Individuals with mild neurocognitive disorder complete many activities of daily living independently; however, they may require the use of compensatory strategies while performing everyday tasks. Compensatory strategies, such as external memory aids, incorporate a strengths-based approach to enhance the functional needs of individuals. Although external memory aids have a strong evidence-base, limited assessment tools and interventions are available to facilitate the development of individualized treatment plans that promote sustained strategy use. To better support the everyday needs of individuals with mild neurocognitive disorder and to inform clinicians who are developing interventions, the current dissertation includes four paper that examine a functional framework for external memory aid assessment and intervention. The first paper examined a group intervention teaching three types of external memory aids on functional strategy use, perceived strategy use, and cognitive skills. The second paper identified individual preferences for experiences with external memory aids during and following intervention. The third paper examined individual changes in functional and perceived strategy use following a group-based intervention teaching external memory aids. Lastly, the fourth paper examined the content validity and internal structure of the Functional External Memory Aid Tool: a measure that explores external memory aid use with simulated everyday tasks. By understanding the weaknesses in currently used assessment and intervention practices and the unique preferences of clients, this multi-manuscript dissertation aims to enhance the immediate and long-term needs of individuals with mild neurocognitive disorder.

Introduction Otitis mediawith effusion is found in almost every patient with cleft palate. Arisk factor for permanent conductive hearing lossis recurring otitis media which is commonly found in cleft palate patients. Several studieshave been conductedto measure the extent of hearing loss in childrenwith cleft palate.Hearing problemsdue to otitis mediaoften persist into adulthood.Thus, it is of interest to see if there are any existing studies onhearing impairments inadultcleft palatepatients. Objective The purpose of this study is tosummarize theexisting literatureon hearing impairments in adult patients with cleft palate and to map the characteristics of the studies found. Method A scoping reviewprotocolproposedby Joanna Briggs Institutewas usedto synthesizeand summerizethe published literaturesearchedinthe PubMed database. Syndromal cleft palates were excluded from this study. Results Onereviewer went through 11full-text articlesthatwere considered relevant.It was possible toidentify five different key areas of research among the included studies. Conclusions It wasfound that there is literature available on this topic,but the heterogeneity of the studies made it impossible to compare the charted data betweenthe studies. We identifieda need for longitudinal studies on this topic and suggest more standardization withregard tothe definitions of cleft palate and hearing impairment.

A small subset of individuals that have experienced mild traumatic brain injury (mTBI) may experience persistent cognitive deficits more than a year following the head injury. Neuroimaging studies reveal structural and functional changes in frontal areas of the brain, exacerbated when loss of consciousness is experienced, and indicate that these changes may be progressive in nature for some people. Social support and social participation have, however, been suggested to confer cognitive reserve - neurocognitive protection against cognitive decline. Analyses were run on Canadian Longitudinal Study on Aging (CLSA) neuropsychological data, consisting of individuals who experienced mTBI with loss of consciousness (n = 536 for less than 1 minute, and n = 435 for unconsciousness between 1 and 20 minutes) more than a year prior, and 13,163 no-head injury comparisons. These same individuals were re-assessed three years later. The results presented in this thesis suggest that at a year or more after a single mTBI with loss of consciousness, a small subset of individuals are more likely to be impaired on prospective memory and other executive functioning tasks, relative to comparisons. In addition, when examined at three-year follow-up, those who experienced mTBI with longer duration of unconsciousness were more likely to exhibit cognitive decline relative to those who experienced less unconsciousness or comparisons. Moreover, greater social participation over the past year, and more perceived social support were predictive of lessened cognitive deterioration in those individuals.

BACKGROUND: Early detection of individuals at risk for converting to Alzheimer’s disease (AD) can potentially lead to more efficient treatment and better disease management. A well-known approach has aimed at identifying individuals at the prodromal stage of dementia; namely, Mild Cognitive Impairment (MCI). Past studies showed that MCI subjects often have accelerated rates of conversion to AD, or to other types of dementia compared to healthy controls (HCs). However, with more investigations of the MCI population, it became evident that a high level of heterogeneity exists within this group: many remain clinically stable even after 10 years. MCI subtypes defined by the conventional classification criteria showed inconsistent results for determining an individual's risk of AD. As another approach, neuroimaging techniques such as magnetic resonance imaging (MRI) are able to successfully identify neurological changes during early AD. MRI markers including morphological, connectional and abnormal signal patterns in the brain have been shown to have good sensitivity for classifying AD. Based on these findings, recent studies started implementing these imaging markers to create computer-aided classification models for predicting the risk of conversion to AD. Most of these studies enrolled MCI subjects who remained stable or converted to AD within 3 years, and generated computer-aided classification models to predict conversion using various imaging markers and clinical data. To our knowledge, no classification models proposed achieved an accuracy of higher than 80% for predicting MCI-AD conversion earlier than 3 years with only using structural MRI features. In this paper, we tested the prediction range beyond 3 years, and suggested new candidate imaging measures for earlier prediction. METHODS: The subjects included in the current study are n=51 MCI non-converter, n=157 MCI converter (115 fast converters and 42 slow converters) and n=38 AD, selected from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. Using subjects' baseline T1-weighted MRI scans, we combined conventional morphometric measures (e.g. cortical thickness, surface area, volume, etc.) with novel intensity measures to differentiate MCI converters from non-converters. We additionally applied a machine learning approach to classify MCI subgroups by combining features in multiple measurement domains. RESULTS: Based on group comparison using independent t-test, we found that while MCI fast converters (conversion within 0-2 years) were highly distinct from MCI non-converters across many cortical and subcortical regions, MCI slow converters (conversion within 3-5 years) demonstrated more focal differences from MCI non-converters mainly in the temporal regions and hippocampal subfields. We identified unique imaging features associated with each converter group and had improved classification performance on both MCI converter groups by adding those markers. The best performing classifiers combined conventional imaging features, novel intensity features and neuropsychological features. For our best performing classification models, we were able to classify MCI fast converters (0-2 years) from non-converter with an average accuracy of 86.1%, sensitivity of 85.5%, and specificity of 89.8%, and to classify MCI slow converters (3-5 years) from non-converters with an accuracy of 80.5%, sensitivity of 75.7%, and specificity of 82.3%. CONCLUSION: Our results demonstrated the potential of the suggested approach for predicting the conversion from MCI to AD at an even earlier time point (3-5 years) before the onset of AD. The combination of standard morphometric features and proposed novel intensity features improved the sensitivity of using T1-weighted MRI for describing the heterogeneity between MCI subgroups.

As at 2014, 19 million children aged < 16 years were visually impaired, 1.4 million of these children were blind and needed visual rehabilitation interventions. Surveys, mostly utilizing key informants (KI), have suggested that the prevalence of blindness in children in Sub Saharan Africa ranges between 2 -8 per 10,000 children. Childhood eye disease is rare and conditions are difficult to detect; thus, surveys to estimate the prevalence of blindness requires rigorous, costly and difficult methods to obtain reasonable estimates among children. Key informant programs, which engage the community in case finding, have been shown to be a reasonable alternative to large scale surveys and were used in Madagascar in 2014 by four regional eye care programmes. I propose to analyse the data generated from the programmes to quantify the prevalence of eye conditions among children and how the KIs performed. Method: The analysis will use data collected in a cross sectional approach. Statistical analysis will be conducted using Stata (15.0) statistical software. Data from all of the KI registers will be pooled and overall magnitude estimates calculated. KI productivity and sub-group analyses will include assessment of demographic characteristics of the children and the KI by age and sex. Ethical approval will be provided by the UCT Health Research and Ethics Committee and the Madagascar Ministry of Health. Discussion: The results from this study will help child eye health programmes to determine how best to use KI to better serve children with vision loss, and guide in the provision of eye services for children care.

PURPOSE: The purpose of this qualitative descriptive study was to explore the experiences of emerging adults with idiopathic CAS, as they reflected on their transitions through childhood, adolescence, and young adulthood. SPECIFIC AIMS: Describe the experiences of emerging adults with idiopathic CAS as they reflect on developmental stages of childhood, adolescence, and young adulthood, including the situational experiences of transition occurring between elementary, middle, high school, and post-secondary education, training, or work. Identify strategies and the effectiveness of the strategies utilized by emerging adults with idiopathic CAS to manage experiences during different developmental stages and situational experiences of transition occurring between elementary, middle, high school, and post-secondary education, training, or work. FRAMEWORK: Meleis’ Transitions Theory. DESIGN: A qualitative descriptive design with purposive sampling was used. Data was analyzed using thematic analysis. RESULTS: Findings support the use of Transitions Theory. Three major themes were identified: The Child’s Environment, Implications of CAS, and Strategies. The school environment contributed to many implications for children. Older children were able to develop strategies to overcome challenges. In the school setting, children did not access nurses for concerns related to their CAS. CONCLUSIONS: CAS creates many challenges for children. Emerging adults with CAS report that environments in which people are knowledgeable, patient, understanding, accepting, and supportive help them express themselves freely despite their speech impairment. The nurse’s role in supporting children with CAS during grade school is untapped as they were largely invisible to the children as a potential resource for anything other than an injury or illness. To better facilitate supportive environments in which children with CAS can flourish, nursing assessment and interventions are needed.

This study explores the role of rehabilitation in shaping the subjectivity of blind persons. It considers what engaging with rehabilitation services might communicate to people with visual impairments about their status, their value and their place in the world. Rather than being concerned with the practical aspects of rehabilitation, it explores how rehabilitative practices operate at the symbolic level, and interrogates the meanings about blindness which are produced within relationships where help is given and received. Drawing on Foucauldian concepts, this research traces the interplay between discourse, power and knowledge in rehabilitation services. The research design includes two phases. Through analysing the website copy of eight organisations located across South Africa, Phase One identified discourses employed by organisations as they represent themselves in the public realm. In Phase Two, semi-structured interviews were conducted with eight service providers and eighteen service users across four organisations operating in the Western Cape province of South Africa. This phase identified the discourses framing rehabilitative activities and relationships. Visually impaired participants described sight loss as a significant trauma – as dislocation from society and self – revealing that service users might be particularly vulnerable to the shaping influence of rehabilitation. Data analysis found, firstly, that the discourses which frame rehabilitation services position visually impaired service users as passive recipients in relation to the work of service providers and the gifts of the public. This positioning objectifies service users and may signal to them that they are neither valued as stakeholders nor recognised as autonomous adults, while also requiring that they demonstrate gratitude towards service providers and the public. Secondly, rehabilitation is constructed as a linear journey with strictly defined outcomes. This ‘journey discourse' relies on polarised fantasies about blindness involving, on the one hand, dependency, dislocation and struggle and, on the other, independence, integration and coping. Visually impaired service users are required to demonstrate evidence of the latter while the former shadowy figure of pre-intervention blindness must be defended against. This discourse prohibits nuance and expressions of ongoing struggle, underpinning an imperative to cope found within organisations. Amid limiting discursive practices in rehabilitation, a key finding is that visually impaired service users are involved in complex negotiations of self and place. Investigating the discourses which frame and support rehabilitative practices sheds light on investments in promoting particular ways of being for visually impaired people, prompting us to consider what service providers, service users and, indeed, society as a whole might be colluding with. This work offers a novel perspective on blindness rehabilitation in South Africa as it explores an interplay between essential practical interventions found in rehabilitation and the influences on identity which those who experience sight loss undergo as they move into a new life with visual impairment.

This study examined the effects of a vocabulary intervention for 3 children with cleft lip and/or palate who showed limited consonant inventories and delayed expressive language. In a multiple baseline design across behaviors, a vocabulary intervention was implemented using a milieu model. The treatment produced an increase in vocabulary production that generalized to a conversational language sample in the clinic and home as reported by parents. Phonological variables, including consonant repertoire and syllable structure, were monitored before and after language treatment for all children. Phonological performance improved and did not need to be addressed as a separate goal in intervention.

Speech-language impairment is one of the most common clinical features in velocardiofacial syndrome (VCFS). This report describes the speech and language development of four children with VCFS studied longitudinally from 6 to 30 months of age and compares their performance with three groups of children: (1) normally developing children, (2) children with cleft lip and palate, and (3) children with isolated cleft palate. The data show that young children with VCFS show a receptive-expressive language impairment from the onset of language. Further, speech and expressive language development were severely delayed beyond a level predicted by their other developmental or receptive language performance. The children with VCFS showed severe limitations in speech sound inventories and early vocabulary development that far exceeded those shown by the children with cleft lip and palate and children with isolated cleft palate. This study indicates that young children with VCFS emerge from a critical speech and language learning period with severe limitations in their communicative abilities. Further studies are required to describe the later course of these early speech and language impairments and to explore the relationship to learning disabilities described for older children with VCFS.

Physical exercise offers a highly effective health-endowering activity as has been evidence using rodent models of Parkinson’s disease (PD). It is a particularly useful intervention in individuals employed in sedentary occupations or afflicted by a neurodegenerative disorder, such as PD. The several links between exercise and quality-of-life, disorder progression and staging, risk factors and symptoms-biomarkers in PD all endower a promise for improved prognosis. Nutrition provides a strong determinant for disorder vulnerability and prognosis with fish oils and vegetables with a mediterranean diet offering both protection and resistance. Three factors determining the effects of exercise on disorder severity of patients may be presented: (i) Exercise effects upon motor impairment, gait, posture and balance, (ii) Exercise reduction of oxidative stress, stimulation of mitochondrial biogenesis and up-regulation of autophagy, and (iii) Exercise stimulation of dopamine (DA) neurochemistry and trophic factors. Running-wheel performance, as measured by distance run by individual mice from different treatment groups, was related to DA-integrity, indexed by striatal DA levels. Finally, both nutrition and exercise may facilitate positive epigenetic outcomes, such as lowering the dosage of L-Dopa required for a therapeutic effect.