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Kolb RL, McComas JJ, Girtler SN, Simacek J, Dimian AF, Unholz-Bowden EK, Shipchandler AH. Teaching Requesting to Individuals with Rett Syndrome Using Alternative Augmentative Communication (AAC) Through Caregiver Coaching via Telehealth. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2023; 35:1063-1090. [PMID: 38053943 PMCID: PMC10697698 DOI: 10.1007/s10882-023-09894-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 12/07/2023]
Abstract
Rett syndrome is a severe neurodevelopmental disorder that results in both motor and language skill regression with a wide range of severity in symptom presentation. Communication intervention may be particularly challenging for this population due to the decline in speech, motor skills, and motor planning difficulties that characterize the disorder (Townend et al., 2020), often resulting in the need for augmentative and alternative communication (AAC) technology. Very limited research has evaluated communication interventions for individuals with Rett syndrome and even fewer have targeted expressive communication, an important skill required for improved autonomy and quality of life (Sigafoos et al., 2009; Townend et al., 2020). The current study sought to systematically replicate the Simacek et al. (2017) mand training procedures to teach three girls with Rett Syndrome to use AAC to make requests through caregiver coaching by researchers via telehealth. Results suggest that mand training was successful in increasing AAC use for all three participants. Barriers to intervention for this population and implications of results for future research and clinical practice are discussed.
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Affiliation(s)
- Rebecca L. Kolb
- Department of Educational Psychology, The University of Minnesota, 56 River Rd E., Minneapolis, MN 55414, USA
| | - Jennifer J. McComas
- Department of Educational Psychology, The University of Minnesota, 56 River Rd E., Minneapolis, MN 55414, USA
| | - Shawn N. Girtler
- Department of Educational Psychology, The University of Minnesota, 56 River Rd E., Minneapolis, MN 55414, USA
| | - Jessica Simacek
- Institute on Community Integration, University of Minnesota, 2025 E River Pkwy, Minneapolis, MN 55414, USA
| | - Adele F. Dimian
- Institute on Community Integration, University of Minnesota, 2025 E River Pkwy, Minneapolis, MN 55414, USA
| | - Emily K. Unholz-Bowden
- Department of Educational Psychology, The University of Minnesota, 56 River Rd E., Minneapolis, MN 55414, USA
| | - Alefyah H. Shipchandler
- Department of Educational Psychology, The University of Minnesota, 56 River Rd E., Minneapolis, MN 55414, USA
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Sigafoos J, Roche L, O'Reilly MF, Lancioni GE, Marschik PB. Updated systematic-narrative review on communication intervention in Rett Syndrome: 2010-2022. Augment Altern Commun 2023; 39:241-255. [PMID: 37526342 DOI: 10.1080/07434618.2023.2215864] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 04/27/2023] [Accepted: 05/08/2023] [Indexed: 08/02/2023] Open
Abstract
Due to loss of spoken language and resulting complex communication needs, people with Rett syndrome are obvious candidates for communication intervention. To advance evidence-based practice and guide future research efforts, we identified and summarized 16 communication intervention studies published since a previous 2009 review on this topic. Studies were summarized in terms of (a) participants, (b) dependent variables related to communication, (c) intervention characteristics, (d) outcomes, and (e) certainty of evidence. Across the 16 studies, intervention was provided to a total of 100 participants from 3 to 47 years of age. Half of the studies used systematic instruction to teach aided AAC. Other interventions and associated technologies included music therapy, eye tracking technology, and transcranial stimulation. Positive outcomes (e.g., using AAC devices to make requests and/or initiate social-communication interactions) were reported in 13 of the studies. These 16 new studies provide additional guidance on how to enhance the communicative functioning of people with Rett syndrome. Future research directions are highlighted.
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Affiliation(s)
- Jeff Sigafoos
- School of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Laura Roche
- School of Education, The University of Newcastle, Callaghan, Australia
| | - Mark F O'Reilly
- Department of Special Education, The University of Texas at Austin, Austin, TX, USA
| | - Giulio E Lancioni
- Department of Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Peter B Marschik
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen and Leibniz Science Campus Primate Cognition, Gottingen, Germany
- Division of Phoniatrics, iDN - interdisciplinary Developmental Neuroscience, Medical University of Graz, Graz, Austria
- Center of Neurodevelopmental Disorders (KIND), Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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McComas JJ, Kolb R, Girtler S. The Effect of Caregiver-Implemented Training on Augmentative Alternative Communication Use by Individuals with Rett Syndrome: Remote Coaching via Telehealth. Dev Neurorehabil 2023; 26:436-449. [PMID: 38183414 DOI: 10.1080/17518423.2023.2301617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 12/28/2023] [Indexed: 01/08/2024]
Abstract
Limited published literature exists demonstrating functional relations between idiosyncratic responses or augmentative alternative communication (AAC) and social reinforcement for individuals with Rett syndrome. In this study, six females with Rett syndrome ages 2-25 demonstrated requesting for preferred items using both idiosyncratic responses (e.g, looking, reaching) and AAC (e.g. single response microswitches). Researchers connected remotely via telehealth to coach caregivers to implement all sessions in home environments. Researchers individualized response prompt delays during AAC sessions (request/mand training) based on each participants' latency to respond during baseline. Implications for practice and directions for future research are discussed.
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Affiliation(s)
| | - Rebecca Kolb
- The University of Minnesota, Minneapolis, MN, USA
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Unholz-Bowden EK, Girtler SN, Shipchandler A, Kolb RL, McComas JJ. Use of Augmentative and Alternative Communication by Individuals with Rett Syndrome Part 2: High-Tech and Low-Tech Modalities. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2023; 36:1-21. [PMID: 37361459 PMCID: PMC10102680 DOI: 10.1007/s10882-023-09902-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 06/28/2023]
Abstract
The vast majority of individuals with Rett syndrome do not utilize natural speech and therefore require alternative and augmentative communication (AAC). The purpose of the current study was to investigate the use of high- and low-tech AAC modalities by three individuals with Rett syndrome given similar instruction for using both modalities. For all participants, the number of sessions to criterion and cumulative number of trials with independent requests during simultaneous or alternating instruction in the use of a high- and low-tech AAC modality were investigated. Parents conducted all sessions with remote coaching from a research assistant via telecommunication. Each participant exhibited idiosyncratic response patterns in terms of use of their high- and low-tech AAC modalities during instruction but ultimately demonstrated the ability to use both modalities to make requests. Implications for future research and practice pertaining to AAC of individuals with complex communication needs are discussed. This paper is a companion to Girtler et al. (2023).
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Affiliation(s)
- Emily K. Unholz-Bowden
- Department of Educational Psychology, University of Minnesota, 56 E River Rd., Minneapolis, MN 55455 USA
| | - Shawn N. Girtler
- Department of Educational Psychology, University of Minnesota, 56 E River Rd., Minneapolis, MN 55455 USA
| | - Alefyah Shipchandler
- Department of Educational Psychology, University of Minnesota, 56 E River Rd., Minneapolis, MN 55455 USA
| | - Rebecca L. Kolb
- Department of Educational Psychology, University of Minnesota, 56 E River Rd., Minneapolis, MN 55455 USA
| | - Jennifer J. McComas
- Department of Educational Psychology, University of Minnesota, 56 E River Rd., Minneapolis, MN 55455 USA
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Yang D, Robertson HL, Condliffe EG, Carter MT, Dewan T, Gnanakumar V. Rehabilitation therapies in Rett syndrome across the lifespan: A scoping review of human and animal studies. J Pediatr Rehabil Med 2021; 14:69-96. [PMID: 32894256 DOI: 10.3233/prm-200683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To perform a scoping review of the evidence for therapeutic interventions to manage functional impairments associated with Rett syndrome (RTT) throughout the lifespan. METHODS MEDLINE, EMBASE, PsycINFO, CENTRAL, CINAHL, Scopus and Index to Chiropractic Literature were searched systematically up to December 2019. Two investigators independently reviewed all search results and extracted those that met the inclusion criteria. Human and animal model studies pertaining to therapies that increase functional ability or treat RTT-associated symptoms in all age groups were included. Relevant studies were grouped into intervention categories and rated using the Oxford Centre of Evidence Based Medicine Levels of Evidence. Demographics of participants, interventions, and outcomes were summarized. RESULTS Ninety-one articles representing 88 studies met the inclusion criteria, of which 80 were human clinical studies and eight were studies using animal models. Study designs were primarily case series and only six studies involved participants above the age of 40. CONCLUSION A small number of rigorously studied rehabilitation interventions have been published. Published studies aim to address a wide variety of functional impairments. Research regarding implementation of therapies for older patients with RTT is lacking and requires further exploration.
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Affiliation(s)
- David Yang
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Helen Lee Robertson
- Liaison Librarian, Clinical Medicine, Health Sciences Library, University of Calgary, Calgary, AB, Canada
| | - Elizabeth G Condliffe
- Departments of Clinical Neurosciences and Pediatrics, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Melissa T Carter
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Tammie Dewan
- Department of Pediatrics, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Vithya Gnanakumar
- Departments of Clinical Neurosciences and Pediatrics, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
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Lim J, Greenspoon D, Hunt A, McAdam L. Rehabilitation interventions in Rett syndrome: a scoping review. Dev Med Child Neurol 2020; 62:906-916. [PMID: 32472972 DOI: 10.1111/dmcn.14565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 02/06/2020] [Accepted: 03/02/2020] [Indexed: 12/20/2022]
Abstract
AIM To summarize existing interventions and their outcomes in Rett syndrome (RTT) rehabilitation and identify gaps in the literature. METHOD Five databases (Ovid MEDLINE, Ovid Embase Classic, Ovid PsycINFO, EBSCO CINAHL Plus, and ProQuest ERIC) were systematically searched up to 23rd July 2018 for studies describing rehabilitation interventions. Data on study participants, design, and outcomes were extracted. RESULTS Sixty-two articles were included in the final review. Evidence consistently demonstrated that females with RTT can improve their gross motor, fine motor, and communicative skills with rehabilitation. All 11 interventions targeting gross motor function, namely ambulation, achieved functional improvements. Twenty of 24 articles describing fine motor rehabilitation studies succeeded in decreasing stereotypies, improving functional hand use, and/or reducing self-injurious behaviors. Twenty-one of 22 studies describing communication interventions succeeded in training choice-making, communicative language, or socialization behavior. Other key findings include the positive interplay between physical and communicative rehabilitation outcomes, and the ability of females with RTT to improve their cognitive abilities during intervention. INTERPRETATION Rehabilitation can impact the daily lives of females with RTT and their caregivers in clinically meaningful ways.
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Affiliation(s)
- Jan Lim
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Dayna Greenspoon
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Anne Hunt
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Laura McAdam
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
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Sigafoos J, O’Reilly MF, Ledbetter-Cho K, Lim N, Lancioni GE, Marschik PB. Addressing sequelae of developmental regression associated with developmental disabilities: A systematic review of behavioral and educational intervention studies. Neurosci Biobehav Rev 2019; 96:56-71. [DOI: 10.1016/j.neubiorev.2018.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/06/2018] [Accepted: 11/23/2018] [Indexed: 12/11/2022]
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Fabio RA, Gangemi A, Capri T, Budden S, Falzone A. Neurophysiological and cognitive effects of Transcranial Direct Current Stimulation in three girls with Rett Syndrome with chronic language impairments. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 76:76-87. [PMID: 29587149 DOI: 10.1016/j.ridd.2018.03.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 02/17/2018] [Accepted: 03/19/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND this study was based on both neurophysiological decelerated activity and communication deficits in Rett Syndrome (RTT). AIMS the aim was to examine the neurophysiological and cognitive effects of Transcranial Direct Current Stimulation (tDCS) in three girls with RTT with chronic language impairments. METHODS AND PROCEDURES we proposed an integrated intervention: tDCS and cognitive empowerment applied to language in order to enhance speech production (new functional sounds and new words). Because maximal gains usually are achieved when tDCS is coupled with behavioral training, we applied tDCS stimulation on Broca's area together with linguistic training. OUTCOMES AND RESULTS the results indicated a general enhancement in language abilities (an increase in the number of vowel/consonant sounds and words and the production and comprehension through discrimination), motor coordination (functional movements), and neurophysiological parameters (an increase in the frequency and power of alpha, beta and theta bands). CONCLUSION AND IMPLICATIONS we assume that tDCS stimulation combined with the cognitive empowerment applied to language can significantly influence a chronic impairment even in genetic syndromes. Our results provide data that support the role of tDCS in fostering brain plasticity and in particular in empowering speech production and comprehension in girls with RTT.
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Affiliation(s)
- Rosa Angela Fabio
- Department of Cognitive Science, Psychological, Education and Cultural Studies, University of Messina, Italy.
| | - Antonio Gangemi
- Department of Cognitive Science, Psychological, Education and Cultural Studies, University of Messina, Italy.
| | - Tindara Capri
- Department of Cognitive Science, Psychological, Education and Cultural Studies, University of Messina, Italy.
| | - Sarojini Budden
- St. Vincent's Hospital and Medical Center Portland, OR, United States.
| | - Alessandra Falzone
- Department of Cognitive Science, Psychological, Education and Cultural Studies, University of Messina, Italy.
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Ahonniska-Assa J, Polack O, Saraf E, Wine J, Silberg T, Nissenkorn A, Ben-Zeev B. Assessing cognitive functioning in females with Rett syndrome by eye-tracking methodology. Eur J Paediatr Neurol 2018; 22:39-45. [PMID: 29079079 DOI: 10.1016/j.ejpn.2017.09.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/15/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND While many individuals with severe developmental impairments learn to communicate with augmentative and alternative communication (AAC) devices, a significant number of individuals show major difficulties in the effective use of AAC. Recent technological innovations, i.e., eye-tracking technology (ETT), aim to improve the transparency of communication and may also enable a more valid cognitive assessment. OBJECTIVES To investigate whether ETT in forced-choice tasks can enable children with very severe motor and speech impairments to respond consistently, allowing a more reliable evaluation of their language comprehension. METHODS Participants were 17 girls with Rett syndrome (M = 6:06 years). Their ability to respond by eye gaze was first practiced with computer games using ETT. Afterwards, their receptive vocabulary was assessed using the Peabody Picture Vocabulary Test-4 (PPVT-4). Target words were orally presented and participants responded by focusing their eyes on the preferred picture. RESULTS Remarkable differences between the participants in receptive vocabulary were demonstrated using ETT. The verbal comprehension abilities of 32% of the participants ranged from low-average to mild cognitive impairment, and the other 68% of the participants showed moderate to severe impairment. Young age at the time of assessment was positively correlated with higher receptive vocabulary. CONCLUSIONS The use of ETT seems to make the communicational signals of children with severe motor and communication impairments more easily understood. Early practice of ETT may improve the quality of communication and enable more reliable conclusions in learning and assessment sessions.
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Affiliation(s)
- Jaana Ahonniska-Assa
- Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel; School of Behavioral Sciences, The Academic College of Tel Aviv Jaffo, Tel Aviv Jaffo, Israel.
| | - Orli Polack
- Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Einat Saraf
- Shirat Halev School, Ministry of Education, Israel; Israeli Rett Syndrome Center, Israel
| | - Judy Wine
- Israeli Rett Syndrome Center, Israel; Omer Center for Augmentative and Alternative Communication, Israel
| | - Tamar Silberg
- Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel; Department of Psychology, Bar Ilan University, Ramat Gan, Israel
| | - Andreea Nissenkorn
- Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bruria Ben-Zeev
- Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Urbanowicz A, Ciccone N, Girdler S, Leonard H, Downs J. Choice making in Rett syndrome: a descriptive study using video data. Disabil Rehabil 2017; 40:813-819. [PMID: 28112551 DOI: 10.1080/09638288.2016.1277392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe the choice-making abilities of girls and women with Rett syndrome. METHOD Females with Rett syndrome registered with the Australian Rett Syndrome Database with a pathogenic MECP2 mutation were included in this study. Video clips showing choice making in 64 females at a median age of 11.6 years (range 2.3-35.6 years) were analysed. Video clips were coded for the location and nature of the choice-making interaction, and the actions of the communication partner and female with Rett syndrome. RESULTS The majority (82.8%, 53/64) of females made a choice, most using eye gaze. Just under half (24/53) used one modality to communicate their choice, 52.8% used two modalities and one used three modalities. Of those who made a choice, 50% did so within 8 s. The length of time to make a choice did not appear to vary with age. During choice making, 57.8% (37/64) of communication partners used language and gestures, 39.1% (25/64) used only language and two used language, gestures and symbols within the interaction. CONCLUSIONS The provision of adequate time allowing for a response and observation for the use of multiple modalities could promote effective choice making in females with Rett syndrome. Implications for Rehabilitation The provision of adequate time allowing for a response will promote effective choice making in girls and women with Rett syndrome. Although almost all girls and women with Rett syndrome used eye gaze to indicate their choice, communication partners also need to recognise and respond to other communication modalities that are sometimes used like body movements.
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Affiliation(s)
- Anna Urbanowicz
- a Telethon Kids Institute , The University of Western Australia , Subiaco , Australia.,b School of Medical and Health Sciences , Edith Cowan University , Joondalup , Australia.,c Queensland Centre for Intellectual & Developmental Disability , Mater Research Institute-UQ, The University of Queensland , Brisbane , Australia
| | - Natalie Ciccone
- b School of Medical and Health Sciences , Edith Cowan University , Joondalup , Australia
| | - Sonya Girdler
- d School of Occupational Therapy and Social Work , Curtin University , Perth , Australia
| | - Helen Leonard
- a Telethon Kids Institute , The University of Western Australia , Subiaco , Australia
| | - Jenny Downs
- a Telethon Kids Institute , The University of Western Australia , Subiaco , Australia.,e School of Physiotherapy and Exercise Science , Curtin University , Perth , Australia
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Urbanowicz A, Downs J, Girdler S, Ciccone N, Leonard H. An Exploration of the Use of Eye Gaze and Gestures in Females With Rett Syndrome. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2016; 59:1373-1383. [PMID: 27830264 DOI: 10.1044/2015_jslhr-l-14-0185] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 07/27/2015] [Indexed: 06/06/2023]
Abstract
PURPOSE This study investigated the communicative use of eye gaze and gestures in females with Rett syndrome. METHOD Data on 151 females with Rett syndrome participating in the Australian Rett Syndrome Database was used in this study. Items from the Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist (Wetherby & Prizant, 2002) were used to measure communication. Relationships between the use of eye gaze and gestures for communication were investigated using logistic regression. The influences of MECP2 mutation type, age, and level of motor abilities on the use of eye gaze and gestures were investigated using multivariate linear regression. RESULTS Both eye gaze and the use of gestures predicted the ability to make requests. Women aged 19 years or older had the lowest scores for eye gaze. Females with better gross motor abilities had higher scores for the use of eye gaze and gestures. The use of eye gaze did not vary across mutation groups, but those with a C-terminal deletion had the highest scores for use of gestures. CONCLUSIONS Eye gaze is used more frequently than gestures for communication, and this is related to age, MECP2 mutation type, and gross motor abilities.
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Affiliation(s)
- Anna Urbanowicz
- Telethon Kids Institute, The University of Australia, Perth, Western AustraliaSchool of Exercise and Health Sciences, Edith Cowan University, Perth, Western Australia
| | - Jenny Downs
- Telethon Kids Institute, The University of Australia, Perth, Western AustraliaSchool of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Sonya Girdler
- School of Occupational Therapy and Social Work, Curtin University, Perth, Western Australia
| | - Natalie Ciccone
- School of Psychology and Social Science, Edith Cowan University, Perth, Western Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Australia, Perth, Western Australia
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Urbanowicz A, Leonard H, Girdler S, Ciccone N, Downs J. Parental perspectives on the communication abilities of their daughters with Rett syndrome. Dev Neurorehabil 2016; 19:17-25. [PMID: 24564222 DOI: 10.3109/17518423.2013.879940] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study describes, from the perspective of parents, how females with Rett syndrome communicate in everyday life and the barriers and facilitators to successful communication. METHODS Sixteen interviews were conducted with parents with a daughter with Rett syndrome with a pathogenic mutation in the methyl-CpG-binding protein 2 gene. Interviews were recorded and transcribed verbatim. Transcripts were analysed using directed content analysis. RESULTS All parents reported their daughters were able to express discomfort and pleasure, and make requests and choices using a variety of modalities including vocalisations, body movements and eye gaze. Parents also reported their daughters understood most of what they said and that the level of functional abilities, such as mobility, and environmental factors, such as characteristics of the communication partner, influenced successful communication. CONCLUSIONS The perspectives of parents are integral to the assessment of communication abilities and have the potential to inform communication interventions for girls and women with Rett syndrome.
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Affiliation(s)
- Anna Urbanowicz
- a Telethon Institute for Child Health Research, The University of Western Australia , Perth , WA , Australia .,b School of Exercise and Health Sciences, Edith Cowan University , Perth , WA , Australia
| | - Helen Leonard
- a Telethon Institute for Child Health Research, The University of Western Australia , Perth , WA , Australia
| | - Sonya Girdler
- c School of Occupational Therapy and Social Work, Centre for Research into Disability and Society, Curtin University , Perth , WA , Australia
| | - Natalie Ciccone
- d School of Psychology and Social Science, Edith Cowan University , Perth , WA , Australia , and
| | - Jenny Downs
- a Telethon Institute for Child Health Research, The University of Western Australia , Perth , WA , Australia .,e School of Physiotherapy and Exercise Science, Curtin University , Perth , WA , Australia
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Sandberg AD, Ehlers S, Hagberg B, Gillberg C. The Rett Syndrome Complex. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016. [DOI: 10.1177/1362361300004003003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Communicative functions and their relationship with overall developmental level and autistic features were studied in eight young women with disorders in the Rett syndrome complex, three with the classical variant and five with variants with partially preserved/regained speech. The Vineland Adaptive Behaviour Scales, individual structured observation, and a specially designed structured interview covering early pre-linguistic and linguistic development, current receptive and expressive language and non-verbal communication skills, were used. Autistic features were evaluated in accordance with the DSM-IV. Low levels of communicative abilities and overall functioning were demonstrated. In most cases, the communicative abilities did not reach the level expected on the basis of overall development. Joint attention behaviours and expressions of communicative intent were rare. However, six of the eight subjects showed clear examples of social interaction abilities.‘Eye pointing’, as distinct from ‘eye communication’, was demonstrated only in a minority of the cases. The level of communicative function at developmental arrest did not predict later language ability. It is suggested that intervention should focus on developing further the joint attention behaviours, intentional communications and communicative functions spontaneously used by individuals with disorders in the Rett syndrome complex.
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Abstract
This article provides a selected review of several contemporary communication intervention programs for people with developmental disabilities and severe communication impairment. Consideration of the extent and negative effects of severe communication impairment indicates the need for systematic intervention focused on teaching functional communication skills. Behaviour analysis procedures have demonstrated effectiveness for teaching functional communication skills. The major features of several behaviourally oriented communication intervention programs are reviewed. It is concluded that these programs have a sound empirical basis and demonstrated effectiveness for teaching functional communication skills to learners with developmental disabilities and severe communication impairment.
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Teaching Children and Young Adults with Mental Retardation in School Programs: Current Research. BEHAVIOUR CHANGE 2014. [DOI: 10.1017/s0813483900003557] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper reviews the recent behavioural research on instruction of children and young adults with mental retardation in schools settings and community-based school programs. Instructional research in 12 skill areas (motor, self-care, communication, social skills, choice making, school behaviours, health and safety skills, home management, leisure skills, community use, vocational skills, and academics) meeting specified criteria on population (age and disability), location of instruction, functionality of skill, and research integrity was identified in 11 journals from 1990 through 1996. The pool of identified research is discussed by skill category and by intervention method, with critical comments made regarding strengths and weaknesses. Conclusions are drawn for practitioners and future researchers.
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Byiers BJ, Dimian A, Symons FJ. Functional communication training in rett syndrome: a preliminary study. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014; 119:340-350. [PMID: 25007298 DOI: 10.1352/1944-7558-119.4.340] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Rett syndrome (RTT) is associated with a range of serious neurodevelopmental consequences including severe communicative impairments. Currently, no evidence-based communication interventions exist for the population ( Sigafoos et al., 2009 ). The purpose of the current study was to examine the effectiveness of functional assessment (FA) and functional communication training (FCT) methods for teaching 3 individuals (ages 15-47 years) with classic RTT novel communicative behaviors. Using single-case experimental designs, functional reinforcers were identified (FA) and each participant quickly learned to activate a voice-output switch to obtain a reinforcer (FCT). These results suggest that individuals with classic RTT can learn novel communicative responses, which has important implications for future intervention research.
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Didden R, Korzilius H, Smeets E, Green VA, Lang R, Lancioni GE, Curfs LM. Communication in Individuals with Rett Syndrome: an Assessment of Forms and Functions. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2010; 22:105-118. [PMID: 20339577 PMCID: PMC2837828 DOI: 10.1007/s10882-009-9168-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In the present study we assessed the forms and functions of prelinguistic communicative behaviors for 120 children and adults with Rett syndrome using the Inventory of Potential Communicative Acts (IPCA) (Sigafoos et al. Communication Disorders Quarterly 21:77-86, 2000a). Informants completed the IPCA and the results were analysed to provide a systematic inventory and objective description of the communicative forms and functions present in each individual's repertoire. Results show that respondents reported a wide variety of communicative forms and functions. By far most girls used prelinguistic communicative behaviors of which eye contact/gazing was the most common form. The most often endorsed communicative functions were social convention, commenting, answering, requesting and choice-making. Problematic topographies (e.g., self-injury, screaming, non-compliance) were being used for communicative purposes in 10 to 41% of the sample. Exploratory analyses revealed that several communicative forms and functions were related to living environment, presence/absence of epilepsy, and age. That is, higher percentages of girls who showed some forms/functions were found in those who lived at home, who had no epilepsy and who were relatively young.
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Affiliation(s)
- Robert Didden
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
| | - Hubert Korzilius
- Institute for Management Research, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Eric Smeets
- University of Maastricht, Maastricht, The Netherlands
| | | | - Russell Lang
- The Eli and Edythe L. Broad Asperger Research Center, University of California, Santa Barbara, CA USA
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Schlosser RW, Raghavendra P. Evidence-Based Practice in Augmentative and Alternative Communication. Augment Altern Commun 2009. [DOI: 10.1080/07434610310001621083] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Schlosser R, Sigafoos J. Selecting graphic symbols for an initial request lexicon: integrative review. Augment Altern Commun 2009. [DOI: 10.1080/07434610212331281201] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ryan D, McGregor F, Akermanis M, Southwell K, Ramke M, Woodyatt G. Facilitating communication in children with multiple disabilities: three case studies of girls with Rett syndrome. Disabil Rehabil 2009; 26:1268-77. [PMID: 15513725 DOI: 10.1080/09638280412331280280] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the effect of cueing on communicative responses of children with multiple disabilities in an educational setting. It was hypothesized that differences would exist in teacher interactional styles and the use of orienting cues would increase the communicative responses of the participants. METHOD A naturalistic observation research method was employed in order to examine the interaction of three student-teacher dyads in three special schools. Three different activity types were videotaped from which interactions were coded and analysed. RESULTS Multi-modal cueing facilitated communicative responses of children with Rett syndrome. However, increased communication opportunities provided by caregivers did not elicit increased responses from the girls. CONCLUSION There is a difference in cueing by teachers in their interactions with children with multiple disabilities. Also, more frequent communicative interactions did not necessarily lead to increased student responses. It is suggested that amount and type of cueing may need to be considered to be effective in generating student responses. The small number of participants, however, means findings should be viewed cautiously and that more research is indicated.
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Affiliation(s)
- D Ryan
- Division of Speech Pathology, University of Queensland, Brisbane, Queensland 4072, Australia
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A Review of the Efficacy of the Picture Exchange Communication System Intervention. J Autism Dev Disord 2009; 39:1471-86. [PMID: 19495952 DOI: 10.1007/s10803-009-0763-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Accepted: 05/14/2009] [Indexed: 10/20/2022]
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Lancioni GE, O'Reilly MF, Cuvo AJ, Singh NN, Sigafoos J, Didden R. PECS and VOCAs to enable students with developmental disabilities to make requests: an overview of the literature. RESEARCH IN DEVELOPMENTAL DISABILITIES 2007; 28:468-88. [PMID: 16887326 DOI: 10.1016/j.ridd.2006.06.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Accepted: 06/28/2006] [Indexed: 05/11/2023]
Abstract
This paper provides an overview of the literature dealing with the use of the Picture Exchange Communication System (PECS) and voice output communication aids (VOCAs) for promoting the performance of requests by students with developmental disabilities. Computerized and manual searches were carried out to identify the studies published during the last 15 years (i.e., the period between 1992 and 2006 during which PECS and VOCA approaches became popular). Thirty-seven studies were identified and then divided into three groups concerning the use of the PECS or equivalents, the use of VOCAs or equivalents, and the comparison of both these approaches, respectively. Of the 173 students involved in studies using the PECS or equivalents only three could be considered failures, while a fourth one did not progress in the program due to illness. Similarly, of the 39 students who used VOCAs or equivalents only three could be considered failures, while one was partly successful. Finally, of the 11 students involved in the comparisons between PECS and VOCAs none could be classified as a failure. The results are very encouraging but methodological concerns and the relatively limited use of the systems in terms of request items and request opportunities suggest caution. Caution may also be needed in interpreting the reported similarities between the two systems in usability and effectiveness.
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Affiliation(s)
- Giulio E Lancioni
- Department of Psychology, University of Bari, Via Quintino Sella 268, 70100 Bari, Italy.
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Hetzroni OE, Rubin C. Identifying patterns of communicative behaviors in girls with Rett syndrome. Augment Altern Commun 2006; 22:48-61. [PMID: 17114158 DOI: 10.1080/17461390500387320] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
The purpose of this study was to investigate behaviors of girls with Rett syndrome under different conditions and to determine if there were patterns of functional communicative behaviors. Six communication protocols portraying familiar and non-familiar activities were created to assist in identifying specified behaviors. The protocols incorporated activities and pre-scheduled interruptions designed to enhance communicative behaviors. Eight girls in the third and fourth stages of Rett syndrome were videotaped during the protocols. Results indicated that the girls' alternating eye gazing increased and persistence decreased when activities were interrupted. Additional behaviors varied by participant across different protocols. Several patterns of effective and ineffective communication were observed. Implications for practice and future research are discussed.
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Baptista PM, Mercadante MT, Macedo EC, Schwartzman JS. Cognitive performance in Rett syndrome girls: a pilot study using eyetracking technology. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2006; 50:662-6. [PMID: 16901293 DOI: 10.1111/j.1365-2788.2006.00818.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Rett syndrome (RS) is a pervasive developmental disorder with cognitive and neuromotor impairments (including loss of handiness and loss of communicative skills). OBJECTIVE To verify whether girls with RS use their gaze intentionally, by observing their performance in three cognitive tasks: (1) verbal instruction condition (look at picture X), (2) recognition and matching of pictures (look at the one that is the same), and (3) categorization of pictures (look at the one that is similar). METHOD Seven girls diagnosed with RS according to DSM-IV criteria were studied. Eyegaze technology was used to record the girls' eye movements' responses to visual stimulation. RESULTS The comparison of fixation time on the alternatives revealed a higher percentage (62.4%) of correct alternatives (chi(2) = 76.31; P = 0.000). Of the seven children assessed, only one did not present predominance of fixations on the correct alternatives in any one of the tasks. One did well in all tasks. Six responded correctly to all verbal instructions. CONCLUSION The rate of correct answers suggests that there is measurable and intentional gaze in RS girls and it can be used as a path to explore their cognitive performance.
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Affiliation(s)
- P M Baptista
- Development Disorders Program, Mackenzie Presbyterian University, São Paulo, Brazil.
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Elefant C, Wigram T. Learning ability in children with Rett syndrome. Brain Dev 2005; 27 Suppl 1:S97-S101. [PMID: 16182495 DOI: 10.1016/j.braindev.2005.03.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2004] [Revised: 09/09/2004] [Accepted: 03/02/2005] [Indexed: 10/25/2022]
Abstract
The purpose of this article is to present results of a research study examining learning ability in individuals with Rett syndrome. The material for this article was drawn from a more extensive doctoral study, designed to investigate intentional communication in this population, through the use of songs in music therapy. Rett syndrome is a neurological disorder resulting from an X-linked mutation, affecting mainly females, and found across racial and ethnic groups worldwide. One of the main areas affecting functioning in individuals with Rett syndrome is a severe impairment of receptive and expressive communication. This creates difficulties when attempting to reveal their potential learning abilities. This population has been observed as very responsive to music hence music therapy intervention has been advocated in promoting and motivating them to communicate and to learn. Seven girls with Rett syndrome, between ages 4 and 10 participated in the study. A single subject, multiple probe design was applied during 30-min trials, three times per week and lasted 8 months. During the trials the participants were asked to choose from a selection of 18 familiar and unfamiliar songs, while their ability to learn was observed and measured. Findings revealed that all seven girls demonstrated an ability to learn and to sustain learning over time. This intervention demonstrated that individuals with Rett syndrome could be promoted and motivated to communicate and learn when therapeutically employed by a trained music therapists.
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Harris MD, Reichle J. The impact of aided language stimulation on symbol comprehension and production in children with moderate cognitive disabilities. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2004; 13:155-167. [PMID: 15198634 DOI: 10.1044/1058-0360(2004/016)] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Over the past decade, aided language stimulation has emerged as a strategy to promote both symbol comprehension and symbol production among individuals who use graphic mode communication systems. During aided language stimulation, an interventionist points to a graphic symbol while simultaneously producing the corresponding spoken word during natural communicative exchanges. The purpose of this study was to determine the impact of aided language stimulation on children with moderate cognitive disabilities. Three preschool children with moderate cognitive disabilities who were functionally nonspeaking participated in the investigation. The investigator implemented a multiple-probe design across symbol sets/activities. Elicited probes were used to determine whether the children increased their comprehension and production of graphic symbols. Results indicated that all 3 children displayed increased symbol comprehension and production following the implementation of aided language stimulation.
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Mirenda P. Toward Functional Augmentative and Alternative Communication for Students With Autism. Lang Speech Hear Serv Sch 2003; 34:203-216. [DOI: 10.1044/0161-1461(2003/017)] [Citation(s) in RCA: 214] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2002] [Accepted: 03/24/2003] [Indexed: 11/09/2022] Open
Abstract
Many individuals with autism are candidates for augmentative and alternative communication (AAC) systems, either to supplement (i.e., augment) their existing speech or to act as their primary (i.e., alternative) method of expressive communication. The purpose of this article is to summarize research and directions for future research with regard to two questions related to the delivery of AAC supports to these individuals: (a) What AAC modality is preferable to use? and (b) What do we know about the use of voice output communication aids with people with autism?
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Sarimski K. [Rett syndrome: individual differences in developmental and behavioral markers and psychosocial stress]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2003; 31:123-32. [PMID: 12784522 DOI: 10.1024/1422-4917.31.2.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Rett Syndrome is a severe neurological developmental disorder caused by a genetic mutation on the long arm of the X chromosome (Xq28). This disorder is characterized by a loss of purposeful hand use, verbal language, and specific behaviors. METHODS Data were obtained from a survey of the parents of 83 girls on pre-verbal skills (Pre-verbal Communication Schedule), behavioral characteristics and emotional expression (Rett Syndrome Behaviour Questionnaire) and on maternal psychosocial stress (Handicap-related Problems for Parents Inventory). RESULTS There is considerable individual variability in the developmental and behavioral characteristics which is not explained as a function of age. Maternal stress correlates with the daughters' mood, anxious reactions and night-time behaviors. CONCLUSIONS Some implications for diagnosis and family counseling are discussed.
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Hetzroni OE. Identifying Intentional Communication in Children With Severe Disabilities. ACTA ACUST UNITED AC 2001. [DOI: 10.1044/aac10.2.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Merker B, Bergström-Isacsson M, Engerström IW. Music and the Rett Disorder: The Swedish Rett Center Survey. NORDIC JOURNAL OF MUSIC THERAPY 2001. [DOI: 10.1080/08098130109478016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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