Measures of functional, real-world communication for aphasia: a critical review

Purpose: Aphasia is a language impairment caused by acquired brain damage such as stroke. For successful rehabilitation, a thorough understanding of naturalistic, real-world communication is imperative, as this is the behaviour speech and language therapy (SLT) ultimately aims to improve. In the field of aphasiology, there currently is a lack of consensus about the way in which communication should be measured. Underlying this is a fundamental lack of agreement over what real-world communication entails and how it should be defined. Method: In this critical review, we review the instruments that are currently used to quantify functional, real-world communication in people with aphasia (PWA). Each measure is checked against a newly proposed, comprehensive, theoretical framework of situated language use, which defines communication as: (1) interactive, (2) multimodal, and (3) based on context (common ground). Results: The instrument that best fits the theoretical definition of situated language use and allows for the quantification of communicative ability is the Scenario Test. Conclusions: This article provides a start in a more systematic and theoretically founded approach to the study and measurement of functional, real-world communication in aphasia. More work is needed to develop an instrument that can quantify communicative ability across different aphasia types and severities

De week van... Lisanne Doedens

Zoals in elke editie van Bestuurskundige Berichten nemen we ook dit keer een kijkje in het leven van een student. Dit keer is het de beurt aan derdejaarsstudent en tevens dit jaar B.I.L.-bestuurslid Lisanne Doedens. Lisanne bekleedt in het bestuur de functie Commissaris Acquisitie & Alumni

Association between characteristics of nursing teams and patients' aggressive behavior in closed psychiatric wards

PURPOSE: Estimate the effect of nursing, shift, and patient characteristics on patients' aggression. DESIGN AND METHODS: Follow‐up study on a closed psychiatric ward was performed to estimate the effect of nursing team characteristics and patient characteristics on the incidence of aggression. FINDINGS: The incidence of aggression (n = 802 in sample) was lower in teams with >75% male nurses. Teams scoring high on extraversion experienced more verbal aggression and teams scoring high on neuroticism experienced more physical aggression. Younger patients and/or involuntarily admitted patients were more frequently aggressive. PRACTICE IMPLICATIONS: These findings could stimulate support for nurses to prevent aggression

What is functional communication? A theoretical framework for real-world communication applied to aphasia rehabilitation

Aphasia is an impairment of language caused by acquired brain damage such as stroke or traumatic brain injury, that affects a person’s ability to communicate effectively. The aim of rehabilitation in aphasia is to improve everyday communication, improving an individual’s ability to function in their day-to-day life. For that reason, a thorough understanding of naturalistic communication and its underlying mechanisms is imperative. The field of aphasiology currently lacks an agreed, comprehensive, theoretically founded definition of communication. Instead, multiple disparate interpretations of functional communication are used. We argue that this makes it nearly impossible to validly and reliably assess a person’s communicative performance, to target this behaviour through therapy, and to measure improvements post-therapy. In this article we propose a structured, theoretical approach to defining the concept of functional communication. We argue for a view of communication as “situated language use”, borrowed from empirical psycholinguistic studies with non-brain damaged adults. This framework defines language use as: (1) interactive, (2) multimodal, and (3) contextual. Existing research on each component of the framework from non-brain damaged adults and people with aphasia is reviewed. The consequences of adopting this approach to assessment and therapy for aphasia rehabilitation are discussed. The aim of this article is to encourage a more systematic, comprehensive approach to the study and treatment of situated language use in aphasia

Cross-classified multilevel models improved standard error estimates of covariates in clinical outcomes – a simulation study

Objective: To compare estimates of effect and variability resulting from standard linear regression analysis and hierarchical multilevel analysis with cross-classified multilevel analysis under various scenarios. Study design and setting: We performed a simulation study based on a data structure from an observational study in clinical mental health care. We used a Markov chain Monte Carlo approach to simulate 18 scenarios, varying sample sizes, cluster sizes, effect sizes and between group variances. For each scenario, we performed standard linear regression, multilevel regression with random intercept on patient level, multilevel regression with random intercept on nursing team level and cross-classified multilevel analysis. Results: Applying cross-classified multilevel analyses had negligible influence on the effect estimates. However, ignoring cross-classification led to underestimation of the standard errors of the covariates at the two cross-classified levels and to invalidly narrow confidence intervals. This may lead to incorrect statistical inference. Varying sample size, cluster size, effect size and variance had no meaningful influence on these findings. Conclusion: In case of cross-classified data structures, the use of a cross-classified multilevel model helps estimating valid precision of effects, and thereby, support correct inferences

Mortality in paediatric burns victims: A retrospective review from 2009 to 2012 in a single centre

Background. Childhood mortality is high in low- and middle-income countries. Burns are one of the five leading causes of childhood injury mortality in South Africa (SA). While there is an abundance of literature on burns in the developed world, there are far fewer publications dealing with childhood mortality related to burns in Africa and SA.Objective. To describe the mortality of children admitted to a dedicated paediatric burns unit, and investigate factors contributing to reducing mortality.Methods. A retrospective review was performed of patients admitted to the Johnson & Johnson Paediatric Burns Unit, Chris Hani Baragwanath Academic Hospital, Johannesburg, SA, between May 2009 and April 2012.Results. During the study period, 1 372 patients aged ≤10 years were admitted to the unit. There were 1 089 admissions to the general ward and 283 admissions to the paediatric burns intensive care unit (PBICU). The overall mortality rate was 7.9% and the rate for children admitted to the PBICU 29.3%; 90.8% of deaths occurred in children aged ≤5 years. Of children admitted with an inhalational injury, 89.5% died. No child with a burn injury >60% of total body surface area (TBSA) survived.Conclusions. Our overall mortality rate was 7.9%, and the rate declined significantly over the 3-year study period from 11.7% to 5.1%. Age ≤5 years, the presence of inhalational injury, burn injury >30% of TBSA and admission to the PBICU were significant risk factors for mortality