Speech and language therapists' management practices, perceived effectiveness of current treatments and interest in neuromuscular electrical stimulation for acquired dysarthria rehabilitation: an international perspective

Background Research is beginning to shed light on the practices employed by speech-language therapists (SLTs) for the management of acquired dysarthria. However, studies that explore SLTs’ satisfaction with the effectiveness of current therapies and their interest in new treatment methods for this population have not been carried out. One potential new method is neuromuscular electrical stimulation (NMES): the pool of evidence for its use in rehabilitation is increasing, yet it has not been widely explored for use with dysarthria. Aim To extend the understanding of acquired dysarthria management practices employed by SLTs across the globe and determine their satisfaction with current therapy options. To explore their interest in using NMES with this population. Methods and Procedures A cross-sectional international online survey was developed and disseminated to SLTs working with adults with acquired dysarthria through international professional associations. The survey collected information on demographic characteristics, dysarthria management practices, satisfaction with treatment effectiveness and interest in and knowledge of NMES. Survey responses were analysed using descriptive and inferential statistics, and quantitative content analysis. Outcomes and Results A total of 211 SLTs (North America, 48.8%; Europe, 36%; Asia, 8.1%; Oceania, 5.7%; Africa, 0.9%; South America, 0.5%) completed the survey in full. Management practices varied considerably. There was a clear preference for informal assessments, mainly oral-motor examinations, focusing on body functions and structures. The majority of respondents rejected the use of non-speech oral motor exercises as a clinical or carryover exercise. Variable satisfaction with current speech subsystem treatments was noted; however, overall, there was a general dissatisfaction. Whilst a strong interest in the use of NMES for dysarthria was evidenced, it was noted that most SLTs lacked fundamental knowledge of NMES principles and application. Conclusion SLTs’ management practices and satisfaction with acquired dysarthria treatments differed substantially. Investigations of the potential use of NMES for dysarthria treatment are of interest. WHAT THIS PAPER ADDS What is already known on the subject Recent country-specific surveys have explored speech-language therapists’ (SLTs’) assessment and intervention practices for acquired dysarthria. These studies indicate that although clinical management for this speech disorder mainly involves informal assessment tools and impairment-focused treatment, communication beyond the impairment, such as the activity and participation domains, is also frequently assessed and treated. What this paper adds to existing knowledge The majority of SLTs are dissatisfied with the overall benefits of current acquired dysarthria treatment. Phonatory, respiration and speech rate therapies are perceived to be more effective than prosody, articulation and resonance treatments. Despite a general lack of theoretical knowledge, most SLTs are interested in neuromuscular electrical stimulation treatment for acquired dysarthria. What are the potential or actual clinical implications of this work? New, evidence-based treatments are needed for SLTs to be confident in the effectiveness of their acquired dysarthria treatment

Prolonged rather than hasty decision-making in schizophrenia using the box task. Must we rethink the jumping to conclusions account of paranoia?

Accepted manuscript version, licensed CC BY-NC-ND 4.0. Jumping to conclusions (JTC) is the best established cognitive bias in schizophrenia and is increasingly targeted in interventions aimed to improve positive symptoms. To address shortcomings of the standard measure to capture JTC, the beads task, we developed a new variant—the box task—which was subsequently validated in people with elevated psychotic-like experiences. For the first time, the box task was administered in a sample of individuals with manifest schizophrenia. We hypothesized that patients with schizophrenia would display an elevated JTC bias relative to controls. Method - We recruited a large sample of 101 patients with schizophrenia and matched them to an online sample recruited from the general population. In the box task, participants must decide which of two kinds of colored balls are presented more often. Participants are told that the task may end prematurely, and that task performance will be counted as an error if no decision had been made before that point. The primary measure was the number of draws to decision (DTD), where fewer DTD corresponds to greater JTC. Results - In contrast to expectations, participants with schizophrenia showed significantly higher DTD (i.e., reduced JTC). Consistent with our previous findings, patients also displayed a lowered decision threshold compared to controls. Response confidence for the final decision was lower in patients and correlated with self-esteem and positive symptoms. While there was evidence that previous knowledge of the box task lowered DTD, exclusion of participants with experience on the box task did not substantially change results. Discussion - The study fits a growing body of experiments casting doubt on the generalizability of the JTC effect in schizophrenia across different tasks. While the study tentatively supports a liberal acceptance account of psychosis, caution is warranted and we recommend that research should explore and control for potentially important mediators (e.g., task difficulty, stress, test-taking attitudes)

Evaluating the impact of design affordances in preschool children's toy preferences

The role of toys in early childhood intervention is crucial for children to acquire and improve their skills. A study with preschool children has been carried out in order to establish, from a product design perspective, how toys' innate characteristics trigger toy preferences. It was found that children's preference is presided by the play value that is perceived. By exploiting hedonic and pragmatic qualities, designers can embed persuasive qualities in toys. A framework for toy design is proposed as a model for a computer-aided support tool that helps toy designers reach their design goal

Letter to the Editor: Metacognitive training and metacognitive therapy. A reply to Lora Capobianco and Adrian Wells

© 2018 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 24 month embargo from date of publication (Jan 2018) in accordance with the publisher’s archiving policyTo the Editor: It is indeed unfortunate that our metacognitive treatment programs use a similar name as the psychotherapy developed by Adrian Wells. Nevertheless, we believe that our use of the term ‘metacognitive’ is justified. The term ‘metacognition’ is somewhat over-inclusive. Coined by Flavell (1979) it is usually understood as “thinking about one's thinking”. Yet, subsequent research used the term in various ways (Koriat, 2002). For example, confidence/doubt is at the heart of metacognition according to Asher Koriat (Koriat & Levy-Sadot, 1999). In neuropsychology, a discrepancy between subjective and objective performance is termed a deficit in metacognition (for an early study see Anderson-Parenté, 1994). Moreover, Flavell's definition of metacognitive knowledge about oneself versus others is quite close to the concept of social cognition, further blurring the boundaries (p. 906). The idea for metacognitive training for psychosis originated in the early 2000s based on research suggesting ‘cognitive biases’ in people with psychosis (Garety & Freeman, 1999), such as jumping to conclusions (JTC), incorrigibility and overconfidence (note that these are not “thought contents” as Capobianco and Wells write, but rather overarching distortions in the processing of information; see Pohl, 2004). Importantly, awareness of these biases is poor in many patients. The primary goal of our approach was to ‘straighten’ these cognitive biases (not to be confused with emotional distortions/biases proposed by Aaron Beck) and raise metacognitive awareness in a gentle, non-confrontational manner (e.g., through playful exercises that generate surprising outcomes [i.e., metacognitive experience] and through education regarding cognitive biases [i.e., metacognitive knowledge]). A recurring theme in MCT for psychosis is that patients should check whether their confidence in a given judgment is justified (metacognitive strategy, cf. Koriat, 2002) and to “sow the seeds of doubt”. Importantly, MCT exercises on cognitive biases use delusion-neutral material. Although the ultimate goal is to improve delusions, this is achieved indirectly, as the main emphasis of the intervention remains on the modification at a meta-level of processing (e.g., confidence in judgements). We therefore reject the claim by Capobianco and Wells that our program “is clearly a cognitive behavioral approach that deals with the content of negative thoughts." Over the years, we incorporated compatible elements from CBT, while the focus remained on metacognition. Why did we do this? Initially, we had the perhaps naive hope that our MCT would run alongside other psychotherapeutic programs in mental health institutions. However, as the literature shows, psychotherapy for psychosis is rarely provided. In order to address this problem within our low-threshold program, the newest versions of MCT and MCT + include additional modules with a CBT orientation, dealing with issues deemed by patients to be a priority in treatment, namely self-esteem and stigma. We have devised a number of MCT interventions for other disorders, which are clearly rooted in the setup and presentation mode of MCT for psychosis. These disorder-specific versions were developed as hybrids to amalgamate a cognitive and a metacognitive perspective, as we do not view working on a cognitive or metacognitive level as mutually exclusive. Wells' work dates back to the 1990s - however, to the best of our knowledge, the term ‘metacognitive therapy’ was introduced much later. When we became aware of its existence, MCT for psychosis was already available and used in many different languages (currently 33 languages). Therefore, changing its name would have created new confusion; however, we used slightly different names or acronyms (e.g., myMCT) to distinguish the two approaches

Beads task vs. box task: The specificity of the jumping to conclusions bias

Previous research involving the probabilistic reasoning 'beads task' has consistently demonstrated a jumping-to-conclusions (JTC) bias, where individuals with delusions make decisions based on limited evidence. However, recent studies have suggested that miscomprehension may be confounding the beads task. The current study aimed to test the conventional beads task against a conceptually simpler probabilistic reasoning "box task" METHODS: One hundred non-clinical participants completed both the beads task and the box task, and the Peters et al. Delusions Inventory (PDI) to assess for delusion-proneness. The number of 'draws to decision' was assessed for both tasks. Additionally, the total amount of on-screen evidence was manipulated for the box task, and two new box task measures were assessed (i.e., 'proportion of evidence requested' and 'deviation from optimal solution').; Despite being conceptually similar, the two tasks did not correlate, and participants requested significantly less information on the beads task relative to the box task. High-delusion-prone participants did not demonstrate hastier decisions on either task; in fact, for box task, this group was observed to be significantly more conservative than low-delusion-prone group.; Neither task was incentivized; results need replication with a clinical sample.; Participants, and particularly those identified as high-delusion-prone, displayed a more conservative style of responding on the novel box task, relative to the beads task. The two tasks, whilst conceptually similar, appear to be tapping different cognitive processes. The implications of these results are discussed in relation to the JTC bias and the theoretical mechanisms thought to underlie it

Towards a reliable repeated-measures beads task for assessing the jumping to conclusions bias

© 2017 Elsevier BV. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (April 2018) in accordance with the publisher’s archiving policyThe jumping to conclusions bias (JTC), in which some people gather less information than others before making a decision, has been linked to delusions in psychosis. JTC is usually identified via the beads task, in which a sequence of beads (the “target” sequence) is used to measure the amount of evidence participants require before making a decision. Yet, despite its common use, the reliability of the task has never been properly investigated. We investigated its reliability, and tested an alternate version which used distractor sequences to obfuscate the target sequence. Healthy participants (N = 212) were randomised into two groups. One group completed ten trials using the target sequence, while the other completed ten trials of the target sequence and three distractor sequences. Our data indicated the standard task may not be reliable over repeated measures, but that by including distractor sequences, the task becomes more believable, repeatable, and reliable. Additionally, excluding first-trial data (a “silent” practice trial) also improves repeatability. These improvements to the task are relevant to single trial studies, and will be especially useful to repeated-measures longitudinal, experimental, and treatment studies. Such repeated-measures studies are important for investigating the causal link between JTC and delusions

Sowing the seeds of doubt: a narrative review on metacognitive training in schizophrenia

AbstractThe present article provides a narrative review of empirical studies on metacognitive training in psychosis (MCT). MCT represents an amalgam of cognitive-behavioral therapy (CBT), cognitive remediation (CRT) and psychoeducation. The intervention is available in either a group (MCT) or an individualized (MCT+) format. By sowing the seeds of doubt in a playful and entertaining fashion, the program targets positive symptoms, particularly delusions. It aims to raise patients’ awareness for common cognitive traps or biases (e.g., jumping to conclusions, overconfidence in errors, bias against disconfirmatory evidence) that are implicated in the formation and maintenance of psychosis. The majority of studies confirm that MCT meets its core aim, the reduction of delusions. Problems (e.g., potential allegiance effects) and knowledge gaps (i.e., outcome predictors) are highlighted. The preliminary data suggest that the individual MCT format is especially effective in addressing symptoms, cognitive biases and insight. We conclude that MCT appears to be a worthwhile complement to pharmacotherapy

Wind turbine wake properties: Comparison between a non-rotating simplified wind turbine model and a rotating model

Experimental results on the wake properties of a non-rotating simplified wind turbine model, based on the actuator disc concept, and a rotating model, a three-blade wind turbine, are presented. Tests were performed in two different test sections, one providing a nominally decaying isotropic turbulent inflow (turbulence intensity of 4% at rotor disc location) and one providing a neutral atmospheric boundary layer above a moderately rough terrain at a geometric scale of 1:300 (determined from the combination of several indicators), with 13% of turbulence intensity at hub height. The objective is to determine the limits of the simplified wind turbine model to reproduce a realistic wind turbine wake. Pressure and high-order velocity statistics are therefore compared in the wake of both rotor discs for two different inflow conditions in order to quantify the influence of the ambient turbulence. It has been shown that wakes of rotating model and porous disc developing in the modeled atmospheric boundary layer are indistinguishable after 3 rotor diameters downstream of the rotor discs, whereas few discrepancies are still visible at the same distance with the decaying isotropic turbulent inflow

ANALYTICAL EMPLOYMENT OF STABLE ISOTOPES OF CARBON, NITROGEN, OXYGEN AND HYDROGEN FOR FOOD AUTHENTICATION

Stable isotopes of carbon, nitrogen, oxygen and hydrogen were used for analytical purposes for the discrimination of the type of production (farming vs. fishing) in the case of sea bass and for geographical origin in the case of milk. These results corroborate similar experimental evidences and confirm the potential of this analytical tool to support of food traceability