Conversations about self-identity in Alzheimer disease: augmentative and alternative Communication memory books as an aid / Conversaciones sobre la propia identidad en la Enfermedad de Alzheimer: ayuda de los libros de memoria de Comunicación Aumentativa y Alternativa

Alzheimer disease (AD) is a progressive and degenerative neurological disorder that affects memory, language and communication, thinking, and social skills. The inability to recall incidents and events, especially when symptoms become more prevalent and severe, can cause a person to experience a loss of self or to have doubts about his or her identity. One approach to helping these patients with their memory and language problems is to use memory books, a kind of Augmentative and Alternative Communication (AAC) tool. The aim of this study was to verify whether the introduction of AAC books could have an impact on conversations about self-identity through an increase of ‘self’-positive conversational contents and on improving conversational skills. Three single case studies were carried out with three elderly women with mild, moderate and severe AD, respectively. Each participant was involved in a conversation about their ‘selves’ in an alternating treatment design (ABAB) without a memory book in phase A and with the aid of this AAC tool in phase B. The results showed a similar conversational response pattern in all participants. AAC aids increased the number of ‘self’-positive conversational statements with a reduction in negative, ambiguous and repetitive utterances. In conclusion, AAC memory tools seemed to help participants with dementia to focus their attention on relevant personal information, allowing them to centre the conversation on core positive identity contents, thus improving the quality of the conversations with fewer ambiguous utterances (AU)

La Enfermedad de Alzheimer es una enfermedad neurológica degenerativa y progresiva que afecta a la memoria, el lenguaje y la comunicación, el pensamiento y las habilidades sociales. La incapacidad para recordar incidentes y acontecimientos, cuando los síntomas son más prevalentes y severos, puede causar que la persona experimente una pérdida del self o tenga dudas sobre su identidad. Un enfoque que ayuda con los problemas de memoria y de lenguaje es el uso de los libros de memoria, herramientas de Comunicación Aumentativa y Alternativa (CAA). El objetivo de este estudio es comprobar si la introducción de libros de CAA tiene un impacto en las conversaciones sobre la propia identidad, a través del incremento de contenidos conversacionales positivos sobre "si mismo", y en la mejora de habilidades conversacionales. Se llevaron a cabo tres estudios de caso único con tres mujeres mayores con enfermedad de Alzheimer, leve, moderada y severa, respectivamente. Se implicó a cada participante en una conversación sobre "si misma" en un diseño de tratamientos alternos (ABAB) sin libro de memoria en la fase A y con apoyo de la CAA en B. Los resultados muestran un patrón de respuesta conversacional similar para las tres participantes. Con las ayudas de CAA se incrementaron las frases positivas sobre "si misma" en la conversación y se redujeron las declaraciones negativas, ambiguas y repetitivas. La conclusión es que parece que las herramientas de memoria han ayudado a enfocar la atención sobre información personal relevante, permitiendo centrar la conversación en contenidos básicos de su identidad y mejorando su calidad con menos ambigüedades (AU)

Clinical and acoustic vocal profile in children with attention deficit hyperactivity disorder.

PURPOSE: The objective of this study was to evaluate the presence of etiologic factors, symptoms, and vocal acoustic alterations related to vocal hyperfunction in children with attention deficit hyperactivity disorder (ADHD). METHOD: In 23 children with ADHD and 28 control children, vocal acoustic exploration was performed to analyze the F0, jitter %, and voice turbulence index for the sustained vowels /a/ and /i/ and the average tone and intensity and tonal modulation in tests of continuous speech. The children's parents completed a specific questionnaire aimed at detecting etiologic factors and vocal symptoms. RESULTS: Children with ADHD displayed more vocal symptoms (hoarseness, neck strain, and shortness of breath while talking) and more etiologic factors (they shouted more, spoke louder and faster, and became angry more easily) than did children in the Control group. Likewise, children in the ADHD group exhibited a greater % jitter and a lower average intensity in the continuous speech tests. CONCLUSIONS: These results indicate that children with ADHD display greater vocal hyperfunction as compared with children in the Control group and suggest a higher risk of developing dysphonia. The results of this study could be useful for designing vocal programs focusing on vocal education and hygiene to prevent and decrease vocal risks and on promoting vocal health in children with ADHD.

An exploratory study of phonological awareness and working memory differences and literacy performance of people that use AAC

Twelve cerebral palsied adolescents and young adults with complex communicative needs who used augmentative and alternative communication were studied. They were classified according to their working memory capacity (high vs. low) into two groups of 6 participants. They were also divided into two groups of 6 participants according to their high vs. low phonological skills. These groups were compared on their performance in reading tests -orthographic knowledge, a word test and a pseudoword reading test- and in the spelling of words, pseudowords and pictures’ names. Statistical differences were found between high vs. low phonological skills groups, and between high and low working memory groups. High working memory capacity group scored significantly higher than low working memory group in the orthographic and word reading tests. The high phonological skills group outperformed the low phonological skills group in the word reading test and in the spelling of pseudowords and pictures’ names. From a descriptive point of view, phonological skills and working memory, factors known to be highly predictive of literacy skills in people without disabilities, also hold as factors for the participants that used AAC in our study. Implications of the results are discussed (AU)

En nuestro estudio participaron doce adolescentes y adultos jóvenes con parálisis cerebral con necesidades comunicativas especiales, usuarios de comunicación aumentativa y alternativa. Éstos fueron clasificados según su capacidad de memoria operativa (alta vs. baja) en 2 grupos de 6 participantes, y en otros dos, también de 6 participantes de acuerdo a sus habilidades fonológicas (altas vs. bajas). Todos ellos fueron comparados según sus habilidades lectoras (conocimiento ortográfico, lectura de palabras, de pseudopalabras, capacidad de deletreo de palabras, de pseudopalabras y deletreo de nombres de dibujos. Los resultados mostraron diferencias significativas entre los grupos de altas y bajas capacidades fonológicas así como entre los grupos de alta y baja capacidad de memoria en algunas de las medidas estudiadas. Los sujetos con alta capacidad de memoria obtuvieron puntuaciones significativamente mejores en la tarea ortográfica y en la lectura de palabras. Por otra parte, los sujetos con mejores habilidades fonológicas rindieron significativamente mejor en las tareas de lectura de palabras, deletreo de pseudopalabras y de nombres de dibujos. Desde un punto de vista descriptivo, podemos afirmar que las habilidades fonológicas y de memoria operativa se mostraron como buenos predictores del éxito lector en sujetos usuarios de CAA, del mismo modo que sucede en el resto de la población sin trastornos. Las implicaciones de estos resultados se discuten en este trabajo (AU)

An exploratory study of phonological awareness and working memory differences and literacy performance of people that use AAC.

Twelve cerebral palsied adolescents and young adults with complex communicative needs who used augmentative and alternative communication were studied. They were classified according to their working memory capacity (high vs. low) into two groups of 6 participants. They were also divided into two groups of 6 participants according to their high vs. low phonological skills. These groups were compared on their performance in reading tests -orthographic knowledge, a word test and a pseudoword reading test- and in the spelling of words, pseudowords and pictures' names. Statistical differences were found between high vs. low phonological skills groups, and between high and low working memory groups. High working memory capacity group scored significantly higher than low working memory group in the orthographic and word reading tests. The high phonological skills group outperformed the low phonological skills group in the word reading test and in the spelling of pseudowords and pictures' names. From a descriptive point of view, phonological skills and working memory, factors known to be highly predictive of literacy skills in people without disabilities, also hold as factors for the participants that used AAC in our study. Implications of the results are discussed.

Un procedimiento de instrucción eficaz para la comunicación y el mantenimiento de peticiones específicas / An effective instructional procedure for communicating specific requesting and its maintenance

Se presentan los resultados de dos estudios. El objetivo del primer estudio ha sido aplicar un procedimiento de instrucción basado en una jerarquía decreciente de claves instruccionales para enseñar a un niño con retraso mental severo a pedir acceso a un objeto preferido mediante una petición específica activando una casilla de un dispositivo de comunicación aumentativa y alternativa con salida de voz usando una fotografía como símbolo. Asimismo, se comprobó la validez ecológica de la intervención. En un segundo estudio relacionado, se evaluó el papel de la salida de voz digitalizada en el mantenimiento de la petición para este mismo participante. Los resultados del primer estudio indicaron que el procedimiento de instrucción para la sustitución de los actos comunicativos prelingüísticos ha sido eficaz para enseñar la nueva conducta comunicativo-simbólica, conducta que ha sido funcionalmente equivalente a los actos prelingüísticos utilizados para pedir elementos preferidos. Además, se produjo la generalización de la conducta comunicativa aprendida en presencia de diversos interlocutores y en lugares variados. En el segundo estudio, una vez enseñada la nueva conducta comunicativa simbólica, y comparadas las tasas de adquisición en dos condiciones alternas, con la función de salida de habla del comunicador encendida y con la función de habla apagada, a lo largo de sucesivas sesiones, la nueva conducta de petición se mantuvo con independencia de la salida de voz (AU)

Results of two studies are presented. The aim of the first study has been the application of an instructional procedure, based on a top down hierarchy of instructional keys, to teach a boy with severe mental retardation to request access to a preferred item by means of a specific requesting and activating a cell of an augmentative and alternative communication device with voice output using a photograph as a symbol. Ecological validity of the intervention was assessed. In a second related study the effect of digitized voice output in the maintenance of requesting for the same boy was assessed. Results for the first study showed that the instructional procedure for the substitution of prelinguistic communicative acts has been an effective one in order to teach the new symbolic communicative behaviour. This symbolic communicative behaviour has been functionally equivalent to the prelinguistics acts the boy used to employ to request favourite items. Generalization of the new learnt communicative behaviour was observed with different communicative partners and in varied settings. In the second study, once the new symbolic communicative behaviour was taught and acquired by the boy, rates of requesting were compared across two conditions, speech output on versus speech output off, that were alternated on a session by session basis, and results showed that the new requesting behaviour was maintained regardless speech output (AU)