Alternative and Augmentative Communication in Hospital – Nurses’ Knowledge, Experience and Attitudes

Nadomjesna i potpomognuta komunikacija (NPK) unaprjeđuje kvalitetu zdravstvene skrbi i zadovoljstvo pacijenata. U Hrvatskoj nedostaju istraživanja o primjeni NPK u bolnicama. Cilj ovog istraživanja je ispitati komunikaciju medicinskih sestara s pacijentima sa složenim komunikacijskim potrebama te njihovu upoznatost i stavove o NPK. U istraživanju su sudjelovale medicinske sestre (N=121) iz jedne od najvećih hrvatskih bolnica. Anketni upitnik sastojao se od pitanja o iskustvu sudionika s pacijentima sa složenim komunikacijskim potrebama, znanju, iskustvima i edukaciji o NPK. Stavovi prema implementaciji metode komunikacijskih ploča u bolnici ispitani su sa skalama tipa semantičkog diferencijala. Više od 50% sudionika u redovitim je kontaktima s pacijentima čija je komunikacija narušena zbog moždanog udara, kognitivnih i senzornih oštećenja, degenerativnih bolesti, utjecaja lijekova, jake boli ili jer ne govore hrvatski. Međutim, većina sudionika su slabo ili nikako upoznati sa značenjem pojma NPK te većina nema edukaciju iz tog područja. Većina medicinskih sestara koristi jednostavne metode NPK, ponajviše za komunikaciju o pacijentovim osnovnim potrebama, dok samo mali broj koristi NPK za komunikaciju u terapijske svrhe. Najveće prepreke korištenju NPK su nedostatak edukacije i resursa/pomagala. Sudionici imaju pozitivne stavove prema mogućem uvođenju komunikacijskih ploča u sestrinsku praksu, osobito stariji sudionici i oni s dužim stažem. Rezultati ukazuju na nedostatnu upoznatost i iskustvo medicinskih sestara s NPK te veliku potrebu za edukacijom. Preporučuje se uključivanje edukacije o NPK u obrazovne kurikulume na svim razinama sestrinskog obrazovanja.Alternative and augmentative communication (AAC) improves quality of patient care and their satisfaction. There is a lack of research about AAC in Croatian hospitals. The objective of this study was to explore nurses’ communication with patients with complex communication needs, as well as their knowledge and attitudes regarding AAC. Subjects were 121 nurses from one of the largest Croatian hospitals. Survey questionnaire consisted of questions regarding the subjects’ experience with patients with communication difficulties, their knowledge, experience and education about AAC. Attitudes regarding the implementation of communication boards in hospital were assessed with semantic differential type scales. Over 50% of the respondents were in regular contact with patients whose communication was disrupted due to the stroke, cognitive and sensory impairment, degenerative diseases, medication, severe pain or because they don’t speak Croatian, but yet the majority of the respondents are vaguely or not at all acquainted with the meaning of AAC and had no education about it. Majority of the respondents use simple AAC methods for communication about patient basic needs and only a small number of the respondents use AAC for therapeutic communication. Lack of education and resources / aids are perceived as major barriers. The respondents have positive attitudes about the possible introduction of communication boards or cards into their practice, especially older and/or more experienced subjects. Results indicates that nurses are in a great need for education about AAC. Education about AAC should be included in health communication curriculum at all levels of the nursing education

Changes of the Corpus Callosum in Children who Suffered Perinatal Injury of the Periventricular Crossroads of Pathways

There is a high incidence of periventricular leukomalacia, caused by hypoxia-ischemia, in preterm infants. These lesions damage the periventricular crossroads of commissural, projection and associative pathways, which are in a close topographical relationship with the lateral ventricles. We explored to what extent abnormalities of echogenicity of the periventricular crossroads correlate with changes in size of the corpus callosum. Our study included nine infants (gestation from 26–41 weeks; birth weight between 938–4450 grams) with perinatal brain injury. Periventricular areas, which topographically correspond to the frontal, main and occipital crossroad, were readily visualized by cranial ultrasound scans, performed during the first two weeks after birth. Corpus callosum mediosagittal area measurements were performed using magnetic resonance images, acquired between the first and sixth postnatal month (postmenstrual age 40–49 weeks). We found a statistically significant correlation between the increased echogenicity in the crossroad areas and the decrease of the corpus callosum midsagittal area (p<0.05). This supports the hypothesis that callosal fibers can be damaged, during growth through the periventricular crossroads of pathways

Developmental dynamics of radial vulnerability in the cerebral compartments in preterm infants and neonates

The developmental vulnerability of different classes of axonal pathways in preterm white matter is not known. We propose that laminar compartments of the developing cerebral wall serve as spatial framework for axonal growth and evaluate potential of anatomical landmarks for understanding reorganization of the cerebral wall after perinatal lesions. The 3-T MRI (in vivo) and histological analysis were performed in a series of cases ranging from 22 postconceptional weeks to 3 years. For the follow-up scans, three groups of children (control, normotypic, and preterms with lesions) were examined at the term equivalent age and after the first year of life. MRI and histological abnormalities were analyzed in the following compartments: (a) periventricular, with periventricular fiber system; (b) intermediate, with periventricular crossroads, sagittal strata, and centrum semiovale; (c) superficial, composed of gyral white matter, subplate, and cortical plate. Vulnerability of thalamocortical pathways within the crossroads and sagittal strata seems to be characteristic for early preterms, while vulnerability of long association pathways in the centrum semiovale seems to be predominant feature of late preterms. The structural indicator of the lesion of the long association pathways is the loss of delineation between centrum semiovale and subplate remnant, which is possible substrate of the diffuse periventricular leukomalacia. The enhanced difference in MR signal intensity of centrum semiovale and subplate remnant, observed in damaged children after first year, we interpret as structural plasticity of intact short cortico-cortical fibers, which grow postnatally through U-zones and enter the cortex through the subplate remnant. Our findings indicate that radial distribution of MRI signal abnormalities in the cerebral compartments may be related to lesion of different classes of axonal pathways and have prognostic value for predicting the likely outcome of prenatal and perinatal lesions

Fundamentals of the Development of Connectivity in the Human Fetal Brain in Late Gestation: From 24 Weeks Gestational Age to Term

During the second half of gestation, the human cerebrum undergoes pivotal histogenetic events that underlie functional connectivity. These include the growth, guidance, selection of axonal pathways, and their first engagement in neuronal networks. Here, we characterize the spatiotemporal patterns of cerebral connectivity in extremely preterm (EPT), very preterm (VPT), preterm and term babies, focusing on magnetic resonance imaging (MRI) and histological data. In the EPT and VPT babies, thalamocortical axons enter into the cortical plate creating the electrical synapses. Additionally, the subplate zone gradually resolves in the preterm and term brain in conjunction with the growth of associative pathways leading to the activation of large-scale neural networks. We demonstrate that specific classes of axonal pathways within cerebral compartments are selectively vulnerable to temporally nested pathogenic factors. In particular, the radial distribution of axonal lesions, that is, radial vulnerability, is a robust predictor of clinical outcome. Furthermore, the subplate tangential nexus that we can visualize using MRI could be an additional marker as pivotal in the development of cortical connectivity. We suggest to direct future research toward the identification of sensitive markers of earlier lesions, the elucidation of genetic mechanisms underlying pathogenesis, and better long-term follow-up using structural and functional MRI

Development and structural plasticity of human brain

This review deals with recent evidence on vulnerability and the developmental structural plasticity of the human brain: 1. Special laminar indicators of neurogenetic events and transitory fetal structure in preterm infants 2. New concept of vulnerability and organization of the white matter in preterms 3. Structural changes and abnormalities of the "white" matter of the perinatal lesion The correlation between MR images and the histological section demonstrate typical fetal lamination: ventricular and subventricular proliferative zones separated by periventricular fibrilar layer, intermediate zone (fetal "white" matter), "subplate" zone with waiting and growing fibers and cortical plate composed of migratory neurons. The organization of white matter shows tangentional axonal strata in polar regions of hemispheres and periventricular crossroads of commissural, associative and projectional pathways. It is our opinion that pathogenetic factors in hypoxic-ischemic lesions are not only restricted to cellular and infections mechanisms, but they also include the disturbance of extracellular matrix (ECM) and guidance molecules in periventricular crossroads of pathways. The disturbance of ECM leads to the reduction of commissural (especially corpus callosum), associative and projectional pathways and consecutive poor cognitive and neurological outcome. The results described in this review open new possibilities in the diagnosis and follow up of perinatal lesions as well as in the development of new strategies for neuroprotection

Specific cognitive deficits in preschool age correlated with qualitative and quantitative MRI parameters in prematurely born children

Background: Cognitive deficits after perinatal brain lesion in preterm infants are among the most common neurodevelopmental disturbances. The relationship between structural changes on at term magnetic resonance imaging (MRI) and cognitive deficits in the preschool age should be a special focus due to timely intervention. The aim of this study was to correlate qualitative and quantitative MRI parameters of perinatal brain lesion in preterm children, on early neonatal MRI and follow up MRI, with general and specific cognitive functions in the preschool age. ----- Methods: Twenty-one preterm infants with verified perinatal lesions based on clinical and ultrasound data underwent a brain MRI at term-equivalent age and a second MRI between 3 and 5 years of age. Qualitative and quantitative MRI analyses were done. All subjects underwent cognitive assessment (3-5 years) using Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) and Developmental Neuropsychological Assessment (NEPSY-II). ----- Results: Results show that many structural changes on at term MRI and on follow up MRI in preterm born children moderately correlate with specific cognitive deficits in preschool age. At term equivalent MRI, white matter changes and cortical thickness correlate to general and specific cognitive functions in infants born preterm. By analyzing follow up MRI at preschool age, structural changes of different white matter segments, corpus callosum, cortical thickness and lobe volume correlate to some specific cognitive functions. ----- Conclusion: Besides general cognitive delay, specific cognitive deficits in preterm children should be targeted in research and intervention, optimally combined with MRI scanning, providing timely and early intervention of cognitive deficits after perinatal brain lesion. Our results, as well as previously published results, suggest the importance of detailed preschool neuropsychological assessment, prior to enrolment in the school system. Although preliminary, our results expand our understanding of the relationship between early brain developmental lesions and cognitive outcome following premature birth

Writing and Drawing with Both Hands as Indicators of Hemispheric Dominance

Brain lateralization is a common term used to describe dominance of one brain hemisphere over another for a specific function. The right hand dominance in writing, controlled by the left hemisphere, is preceded by development of communicative gesticulation and followed by development of speech in the same hemisphere1. We assumed that some people are not aware of their own capability of using the other hand for tasks involving fine motor sequential movements. To prove this hypothesis, the participants were asked to perform one trained task (writing) and one less-trained task (drawing) with a dominant and a non-dominant hand. The final sample was comprised of 1189 children from 14 elementary schools and 8 high schools in the Osijek area, of which 685 elementary school children were attending 1st to 4th grade and 504 high school children were attending 3rd and 4th grade. The participants were asked to write two words, draw a specific object (a vase with flowers) and fill out a questionnaire with 10 questions concerning the classification of handedness and cerebral hemisphere dominance. The self-reported cerebral lateralization assessed in the questionnaire was compared with the drawing and the writing performance. The self-reported and objectively measured hand dominance deviated in the cases of the ambidextrous who consider themselves right-handers. Given the fact that the number of ambidextrous persons was greater in elementary schools than in high schools, we concluded how training of the right hand decreases the ability of using both hands equally for either of the tested functions – writing and drawing

Perinatal and early postnatal reorganization of the subplate and related cellular compartments in the human cerebral wall as revealed by histological and MRI approaches

We analyzed the developmental history of the subplate and related cellular compartments of the prenatal and early postnatal human cerebrum by combining postmortem histological analysis with in vivo MRI. Histological analysis was performed on 21 postmortem brains (age range: 26 postconceptional weeks to 6.5 years) using Nissl staining, AChE-histochemistry, PAS-Alcian blue histochemistry, Gallyas' silver impregnation, and immunocytochemistry for MAP2, synaptophysin, neurofilament, chondroitin sulfate, fibronectin, and myelin basic protein. The histological findings were correlated with in vivo MRI findings obtained in 30 age-matched fetuses, infants, and children. We analyzed developmental reorganization of major cellular (cell bodies, growing axons) and extracellular (extracellular matrix) components of the subplate and the developing cortex/white matter interface. We found that perinatal and postnatal reorganization of these tissue components is protracted (extending into the second year of life) and characterized by well-delineated, transient and previously undescribed structural and molecular changes at the cortex/white matter interface. The findings of this study are clinically relevant because they may inform and guide a proper interpretation of highly dynamic and hitherto puzzling changes of cortical thickness and cortical/white matter interface as described in current in vivo MRI studies