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Communication abilities and work reentry following traumatic brain injury
No full textThe purpose of this exploratory study was to determine if a single communication measure or combination of measures could discriminate employed from unemployed individuals with traumatic brain injury (TBI). Twenty adult subjects (ten employed and ten unemployed), one to four years post injury, with comparable severity of injury and type of work participated in the study. Each subject was given ten communication tests measuring: auditory processing (Filtered Words, Auditory Figure Ground, Competing Words, and Competing Sentences subtests of the SCAN-A); the effects of speaking under time pressure (FAS and Rapid Automatized Naming); production of oral language (local coherence); language ability (Aphasia Quotient portion of the Western Aphasia Battery); and functional verbal reasoning ability (Scheduling and Planning an Event subtests of the Functional Assessment of Verbal Reasoning (FAVR)). Results revealed that when a combination of three communication tests, the Scheduling subtest of the FAVR, and the Filtered Words and Competing Sentences subtests of the SCAN-A, was used, the model correctly classified 85% of employed and unemployed individuals. The findings suggest that both impairment and disability-based tasks (i.e. those measuring activities that reflect daily communication) may be more revealing than the impairment-level tasks alone that frequently appear in the TBI and work re-entry literature. Impairment and disability level communication tasks may provide functional and practical information, which can be used to assist in work re-entry
Assessment of Social Cognition by Site of Lesion in Adults with Traumatic Brain Injury Using the Visual Social Inference Test
Get PDFIndividuals with Traumatic Brain Injury (TBI) exhibit impaired performance on social cognition and theory of mind (ToM) measures, like the Video Social Inference Test (VSIT). The frontal lobe, being the primary region involved in higher level cognitive functions mediates the neural mechanisms involved in social cognition and ToM abilities, according to studies on brain and behaviour. The goal of this study was to examine if individuals with TBI who did not damage their frontal lobe would perform differently on the VSIT than individuals with TBI who did. This study was a secondary analysis of documented imaging data and VSIT scores obtained from 51 adults with moderate-to-severe TBI (23 females). A comparison was made between scores obtained on the VSIT between participants with and without frontal lobe lesions. The results indicated that there was no significant difference between the two groups, in other words, site of lesion in participants with TBI did not predict performance on the VSIT. The results suggest that while the VSIT may yield critical information about social cognition, it is not sensitive to individual site of lesion. There is evidence that aspects of social cognition are impaired in this clinical population, however, most research in this area is obstructed by the complex nature of TBI neuropathology in addition to small heterogenous samples involved in studies. Further research in this area is required in order to reveal and enhance our understanding of social cognition deficits following TBI.
Keywords: social cognition, traumatic brain injury, theory of mind, frontal lobe lesions, video social inference testThesisMaster of Science (MSc
AN AUGMENTATIVE AND ALTERNATIVE VOCABULARY FOR NON-SPEAKING PATIENTS TO PARTICIPATE IN THEIR GOALS OF CARE/END-OF-LIFE DISCUSSIONS IN INTENSIVE CARE
No full textThis dissertation explores the vocabulary needed by non-speaking patients who use Augmentative and Alternative communication (AAC) to participate in their Goals of Care/End of Life (GoC/EoL) discussions in Intensive Care (ICU). Chapter One provides a foundation for this thesis, by describing adults who are non-speaking in Intensive Care (ICU): the circumstances that lead to them being non-speaking, barriers to their use of aided and unaided communication, and risks associated with not being able to communicate in the ICU. To set the context for the importance of AAC services, strategies and tools for non-speaking patients, this chapter begins with a review of the literature on the moral, legal, and ethical arguments for supporting patients to be involved in any discussions and decisions about their care and medical treatments while in ICU. The review shows the gap in knowledge of AAC for GoC/EoL discussions and decision making and the clinical need that form the rationale for the research question.
Chapter Two presents a qualitative study that explores the experiences of adult patients who had been non-speaking and their families during their ICU stay when the patient used AAC to discuss their GoC/EoL preferences and decisions. Themes emerging from the data highlight the unmet communication needs of these patients and the need for further development of a AAC vocabulary system that can improve patients' ability to participate in their own GoC/EoL discussions.
Chapter Three presents an Inclusive Design study that involved collaborative design with patients who use AAC to create a new AAC vocabulary system for GoC/EoL discussions in ICU using a high-tech, speaking software platform. This study resulted in a high-resolution working prototype that, once refined, could be made available worldwide using an online sharing portal.
Chapter Four presents a survey study that explores health professionals’ perspectives of this prototype designed in Grid 3 speaking software (Sensory Software). This study found that health professionals agreed that 70% of the GoC vocabulary would enable non-speaking people to communicate during their GoC/EoL discussion. Participants suggested over 100 new phrases to enhance the vocabulary, and this will be used to make another prototype ready for testing with non-speaking patients in ICU during their GoC discussions and decision-making.
Finally, Chapter Five reviews the purpose of this dissertation and gives an integrated overview of the overall findings. This chapter discusses the contributions of this dissertation to clinical practice in ICU as well as it’s contributions to the field of AAC. Equipment recommendations are made to enhance the AAC vocabulary in clinical practice in ICU. Design improvements, clinical trials of the GoC/EoL vocabulary and knowledge translation approaches are recommended. Chapter Five also focuses on the rights of non-speaking patients and posits that results from this dissertation could form part of a moral argument for greater patient agency and inclusion in ICU. These patients have a right to – and wish to – participate in all aspects of daily living, including engaging in shared decision-making with their family and health care staff about their care during critical healthcare treatments and possibly during the twilight of their life.ThesisDoctor of Philosophy (PhD)The goal of this work is to make it easier for people in hospital, who cannot speak, to still communicate using words and pictures instead. Sometimes people want to communicate about their care in hospital. People in hospital (patients) get offered many different treatments and if they are very ill they may need Intensive Care. We were able to interview patients who could not speak and used words and pictures in hospital. These patients did not have enough words and pictures to communicate what they wanted. They told us they were being left out of conversations about their care and treatments. The patients had suggestions about what they needed to communicate in hospital.
We gathered five people who were already used to communicating by choosing words and pictures on a computer. These five people and the researchers talked about the experiences and needs of the hospital patients in a workshop. The five people in the workshop suggested words and pictures to match the needs of hospital patients. Once the word/picture list was made this was put into a speaking app on a computer by the lead researcher. The five people tested the words and pictures on this computer app and noted that it was easy to use. To make sure we had not missed anything we asked health care workers to test the speaking app. Health care workers agreed that most of the words and pictures would help people to talk about their care and make treatment decisions. These Health care workers suggested over 100 extra question words and comments to add to the program to make it better. The resulting computer app was called a Goals of Care Vocabulary
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
IMPACT-ICU: IMPROVED UPTAKE AND UNDERSTANDING OF RESEARCH IN THE INTENSIVE CARE UNIT
Get PDFPhysical rehabilitation (PR) started in the intensive care unit (ICU) may mitigate the physical functional impairments often experienced by survivors. The field of ICU-based PR research is growing; however, trials have had mixed results. While conducting this research, we must consider that deciding whether to participate in clinical research can be stressful for patients and families. This PhD thesis, consisting of four manuscripts, addressed two distinct aims.
One explanation for the mixed results in ICU-based trials of PR may be differences across studies in the characteristics of comparator groups. Thus, the first aim was to advance our understanding of comparator groups in this context. The first manuscript (Chapter 2) was a scoping review of the type, content and reporting of comparator groups in 125 ICU-based trials of PR. The second manuscript (Chapter 3) was a secondary analysis of usual care PR received by 30 patients (262 study days) in the comparator group of an ICU-based pilot randomized trial of early in-bed cycling. Together, these manuscripts facilitate the understanding and uptake of current evidence describing comparator groups in ICU-based trials of PR.
Traditional research consent forms are long and scientific, particularly for complex interventions and trials, making them challenging to explain and understand in stressful environments such as the ICU. The second aim of this PhD thesis was to support communication for patients, families, and research coordinators during informed consent for a complex ICU-based trial. The first manuscript (Chapter 4) was a protocol for a mixed methods study to co-design and pilot-test a consent infographic. The second manuscript (Chapter 5) reported results of a six-month multi-centre pilot and feasibility study implementing the infographic. Together, these manuscripts provide a foundation for the future evaluation of a consent infographic, which may ease uptake and understanding of trial information during consent discussions.DissertationDoctor of Philosophy (PhD)Individuals admitted to the intensive care unit (ICU) may experience a decrease in their physical function for several years after leaving the hospital. To improve outcomes for individuals who survive critical illness, research in physical rehabilitation is rapidly growing. However, recent studies have had mixed results. One explanation for these mixed results may be that similar interventions are assessed against different comparator groups. Thus, the first two papers of this PhD thesis aimed to develop an understanding of comparator groups in studies of physical rehabilitation conducted in the ICU.
In addition, with this research occurring during a time of heightened stress, it is important that we consider ways to improve the experience of being asked to participate in research for patients and their families. The second two papers of this thesis describe the design and pilot testing of an infographic to support communication during research consent
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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