Assessment of effects of position on communication board access by individuals with cerebral palsy

Social Positioning to Increase Communication of Adults With Extensive Support Needs

Social positioning involves positioning individuals with extensive support needs (ESN) in proximity to and facing a communication partner, with access to a speech-generating device (SGD). We used a multiple probe design to evaluate if social positioning would increase the symbolic and nonsymbolic communication of 10 adults with ESN when they were out of their wheelchairs. Dependent variables included (a) SGD activations, (b) eye gaze, (c) vocalizations, and (d) reaching. Visual analysis of the results indicated a functional relation between the introduction of social positioning and increased eye gaze and SGD activations of participants while maintenance data were variable. Implications for service providers and future research directions are discussed.

Promoting functional seated positioning and communication utilising a custom cervical and trunk orthosis in severe traumatic brain injury: a case report

BACKGROUND AND PURPOSE

Published evidence to guide therapists regarding positioning strategies for patients with TBI is limited. This case report describes the development of a custom cervical-thoracic-lumbar orthosis to improve functional seated positioning and communication for an individual with severe traumatic brain injury (TBI).

CASE DESCRIPTION

A man in his 20 s admitted to an inpatient rehabilitation hospital nine weeks after sustaining a TBI. Upon admission, he presented in a vegetative state with severe positioning and postural impairments.

INTERVENTION

Despite evidence of cognitive progression at 7 weeks post-admission, the patient demonstrated persistent postural deficits and limitations in functional activities and communication. To provide additional postural support, a custom cervico-thoracic-lumbar orthosis was fabricated to promote improved function and communication.

OUTCOMES

From the time of admission to post-admission weeks 7-8, the patient progressed on multiple measures: Rancho Los Amigos scale: level II to level VII; Coma Recovery Scale Revised 6 points to 15 points; Disability Rating Scale decreased from 25 points to 12 points. Functional Independence Measure 20 points at 6 weeks post-admission to 23 points at 8 weeks post-admission.

DISCUSSION

Custom cervico-thoracic-orthoses may provide additional postural support to promote improved function in individuals post-TBI. Further studies are needed to provide evidence of custom orthoses' effect on function and communication in this population.IMPLICATIONS FOR REHABILITATIONTo provide evidence of the influence of a custom orthosis on achieving a stable seated postureTo provide evidence of the influence of a custom orthosis on the functional use of an alternative communication device in the traumatic brain injury population.

Mobile communication jacket for people with severe speech impairment

PURPOSE

Cerebral palsy is a movement disorder caused by damage to motor control areas of the developing brain during early childhood. Motor disorders can also affect the ability to produce clear speech and to communicate. The aim of this study was to develop and to test a prototype of an assistive tool with an embedded mobile communication device to support patients with severe speech impairments.

METHODS

A prototype was developed by equipping a cycling jacket with a display, a small keyboard, a LED and an alarm system, all controlled by a microcontroller. Functionality of the prototype was tested in six participants (aged 7-20 years) with cerebral palsy and global developmental disorder and three healthy persons. A patient questionnaire consisting of seven items was used as an evaluation tool.

RESULTS

A working prototype of the communication jacket was developed and tested. The questionnaire elicited positive responses from participants. Improvements to correct revealed weaknesses were proposed. Enhancements like voice output of pre-selected phrases and enlarged display were implemented.

CONCLUSIONS

Integration in a jacket makes the system mobile and continuously available to the user. The communication jacket may be of great benefit to patients with motor and speech impairments. Implications for Rehabilitation The communication jacket developed can be easily used by people with movement and speech impairment. All technical components are integrated in a garment and do not have to be held with the hands or transported separately. The system is adaptable to individual use. Both expected and unexpected events can be dealt with, which contributes to the quality of life and self-fulfilment.

Communication Options for Persons with Severe and Profound Disabilities: State of the Art and Future Directions

This article reviews the literature related to issues of communication augmentation for individuals with severe and profound intellectual disabilities within the framework of the “Participation Model” (Rosenberg & Beukelman, 1987). This model consists of a communication opportunity strand and a communication access strand. The opportunity strand is discussed briefly in terms of the knowledge and attitudinal barriers that may limit communication, with suggestions for remediation of these problems. The access strand is discussed in detail, beginning with a review of current methods of assessing capability in relevant domains. The relevant literature related to the learning characteristics of both unaided and aided communication techniques is reviewed next, followed by a discussion of potential external constraints that may affect the range of options for consideration. This information facilitates the next step of selecting communication options with a view to the current and future needs and capabilities of the individual. Following this, a review is presented of vocabulary selection and effective instructional techniques in augmentative communication interventions. Finally, evaluation issues are discussed in relation to level of disability.

Analyzing the Communication Environment to Increase Functional Communication

Many students with severe and multiple disabilities demonstrate severe communication impairments. Efforts to improve communication in these students often embrace a “natural environment” or “milieu” approach, embedding opportunities to communicate within natural, functional activities across the entire schedule of daily activities. In reality, functional activities differ greatly in the degree to which they foster communication. This article describes an environmental inventory designed to allow a teacher or speech-language pathologist to analyze the extent to which a specific activity encourages functional communication for a particular student. The inventory may be used to compare different activities across the student's day or to track the improvement of specific activities that initially may show little communicative value for the student. Reliability and validity data for the inventory are presented along with a case study of its use to monitor and guide improvements in a functional activity to increase communication by a young child with multiple disabilities.

Augmentative and alternative communication interventions for persons with developmental disabilities: narrative review of comparative single-subject experimental studies

Augmentative and alternative communication (AAC) as an area of clinical and educational practice involves a myriad of decisions related to the symbols, devices, and strategies from which each client must choose. These decision-making points can be productively informed through evidence from comparative intervention studies. The purpose of this review was to synthesize comparative AAC intervention studies using single-subject experimental designs involving participants with developmental disabilities. Following a systematic search, each qualifying study was reviewed in terms of a priori determined appraisal criteria, and summarized in tabular format. Studies were divided into three groups according to their study of aided approaches, unaided approaches, or a combination of both. Results are discussed in terms of methodological adequacy of the studies and their implications for future research and practice.

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.

Five-year follow-up of functional sitting position in children with cerebral palsy

Ten children with cerebral palsy (CP) were videotaped and photographed after the introduction to a functional sitting position (FSP--defined as a position in which children with CP could gain head-, trunk- and foot-control and the maximum degree of independent function when performing arm and hand movements during tasks) and again five years later. Head-, trunk- and foot-control, and arm- and hand-function were assessed from video-tapes by the Sitting Assessment Scale. The eight children who had been using the FSP throughout this period showed slight but significant improvement; the remaining two had deteriorated. Since all 10 children had undergone similar rehabilitation programmes, it is concluded that sitting in an FSP contributed to their improvement in the ability to use the hand and arm.

Reviewing Muscle Cocontraction

From a purely mechanical standpoint, muscle cocontraction is an inefficient utilization of muscle forces. Muscles resist each other producing little, if any, net movement. In mature gait and posture, as well as in many skilled motor activities, reciprocal activation or inhibition commonly occurs. Muscle cocontraction is frequently seen in infants and toddlers, in persons with central nervous system (CNS) damage, and interestingly, it is also seen in normal adults when they are attempting a novel complex motor skill. How might these three situations be related? This article summarizes the developmental trend of decreasing cocontraction with age. The relationship of cocontraction to motor skill development is described. Finally, the role of co contraction in movement disorders of persons with CNS deficits is explored, and an attempt is made to synthesize the presented material.