Technology-Driven Dyadic Interaction Support for Community-Dwelling People With Dementia and Family Caregivers

People with dementia and their family caregivers struggling with the impacts of the condition on cognitive abilities, experience deterred social interactions and strained relationships. Technology can potentially sustain the relationship by engaging dyads in joint activities and supporting their interaction. This study aimed to evaluate the impact of a tablet-based activation system, I-CARE, specifically designed to engage people with dementia in meaningful activities. In this intervention, community-dwelling people with dementia and their family caregiver engaged in joint activities supported by the I-CARE system. Quantitative measures on quality of life, relationship quality and caregiver burden are collected, while semi-structured interviews explore the impact of Covid-19, as well as what motivates the participants to invite technology into their dyadic interactions. Our findings provide important insight in how technology can support social health and relationship sustenance of dyads living with dementia, and what implications Covid-19 has for their social participation in society.

Language and Movement Synchronization in Dyadic Psychotherapeutic Interaction – A Qualitative Review and a Proposal for a Classification

In individual psychotherapy verbal communication and movement synchronization are closely interrelated. The microanalysis of timing, rhythm and gestalt of movement has established dynamic movement coordination as a systemic property of the dyadic interaction. Movement synchronization supports and enhances the unfolding of linguistic meaning. In order to substantiate the importance of the concept of synchrony for adult psychotherapy we review evidence from developmental psychology and discuss approaches to measure synchrony with particular reference to the naturalistic setting of dyadic psychotherapy. As the concept of synchrony is still ambiguous, and the respective interactional phenomena are ephemeral and fluid, in the current paper we suggest a set of five criteria for the description of synchronization in general terms and eight additional criteria which specifically enable the description of phenomena of movement synchronization. The five general dimensions are: (1) context, (2) modality, (3) resources, (4) entrainment, and (5) time-lag. The eight categories for the description of movement synchrony are: (1) spatial direction, (2) amplitude, (3) sinuosity, (4) duration, (5) event structure, (6) phase, (7) frequency, and (8) content. To understand the process of participatory sense-making and the emergence of meaning in psychotherapy, synchrony research has to cope with the multimodality of the embodied interaction. This requires an integrated perspective of movement and language. A system for the classification of synchrony phenomena may contribute to the linking of variations and patterns of movement with language and linguistic utterances.

Alone Again: Altered Activation in the Observation Execution System during Synchronization in High Loneliness Individuals

Lonely people evaluate social exchanges and relationships negatively and display difficulties in interpersonal interaction. Interpersonal synchronization is crucial for achieving positive interactions, promoting affinity, closeness, and satisfaction. However, little is known about lonely individuals ability to synchronize and about the activity in the lonely brain while synchronizing. In the present neuroimaging study, 64 participants engaged in interpersonal synchronization, using a novel paradigm involving real dyadic interaction. Results show that high loneliness individuals exhibited a reduced ability to adapt their movement to their partners movement. Intriguingly, during periods in which participants adapted their movement, high loneliness individuals showed increased activation in the observation-execution (OE) system, specifically in the inferior frontal gyrus (IFG) and the inferior parietal lobule (IPL). They did not show increased activation in the dmPFC, which in the context of synchronization was suggested to be related to gap-monitoring. Based on these findings, we propose a model according to which lonely people may require a stronger activation of their OE system for movement alignment to compensate for some deficiency in their ability to synchronize. However, despite this hyper-activation, they still suffer from reduced synchronization capacity. Consequently, synchronization may be a relevant intervention area for the amelioration of chronic loneliness.

HEALTHCARE PROVIDER PATIENT NONVERBAL COMMUNICATIVE BEHAVIOUR ON DIABETES MELLITUS MANAGEMENT PRACTICES IN SELECTED HOSPITALS IN KENYA

Purpose: To examine the effect of healthcare provider patient communication nonverbal communicative behaviour on diabetes mellitus management practices in selected hospital in Kenya. Methodology: This was a causal comparative research design study with application of quantitative methodology. The study was carried out at Kenyatta National Hospital (KNH) and MP Shah Hospital. Systematic random sampling was used to sample patients. 400 participants were involved in the study and comprised 313 patients at KNH and 87 patients at MP Shah Hospital studied between the months of February 2019 and November 2019. The researcher administered questionnaire was used to collect data. The results were summarized using percentages and means or medians for categorical and continuous data respectively. Comparisons were done using chi square test of association of categorical variables and independent t-test for comparison of means. Linear regression and ANOVA were used to test for associations and hypothesis between healthcare provider patient nonverbal communicative behaviour (NVCB) and diabetes mellitus management practices (DMMPs). Findings: The rating of nonverbal communicative behavior was significantly higher at MP Shah Hospital than at KNH, p=0.010. Nonverbal communicative behavior had positive significant effect on diabetes mellitus management practices in Kenya [β=0.15, (95% CI 0.03, 0.27), p=0.016] with similar outcome at KNH [β=0.20, (95% CI 0.08, 0.33), p=0.002] and not at MP Shah Hospital [β=0.03, (95% CI 0.37, 0.42), p=0.899]. Thus, the null hypothesis was rejected in Kenya; the null hypothesis was rejected at KNH; the null hypothesis was not rejected at MP Shah Hospital. Therefore, there was significant effect of NVCB on DMMPs in Kenya, at KNH and not at MP Shah Hospital. Unique contribution to theory, practice and policy: Nonverbal communicative behaviour was responsible for improved performance in diabetes mellitus management practices among patients in Kenya and at KNH. At MP Shah Hospital, NVCB was not responsible for improvement in the DMMPs. The findings reinforce uncertainty reduction and communication accommodation theories basis in the dyadic interaction between patients and healthcare providers. Therefore, NVCB needs to be well conceptualized and incorporated at the health ministry and medical training institutions to equip medical workers with the required communication skills.

Unanswered Questions and Hypotheses about Domestic Cat Behavior, Ecology, and the Cat–Human Relationship

After recent publication of several reviews covering research results from the last 35 years of domestic cat studies, a number of important unanswered questions and hypotheses have arisen that could interest active researchers, especially those beginning their academic careers. Some sections of this paper concern methodologies that have yielded new insights and could provide more in the future; other sections concern findings and interpretations of those that need further testing. First, hypotheses arise from combining subjective (or psychological) assessments of cat and human personality traits and observational (ethological) studies of cat–human interactions: e.g., do owners with high attachment to their cats interact differently with them than owners with low attachment levels? New analytical methods of dyadic interaction observations open the door for testing further hypotheses. In particular, the Theme® (Noldus bv, NL) program could be used to determine if there are differences between cat breeds in interaction patterns with people, which is not only of interest to owners but also therapists employing cats in their practices. Cat breed differences have been found using subjective ratings, but these need to be corroborated by direct observational data from the home setting and/or non-invasive colony observations, since ratings based on anthropomorphic projections might not be reliable. This should be done before searching for the genetic basis of such differences. Reliable information on breed differences is also needed before prescribing certain breeds for animal-assisted interventions. A model has predicted that the degree of socialization as a kitten affects cats’ responses to positive and negative experiences with unfamiliar humans and their formation of feline–human relationships later on. This needs to be tested in an ethically approved manner on cats of known socialization status and has enormous consequences for cat adoptions from animal shelters. Observations of human–cat interactions have yielded many correlations, which can be tested by non-invasive manipulations of human behavior in the home setting. Examples of these will be given and are of general interest to the cat-owning public. A review of first findings on social cognition in cats has resulted in further unanswered questions and hypotheses. Finally, two aspects of domestic cat ecology will be considered (effects on wildlife and space utilization), which are of great interest to the public and conservationists alike.

A Dynamic Dyadic Systems Approach to Interpersonal Communication

This article articulates conceptual and methodological strategies for studying the dynamic structure of dyadic interaction revealed by the turn-to-turn exchange of messages between partners. Using dyadic time series data that capture partners’ back-and-forth contributions to conversations, dynamic dyadic systems analysis illuminates how individuals act and react to each other as they jointly construct conversations. Five layers of inquiry are offered, each of which yields theoretically relevant information: (a) identifying the individual moves and dyadic spaces that set the stage for dyadic interaction; (b) summarizing conversational units and sequences; (c) examining between-dyad differences in overall conversational structure; (d) describing the temporal evolution of conversational units and sequences; and (e) mapping within-dyad dynamics of conversations and between-dyad differences in those dynamics. Each layer of analysis is illustrated using examples from research on supportive conversations, and the application of dynamic dyadic systems analysis to a range of interpersonal communication phenomena is discussed.

Interaction of caregiver-expressed emotions and neuropsychiatric symptoms in persons with dementia: a longitudinal cohort study

ObjectivesNeuropsychiatric symptoms (NPS) have a major impact in persons with dementia (PwD). The interaction between the caregiver and the person with dementia may be related to the emergence of NPS. The concept of expressed emotion (EE) is used to capture this dyadic interaction. The aim of the present study is to examine longitudinally the association between EE in caregivers and NPS in PwD living at home.DesignA longitudinal cohort study with 2 years of follow-up.SettingPwD and their informal caregivers living at home in the south of the Netherlands.Participants112 dyads of PwD and their caregivers from the MAAstricht Study of BEhavior in Dementia.Main outcome measuresEE was measured at baseline with the Five-Minute Speech Sample and was used to classify caregivers in a low-EE or high-EE group. Associations between EE and neuropsychiatric subsyndromes (hyperactivity, mood and psychosis) measured with the Neuropsychiatric Inventory (NPI) were analysed over time.ResultsSeventy-six (67.9%) caregivers were classified in the low-EE group and 36 (32.1%) in the high-EE group. There was no difference between the EE groups in mean NPI scores over time. In the high-EE group, hyperactivity occurred more frequently than in the low-EE group at baseline (p=0.013) and at the other time points, but the mean difference was not always significant. There were no differences for the mood and psychosis subsyndromes. PwD with caregivers scoring high on the EE subcategory critical comments had an increased risk of institutionalisation (OR 6.07 (95% CI 1.14 to 32.14, p=0.034)) in comparison with caregivers scoring low on critical comments.ConclusionsHigh EE in informal caregivers is associated with hyperactivity symptoms in PwD. This association is likely to be bidirectional. Future studies investigating this association and possible interventions to reduce EE are needed.