The role of maternal psychosocial perceptions in parent-training programs: a preliminary randomized controlled trial.

Parent-child interaction is critical for early language and literacy development. Parent training programs have proliferated to support early interactions. However, many environmental and psychosocial factors can impact the quality of parent-child language and literacy interactions as well as training program outcomes. This preliminary randomized controlled trial examined maternal perceived self-efficacy and locus of control during a language and literacy parent training program. Thirty mother-child dyads (mother age 21-40; children 2;6-4;0) were assigned in parallel to the training or control group. The training was efficacious for mothers and children - training-group dyads made significantly greater gains in maternal strategy use, responsivity, and child print awareness than the control group. Gains were maintained one month post-training. Children whose mothers had more external baseline control perceptions identified significantly fewer print targets at baseline and made greater gains than those with more internal control perceptions. Future directions and implications are discussed.

Improving Patient Safety and Patient-Provider Communication.

PURPOSE: Many hospitalized patients experience barriers to effective patient-provider communication that can negatively impact their care. These barriers include difficulty physically accessing the nurse call system, communicating about pain and other needs, or both. For many patients, these barriers are a result of their admitting condition and not of an underlying chronic disability. Speech-language pathologists have begun to address patients' short-term communication needs with an array of augmentative and alternative communication (AAC) strategies. METHOD: This study used a between-groups experimental design to evaluate the impact of providing patients with AAC systems so that they could summon help and communicate with their nurses. The study examined patients' and nurses' perceptions of the patients' ability to summon help and effectively communicate with caregivers. RESULTS: Patients who could summon their nurses and effectively communicate-with or without AAC-had significantly more favorable perceptions than those who could not. CONCLUSIONS: This study suggests that AAC can be successfully used in acute care settings to help patients overcome access and communication barriers. Working with other members of the health care team is essential to building a "culture of communication" in acute care settings. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.9990962.

Forum on Augmentative and Alternative Communication in Acute Care.

This forum provides some insights into the process of initiating a clinical service to enhance patient- provider communication. It also provides a report of a large-scale clinical trial that introduced augmentative and alternative communication (AAC) tools in an acute-care setting.

Developing a Culture of Successful Communication in Acute Care Settings: Part I. Solving Patient-Specific Issues.

PURPOSE: Establishing services for hospitalized patients with complex communication needs requires identifying and addressing both patient-based and institutional barriers. In this 1st article, we focus on overcoming patient-based barriers. The companion paper (Marshall & Hurtig, 2019) addresses overcoming institutional barriers. METHOD: We present a series of cases that illustrate both the challenges and some of the solutions that have emerged in addressing the specific needs of individual patients with complex communication needs. RESULTS: Each case illustrates how a dynamic assessment approach was used to allow patients with complex communication needs to more effectively communicate with caregivers and participate in their care. CONCLUSION: Building a culture of improved patient-provider communication involves more than just providing patients with augmentative and alternative communication tools.

Developing a Culture of Successful Communication in Acute Care Settings: Part II. Solving Institutional Issues.

PURPOSE: Establishing services for hospitalized patients with complex communication needs (CCNs) requires identifying and addressing both patient-based and institutional barriers. Although the previous paper (Marshall & Hurtig, 2019) focused on patient-based barriers, this paper addresses overcoming institutional barriers. METHOD: We present a series of cases to illustrate the institutional challenges in meeting the CCNs of patients in an acute care setting. RESULTS: Each case illustrates how the deployment of augmentative and alternative communication tools required addressing institutional/systems barriers and how critical collaborations help patients with CCNs to more effectively communicate with caregivers and participate in their care. CONCLUSION: Building a culture of improved patient-provider communication involves establishing a wider range of interprofessional collaborations and shared resources in order to effectively provide patients with CCNs the tools to summon assistance and communicate with their caregivers.

The cost of not addressing the communication barriers faced by hospitalized patients.

Preventable adverse events (AEs) lead to poorer patient outcomes, added patient suffering and dissatisfaction, longer hospital stays, and billions in additional annual healthcare spending. Patients facing barriers to communication are three times more likely to experience a preventable adverse event than patients who faced no communication barriers. National data on hospital admissions, incidence and cost of preventable AEs, and the odds ratio regarding the risk of preventable AEs in people facing communication barriers were used to estimate potential benefits of improving patient communication. Reducing communication barriers could lead to an estimated reduction of 671,440 preventable AE cases and a cost savings of $6.8 billion annually. Facilitating patient-provider communication is an ethical and financial imperative. A multi-pronged approach, including increased awareness of and support for speech-language pathology services, is essential to creating a communication-friendly hospital culture, reducing patient suffering, and decreasing the financial cost of preventable AEs. Speech-language pathologists and allied healthcare professionals play a critical role in facilitating patient-provider communication and improving patient outcomes.

Imitative production of rising speech intonation in pediatric cochlear implant recipients.

PURPOSE: This study investigated the acoustic characteristics of pediatric cochlear implant (CI) recipients' imitative production of rising speech intonation, in relation to the perceptual judgments by listeners with normal hearing (NH). METHOD: Recordings of a yes-no interrogative utterance imitated by 24 prelingually deafened children with a CI were extracted from annual evaluation sessions. These utterances were perceptually judged by adult NH listeners in regard with intonation contour type (non-rise, partial-rise, or full-rise) and contour appropriateness (on a 5-point scale). Fundamental frequency, intensity, and duration properties of each utterance were also acoustically analyzed. RESULTS: Adult NH listeners' judgments of intonation contour type and contour appropriateness for each CI participant's utterances were highly positively correlated. The pediatric CI recipients did not consistently use appropriate intonation contours when imitating a yes-no question. Acoustic properties of speech intonation produced by these individuals were discernible among utterances of different intonation contour types according to NH listeners' perceptual judgments. CONCLUSIONS: These findings delineated the perceptual and acoustic characteristics of speech intonation imitated by prelingually deafened children and young adults with a CI. Future studies should address whether the degraded signals these individuals perceive via a CI contribute to their difficulties with speech intonation production.

Effects of smoking marijuana on brain perfusion and cognition.

The effects of smoking marijuana on regional cerebral blood flow (rCBF) and cognitive performance were assessed in 12 recreational users in a double-blinded, placebo-controlled study. PET with [(15)Oxygen]-labeled water ([(15)O]H(2)O) was used to measure rCBF before and after smoking of marijuana and placebo cigarettes, as subjects repeatedly performed an auditory attention task. Smoking marijuana resulted in intoxication, as assessed by a behavioral rating scale, but did not significantly alter mean behavioral performance on the attention task. Heart rate and blood pressure increased dramatically following smoking of marijuana but not placebo cigarettes. However, mean global CBF did not change significantly. Increased rCBF was observed in orbital and mesial frontal lobes, insula, temporal poles, anterior cingulate, as well as in the cerebellum. The increases in rCBF in anterior brain regions were predominantly in "paralimbic" regions and may be related to marijuana's mood-related effects. Reduced rCBF was observed in temporal lobe auditory regions, in visual cortex, and in brain regions that may be part of an attentional network (parietal lobe, frontal lobe and thalamus). These rCBF decreases may be the neural basis of perceptual and cognitive alterations that occur with acute marijuana intoxication. There was no significant rCBF change in the nucleus accumbens or other reward-related brain regions, nor in basal ganglia or hippocampus, which have a high density of cannabinoid receptors.

Effects of frequent marijuana use on memory-related regional cerebral blood flow.

It is uncertain whether frequent marijuana use adversely affects human brain function. Using positron emission tomography (PET), memory-related regional cerebral blood flow was compared in frequent marijuana users and nonusing control subjects after 26+ h of monitored abstention. Memory-related blood flow in marijuana users, relative to control subjects, showed decreases in prefrontal cortex, increases in memory-relevant regions of cerebellum, and altered lateralization in hippocampus. Marijuana users differed most in brain activity related to episodic memory encoding. In learning a word list to criterion over multiple trials, marijuana users, relative to control subjects, required means of 2.7 more presentations during initial learning and 3.1 more presentations during subsequent relearning. In single-trial recall, marijuana users appeared to rely more on short-term memory, recalling 23% more than control subjects from the end of a list, but 19% less from the middle. These findings indicate altered memory-related brain function in marijuana users.