Creating synergies among education/research, practice, and policy environments to build capacity for the scholar role in occupational therapy and physiotherapy in the Canadian context

Scholarly practice (SP) is considered a key competency of occupational therapy and physiotherapy. To date, the three sectors-education/research, practice, and policy/regulation-that support SP have been working relatively independently. The goals of this project were to (a) understand how representatives of the three sectors conceptualize SP; (b) define each sector's individual and collective roles in supporting SP; (c) identify factors influencing the enactment of SP and the specific needs of how best to support SP; and (d) co-develop goals and strategies to support SP across all sectors. We used interpretive description methodology. Consistent with an integrated knowledge translation approach, partners representing the three sectors across Canada recruited individuals from each sector, developed the content and questions for three focus groups, and collected and analyzed the data. Inspired by the Consolidated Framework for Implementation Research, we developed the questions for the second focus group. We analyzed the data using an inductive thematic analysis method. Thirty-nine participants from the three sectors participated. Themes related to participants' conceptualization of SP included (a) ongoing process, (b) reflective process, (c) broad concept, and (d) collective effort. Themes describing factors influencing and supporting SP were (a) recognition, (b) appropriate conceptualization, (c) social network, (d) accessibility to resources, and (e) forces outside of practitioners' effort. Goals to support SP included (a) further recognizing SP, (b) sustaining SP competency, and (c) ensuring access to information. SP requires collaborative and integrated intersectoral support and further recognition of its importance through the collaboration of multiple stakeholders.

Visual and cognitive functioning among older adults with low vision before vision rehabilitation: A pilot study

Introduction

The occurrence of age-related vision changes is inevitable. However, some of these changes can become pathological. Research indicates that vision and hearing loss is correlated with age-related cognitive decline, and with a higher risk of developing dementia due to Alzheimer's disease. Low vision rehabilitation could possibly be a protective factor against cognitive decline, as it provides the clients with compensatory strategies to overcome their visual deficits.

Objectives and hypothesis

The aim of this pilot study was to assess correlations between visual and cognitive functions in older adults referred for low vision rehabilitation. We hypothesized that more severe impairment of visual acuity and contrast sensitivity would be correlated with more advanced levels of cognitive impairment. The second objective was to examine which of these correlations would remain significant once established variables that influence cognition are statistically removed (e.g., age, education).

Methods

Thirty-eight older adults (age range: 66-97 years old) with a visual impairment (acuity <20/70) were recruited before the onset of their low vision rehabilitation. They underwent vision (reading acuity, reading speed, contrast sensitivity), hearing (audiogram, speech-in-noise perception) and cognitive (global cognition, memory, executive functions) testing, and demographic information was obtained.

Results and discussion

Correlations among global cognition and visual aid use, memory and reading speed, memory and contrast sensitivity, memory, and visual aid use, and between executive functions and contrast sensitivity were significant. Correlations between contrast sensitivity and memory, as well as between global cognition and visual aid use remained significant after controlling for age and education. The present study is relevant to clinicians who are assessing the cognitive status of older adults, such as neuropsychologists, because it highlights the importance of considering low vision when administering neuropsychological tests, especially to persons who have not yet received rehabilitation for their visual impairment.

Advancing social inclusion of people with disabilities through awareness and training activities: A collaborative process between community partners and researchers

OBJECTIVE

The main objectives were to 1) search and map current disability awareness and training activities in Quebec, Canada, 2) collectively reflect on these practices, and 3) develop a five-year strategic plan.

METHODS

We used an integrated knowledge translation approach whereby researchers and community partners were involved in all stages. This project consisted of two sequential phases: 1) an environmental scan (web review and interview) of current practices, and 2) a reflection process with an external expert-facilitator in social transformation. Outcome results and process data are reported.

RESULTS

We identified 129 activities (71 training, 58 awareness) from 39 organizations (from 123 organizations initially invited). A wide range of characteristics were collected for each activity which allowed for the identification of gaps. The working group met seven times in one year to discuss results from phase 1 and co-create a five-year strategic plan. Main priorities are 1) the development of a methodology for measuring collective impact and 2) content synchronization of activities.

CONCLUSION

Involvement of partners and researchers enabled a concerted and efficient approach to the development of a five-year strategic plan.

PRACTICE IMPLICATIONS

A transition committee led by partners will ensure implementation and sustainability of the plan across the province.

Digital Biomarkers for Supporting Transitional Care Decisions: Protocol for a Transnational Feasibility Study

Background

Virtual Health and Wellbeing Living Lab Infrastructure is a Horizon 2020 project that aims to harmonize Living Lab procedures and facilitate access to European health and well-being research infrastructures. In this context, this study presents a joint research activity that will be conducted within Virtual Health and Wellbeing Living Lab Infrastructure in the transitional care domain to test and validate the harmonized Living Lab procedures and infrastructures. The collection of data from various sources (information and communications technology and clinical and patient-reported outcome measures) demonstrated the capacity to assess risk and support decisions during care transitions, but there is no harmonized way of combining this information.

Objective

This study primarily aims to evaluate the feasibility and benefit of collecting multichannel data across Living Labs on the topic of transitional care and to harmonize data processes and collection. In addition, the authors aim to investigate the collection and use of digital biomarkers and explore initial patterns in the data that demonstrate the potential to predict transition outcomes, such as readmissions and adverse events.

Methods

The current research protocol presents a multicenter, prospective, observational cohort study that will consist of three phases, running consecutively in multiple sites: a cocreation phase, a testing and simulation phase, and a transnational pilot phase. The cocreation phase aims to build a common understanding among different sites, investigate the differences in hospitalization discharge management among countries, and the willingness of different stakeholders to use technological solutions in the transitional care process. The testing and simulation phase aims to explore ways of integrating observation of a patient’s clinical condition, patient involvement, and discharge education in transitional care. The objective of the simulation phase is to evaluate the feasibility and the barriers faced by health care professionals in assessing transition readiness.

Results

The cocreation phase will be completed by April 2022. The testing and simulation phase will begin in September 2022 and will partially overlap with the deployment of the transnational pilot phase that will start in the same month. The data collection of the transnational pilots will be finalized by the end of June 2023. Data processing is expected to be completed by March 2024. The results will consist of guidelines and implementation pathways for large-scale studies and an analysis for identifying initial patterns in the acquired data.

Conclusions

The knowledge acquired through this research will lead to harmonized procedures and data collection for Living Labs that support transitions in care.

International Registered Report Identifier (IRRID)

PRR1-10.2196/34573

Biomedical Research & Informatics Living Laboratory for Innovative Advances of New Technologies in Community Mobility Rehabilitation: Protocol for a longitudinal evaluation of mobility outcomes (Preprint)

Background

Rapid advances in technologies over the past 10 years have enabled large-scale biomedical and psychosocial rehabilitation research to improve the function and social integration of persons with physical impairments across the lifespan. The Biomedical Research and Informatics Living Laboratory for Innovative Advances of New Technologies (BRILLIANT) in community mobility rehabilitation aims to generate evidence-based research to improve rehabilitation for individuals with acquired brain injury (ABI).

Objective

This study aims to (1) identify the factors limiting or enhancing mobility in real-world community environments (public spaces, including the mall, home, and outdoors) and understand their complex interplay in individuals of all ages with ABI and (2) customize community environment mobility training by identifying, on a continuous basis, the specific rehabilitation strategies and interventions that patient subgroups benefit from most. Here, we present the research and technology plan for the BRILLIANT initiative.

Methods

A cohort of individuals, adults and children, with ABI (N=1500) will be recruited. Patients will be recruited from the acute care and rehabilitation partner centers within 4 health regions (living labs) and followed throughout the continuum of rehabilitation. Participants will also be recruited from the community. Biomedical, clinician-reported, patient-reported, and brain imaging data will be collected. Theme 1 will implement and evaluate the feasibility of collecting data across BRILLIANT living labs and conduct predictive analyses and artificial intelligence (AI) to identify mobility subgroups. Theme 2 will implement, evaluate, and identify community mobility interventions that optimize outcomes for mobility subgroups of patients with ABI.

Results

The biomedical infrastructure and equipment have been established across the living labs, and development of the clinician- and patient-reported outcome digital solutions is underway. Recruitment is expected to begin in May 2022.

Conclusions

The program will develop and deploy a comprehensive clinical and community-based mobility-monitoring system to evaluate the factors that result in poor mobility, and develop personalized mobility interventions that are optimized for specific patient subgroups. Technology solutions will be designed to support clinicians and patients to deliver cost-effective care and the right intervention to the right person at the right time to optimize long-term functional potential and meaningful participation in the community.

International Registered Report Identifier (IRRID)

PRR1-10.2196/12506

Cocreating a Harmonized Living Lab for Big Data-Driven Hybrid Persona Development: Protocol for Cocreating, Testing, and Seeking Consensus

Background

Living Labs are user-centered, open innovation ecosystems based on a systematic user cocreation approach, which integrates research and innovation processes in real-life communities and settings. The Horizon 2020 Project VITALISE (Virtual Health and Wellbeing Living Lab Infrastructure) unites 19 partners across 11 countries. The project aims to harmonize Living Lab procedures and enable effective and convenient transnational and virtual access to key European health and well-being research infrastructures, which are governed by Living Labs. The VITALISE consortium will conduct joint research activities in the fields included in the care pathway of patients: rehabilitation, transitional care, and everyday living environments for older adults. This protocol focuses on health and well-being research in everyday living environments.

Objective

The main aim of this study is to cocreate and test a harmonized research protocol for developing big data–driven hybrid persona, which are hypothetical user archetypes created to represent a user community. In addition, the use and applicability of innovative technologies will be investigated in the context of various everyday living and Living Lab environments.

Methods

In phase 1, surveys and structured interviews will be used to identify the most suitable Living Lab methods, tools, and instruments for health-related research among VITALISE project Living Labs (N=10). A series of web-based cocreation workshops and iterative cowriting processes will be applied to define the initial protocols. In phase 2, five small-scale case studies will be conducted to test the cocreated research protocols in various real-life everyday living settings and Living Lab infrastructures. In phase 3, a cross-case analysis grounded on semistructured interviews will be conducted to identify the challenges and benefits of using the proposed research protocols. Furthermore, a series of cocreation workshops and the consensus seeking Delphi study process will be conducted in parallel to cocreate and validate the acceptance of the defined harmonized research protocols among wider Living Lab communities.

Results

As of September 30, 2021, project deliverables Ethics and safety manual and Living lab standard version 1 have been submitted to the European Commission review process. The study will be finished by March 2024.

Conclusions

The outcome of this research will lead to harmonized procedures and protocols in the context of big data–driven hybrid persona development among health and well-being Living Labs in Europe and beyond. Harmonized protocols enable Living Labs to exploit similar research protocols, devices, hardware, and software for interventions and complex data collection purposes. Economies of scale and improved use of resources will speed up and improve research quality and offer novel possibilities for open data sharing, multidisciplinary research, and comparative studies beyond current practices. Case studies will also provide novel insights for implementing innovative technologies in the context of everyday Living Lab research.

International Registered Report Identifier (IRRID)

DERR1-10.2196/34567

Rehabilitation supported by technology: Protocol for an international co-creation and user experience study (Preprint)

Background

Living labs in the health and well-being domain have become increasingly common over the past decade but vary in available infrastructure, implemented study designs, and outcome measures. The Horizon 2020 Project Virtual Health and Wellbeing Living Lab Infrastructure aims to harmonize living lab procedures and open living lab infrastructures to facilitate and promote research activities in the health and well-being domain in Europe and beyond. This protocol will describe the design of a joint research activity, focusing on the use of innovative technology for both rehabilitation interventions and data collection in a rehabilitation context.

Objective

With this joint research activity, this study primarily aims to gain insight into each living lab’s infrastructure and procedures to harmonize health and well-being living lab procedures and infrastructures in Europe and beyond, particularly in the context of rehabilitation. Secondarily, this study aims to investigate the potential of innovative technologies for rehabilitation through living lab methodologies.

Methods

This study has a mixed methods design comprising multiple phases. There are two main phases of data collection: cocreation (phase 1) and small-scale pilot studies (phase 2), which are preceded by a preliminary harmonization of procedures among the different international living labs. An intermediate phase further allows the implementation of minor adjustments to the intervention or protocol depending on the input that was obtained in the cocreation phase. A total of 6 small-scale pilot studies using innovative technologies for intervention or data collection will be performed across 4 countries. The target study sample comprises patients with stroke and older adults with mild cognitive impairment. The third and final phases involve Delphi procedures to reach a consensus on harmonized procedures and protocols.

Results

Phase 1 data collection will begin in March 2022, and phase 2 data collection will begin in June 2022. Results will include the output of the cocreation sessions, small-scale pilot studies, and advice on harmonizing procedures and protocols for health and well-being living labs focusing on rehabilitation.

Conclusions

The knowledge gained by the execution of this research will lead to harmonized procedures and protocols in a rehabilitation context for health and well-being living labs in Europe and beyond. In addition to the harmonized procedures and protocols in rehabilitation, we will also be able to provide new insights for improving the implementation of innovative technologies in rehabilitation.

International Registered Report Identifier (IRRID)

PRR1-10.2196/34537

Effect of Reading Rehabilitation for Age-Related Macular Degeneration on Cognitive Functioning: Protocol for a Nonrandomized Pre-Post Intervention Study

BACKGROUND

Age-related vision impairments and dementia both become more prevalent with increasing age. Research into the mechanisms of these conditions has proposed that some of their causes (eg, macular degeneration/glaucoma and Alzheimer's disease) could be symptoms of an underlying common cause. Research into sensory-cognitive aging has provided data that sensory decline may be linked to the progression of dementia through reduced sensory stimulation. While hearing loss rehabilitation may have a beneficial effect on cognitive functioning, there are no data available on whether low vision rehabilitation, specifically for reading, could have a beneficial effect on cognitive health.

OBJECTIVE

The research questions are: (1) Does low vision rehabilitation reduce reading effort? (2) If so, does reduced reading effort increase reading activity, and (3) If so, does increased reading activity improve cognitive functioning? The primary objective is to evaluate cognition before, as well as at 6 months and 12 months after, 3 weeks of low vision reading rehabilitation using magnification in individuals with age-related macular degeneration, with or without coexisting hearing impairments. We hypothesize that improvements postrehab will be observed at 6 months and maintained at 12 months for participants with vision loss and less so for those with dual sensory loss. The secondary objective is to correlate participant characteristics with all cognitive outcomes to identify which may play an important role in reading rehabilitation.

METHODS

We employ a quasiexperimental approach (nonrandomized, pre-post intervention study). A 3x3 design (3 groups x 3 time points) allows us to examine whether cognitive performance will change before and after 6 months and 12 months of a low vision reading intervention, when comparing 75 low vision and 75 dual sensory impaired (vision & hearing) participants to 75 age-matched healthy controls. The study includes outcome measures of vision (eg, reading acuity and speed), cognition (eg, short-term and long-term memory, processing speed), participant descriptors, demographics, and clinical data (eg, speech perception in noise, mental health).

RESULTS

The study has received approval, and recruitment began on April 24, 2019. As of March 4, 2021, 38 low vision and 7 control participants have been enrolled. Lockdown forced a pause in recruitment, which will recommence once the COVID-19 crisis has reached a point where face-to-face data collection with older adults becomes feasible again.

CONCLUSIONS

Evidence of protective effects caused by reading rehabilitation will have a considerable impact on the vision rehabilitation community and their clients as well as all professionals involved in the care of older adults with or without dementia. If we demonstrate that reading rehabilitation has a beneficial effect on cognition, the demand for rehabilitation services will increase, potentially preventing cognitive decline across groups of older adults at risk of developing macular degeneration.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04276610; Unique Protocol ID: CRIR-1284-1217; https://clinicaltrials.gov/ct2/show/NCT04276610.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/19931.

Category-specific verb-semantic deficits in Alzheimer's disease: Evidence from static and dynamic action naming

We investigated the representation and breakdown of verb knowledge employing different syntactic and semantic classes of verbs in a group of individuals with probable Alzheimer's Disease (pAD). In an action naming task with coloured photographs (Fiez & Tranel, 1997. Standardized stimuli and procedures for investigating the retrieval of lexical and conceptual knowledge for action. Memory and Cognition, 25(4), 543-569. https://doi.org/10.3758/BF03201129), pAD individuals were impaired for naming actions compared to objects. Verb tense was also affected, with simple-past (e.g., chopped) being more difficult to name than the gerundial form (e.g., chopping). Employing action-naming with short movies depicting events and states, we contrasted three verb classes based on their hypothetical structural and semantic/conceptual properties: argument structure, thematic structure, and conceptual templates. The three classes were: causatives (peel), verbs of perception (hear), and verbs of motion (run) Overall, results suggest that individuals with pAD are selectively impaired for verb tense and thematic assignment, but not conceptual-template complexity. Methodologically, we also show that dynamic scenes are more ecologically valid than static scenes to probe verb knowledge in AD.

The role of clothing on participation of persons with a physical disability: A scoping review

Determining ways to facilitate participation of persons with a physical disability is crucial and clothing may play a central role. This review aims to synthesize and examine the role of clothing on participation of persons with a physical disability. Six research databases and grey literature were searched following Arksey & O'Malley's six steps, including multiple expert consultations. English and French articles contributing to how clothing affects participation were included and tabulated based on the International Classification of Functioning, Disability and Health. Fifty-seven articles and 88 websites were included. A variety of stakeholder perspectives, diagnoses, and types of clothing were represented. Clothing mostly influences mobility and self-care, as well as various personal factors. Forty-nine percent of articles reported essential clothing design features to consider. Clothing is an important and complex environmental factor that interacts with all health domains, including participation. Future research should consider intersectoral initiatives.

Phone messages affect the detection of approaching pedestrians in healthy young and older adults immersed in a virtual community environment

Background

Mobile phones are increasingly associated with accidents while walking. Little is known, however, about the impact of phone messaging on the actual perception of other pedestrians. This study aimed to investigate the extent to which the detection of approaching pedestrians is affected by the sensory modality (text or audio) of phone messages in young vs. older adults.

Methods

Eighteen healthy young (24 ± 2.9 years) and 15 older adults (68 ± 4.2 years) performed a phone message deciphering task, an obstacle detection task, and a dual-task condition combining both tasks. Participants were tested while seated and viewing a virtual subway station (VE) in a helmet mounted display. As they were passively moved within the VE one of three virtual pedestrians randomly approached them from the center (0°), right (+40°) or left (+40°). When present, phone message conditions were delivered at obstacle movement onset and presented either as (1) text messages on the screen of a virtual phone or (2) audio messages delivered through earphones. Participants were instructed to press a joystick button as soon as they detected the approaching virtual pedestrian and to report the message content at the end of the trials.

Results

Young and older participants showed delayed obstacle detection times with vs. without text messages. Older adults further showed reduced accuracy of message report for texts compared to audio messages. In both groups, audio messages yielded no difference in obstacle detection time or accuracy of message report compared to the no message condition.

Conclusions

Findings indicate that text messages prolong the detection of approaching pedestrians, suggesting that they compromise safe ambulation in community environments. Older adults, who show larger deteriorations on the obstacle detection and message deciphering tasks, may be at even greater risk of collision. Audio messages could be a safer alternative for on-the-go communication.

The role of clothing in participation of persons with a physical disability: a scoping review protocol

INTRODUCTION

Clothing is an important aspect of nearly all human societies from performing social and cultural functions to indicating social status, a form of protection and a way for self-expression. It can help or hinder the ability to fulfil everyday activities and social roles and with the rising industry of wearable technologies, smart textiles are adding health-monitoring functions to clothing. The influence that clothing can have on the life of someone with a physical disability is significant, and further research is needed to understand it better. To achieve this, a scoping review will be performed with the aim of understanding the role of clothing in participation (ie, at home, in the community, etc) of individuals with a physical disability. This article presents the protocol and procedure to be adopted.

METHODS AND ANALYSIS

An in-depth iterative analysis of the scientific literature from six databases (MEDLINE, Embase, CINAHL, Scopus, PsycINFO and ERIC) as well as a hand search of grey literature and reference lists will be performed. After an abstract and full-text review of references by three reviewers independently, data from the selected articles will be tabulated and synthesised with a qualitative and quantitative approach using the International Classification of Functioning, Disability and Health as a unifying conceptual framework. A multidisciplinary consultation group of experts from various stakeholder groups will be involved in multiple steps to ensure validation and relevance of the data.

ETHICS AND DISSEMINATION

As this is a review involving analysis of data available in the public domain and does not involve human participants, ethical approval was not required. Results will be presented in a co-constructed format with the expert consultation group to ensure validity and maximise its practicality moving forward. Our dissemination plan includes peer-reviewed publications, presentations and stakeholder meetings.

Rehabilitation in the real-life environment of a shopping mall

AIM

The aim of this study was to explore how shopping malls could be used during rehabilitation and to identify the facilitators and barriers to their use.

METHOD

Two focus groups, conducted with 15 rehabilitation professionals from various disciplines and working with people with disabilities of all ages were structured around two topics: (i) The usage of malls for rehabilitation and (ii) Factors that facilitate or limit rehabilitation professionals' use of the mall as an environment for clinical assessment and/or intervention.

RESULTS

The thematic analysis revealed that shopping malls were used to achieve several rehabilitation goals targeting physical and cognitive skills, psychological health and socialization. This real-life environment is motivating and helps foster independence and normalization. Factors affecting mall use during rehabilitation included personal factors (e.g. clients' personality and level of readiness) and environmental factors (e.g. clinical context, accessibility of the mall and social attitudes of store owners).

CONCLUSION

Shopping malls may be a relevant rehabilitation assessment and treatment environment that could contribute to optimizing community integration of people with disabilities. Implications for rehabilitation To ensure successful community reintegration, clients could be trained at some point during their rehabilitation, to perform activities in real-life settings, such as a shopping mall. Shopping malls appear to enable the attainment of rehabilitation goals targeting a variety of skills. This real-life environment appears to be motivating and helps foster independence and normalization. Factors felt to affect mall use during rehabilitation include personal factors (e.g. clients' personality and level of readiness) and environmental factors (e.g. clinical context, accessibility of the mall and social attitudes of store owners). The shopping mall may be an untapped resource as it appears to be a relevant rehabilitation assessment and treatment environment that could contribute to optimizing community integration of people with disabilities.

Creating an inclusive mall environment with the PRECEDE-PROCEED model: a living lab case study

PURPOSE

Although public environments provide opportunities for participation and social inclusion, they are not always inclusive spaces and may not accommodate the wide diversity of people. The Rehabilitation Living Lab in the Mall is a unique, interdisciplinary, and multi-sectoral research project with an aim to transform a shopping complex in Montreal, Canada, into an inclusive environment optimizing the participation and social inclusion of all people.

METHODS

The PRECEDE-PROCEDE Model (PPM), a community-oriented and participatory planning model, was applied as a framework. The PPM is comprised of nine steps divided between planning, implementation, and evaluation.

RESULTS

The PPM is well suited as a framework for the development of an inclusive mall. Its ecological approach considers the environment, as well as the social and individual factors relating to mall users' needs and expectations. Transforming a mall to be more inclusive is a complex process involving many stakeholders. The PPM allows the synthesis of several sources of information, as well as the identification and prioritization of key issues to address. The PPM also helps to frame and drive the implementation and evaluate the components of the project.

CONCLUSION

This knowledge can help others interested in using the PPM to create similar enabling and inclusive environments world-wide. Implication for rehabilitation While public environments provide opportunities for participation and social inclusion, they are not always inclusive spaces and may not accommodate the wide diversity of people. The PRECEDE PROCEDE Model (PPM) is well suited as a framework for the development, implementation, and evaluation of an inclusive mall. Environmental barriers can negatively impact the rehabilitation process by impeding the restoration and augmentation of function. Removing barriers to social participation and independent living by improving inclusivity in the mall and other environments positively impacts the lives of people with disabilities.

Cognitive reserve in a cross-cultural population: the case of Italian emigrants in Montreal

BACKGROUND

Cognitive reserve could be defined as the accumulation of experiences, abilities, knowledge and changes that occur throughout the lifespan. One of the most difficult changes in life is the experience of emigrating to a foreign country.

AIMS

The present investigation aimed to compare the cognitive reserve of two paired groups of elderly: Italians living in Italy and Italians who in adult age (around 20 years) emigrated to Montreal. Both groups attended the same years of school, in Italy.

METHODS

Cognitive reserve was measured in the two groups by a structured and standardised questionnaire, the cognitive reserve questionnaire.

RESULTS

Cognitive reserve showed to be significantly higher in the Italian-Canadian individuals (i.e. Italians who emigrated).

CONCLUSIONS

Emigration might act as an environmental factor that enriches people's lifestyle and reflects itself in the amount of their cognitive reserve.

Does occupational therapy play a role for communication in children with autism spectrum disorders?

This study investigates occupational therapy for early communication in children with autism spectrum disorders (ASD). The research explored the role of occupational therapists in supporting children with ASD to become better communicators by considering their inter-professional collaboration with speech-language pathologists. Convenience samples of 21 clinical occupational therapists and speech-language pathologists were recruited to participate in semi-structured audio-recorded focus groups, using a qualitative design. Distinct views included a child-centred focus from speech-language pathologists, whereas occupational therapists spoke of the child through societal viewpoints, which later pointed to occupational therapists' proficiency in enabling skill generalization in ASD. An equal partnership was consistently reported between these clinicians, who identified the same objectives, shared strategies, joint treatments, and ongoing collaboration as the four main facilitators to inter-professional collaboration when treating children with ASD. Three unique roles of occupational therapy comprised developing non-verbal and verbal communication pre-requisites, adapting the setting, educating-partnering-advocating for the child, and providing occupation-based intervention. These three themes meshed with the discipline-specific occupational therapy domains represented in the Person-Environment-Occupation framework. When working in inter-professional collaboration, speech-language pathologists and occupational therapists agree that occupational therapy is indispensable to early intervention in enabling communication in ASD.

Health-related quality of life in children with high-functioning autism

The health-related quality of life of school-aged children with high-functioning autism is poorly understood. The objectives of this study were to compare the health-related quality of life of children with high-functioning autism to that of typically developing peers and to compare child-self and parent-proxy reports of health-related quality of life of children. A cross-sectional study of children with high-functioning autism ( n = 30) and peers ( n = 31) was conducted using the Pediatric Quality of Life Inventory 4.0 Generic Core Scales. Children with high-functioning autism had significantly poorer health-related quality of life than peers whether reported by themselves ( p < .001) or their parents ( p < .001), although disagreement (intra-class coefficient = −.075) between children and parental scores suggested variance in points of view. This study specifically investigated health-related quality of life in children with high-functioning autism as compared to a sample of peers, from the child’s perspective. It strengthens earlier findings that children with high-functioning autism experience poorer health-related quality of life than those without this disorder and points to the importance of clinicians working with families to identify areas in a child’s life that promote or hinder their sense of well-being.

Children's assessment of participation and enjoyment/preference for activities of children: psychometric properties in a population with high-functioning autism

The psychometric properties of assessments must be established for specific populations. The psychometric properties of the Children's Assessment of Participation and Enjoyment/Preference for Activities of Children have been studied only in a sample of children with physical disability. We conducted a study to determine the appropriateness of drawing inferences from this assessment for children with high-functioning autism (HFA). The content validity and test-retest reliability (r > .7) were both found to be adequate for this population. Parents' agreement with most of their children's self-ratings on this assessment provided an estimate of interrater reliability. We also ascertained the feasibility of gathering recreational participation information from children with HFA and found that adaptations to facilitate the self-completion of the tool should be made available. The study findings support the use of this tool to assess recreational participation among children with HFA.

Sensitivity and specificity of French language and processing measures for the identification of primary language impairment at age 5

PURPOSE

Research on the diagnostic accuracy of different language measures has focused primarily on English. This study examined the sensitivity and specificity of a range of measures of language knowledge and language processing for the identification of primary language impairment (PLI) in French-speaking children. Because of the lack of well-documented language measures in French, it is difficult to accurately identify affected children, and thus research in this area is impeded.

METHOD

The performance of 14 monolingual French-speaking children with confirmed, clinically identified PLI (M = 61.4 months of age, SD = 7.2 months) on a range of language and language processing measures was compared with the performance of 78 children with confirmed typical language development (M age = 58.9 months, SD = 5.7). These included evaluations of receptive vocabulary, receptive grammar, spontaneous language, narrative production, nonword repetition, sentence imitation, following directions, rapid automatized naming, and digit span. Sensitivity, specificity, and likelihood ratios were determined at 3 cutoff points: (a) -1 SD, (b) -1.28 SD, and (b) -2 SD below mean values. Receiver operator characteristic curves were used to identify the most accurate cutoff for each measure.

RESULTS

Significant differences between the PLI and typical language development groups were found for the majority of the language measures, with moderate to large effect sizes. The measures differed in their sensitivity and specificity, as well as in which cutoff point provided the most accurate decision. Ideal cutoff points were in most cases between the mean and -1 SD. Sentence imitation and following directions appeared to be the most accurate measures.

CONCLUSIONS

This study provides evidence that standardized measures of language and language processing provide accurate identification of PLI in French. The results are strikingly similar to previous results for English, suggesting that in spite of structural differences between the languages, PLI in both languages involves a generalized language delay across linguistic domains, which can be identified in a similar way using existing standardized measures.

Rehabilitation services for children: Therapists’ perceptions

The objective of this study was to examine occupational therapists' (OT) and physiotherapists' (PT) perceptions regarding waiting time and the quality and quantity of the services they provide for children with disabilities. A survey was sent by post to all paediatric OTs and PTs in Quebec, Canada. A Service Delivery Questionnaire included questions regarding therapist/client characteristics, waiting times and quality and quantity of services provided. The Measure of Processes of Care for Service Providers (MPOC-SP) rated use of family-centred care by responding clinicians. Waiting times were longest for OT services (p<0.0001), speech/language interventions (p<0.0001) and services in rehabilitation and community health centres (p<0.0001). Quality of services was rated higher by PTs, experienced therapists and those using more methods of keeping up-to-date. The frequency and duration of services varied according to profession, type of clientele and setting. According to clinicians directly involved in the provision of rehabilitation services, long delays exist for children waiting for rehabilitation services, and perceived quality of services differs according to specific therapist and client characteristics. These findings will assist those involved in planning the distribution of co-ordinated rehabilitation services for children.

Neurological and magnetic resonance imaging findings in children with developmental language impairment

Neurologic and radiologic findings in children with well-defined developmental language impairment have rarely been systematically assessed. Children aged 7 to 13 years with developmental language impairment or normal language (controls) underwent language, nonverbal cognitive, motor and neurological assessments, standardized assessment for subtle neurological signs, and magnetic resonance imaging. Nine children with developmental language impairment and 12 controls participated. No focal abnormalities were identified on standard neurological examination. Age and developmental language impairment were independent predictors of neurological subtle signs scores (r(2) = 0.52). Imaging abnormalities were identified in two boys with developmental language impairment and no controls (P = .17). Lesions identified were predicted neither by history nor by neurological examination. Previously unsuspected lesions were identified in almost 25% of children with developmental language impairment. Constraints regarding cooperation and sedation requirements may limit the clinical application of imaging modalities in this population.

The clinical spectrum of developmental language impairment in school-aged children: language, cognitive, and motor findings

OBJECTIVE

Our goal was to evaluate detailed school-age language, nonverbal cognitive, and motor development in children with developmental language impairment compared with age-matched controls.

METHODS

Children with developmental language impairment or normal language development (controls) aged 7 to 13 years were recruited. Children underwent language assessment (Clinical Evaluation of Language Fundamentals-4, Peabody Picture Vocabulary-3, Goldman-Fristoe Test of Articulation-2), nonverbal cognitive assessment (Wechsler Intelligence Scale for Children-IV), and motor assessment (Movement Assessment Battery for Children). Exclusion criteria were nonverbal IQ below the 5th percentile or an acquired language, hearing, autistic spectrum, or neurologic disorder.

RESULTS

Eleven children with developmental language impairment (7:4 boys/girls; mean age: 10.1 +/- 0.8 years) and 12 controls (5:7 boys/girls; mean age: 9.5 +/- 1.8 years) were recruited. Children with developmental language impairment showed lower mean scores on language (Clinical Evaluation of Language Fundamentals-4--developmental language impairment: 79.7 +/- 16.5; controls: 109.2 +/- 9.6; Goldman-Fristoe Test of Articulation-2--developmental language impairment: 94.1 +/- 10.6; controls: 104.0 +/- 2.8; Peabody Picture Vocabulary-3--developmental language impairment: 90.5 +/- 13.8; controls: 100.1 +/- 11.6), cognitive (Wechsler Intelligence Scale for Children-IV--developmental language impairment: 99.5 +/- 15.5; controls: 113.5 +/- 11.9), and motor measures (Movement Assessment Battery for Children percentile--developmental language impairment: 12.7 +/- 16.7; controls: 66.1 +/- 30.6) and greater discrepancies between cognitive and language scores (Wechsler Intelligence Scale for Children-IV/Clinical Evaluation of Language Fundamentals-4--developmental language impairment: 17.8 +/- 17.8; controls: 1.2 +/- 12.7). Motor impairment was more common in children with developmental language impairment (70%) than controls (8%).

CONCLUSIONS

Developmental language impairment is characterized by a broad spectrum of developmental impairments. Children identified on the basis of language impairment show significant motor comorbidity. Motor assessment should form part of the evaluation and follow-up of children with developmental language impairment.

Eliciting Information on Differential Sensation of Heat in Those With and Without Poststroke Aphasia Using a Visual Analogue Scale

Background and Purpose— Aphasia can result in an inability to communicate the presence, location, or intensity of pain. Although visual analogue scales (VASs) exist, it is unknown whether they are useful in assessing pain in individuals with aphasia. The objective was to determine whether those with poststroke aphasia could respond differentially to thermal stimuli of varying intensities using a standardized VAS.

Methods— Five groups of participants were assessed: those without stroke, those with stroke but without aphasia, and 3 groups with varying degrees of aphasia. A 10-cm vertical VAS was used to measure responses to varying thermal intensities delivered on the participant’s forearm.

Results— Across all 5 groups, a similar proportion demonstrated ability to discriminate between 2 temperatures (χ 2 =1.899; P =0.75). When presented with 4 temperatures, all groups performed more poorly, yet with similar success rates across groups (χ 2 =0.1267; P =0.88). The repeated-measures ANOVA revealed no effect of group but a significant effect of temperature ( P <0.0001).

Conclusion— A VAS may be useful in clinical identification of differing intensities of stimuli in a substantial proportion of those with aphasia.

Morphological units in the Arabic mental lexicon: evidence from an individual with deep dyslexia

An ongoing debate in Arabic morphology concerns the nature of the smallest unit governing lexical organization and representation in this language. A standard model maintains that Arabic words are typically analyzable into a three-consonantal root morpheme carrying the core meaning of words and a prosodic template responsible mostly for grammatical information. This view has been largely supported by research in both theoretical linguistics and psycholinguistics. An alternative theory holds that the meaning of words in Arabic is, rather, encoded in the 'etymon' comprising two unordered consonants of the root only. Results from a recent priming experiment have shown that the etymon induces strong morphological priming effects, supporting its morphological/lexical status. In this paper we present data from a patient with deep dyslexia questioning the role of the etymon as a psychologically real representational unit in Arabic and arguing, instead, for the central role of the root in both morphological and lexical representation in this language.

Regularity re-revisited: modality matters

The issue of regular-irregular past tense formation was examined in a cross-modal lexical decision task in Modern Greek, a language where the orthographic and phonological overlap between present and past tense stems is the same for both regular and irregular verbs. The experiment described here is a follow-up study of previous visual lexical decision experiments (Tsapkini, Kehayia, & Harema, 2002) that also addressed the regular-irregular distinction in Greek. In the present experiment, we investigated the effect of input modality in lexical processing and compared different types of regular and irregular verbs. In contrast to our previous intra-modal (visual-visual) priming experiments, in this cross-modal (auditory-visual) priming study, we found that regular verbs with an orthographically salient morphemic aspectual marker elicited the same facilitation as those without an orthographically salient marker. However, irregular verbs did not exhibit a different priming pattern with respect to modality. We interpret these results in the framework of a two-level lexical processing approach with modality-specific access representations at a surface level and modality-independent morphemic representations at a deeper level.

Verb reading in developmental language impairment

This research addresses the issues of frequency and regularity in verb reading and their importance for the organization of the mental lexicon in DLI francophones. A reading task probes response latencies and response accuracy for DLI and control participants on frequent and infrequent inflected forms of verbs. DLI participants are slower at reading verbs even if their mean accuracy rates are higher than controls'. Results also indicate that the type of suffix on the verb affects controls and DLI participants differently in their accuracy rates: DLI participants exhibit higher error rates on less frequent inflections, while controls do not. Finally, unusual patterns are found for DLI participants on regular versus irregular verbs: regular verbs are slower to be read by DLI participants. These results are compared to findings from a previous simple lexical decision study. They are interpreted as indicating that DLI word reading patterns are qualitatively different from those evidenced by controls.

Regularity revisited: evidence from lexical access of verbs and nouns in Greek

The present study investigates the relationship between morphological regularity and form during lexical processing using a visual priming paradigm varying the prime duration. We addressed the effect of regularity on morphological facilitation in nouns and verbs by exploiting particular characteristics of a highly inflected language, Greek, in which it is possible to manipulate morphological regularity while controlling the degree of orthographic overlap between morphological relatives. The effects of morphological regularity were found to crucially depend on the time course of lexical access. Moreover, morphological regularity was found to affect nouns and verbs differentially. We interpret these findings with respect to the distinction between affix processing and allomorph retrieval and discuss the issues of form overlap and orthographic boundaries in morphological processing.

Auditory verb recognition in developmental language impairment

This research addresses the issues of frequency and regularity in auditory verb recognition and their importance for the organization of the mental lexicon in DLI francophones. A primed auditory lexical decision task probes reaction times and response accuracy in DLI and control participants on frequent and infrequent, and regular and irregular, inflected forms of verbs. Results show no priming for inflectionally related forms as well as strong frequency effects in DLI participants. These findings lend additional support to the hypothesis that developmental language impairment is a deficit in lexical representation.

The role of typological variation in the processing of interfixed compounds

This study investigates the processing of interfixed compounds within a primed lexical decision paradigm. Results from an experiment on German are compared with those from a previous study on Greek and Polish, demonstrating that patterns of morphological priming in German differ from those obtained in the other two languages. In all experiments compounds were primed by initial morphemes with and without the interfix. In Greek and Polish priming was significantly facilitated in cases where the mophological prime was homophonous with a real word. In German, however, the effect of wordness was found for un-interfixed but not for interfixed primes. Our data suggest that patterns of morphological priming for a given structure may not be generalizable to analogous structures in other languages without a consideration of language-specific morphological properties.

The role of morphological structure in the processing of compounds: the interface between linguistics and psycholinguistics

This study presents a cross-linguistic investigation of lexical access and subjects' sensitivity to the internal morphological structure of compounds in two highly inflected languages, Greek and Polish. The following questions were addressed: Are individual constituents activated during on-line word recognition? To what extent does internal morphological structure play a role during lexical access? Is there an interaction between headedness and constituent-priming given that the inflection that the second constituent carries determines the gender, number, and case of the compound? Our results show activation of individual constituents of compounds during priming, a strong word effect, and a positional advantage for first constituents in spite of the presence of second constituent heads.

What is a word? Recognizing polymorphemic lexical items in DLI

This paper addresses issues of frequency and transparency in word recognition and their importance for the organization of the mental lexicon in Developmentally Language Impaired (DLI) francophones. A simple visual lexical decision task probes responses of DLI and control participants when presented with verbs. DLI participants are sensitive to whole-word frequency and show little or no transparency effects. These results are interpreted as indicating that words are not organized according to "morphological families" in the DLI mental lexicon, but rather according to a principle of frequency. These facts support the hypothesis that words in the DLI mental lexicon lack lexical features and morphological structure.

Does phonological change play a role in the recognition of derived forms across modalities?

This study investigates the way in which phonological change during derivation influences the access of complex words in the on-line performance of English-speaking subjects during word recognition. Three visual lexical decision experiments were administered (cross-modal priming, visual priming and simple). Overall, the results showed that the forms which were subject to phonological change during derivation were always recognized significantly slower than those without phonological alterations. The results confirm the role of phonological change in accessing derived words. They also have important implications for a theory of lexical representation.

The mass/count distinction: evidence from on-line psycholinguistic performance

Under the hypothesis that the mass/count distinction in English is marked by a monovalent lexical feature, this article investigates whether features, lexical or morphosyntactic, play a role in simple lexical decision. Research findings have yet to settle how many features are accessed during lexical decision and to what extent morphosyntactic features are computed out of context. We used two on-line lexical decision experiments (simple and morphosyntactic priming). Results show that the lexical feature "mass" is computed in both experiments. However, the morphosyntactic feature "plural" is subject to task-specific effects and surfaces only where operative.

The mental representation of singular and plural nouns in Algerian Arabic as revealed through auditory priming in agrammatic aphasic patients

Working within the theoretical framework of prosodic nonconcatenative morphology developed by McCarthy (1975) for Semitic languages, we addressed, in the present paper, the issues of lexical representation, morphological relatedness, and modes of access in Algerian Arabic--a dialect of Standard Arabic--in an auditory morphological priming experiment. More specifically, we investigated the process of word recognition of singular and plural nouns in the performance of 24 non-brain-damaged subjects and 2 Algerian-speaking agrammatic aphasics. Plurals in Arabic involve either suffixation as in the sound plural (e.g., lbas "dress"/lbasat "dresses"), or stem-internal changes as in the broken plurals (e.g., kursi "chair"/krasa "chairs"). Our findings reveal a differential processing of the two forms, indicating whole word access for broken plurals and decomposition into word and suffix for suffixed plurals. Further, the evidence suggests for Algerian Arabic an architecture of the lexicon reflecting a family-like organization which takes into account language-specific features.

Differences in pain medication use in stroke patients with aphasia and without aphasia

BACKGROUND AND PURPOSE

While individuals with stroke are known to experience pain for a variety of reasons including premorbid conditions and stroke-specific sequelae, there are some groups of individuals with stroke, who because of aphasia, are unable to express their pain. This study investigated whether there exists an association between severity of aphasia and overall pain medication use as indicated (1) by the proportion of individuals medicated according to aphasia severity and (2) by the dosage of pain medication used according to aphasia severity.

METHODS

The study involved a retrospective chart review of 207 charts of patients with stroke admitted to the Jewish Rehabilitation Hospital (JRH), Laval, Canada. Patients were classified into three groups according to level of expressive aphasia: those without aphasia, those with mild-to-moderate aphasia, and those severe aphasia. Information on medications used primarily for pain management was elicited for the first 21 days and the last 5 days of hospitalization. Any substitution, increase, elimination, or addition of pain medication during hospitalization was also monitored.

RESULTS AND CONCLUSIONS

While the findings indicate that pain medication prescriptions were similar for all patients, a significantly smaller number of individuals with aphasia received pro re nata (prn) "as required" pain medication when compared with those without aphasia, for the first 21 days and for the last 5 days of hospitalization at the JRH. Similarly, when daily dose was monitored for the same time periods, individuals with aphasia were found to have received less medication for pain than those without aphasia.