Engagement in Clinical Interaction: An Introduction

This article defines and reviews the concept of engagement in social interaction. Engagement refers to the level of interpersonal involvement displayed by participants in social situations. Various signals, including both spoken and unspoken signals, display engagement of participants in social exchanges. Engagement has been studied from a variety of perspectives, such as language development in children, educational interactions, human-machine exchanges, and medical encounters. Engagement can be conceptualized from a global level (e.g., engagement of persons with a disability in community life) to a local level (e.g., engagement in a particular conversation). Engagement has not been widely studied in the field of speech-language pathology. Therefore, this special issue on engagement in clinical interactions is offered to provide insights that may help clinicians consider methods of improving clinical practices by heightening client engagement in clinical interactions and communicative exchanges.

from Seminars in Speech and Language

Engagement in Group Therapy for Aphasia

For group therapy for aphasia to be maximally effective, group members must be engaged in the clinical interaction. Engagement is a process through which people establish, maintain, and terminate collaborative exchanges. To investigate the interactive resources employed for managing and monitoring engagement in group therapy interactions, two videotaped conversation therapy groups for aphasia were analyzed via conversation analysis. Examples of clinician behaviors that engaged group members included gaze, body orientation, gesture, and mirrored acts. In addition, gaze, gesture, body position, and shared laughter provided evidence of engagement of group members. The study of these subtle interactive elements within clinical discourse provides information about the mechanisms that promote successful clinical interactions.

from Seminars in Speech and Language

Engagement: A Concept and Some Possible Uses

This article examines how the term engagement has been used in various literatures. The construct of engagement is found to have advantages over other similar constructs in that it portrays degrees of involvement, it readily assumes the point of view of the person with disability, and it conveys involvement in interpersonal relationships as well in ongoing imagined or directly experienced activities. The article concludes with a set of points that can help create a framework for incorporating the construct of engagement into clinical practice, including the creation of climates for fostering engagement and indicators for measuring it.

from Seminars in Speech and Language

A Generalized Mechanism for Perception of Pitch Patterns

Surviving in a complex and changeable environment relies on the ability to extract probable recurring patterns. Here we report a neurophysiological mechanism for rapid probabilistic learning of a new system of music. Participants listened to different combinations of tones from a previously unheard system of pitches based on the Bohlen-Pierce scale, with chord progressions that form 3:1 ratios in frequency, notably different from 2:1 frequency ratios in existing musical systems. Event-related brain potentials elicited by improbable sounds in the new music system showed emergence over a 1 h period of physiological signatures known to index sound expectation in standard Western music. These indices of expectation learning were eliminated when sound patterns were played equiprobably, and covaried with individual behavioral differences in learning. These results demonstrate that humans use a generalized probability-based perceptual learning mechanism to process novel sound patterns in music.

from the Journal of Neuroscience

Laughter and Communicative Engagement in Interaction

We examined if and how laughter functioned communicatively as an indicator of engagement in group interactions involving adults with traumatic brain injury (TBI). Engagement refers to the intensity and manner of interpersonal involvement displayed by participants in social situations, and it reflects the extent to which they are mutually engrossed in, and alive to, the unfolding interaction. Analysis revealed that laughter functioned communicatively to support the “face,” or public self-image, of those with TBI and to foster rapport and social closeness.

The distribution of laughables, or verbal and nonverbal behaviors that occasion laughter, between participants was also examined and compared with data collected by Simmons-Mackie and Schultz in their analysis of humor during traditional aphasia therapy. Results revealed that laughter and laughables are sensitive to how individuals engage one another in interaction. Implications are considered with respect to more recent models of intervention that seek to promote more discourse equality between participants.

from Seminars in Speech and Language

Oral contraceptive pill containing drospirenone and the professional voice: An electrolaryngographic analysis

Few studies have been concerned with the effects of combined oral contraceptive pills (OCP) on those who use their voices as a tool of trade. A cohort study involving 20 female professional voice users was carried out assessing irregularity of vocal fold vibration, based on: 1) period-to-period frequency peaks (CFx), and 2) period-to-period amplitude peaks (CAx) in the cycle-to-cycle excitation of the vocal tract. These vocal measures and blood samples were collected at three points of the menstrual cycle, for both natural and OCP cycles. No significant differences were found in vocal parameters assessed between the natural and OCP cycles. The intake of this OCP was not found to have a systematic effect on the vocal parameters studied. Based on these results the modern OCP preparations can be considered safe medications which do not have a negative effect on voice quality in professional voice users.

from Logopedics Phoniatrics Vocology

A Generalized Mechanism for Perception of Pitch Patterns

Surviving in a complex and changeable environment relies on the ability to extract probable recurring patterns. Here we report a neurophysiological mechanism for rapid probabilistic learning of a new system of music. Participants listened to different combinations of tones from a previously unheard system of pitches based on the Bohlen-Pierce scale, with chord progressions that form 3:1 ratios in frequency, notably different from 2:1 frequency ratios in existing musical systems. Event-related brain potentials elicited by improbable sounds in the new music system showed emergence over a 1 h period of physiological signatures known to index sound expectation in standard Western music. These indices of expectation learning were eliminated when sound patterns were played equiprobably, and covaried with individual behavioral differences in learning. These results demonstrate that humans use a generalized probability-based perceptual learning mechanism to process novel sound patterns in music.

from the Journal of Neuroscience

Princess opens speech therapy centre for disabled

The Princess Royal has opened an education centre in Bristol to help disabled children improve their communication skills.

from Topix.net

Intact Spectral but Abnormal Temporal Processing of Auditory Stimuli in Autism

Abstract The perceptual pattern in autism has been related to either a specific localized processing deficit or a pathway-independent, complexity-specific anomaly. We examined auditory perception in autism using an auditory disembedding task that required spectral and temporal integration. 23 children with high-functioning-autism and 23 matched controls participated. Participants were presented with two-syllable words embedded in various auditory backgrounds (pink noise, moving ripple, amplitude-modulated pink noise, amplitude-modulated moving ripple) to assess speech-in-noise-reception thresholds. The gain in signal perception of pink noise with temporal dips relative to pink noise without temporal dips was smaller in children with autism (p = 0.008). Thus, the autism group was less able to integrate auditory information present in temporal dips in background sound, supporting the complexity-specific perceptual account.

from the Journal of Autism and Developmental Disorders

Subacute onset of deafness and vertigo in a patient with leptomeningeal metastasis from ovarian cancer

Abstract Ovarian carcinoma is a common gynecological malignancy. Distant metastases usually involve the liver and lung while neurological complications are rare. We describe the case of a 63-year-old woman diagnosed from an ovarian carcinoma with peritoneal seed, which was treated surgically and with chemotherapy. After 4 years she was admitted to our Department for the development of subacute right deafness, vertigo and imbalance. MRI revealed the presence of leptomeningeal carcinomatosis and an expansive formation in the right pontocerebellar angle, suggesting involvement of the right VIII cranial nerve. Examination of the cerebrospinal fluid disclosed the presence of neoplastic cells. Subsequently the patient rapidly deteriorated and eventually died. Involvement of VIII cranial nerve as the presentation of leptomeningeal carcinomatosis in ovarian carcinoma is rare. In the literature at least two other cases presented with deafness, suggesting that leptomeningeal carcinomatosis should be considered in the differential diagnosis when deafness appears in a cancer patient.

from Neurological Sciences

Evidence of persisting cognitive impairment in a case series of patients with locked-in syndrome

Objective: Previous research on cognition and locked-in syndrome (LIS) is limited to single case reports, and usually reported normality of performance. Here, cognitive disorders in a group of LIS patients are investigated, using a specific test relying only on a yes/no response indicated by eye movements or verbally.
Methods: Nine patients with LIS resulting from brainstem stroke were compared with seven patients with frontal or frontotemporal lesions and 16 matching normal control subjects. The test comprised 19 subtests of perception (visual and auditory recognition), oral comprehension (identity, words and sentences), written comprehension (words and sentences), orientation (in time and place), immediate and delayed memories (verbal and visuo-spatial information), calculation and problem solving, and analysis of verbal logic.

Results: LIS patients showed significant difficulties in auditory recognition (associative level), oral comprehension of complex sentences, delayed visuospatial memory, mental calculation and problem solving. Patients with hemispheric lesions were more severely impaired. Single case analysis revealed that four LIS patients showed cognitive disorders in at least three subtests. These disorders were not related to a specific localisation of lesions.

from the Journal of Neurology, Neurosurgery, and Psychiatry

Hearing preservation and intraoperative auditory brainstem response and cochlear nerve compound action potential monitoring in the removal of small acoustic neurinoma via the retrosigmoid approach

Objective: Hearing preservation is the main focus of small acoustic neurinoma (AN) removal. Refinement of intraoperative auditory monitoring may improve postoperative hearing. We have introduced a newly designed intracranial electrode enabling continuous monitoring of the cochlear nerve compound action potential (CNAP). We performed simultaneous monitoring of the auditory brainstem response (ABR) and CNAP during retrosigmoid small AN removal, and clarified the surgical outcome and the usefulness of CNAP monitoring.
Methods: Twenty-two consecutive patients with a small AN underwent retrosigmoid tumour removal with attempting hearing preservation. ABR and CNAP were simultaneously monitored during tumour removal.

Results: AN was totally removed in all patients without facial palsy. Preservation rate of useful and serviceable hearing was 82% and 91%, respectively. During microsurgical tumour removal, various surgical equipments and procedures intensified artefacts of ABR, and reliable ABR monitoring with distinct wave V was obtained in 9/22 patients. Unaffected by artefacts, reliable CNAP monitoring was obtained more frequently (in 20/22 patients) than ABR (p = 0.0005). CNAP on completion of tumour removal predicted hearing preservation with no false positive or negative (100% sensitivity and 100% specificity). CNAP changed dynamically and stepwise with surgical manipulations.

Conclusion: The retrosigmoid approach using auditory monitoring for a small AN can accomplish total tumour removal with an excellent hearing preservation rate. CNAP provides reliable auditory monitoring more frequently than ABR, reflects the intraoperative auditory function almost in real-time, predicts postoperative hearing with excellent sensitivity and specificity, and is more useful for monitoring in the removal of small AN with hearing preservation.

from the Journal of Neurology, Neurosurgery, and Psychiatry

Smoking, dementia and cognitive decline in the elderly, a systematic review

Nicotine may aid reaction time, learning and memory, but smoking increases cardiovascular risk.

from Topix.net

An approach to tinnitus management

A 46-year-old man presented with a 4-month history of tinnitus. Six months earlier, he had experienced a dental infection. Two months later, he noticed the tinnitus one day upon awakening. He also noticed bi-frontal pressure in his head that extended across the temporal area and a feeling of dizziness with associated nausea. He remained in bed for the rest of that day, and when he awoke the next morning, his symptoms were completely gone.

from Ear, Nose & Throat Journal

Evidence of persisting cognitive impairment in a case series of patients with locked-in syndrome

Objective: Previous research on cognition and locked-in syndrome (LIS) is limited to single case reports, and usually reported normality of performance. Here, cognitive disorders in a group of LIS patients are investigated, using a specific test relying only on a yes/no response indicated by eye movements or verbally.
Methods: Nine patients with LIS resulting from brainstem stroke were compared with seven patients with frontal or frontotemporal lesions and 16 matching normal control subjects. The test comprised 19 subtests of perception (visual and auditory recognition), oral comprehension (identity, words and sentences), written comprehension (words and sentences), orientation (in time and place), immediate and delayed memories (verbal and visuo-spatial information), calculation and problem solving, and analysis of verbal logic.

Results: LIS patients showed significant difficulties in auditory recognition (associative level), oral comprehension of complex sentences, delayed visuospatial memory, mental calculation and problem solving. Patients with hemispheric lesions were more severely impaired. Single case analysis revealed that four LIS patients showed cognitive disorders in at least three subtests. These disorders were not related to a specific localisation of lesions.

Conclusions: Moderate and selective cognitive disorders can be observed in LIS patients. Systematic assessment is needed, because of their possible consequences for communication and rehabilitation protocols.

from the Journal of Neurology, Neurosurgery, and Psychiatry