Severe Communication Difficulties Research Articles

Особенности интеллектуального развития при расстройстве аутистического спектра (РАС)

<p style="text-align: justify;">The article presents an overview of the current understanding of the intellectual development of children and adults with autism spectrum disorder (ASD). A review of research indicates a wide heterogeneity in the levels of intellectual development in autism (from severe intellectual disability to giftedness) and demonstrates a lack of specific cognitive and intellectual profiles. The assessment of "strengths" and "weaknesses" of individual cognitive abilities and/or subtests of the measures comes to the fore. At the same time, the incidence of ASD and intellectual disability is higher than in the general population (33% to 70% in the studies reported in this article), indicating that these conditions are comorbid. These rates vary according to the methodological design of the studies, especially the type of data used (administrative, medical, educational, etc.) and the instruments used to assess intellectual ability. For example, Wechsler tests may underestimate scores in children and adults with ASD because of the large number of verbal instructions that are difficult for people with severe communication difficulties. Comprehensive nonverbal intelligence tests (e.g., Leiter-3 or UNIT-2) are the most appropriate methods. Assessing the level of intellectual ability in people with autism spectrum disorders in Russia is complicated by the existing deficit of methods, the elimination of which is an important task that researchers face.</p>

Unmet environmental needs and unmet healthcare needs in a population of young adults with cerebral palsy: what the SPARCLE study tells us.

Optimizing care for young adults with cerebral palsy is crucial for their physical and psychological well-being. The inadequacy of proximal environment may play a role in the provision of health services. The aim of this study is to explore the association between unmet environmental needs in the physical, social and attitudinal domains and unmet healthcare needs in four interventions: physiotherapy, occupational therapy, speech therapy and psychological counselling. Young adults with cerebral palsy were recruited in the SPARCLE3 European multicenter cross-sectional study. Healthcare needs and coverages were assessed using the Youth Health Care, Satisfaction, Utilization and Needs questionnaire. The need and availability of environmental factors in physical, social and attitudinal domains were collected using the European Adult Environment Questionnaire. Logistic regressions were conducted separately for each intervention to measure associations between unmet environmental needs and unmet healthcare needs. We studied 310 young adults with cerebral palsy, with a mean age of 24.3 years; 37.4% could not walk independently, 51.5% had an IQ below 70, 34.2% had severe communication difficulties. The most commonly expressed need was physiotherapy (81.6% of participants). Unmet healthcare needs were reported by 20.9%, 32.4%, 40.3% and 49.0% of participants requiring physiotherapy, occupational therapy, psychological counselling and speech therapy, respectively. The physical environment was never significantly associated with unmet healthcare needs. In contrast, the social environment was significantly associated with unmet healthcare needs across all interventions, with odds ratios over 2.5, depending on the number of unmet needs and the nature of intervention needed. With regard to the attitudinal environment, when at least one unmet attitudinal environmental need was reported, the odds of also reporting an unmet healthcare need were of 3.68 for speech therapy and 3.77 for physiotherapy. The latter association was significant only for individuals with severe motor impairment. Our results highlight the importance of the social and attitudinal environment in meeting healthcare needs in young adults with cerebral palsy. The lack of correlation between unmet healthcare needs and the physical environment suggests that it can be partly compensated for by social support.

Feasibility of an eye-gaze technology intervention for students with severe motor and communication difficulties in Taiwan

Eye-gaze technology provides access to a computer through the control of eye movements, thus allowing students with severe motor and communication difficulties to communicate and participate in curriculum activities and leisure; however, few studies have investigated whether any challenges exist to its implementation. This study examines the feasibility for teachers, parents, and therapists of applying an eye-gaze technology intervention for students with severe motor and communication difficulties in everyday settings. A mixed-method design was applied, focusing on the acceptability, demands, implementation, and practicality of the technology applications. Data was collected from 16 participants who assisted five students using eye-gaze technology in a previous 6-month intervention. The intervention comprised (a) use of eye-gaze devices with individualized content; and (b) services including training in use, team meetings, and bi-monthly support on implementation problems. The results showed that the participants perceived the technology as appropriate to enhance interaction and understanding of the students’ learning and communication messages. Portable and easy-to-adjust systems were crucial to apply eye-gaze technology in different contexts. Improving eye-gaze services was required to afford in-service education, follow-up services, and loaning programs for sustainable implementation. The facilitators and barriers could guide researchers and practitioners to enhance the implementation of eye-gaze technology.

Worsening of cerebral palsy following neonatal encephalopathy: A meta-analysis

Cerebral palsy (CP), the most common motor disorder in early childhood, arises from neonatal brain injury. The potential role of neonatal encephalopathy (NE) as a risk factor for cerebral palsy has been postulated, yet a systematic examination of its clinical impact on cerebral palsy patients remains absent. This meta-analysis aims to delineate the incidence of commonly reported complications associated with cerebral palsy following NE compared to those without a history of NE. A systematic search of PubMed and Google Scholar yielded 424 studies, with 7 meeting the inclusion criteria. These studies reported at least one comparison of cerebral palsy symptoms between patients with or without NE and provided the corresponding case numbers for each group. Utilizing RevMan 5.4, we analyzed the data and assessed potential publication bias. Among the 7 studies included, we compared the characteristics of 117 patients with cerebral palsy with preceding NE to 287 without such antecedents. Significantly, the incidence of the spastic quadriplegic subtype of cerebral palsy was higher in patients with NE (odds ratio [OR]: 4.34, 95% confidence interval [CI]: 2.69 – 7.00, P < 0.00001). CP patients following NE exhibited a significantly increased incidence of severe communication difficulties (OR: 2.33, 95% CI: 1.32 – 4.10, P = 0.003), difficulty swallowing (OR: 2.50, 95% CI: 1.31 – 4.77, P = 0.005), and cognitive impairment (OR: 2.73, 95% CI: 1.45 – 5.13, P = 0.002). Children with cerebral palsy born following NE were more predisposed to the most severe spastic quadriplegic subtype and encountered significant comorbidities. It is essential to acknowledge the limitations of this study, primarily the small number of studies that separately reported cerebral palsy cases with or without NE. Nevertheless, these findings contribute valuable insights for a more accurate clinical prognosis and the prospective development of targeted treatments for specific complications associated with cerebral palsy in patients with NE.

Case Study: COVID-19 Brain Fog or Auditory Processing Disorder?

Case Study: COVID-19 Brain Fog or Auditory Processing Disorder?

A Study on Evaluation of Before and After Wearing the Deep Touch Pressure Therapy Compression Garment by Children with Autism

Autism is a neurodevelopmental disorder characterised by severe difficulties in communication and social interaction as well as a restricted pattern of repetitive and stereotyped behaviour. Due to its extensive range of symptoms, including issues with communication and social interaction, repetitive behaviours, and sensory processing disorder, it is known as autism spectrum disorder (ASD). Children with ASD experience anxiety which leads to outbursts and eventual meltdowns. Autism interventions typically involve Deep Touch Pressure (DTP) Therapy. Occupational therapists frequently apply deep pressure to patients with autism spectrum disorders. For children with autism, occupational therapists employ a variety of devices to provide deep contact pressure, including weighted vests, compression vests, pneumatic pressure garments, and weighted blankets etc. Research examining deep pressure is scarce. Additionally, a number of studies have shown the efficacy of DTP. A therapy compression garment for autistic children with sensory defensiveness was developed using a user-centric design paradigm. The aim of this study was to evaluate the before and after wearing the deep touch pressure therapy compression garment worn by the six wearer children with Autism.

Virtual INSIGHT: Improving natural social interaction: Group reHabilitation after traumatic brain injury.

There is a growing body of literature that indicates positive outcomes of group treatment approaches to intervention for communication difficulties in chronic traumatic brain injury (TBI). The published research to date examines face-to-face group intervention. This study draws on one of these approaches, 'Improving Natural Social Interaction: Group reHabilitation after Traumatic brain injury' (INSIGHT), and examines the adaptation of this program to a virtual setting. The principles underlying the program, which involved providing an authentic contextualised and natural environment for group interactions and enhancing opportunities for identity expression, were maintained. Six participants with mild to severe TBI and cognitive communication difficulties participated in an 8-week pilot program of the virtual INSIGHT program. Goal Attainment Scaling (GAS) scores completed over the course of the intervention served as the primary outcome measure. Secondary outcomes measures included The Repeatable Battery for the Assessment of Neuropsychological Status Update, The Awareness of Social Inference Test-Revised, the La Trobe Communication Questionnaire and the Satisfaction with Life Scale. A mixed multilevel analysis revealed significant improvement in GAS scores. A Wilcoxon signed rank test revealed no significant changes in secondary measures. There is a growing potential for this group treatment approach, in an online medium, and progress towards individualised goals was clear. The data have implications for examining the assessment measures typically used to document functional outcomes in clinical intervention. Future directions indicate a need to pursue more ecologically valid assessment methods. What is already known on the subject Recent literature has focused on the benefits of group intervention for cognitive communication diffuclties after traumatic brain injury (TBI). However, research to date examines only face-to-face group rehabilitation. As there has been a demand for a shift in the way we communicate worldwide, we must make adaptations to current intervention procedures to continue to serve individuals with diverse communication needs. What this paper adds to existing knowledge This study contributes new information about the feasibility of a virtual communication skills group for individuals with TBI. This virtual INSIGHT (Improving Natural Social Interaction: Group ehabilitation after Traumatic brain injury) group intervention facilitates progress towards collaboratively set communication goals and the online setting has the potential to increase the accessibility of these services. What are the potential or actual clinical implications of this work? Progress towards cognitive and social communication goals can be facilitated by an online group intervention. However, this progress was not correlated with scores on standard assessments of cognitive communication, social communication and quality of life. This has implications for the evaluation of the assessments typically used and their ecological validity and applicability to the communication context.

AAC and Autism: Manual Signs and Pecs, a Comparison.

Autism Spectrum Disorders (ASD) represent a heterogeneous group of disorders, with onset in developmental age, which present a clinical expressiveness that varies from subject to subject and in the same subject over time. The DSM 5 defines Autism Spectrum Disorders according to two main criteria: persistent deficits in social communication and social interaction in multiple contexts and limited and repetitive patterns of behavior, interests or activities. This disorder can manifest itself across a broad spectrum of severity levels. Indeed, ASD includes clinical conditions from low functioning (LF—Low Functioning) to high functioning (HF—High Functioning), taking cognitive and adaptive functioning as a reference. One of the main characteristics of individuals with ASD is a delay in receptive and expressive communication. These deficits have led to the identification of evidence-based practices, particularly for those with severe communication difficulties. Augmentative Alternative Communication (AAC) has been implemented to compensate for deficits in functional communication and language skills in individuals with complex communication deficits. The AAC comprises communication systems including the Manual Signs, speech and image output devices (Communicators), and Image Exchange Systems (PECS); these systems have been shown to actually improve various abilities in autism such as social skills, modify and improve dysfunctional behaviors and, above all, improve learning. Recent meta-analyses have shown how PECS and Manual Sign can have great effects on the communication skills of young people with autism. The aim of this study is to compare these two types of intervention to improve communication in terms of vocalization in subjects with ASD and try to understand which of the two lead to more significant and rapid improvements.

Speech and language development and genotype-phenotype correlation in 49 individuals with KAT6A syndrome.

Pathogenic KAT6A variants cause syndromic neurodevelopmental disability. "Speech delay" is reported, yet none have examined specific speech and language features of KAT6A syndrome. Here we phenotype the communication profile of individuals with pathogenic KAT6A variants. Medical and communication data were acquired via standardized surveys and telehealth-assessment. Forty-nine individuals (25 females; aged 1;5-31;10) were recruited, most with truncating variants (44/49). Intellectual disability/developmental delay (42/45) was common, mostly moderate/severe, alongside concerns about vision (37/48), gastrointestinal function (33/48), and sleep (31/48). One-third (10/31) had a diagnosis of autism. Seventy-three percent (36/49) were minimally-verbal, relying on nonverbal behaviors to communicate. Verbal participants (13/49) displayed complex and co-occurring speech diagnoses regarding the perception/production of speech sounds, including phonological impairment (i.e., linguistic deficits) and speech apraxia (i.e., motor planning/programming deficits), which significantly impacted intelligibility. Receptive/expressive language and adaptive functioning were also severely impaired. Truncating variants in the last two exons of KAT6A were associated with poorer communication, daily-living skills, and socialization outcomes. In conclusion, severe communication difficulties are present in KAT6A syndrome, typically on a background of significant intellectual disability, vision, feeding and motor deficits, and autism in some. Most are minimally-verbal, with apparent contributions from underlying motor deficits and cognitive-linguistic impairment. Alternative/augmentative communication (AAC) approaches are required for many into adult life. Tailored AAC options should be fostered early, to accommodate the best communication outcomes.

Increasing participation in computer activities using eye-gaze assistive technology for children with complex needs

Purpose Eye-gaze assistive technology offers children with severe motor and communication difficulties the opportunity to access and control a computer through eye movements. The aim of this study was to examine the impact of eye-gaze assistive technology intervention on participation in computer activities and technology usability among children with complex needs in Taiwan. Materials and methods This study involved a multiple baseline design across individuals. The participants were four children aged three to six years with severe motor and communication difficulties and low eye-control skills. The six-month intervention consisted of two collaborative team meetings and 12 individual supports to facilitate the use of eye-gaze assistive technology at home or in educational environments. Participation in computer activities (diversity, frequency, and duration) was repeatedly measured through a computer use diary. Other outcomes included assessments of goal achievements and parents/teachers’ ratings on children’s performance in computer activities. Results The young children increased the diversity of their computer activities and their frequency and duration of computer use from baseline to the intervention phase. The children attained six of eight predefined goals related to play, communication, and school learning. Parents and teachers perceived the children’s changes in performance as meaningful. Conclusion This study strengthens the evidence that eye-gaze assistive technology is useful in everyday contexts for children with complex needs in Taiwan. The findings add knowledge that children with weak eye-control skills increased participation in computer activities as a result of the eye-gaze assistive technology. Implications for Rehabilitation Eye-gaze assistive technology (EGAT) as an access method to control a computer can provide opportunities for children with severe motor and communication difficulties to participate in computer activities. Children with severe motor and communication difficulties and low eye-control skills with sufficient practice can learn to use EGAT for communication and learning, with support from stakeholders and collaborative service. EGAT could be introduced for children with complex needs at early ages as a means of using computers for play, communication, and school learning, which could be helpful for later education and learning. Stakeholders in educational environments could include EGAT in educational computer systems so that pupils with severe motor and communication difficulties could interact with a computer, thereby enhancing their engagement and learning.

773 BARRIERS TO RECOGNISING PAIN IN PATIENTS WITH DEMENTIA AND DELIRIUM ON A HEALTHCARE OF THE ELDERLY INPATIENT WARD

Abstract Introduction Pain is often poorly recognised and remains under-treated in older patients, especially those who are unable to articulate their discomfort. In those with severe cognitive impairment or communication difficulties, recognition of the non-verbal manifestations of pain is needed to ensure patient comfort. Understanding how likely these patients are to have pain, how we improve recognition of the signs of discomfort, and encouraging doctors to think about prescribing analgesics will allow these patients to retain their dignity, and reduce their physical and psychological distress during their inpatient stays. Method Over two periods in 2019–2020, pre and post introduction of Abbey Pain Scale. Inpatients on a HCE ward >65 years old Diagnosis of dementia and/or delirium Review of pain scores on the observation charts, analgesia and documentation of sources of pain. Results 75 patients were reviewed, 39% with delirium, 45% with dementia Pain was often not considered during medical assessments, even if patients had presented with a fall 56% had a potential source of pain identified either in their medical or nursing notes, however there was disparity between these The majority of sources of pain were chronic joint issues or injuries sustained from falls Patients had their observations checked 2–4 times/day. A pain score was entered 56% of the time and less frequently in: diabetics (due to chart layout), long-stayers and those who refused their observations Use of the Abbey Pain Scale made no significant difference. Conclusion (s). Disparity between notes highlighted a gap in communication. There is a risk of complacency with long-staying patients. Ketone readings are recorded over the pain score area on the observation charts, this needs to change. Refusing observations may be a sign of pain and staff should be more vigilant in these cases. A more integrative tool to monitor pain is required.

Comparing participation in sports discussion and art therapy groups in ABI

AbstractBackground:Social connection is often impacted by acquired brain injury (ABI), contributing to isolation and compromised mental health. Group therapy is thought useful in this context. For those experiencing cognitive communication challenges, finding alternative ways to engage is also valuable. Art therapy may offer pro-social support through shared activity, self-expression, organic subject matter and enduring visual prompts.Method:A multiple A-B-A single case experimental design compared participation in sports discussion and art therapy groups on a long-stay secure unit. Nine individuals with ABI and complex combinations of communication, cognitive and mental health needs were studied. It was hypothesised that for some individuals, participation would be greater in art therapy than sports discussion groups.Results:Results from six individuals with at least five measurement points per phase are reported. Tau statistics revealed significant interphase differences for three individuals. Significantly less participation was recorded for two individuals in art than sports discussion, however they still appeared invested in the art groups. The remaining participant, with the most severe communication difficulties, avoided all baseline sports discussion groups, but participated in almost all art groups, with significant increase between initial sports discussion and art phases.Conclusion:Further research is warranted regarding the potential art therapy offers for group engagement, particularly where complex challenges render traditional talking-style groups less appropriate. Furthermore, disparate and complex needs in severe ABI require diverse, well-designed groups offering different opportunities and responding to individual strengths and motivations. More research into such approaches may increase group participation in this challenging cohort.

Unaided communication behaviours displayed by adults with severe cerebrovascular accidents and little or no functional speech: A scoping review.

Unaided communication behaviours may provide communication support for persons with severe cerebrovascular accidents (CVA), as these individuals often experience severe communication difficulties, regardless of the aetiology. Though often subtle, these behaviours are present during all stages of recovery, and therefore communication partners need to know not only which unaided strategies are used as communication attempts, but also what their function is (i.e., what the person aims to achieve with the communication). To identify the unaided communication behaviours that adults with severe CVA and little or no functional speech use to communicate, and to determine the communication functions addressed by these behaviours. The study used a scoping review methodology and included articles on communication partners of persons with CVA published between 1986 and 2020. Initially the searches yielded 732 studies from which 211 duplicates were identified. The remaining studies (n = 531) were then screened on title, abstract and full-text level resulting in a final inclusion of 18 studies. Of the 18 studies, five were qualitative and 13 consisted of quantitative methodologies. The subtle communication behaviours used by persons with CVA (and resultant severe communication difficulties) are often misinterpreted or overlooked by their partners. If partners are trained to recognise such subtle or unaided communication behaviours, they can provide adequate support to access a range of communication functions. The unaided communication behaviours, which include 13 primary behaviours ranging from non-linguistic to linguistic, were utilised to convey 31 communication functions classified into four main communication categories. Although unaided communication behaviours often appear as limiting, they can be utilised to communicate various communication functions. The findings of this review support the training of partners to identify these behaviours and improve person-partner communication. WHAT IS KNOWN?: Unaided communication has been widely researched. However, a summary is needed of the various unaided communication behaviours and of the different communication functions addressed by these behaviours. What the paper adds… This paper emphasises that unaided communication behaviours range from non-linguistic to linguistic, and they can support unintentional, pre-intentional and intentional communication functions. Clinical implications Even though aided communication is preferred, unaided communication behaviours are generally used in contexts with limited resources, as well as among culturally and linguistically diverse populations. This study advocates the identification of unaided communication behaviours by partners as well as the support and provision of access to communication strategies for persons with severe CVA. Future research should include more untrained communication partners.

Expanding arts therapies provision: a pilot project in Older Adult Mental Health Services, Aneurin Bevan University Health Board

ObjectivesThe aim of the report is to summarise the progress made during a six-month pilot project expanding arts therapies provision from an inpatient service to community services, in a National Health Service health board's Older Adult Mental Health Services, in response to the need for direct therapy with older adults who have severe cognitive impairment and communication difficulties arising from dementia and/or complex mental health difficulties. Study designThis is a case report on a pilot project. MethodsThe level of need for the service was explored, and indicators of effectiveness were gathered using evaluation forms—observer feedback forms and ARM-5 (Agnew Relationship Measure - 5) - to indicate the therapeutic alliance, team review and feedback from colleagues. ResultsTo gather indications about the level of need, we recorded the following: number of referrals (n = 125) and waiting list numbers at the end of the project (n = 34). ConclusionsThis pilot project indicates that there is need for psychological interventions in older adult community mental health services that arts therapies provision can help address. The number of referrals is one indicator of the level of need, and positive feedback from clients, families and colleagues, is an indicator that the team delivered effectively. The areas of client need addressed in sessions as documented in observer feedback forms indicate that for these clients, arts therapies was a valuable resource in addressing challenges arising from mental health difficulties and/or dementia.

Conversation analysis, psychopathology and subjective experience in patients with schizophrenia

IntroductionPatients with schizophrenia show severe difficulties in interpersonal communication, including impairments in conversation skills, like the turn-taking. To our knowledge, very few studies to date have taken into account conversation analysis in order to investigate turn-taking in schizophrenia patients.ObjectivesTo investigate the conversational patterns in schizophrenia patients; to assess possible associations between dialogic features, abnormal subjective experiences and symptom dimensions.MethodsThirty-six patients with Schizophrenia underwent an interview, subsequently analyzed with an innovative semi-automatic analysis. Positive and Negative Syndrome Scale (PANSS) was adopted for the investigation of psychopathology and Examination of Anomalous Self Experience (EASE) for Self-Disorders.ResultsDialogic exchanges are graphically represented in Figure 1. An inverse correlation was found between participant speaking time and PANSS negative symptoms score (r = -0.44, p value < 0.05; Figure 2), whereas no associations were found between conversational variables and PANSS positive or disorganization dimensions. Finally, a positive correlation was found between the EASE item “spazialization of thought” and average pause duration (r = 0.42, p value < 0.05).ConclusionsThe finding of a relationship between negative symptoms and conversational patterns suggest that conversational features in schizophrenia are expression of the “core” negative dimension of the disorder. The association with the phenomenon of thought spatialization seems to suggest that the disturbances of the stream of consciousness impact on natural dialogic interactions. Ultimately, conversation analysis seems a promising tool to study dialogic exchanges of patients with schizophrenia.DisclosureNo significant relationships.

Speech Prosody as a Bridge Between Psychopathology and Linguistics: The Case of the Schizophrenia Spectrum

Patients with schizophrenia spectrum disorders experience severe difficulties in interpersonal communication, as described by traditional psychopathology and current research on social cognition. From a linguistic perspective, pragmatic abilities are crucial for successful communication. Empirical studies have shown that these abilities are significantly impaired in this group of patients. Prosody, the tone of voice with which words and sentences are pronounced, is one of the most important carriers of pragmatic meaning and can serve a range of functions from linguistic to emotional ones. Most of the existing literature on prosody of patients with schizophrenia spectrum disorders focuses on the expression of emotion, generally showing significant impairments. By contrast, the use of non-emotional prosody in these patients is scarcely investigated. In this paper, we first present a linguistic model to classify prosodic functions. Second, we discuss existing studies on the use of non-emotional prosody in these patients, providing an overview of the state of the art. Third, we delineate possible future lines of research in this field, also taking into account some classical psychopathological assumptions, for both diagnostic and therapeutic purposes.

Relationships between reading profiles and narrative writing abilities in school-age children with autism spectrum disorder

Reading and writing are distinct skill areas that influence each other across development. Children with autism spectrum disorder (ASD) are noted to exhibit challenges in both skill areas, though relatively few studies have examined relationships between reading and writing skills. This study adopted a reading-to-writing framework to examine if school-age children differ in their narrative writing performance based on their categorically heterogeneous, empirically derived latent reading profiles. Sixty-four school-age (10–18 years old) children with ASD without co-occurring intellectual or severe communication difficulties completed a battery of reading and writing assessments, and reading profiles were examined using latent profile analysis with narrative writing skills, ASD symptom severity, and age included as auxiliary outcome variables. Average readers demonstrated significantly higher narrative writing performance compared to Below Average/Intact Receptive Vocabulary, Comprehension Disturbance, and Global Disturbance readers. Subgroups of readers with reading difficulties did not significantly differ on writing outcomes. While findings support that stronger readers appeared to be also stronger writers, questions remain about differences in the writing skills of individuals with ASD with specific or broad reading difficulties. Implications for researchers and practitioners are discussed regarding the need for continued examination into the reading and writing abilities of children with ASD.

The concomitant lower concentrations of vitamins B6, B9 and B12 may cause methylation deficiency in autistic children

Autism spectrum disorder (ASD) is characterized by severe and persistent difficulties in social communication and social interaction at multiple levels. Recently, metabolic disorders have been associated with most cases of patients with ASD. The aim of this study was to investigate, through a new and more sophisticated mass technique, such as UHPLC-mass spectrometry (Q-exactive analyzer), alteration in metabolisms analyzing ASD children urine samples from children showing simultaneous vitamin B6, B9 and B12 deficiencies. This in order to study how these concurrent deficiencies may influence some phenotypic aspects of autistic disorder. Thus, urinary metabolic patterns specific to ASD were explored at an early age in 60 children with ASD, showing lower three vitamins levels, and 60 corresponding controls (age group 3–8, M: F=42:18). The results showed significant block of cystathionine formation with consequent accumulation of homocysteine. A lower glutathione levels (GSH), with reduction of essential intracellular reducing environment required for normal immune function, detoxification capacity and redox-sensitive enzyme activity. Increased concentration of 5-methyltetrahydrofolate, which leads to a lower availability of methyl group and significant decrease in urinary methionine and S-adenosyl-L-methionine (SAM) concentrations, the major methyl donor. The latter justify the well-known reduction in protein and DNA methylation reported in autistic children. As a final consideration, the concomitant deficiencies of all three B vitamins, recorded in a significant number of autistic children, suggests that intestinal dysbiosis in these patients may be the main cause of a reduction in their absorption, in addition to the genetic mutation of a specific gene.

Do patients with severe poststroke communication difficulties have a higher incidence of falls during inpatient rehabilitation? A retrospective cohort study

ABSTRACTBackground: Falls in hospital are common and serious complications of stroke. Associations have been found between communication disorders and increased rates of falls, but have received relatively little consideration as a risk factor for falls among stroke survivors.Objectives: To investigate whether there is an association between severe communication impairment and falls among patients receiving inpatient rehabilitation after stroke.Methods: A retrospective audit of 149 records of consecutive patients admitted to an inpatient rehabilitation facility after stroke over a two-year period was conducted. The relationship between falls and severe communication impairment was explored using (1) direct comparison of falls in patients with and without functional communication for the inpatient ward environment and (2) multivariate logistic regression to examine factors that may predict falls, including presence or absence of functional communication. In each analysis, falls were examined both as a binary outcome (fall or no fall), and the rate of falls per day.Results: The 32 patients in the sample (21.7%) who were unable to communicate their basic needs were almost twice as likely to fall in hospital as those with functional communication (RR 1.94, 95% CI 1.15 to 3.24). Several commonly assessed factors were not significant predictors of falls (including falls history, polypharmacy, and cognitive impairment) in this population. Lack of functional communication was the strongest independent predictor of falls rate.Conclusions: Findings suggest that severe communication disorders may be under recognized as a falls risk factor after stroke.

Improving the effectiveness of communication in hospitals for people with communication difficulties: results of an online Phase II survey.

In a recent paper a working group set up by the Lay Advisory Committee of the Royal College of Physicians of Edinburgh (RCPE) had looked into the problems of patients with severe communication difficulties in hospital (J R Coll Physicians Edinb 2017; 47: 211-3). The present online survey expands on this with the objective of garnering the views of physicians on this matter. An invitation aimed at physicians to complete an online survey was made through the recently published paper. The survey was open between September and December 2017. There were 83 completed surveys. A total of 69 of the returns were UK based, with the remainder from Asia, Australia, Africa and non-UK Europe and one unidentified location. The majority (44) were consultants, the remainder included those in core medical training, general practice and psychology. A wide range of medical departments were represented in the returns, with the largest returns coming from care of the elderly and acute medical departments. Four key themes were highlighted by responders: time, training, resources and environment. Based on these results, the working group have embarked upon the next phase of the project with three main tasks: firstly, to work with the RCPE to disseminate the survey findings to a wider audience; secondly, to collate the detailed suggestions for improvement to be used alongside the survey findings and any subsequent documentation or advice; thirdly, to formulate with the RCPE a strategy to promote good practice in hospitals related to the experiences of patients with severe communication difficulties.