An Analytical Study on Communication Abilities and Schooling in Children with Cochlear Implantation

Background: As per the World Health Organization 2018, the new estimate of disabling of hearing loss is 466 million people.The State Initiative on Disabilities Survey (2015), Kerala, India, indicates that 2.32% of populations in Kerala, India, are affectedby some form of disabilities. Among them, 60,925 are hearing disabled based on the definition of hearing impairment in thePersons with Disabilities Act 1995. A cochlear implant (CI) is a surgically implanted electronic device that provides a sense ofsound to a person with severe to profound sensorineural hearing loss in both ears.Need for the Study: Even though the Sruthitharangam scheme was started by the Government of Kerala, India, in 2012, no studywas carried out to estimate the outcomes in terms of usage of CI, education placement, and mode of communication after CI surgery.Aims and Objectives: The aim of the study was to investigate the usage of CI, communication abilities, and schooling in CIchildren who have undergone surgery under Kerala Government free CI program. The current study was to report the usageof cochlear implantation, the education status, and mode of communication of the children who had undergone, free of cost CIsurgery from June 2012 to December 2015 in Kerala, India.Materials and Methods: The demographical data were collected from the register maintained at Government Medical College,Kozhikode, Kerala, India. The study was a cross-sectional study and the data were collected through the telephonic interview of 114parents or caregivers among 132 parents who had undergone free CI surgery from June 2012 to December 2015 at GovernmentMedical College Kozhikode. Eighteen parents or caregivers could not be contacted due to unavailability or change of contact numberand data collection was possible only for 114 parents among the 132 parents. All the children had attended a minimum of 2 years ofpost-implantation Auditory-Verbal Habilitation (AVH) from Sruthitharangam empanelled centers. Each subject was asked questionsto understand the current usage of the device, the mode of communication, type of schooling, and associated issues that affect theprognosis of CI is also considered. The obtained responses were scored accordingly and tabulated for further statistical analysis.Observations and Results: The result reveals that among the 114 CI recipients, 93.8% (107 recipients) were using CI and 6.14%(seven recipients) were non-users. These data found that all children were enrolled in school and attending in variety of educationalsettings. In that, 82.45% (94 children) were attending mainstream education and 17.54% (20 children) were going to specialschools. On further analysis of the communication, abilities showed that the majority of the children (75.43%) communicated orally,21.05% of them communicated through total communication and 3.5% of them used sign language.Conclusions: Kerala government Sruthitharangam CI program aid the majority of the children with severe to profoundsensorineural hearing loss in acquiring oral communication skills and also benefiting integration in normal schools. Steps shouldbe taken to reduce the number of non- users and also plan new strategies for better normal school integration for CI childrenunder the government scheme

Comunicação por troca de figuras e relações condicionais com estudantes com autismo / Communication by changing figures and conditional relations with students with autism / Comunicación por cambio de figuras y relaciones condicionales con estudiantes con autismo

Pessoas com Transtorno do Espectro do Autismo (TEA) podem apresentar dificuldade em aprender habilidades apropriadas de comunicação, sendo que muitas são não vocais. Para esses casos mais severos, uma estratégia compensatória seria o uso de Comunicação Alternativa e Aumentativa (CAA), como a comunicação por troca de figuras. O objetivo desse estudo foi investigar se as três primeiras fases do Sistema de Comunicação por Troca de Figuras poderiam ser apresentadas em uma única fase, em que respostas corretas de tentativas de escolha de acordo com o modelo (MTS) de identidade com as figuras de comunicação, produzissem acesso ao reforço específico, representado por cada figura. Participaram quatro estudantes com TEA, com idades entre quatro e 13 anos. O procedimento foi avaliado a partir de um esquema de linha de base (LB) múltipla entre participantes e teve início com avaliação de preferência, LB, seguida pelo ensino com tentativas de MTS de identidade e uso de dicas físicas e visuais, e retorno à LB. Em geral, os estudantes passaram de repertórios nulos avaliados no pré-teste para até sete respostas no retorno à linha de base. Isso significa que aprenderam a emitir respostas espontâneas de troca de figuras para ter acesso ao item reforçador. Os dados mostram uma viabilidade econômica no ensino de comunicação por troca de figuras, por ensinar várias respostas simultaneamente, ao invés de ensinar cada resposta individualmente. São propostas sugestões para condução de estudos futuros.

People with Autism Spectrum Disorder (ASD) may have difficulty learning appropriate communication skills, and many of them are non-vocal. For these more severe cases, a compensatory strategy would be the use of Alternative and Augmentative Communication, as the communication by exchange of figures. The purpose of this study was to investigate if the first three phases of the Picture Change Communication System could be presented in a single phase, where correct answers of attempts to choose according to the identity model (MTS) with the communication figures, to produce access to the specific reinforcement, represented by each figure. Four students with ASD, aged between four and 13 years participated. The procedure was evaluated from a multiple baseline scheme among participants and started with preference assessment, baseline, followed by teaching with MTS attempts of identity and use of physical and visual cues, and return to baseline. In general, students moved from null repertoires evaluated in the pre-test to up to seven responses on return to the baseline. This means that they have learned to issue spontaneous picture-exchange responses to gain access to the reinforcing item. The data show an economic viability in the teaching of communication by exchanging figures, by teaching several responses simultaneously, rather than teaching each response individually. Suggestions for conducting future studies are proposed.

Las personas con trastorno del espectro del autismo (TEA) pueden presentar dificultades para aprender habilidades apropiadas de comunicación, muchas de las cuales no son vocales. Para en estos casos más severos, una estrategia compensatoria sería el uso de Comunicación Alternativa y Aumentativa (CAA), como la comunicación por intercambio de figuras. El objetivo de este estudio fue investigar si las tres primeras fases del Sistema de Comunicación por Intercambio de Figuras podrían ser presentadas en una sola fase, en que respuestas correctas de intentos de elección de acuerdo con el modelo (MTS) de identidad con las figuras de comunicación, produjeran acceso al refuerzo específico, representado por cada figura. Participaron cuatro estudiantes con TEA, con edades entre cuatro y 13 años. El procedimiento fue evaluado a partir de un esquema de línea de base (LB) múltiple entre participantes y tuvo inicio con evaluación de preferencia, LB, seguida por la enseñanza con intentos de MTS de identidad y uso de indicios físicos y visuales, y retorno a la LB. En general, los estudiantes pasaron de repertorios nulos evaluados en el pre test para hasta siete respuestas al retorno a la línea de base. Esto significa que han aprendido a emitir respuestas espontáneas de intercambio de figuras para tener acceso al elemento reforzador. Los datos muestran una viabilidad económica en la enseñanza de la comunicación por intercambio de figuras, por enseñar varias respuestas simultáneamente, en lugar de enseñar cada respuesta individualmente. Se proponen sugerencias para la conducción de estudios futuros.

Low frequency, repetitive transcranial magnetic stimulation can alleviate non-fluent aphasia after stroke / 中华物理医学与康复杂志

Objective To investigate the effects of low frequency repetitive transcranial magnetic stimulation (rTMS) on non-fluent aphasia in patients after stroke.Methods Forty stroke patients displaying non-fluent aphasia were randomly assigned to an rTMS group and a control group using a random number table.Both groups were treated with conventional language therapy,while the rTMS group was additionally given 0.5 Hz rTMS over the Broca's homologues of the unaffected hemisphere 5 days a week for 3 weeks.The patients were stimulated at 90％ of the motor threshold (MT),with 16 second trains and intervals of 3 seconds 48 times (384 pulses) in a session.Before and after the 3 weeks of treatment,the Western Aphasia Battery (WAB) and the Communicative Abilities in Daily Living (CADL) test were conducted in both groups to evaluate their language function and communication ability.Results Only spontaneous speech improved significantly (P＜0.05) in the control group after 3 weeks of treatment.In the rTMS group,the spontaneous speech,auditory comprehension,repetition,naming and aphasia quotient (AQ) had all improved significantly (P＜0.05).Moreover,after the treatment,the average score of the auditory comprehension (153.90± 31.79),repetition (82.65± 15.14),naming(81.28±22.12) and AQ (63.66± 13.64) of the rTMS group were significantly higher than those of the control group (P＜0.05).Conclusion rTMS applied to the Broca's homologues of the unaffected hemisphere can significantly improve language function in those exhibiting non-fluent aphasia after stroke.

Habilidades de comunicación en la relación médico-enfermera en la Atención Primaria de Salud / Abilities of communication in the physician-nurse relation in Primary Health Care

Objetivo: Proponer las habilidades de comunicación que deben desarrollar el médico-enfermera, en la atención primaria de salud. Metodología: Es una investigación descriptiva, de perspectiva metodológica cualitativa. Se realizó en el Policlínico Rampa del Municipio Plaza de la Revolución en el período comprendido enero a diciembre del 2010. El universo está conformado por 30 consultorios, se tomó como muestra cuatro consultorios constituido por cuatro médicos y cuatro enfermeras. Se utilizó el criterio de selección de inclusión y exclusión. Se realizó revisión bibliográfica o documental. Las técnicas utilizadas son una guía de observación del participante y grupo focal. Se procesó la información mediante lo percibido en la guía de observación y la interpretación de las opiniones recogidas en el grupo focal para el análisis de los resultados obtenidos. Resultados: Desarrollan las habilidades de observación y de empatía, no poseen dominio de los factores internos y externos que influyen en la comunicación. Conclusiones: Reconocen la habilidad de observación y de empatía, no así la habilidad de expresión(AU)

Objective: To propose the communication abilities developed by physician-nurse in the primary health care. Methodology: It is a qualitative, methodological, prospective and descriptive research conducted in the Rampa Polyclinic from Plaza municipality from January to December, 2,010. Universe included 30 consulting rooms with a sample of four of them where work four physicians and four nurses. The inclusion and exclusion criterion was used. A bibliographic or documentary review was carried out. Techniques used are an observation guidance of the participant and focal group. Information was processed according to features in the above guidance and the interpretation of opinions collected in the focal group for analysis of results obtained. Results: The abilities of observation and empathy, there is no domain of internal and external factors influencing in communication. Conclusions: The ability of observation and empathy are recognized but not the ability of expression(AU)

Relação médico-paciente em oncologia: medos, angústias e habilidades comunicacionais de médicos na cidade de Fortaleza (CE) / Relation doctor-patient in oncology: fears, anguishes and communication abilities among doctors in Fortaleza, Ceará State, Brazil

A relação médico-paciente, em oncologia, adquire uma particular importância devido à gravidade da doença e ao estigma que muitas vezes acompanha a experiência do paciente. Esta pesquisa teve como objetivo analisar percepções e dificuldades que os médicos vivenciam frente ao paciente oncológico. Trata-se de um estudo qualitativo, baseado principalmente em entrevistas abertas e aprofundadas, realizado com vinte médicos que trabalham no Instituto do Câncer do Ceará. Baseando-se na convivência da Dra. Sheila com seus pacientes, Cássio e Elisa, personagens fictícios de uma crônica entremeada na discussão do artigo, ilustram-se os principais registros encontrados. Procurou-se abordar quatro temas centrais: a construção do vínculo, o desempenho de habilidades comunicacionais, a abordagem terapêutica e a interação com a família. O sofrimento e as implicações emocionais de pacientes e familiares, as diferenças comunicacionais existentes entre os médicos entrevistados, principalmente em referência à transmissão do diagnóstico e à terapêutica, tornam-se fatores importantes que influenciam a relação e o estabelecimento ou não do vínculo terapêutico. Diante disso, vê-se ser necessário estudos e debates acerca do tema, visando a uma incorporação desta temática na formação médica.

In oncology the doctor-patient relationship has a particular importance due to the gravity of the illness and to the stigma that is followed many times by the experience of the patient. This research was designed to analyze perceptions and difficulties that doctors face when they are dealing with oncology patient. It is a qualitative study, based mainly on open and in-depth interviews, involving 20 doctors from the Cancer Institute of Ceará. From the relationship of Dr. Sheila with her patients, Cássio and Elisa, fictitious personages of a chronicle larded in the quarrel of the article, the main facts are illustrated. We tried to approach four main subjects: the construction of the bond, the communication abilities performance, the therapeutic approach and the family interaction. The suffering and the emotional implications of patients and familiars, the differences in communication between the interviewed doctors, mainly in reference to the transmission of the diagnosis and the therapy, become important factors that influence the relation and the establishment or not of the therapeutic bond. Because of this, it seems to be necessary studies and debates concerning this subject, aiming at an incorporation of this thematic in the medical training.

Communication abilities, Interpersonal Relationship, Anxiety, and Depression in Korean Soldiers / 정신간호학회지

PURPOSE: The purpose of this study was to explore status and level of communication ability, interpersonal relationships, anxiety, and depression in Korean soldiers and identify factors that influence depression. METHODS: A cross sectional study design was employed. The instruments were PCI (Primary Communication Inventory), RCS (Relationship Change Scale), STAI (State-Trait Anxiety Inventory), and CES-D (The Center for Epidemiologic Studies-Depression Scale). Data were collected from 961 soldiers from Gyeong-gi Province and analyzed using SPSS/WIN 17.0 program. RESULTS: The mean score for PCS, RCS were 87.0+/-11.43; and 98.8+/-14.17 respectfully and for STAI-I (state-anxiety), and STAI-II (trait-anxiety), 34.7+/-10.36; and 36.6+/-9.64 respectfully, and for CES-D, 11.2+/-7.0. Of the participants 22.2% were in the clinical group for depression. Major variables showing significant correlations were family intimacy, intimacy with friends or colleague, and inconvenience in not being able to use computer or internet. STAI-II, intimacy with friends or colleague, STAI-I accounted for 44.2double dagger of the variance in depression. CONCLUSION: The study results suggest that a systemic approach needed to relieve soldiers' anxiety and depression. Development of program for communication training, activities for leisure and interpersonal relationship during military life could contribute to lessening depression and anxiety in solder.

Uso de expressões orais durante a implementação do recurso de comunicação suplementar e alternativa / The use of oral expressions during the implementation of augmentative and alternative communication resources

A literatura tem discutido a importância da implementação precoce de sistemas de comunicação suplementar e alternativa em pessoas com deficiência. Esta discussão está vinculada à preocupação com a aquisição e desenvolvimento da linguagem e suas diferentes possibilidades expressivas. Os autores também alertam que a intervenção precoce por meio de recursos e estratégias utilizando a comunicação suplementar e alternativa não impossibilita a aquisição e desenvolvimento da fala. Este trabalho teve como objetivo descrever as habilidades expressivas orais durante a implementação do recurso de comunicação suplementar e alternativo em um aluno com paralisia cerebral. Um aluno com paralisia cerebral de 11 anos de idade participou de um programa na área de comunicação suplementar e alternativa durante dois anos. Foram selecionadas 12 sessões durante o primeiro ano de intervenção. As sessões foram filmadas e após a transcrição dos procedimentos envolvendo recursos de comunicação alternativa foram estabelecidas as categorias de análises: expressão verbal; não-verbal e expressão verbal concomitante a expressão não-verbal. Por meio dos resultados obtidos foi possível identificar que o recurso de comunicação suplementar e alternativo favoreceu o uso das formas de expressões verbais, como no caso das vocalizações, palavras e emissões orais ininteligíveis.

The literature has discussed the importance of early implementation of augmentative and alternative systems with people with various disabilities. This discussion is related to concerns about language acquisition and development within the various expressive possibilities. Researchers advise that starting intervention early through resources and procedures using augmentative and alternative communication does not impede speech acquisition and development. This paper aimed to describe oral expressive abilities during the implementation of augmentative and alternative communication with a student with cerebral palsy. An 11-year-old student with cerebral palsy participated in the augmentative and alternative communication program for two years. Twelve sessions were selected during the first year of the intervention. The sessions were filmed and the augmentative and alternative communication resource procedures were transcribed. The categories of analysis were defined as verbal expression; nonverbal expression and verbal and nonverbal expression associated. The results of this study identified that augmentative and alternative communication resources supported the use of verbal expression such as vocalizations, words and unintelligible oral expressions.

Las habilidades comunicativas en la entrevista médica / Communicative skills during the medical interview

Las habilidades comunicativas son imprescindibles para establecer una relación médico-paciente satisfactoria y obtener la información para llegar a un diagnóstico correcto, de ahí la importancia de comunicarse con habilidad con el paciente. En el presente trabajo se propusieron adaptar las habilidades comunicativas utilizadas en el ámbito pedagógico al contexto del interrogatorio médico. Estas se agruparon en: habilidades para expresar, habilidades para observar y escuchar, y habilidades para establecer una relación empática. De cada grupo se expresaron sus componentes, así como el significado de cada uno como habilidad. Se concluye que al ser la comunicación una actividad esencial en las relaciones humanas y por tener un carácter de invariante esencial, las habilidades comunicativas definidas por la pedagoga Ana María Fernández González para la comunicación profesor-estudiante, se pueden adaptar al contexto del interrogatorio médico.

Communication abilities are essential to establish a satisfactory physician-patient relation ant to obtain information to made a appropriate diagnosis, hence the significance to achieve a skilful communication with the patient. In present our aim was to adapt the communication abilities used in educational scope to the medical questioning context. These are grouped in: expression abilities watch and heed abilities, and abilities to establish an empathy relation. From each group its components were expressed, as well as the meaning of each as ability. We conclude that communication is an essential activity in human relations and by its significant character, communication abilities, defined by the educator Ana María Fernández González in case of professor-student communication, may be adapted to medical questioning context.