Impaired Communication Abilities Research Articles

Cognitive factors underpinning poor expressive communication skills after traumatic brain injury: theory of mind or executive function?

The ability to see things from another's perspective, that is, have a theory of mind (ToM), is essential to effective communication. So too is the ability to regulate verbal output, that is, to exercise executive control. People with traumatic brain injuries (TBIs) have impaired communication abilities, but the extent to which this reflects ToM versus executive dysfunction is unclear. This study explored the relative contributions of executive abilities, specifically flexibility and inhibition and ToM abilities in language production post-TBI. Twenty-five adults (18 males: mean age of 48.2 years, SD = 12.0 years) with moderate to severe TBI (posttraumatic amnesia = 69.2, SD = 54.6 days) and 28 noninjured adults (19 males: mean age 49.0, SD = 12.2 years) completed three sets of communication tasks with low executive demands, high flexibility, and high inhibition demands. Within each, parallel versions had low or high ToM requirements. For low executive and high flexibility tasks, scores on the high ToM versions were predicted by scores on the low ToM versions, suggesting that poor performance was explained by the executive demands the parallel tasks had in common. The exception was the high inhibition task. In this case, speakers with TBI had differential difficulty with the high ToM version, that is, they had specific difficulty inhibiting self-referential thoughts in order to cater for another's perspective. We found problems with inhibiting the self-perspective accords with descriptive accounts of the egocentric nature of some communication patterns following TBI, which points to potential targets for remediation.

Striatal Development in Autism: Repetitive Behaviors and the Reward Circuitry

Striatal Development in Autism: Repetitive Behaviors and the Reward Circuitry

Assessment and Treatment of Pain in Adult Intensive Care Unit Patients

In most cases, patients admitted to an intensive care unit (ICU) have suffered from severe trauma, undergone major surgery or been treated for a serious medical illness. Although they often experience more intense pain than general ward patients, they are frequently unable to communicate their experiences to health care providers, thus preventing accurate assessment and treatment of their pain. If appropriate measures are not taken to treat pain in critically ill patients, stress response or sympathetic overstimulation can lead to complications. The short-term consequences of untreated pain include higher energy expenditure and immunomodulation. Longer-term, untreated pain increases the risk of post-traumatic stress disorder. Because pain is quite subjective, the accurate assessment of pain is very difficult in the patients with impaired communication ability. The current most valid and reliable behavioral pain scales used to assess pain in adult ICU patients are the Behavioral Pain Scale and the Critical-Care Pain Observation Tool. Once pain has been accurately assessed using these methods, various pharmacologic and non-pharmacologic therapies should be performed by the multidisciplinary care team. Accurate assessment and proper treatment of pain in adult ICU patients will improve patients outcome, which reduces the stress response and decreases the risk of post-traumatic stress disorder.

Exaggerated translation causes synaptic and behavioural aberrations associated with autism

Autism spectrum disorders (ASDs) are an early onset, heterogeneous group of heritable neuropsychiatric disorders with symptoms that include deficits in social interaction skills, impaired communication abilities, and ritualistic-like repetitive behaviours. One of the hypotheses for a common molecular mechanism underlying ASDs is altered translational control resulting in exaggerated protein synthesis. Genetic variants in chromosome 4q, which contains the EIF4E locus, have been described in patients with autism. Importantly, a rare single nucleotide polymorphism has been identified in autism that is associated with increased promoter activity in the EIF4E gene. Here we show that genetically increasing the levels of eukaryotic translation initiation factor 4E (eIF4E) in mice results in exaggerated cap-dependent translation and aberrant behaviours reminiscent of autism, including repetitive and perseverative behaviours and social interaction deficits. Moreover, these autistic-like behaviours are accompanied by synaptic pathophysiology in the medial prefrontal cortex, striatum and hippocampus. The autistic-like behaviours displayed by the eIF4E-transgenic mice are corrected by intracerebroventricular infusions of the cap-dependent translation inhibitor 4EGI-1. Our findings demonstrate a causal relationship between exaggerated cap-dependent translation, synaptic dysfunction and aberrant behaviours associated with autism.

A Randomized Controlled Trial on Very Early Speech and Language Therapy in Acute Stroke Patients with Aphasia

Background: Aphasia affects one third of acute stroke patients. There is a considerable spontaneous recovery in aphasia, but impaired communication ability remains a great problem. Communication difficulties are an impediment to rehabilitation. Early treatment of the language deficits leading to increased communication ability would improve rehabilitation. The aim of this study is to elucidate the efficacy of very early speech and language therapy (SLT) in acute stroke patients with aphasia. Methods: A prospective, open, randomized, controlled trial was carried out with blinded endpoint evaluation of SLT, starting within 2 days of stroke onset and lasting for 21 days. 123 consecutive patients with acute, first-ever ischemic stroke and aphasia were randomized. The SLT treatment was Language Enrichment Therapy, and the aphasia tests used were the Norsk grunntest for afasi (NGA) and the Amsterdam-Nijmegen everyday language test (ANELT), both performed by speech pathologists, blinded for randomization. Results: The primary outcome, as measured by ANELT at day 21, was 1.3 in the actively treated patient group and 1.2 among controls. NGA led to similar results in both groups. Patients with a higher level of education (>12 years) improved more on ANELT by day 21 than those with <12 years of education (3.4 vs. 1.0, respectively). In 34 patients in the treatment group and 19 in the control group improvement was ≧1 on ANELT (p < 0.05). There was no difference in the degree of aphasia at baseline except for fluency, which was higher in the group responding to treatment. Conclusions: Very early intensive SLT with the Language Enrichment Therapy program over 21 days had no effect on the degree of aphasia in unselected acute aphasic stroke patients. In aphasic patients with more fluency, SLT resulted in a significant improvement as compared to controls. A higher educational level of >12 years was beneficial.

Use of Yi-Gan San (TJ-54) in patients with motor aphasia who refuse to participate in rehabilitation

Sato S, Bunno K. Use of Yi-Gan San (TJ-54) in patients with motor aphasia who refuse to participate in rehabilitation. Jpn J Compr Rehabil Sci 2010; 7-10. Since aphasic patients have difficulty communicating, they often have emotional lability, which can make clinical management difficult and may even lead to the patients' refusal to participate in rehabilitation programs. Yi-Gan San (YGS) has recently been shown to improve behavioral and psychological symptoms of dementia (BPSD) associated with Alzheimer's dementia. Recently, 3 patients with motor aphasia were treated with YGS to stabilize psychiatric symptoms, and this treatment helped the patients, who initially refused to undergo rehabilitation, adapt to rehabilitation therapy. Within 1 to 2 weeks of starting the treatment with YGS, there was a marked improvement in the patients' emotional lability. Since the patients showed improvement within a short period, we think that the serotonin 5-HT1A receptor partial agonist action of YGS is the main factor responsible for these pharmacologic effects. In patients with impaired communication ability, such as those with motor aphasia, YGS may be effective and worthwhile as a supplemental therapy for secondary psychiatric symptoms such as emotional lability.

Postoperative Orthopaedic Neurovascular Monitoring in the Pediatric Population

Many orthopaedic procedures carry risks of neurovascular compromise. We hypothesized that risk factors for neurovascular compromise and for its delayed detection exist in the pediatric orthopaedic population. We searched our institution's pediatric patient database from January 2004 through December 2006, randomly selecting (arbitrarily choosing every 20th patient) 286 patients, 34 of whom went to the operating room twice for 320 procedures. We retrospectively reviewed their records for these potential risk factors: altered communication ability (for age), abnormal baseline neurovascular status, imprecise documentation of neurovascular baseline status, nonspecific or inappropriate postoperative monitoring orders, and monitoring not carried out by nursing staff. Outcomes were analyzed via Fisher exact test (P < 0.05). Ten patients (3%) had new postoperative neurovascular events, and 4 (1%) were recognized to have neurological deterioration detected on a delayed basis. Fifty-seven (18%) had impaired communication ability (significant correlation with increased risk for neurovascular events), 97 (30%) had abnormal neurovascular preoperative status, and 21 (22%) had no specific documentation of neurovascular condition in the perioperative chart. Insufficient documentation of abnormal neurovascular baseline correlated significantly with an increased risk for delayed detection of postoperative neurovascular events. Although all written orders for neurovascular checks were carried out and specific with respect to timing, 133 patients (42%) had neurovascular monitoring orders that were nonspecific about the functions to be checked. All patients with delayed deficit detection had impaired ability to communicate, abnormal baseline values, or improperly written orders. The risk of postoperative neurovascular events is significantly higher in patients with impaired communication ability, and the risk for delayed detection of such events is significantly higher in patients without proper documentation of an abnormal neurovascular baseline. Clear documentation of baseline function may avoid delayed detection, and more specific monitoring processes may improve patient safety.

Prévention et soulagement des douleurs induites par les soins en ORL

There are many types of pain induced in otolaryngology, stemming from medical acts, sinus drainage, packing of the nasal fossae, or complex bandaging after cancer surgery. In patients with impaired communication abilities resulting from impaired speech, greater attention must be paid to induced pain, sometimes requiring the use of behavioral evaluation scales. Preventing this pain means organizing medical acts and painful treatments by attempting to group them and informing the patient that the caregiver is listening to him and relieving his pain. Non-drug treatments should always be attempted, are based on a trusting relationship with the patient, a comfortable position, diverting his attention, and using bandaging that is less painful when removed. However, use of drug treatments often remains indispensable. The strong morphinics are used most often despite a pharmacokinetic profile that is poorly adapted and the undesirable side effects in case of repeated administration. Local anesthetics should be used whenever possible. Dissemination of nursing protocols for the use of MEOPA provides good pain relief providing that there are trained personnel in sufficient numbers. The intensity of pain induced by certain medical acts requires use of brief general anesthesia, which can often be done in the ambulatory situation and is preferable to deep sedation outside of the safety of the operating room.

Communication Disorders in Children: A Challenge for Health Care

Background. Today"s children will participate in a society whose economic basis will be information and communication and they must have optimal communication skills to be able to be functional optimally within the information society. Heretofore, in the United States, there has been no systematic attempt to diagnose and care for children with communication disorders. Methods. It is essential that the child be diagnosed early because there appears to be a critical period for language development. Conclusion. If interventions do not occur early, in the area of communication disorders, there is a high probability of significant morbidity because of impaired communication abilities. This morbidity can manifest itself in asocial activity and loss of economic opportunity.