Patients who suffer from traumatic brain injury often face communication deficits during their hospital stay. This thesis intended to examine approaches the nurse can use to facilitate communication in collaboration with the speech-language pathologist. A review of literature was conducted to examine current research on the most effective devices used to facilitate communication in this patient population. Research revealed that low-technology devices were the most effective means of communicating in the hospital setting. Barriers to effective communication were identified as lack of time, education and access to the devices. Recommendations for future research include developing a documentation component that emphasizes nursing assessment and intervention through collaboration with the SLP. Additional recommendations for research include the examination of impact of AAC use on patient satisfaction and outcomes. Communication using AAC is necessary in order to improve patient outcomes for traumatic brain injured individuals. This can be achieved through increased collaboration with the SLP, and increased nursing knowledge of the available devices and their implementation.

The ability to communicate is essential for children with developing language systems, and ultimately to being successful academically and eventually vocationally. In a world where communication is vital, children with autism spectrum disorder (ASD) are at a disadvantage and require additional options to express themselves; augmentative and alternative communication (AAC) technologies have presented promising options for helping these children communicate. One technology option that has proven to be of particular interest to families of children with ASD involves the use AAC iPad apps. Research has been conducted in AAC, ASD, and music, but there is limited research to date, which integrates these three areas. This investigation was designed to address the lack of evidence-based AAC app interventions specifically designed to meet the communication needs of children with ASD. This pilot study will serve to further the evidence available to date indicating that SpeakAll! can be effectively implementing in 1:1 interventions using food reinforcers. This intervention adapts the SpeakAll! intervention protocol in a classroom setting with natural music activities to aid in functional communication.

Syfte: Syftet med studien var att undersöka tandhygienisters användning av alternativ kompletterande kommunikation i form av bildstöd i möte med barnpatienter. Metod och material: En digital enkät bestående av 15 frågor skickades ut till samtliga (102 stycken) verksamma tandhygienister i Region Jönköpings län. Antal deltagare var totalt 57 stycken, 54 kvinnor och 3 män. Resultatet redovisades i absoluta – och relativa frekvenser, samt medelvärde. p-värde ≤ 0,05 ansågs statistiskt signifikant. Chi2test användes för jämförelse mellan grupper. Resultat: Intresse för användning av bildstöd fanns bland tandhygienisterna. Totalt var det 32 % som använde bildstöd. Inom specialisttandvård använde samtliga tandhygienister bildstöd och bland tandhygienisterna inom allmäntandvård användes bildstöd av 23,5%.. Resultatet visade även att 55,6% av tandhygienisterna använde bildstöd på alla barn inte bara enstaka grupper. Det fanns inget statistisk signifikant samband mellan användning av bildstöd och längden på tandhygienistutbildningen, men tandhygienister med en treårig utbildning använde sig av bildstöd i större utsträckning än tandhygienister med kortare utbildning. Slutsats: Bildstöd har visat sig vara ett bra hjälpmedel vid möte med barnpatienter inom tandvården. Trots detta använder inte alla tandhygienister sig av bildstöd pga. bland annat tidsbrist. Därför behövs mer kunskap om bildstöd samt om deras användning och fördelar inom tandvården. / Aim: The aim of the study was to evaluate the use of pictorial support among dental hygienists when meeting children in a dental environment. Method and material: A digital questionnaire with 15 questions was send out to all (102) actively working dental hygienists in the county of Jönköping. There were a total of 57 participants, 54 women and 3 men who answered the questionnaire. Results were presented with absolute and relative frequencies, mean value and Chi-square test. Results: There was an interest in using pictorial support among dental hygienists. All dental hygienists in special dental care used pictorial support. Among dental hygienists in public dental care 23.5% used pictorial support. Results showed that the majority of dental hygienists preferred using pictorial support on all children. There was no statistically significant difference between using pictorial support and the length of dental hygienist education, but participants who finished a three-year education used pictorial support more often. Conclusion: Pictorial support has found to be a useful tool in dental care, still there are dental hygienists that don’t use it. More knowledge and research are needed about pictorial support so the effect of augmentative and alternative communication can be evaluated.

Background: Participation in every life situation is a basic child’s right. Within health care, participation is achieved by effective patient-provider communication. Increased participation is shown to be beneficial for the well-being of the child. To achieve this, augmentative and alternative communication (AAC) could be implemented during the care.  Aim: To explore the use of communication aids with children in health care settings and to see what the outcomes are for a child’s functioning based on the ICF-CY.  Method: A systematic literature review was conducted. The databases MEDLINE, PubMed, CINAHL and Dentistry and Oral Sciences Source were searched and nine articles were included for review. Results: It was found that both typically developing children and children with a variety of disabilities have been studied, as well as a wide age range. Low-tech aids have been practised most often, particularly visual picture schedules. Five studies measured ‘Activity and participation’ outcomes and the results showed improvement of patient-provider communication and enhanced completion of a medical procedure. Six studies measured outcomes that could be identified as ‘Body functions’ and results showed a decrease in anxiety, stress or pain at some point of the medical procedure.  Conclusion: This systematic literature review shows that AAC is still an emerging concept within health care with children, but the first results suggest that it has benefits for different child populations and for different aspects of a child’s functioning. However, it is not clear what the outcomes are for participation in particular. The limited amount of studies on this topic could be due to several barriers to achieve participation and use of AAC. Future research should focus more on using specific measures for participation. Also, researchers need to explore ways to overcome the barriers to implement AAC. Finally, new technologies such as tablet devices could be studied. / Participatie in elke levenssituatie is een basisrecht van elk kind. In de gezondheidszorg betekent dit een optimale communicatie tussen de patiënt en de hulpverlener. Verhoogde participatie blijkt gunstig te zijn voor het welzijn van het kind. Augmentatieve en alternatieve communicatie (AAC) zou hiervoor gebruikt kunnen worden binnen de gezondheidszorg. Het doel van deze studie is om het gebruik van communicatiehulpmiddelen met kinderen binnen de gezondheidszorg te verkennen en om na te gaan wat de resultaten hiervan zijn voor het functioneren van het kind gebaseerd op de ICF-CY. Er werd een systematische literatuurstudie uitgevoerd. Vier databanken werden doorzocht en in totaal werden negen artikels inbegrepen.  De resultaten toonden aan dat zowel typisch ontwikkelende kinderen als kinderen met een verscheidenheid aan beperkingen binnen een groot leeftijdsbereik reeds onderzocht zijn. Lowtech communicatiehulpmiddelen werden het vaakst gebruikt in de studies, waarvan het vaakst visuele schema’s. Vijf studies meten resultaten die behoren tot ‘Activiteiten en Participatie’ en toonden een verbeterde patiënt-hulpverlener communicatie en een betere bekwaamheid tot het beëindigen van een medische procedure. Zes studies meten resultaten die behoren tot ‘Lichaamsfuncties’ en toonden aan dat de angst, stress of pijn verlaagden bij het gebruik van een communicatiehulpmiddel. Deze systematische literatuurstudie toont aan dat AAC nog steeds een groeiend concept is binnen de gezondheidszorg voor kinderen. De eerste resultaten tonen echter dat AAC voordelen heeft voor verscheidene populaties van kinderen alsook voor verscheidene aspecten van het functioneren van een kind. Desalniettemin is het onduidelijk wat de resultaten zijn voor de participatie van het kind. Het beperkt aantal studies kan verklaard worden door het bestaan van allerhande barrières om participatie te bereiken en/of om AAC te gebruiken binnen de gezondheidszorg. Toekomstig onderzoek zou meer moeten focussen op de effecten voor participatie. Ook dient er onderzocht te worden hoe de meervoudige barrières overwonnen kunnen worden en hoe nieuwe technologieën zoals tablet computers mogelijks ingezet kunnen worden als communicatiehulpmiddel.

The purpose of this study was to assess the relationship between parental responsivity and language outcomes after a 24-session language intervention in a sample of 62 toddlers with significant developmental delays and fewer than 10 spoken words. The data for this secondary analysis were taken from a longitudinal study that evaluated language outcomes after augmented or spoken language intervention (Romski et al., 2010). Instances of parental responsivity increased from pre-intervention to post-intervention and directive behaviors decreased slightly across all intervention groups. The results suggest a relationship between parental responsivity and expressive language outcomes in children with developmental delay who use augmentative and alternative communication. These findings support the role of parents as social partners in language interventions.

Thesis advisor: Susan Bruce / Augmentative and alternative communication (AAC) is central to the lives of many individuals who are not able to effectively use spoken language. AAC systems are an essential component of a student’s ability to access his/her world, including daily communication and school content. The provision of such systems is a high priority in the field and supports the emancipation of those with limited voice, power, and independence that must function within a social structure that has been designed for the more typically abled. The study employed a single-case multiple staggered baseline design with randomized intervention implementation and intervention schedule using the What Works Clearinghouse (WWC) standards from 2010. Five students with complex disabilities using advanced speech generating devices with the LAMP method, Language Acquisition Through Motor Planning, (Halloran & Halloran, 2006), of picture symbol organization participated in the study. The LAMP method was examined, and the potential impact on language and communication it may have. Specifically, the ability to use print versus picture symbols for communication and literacy was investigated within the context of a highly structured 1:1 literacy lesson facilitated by interventionists. Results indicated that all students made varying degrees of gains in the use of print words. These gains were sustained in the generalization phase. Operational skills were impacted demonstrated by increased skill development in navigation of the speech generating device and the type of vocabulary selected. In addition, communication functions were expanded, and in some cases, there was a significant increase in the complexity of word usage across people and settings. Discussions on interventionists perceptions are presented and integrated within individual student results providing context and direction on training needs. / Thesis (PhD) — Boston College, 2016. / Submitted to: Boston College. Lynch School of Education. / Discipline: Teacher Education, Special Education, Curriculum and Instruction.

Up to 1.2% of the population is unable to meet daily communication needs using typical speech and may use augmentative and alternative communication (AAC) strategies to communicate, including manual sign language, facial gestures, and aided strategies such as selecting targets on an onscreen keyboard. However, for individuals whose impairments affect both speech and non-speech motor systems (e.g., spinal cord injury, amyotrophic lateral sclerosis, multiple sclerosis), their ability to use manual sign and access computer systems are impacted. AAC access methods in this population remain inherently slow and effortful (e.g., eye-tracking, head-tracking, mechanical switches). Thus, optimizing communication interfaces for alternate access methods may provide significant improvements in communication rates and quality of life. In this series of studies, we developed and evaluated methods for improving communication rates through optimization and prediction in communication interfaces. These interfaces enabled participants to select sounds (phonemes) instead of letters and were computationally optimized offline via a model of human movement in order for targets likely to be selected together to be in close proximity. Online prediction was implemented such that likely targets were dynamically enlarged. Computational simulations suggested that optimized phonemic interfaces could increase communication rates by up to 30.9% compared to random phonemic interfaces. Communication rates were empirically evaluated in 36 participants without motor impairment using an alternate computer access method to produce messages with phonemic interfaces over 12 sessions. Results suggested that optimization increased communication rates by 10.5–23.0% compared to a random phonemic interface. Prediction increased communication rates during training sessions, but was not a significant factor in communication rates during the final session. Empirical evaluations in individuals with motor impairment revealed that all participants strongly agreed that they would improve with practice, and four out of six participants strongly preferred the interface with prediction. Results of these studies suggest that optimized and predictive phonemic interfaces may provide increased communication rates for individuals with motor impairments affecting both oral communication and computer access. Methods for dynamically enlarging targets may also be applicable to other (non-phonemic) interfaces to increase communication rates. Further research is needed to fully translate these results into clinical practice. / 2020-10-24T00:00:00Z

Resumo: A avaliação é um processo que demanda tempo, uma vez que visa não só avaliar os déficits do sujeito, mas também suas necessidades e habilidades. No caso de alunos não-falantes, os familiares têm grande importância no processo de avaliação, pois os pais são os maiores conhecedores das formas de expressão de seus filhos, sendo imprescindíveis para obtenção de informações a respeito dos centros de interesse, habilidades comunicativas e vocabulário do aluno. Após um trabalho anterior realizado pelos pesquisadores com a finalidade de construir um Protocolo para Avaliação de Habilidades Comunicativas para Alunos Não-Falantes Em Situação Familiar, o objetivo dessa pesquisa foi desenvolver esse mesmo protocolo. Para tanto, o desenvolvimento do protocolo foi realizado por estudos. No Estudo 1, reformulamos a primeira versão do Protocolo para Avaliação de Habilidades Comunicativas para Alunos Não-Falantes em Situação Familiar e criamos uma outra versão desse mesmo protocolo, intitulada protocolo reformulado, que contava com as seções: Identificação, Principal, Rotina, Preferências, Profissionais e Auxiliares, sendo que a seção Principal continha 59 itens. Ainda no Estudo 1, fizemos a aplicação do protocolo reformulado e analisamos os resultados dessa aplicação. A aplicação ocorreu na cidade de Curitiba-Pr e contou com a participação de 17 pais de alunos com deficiência. Os resultados do Estudo 1 deram origem à segunda versão do protocolo, que continha as mesmas seções das versões anteriores, sendo que a seção Principal continha 64 itens. No Estudo 2, realizamos a aplicação da segunda versão e fizemos a análise dos resultados dessa aplicação, que também aconteceu em Curitiba-Pr e contou com a participação de 17 pais e uma avó de alunos com deficiência. No Estudo 3, realizamos a aplicação e a reaplicação da segunda versão do protocolo... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The evaluation is a time-demanding process, since not only is it aimed at evaluating the subject deficits but also its needs and skills. In case of non-speaking students, family members have great importance on the evaluation process, for parents know better their children’s forms of expression and are irreplaceable for the purpose of acquiring information concerning student’s center of interest, communication skills, and vocabulary. Following a previous work by the authors trying to set the frame of an Evaluation Protocol of Communication Skills for Non-Speaking Students in Family Situation, the present research intends to establish the Protocol’s final version. For doing so, the Protocol’s development was carried at trough studies. In Study 1, we have reformulated the first version of the Evaluation Protocol of Communication Skills for Non-Speaking Students in Family Situation, and created another version of the protocol, named Reformulated Protocol, which was formed by sections: Identification, Principal, Routine, Preferences, Professionals, and Auxiliaries, noticing that the Principal section contained 59 items. Still in Study 1, we have applied the reformulated protocol and analyzed its results. It took place in the city of Curitiba, Pr, and 17 parents of challenged students participated. Results of Study 1 originated the second version of the protocol, which was formed by the same sections of previous versions, noticing that the Principal section contained 64 items. In Study 2, we applied the second version and proceeded with the analysis of the results, which also happened to take place in the city of Curitiba, Pr, and 17 parents and one grandparent of challenged students participated. In Study 3, we applied and reapplied the second version of the protocol on the same subject, a challenged student’s mother, with the purpose of verifying whether or not the second version... (Complete abstract, click electronic address below) / Orientador: Eduardo José Manzini / Coorientador: Débora Deliberato / Banca: Leila Regina d'Oliveira de Paula Nunes / Banca: Tânia Moron Saes Braga / Mestre

Orientador: Eduardo José Manzini / Banca: Dionísia Aparecida Cusin Lamônica / Banca: Sadao Omote / Resumo: Muitos pesquisadores têm se preocupado com a avaliação na educação especial para o conhecimento das necessidades e habilidades do aluno deficiente. Em se tratando de alunos não-falantes, é fundamental a avaliação de suas habilidades comunicativas, dada a sua importância para o processo de ensino-aprendizagem. Visando a colaborar com instrumentos já existentes e devido à escassez de trabalhos na área, o objetivo deste estudo foi desenvolver um protocolo para avaliação de habilidades comunicativas de alunos não-falantes em ambiente escolar. O desenvolvimento do protocolo foi realizado cinco etapas. Na primeira etapa, o protocolo apresentado inicialmente sofreu três mudanças referentes ao lay out e a redação de algumas perguntas para aplicação na próxima etapa. Na segunda etapa, aplicou-se o protocolo a um grupo de 23 professores que lecionavam para alunos não-falantes, três fonoaudiólogas, uma assistente social e uma psicóloga a fim de verificar possíveis problemas no instrumento. Após análise, foi verificado um número elevado de itens deixados em branco e itens preenchidos de maneira inadequada na seção Principal e também se verificou a necessidade de mudanças em todas as outras quatro seções para que houvesse maior clareza aos respondentes. Na terceira etapa, após reformulação, aplicou-se o protocolo a um grupo de dois coordenadores, 16 professores que também lecionavam para alunos não-falantes, dois fisioterapeutas, cinco fonoaudiólogas e dois terapeutas ocupacionais e, após análise, também foram encontrados itens em brancos, mas em número menor que na etapa anterior, na seção Principal. Não houve itens preenchidos de maneira inadequada, sendo que nas outras seções também não foram encontrados problemas, exceto na da Rotina, encontrada em branco em alguns protocolos...(Resumo completo, clicar acesso eletrônico abaixo) / Abstract: A number of researchers have been giving attention to evaluation in special education for identifying the challenged student’s needs and skills. When it comes to non-speaking students, it is essential to evaluate his/her communication skills, given the importance to the teaching-learning process. Aiming at collaborating with already existent instruments and due to the lack of studies on the matter, the objective of the present study was to develop a protocol for evaluating communication skills of non-speaking students in school environment. In order to develop the protocol, five steps were taken. During the first step, the protocol suffered three lay-out changes and some questions were formulated to be applied on the next step. During the next step, the protocol was submitted to a group of 23 teachers who taught non-speaking students, 3 speech language pathologists, 1 social worker, and 1 psychologist with the purpose of checking for possible problems with the instrument. It was verified there was a great number of blank items as well inadequately filled ones on the Principal section. It was also noticed that the four other sections had to be modified for the sake of a better understanding. During the third step, after changes had been made, the protocol was submitted to a group of 2 coordinators, 16 teachers who also taught non-speaking students, 2 physiotherapists, 5 speech-language pathologists, and 2 occupational therapists. After analysis, blank items were also found, although not as many as before. There were no inadequately filled items, no problems were found on other sections, exception made on the Routine section, which was blank in some protocols. During the forth step, interviews were carried out, using the very protocol itself to also find out what could justify the problems during the previous step, given the fact that changes had already been made...(Complete abstract click electronic access below) / Mestre

Resumo: As estratégias de mediação utilizadas pelo mediador nas atividades de ensino favorecem o aprendizado do aluno. Dentre as diversas atividades que podem ser realizadas pelo mediador com seu aluno, destaca-se a atividade de recontar histórias. As estratégias de ensino que envolvem a elaboração da estrutura narrativa proporcionam o desenvolvimento linguístico do aluno, pois essa estrutura pode conectar elementos semânticos diversos e promover a construção de sentenças verticais e horizontais para a posterior elaboração do discurso narrativo. Torna-se fundamental a realização de estratégias de mediação que proporcione ao aluno sem oralidade o desenvolvimento dessas habilidades lingüísticas por meio de recursos comunicativos e/ou pedagógicos. Nesse sentido, o papel do mediador é de suma importância para utilizar estratégias de ensino eficazes e aliadas ao uso adequado dos recursos. Assim, o objetivo deste trabalho consistiu em identificar e analisar as estratégias de mediação em atividades de reconto de histórias com alunos sem oralidade acometidos por paralisia cerebral. Participaram deste estudo sete sujeitos sendo três mediadoras e quatro alunos. As três mediadoras eram fonoaudiólogas que trabalhavam no Projeto de Comunicação Alternativa que estava inserido no setor de linguagem de uma universidade estadual paulista no qual atendiam os alunos selecionados para essa pesquisa. Os alunos não apresentavam oralidade, eram usuários de recurso suplementar e alternativo de comunicação e freqüentavam sala especial para deficientes físicos. Na coleta de dados, foi selecionada e adaptada uma história lúdica com cada aluno participante, para que todos eles pudessem realizar o reconto diante da mediação. As sessões das atividades de reconto foram filmadas e, posteriormente, transcritas, analisadas e discutidas. Os resultados indicaram a recorrência de nove... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The intercession strategies used by the mediator in the education activities are in favor of student's learning. Among several activities that can done by the mediator with the students, the retelling stories is stand out. The learning strategies that involve the elaboration of the narrative structure provide the linguistic development of the student, because this structure can connect several semantic elements and provide the building of vertical and horizontal sentences to the further elaboration of the narrative speech. It's essential to do intercession strategies that provide the no speaking student the development of these linguistics abilities through communicative and/or pedagogical tools. This way, the mediator hole is very important to use effective educational strategies and join to the correct use of these tools. Therefore, the objective of this paper was to identify and analyze the intercession strategies in retelling stories activities with no speaking students with cerebral palsy. Seven people participated in this study, three mediators and four students. The three mediators were speech and language therapists who worked in the "Projeto de Comunicação Alternativa", placed in the language sector in a paulista public university, where they cared selected students to this research. The students didn't speak. They used supplementary and alternative communication resource and attended special classes to physically handicapped person. On the data collection, it was selected and adapted a ludic story with each participating student, so that everyone could retell the story in front of the mediator. These retelling sessions were filmed and later transcripted, analyzed and discussed. The results showed nine intercession strategies which were used by all the mediators, used occasionally and according to the development of the students during the retelling. The strategies... (Complete abstract click electronic access below) / Orientador: Eduardo José Manzini / Coorientador: Débora Deliberato / Banca: Lígia Maria Presumido Braccialli / Banca: Maria Cristina Marquezini / Mestre