Conceptualizing communication enhancement in dementia for family caregivers using the WHO-ICFframework

Lexical-semantic properties of verbs and nouns used in conversation by people with Alzheimer's disease

Alzheimer's disease (AD) is accompanied by language impairments and communicative breakdowns. Research into language processing by people with AD (pwAD) has focused largely on production of nouns in isolation. However, impairments are consistently found in verb production at word and sentence levels, and comparatively little is known about word use by pwAD in conversation. This study investigated differences between pwAD and cognitively healthy controls in conversational use of nouns, verbs, and pronouns. Speech samples produced by 12 pwAD and 12 controls for the Carolinas Conversations Collection were analysed for noun, verb and pronoun counts and ratios, lexical diversity overall and among nouns and verbs, copula use, and frequencies and ages of acquisition (AoA) of nouns and verbs produced. pwAD used fewer nouns and a narrower range of words than controls, exhibiting signs of increased reliance on pronouns and decreased noun diversity. Age affected noun frequencies differently within each group-pwAD produced nouns of lower frequencies with age, while controls produced nouns of higher frequencies. pwAD produced nouns of higher AoA than controls. Verb use differed little by group. These findings highlight the need to account for differences between nouns and verbs, including in frequency, AoA, proportion of all words spoken, and context-dependent processing demands, when drawing conclusions on language use by pwAD. They also suggest potential for communicative interventions targeting contextual use of both nouns and verbs.

Application of the International Classification of Functioning, Disability and Health (ICF) in dementia research and practice: A scoping review

OBJECTIVES

The International Classification of Functioning, Disability and Health (ICF) endorsed by the World Health Organization provides a conceptual framework for describing functioning and disability based on a biopsychosocial model. Although dementia is one of the leading causes of disability, yet little is known on the extent to how the ICF has been utilized in dementia research and practice. The study aimed to examine and map the current applications of the ICF with dementia from a body of earlier studies and to explore the potential use in person-centred dementia care.

METHODS

The Arksey and O'Malley framework was used to guide the searching, selecting, and synthesizing process. The scoping review was reported following The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) guidelines.

RESULTS

A total of 34 studies were included. The applications of ICF were classified into 4 themes: (1) in clinical practice and the education of health professionals (n = 20); (2) community support services and income support (n = 3); (3) population-based, census, or survey data (n = 10); (4) advocacy and empowerment purposes (n = 1).

CONCLUSION

The ICF has made a major impact on dementia in clinical settings. Findings strongly support applying the ICF to person-centered dementia care. In the future, more empirical studies are needed to expand the scope of ICF use in dementia research and practice.

When an Aging Spouse Has Dementia: Impact of a Home-Based Intervention on Marital Communication

Researchers tested the impact of a 10-week intervention, Communicating About Relationships and Emotions (CARE), on misunderstandings and resolutions in marital communication between spouses affected by dementia. A single group, repeated-measures secondary analysis was used to analyze 65 transcribed dyadic conversations for misunderstandings, resolutions, number of caregiver and care receiver words over 10 sessions. Misunderstandings continued to occur over 10 weeks, but resolution of misunderstandings increased (β = 5.75, p = .044). Increased caregiver words escalated misunderstandings. Dementia-related language impairments threaten relationships by creating frustration and stress in older couples. With CARE, spouse caregivers can improve resolution of misunderstandings.

The need for psychological, caregiver-centered intervention in the time of COVID-19

We focus attention on problems that are affecting the informal caregivers of patients with neurodegenerative disorders in the time of COVID-19. The pandemic is increasing difficulties in the management of the frailest people and their isolation is actually even more tangible than it was in the past. The social restrictions and the lockdown of many activities are putting the system of care provided by informal caregivers on the edge of collapse. We incite the scientific community to face these concerns and provide clinicians clear indications for assisting and supporting caregivers in the care of their relatives during this period. We suggest that e-health programs could become the ideal "environment" to favor the continuity of care for patients with neurodegenerative conditions and guarantee the required support to their caregivers, both directly in terms of psychological management and indirectly for helping them in disease management.

The contribution of cognition to the rehabilitation of language and communication deficits

Background/Aims

There is growing evidence to suggest that cognitive processes, in particular working memory and executive functions, are related to language functions such as syntactic processing, reading comprehension, narration and conversational discourse. This article offers rehabilitation considerations for speech-language pathologists to include cognitive assessment and treatment in their clinical practice. The information presented will also be useful in promoting multidisciplinary rehabilitation.

Methods

A critical review of the literature on the interaction between cognitive processes and linguistic functions in communication disorders was undertaken. Specific key terms including but not limited to executive functioning, working memory, language, assessment, intervention and communication disorders were searched on the Google Scholar database. Relevant literature from the last three decades pertaining to cognitive behavior, assessment and intervention in communication disorders of all age groups and severities is included in the review.

Results

The review presents analyses of the multidimensional and dynamic interaction of language and cognition in children (specific language impairment, attention deficit hyperactivity disorder, stuttering) and adults (traumatic brain injury, stroke, dementia) with communication disorders. The article elaborates on the speech-language pathologist's scope of practice in cognitive assessment and intervention that are consistent with the World Health Organization's International Classification of Functioning, Disability and Health framework.

Conclusions

By documenting cognitive-communication behaviour, speech-language pathologists are able to effectively contribute to the clinical assessment and management of cognitive deficits. However, future research efforts are required to develop clinically reliable tests of cognitive functioning in communication disorders and promote evidence-based cognitive treatment practices.

The Role of the Speaker, the Listener, and Their Joint Contributions During Communicative Interactions: A Tripartite View of Intelligibility in Individuals With Dysarthria

Purpose We present a tripartite view of intelligibility in which the contributions of both the speaker and listener, as well as their joint effort during interaction, are considered. While considerable research has examined communicative interactions in situ, there is a critical gap in current knowledge on how speech intelligibility unfolds during such interactions. Here, we argue that research examining speech intelligibility in communicative interactions may provide important groundwork for advancement in clinical interventions for individuals with dysarthria. Method First, we describe the view and argue for its consideration as a powerful way of thinking about speech intelligibility. We then briefly situate the view in the relevant literature on speech intelligibility and existing theoretical frameworks. We then identify suitable methodological paradigms for studying joint contributions to intelligibility and, lastly, discuss the clinical application and potential impact of this tripartite view. Conclusions Speech communication occurs through interaction; however, in the laboratory and clinic, emphasis is usually placed on individual speakers and listeners. We have proposed that it is critical to consider how the joint contributions of speakers and listeners affect speech intelligibility in communicative interaction. This conceptualization is well aligned with the International Classification of Functioning, Disability and Health, and the findings from such an approach will allow us to better understand how to maximize available resources to enhance speech intelligibility.

Development of a new tool for the early identification of communication-support needs in people living with dementia: An Australian face-validation study

Language and communication difficulties are common in dementia but limited tools are available for a timely assessment of those individuals who experience these difficulties. The Communication-Support Needs Assessment Tool in Dementia (CoSNAT-D) was developed to assist in (a) the early identification of communication difficulties among people with dementia in the community context; and (b) determining the level of their communication support needs to guide appropriate service access. The CoSNAT-D was developed based on a literature review. The face validity was tested with end-users (people with dementia and support persons of people with dementia) regarding relevance, wording, syntax, appropriateness and comprehensiveness of the items of the tool. Data were collected using semi-structured phone interviews. Seven people with dementia and 15 carers participated in the study. Feedback regarding items' appropriateness was largely positive and minor changes were made to improve comprehensiveness. A new item was added to the original item pool. The interviews highlighted the importance of including people with dementia in the assessment processes and person-centered approaches in this context. The CoSNAT-D presents a first step for the early identification of individual support needs of people living with dementia and communication difficulties who live in the community. Items of the CoSNAT-D have been determined face-valid by end-users. The face-validated version of the tool is currently undergoing further testing to determine additional relevant psychometric properties.

Adapting the Resilience Framework for Family Caregivers of Hospice Patients With Dementia

Family caregivers face ongoing, formidable stress and burden. Caregivers need sustainable support to maintain resilience. We aim to identify challenges, possible solutions that are resources for resilience, and expected consequences from the perspective of 39 family caregivers of hospice patients with dementia. The resilience framework was used to guide the coding and synthesis of the qualitative data. Identified challenges included difficulties in communication, providing care and decision-making, lack of knowledge, emotional challenges, concern about care facility selection, death with dignity, and lack of public awareness. Resilience resources for caregiving challenges were identified at the individual, community, and societal levels. Anticipated benefits of using these resources included the ability to provide better care and have a better quality of life for both patients and caregivers. The findings of this study can guide the design and implementation of supportive interventions designed for family caregivers of hospice patients with dementia to bolster available resilience resources.

Validation study of the Italian version of Communication Activities of the Daily Living (CADL 2) as an ecologic cognitive assessment measure in older subjects

INTRODUCTION

Communication can be affected by age related cognitive decline and mental deterioration. The second edition of the Communication Activities of the Daily Living (CADL 2) appears as an interesting ecological assessment tool of cognitive functions in old age.

OBJECTIVE

The aim of this work is to (1) develop an Italian version of CADL 2, (2) to test its psychometric properties in terms of reliability and validity, and (3) to measure CADL 2 discriminative capacity between cognitively healthy and cognitively impaired older subjects.

METHOD

One hundred and eleven subjects were enrolled (36 M; 75 F, age 80, 80.85 ± 7 years, education 9.3 ± 4.7 years). The CADL 2 was administered together with a standard neuropsychological battery.

RESULTS

The CADL 2 showed good reliability and correlates with all the cognitive evaluation tests. The CADL 2's area under the curve was equal to 0.80, index of good diagnostic accuracy.

CONCLUSIONS

The CADL 2 is an appropriate assessment tool for communication skills in aging.

A conversation analytic study of patterns of overlapping talk in conversations between individuals with dementia and their frequent communication partners

BACKGROUND

Difficulty participating in conversation is commonly experienced by individuals with dementia, secondary to cognitive and language deficits. Frequent communication partners (FCPs), however, report being largely unaware of how to support their conversation partners with dementia during conversation. In particular, taking a turn appropriately may be difficult for either partner due to trouble predicting a partner's behaviour and, hence, difficulty with timing conversational turns appropriately, potentially resulting in overlapping talk.

AIMS

To investigate the patterns of overlapping talk in the interaction between individuals with dementia and their FCPs.

METHODS & PROCEDURES

Three participants with moderate-severe dementia participated in conversation with an FCP. Ten minutes of 'casual' and 'task-oriented' conversation were audio- and video-recorded. Patterns of overlapping talk were investigated using conversation analytic methods.

OUTCOMES & RESULTS

Overlapping talk was a consistent feature of all three dyadic interactions during both social and task-oriented talk. All participants exhibited competitive and non-competitive forms of overlapping talk. The data reveal that FCPs commonly yielded their own turns when overlapped by a partner in order to create opportunities for their partners with dementia to communicate. Participants with dementia demonstrated some retained pragmatic abilities, both using continuers and yielding the floor to their partner when competitively overlapped in order to encourage a speaker to continue.

CONCLUSIONS & IMPLICATIONS

These findings contribute to the understanding of the impact of dementia on the maintenance of sensitivity to the sequential aspects of everyday talk. From a clinical perspective, these findings can inform the training of FCPs about retained abilities and evidence-based support strategies, equipping them with knowledge and skills to structure and maintain fluent conversation.

The Quality of Pain Treatment in Community-Dwelling Persons with Dementia

Purpose

Dementia of Alzheimer's type (DAT) is a major cognitive communication disorder. The present study attempted to analyse communication disorders in DAT in the International Classification of Functions (ICF) framework. The study investigated the impact of the severity of communication disorders in persons with DAT on activity participation and environment components of the ICF.

Method

Thirty bilingual individuals with DAT in the age range of 65-88 years were classified into three groups of mild, moderate and severe degree of dementia. Forty-three items of the American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Adults (ASHA FACS) were linked to the ICF framework. A few additional items were also added for a complete profiling of DAT. A total of 50 (ASHA FACS + ICF) items were rated and administered for the purpose of the study.

Results

The study revealed a disproportionate impact of the severity of DAT on activity participation and environment components of the ICF.

Conclusion

The present study investigated the utility of the ICF framework for profiling the functionality of persons with DAT. This profiling highlighted the need for ensuring effective communication and quality of life in the DAT population.

Supporting communication in semantic dementia: clinical consensus from expert practitioners

Purpose

The purpose of this paper is to gain consensus regarding the clinical priorities and tasks required in supporting communication needs in those living with semantic dementia and their families, by specialist speech and language therapists (SLTs), working in clinical practice within dementia care settings in the UK.

Design/methodology/approach

A nominal group technique was used, followed by further exploration and refinement of issues using a modified Delphi technique with a group of six SLTs who specialised in dementia care and who had experience of working with individuals with semantic dementia and their families.

Findings

The findings in the study demonstrate a broader scope of practice than is evident within the research literature with this client group. Therapists identified a range of psychosocial issues for both the person with semantic dementia and their family, in particular finding ways to support activity and participation in conversation and explore barriers and facilitators within the communication environment.

Originality/value

This represents the first study to explore everyday practice in this rarer dementia and the information gathered here will be of use to a variety of health and social care professions interested in supporting those with semantic dementia and their families.

A Direct Performance Test for Assessing Activities of Daily Living in Patients with Mild Degenerative Dementia: The Development of the ETAM and Preliminary Results

BACKGROUND

There are currently only a few performance tests that assess the capacity to perform activities of daily living. These measures frequently require a long time to administer, are strongly cognition oriented, or have not been adequately validated.

METHODS

The Erlangen Test of Activities of Daily Living in Mild Dementia (ETAM) was developed in a 4-phase process that was based on the International Classification of Functioning, Disability, and Health (ICF). A pilot study was conducted on 30 subjects with mild dementia with a mean age of 80 years. The subjects' mean score on the MMSE was 21.5. Twenty-one of the 30 subjects were women.

RESULTS

Ten items were developed and tested in the pilot study. The mean time required to complete the test was 26 min. The item analysis showed difficulties that ranged primarily from r = 0.28 to r = 0.79. The ETAM had a moderate correlation with the MMSE (rMMSE = 0.310) and a low correlation with the Geriatric Depression Scale-15 (GDS-15; rGDS-15 = 0.149).

CONCLUSION

The preliminary version of the ETAM is quick and easy to use and has predominantly satisfactory item characteristics. There still is the need to revise the items 'giving directions' and 'making tea' with regard to standardisation.

Using the WHO-ICF with talking mats to enable adults with long-term communication difficulties to participate in goal setting

The World Health Organization International Classification of Functioning, Disability and Health (WHO-ICF) provides a framework that helps rehabilitation staff to take a holistic view of the patient. However, it is used predominantly by professionals rather than by active participation on behalf of the person with the disability. In addition, the language used within the framework can be difficult for patients to understand. In order to address these issues the Activities and Participation section of the ICF has been adapted by using graphic symbols. It has been used in conjunction with Talking Mats(™ 1 ), a low-tech communication framework, to help adults with long-term conditions participate in goal setting. This paper describes how this was done and provides examples from clinical practice. The paper discusses how this combined framework can empower people with communication difficulties and long-term conditions to become active participants in the rehabilitation process by identifying their own goals, indicating changing priorities and tracking their progress.

Applying the WHO ICF framework to communication assessment and goal setting in Huntington's disease: a case discussion

PURPOSE

Huntington's Disease (HD) is a fatal, hereditary neurodegenerative disorder that is characterized by a triad of motor, cognitive and psychiatric symptoms that impact on both communicative effectiveness and the treatment techniques used to maximize communicative participation. The purpose of this article is to describe the application of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) to communication assessment and goal setting for a 37 year old man with HD.

METHOD

Communication assessment consisted of qualitative interviews based on the ICF framework with the client and his mother, supplemented with quantitative communication assessments. Analysis and conceptualization of assessment information was completed with a modified version of the Rehabilitation Problem Solving Form (RPS-Form) (Steiner et al., 2002).

RESULTS

While impairments in body structures and functions were evident, analysis revealed that environmental factors such as family support were both key barriers and facilitators to communicative participation.

CONCLUSIONS

This case illustrates the potential of using the ICF to conceptualize communicative functioning and disability in HD and particularly highlights the importance of consideration of personal and environmental factors in revealing contributions to activity limitations and participation restrictions. Further investigation of applications of ICF for individuals with HD is suggested.

LEARNING OUTCOMES

As a result of this activity, readers will recognize the application of the WHO ICF to assessment and goal setting in a complex hereditary condition, Huntington Disease. As a result of this activity, readers will describe the use of the Rehabilitation Problem Solving Form (RPS-Form) for communication disorders. As a result of this activity, readers will identify relevant issues in comprehensive communication assessment of a fatal, degenerative neurological condition such as the advantages and challenges of clinical use of the ICF and its coding. As a result of this activity, readers will introduce life storybooks as a potential legacy item in degenerative diseases.

Systematic literature review on ICF from 2001 to 2009: its use, implementation and operationalisation

PURPOSE

To present a systematic literature review on the state of the art of the utilisation of the International Classification of Functioning, Disability and Health (ICF) since its release in 2001.

METHOD

The search was conducted through EMBASE, MEDLINE and PsychInfo covering the period between 2001 and December 2009. Papers were included if ICF was mentioned in title or abstract. Papers focussing on the ICF-CY and clinical research on children and youth only were excluded. Papers were assigned to six different groups covering the wide scenario of ICF application.

RESULTS

A total of 672 papers, coming from 34 countries and 211 different journals, were included in the analysis. The majority of publications (30.8%) were conceptual papers or papers reporting clinical and rehabilitation studies (25.9%). One-third of the papers were published in 2008 and 2009.

CONCLUSIONS

The ICF contributed to the development of research on functioning and on disability in clinical, rehabilitation as well as in several other contexts, such as disability eligibility and employment. Diffusion of ICF research and use in a great variety of fields and scientific journals is a proof that a cultural change and a new conceptualisation of functioning and disability is happening.