Identifying and applying psychological theory to setting and achieving rehabilitation goals: development of a practice framework

Goal setting is considered to be a fundamental part of rehabilitation; however, theories of behaviour change relevant to goal-setting practice have not been comprehensively reviewed. To identify and discuss specific theories of behaviour change relevant to goal-setting practice in the rehabilitation setting. (ii) To identify 'candidate' theories that that offer most potential to inform clinical practice. The rehabilitation and self-management literature was systematically searched to identify review papers or empirical studies that proposed a specific theory of behaviour change relevant to setting and/or achieving goals in a clinical context. Data from included papers were extracted under the headings of: key constructs, clinical application and empirical support. Twenty-four papers were included in the review which proposed a total of five theories: (i) social cognitive theory, (ii) goal setting theory, (iii) health action process approach, (iv) proactive coping theory, and (v) the self-regulatory model of illness behaviour. The first three of these theories demonstrated most potential to inform clinical practice, on the basis of their capacity to inform interventions that resulted in improved patient outcomes. Social cognitive theory, goal setting theory and the health action process approach are theories of behaviour change that can inform clinicians in the process of setting and achieving goals in the rehabilitation setting. Overlapping constructs within these theories have been identified, and can be applied in clinical practice through the development and evaluation of a goal-setting practice framework

A single case study of articulatory adaptation during acoustic mimicry

The distribution of fine-grained phonetic variation can be observed in the speech of members of welldefined social groups. It is evident that such variation must somehow be able to propagate through a speech community from speaker to hearer. However, technological barriers have meant that close and direct study of the articulatory links of this speaker-hearer chain has not, to date, been possible. We present the results of a singlecase study using an ultrasound-based method to investigate temporal and configurational lingual adaptation during mimicry. Our study focuses on allophonic variants of postvocalic /r/ found in speech from Central Scotland. Our results show that our informant was able to adjust tongue gesture timing towards that of the stimulus, but did not alter tongue configuration

Articulatory insights into language variation and change: preliminary findings from an ultrasound study of derhoticization in Scottish English

<p>Scottish English is often cited as a rhotic dialect of English. However, in the 70s and 80s, researchers noticed that postvocalic /r/ was in attrition in Glasgow (Macafee, 1983) and Edinburgh (Romaine, 1978; Johnston and Speitel 1983). Recent research (Stuart-Smith, 2003) confirms that postvocalic /r/ as a canonical phonetically rhotic consonant is being lost in working-class Glaswegian speech. However, auditory and acoustic analysis revealed that the situation was more complicated than simple /r/ vs. zero variation. The derhoticized quality of /r/ seemed to vary socially; in particular male working class speakers often produced intermediate sounds that were difficult to identify. It is clear that although auditory and acoustic analysis are useful, they can only hint at what is going on in the vocal tract. A direct articulatory study is thus motivated.</p> <p>Instrumental phonetic studies that examine the vocal tract during the production of sustained rhotic consonants and in laboratory-based studies of American English /r/ have identified a complex relationship between articulation and acoustics, including articulatory differences with minimal acoustic consequences (starting with Delattre and Freeman, 1968). In other words, different gestural configurations can be used to generate a canonically rhotic consonant. A pilot study (Scobbie and Stuart-Smith, 2006) using Ultrasound Tongue Imaging (UTI) with a Scottish vernacular speaker revealed something rather different: the occurrence of a strong articulatory retroflex tongue motion, which generated little or no rhotic acoustic consequences because it was timed to occur after phonation had ceased, before pause. This tongue motion was found in a speaker who was weakly rhotic. Thus we may have a situation in which acoustic differences with a sociolinguistic function have, in some prosodic contexts, imperceptible articulatory differences in tongue position, though timing will vary. The situation of language variation and change in Scotland means that an articulatory/acoustic study is likely to give very different results to similar studies of rhotic speakers in the USA (Mielke, Twist, and Archangeli, 2006), and be particularly relevant to understanding social variation.</p> <p>Ultrasound is non-invasive and portable and therefore has great potential as an instrumental method for studying aspects of socially stratified variation: articulatory data can be physically collected in every-day social settings. However the technique requires refinement for effective use in recording locations outside the laboratory (e.g. in school, at home), and the potential impact of using the equipment on speech is not known. Gick (2002) suggest methods for fieldwork, but we are not aware of any study which attempts to quantify the effects of the technique on vernacular speakers.</p> <p>Ultrasound is non-invasive and portable and therefore has great potential as an instrumental method for studying aspects of socially stratified variation: articulatory data can be physically collected in every-day social settings. However the technique requires refinement for effective use in recording locations outside the laboratory (e.g. in school, at home), and the potential impact of using the equipment on speech is not known. Gick (2002) suggest methods for fieldwork, but we are not aware of any study which attempts to quantify the effects of the technique on vernacular speakers.</p&gt

The role of gesture delay in coda /r/ weakening: an articulatory, auditory and acoustic study

The cross-linguistic tendency of coda consonants to weaken, vocalize, or be deleted is shown to have a phonetic basis, resulting from gesture reduction, or variation in gesture timing. This study investigates the effects of the timing of the anterior tongue gesture for coda /r/ on acoustics and perceived strength of rhoticity, making use of two sociolects of Central Scotland (working- and middle-class) where coda /r/ is weakening and strengthening, respectively. Previous articulatory analysis revealed a strong tendency for these sociolects to use different coda /r/ tongue configurations—working- and middle-class speakers tend to use tip/front raised and bunched variants, respectively; however, this finding does not explain working-class /r/ weakening. A correlational analysis in the current study showed a robust relationship between anterior lingual gesture timing, F3, and percept of rhoticity. A linear mixed effects regression analysis showed that both speaker social class and linguistic factors (word structure and the checked/unchecked status of the prerhotic vowel) had significant effects on tongue gesture timing and formant values. This study provides further evidence that gesture delay can be a phonetic mechanism for coda rhotic weakening and apparent loss, but social class emerges as the dominant factor driving lingual gesture timing variation

The development and initial evaluation of a Goal setting and Action Planning (G-AP) framework for use in community based stroke rehabilitation

Background Goal setting is accepted ‘best practice’ in stroke rehabilitation however, there is no consensus about what the key components of goal setting interventions are, how they should be optimally delivered in practice and how best to involve stroke survivors in the process. This PhD by publication describes the development and initial evaluation of a theory-based goal setting and action planning framework (G-AP) to guide goal setting practice in community based stroke rehabilitation settings. Included studies The Medical Research Council (MRC) framework for developing and evaluating complex interventions guided the development and conduct of a programme of research which included the following studies: (i) a review of the literature to identify theories of behaviour change with most potential to inform goal setting practice (Paper 1) (ii) a causal modelling exercise to map identified theoretical constructs onto a goal setting process and convening of a multi-disciplinary task group to develop the theoretical process into a Goal setting and Action Planning (G-AP) practice framework (Paper 2) (iii) a process evaluation of the G-AP framework in one community rehabilitation team (Paper 3) (iv) a United Kingdom (UK) wide survey to investigate the nature of services providing community based stroke rehabilitation across the UK and what goal setting practice is in these settings in order to understand the context into which an evaluation of the G-AP framework could be introduced (Paper 4) Main Findings The review of the literature identified three theories of behaviour change that offered most potential to inform goal setting practice: Social Cognitive Theory, Health Action Process Approach and Goal Setting Theory. These theories contained constructs directly relevant to the goal setting practice: self-efficacy, outcome expectancies, goal attributes, action planning, coping planning and appraisal and feedback. The causal modelling and Task group exercise: (i) Informed development of the G-AP framework into a four stage, cyclical process that included (i) goal negotiation and setting (ii) planning and measuring confidence (iii) action and (iv) appraisal, feedback and decision making. (ii) Proposed mechanisms of action: successful completion of action plans resulting in incremental improvements in goal sub-skills and self-efficacy. (iii) Predicted outcomes G-AP was likely to impact on: goal attainment and improved rehabilitation outcomes. The process evaluation suggested that each stage of the G-AP framework had a distinct purpose and made a useful contribution to the overall process. Overall, G-AP was acceptable and feasible to use but implementation of novel aspects of the framework (coping planning and measuring confidence) was inconsistent and health professionals had concerns about the potential impact of unmet goals on patients’ wellbeing. Patient reports suggested that (i) the experience of goal non-attainment could facilitate adjustment to limitations resulting from stroke and (ii) feeling involved in the goal setting process can incorporate both patient-led and professional-led approaches. The survey findings highlighted the variability that exists in community based stroke rehabilitation services in the UK (e.g. the patients they see; the input they provide). Goal setting is reportedly used with all or most stroke survivors in these services; however, practice is variable and may be sub-optimal. Conclusions G-AP is the first practice framework which has been explicitly developed to guide health professionals through a systematic, theoretically based and patient centred goal setting process in community based stroke rehabilitation. G-AP is a cyclical process that that has four key stages, proposed mechanisms of action and has shown promise as an acceptable, feasible and effective framework to guide goal setting practice. The complexity that exists within community based stroke rehabilitation services, and the variability in usual goal setting practice used within them, should be considered when designing a study to evaluate the effectiveness of G-AP in routine practice

Attribute value phonology

SIGLEAvailable from British Library Document Supply Centre- DSC:D93955 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

The Israel-Palestine Conflict in International Law: Territorial Issues

This paper addresses the question of what territory a future State of Palestine may lay claim to under contemporary international law. It also addresses the question of what is the legal basis for, and integrity of, Israel’s territorial claims. Further, should the Middle East Peace Process fail, the question arises whether Israel could lawfully retain the occupied territories under its control