Is speech and language therapy effective at improving the communication of adults with intellectual disabilities?: A systematic review.

BACKGROUND: A significant proportion of adults with intellectual disabilities (ID) experience speech, language and communication difficulties which are associated with poor physical and mental health outcomes. Speech and language therapy (SLT) interventions are an important way to address these communication difficulties, yet there is limited available evidence to provide information about the effectiveness of the different approaches used for this heterogeneous group. AIMS: To review the evidence available for the effectiveness of SLT interventions aimed at improving communication for adults with ID. METHODS & PROCEDURES: A systematic search across relevant databases was performed. Information on methodological details of each relevant study, along with descriptions of the SLT interventions employed, were extracted and the Crowe Critical Appraisal Tool (CCAT) was used to assess quality. Findings were discussed in a narrative synthesis grouped by target communication skill. OUTCOMES & RESULTS: A total of 10 relevant studies met the inclusion criteria. These were predominantly interventions aimed directly at adults with ID to improve speech, increase augmentative and alternative communication (AAC) use and develop interaction skills, with one study addressing work with carers. The included studies were all rated as low quality. There is weak preliminary evidence that SLT input can improve the communication skills of adults with ID. CONCLUSIONS & IMPLICATIONS: There is insufficient evidence to draw strong conclusions about the effectiveness of SLT in this population. Further high-level evidence across speech, language and communication domains is urgently needed. What this paper adds What is already known on the subject There is limited evidence for community health interventions used with adults with ID. Previous reviews of SLT interventions found a lack of evidence base for this population. Some areas of SLT practice such as AAC have demonstrated potential benefits and other areas including speech work, social communication skills and training for communication partners have some evidence base for children with ID but there is currently insufficient evidence for adults with ID. What this paper adds to existing knowledge The study systematically reviews the current evidence base available when considering the effectiveness of SLT intervention for adults with ID. It provides weak evidence to suggest SLT intervention can improve communication in this population and highlights the need for clinically relevant, robustly designed studies to be undertaken in this field. What are the potential or actual clinical implications of this work? The lack of high-quality studies with sufficient power to draw conclusions about effectiveness means SLTs are not able to base their intervention choices on firm evidence. There is an urgent need to conduct robust research into the effectiveness of SLT interventions for adults with ID.

Systematic review and meta-analysis of association between cognitive tests and on-road driving ability in people with dementia.

OBJECTIVES: To assess the strength of association between cognitive tests and on-road driving ability in people with dementia by conducting a systematic review and meta-analysis. METHODS: A literature search strategy was developed using terms related to dementia and driving. Fifteen databases were searched. Studies were selected if they investigated the predictive ability of cognitive tests and on-road fitness to drive in people with dementia. The primary author performed the initial screening of title and abstract of each paper. Two reviewers then independently checked whether the abstracts met the inclusion and exclusion criteria. The primary author also hand searched included studies, reference lists and conducted citation searches. Studies were quality assessed using Newcastle-Ottawa Quality Assessment Scale for Cohort and Case-Control Studies. A random effect model was employed to analyse effect size. RESULTS: The initial search identified 6734 articles, of which 47 full-text articles were screened for inclusion. Thirty articles were included in the review and sixteen articles were included in the meta-analysis. Analysis showed statistically significant weak to moderate (0.3-0.4) relationships between cognitive measures and on-road driving for all cognitive domains except language. CONCLUSION: All cognitive domains apart from language showed a statistically significant moderate association with on-road driving outcome in patients with mild dementia. A composite cognitive battery is likely to be better than testing single cognitive domains in assessing fitness to drive in patients with dementia.

Segmentation of Exercise Repetitions Enabling Real-Time Patient Analysis and Feedback Using a Single Exemplar.

We present a segmentation algorithm capable of segmenting exercise repetitions in real time. This approach uses subsequence dynamic time warping and requires only a single exemplar repetition of an exercise to correctly segment repetitions from other subjects, including those with limited mobility. This approach is invariant to low range of motion, instability in movements, and sensor noise while remaining selective to different exercises. This algorithm enables responsive feedback for technology-assisted physical rehabilitation systems. We evaluated the algorithm against a publicly available dataset (CMU) and against a healthy population and stroke patient population performing rehabilitation exercises captured on a consumer-level depth sensor. We show that the algorithm can consistently achieve correct segmentation in real time.

Clinical assessment of depth sensor based pose estimation algorithms for technology supervised rehabilitation applications.

Encouraging rehabilitation by the use of technology in the home can be a cost-effective strategy, particularly if consumer-level equipment can be used. We present a clinical qualitative and quantitative analysis of the pose estimation algorithms of a typical consumer unit (Xbox One Kinect), to assess its suitability for technology supervised rehabilitation and guide development of future pose estimation algorithms for rehabilitation applications. We focused the analysis on upper-body stroke rehabilitation as a challenging use case. We found that the algorithms require improved joint tracking, especially for the shoulder, elbow and wrist joints, and exploiting temporal information for tracking when there is full or partial occlusion in the depth data.

Virtual rehabilitation: What are the practical barriers for home-based research?

Virtual reality technologies are becoming increasingly accessible and affordable to deliver, and consequently the interest in applying virtual reality within rehabilitation is growing. This has resulted in the emergence of research exploring the utility of virtual reality and interactive video gaming interventions for home use by patients. The aim of this paper is to highlight the practical factors and difficulties that may be encountered in research in this area, and to make recommendations for addressing these. Whilst this paper focuses on examples drawn mainly from stroke rehabilitation research, many of the issues raised are relevant to other conditions where virtual reality approaches have the potential to be applied to home-based rehabilitation.

Patients' use of a home-based virtual reality system to provide rehabilitation of the upper limb following stroke.

BACKGROUND: A low-cost virtual reality system that translates movements of the hand, fingers, and thumb into game play was designed to provide a flexible and motivating approach to increasing adherence to home-based rehabilitation. OBJECTIVE: Effectiveness depends on adherence, so did patients use the intervention to the recommended level? If not, what reasons did they give? The purpose of this study was to investigate these and related questions. DESIGN: A prospective cohort study, plus qualitative analysis of interviews, was conducted. METHODS: Seventeen patients recovering from stroke recruited to the intervention arm of a feasibility trial had the equipment left in their homes for 8 weeks and were advised to use it 3 times a day for periods of no more than 20 minutes. Frequency and duration of use were automatically recorded. At the end of the intervention, participants were interviewed to determine barriers to using it in the recommended way. RESULTS: Duration of use and how many days they used the equipment are presented for the 13 participants who successfully started the intervention. These figures were highly variable and could fall far short of our recommendations. There was a weak positive correlation between duration and baseline reported activities of daily living. Participants reported lack of familiarity with technology and competing commitments as barriers to use, although they appreciated the flexibility of the intervention and found it motivating. LIMITATIONS: The small sample size limits the conclusions that can be drawn. CONCLUSIONS: Level of use is variable and can fall far short of recommendations. Competing commitments were a barrier to use of the equipment, but participants reported that the intervention was flexible and motivating. It will not suit everyone, but some participants recorded high levels of use. Implications for practice are discussed.

Emerging issues and current trends in assistive technology use 2007-2010: practising, assisting and enabling learning for all.

Following an earlier review in 2007, a further review of the academic literature relating to the uses of assistive technology (AT) by children and young people was completed, covering the period 2007-2011. As in the earlier review, a tripartite taxonomy: technology uses to train or practise, technology uses to assist learning and technology uses to enable learning, was used in order to structure the findings. The key markers for research in this field and during these three years were user involvement, AT on mobile mainstream devices, the visibility of AT, technology for interaction and collaboration, new and developing interfaces and inclusive design principles. The paper concludes by locating these developments within the broader framework of the Digital Divide.

Smoking in pregnancy, where are we now?

The harmful effects of smoking during pregnancy have been well documented within the literature (Eastham and Gosakan 2010; British Medical Association (BMA) 2004). However, although the number of women smoking during pregnancy has fallen over the last few years, this still remains a major health concern for both women and their families. This paper aims to explore recent media campaigns and social policies focusing on smoking in pregnancy and the general population. Midwives need to be aware of current policies with regard to smoking cessation to enable high quality evidence based information and support to be provided at an optimum time in women's lives.

An analysis of injury rates after the seasonal change in rugby league.

OBJECTIVES: To determine whether the increase in the incidence of injury found for the first summer season in which rugby league (RL) was played in the UK was repeated in subsequent summer seasons. DESIGN: A retrospective and prospective cohort study design. SETTING AND PARTICIPANTS: Injuries were recorded from all players who took part in 141 games over 3 summer seasons (1997 to 1999) for 1 professional team. These were compared against rates from previously collected data for 3 earlier winter and 1 summer season. ASSESSMENT OF RISK FACTORS: For each injury it was recorded in which season it occurred; how many games or training sessions, if any, were subsequently missed; the type, site and severity of injury. MAIN OUTCOME MEASURES: Injuries were reported as rate per 1000 hours, also broken down into severity according to the number of games missed and whether subsequent training sessions were missed. RESULTS: A sustained increase in injury incidence has been found comparing summer RL over RL played in the winter. There was an increase in injury rates for all sites and types, but not all reached significance. CONCLUSIONS: Data collected over 6 seasons indicate a higher risk of sustaining an injury playing summer RL, but the cause may be related to a combination of factors. These may include the ground or weather conditions associated with summer rugby, player characteristics or changes in the game itself and future research needs to investigate these further.

Virtual reality in the rehabilitation of people with intellectual disabilities: review.

Virtual reality (VR) possesses many qualities that give it rehabilitative potential for people with intellectual disabilities, both as an intervention and an assessment. It can provide a safe setting in which to practice skills that might carry too many risks in the real world. Unlike human tutors, computers are infinitely patient and consistent. Virtual worlds can be manipulated in ways the real world cannot be and can convey concepts without the use of language or other symbol systems. Published applications for this client group have all been as rehabilitative interventions. These are described in three groups: promoting skills for independent living, enhancing cognitive performance, and improving social skills. Five groups of studies are reviewed that utilize virtual technology to promote skills for independent living: grocery shopping, preparing food, orientation, road safety, and manufacturing skills. Fears that skills or habits learnt in a virtual setting would not transfer to the real world setting have not been supported by the available evidence, apart from those studies with people with autistic spectrum disorders. Future directions are in the development of more applications for independent living skills, exploring interventions for promoting motor and cognitive skills, and the developments of ecologically valid forms of assessment.

Nurses' and doctors' perceptions of young people who engage in suicidal behaviour: a contemporary grounded theory analysis.

Over the past 25 years, suicidal behaviour in young people has continued to be a major concern for health services around the world. Self-harm in individuals aged 13-18 is common and represents a significant reason for admission to accident and emergency departments, paediatric medical services and child and adolescent mental health services. Nurses' and doctors' working in these areas are the first point of contact for young people following an episode of self-harm. This paper presents a study exploring nurses and doctors perceptions of young people who engage in suicidal behaviour. The data presented form part of larger project conducted using both quantitative and qualitative methods, and a contemporary grounded theory approach to analysis. The findings revealed two main categories and associated subcategories: Experiences of frustration in practice (subcategories: non-therapeutic situations, insubstantiality of interventions and value of life) and strategies for relating to young people (sub-categories: specialist skills in care and reflections on own experience). The meanings of these categories highlight barriers in the relationship nurses and doctors have with young people who engage in suicidal behaviour. If suicide prevention policies around the world are to succeed the phenomena impacting on the communication between these professionals and young people needs to be addressed in research, education and in the development of practice.