Quantifying the Impact of Common Feeding Interventions on Nutritive Sucking Performance Using a Commercially Available Smart Bottle.

An estimated 25% to 40% of infants experience difficulties with learning to breast- or bottle-feed. Yet, guidelines and evidence-based support for common feeding practices are limited. The objective of this case report was to quantify the impact of feeding interventions on nutritive sucking performance after discharge in an outpatient setting. This observational case series involved 2 infants. To determine the impact of cumulative interventions, pre- and postintervention effect sizes were calculated. Sucking performance metrics of interest included nipple movement peak sucking amplitude, duration, frequency, and smoothness. Interventions included positional changes and changes in nipple flow rate, among others. For both infants, cumulative interventions had the greatest impact on suck frequency; postintervention, infants were able to increase their rate of nutritive sucking per burst. Other aspects of sucking performance were differentially impacted for each baby. Researchers agree that neonatal and infant feeding has been understudied and that the evidence for common interventions needs to be strengthened. We have demonstrated the implementation of readily available technology that can be used to quantify the direct impact of any intervention on actual sucking performance. In doing so, we can individualize care to support skill development and improve outcomes for infants at risk for ongoing feeding challenges.

A comparison of the nutritive sucking performance of full term and preterm neonates at hospital discharge: A prospective study.

BACKGROUND: Studies show that 40% to 70% of premature infants exhibit both immature and atypical feeding ability. To establish thresholds of performance and develop efficacious treatments for initiating and advancing oral feedings, we must first identify the nutritive sucking performance measures impacted by preterm birth. AIMS: To compare objective measures of neonatal nutritive sucking between full term and preterm infants at hospital discharge. STUDY DESIGN AND METHODS: This was a prospective observational study including full term (FT; N = 32) and preterm (PT; N = 44) infants. Nutritive sucking performance at discharge was assessed. The outcome measures of interest were means and coefficients of variability of nutritive sucking peak amplitude, frequency, duration, and smoothness, and feeding-related length of stay. RESULTS: There was a significant difference in sucking performance between groups; FT infants demonstrated significantly lower mean suck frequency, with longer suck duration and greater suck smoothness as compared to PT. PT infants had significantly less variability in suck amplitude and frequency as compared to FT, while FT infants had significantly less variability in suck smoothness as compared to PT. Post hoc regression analyses found suck frequency alone accounted for 28% of the variance in feeding length of stay for PT; suck smoothness alone accounted for 34% of the variance in feeding length of stay for FT. CONCLUSIONS: Suck frequency may be an important intervention target for PT infants having difficulty transitioning to oral feeding. Suck smoothness may be a sensitive marker for identifying infants at high risk for feeding challenges.

Quantifying Neonatal Sucking Performance: Promise of New Methods.

Neonatal feeding has been traditionally understudied so guidelines and evidence-based support for common feeding practices are limited. A major contributing factor to the paucity of evidence-based practice in this area has been the lack of simple-to-use, low-cost tools for monitoring sucking performance. We describe new methods for quantifying neonatal sucking performance that hold significant clinical and research promise. We present early results from an ongoing study investigating neonatal sucking as a marker of risk for adverse neurodevelopmental outcomes. We include quantitative measures of sucking performance to better understand how movement variability evolves during skill acquisition. Results showed the coefficient of variation of suck duration was significantly different between preterm neonates at high risk for developmental concerns (HRPT) and preterm neonates at low risk for developmental concerns (LRPT). For HRPT, results indicated the coefficient of variation of suck smoothness increased from initial feeding to discharge and remained significantly greater than healthy full-term newborns (FT) at discharge. There was no significant difference in our measures between FT and LRPT at discharge. Our findings highlight the need to include neonatal sucking assessment as part of routine clinical care in order to capture the relative risk of adverse neurodevelopmental outcomes at discharge.

Objective assessment of a preterm infant's nutritive sucking from initiation of feeding through hospitalization and discharge.

INTRODUCTION: In 2008, the American Academy of Pediatrics recommended that an infant's ability to feed independently be considered a primary consideration for discharge home. To date, NICU healthcare teams have relied on clinical experience as well as descriptive scales to determine a high risk infant's ability to transition safely from tube feeding to oral feeding. The aim of the current case study was to illustrate the clinical utility of nfant® Feeding Solution as a noninvasive and objective instrument for determining a neonate's readiness to begin and advance oral feeding. MATERIALS AND METHODS: We present the case of AC, a female infant born at 28.6 weeks, with an admitting diagnosis of respiratory distress syndrome. Data collection began when AC was declared medical stable by her attending physician and ready to begin oral feedings. Data was captured during hospitalization and at discharge as well as post discharge for a total of eleven (11) data collections. RESULTS: Results suggested that the subject progressed in all sucking metrics over time. Data analyses revealed three general amplitude and temporal patterns against the nipple: disorganized, hypervigilant, and then organized. Real time data was used to gain immediate feedback on the impact of interventions on sucking performance. CONCLUSIONS: Successful infant feeding is a complex process that requires integration of physiologic function and neurobehavioral ability. To model AC's feeding performance over time, we used nfant Feeding Solution which measures tongue movement against the nipple and streams the data to a mobile tablet so it is displayed in real time. Access to real-time data provides caregivers with objective information that can be used to guide bedside care, help clinicians avoid complications and navigate infants to faster oral feeds and subsequently earlier and safer hospital discharge with lowered expense.

Microlinguistic processes that contribute to the ability to relay main events: influence of age.

The purpose of the current study was to determine the microlinguistic processes that contribute to picture description in healthy adults across the life span. Two-hundred forty healthy adults were separated into three groups, young (n = 80; 20-39), middle (n = 80; 40-69), and older (n = 80; 70-89). Participants provided language samples in response to two single and two sequential pictures analyzed for total number of words, informativeness, lexical diversity, syntactic complexity, and main events. The older group produced a significantly lower proportion of main events for the single and sequential pictures compared to the other groups. Group differences on the microlinguistic measures varied depending on the measure and the stimulus type. Further, regardless of task, total number of words significantly related to main event production for the young and middle aged groups, but not the older group. Results of the current study extend previous findings by researchers who have investigated discourse production in cognitively healthy, older adults. Using a multi-level approach, we found that linguistic processes across different levels interact; however, the relationship is age-dependent. By including a middle-aged group we identify the potential course of documented change and our results indicate that the changes in language processes with age may not be linear.

Global coherence in younger and older adults: Influence of cognitive processes and discourse type.

The purpose of the present research was to examine the influence of cognitive processes on discourse global coherence ability measured across different discourse tasks and collected from younger (n = 40; 20-39 years) and older (n = 40; 70-87 years) cognitively healthy adults. Study participants produced oral language samples in response to five commonly used discourse elicitation tasks and they were analyzed for maintenance of global coherence. Participants also completed memory and attention measures. Group differences on the global coherence scale were found for only one type of discourse-recounts. Across discourse elicitation tasks the lowest global coherence scores were found for recounts compared to the other discourse elicitation tasks. The influence of cognitive processes on maintenance of global coherence differed for the two age groups. For the younger group, there were no observed significant relationships. For the older group, cognitive measures were related to global coherence of stories and procedures.

Evaluating measures of global coherence ability in stories in adults.

BACKGROUND: Discourse coherence is a reflection of the listener's ability to interpret the overall meaning conveyed by the speaker. Measuring global coherence (maintenance of thematic unity of the discourse) is useful for quantifying communication impairments at the discourse level in clinical populations and for measuring response to discourse-level treatments. AIMS: The aim was to determine feasibility of a four-point global coherence scale developed by the authors. Specifically, they were (1) to estimate measurement reliability of the four-point global coherence scale; and (2) to estimate construct validity for the four-point global coherence scale. METHOD & PROCEDURES: Fifty cognitively healthy adults aged between 28 and 58 years participated in the study. Participants viewed and then told the stories depicted in two wordless picture books. Participants' stories were orthographically transcribed and segmented into communication units (C-unit). Raters scored each participant's story for global coherence using two global coherence scales (four- and five-point scales). Each C-unit received an individual score, then the mean global coherence score was computed, resulting in two mean global coherence scores for each coherence scale, one for each story, for all participants. OUTCOMES & RESULTS: Results indicated high reliability estimates for the scale. In addition, construct validity, specifically face validity and convergent validity, was effectively estimated for using the four-point scale as a measure of maintenance of global coherence in stories told by cognitively healthy adults. Lastly, it was found that the wordless picture books elicited stories that are comparable and can be reliably interchanged as different forms to evaluate maintenance of global coherence. CONCLUSIONS & IMPLICATIONS: The assumptions that the measure is feasible were achieved and face and convergent validity were adequately estimated. Future investigations should consider estimating predictive validity, concurrent validity and discriminant validity of the measure.

Considering a multi-level approach to understanding maintenance of global coherence in adults with aphasia.

BACKGROUND: Discourse is a naturally occurring, dynamic form of communication. Coherence is one aspect of discourse and is a reflection of the listener's ability to interpret the overall meaning conveyed by the speaker. Adults with aphasia may present with impaired maintenance of global coherence, which, in turn, may contribute to their difficulties in overall communicative competence. AIMS: The aim of the study was to determine if microlinguistic processes contribute to maintenance of global coherence in adults with and without aphasia. METHOD AND PROCEDURES: Participants included 15 adults with aphasia (PWA) and 15 healthy controls (HC). Study participants told stories conveyed in wordless picture books. The discourse samples were transcribed and then analyzed for percent of information units produced, lexical diversity, syntactic complexity, and maintenance of global coherence. OUTCOMES AND RESULTS: Several linear regression models were carried out to investigate the relationship among the microlinguistic and macrolinguistic measures. For the control group, percent of information units conveyed was a significant predictor of maintenance of global coherence for stories told. For the aphasia group, percent of information units conveyed and lexical diversity were significant predictors of maintenance of global coherence for stories told. CONCLUSIONS: Results indicated that microlinguistic processes contribute to the maintenance of global coherence in stories told by adults with aphasia. These findings have important clinical implications for using a multi-level discourse model for analyzing discourse ability in adults with aphasia and measuring individual response to treatment.

Measurement of infant tongue thickness using ultrasound: a technical note.

Novel uses of ultrasound include obtaining images of intra-oral structures to further research in speech production and feeding. In this technical note we describe a noninvasive, cost-effective, and reliable method for measuring infant tongue muscle thickness. The current pilot study demonstrates high reliability of a trained ultrasonographer to obtain adequate images of the infant tongue and the ability to measure reliably between two anatomic landmarks to determine tongue thickness and investigate a potential relationship between tongue size and tongue force.

Attention and Off-Topic Speech in the Recounts of Middle-Age and Elderly Adults: A Pilot Investigation.

PURPOSE: The discourse of healthy older adults is commonly described as being lengthy and off-topic and is thought to be associated with a general cognitive decline that accompanies healthy aging. The purpose of this preliminary study was to investigate the overall decline in attention associated with healthy aging and its relationship to instances of off-topic speech (OTS). METHOD: Thirty cognitively healthy adults divided into 5 age cohorts (40-80) completed cognitive measures of attention and several discourse tasks that included recounting personal events. RESULTS: Cohorts differed significantly with respect to the measures of attention. However, no significant differences in the incidence of OTS were detected between the cohorts. Attention and the incidence of OTS were not significantly correlated within any of the cohorts. CONCLUSION: No significant differences in the incidence of OTS and its relation to attention measures were found. However, the relationship between age-related declines in attention and increased OTS approached significance, suggesting the need for further study.

Productive vocabulary across discourse types.

AIMS: The goals of the study were (a) to examine the effect of discourse type on lexical diversity by testing whether there are significant differences among language samples elicited using four discourse tasks (procedures, eventcasts, story telling, and recounts); and (b) to assess the extent to which age influences lexical diversity when different types of discourse are elicited. METHODS #ENTITYSTARTX00026; PROCEDURES: A total of 86 cognitively healthy adults participated in the study and comprised two groups - young adults (20-29 years old) and older adults (70-89 years old). Participants completed the discourse tasks and their language samples were analysed using dedicated software (voc-D) to obtain estimates of their lexical diversity. OUTCOMES #ENTITYSTARTX00026; RESULTS: A mixed 2 × 4 ANOVA was conducted and followed by an investigation of simple main effects. A lexical diversity hierarchy was established that was similar for both age groups. The study also uncovered age-related differences that were evident when the stimuli were verbally presented but were eliminated when the language samples were elicited using pictorial stimuli. CONCLUSIONS: Results indicated that lexical diversity is one of the microlinguistic indices that are influenced by discourse type and age, a finding that carries important methodological implications. Future investigations are warranted to explore the patterns of lexical diversity in individuals with neurogenic language disorders and assess the clinical utility of measures of lexical diversity.

Story processing ability in cognitively healthy younger and older adults.

PURPOSE: The purpose of the study was to examine the relationships among measures of comprehension and production for stories depicted in wordless pictures books and measures of memory and attention for 2 age groups. METHOD: Sixty cognitively healthy adults participated. They consisted of two groups--young adults (20-29 years of age) and older adults (70-89 years of age). Participants completed cognitive measures and several discourse tasks; these included telling stories depicted in wordless picture books and answering multiple-choice comprehension questions pertaining to the story. RESULTS: The 2 groups did not differ significantly for proportion of story propositions conveyed; however, the younger group performed significantly better on the comprehension measure as compared with the older group. Only the older group demonstrated a statistically significant relationship between the story measures. Performance on the production and comprehension measures significantly correlated with performance on the cognitive measures for the older group but not for the younger group. CONCLUSIONS: The relationship between adults' comprehension of stimuli used to elicit narrative production samples and their narrative productions differed across the life span, suggesting that discourse processing performance changes in healthy aging. Finally, the study's findings suggest that memory and attention contribute to older adults' story processing performance.

Performance of able-bodied subjects on a text-typing task using a head-operated device and expanded membrane cursor keys.

Children and adults with disabilities frequently rely on computers to complete written tasks. Those with significant motor limitations typically use alternative computer-input devices since the traditional keyboard and mouse are insufficient to accommodate their abilities. For persons unable to isolate their fingers, input devices controlled by movements of the head or whole hand or arm movements may be among the options considered. This study investigated the performance of a head-operated device and expanded membrane cursor keys for text entry. Data from 24 young adults indicated the head-operated device performed significantly faster given reduced cognitive demands for device operation, increased stimulus-response compatibility, and simplicity of movement. Use of the expanded membrane cursor keys resulted in significantly lower error rates. No significant differences in comfort or ease of use were reported for the two devices. The relative performance of device options for users sharing similar motor challenges provides rehabilitation specialists with important clinical information.