The effect of telepractice on vocal turn-taking between a provider, children with cochlear implants, and caregivers: A preliminary report.

OBJECTIVES: To examine the effect of telepractice on vocal turn-taking between one clinical provider and children with cochlear implants and their caregivers during child-centered auditory rehabilitation intervention. METHODS: Seven dyads of children with cochlear implants (mean age 4:11 years) and their hearing mothers and one speech-language pathologist participated together in a telepractice session and an in-person intervention session. Dependent variables were vocalization rate, turn taking rate, rate of speech overlap per second, and between-speaker pause duration. RESULTS: The speech-language pathologist and children had lower rates of vocalization in the telepractice session than the in-person session. However, maternal vocalization rate was higher in the telepractice than in-person session. The rate of turn-taking between the provider and children was lower in telepractice than in-person sessions but the rate of turn taking between mothers and children was higher in telepractice than in-person sessions. Between-speaker pause duration between children and the provider and between mothers and children was longer in telepractice than in-person sessions. Rate of speech overlap did not vary significantly by session type. DISCUSSION: The quantity and temporal characteristics of vocal turn-taking were impacted by remote communication during tele-intervention suggesting a potential increase in the cognitive effort required of participants.

Prelinguistic Consonant Production and the Influence of Mouthing Before and After Cochlear Implantation.

OBJECTIVES: The goal of the study was to investigate prelinguistic consonant production and the influence of vocalizations that co-occurred with object mouthing on consonant production in infants with profound sensorineural hearing loss before and after cochlear implantation to advance knowledge of early speech development in infants with profound hearing loss. DESIGN: Participants were 43 infants, 16 infants with profound sensorineural hearing loss and 27 hearing infants. In the mixed longitudinal and cross-sectional design, infants with profound hearing loss and age-matched hearing infants participated before cochlear implantation, at an average age of 9.9 mo, and/or after cochlear implantation, at an average age of 17.8 mo. Mean age at cochlear implantation for infants with profound hearing loss was 12.4 mo; mean duration of cochlear implant use at time of testing was 4.2 mo. RESULTS: Before and after cochlear implantation, infants with profound hearing loss produced significantly fewer supraglottal consonants per consonant-vowel vocalization than hearing peers and had smaller overall consonant inventories. Before, but not after cochlear implantation, infants with profound hearing loss produced proportionally more vocalizations, supraglottal consonant-vowel vocalizations, and different supraglottal consonants in vocalizations during mouthing than did hearing infants. CONCLUSIONS: The results document consonant production before cochlear implantation in a larger group of infants with profound hearing loss than previously examined. The results also extend evidence of early delays in consonant production to infants who received cochlear implants at 12 mo of age, and show that they likely miss the potential benefits of auditory-motor feedback in vocalization-mouthing combinations that occur before they have access to sound through cochlear implants.

Story hour at a family homeless center: contribution to graduate students' preparation and confidence in preliteracy skills.

PURPOSE: This study evaluated the potential benefit to graduate students' of participating in a service-learning program conducting a storybook reading program for children in a family homeless shelter. METHOD: Ten graduate students in the second year of a two-year master's degree program in communication science and disorders participated in the storybook reading program. The graduate students engaged in reflective writing about their experiences and completed self-ratings of confidence in preliteracy skills before and after program participation. Twenty graduate students in two comparison groups (10 students in a pre-program comparison group, and 10 in a post-program comparison group) also completed questionnaires. The mixed-methods study used quantitative analyses to analyze questionnaire ratings and qualitative methods to analyze reflective writings. RESULTS: Together, the quantitative and qualitative results indicated positive outcomes from the service-learning experience with regard to graduate students' perceived confidence in preliteracy skills and preparation for careers as speech-language pathologists. The results provide empirical data showing that service-learning experiences with at-risk populations can contribute to graduate students' clinical education and preparation as speech-language pathologists. CONCLUSION: The results support the value of service-learning experiences in communication sciences and disorders. Clinical preparation in preliteracy development also supports the American Speech-Language-Hearing Association statement on the roles and responsibilities of speech-language pathologists in relation to reading and writing in children.

Vocal imitation between mothers and their children with cochlear implants.

To better explain variation in language acquisition in children with hearing loss, this study examined vocal (e.g., vocalization) and lexical (e.g., word) imitation in spontaneous interactions between mothers and children with 12 months of hearing experience using their cochlear implants (n = 12; mean age 27.9 months). Hearing children in two control groups were matched to children with cochlear implants, either by child chronological age (n = 12; mean age = 27.4 months) or by child hearing experience (n = 12; mean age 12 months). All three groups of mother-child dyads were audio-recorded playing together. Mothers and children in all groups imitated their partners' vocalization and word utterances; however, the cochlear implant and hearing experience-matched groups produced fewer word imitations than the age-matched group. The frequency of preceding child vocalization or word production predicted maternal imitation type (vocalization or word); however, frequency of maternal vocalization predicted child vocalization imitation only. The results showed that child hearing experience affected imitation in both communication partners.

Aligning Organizational Culture and Infrastructure to Support Evidence-Based Practice.

Standardized nursing practice based on the foundations of evidence-based practice leads to high-quality patient care and optimal outcomes. Despite knowing the benefits of evidence-based practice, health care organizations do not consistently make it the standard of care; thus, implementation of evidence-based practice at the system level continues to be challenging. This article describes the process adopted by a facility in the Southwest that took on the challenge of changing the organizational culture to incorporate evidence-based practice. The organization met the challenges by identifying perceived and actual barriers to successful implementation of evidence-based practice. The lack of standardized practice was addressed by developing a group of stakeholders including organizational leaders, clinical experts, and bedside providers. Changing the culture required a comprehensive process of document selection and development, education, and outcome evaluation. The ultimate aim was to implement an integrated system to develop practices and documents based on the best evidence to support patient outcomes.

Optimizing the Translational Value of Mouse Models of ALS for Dysphagia Therapeutic Discovery.

The goal of this study was to compare dysphagia phenotypes in low and high copy number (LCN and HCN) transgenic superoxide dismutase 1 (SOD1) mouse models of ALS to accelerate the discovery of novel and effective treatments for dysphagia and early amyotrophic lateral sclerosis (ALS) diagnosis. Clinicopathological features of dysphagia were characterized in individual transgenic mice and age-matched controls utilizing videofluoroscopy in conjunction with postmortem assays of the tongue and hypoglossal nucleus. Quantitative PCR accurately differentiated HCN-SOD1 and LCN-SOD1 mice and nontransgenic controls. All HCN-SOD1 mice developed stereotypical paralysis in both hindlimbs. In contrast, LCN-SOD1 mice displayed wide variability in fore- and hindlimb involvement. Lick rate, swallow rate, inter-swallow interval, and pharyngeal transit time were significantly altered in both HCN-SOD1 and LCN-SOD1 mice compared to controls. Tongue weight, tongue dorsum surface area, total tongue length, and caudal tongue length were significantly reduced only in the LCN-SOD1 mice compared to age-matched controls. LCN-SOD1 mice with lower body weights had smaller/lighter weight tongues, and those with forelimb paralysis and slower lick rates died at a younger age. LCN-SOD1 mice had a 32% loss of hypoglossal neurons, which differed significantly when compared to age-matched control mice. These novel findings for LCN-SOD1 mice are congruent with reported dysphagia and associated tongue atrophy and hypoglossal nucleus pathology in human ALS patients, thus highlighting the translational potential of this mouse model in ALS research.

Vocal Turn-Taking Between Mothers and Their Children With Cochlear Implants.

OBJECTIVES: The primary objective of the study was to examine the occurrence and temporal structure of vocal turn-taking during spontaneous interactions between mothers and their children with cochlear implants (CI) over the first year after cochlear implantation as compared with interactions between mothers and children with normal hearing (NH). DESIGN: Mothers' unstructured play sessions with children with CI (n = 12) were recorded at 2 time points, 3 months (mean age 18.3 months) and 9 months (mean age 27.5 months) post-CI. A separate control group of mothers with age-matched hearing children (n = 12) was recorded at the same 2 time points. Five types of events were coded: mother and child vocalizations, vocalizations including speech overlap, and between- and within-speaker pauses. We analyzed the proportion of child and mother vocalizations involved in turn-taking, the temporal structure of turn-taking, and the temporal reciprocity of turn-taking using proportions of simultaneous speech and the duration of between- and within-speaker pauses. RESULTS: The CI group produced a significantly smaller proportion of vocalizations in turn-taking than the NH group at the first session; however, CI children's proportion of vocalizations in turn-taking increased over time. There was a significantly larger proportion of simultaneous speech in the CI compared with the NH group at the first session. The CI group produced longer between-speaker pauses as compared with those in the NH group at the first session with mothers decreasing the duration of between-speaker pauses over time. NH infants and mothers in both groups produced longer within- than between-speaker pauses but CI infants demonstrated the opposite pattern. In addition, the duration of mothers' between-speaker pauses (CI and NH) was predicted by the duration of the infants' between-speaker pauses. CONCLUSIONS: Vocal turn-taking and timing in both members of the dyad, the mother and infant, were sensitive to the experiential effects of child hearing loss and remediation with CI. Child hearing status affected dyad-specific coordination in the timing of responses between mothers and their children.

Exploring in Silence: Hearing and Deaf Infants Explore Objects Differently before Cochlear Implantation.

Infant development has rarely been informed by the behavior of infants with sensory differences despite increasing recognition that infant behavior itself creates sensory learning opportunities. The purpose of this study of object exploration was to compare the behavior of hearing and deaf infants, with and without cochlear implants, in order to identify the effects of profound sensorineural hearing loss on infant exploration before cochlear implantation, the behavioral effects of access to auditory feedback after cochlear implantation, and the sensory motivation for exploration behaviors performed by hearing infants as well. The results showed that 9-month-old deaf infants explored objects as often as hearing infants but they used systematically different approaches and less variation before compared to after cochlear implantation. Potential associations between these early experiences and later learning are discussed in the context of embodied developmental theory, comparative studies, and research with adults. The data call for increased recognition of the active sensorimotor nature of infant learning and future research that investigates differences in sensorimotor experience as potential mechanisms in later learning and sequential memory development.

What Mothers Do After Infants Vocalize: Implications for Vocal Development or Word Learning?

Purpose The goal of this study was to analyze verbal and nonverbal maternal response types following infant vocalizations in younger (ages 4-8 months) versus older (ages 10-14 months) infant groups and their potential implications for infant vocal development or word learning. Method Maternal response types that occurred within 3 s of infant vocalizations were examined in this cross-sectional study of naturalistic interactions in 35 mother-infant dyads. Response types were defined as vocally responsive to infant vocalizations (i.e., responsive vocal behaviors), not responsive to infant vocalizations directly (nonresponsive vocal behaviors), and silences. Mothers' nonverbal actions associated with each response type were also examined. Subcategories of these verbal and nonverbal response types were examined in relation to infant age group. Results The occurrence of responsive and nonresponsive verbal subcategory types differed by infant age group. When verbally responsive to infant vocalizations, mothers commented on younger infants' vowel and consonant-vowel vocalizations, but with older infants, mothers identified or named the referents of their vocalizations. When nonresponsive to vocalizations directly, mothers commented on younger infants' activities but redirected older infants' behaviors or commented on their movements. Silence after infant vocalizations was infrequent. Mothers' nonverbal actions associated with each response type were primarily object related and did not differ by age group. Conclusions Evaluating response type subcategories by age group indicated mothers did not respond differentially (verbally or nonverbally) to vowel or consonant-vowel vocalizations. Overall, the results suggest mothers' verbal and nonverbal response types may be more likely to facilitate word learning than vocal development.

Public Library Programs and Accommodations for Deaf and Hard-of-Hearing Children in the United States†.

In today's public libraries, children's librarians are challenged to provide inclusive programming that welcomes all individuals, including deaf and hard-of-hearing children at risk for delayed reading and literacy development. This study, using quantitative survey data and qualitative interview methods, investigated the programs and accommodations public libraries provide for deaf and hard-of-hearing children, the impetus for providing these programs, and the training required. Nearly 500 public libraries in the United States with service areas greater than 100,000 patrons were invited to participate in an online survey. Fifty-nine librarians completed the survey and 11 participated in an additional telephone interview. Results indicated less than half of the libraries surveyed provided services for deaf and hard-of-hearing children. Nearly all of the programs offered were inclusive; among the accommodations provided were books with sign language and sign language interpreters. Training was the most common limitation facing librarians in their role as community partners in the literacy development of deaf and hard-of-hearing children.

Integrating Team Training in the Pediatric Life Support Program: An Effective and Efficient Approach?

OBJECTIVE: The aim of this study was to examine the feasibility of integrating teamwork training into an established Pediatric Advanced Life Support (PALS) program to assess the effect on teamwork and collaboration among interprofessionals. BACKGROUND: Lack of teamwork and ineffective communication are common contributors to hospital sentinel events. Interprofessional teamwork training to support a culture of patient safety is advocated; however, training methods and related expenses vary widely. METHODS: This study used a descriptive design. All participants received PALS recertification training; the intervention group received an additional 2-hour TeamSTEPPS (R) 2.0 Essentials curriculum with didactic and video critique including role-play on error, communication behaviors, and standard terms. Data were collected on perceptions of teamwork and collaboration. χ, Mann-Whitney U, and t tests were used. RESULTS: The intervention group reported significantly higher perceptions of teamwork and collaboration, situational awareness, and ability to help a team make decisions. CONCLUSIONS: Results suggest that integrating brief team training into an existing PALS program is a feasible, cost-effective, and sustainable method to provide interprofessional team training and positively influence the culture of safety.

Ordinary Interactions Challenge Proposals That Maternal Verbal Responses Shape Infant Vocal Development.

Purpose: This study tested proposals that maternal verbal responses shape infant vocal development, proposals based in part on evidence that infants modified their vocalizations to match mothers' experimentally manipulated vowel or consonant-vowel responses to most (i.e., 70%-80%) infant vocalizations. We tested the proposal in ordinary rather than experimentally manipulated interactions. Method: Response-based proposals were tested in a cross-sectional study of 35 infants, ages 4 to 14 months, engaged in everyday interactions in their homes with their mothers using a standard set of toys and picture books. Results: Mothers responded to 30% of infant vocalizations with vocal behaviors of their own, far fewer than experimentally manipulated response rates. Moreover, mothers produced comparatively few vowel and consonant-vowel models and responded to infants' vowel and consonant-vowel vocalizations in similar numbers. Infants showed little evidence of systematically modifying their vocal forms to match maternal responses in these interactions. Instead, consonant-vowel vocalizations increased significantly with infant age. Conclusions: Results obtained in ordinary interactions, rather than response manipulation, did not provide substantial support for response-based mechanisms of infant vocal development. Consistent with other research, however, consonant-vowel productions increased with infant age.

Why repetition? Repetitive babbling, auditory feedback, and cochlear implantation.

This study investigated the reduplicated, or repetitive vocalizations of hearing infants and infants with profound hearing loss with and without cochlear implants using a new measure of repetition in order to address questions not only about the effects of cochlear implantation on repetitive babbling, but also about the reason repetitive vocalizations occur at all and why they emerge around 7 or 8 months of age in hearing infants. Participants were 16 infants with profound hearing loss and 27 hearing infants who participated at a mean age of 9.9 months and/or a mean age of 17.7 months. Mean age at cochlear implantation for infants with profound hearing loss was 12.9 months, and mean duration of implant use was 4.2 months. The data show that before cochlear implantation, repetitive vocalizations were rare. However, 4 months after cochlear implant activation, infants with hearing loss produced both repetitive vocalizations and repetitions per vocalization at levels commensurate with their hearing peers. The results support the hypothesis that repetition emerges as a means of vocal exploration during the time when hearing infants (and infants with cochlear implants) form auditory-motor representations and neural connections between cortical areas active in syllable production and syllable perception, during the transition from nonlinguistic to linguistic vocalization.

Cochlear implantation at 12 months: Limitations and benefits for vocabulary production.

OBJECTIVE: The purpose of this investigation was to learn the degree to which cochlear implantation at 12 months of age could reduce gaps in performance between hearing age and chronological age - that is, whether infants with access to cochlear implants at 12 months of age would be 12 months delayed, or less, in vocabulary production one year later. METHOD: Baseline vocabulary production was measured by parent interview and direct observation approximately 4 months post cochlear implant (CI) activation, and again 12 months after CI activation using the MacArthur-Bates Communicative Development Inventory: Words and Sentences. RESULTS: Infants produced few if any words shortly after CI activation. Word production increased significantly during the 12 months following CI activation but scores were still significantly below age-level expectations based on chronological age. Vocabulary scores were, however, significantly better than expected based on hearing age, or duration of implant use. CONCLUSION: Word production was delayed at both time points; however, access to cochlear implants at 12 months of age decreased the size of anticipated delays one year later, narrowing the expected gap between hearing age and chronological age.

Techniques to improve patient safety in hospitals: what nurse administrators need to know.

Nurse administrators are challenged to determine the best use of limited resources to support organizational patient safety improvement efforts. This article reviews the literature on techniques to reduce errors and improve patient safety in hospitals with a focus on team training initiatives. Implications for nurse administrators are discussed.

Frequency of vocalization before and after cochlear implantation: dynamic effect of auditory feedback on infant behavior.

The motivation for infants' non-word vocalizations in the second half of the first year of life and later is unclear. This study of hearing infants and infants with profound hearing loss with and without cochlear implants addressed the hypothesis that vocalizations are primarily motivated by auditory feedback. Early access to cochlear implants has created unique conditions of auditory manipulation that permit empirical tests of relations between auditory perception and infant behavior. Evidence from two separate tests of the research hypothesis showed that, before cochlear implantation, infants with profound hearing loss vocalized significantly less often than hearing infants; however, soon after cochlear implantation, they vocalized at levels commensurate with hearing peers. In contrast, vocal behaviors that are typically considered reflexive or emotion-based signals (e.g., crying) were infrequent overall and did not vary with auditory access. These results support the hypothesis that auditory feedback is a critical component motivating early vocalization frequency.

Synchrony, complexity and directiveness in mothers' interactions with infants pre- and post-cochlear implantation.

This study investigated effects of profound hearing loss on mother-infant interactions before and after cochlear implantation with a focus on maternal synchrony, complexity, and directiveness. Participants included two groups of mother-infant dyads: 9 dyads of mothers and infants with normal hearing; and 9 dyads of hearing mothers and infants with profound hearing loss. Dyads were observed at two time points: Time 1, scheduled to occur before cochlear implantation for infants with profound hearing loss (mean age=13.6 months); and Time 2 (mean age=23.3 months), scheduled to occur approximately six months after cochlear implantation. Hearing infants were age-matched to infants with hearing loss at both time points. Dependent variables included the proportion of maternal utterances that overlapped infant vocalizations, maternal mean length of utterance, infant word use, and combined maternal directives and prohibitions. Results showed mothers' utterances overlapped the vocalizations of infants with hearing loss more often before cochlear implantation than after, mothers used less complex utterances with infants with cochlear implants compared to hearing peers (Time 2), and mothers of infants with profound hearing loss used frequent directives and prohibitions both before and after cochlear implantation. Together, mothers and infants adapted relatively quickly to infants' access to cochlear implants, showing improved interactional synchrony, increased infant word use, and levels of maternal language complexity compatible with infants' word use, all within seven months of cochlear implant activation.

Techniques to improve patient safety in hospitals: what nurse administrators need to know.

Nurse administrators are challenged to determine the best use of limited resources to support organizational patient safety improvement efforts. This article reviews the literature on techniques to reduce errors and improve patient safety in hospitals with a focus on team training initiatives. Implications for nurse administrators are discussed.