Facilitating End-of-Life Interaction Between Patients With Severe Communication Impairment and Their Families

Purpose The purpose of this report is to promote conversation among medical speech-language pathologists (SLPs) about their role in facilitating family–patient interaction involving patients who acutely encounter the end-of-life (EOL) phase and have severe communication impairment. Case Report We provide self-reflections from our own clinical practice, pertinent literature review, and medical chart review of a relevant patient to serve as a catalyst for such discussion. Reflections We share a preliminary handout containing strategies that SLPs could provide family members of patients who have encountered an EOL phase and have severe communication impairment (e.g., global aphasia) and reduced alertness level. Clinical Implications SLPs can play an important role in facilitating EOL patient–family interaction and alleviate suffering even when patients have severe communication impairment.

2B-Alert Web 2.0: An Open-Access Tool for Predicting Alertness and Optimizing the Benefits of Caffeine (Preprint)

BACKGROUND One-third of the U.S. population experiences sleep loss, with the potential to impair physical and cognitive performance, and result in reduced productivity and imperil safety during work and daily activities. Computer-based fatigue-management systems, with the ability to predict the effects of sleep schedules on alertness and identify safe and effective caffeine interventions that maximize its stimulating benefits, could help mitigate cognitive impairment due to limited sleep. To provide these capabilities to broad communities, we previously released the 2B-Alert Web, a publicly available tool for predicting the average alertness level of a group of individuals as a function of time of day, sleep history, and caffeine consumption. OBJECTIVE Here, we aimed to enhance the capability of the 2B-Alert Web by providing the means for the tool to automatically recommend safe and effective caffeine interventions (time and dose) that lead to optimal alertness levels at user-specified times, under any sleep-loss condition. METHODS We incorporated a recently developed caffeine-optimization algorithm into the predictive models of the original 2B-Alert Web, allowing the system to search for and identify viable caffeine interventions that result in user-specified alertness levels at desired times of the day. To assess the potential benefits of this new capability, we simulated four sleep-deprivation conditions (sustained operations, restricted sleep with morning or evening shift, and night shift with daytime sleep) and compared the alertness levels resulting from the algorithm’s recommendations with those based on the U.S. Army caffeine-countermeasure guidelines. In addition, we enhanced the usability of the tool by adopting a drag-and-drop graphical interface for the creation of sleep and caffeine schedules. RESULTS For the four simulated conditions, the 2B-Alert Web-proposed interventions increased average alertness by 36 to 94% and decreased peak alertness impairment by 31 to 71%, while using equivalent or smaller doses of caffeine as the corresponding U.S. Army guidelines. CONCLUSIONS The enhanced capability of this evidence-based, publicly available tool increases the efficiency by which diverse communities of users can identify safe and effective caffeine interventions to mitigate the effects of sleep loss in the design of research studies and work/rest schedules. 2B-Alert Web is accessible at: <https://2b-alert-web.bhsai.org>.

COGNITIVE REACTION TIME PERFORMANCE AND SUBJECTIVE DROWSINESS: A CRITICAL EVALUATION OF THE EFFECT OF WHOLE-BODY VIBRATIONS

It is believed that exposure to whole-body vibration (WBV) may increase seated occupant drowsiness, and seated occupant drowsiness may contribute to vehicular accidents. Previous studies on driver comfort have indicated that long-term exposure to WBV may have an adverse effect on musculoskeletal disorders. However, the effects of WBV on seated occupants’ drowsiness have been less rigorously studied. Thus, this study aims to investigate the association between exposure to WBV and drowsiness level. Laboratory experiments were designed and involved eighteen healthy male volunteers. Volunteers were exposed to random gaussian vibration for 20-minutes with the frequency between 1-15Hz. The transmitted vibration magnitude was adjusted for each volunteer to become 0.2ms-2 for low vibration magnitude and 0.4ms2 for medium vibration magnitude. Volunteers’ vigilance was measured by the Psychomotor Vigilance Task (PVT) before and after the vibration exposure. The analyses revealed a substantial drop in volunteers’ vigilance level after exposure to vibration and the effect was more pronounced in high vibration amplitude 0.4 ms-2. These findings suggested that exposure to vibration even as low as 20-minutes may attribute to the reduction of alertness level.

Sleep Inertia Countermeasures in Automated Driving: A Concept of Cognitive Stimulation

When highly automated driving is realized, the role of the driver will change dramatically. Drivers will even be able to sleep during the drive. However, when awaking from sleep, drivers often experience sleep inertia, meaning they are feeling groggy and are impaired in their driving performance―which can be an issue with the concept of dual-mode vehicles that allow both manual and automated driving. Proactive methods to avoid sleep inertia like the widely applied ‘NASA nap’ are not immediately practicable in automated driving. Therefore, a reactive countermeasure, the sleep inertia counter-procedure for drivers (SICD), has been developed with the aim to activate and motivate the driver as well as to measure the driver’s alertness level. The SICD is evaluated in a study with N = 21 drivers in a level highly automation driving simulator. The SICD was able to activate the driver after sleep and was perceived as “assisting” by the drivers. It was not capable of measuring the driver’s alertness level. The interpretation of the findings is limited due to a lack of a comparative baseline condition. Future research is needed on direct comparisons of different countermeasures to sleep inertia that are effective and accepted by drivers.