Using Adaptive Interaction to Simplify Caregiver’s Communication with People with Dementia Who Cannot Speak

Caregivers find it difficult to interact with people with dementia who have lost the capacity for speech. Adaptive Interaction is a simplified approach that uses the nonverbal fundamentals of communication to connect with people who can no longer speak. Here we present Adaptive Interaction as a method for equipping caregivers with these nonverbal skills to increase communication with the people they care for. Six caregivers were each paired with one individual with dementia and trained in Adaptive Interaction. After receiving training in Adaptive Interaction, caregivers identified more communicative behaviours in their interactions partners and engaged in more frequent positive social behaviours and meaningful actions during interactions. These findings suggest that it is possible to equip staff to use simplified communication based on nonverbal fundamentals to connect with people with dementia who can no longer speak.

Higher Order Language: Risk, Promotive, and Risk-Based Protective Associations with Youth Offending

Research has implicated oral language deficits as risk factors for antisocial behavior. The aim of this study was to investigate the relationship between higher order language skills and youth offending through a risk, promotive and risk-based protective factor paradigm. In a sample of adolescent males ( n = 130; 13 to 20 years; 62% youth offenders) skills in understanding ambiguity, making inferences, and understanding figurative language were demonstrated to have risk and promotive effects in association with youth offending. Figurative language also met criteria for having risk-based protective effects for youth at high offending risk due to poor nonverbal skills. Conceptualization of higher order language skills through this paradigm promotes a broader frame of reference for considering theoretical models and practical interventions.

Hydroxyurea Use Associated with Nonverbal and Executive Skills in Sickle Cell Anemia

ObjectiveHydroxyurea (HU) is used in children with sickle cell disease (SCD) to increase fetal hemoglobin (HF), contributing to a decrease in physical symptoms and potential protection against cerebral microvasculopathy. There has been minimal investigation into the association between HU use and cognition in this population. This study examined the relationship between HU status and cognition in children with SCD.MethodsThirty-seven children with SCD HbSS or HbS/β0 thalassaemia (sickle cell anemia; SCA) ages 4:0–11 years with no history of overt stroke or chronic transfusion completed a neuropsychological test battery. Other medical, laboratory, and demographic data were obtained. Neuropsychological function across 3 domains (verbal, nonverbal, and attention/executive) was compared for children on HU (n = 9) to those not taking HU (n = 28).ResultsChildren on HU performed significantly better than children not taking HU on standardized measures of attention/executive functioning and nonverbal skills. Performance on verbal measures was similar between groups.ConclusionsThese results suggest that treatment with HU may not only reduce physical symptoms, but may also provide potential benefit to cognition in children with SCA, particularly in regard to attention/executive functioning and nonverbal skills. Replication with larger samples and longitudinal studies are warranted.

Boosting nonverbal physician-patient communication in medical education

Introduction: Nonverbal communication is an important part of the medical interview. However, nonverbal skills are still underestimated in medical education and instruments for their teaching and assessing in medical schools are scarce. Objective: We aimed to translate and culturally adapt the Relational Communication Scale for Observational measurement of doctor-patient interactions (RCS-O) to Brazilian Portuguese. Methods: We translated the RCS-O in seven stages: initial translation, reconciliation, back translation, review by the author, independent review, consensus version through the Delphi technique, review by a language coordinator, and pre-test. We used video recordings of four medical consultations performed by medical students and residents to pre-test the instrument. During this phase, three independent observers assessed the medical students and residents’ performance in real health care scenarios through the use of the recordings. Results: Most of the difficulties regarding the translation and cultural adaptation were related to the polysemic meaning of some items. Words and expressions such as “stimulating”, “warmth”, “desire”, “relaxed”, “conversation to a deeper level”, “deeper relationship”, “casual”, and “intensely” required adaptation in order to remove the potential sexual connotation that could arise from overintimacy in the physician-patient relationship. Conclusion: The Brazilian version of the RCS-O is a culturally, conceptually, semantically and operationally valid instrument. It may represent an important advance for the strengthening of learning and assessing nonverbal communication in medical education. We hope this study may encourage health educators to invest in the teaching and assessment of nonverbal communication skills in other countries.

Study of Communication Skills in Children with Attention Deficit /Hyperactivity Disorder in Shahrekord

Objective: This study was to investigate those pragmatic skills that children with attention deficit/hyperactivity disorder, especially children with pragmatic impairment, show in their colloquial interactions with their parents. Method: In this regard, all children aged 6 to 13 years old with a diagnostic criterion for attention deficit/hyperactivity disorder in a a center for learning disabilities in Shahrekord were selected as research participants in a census method. Required data were collected by using an ADHD rating scale–IV (DuPaul et al., 1998) as well as a Five to fifteen parent questionnaire and were examined through descriptive statistics and chi square test methods. Results: Findings showed that children with more hyperactivity were of more problem, especially in nonverbal skills (r=0.079; p≤0.05) and subject Maitaining skills (r=0.032, p≤0/05), than children with more attention deficit (r =0.00; p≤0.05). In addition, compared to girls, boys had more problems in subject Maitaining skills (p= 0.02) and non-verbal ones (p=0.014). The results of the analysis also showed that most issues related to pragmatic skills occur at younger ages and decrease with age. The study of previous research literature also confirmed that the low level of such skills can have adverse consequences for such children and pose serious risks to their future psychologically, educationally and behaviorally. Conclusion: Psychological interventions and educational strategies seem necessary to increase the level of these skills in children with this disorder.

Assessment of neuropsychological function during early treatment of diffuse glioma

BackgroundCognitive function in patients with diffuse glioma is frequently impaired and can have a profound impact on quality of life. Accurate, reproducible and accessible tools to assess cognition are mandatory to understand the effects of the tumour and treatment. Our hypothesis was that an app-based assessment would be complementary to traditional neuropsychological testing, thereby aiding in defining cognitive profiles and trajectories during early treatment of diffuse glioma.MethodsSeventeen subjects with diffuse low-grade gliomas completed a traditional neuropsychological assessment battery before and after surgery. In addition an app-based tablet assessment (OCS-Bridge) was administered pre- and post-operatively as well as longitudinally at 3- and 12-month follow-up. Deficit rates, mean performance, and changes over time were compared using standardized z-scores between the two testing methods. Unsupervised k-means clustering was performed on individual cognitive tests in each battery.ResultsPreoperative testing showed an average of 2.88 deficits and 1.18 deficits per patient on neuropsychological testing and the tablet-based OCS-Bridge assessment, respectively. Digit span testing demonstrated agreement between testing modalities, but otherwise there was no significant correlation (Pearson’s correlation: p=0.7723, r-value = 0.0758, df = 16). Longitudinal assessment revealed dynamic changes in attention and nonverbal skills. Traditional assessment was more sensitive to memory deficits, showing 22 preoperative deficits within the cohort vs. 1 for the app-based assessment, while app-based assessment was more sensitive to nonverbal skills, showing 8 deficits preoperatively vs. none in the traditional assessment. Clustering analysis did not create clusters along the predetermined domains, indicating that certain individual tests may test more than one cognitive function.ConclusionsThese data suggest app-based assessment is reliable and complementary to data obtained from traditional neuropsychological testing. Advantages include efficiency, facilitation of longitudinal testing, and increased sensitivity in domains of non-verbal skills and attention. Patients with diffuse glioma show subtle neuropsychological impairments, unique cognitive profiles, and discrete trajectories during early treatment, therefore judicious assessment is imperative.Key PointsPatients with glioma have subtle cognitive changes requiring judicious testingApp-based assessment is effective in understanding neuropsychological functionDistinct cognitive profiles and trajectories are demonstrated during treatmentImportance of the StudyUnderstanding cognitive function over time is an essential marker of quality of life and treatment outcomes in patients with diffuse glioma. Because diffuse gliomas are associated with few impairments, careful choice of individual neurocognitive testing is paramount to ensure sufficient sensitivity. Additionally, individuals with similar presentations or seemingly innocuous tumour locations can have profound differences in cognitive outcomes (Romero-Garcia et al., 2020).Studies have demonstrated that traditional neuropsychological testing can be resource-intensive and unsuitable for administration at multiple time points. New app-based testing modalities aim to address these issues, and theoretically offer advantages in terms of novel interactive paradigms, ease of administration, and efficiency of repeated testing in longitudinal studies. However, they have not been extensively validated for use in this population, nor compared with traditional neuropsychology testing.This study compares two neurocognitive testing modalities in a single population with diffuse glioma. Our study demonstrated that patients with diffuse glioma had subtle deficits, and the two modalities were complementary in their sensitivity to deficits in different domains of cognitive function. Traditional neuropsychology testing was more sensitive to memory deficits, while app-based assessment was more sensitive nonverbal skills and attention deficits. In addition, the app-based assessment allowed identification of longitudinal cognitive trajectories, while combined analysis identified discrete cognitive profiles specific to patients with diffuse glioma. Overall these data demonstrate the importance of cognitive testing in this population and highlight the complementary role of combined testing.

Nonverbal communication of young players in team sports

Background and study aim : Nonverbal communication is always present in sport teams’ competition, on the court and around the court. This paper purpose is to investigate the nonverbal skills in two elite basketball cadet teams. Material and Methods: Pursuing this goal, we applied the PONS test to a group of 38 young basketball players 15 -16-year-old: 20 girls and 18 boys. The teenagers were members of Romanian national cadet teams having at least 3 years up to 7 years of experience playing basketball. The test applied to this sample was The Profile of Nonverbal Sensitivity. The test results were statistically analysed aiming to evaluate the nonverbal decoding accuracy of each evaluated athlete and to identify the possible differences between the two teams: boys and girls. Results : There is a statistically significant difference between the two teams in boys’ favor, meaning that the girls have done lower average general scores. In decoding face cues both teams are almost equal, de difference relay on understanding the body movement and attitude. Conclusions: Due the scores obtained by the tested players we can conclude that their nonverbal skills are at high level. Training nonverbal communication potentially enhanced game planning and building into the team a healthy psychological and social environment.

Nonverbal communication of young players in team sports

Background and study aim : Nonverbal communication is always present in sport teams’ competition, on the court and around the court. This paper purpose is to investigate the nonverbal skills in two elite basketball cadet teams. Material and Methods: Pursuing this goal, we applied the PONS test to a group of 38 young basketball players 15 -16-year-old: 20 girls and 18 boys. The teenagers were members of Romanian national cadet teams having at least 3 years up to 7 years of experience playing basketball. The test applied to this sample was The Profile of Nonverbal Sensitivity. The test results were statistically analysed aiming to evaluate the nonverbal decoding accuracy of each evaluated athlete and to identify the possible differences between the two teams: boys and girls. Results : There is a statistically significant difference between the two teams in boys’ favor, meaning that the girls have done lower average general scores. In decoding face cues both teams are almost equal, de difference relay on understanding the body movement and attitude. Conclusions: Due the scores obtained by the tested players we can conclude that their nonverbal skills are at high level. Training nonverbal communication potentially enhanced game planning and building into the team a healthy psychological and social environment.

Medical Students’ Experiences and Outcomes Using a Virtual Human Simulation to Improve Communication Skills: Mixed Methods Study

Background Attending to the wide range of communication behaviors that convey empathy is an important but often underemphasized concept to reduce errors in care, improve patient satisfaction, and improve cancer patient outcomes. A virtual human (VH)–based simulation, MPathic-VR, was developed to train health care providers in empathic communication with patients and in interprofessional settings and evaluated through a randomized controlled trial. Objective This mixed methods study aimed to investigate the differential effects of a VH-based simulation developed to train health care providers in empathic patient-provider and interprofessional communication. Methods We employed a mixed methods intervention design, involving a comparison of 2 quantitative measures—MPathic-VR–calculated scores and the objective structured clinical exam (OSCE) scores—with qualitative reflections by medical students about their experiences. This paper is a secondary, focused analysis of intervention arm data from the larger trial. Students at 3 medical schools in the United States (n=206) received simulation to improve empathic communication skills. We conducted analysis of variance, thematic text analysis, and merging mixed methods analysis. Results OSCE scores were significantly improved for learners in the intervention group (mean 0.806, SD 0.201) compared with the control group (mean 0.752, SD 0.198; F1,414=6.09; P=.01). Qualitative analysis revealed 3 major positive themes for the MPathic-VR group learners: gaining useful communication skills, learning awareness of nonverbal skills in addition to verbal skills, and feeling motivated to learn more about communication. Finally, the results of the mixed methods analysis indicated that most of the variation between high, middle, and lower performers was noted about nonverbal behaviors. Medium and high OSCE scorers most often commented on the importance of nonverbal communication. Themes of motivation to learn about communication were only present in middle and high scorers. Conclusions VHs are a promising strategy for improving empathic communication in health care. Higher performers seemed most engaged to learn, particularly nonverbal skills.