Satisfaction with communicative participation as defined by adults with multiple sclerosis: a qualitative study

PURPOSE

This study examined satisfaction with communicative participation as reported by adults with multiple sclerosis (MS).

METHOD

Eight community-dwelling adults with MS participated in semi-structured interviews. They were asked to discuss their satisfaction with their communication in a variety of situations. Interviews were analyzed using a constant comparative method of qualitative description.

RESULTS

Themes derived included: Comfort, consisting of Ease and Confidence; Success of the Outcome, including Function is Achieved and A Connection is Made; and Personal Meaning of Participation, including Personal Preferences, Comparison with the Past, and Thinking about One's Own Communication.

CONCLUSIONS

Participants described multiple facets of satisfaction with communicative participation. Some of the dimensions were similar to those in existing assessment instruments such as levels of ease or difficulty with performance. Participants did not talk about frequency of activities as a key part of their satisfaction. Implications for identifying intervention targets and treatment outcome measurements are provided.

LEARNING OUTCOMES

The reader should be able to: 1) define communicative participation and identify key elements of this construct; 2) identify the issues that were most relevant to satisfaction with communicative participation with participants with MS; and 3) identify reasons for greater emphasis on the subjective viewpoint of people with communication disorders in measurement of treatment outcomes.

Discovering Indices of Contingency Awareness in Adults With Multiple Profound Disabilities

We conducted two studies to examine parameters of social attention in contingency awareness training using switch activation with individuals who had multiple profound disabilities. In Study 1 we compared leisure devices and social attention as reinforcing stimuli with 5 individuals. Results indicated the reinforcing qualities of social attention over leisure devices with 2 individuals and documented the importance of session length in training. In Study 2 we investigated idiosyncratic behaviors as indicators of responsiveness with 3 of the 5 original participants as they activated switches. Behavior changes during switch activation versus nonactivation times in the leisure device and social attention conditions suggested volitional movement supporting contingency awareness and preference. Implications for clinical practice are discussed.

Measuring communicative participation: a review of self-report instruments in speech-language pathology

PURPOSE

To assess the adequacy of self-report instruments in speech-language pathology for measuring a construct called communicative participation.

METHOD

Six instruments were evaluated relative to (a) the construct measured, (b) the relevance of individual items to communicative participation, and (c) their psychometric properties.

RESULTS

No instrument exclusively measured communicative participation. Twenty-six percent (n = 34) of all items (N = 132) across the reviewed instruments were consistent with communicative participation. The majority (76%) of the 34 items were associated with general communication, while the remaining 24% of the items were associated with communication at work, during leisure, or for establishing relationships. Instruments varied relative to psychometric properties.

CONCLUSIONS

No existing self-report instruments in speech-language pathology were found to be solely dedicated to measuring communicative participation. Developing an instrument for measuring communicative participation is essential for meeting the requirements of our scope of practice.

Taking Part in Life: Enhancing Participation in Multiple Sclerosis

Health care professionals participating in rehabilitation for people with MS can play a critical role in enhancing limited outcomes such as enhanced mobility, reductions in symptoms such as pain and depression, and the metaoutcome-participation. This role will be significantly more effective if the health care professional acknowledges and validates the different perspectives of the professional and the patient and recognizes the expertise of the patient who has lived with MS in the context of his or her life. Assuming this role effectively requires that the health care professional develop a collaborative relationship with the patient and understand that the role may change depending on the stage of MS and the individual's circumstances.

The cost and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis

OBJECTIVE

To attain a better understanding of the benefits and barriers faced by persons with multiple sclerosis (MS) in the workplace.

DESIGN

Qualitative research methodology comprising a series of semistructured interviews.

SETTING

Community-based setting.

PARTICIPANTS

Fourteen women and 2 men with MS living in the community who were employed or recently employed at the time of interviews.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Accounts of personal experiences related to employment.

RESULTS

Four themes emerged: the cost-benefit economy of working; fatigue and cognitive changes; stress in the workplace; and accommodations made to address barriers. Although participants valued work highly, they were also aware of the cost of being employed. The consequences of unemployment or changing jobs were considered negative and appeared stressful. For persons with MS, employment had both costs and significant benefits. Accommodations in the workplace and modifications of roles and responsibilities at home made it possible for individuals to continue working.

CONCLUSIONS

Health care providers must consider the complexity and timing of decisions by people with MS to continue or leave employment before recommending either action. Identifying critical periods of intervention to stabilize this cost-benefit balance is a critical next step for understanding issues of employment and MS.

Getting the work done: a qualitative study of individuals with multiple sclerosis

THE PROBLEM

Work can be defined as an activity performed to accomplish something in the presence of obstacles that may make accomplishing the goal difficult. For individuals with MS, work is not only limited by physical impairments but also by factors such as fatigue and cognitive changes

PURPOSE

The aim of this study is to examine the experiences of individuals with mild to moderate MS as they carry out everyday work activities both inside and outside the home.

METHOD

Eleven women and three men were recruited from the community to participate in a series of semi-structured interviews. Using qualitative research methodology that examined the experiences of the participants, two major themes and seven subthemes emerged.

RESULTS

The first theme, Defining the work, included Priorities: seeing what's important; Plans: learning about resources and requirements; and

PERSPECTIVES

fixing it yourself. The second theme, Changing how things get done, includes Precipitating factors; Awareness; Constructing the strategies; and Evaluating the strategies.

CONCLUSIONS

Individuals with MS develop strategies and utilize resources in order to get the work done. Comparisons are made between existing intervention theories or programmes and the experiences described by participants in this study.

Acoustic analysis of voice in amyotrophic lateral sclerosis: a longitudinal case study

Acoustic measures of phonatory instability (coefficient of variation for amplitude, coefficient of variation for frequency, shimmer, jitter, and harmonics-to-noise ratio), phonatory limits (maximum fundamental frequency range and maximum duration of vowel phonation), and the nasal-oral amplitude ratio were measured five times throughout a 6-month period from the phonation of a 69-year-old male patient with amyotrophic lateral sclerosis (ALS), an age- and sex-matched control subject, and on one occasion from a 16-subject control group matched to the patient in age and sex. The patient was free of vocal symptoms at the initiation of the study. When compared to the other recording sessions, the final recording of the ALS patient was characterized by increased coefficient of variation for amplitude, increased coefficient of variation for frequency, increased shimmer, increased jitter, reduced harmonics-to-noise ratio, and reduced maximum vowel duration. These acoustic manifestations of increased phonatory instability and reduced phonatory limits over time were in contrast to the consistency observed in the phonation of the longitudinal control subject and were outside the range of plus or minus one standard deviation on most acoustic variables when compared to the control group. These findings support the potential use of acoustic analysis in reflecting progression of ALS and suggest the need for further studies to investigate the relationship between acoustic analysis of voice and manifestations of neurological disease.