proposed PESICO template for asking well-built questions.

The effect of a therapy dog on the communication skills of an adult with aphasia

Little evidence-based research has been published within the field of communication disorders on the role of dogs as catalysts for human communication. This single participant study, a point of entry into this realm of research, explores the effects of a therapy dog on the communication skills of a patient with aphasia receiving intensive speech and language therapy within a rehabilitation setting. The researchers conclude that the presence of the dog does have the potential to stimulate both overt social-verbal and social-nonverbal communication.

LEARNING OUTCOMES

As a result of this activity the reader will be able to (1) describe the beneficial role of dogs to serve as catalysts for human communication (2) describe ways in which a person with aphasia may be assisted by a therapy dog and (3) become familiar with an animal-assisted therapy (AAT) program set-up for patients with communication disorders within a rehabilitation setting.

The Effects of Enhanced Milieu Teaching and a Voice Output Communication Aid on the Requesting of Three Children with Autism

The purpose of this study was to evaluate the effects of enhanced milieu teaching when combined with a voice output communication aid on the requesting skills of three children with autism. The research design was a multiple probe across participants. All sessions were conducted during 5-min play sessions in the child's classroom. All three children learned to use the voice output communication aid to request items during play. Additionally, all three children increased their total requesting during play.

Nicaraguan Sign Language and Theory of Mind: the issue of critical periods and abilities

BACKGROUND

Previous studies in the literature report that deaf individuals who experience late access to language perform poorly on false belief tests of Theory of Mind (ToM) compared with age-matched deaf and hearing controls exposed to language early.

METHODS

A group of 22 deaf Nicaraguans (aged 7 to 39 years) who learned Nicaraguan Sign Language (ISN) at different ages were tested on a false belief and a nonverbal cartoon retell task designed to elicit talk about the contents of character's mental states.

RESULTS

Access to sign language by 10 years of age with possible advantages in language fluency was a strong predictor of performance on both the false belief task and mental state narrative task. However, a comparison of performance on the two tests indicated that children and adults who learned sign after the age of 10 were still able to demonstrate a more general ability to use mental state expressions in narratives. Results are discussed in terms of late access to language and critical periods for the parallel development of Theory of Mind and language.

CONCLUSIONS

The findings point to age 10 years as a crucial period when lack of language exposure can lead to long-lasting deficits in false belief abilities. Late exposure to sign language does not, however, rule out all aspects of the ability to consider others' mental states. This paper also highlights the need to take into consideration a variety of communication responses when evaluating deaf children's ToM reasoning.

An ideal observer analysis of variability in visual-only speech

Normal-hearing observers typically have some ability to "lipread," or understand visual-only speech without an accompanying auditory signal. However, talkers vary in how easy they are to lipread. Such variability could arise from differences in the visual information available in talkers' speech, human perceptual strategies that are better suited to some talkers than others, or some combination of these factors. A comparison of human and ideal observer performance in a visual-only speech recognition task found that although talkers do vary in how much physical information they produce during speech, human perceptual strategies also play a role in talker variability.

The language of gestures. searching for effective communication between the dentist and the hearing-impaired patient

The aim of this article is to draw attention to the sign language as an alternative form of communication to oral language. The need to discuss this topic stems from contacts of the practicing dentist with hearing-impaired patients with whom communication should be more effective.

Visual phonics: an English code buster?

Visual phonics is an instructional program to provide print awareness, alphabet knowledge, and sound-letter correspondence for children with hearing loss who experience difficulty developing a foundation of phonemic awareness skills. Its purpose is "to clarify the sound symbol relationship between spoken English and print" (Waddy-Smith & Wilson, 2003, p. 15). It is implemented in numerous school districts, particularly in California and Florida, and can be learned in a 2-day workshop. Administrators, teachers, and speech pathologists see potential benefit in using Visual Phonics to help students with hearing loss raise their achievement scores in reading and spelling. However, it is critical to note that Visual Phonics has virtually no research base. Researchers, teachers, and speech pathologists are called upon to collect their data and begin research on the effectiveness of Visual Phonics. This is a case in which the research-to-practice gap must be closed.

Grammatical Subjects in home sign: Abstract linguistic structure in adult primary gesture systems without linguistic input

Language ordinarily emerges in young children as a consequence of both linguistic experience (for example, exposure to a spoken or signed language) and innate abilities (for example, the ability to acquire certain types of language patterns). One way to discern which aspects of language acquisition are controlled by experience and which arise from innate factors is to remove or manipulate linguistic input. However, experimental manipulations that involve depriving a child of language input are impossible. The present work examines the communication systems resulting from natural situations of language deprivation and thus explores the inherent tendency of humans to build communication systems of particular kinds, without any conventional linguistic input. We examined the gesture systems that three isolated deaf Nicaraguans (ages 14-23 years) have developed for use with their hearing families. These deaf individuals have had no contact with any conventional language, spoken or signed. To communicate with their families, they have each developed a gestural communication system within the home called "home sign." Our analysis focused on whether these systems show evidence of the grammatical category of Subject. Subjects are widely considered to be universal to human languages. Using specially designed elicitation tasks, we show that home signers also demonstrate the universal characteristics of Subjects in their gesture productions, despite the fact that their communicative systems have developed without exposure to a conventional language. These findings indicate that abstract linguistic structure, particularly the grammatical category of Subject, can emerge in the gestural modality without linguistic input.

Grounding words in perception and action: computational insights

We use words to communicate about things and kinds of things, their properties, relations and actions. Researchers are now creating robotic and simulated systems that ground language in machine perception and action, mirroring human abilities. A new kind of computational model is emerging from this work that bridges the symbolic realm of language with the physical realm of real-world referents. It explains aspects of context-dependent shifts of word meaning that cannot easily be explained by purely symbolic models. An exciting implication for cognitive modeling is the use of grounded systems to 'step into the shoes' of humans by directly processing first-person-perspective sensory data, providing a new methodology for testing various hypotheses of situated communication and learning.

Drooling, saliva production, and swallowing in cerebral palsy

Fourteen participants (six females, eight males) ranging in age from 7 years 11 months to 18 years 2 months (mean 11y 7mo) with a confirmed diagnosis of spastic cerebral palsy (CP) were included in the study. Participants included those who drooled (CP+, n=14); age- and sex-matched children with spastic CP who were dry to mild and never to infrequent droolers (CP-, n=14) as well as typically developing peers (CTRL, n=14) served as controls. Frequency of swallowing was measured by using simultaneous cervical ausculation and videotaping of the head and neck. Saliva production was measured with the Saxon test, a simple gauze-chewing procedure. In addition, Pediatric Evaluation of Disability Inventory (PEDI), Test of Nonverbal Intelligence-3 (TONI-3), dysarthria severity scale, and Gross Motor Function Classification System (GMFCS) scores were obtained for each participant. Both groups of participants with CP tended to swallow less frequently than typically developing participants and tended to produce less saliva than typically developing controls; however, these differences were not statistically significant. No correlation was found between amount of saliva produced and amount drooled (r=0.245). An analysis of variance (ANOVA) conducted on the PEDI functional skills mean scores indicated significant differences between the three groups (F(2,39)=23.522,p<0.0001). Likewise, an ANOVA conducted on the TONI-3 scores revealed statistically significant differences between the three groups (F(2,39)=31.761, p<0.0001). A Spearman's rho correlation indicated that GMFCS scores were not significantly correlated with drooling severity (Spearman's rho correlation=0.3951,p=0.037). Drooling severity was found to be positively correlated with dysarthria severity (Spearman's rho correlation=0.82,p<0.0001). These findings suggest that drooling in patients with CP is related to swallowing difficulties rather than hypersalivation.

[Verbal patient information through nurses--a case of stroke patients]

The article represents results of a theoretical work in the field of nursing education, with the topic: Verbal Patient Information through Nurses--A Case of Stroke Patients. The literature review and analysis show that there is a shortage in (stroke) patient information generally and a lack of successful concepts and strategies for the verbal (stroke) patient information through nurses in hospitals. The authors have developed a theoretical basis for health information as a nursing intervention and this represents a model of health information as a "communicational teach-and-learn process", which is of general application to all patients. The health information takes place as a separate nursing intervention within a non-public, face-to-face communication situation and in the steps-model of the nursing process. Health information is seen as a learning process for patients and nurses too. We consider learning as information production (constructivism) and information processing (cognitivism). Both processes are influenced by different factors and the illness-situation of patients, personality information content and the environment. For a successful health information output, it is necessary to take care of these aspects and this can be realized through a constructivational understanding of didactics. There is a need for an evaluation study to prove our concept of health information.

Nonword imitation by children with cochlear implants: consonant analyses

OBJECTIVES

To complete detailed linguistic analyses of archived recordings of pediatric cochlear implant users' imitations of nonwords; to gain insight into the children's developing phonological systems and the wide range of variability in nonword responses.

DESIGN

Nonword repetition: repetition of 20 auditory-only English-sounding nonwords.

SETTING

Central Institute for the Deaf "Education of the Deaf Child" research program, St Louis, Mo.

PARTICIPANTS

Eighty-eight 8- to 10-year-old experienced pediatric cochlear implant users.

MAIN OUTCOME MEASURES

Several different consonant accuracy scores based on the linguistic structure (voicing, place, and manner of articulation) of the consonants being imitated; analysis of the errors produced for all consonants imitated incorrectly.

RESULTS

Seventy-six children provided a response to at least 75% of the nonword stimuli. In these children's responses, 33% of the target consonants were imitated correctly, 25% of the target consonants were deleted, and substitutions were provided for 42% of the target consonants. The children tended to correctly reproduce target consonants with coronal place (which involve a mid-vocal tract constriction) more often than other consonants. Poorer performers tended to produce more deletions than the better performers, but their production errors tended to follow the same patterns as the better performers.

CONCLUSIONS

Poorer performance on labial consonants suggests that scores were affected by the lack of visual cues such as lip closure. Oral communication users tended to perform better than total communication users, indicating that oral communication methods are beneficial to the development of pediatric cochlear implant users' phonological processing skills.

Mode of Communication and Classroom Placement Impact on Speech Intelligibility

OBJECTIVE

To examine the impact of classroom placement and mode of communication on speech intelligibility scores in children aged 8 to 9 years using multichannel cochlear implants.

DESIGN

Classroom placement (special education, partial mainstream, and full mainstream) and mode of communication (total communication and auditory-oral) reported via parental rating scales before and 4 times after implantation were the independent variables. Speech intelligibility scores obtained at 8 to 9 years of age were the dependent variables.

PARTICIPANTS

The study included 131 congenitally deafened children between the ages of 8 and 9 years who received a multichannel cochlear implant before the age of 5 years.

RESULTS

Higher speech intelligibility scores at 8 to 9 years of age were significantly associated with enrollment in auditory-oral programs rather than enrollment in total communication programs, regardless of when the mode of communication was used (before or after implantation). Speech intelligibility at 8 to 9 years of age was not significantly influenced by classroom placement before implantation, regardless of mode of communication. After implantation, however, there were significant associations between classroom placement and speech intelligibility scores at 8 to 9 years of age. Higher speech intelligibility scores at 8 to 9 years of age were associated with classroom exposure to normal-hearing peers in full or partial mainstream placements than in self-contained, special education placements.

CONCLUSIONS

Higher speech intelligibility scores in 8- to 9-year-old congenitally deafened cochlear implant recipients were associated with educational settings that emphasize oral communication development. Educational environments that incorporate exposure to normal-hearing peers were also associated with higher speech intelligibility scores at 8 to 9 years of age.

The development of analogical reasoning in deaf children and their parents' communication mode

The purpose of this article is to analyze the results of a study of the development of analogical reasoning in deaf children coming from two different linguistic environments (deaf children of deaf parents--sign language, deaf children of hearing parents--spoken language) and in hearing children, as well as to compare two groups of deaf children to a group of hearing children. In order to estimate the development of children's analogical reasoning, especially the development of their understanding of different logical relations, two age groups were singled out in each population of children: younger (9- and 10-year-olds) and older (12- and 13-year-olds). In this way it is possible to assess the influence of early and consistent sign-language communication on the development of the conceptual system in deaf children and to establish whether early and consistent sign-language communication with deaf children affects their mental development to the same extent as early and consistent spoken-language communication with hearing children. The children were given three series of analogy tasks based on different logical relations: (a) a series of verbal analogy tasks (the relations of opposite, part-whole, and causality); (b) a series of numerical analogy tasks (the relations of class membership, opposite, and part-whole); and (c) a series of figural-geometric analogy tasks (the relations of opposite and part-whole). It was found that early and consistent sign-language communication with deaf children plays an almost equivalent role in the development of verbal, numerical, and spatial reasoning by analogy as early and consistent spoken-language communication with hearing children.

[Changes in interpersonal communication in pre- and perilingually deafened children after cochlear implantation]

People with deep prelingual deafness cannot fluently use oral language as a basic mode of communication. Hearing impaired subjects elaborated their own mode of communication. Cochlear implants as a surgical mode of deafness treatment may create a new chance for prelingually deaf children to develop vocal speech. The aim of this study was to assess changes in interpersonal mode of communication in pre- and perilingually deaf children after cochlear implantation. It was observed, that cochlear implantation stimulates development of oral language. The possibility of hearing perception of oral language it is a chance for a child for fully participation in life of hearing societies.

Hearing mothers and their deaf children: the relationship between early, ongoing mode match and subsequent mental health functioning in adolescence

In the few studies that have been conducted, researchers have typically found that deaf adolescents have more mental health difficulties than their hearing peers and that, within the deaf groups, those who use spoken language have better mental health functioning than those who use sign language. This study investigated the hypotheses that mental health functioning in adolescence is related to an early and consistent mode match between mother and child rather than to the child's use of speech or sign itself. Using a large existing 15-year longitudinal database on children and adolescents with severe and profound deafness, 57 adolescents of hearing parents were identified for whom data on language experience (the child's and the mother's) and mental health functioning (from a culturally and linguistically adapted form of the Achenbach Youth Self Report) was available. Three groups were identified: auditory/oral (A/O), sign match (SM), and sign mismatch (SMM). As hypothesized, no significant difference in mental health functioning was found between the A/O and SM groups, but a significant difference was found favoring a combined A/O and SM group over the SMM group. These results support the notion of the importance of an early and consistent mode match between deaf children and hearing mothers, regardless of communication modality.

Communication options for children with hearing loss

This article examines the communication options that are available for use within families of infants and young children who are hard-of-hearing or deaf. The need for language development, regardless of the specific communication mode, is stressed. The demands of the current environment of early identification and intervention often put families in a position of needing to decide among communication methods before they are fully knowledgeable and/or emotionally ready. Specific communication options are delineated and considered within a continuum of spoken and visual language. Available research related to early acquisition of language by infants and young children who are hard-of-hearing and deaf is reviewed; outcomes, when available, are presented for specific methods from reports of older children. Factors that influence families' decisions regarding the selection of a communication option are highlighted in the context of the existing literature. An ongoing evaluative process that respects the choices of families is advocated; a context in which change(s) in communication mode through childhood is viewed as a positive circumstance. The ultimate goal in the selection of any communication approach is to ensure that infants and young children who are hard of hearing or deaf and their families are language proficient and fluent communicators.

Cochlear Implants in Aplasia and Hypoplasia of the Cochleovestibular Nerve

OBJECTIVE

To report on the outcome of four patients with aplasia or hypoplasia of the cochleovestibular nerve who have received a cochlear implant.

STUDY DESIGN

Retrospective case review.

SETTING

Tertiary referral center.

PATIENTS

Four patients with: 1) type I aplasia; 2) type IIa aplasia; 3) type IIa hypoplasia; and 4) type IIb aplasia received a cochlear implant. All patients had corner audiograms even with hearing aids.

INTERVENTION

Three patients received a LAURA multichannel implant, and one patient received a Nucleus 24 implant.

MAIN OUTCOME MEASURE

Auditory performance, educational setting.

RESULTS

The patients with type I and type IIb aplasia did not have auditive perception with their implant and became non-users. Both are now in a total communication educational setting. The patients with type IIa aplasia and hypoplasia had moderate audiological results with the implant with audiometrical thresholds of approximately 40-60 dB HL (pure tone average), moderate phoneme discrimination, and poor word discrimination. One child is in a total communication educational setting and the other in an oral educational setting, but the preferred mode of communication remains total communication for both. Both appear to benefit from the implant nonetheless.

CONCLUSION

Patients with aplasia/hypoplasia of the cochleovestibular nerve should be counseled with caution with respect to cochlear implantation, but particular circumstances may justify the intervention. At present these circumstances seem to be a type IIa aplasia or hypoplasia in which the end organ (cochlea or common cavity) still connects to a neural structure on MRI.

Cognition in the hearing impaired and deaf as a bridge between signal and dialogue: a framework and a model

This paper focuses on the role of cognition in visual language processing in the deaf and hard of hearing. Although there are modality-specific cognitive findings in the literature on comparisons across speech communication modes and language (sign and speech), there is an impressive bulk of evidence that supports the notion of general modality-free cognitive functions in speech and sign processing. A working-memory framework is proposed for the cognitive involvement in language understanding (sign and speech). On the basis of multiple sources of behavioural and neuroscience data, four important parameters for language understanding are described in some detail: quality and precision of phonology, long-term memory access speed, degree of explicit processing, and general processing and storage capacity. Their interaction forms an important parameter space, and general predictions and applications can be derived for both spoken and signed language conditions. The model is mathematically formulated at a general level, hypothetical ease-of-language-understanding (ELU) functions are presented, and similarities and differences from current working-memory and speech perception formulations are pointed out.

Thought before language: how deaf and hearing children express motion events across cultures

Do children come to the language-learning situation with a predetermined set of ideas about motion events that they want to communicate? If so, is the expression of these ideas modified by exposure to a language model within a particular cultural context? We explored these questions by comparing the gestures produced by Chinese and American deaf children who had not been exposed to a usable conventional language model with the speech of hearing children learning Mandarin or English. We found that, even in the absence of any conventional language model, deaf children conveyed the central elements of a motion event in their communications. More surprisingly, deaf children growing up in an American culture used their gestures to express motion events in precisely the same ways as deaf children growing up in a Chinese culture. In contrast, hearing children in the two cultures expressed motion events differently, in accordance with the languages they were learning. The American children obeyed the patterns of English and rarely omitted words for figures or agents. The Chinese children had more flexibility as Mandarin permits (but does not demand) deletion. Interestingly, the Chinese hearing children's descriptions of motion events resembled the deaf children's descriptions more closely than did the American hearing children's. The thoughts that deaf children convey in their gestures thus may serve as the starting point and perhaps a default for all children as they begin the process of grammaticization--thoughts that have not yet been filtered through a language model.