Relationships between cognitive status, speech impairment and communicative participation in Parkinson’s disease

Aim: To assess the relationships between cognitive status, speech impairment and communicative participation in Parkinson’s disease. Introduction: Speech and communication difficulties, as well as cognitive impairment, are prevalent in Parkinson’s. The contributions of cognitive impairment and acoustic speech characteristics remain equivocal. Relationships between Impairment and Participation levels of the International Classification of Functioning, Disability and Health (ICF) have not been thoroughly investigated. Methods: 45 people with Parkinson’s and 29 familiar controls performed read, mood and conversational speech tasks as part of a multimethod investigation. Data analysis formed three main parts. Depression, cognition and communication were assessed using questionnaires. Phonetic analysis was used to produce an acoustic characterisation of speech. Listener assessment was used to assess conveyance of emotion and intelligibility. Qualitative Content Analysis was used to provide a participant’s insight into speech and communicative difficulties associated with Parkinson’s disease. Results: Cognitive status was significantly associated with certain read speech acoustic characteristics, emotional conveyance and communicative participation. No association was found with intelligibility or conversational speech acoustic characteristics. The only acoustic speech characteristics that predicted intelligibility were intensity and pause in the read speech condition. The contribution of intelligibility to communicative participation was modest. People with Parkinson’s disease reported a range of psychosocial, cognitive and physical factors affecting their speech and communication. Conclusions: I provide evidence for a role for cognitive status in emotional conveyance and communicative participation, but not necessarily general speech production, in Parkinson’s disease. I demonstrate that there may not be a strong relationship between ICF Impairment level speech measures and functional measures of communication. I also highlight the distinction between measures of communication at the ICF Activity and Participation levels. This study demonstrates that reduced participation in everyday communication in Parkinson’s disease appears to result from a complex interplay of physical, cognitive and psychosocial factors. Further research is required to apply these findings to contribute to future advances in speech and language therapy for Parkinson’s disease

Training Needs and Development of Online AT Training for Healthcare Professionals in UK and France

Background: Assistive Technology (AT) solutions for people with disabilities has become part of mainstream care provision. Despite advantages of AT on offer, abandonment and non-compliance are challenges for healthcare professionals (HCPs), introducing this technology to clients. Studies of abandonment reveal that 1/3 of all devices provided to service users end up stored unused. Key need is training to make informed decisions about AT tailored to individual needs and circumstances. In an online survey undertaken by the ADAPT project, HPCs identified AT training needs and barriers. Currently, a programme is being developed aimed at introducing AT concepts and enhancing practices to a wide range of HCPs. Method: Survey questions explored gaps, availability, qualifications and barriers to AT training in England and France. A series of consultation meetings with ADAPT partners took place. An advisory group consisting of longstanding AT users and their formal/informal carers and HCPs (occupational therapist, speech and language therapist, psychologist and biomedical engineer) contributed to the discussions on survey findings, development and evaluation of AT training for HCPs, key content areas and means of delivery. Key results: HCPs had no AT specific qualifications (UK 94.6%; FR 81.3%) nor in-service AT training (UK 65.1%; FR 66.4%). They either did not know of AT courses (UK 63.3%) or knew that none existed (FR 72.5%). Barriers to AT training were mainly local training (UK 62.7%, FR 50%) and funding (UK 62.7%, FR 55.7%). Some training priorities were clearer for French HCPs – overall knowledge of AT devices (82.1%, UK 45.8%), customization of AT (65.3%, UK 30.1%), assessing patient holistically (53.4%, UK 25.3%), educating patient/carers (56.5%, UK 28.3%) (p < 0.001). Variances may be due to differing country-specific HCP education approach. A third of both groups highlighted also abandonment, client follow-up, powered wheelchair training and prescribing AT. To bridge gaps in knowledge and identified training needs of HCPs, the online interactive training programme starts by introducing foundations of AT, including definitions, types/uses of AT, legislation/policies and AT in practice. More specialist units build and expand on specific areas, e.g. AT for mobility, communication, assessment and evidence-based practice. The biopsychosocial model of Health and World Health Organisation’s (WHO) International Classification of Functioning, Disability and Health (ICF) framework underpin development of content. ICF shifts focus from disability to health and functioning, in line with a social model of rehabilitation. E-learning comprises existing videos, AT textbook material and bespoke animated presentations. Selfassessment and evaluation of training are embedded and learners receive certificate of completion. Training was piloted to a group of HCPs trainees and postregistration HCPs who commented on relevance of AT content, clarity, accessibility of presentation, and usefulness. Users found training very useful, especially legislation/policies and AT literature. Conclusion: Overall, survey results suggest that both UK and French HCPs’ training on AT solutions is limited and highly variable. There is need for crosschannel AT professional competencies, availability of work-based training and funding support. Development of online, interactive training aims to increase professional confidence and competence in this area as well as the evidence base for AT

A Literature Review of the Challenges Encountered in the Adoption of Assistive Technology (AT) and Training of Healthcare Professionals

Background: Long-term disabilities often result in loss of autonomy and social interaction. Accordingly, there is a demand for Assistive Technology (AT) devices to enable individuals to live independently for as long as possible. However, many people experience difficulties in obtaining and using AT. This paper presents findings from a narrative literature review undertaken as part of the development of AT training for healthcare professionals, one of the work areas of the ADAPT project (Assistive Devices for Empowering Disabled People through Robotic Technologies), funded by EU INTERREG France (Channel) England. The results of the review informed the design of a survey of healthcare professionals regarding their views and experiences of AT and the development of AT training. Method: The review sought to understand challenges encountered in the adoption and use of AT as well as how training of healthcare professionals in AT takes place. A narrative approach was adopted as the most appropriate way to synthesise published literature on this topic and describe its current state-of-art. Narrative reviews are considered an important educational tool in continuing professional development. An initial search was conducted via databases in the UK and France, including CINAHL, Academic Search Index, Social Sciences Citation Index, BDSP (Base de données en Santé Publique), Documentation EHESP/MSSH (Ecole des Hautes Etudes en Santé Publique/Maison des Sciences Sociales et Handicap), Cairn, Google Scholar and Pubmed. Inclusion criteria for the review included: covering issues relating to AT provision and training, English or French language, and published from 1990 onwards. Application of these criteria elicited 79 sources, including journal papers (48), reports (11), online sources (11), books (6) and conference papers (3). Sources were thematically analysed to draw out key themes. Key results: The majority of papers were from USA and Canada (27), then UK (20) and France (19). Others were from Europe (7), Australia (3), country unknown (2), and one joint UK/France publication. The main source of literature was journal papers (48), of which the most common types were practice reports (18), evaluation surveys (10) and qualitative studies (9). The review uncovered a number of key challenges related to the adoption of devices, including: difficulty defining AT across disciplines, lack of knowledge of healthcare professionals and users, obtrusiveness and stigmatisation AT users can experience when using devices, and shortfalls in communication amongst professional groups and between professionals and users. These issues can lead to abandonment of AT devices. Furthermore, substantial barriers to healthcare professionals exist, including inconsistent provision and quality of training, lack of evaluation of training, lack of resources and funding, shortage of qualified professionals to teach, and the increasingly rapid development of the technologies. Conclusion: Support, training and education for prescribers, distributors, users, and their carers is vital in the adoption and use of AT. Evidence indicates a need for comprehensive education in the AT field, as well as ongoing assessment, updates and evaluation which is embedded in programmes

A Survey of Assistive Technology (AT) Knowledge and Experiences of Healthcare Professionals in the UK and France: Challenges and Opportunities for Workforce Development

Background: Assistive Technologies (AT) in healthcare can increase independence and quality of life for users. Concurrently, new AT devices offer opportunities for individualised care solutions. Nonetheless, AT remains under-utilised and is poorly integrated in practice by healthcare professionals (HCPs). Although occupational therapists (OTs), physiotherapists and speech and language therapists (SLTs) consider that AT solutions can offer problem-solving approaches to personalised care, they have a lesser understanding of application of AT in their practice. In this paper, we report findings of a survey on AT knowledge and experiences of HCPs in UK and France. Training needs also explored in the survey are presented in a separate paper on development of online training for the ADAPT project. Method: A survey of 37 closed/open questions was developed in English and French by a team of healthcare researchers. Content was informed by published surveys and studies. Email invitations were circulated to contacts in Health Trusts in UK and France ADAPT regions and the survey was hosted on an online platform. Knowledge questions addressed AT understanding and views of impact on user’s lives. Experience questions focussed on current practices, prescription, follow-up, abandonment and practice standards. 429 HCPs completed the survey (UK = 167; FR = 262) between June and November 2018. Key results: Participants were mainly female (UK 89.2%; FR 82.8%) and qualified 10+ years (UK 66.5%; FR 62.2%). A key group in both countries were OTs (UK 34.1%; FR 46.6%), with more physiotherapists and SLTs in UK (16.8%, 16.8%; vs. FR 6.5%, 2.3%), and more nurses in France (22.1% Vs. UK 10.8%). More HCPs were qualified to degree level in France (75.2%; UK 48.5%, p < 0.001). In terms of knowledge, all HCPs agreed that AT helps people complete otherwise difficult or impossible tasks (UK 86.2%; FR 94.3%) and that successful AT adoption always depends on support from carers, family and professionals (UK 52.7%; FR 66.2%). There were some notable differences between countries that require further exploration. For example, more French HCPs thought that AT is provided by trial and error (84.7%, UK 45.5%, p < 0.001), while more UK HCPs believed that AT promotes autonomous living (93.4%; FR 42.8%, p < 0.001). Also, more French HCPs considered that AT refers exclusively to technologically advanced electronic devices (71.8%, UK 28.8%, p <0.001). In both countries, top AT prescribers were OTs, physiotherapists and SLTs. Respondents had little/no knowledge in comparing/choosing AT (UK 86.8%; FR 76.7%) and stated they would benefit from interdisciplinary clinical standards (UK 80.8%; FR 77.1%). A third of HCPs did not know if AT users had access to adequate resources/support (UK 34.1%; FR 27.5%) and rated themselves as capable to monitor continued effective use of AT (UK 38.9%; FR 34.8%). Conclusion: Knowledge and application of AT was varied between the two countries due to differences in health care provision and support mechanisms. Survey findings suggest that HCPs recognised the value of AT for users’ improved care, but had low confidence in their ability to choose appropriate AT solutions and monitor continued use, and would welcome AT interdisciplinary clinical standards

Critical evaluation of the impact of low technology communication aids on the quality of evidence elicited from witnesses with a Learning Disability in Registered Intermediary-mediated Achieving Best Evidence police investigative interviews

This thesis critically evaluates the manner in which low technology communication aids interactionally impact the quality of evidence elicited from witnesses with a Learning Disability (WLD) in real Achieving Best Evidence (ABE) police investigative interviews, when communication between interviewing officers (IO) and WLDs is facilitated by a Registered Intermediary (RI)1. Quality in this context is used in relation to the Youth Justice and Criminal Evidence Act (1999), which describes quality in terms of completeness, coherence and accuracy. Conversation Analysis (CA) (Mondada 2013; Sacks et al 1974) was used to analyse multimodality interactions in video recordings of seven real ABE police interviews, the institutional goal of which was to elicit investigation relevant information. The thesis identifies participants’ orientations to aids as tools to augment or replace talk to enable WLDs to communicate their evidence using the visuospatial modality. It examines the sequential phases during which aids are recruited during multimodality interaction: retrospectively, in episodes of aided repair, but more efficiently, they are recruited prospectively in Planned Intervention by circumventing a conversation breakdown. Aids are recruited by the participants for different interactional purposes, enabling WLDs to communicate complex evidentially relevant information that they would typically find challenging. The manner in which RIs and IOs construct aided requests for information and their unconventional modified discursive practices are analysed. An RI’s position as a language broker during these atypical interactions demonstrates the emergence of a previously undescribed production role. Finally, results from a survey of 21 RIs and 21 IOs is presented, which corroborate the findings of the analysis. This study extends the body of research on multiparty multimodality embodied interactions. To the best of the researcher’s knowledge, it is the first known interactional analysis of low technology aid recruitment in a legal context in atypical interactions. It presents several theoretical and workplace implications, demonstrates how such aids enable WLDs to be given a ‘voice’, improves the quality of their evidence and makes innovative recommendations for further research. 1 An intermediary in the Criminal Justice System is a communication specialist trained to work in legal contexts and relates to Section 29 of the Youth Justice and Criminal Evidence Act (UK Parliament 1999)

An investigation into the impact of computer therapy on people with aphasia.

Use of computers by the general population continues to increase and computers are now an integral part of communication, leisure activities and work. The majority of research into use of computers by people with aphasia has focussed narrowly on evaluating effects of computer therapy on specific language impairments. Little is known about the broader impacts of computer use by people with aphasia, in terms of levels of social activity and social participation and little is known of the views of people with aphasia on using computers. The research in this thesis investigates the outcome of computer therapy from the perspective of people living with aphasia. Outcome was evaluated using the framework of the World Health Organisation International Classification of Functioning, Disability and Health (WHO ICF 2001) to investigate impact not just in terms of impairment but on activity and participation as well. The ICF also provided a framework for investigating contextual factors (environmental and personal) which might effect outcome. The investigation took the form of two complementary but contrasting case series studies: an investigation into the outcome of using computers to target word finding abilities (treatment targeting impairment only); and an investigation into the outcome of training to use voice recognition software as a writing aid (treatment aiming to overcome activity limitations but not targeting impairment itself). Both studies comprised a qualitative investigation of the views of participants on the outcome and process of therapy. Both studies supplemented this qualitative data with complementary quantitative evaluations seeking to quantify key aspects of outcome. Study one findings indicated that all six participants perceived benefits to levels of activity, participation and confidence in addition to benefits to language impairment. Although some of this benefit was attributed to improved language skill, benefits were also attributed to increased confidence associated with acquiring skills. Study two found benefits to levels of activity and participation and confidence for all participants. Benefits were perceived even where there was no measured change to language impairment or quality or quantity of language used. Computer use by people with aphasia can therefore bring much broader benefits than just to language impairment. Benefits include increases in leisure and social activity, social participation and confidence. Previous computer experience is not necessary and benefits can be shown many years post stroke. These broader benefits should be borne in mind when selecting who may be appropriate for computer therapy

Cognition in action C-i-A: Rethinking gesture in neuro-atypical young people: A conceptual framework for embodied, embedded, extended and enacted intentionality

The three aims of my interdisciplinary thesis are: -To develop a conceptual framework for re-thinking the gestures of neuro-atypical young people, that is non-traditional and non-representational -To develop qualitative analytical tools for the annotation and interpretation of gesture that can be applied inclusively to both neuro-atypical and neuro-typical young people -To consider the conceptual framework in terms of its theoretical implications and practical applications Learning to communicate and work with neuro-atypical young people provides the rationale and continued impetus for my work. My approach is influenced by the limited social, physical and communicative experiences of young people with severe speech and motor impairment, due to cerebral palsy (SSMI-CP). CP is described as: a range of non-progressive syndromes of posture and motor impairment. The aetiology is thought to result from damage to the developing central nervous system during gestation or in the neonate. Brain lesions involve the basal ganglia and the cerebellum; both these sites are known to support motor control and integration. However, gaps in theoretical research and empirical data in the study of corporeal expression in young people with SSMI-CP necessitated the development of both an alternative theoretical framework and new tools. Biological Dynamic Systems Theory is proposed as the best candidate structure for the reconsideration of gesture. It encompasses the global, synthetic and embodied nature of gesture. Gesture is redefined and considered part of an emergent dynamic, complex, non-linear and self-organizing system. My construct of Cognition-in-Action (C-i-A) is derived from the notion of knowing-as-doing influenced by socio-biological paradigms; it places the Action-Ready-Body centre stage. It is informed by a theoretical synthesis of knowledge from the domains of Philosophy, Science and Technology, including practices in the clinical, technology design and performance arts arenas. The C-i-A is a descriptive, non-computational feature-based framework. Its development centred around two key questions that served as operational starting points: What can gestures reveal about children’s cognition-in-action? and Is there the potential to influence gestural capacity in children? These are supported by my research objectives. Three case studies are presented that focus on the annotation and interpretative analyses of corporeal exemplars from two adolescent males aged 16.9 and 17.9 years, and one female girl aged 10.7 years. These exemplars were contributed to the Child Gesture Corpus by these young people with SSMI-CP. The Gesture-Action-Entity (GAE) is proposed as a unit of interest for the analysis of procedural, semantic and episodic aspects of our corporeal knowledge. A body-based-action-annotation-system (G-ABAS) and Interpretative Phenomenological Analysis methodology is applied for the first time to gesture (G-IPA). These tools facilitate fine-grained corporeal dynamic and narrative gesture feature analyses. Phenomenal data reveal that these young people have latent resources, capacities and capabilities that they can express corporeally. Iteration of these interpretative findings with the Cognition-in-Action framework allows for the inference of processes that may underlie the strategies they use to achieve such social-motor-cognitive functions. In summary, their Cognition-in-Action is brought-forth, carried forward and has the potential to be culturally embodied. The utility of C-i-A framework lies in its explanatory power to contribute to a deeper understanding of child gesture. Furthermore, I discuss and illustrate its potential to influence practice in the domains of pedagogy, rehabilitation and the design of future intimate, assistive and perceptually sensitive technologies. Such technologies are increasingly mediating our social interactions. My work offers an ecologically valid alternative to tradition conceptualization of perception, cognition and action. My thesis contributes both new knowledge and carries implications across the domains of movement science, gesture studies and applied participatory performance arts and health practices

Attention Restraint, Working Memory Capacity, and Mind Wandering: Do Emotional Valence or Intentionality Matter?

Attention restraint appears to mediate the relationship between working memory capacity (WMC) and mind wandering (Kane et al., 2016). Prior work has identifed two dimensions of mind wandering—emotional valence and intentionality. However, less is known about how WMC and attention restraint correlate with these dimensions. Te current study examined the relationship between WMC, attention restraint, and mind wandering by emotional valence and intentionality. A confrmatory factor analysis demonstrated that WMC and attention restraint were strongly correlated, but only attention restraint was related to overall mind wandering, consistent with prior fndings. However, when examining the emotional valence of mind wandering, attention restraint and WMC were related to negatively and positively valenced, but not neutral, mind wandering. Attention restraint was also related to intentional but not unintentional mind wandering. Tese results suggest that WMC and attention restraint predict some, but not all, types of mind wandering