RESUMEN
Individuals with a brain injury often require a caregiver to live safely in a community-based setting. This role typically defaults to a woman family member. Under the auspices of a constructivist interpretive tradition that honors a desire-based approach, this study blended narrative inquiry and grounded theory to explore the lived experiences of women caring for loved ones with brain injury. Twenty women completed the semi-structured interview, electing to participate either via videoconferencing or telephone. Employing a constant comparative method, three consecutive rounds of interviews, coding, and analysis occurred. Findings revealed an overarching theme surrounding the intractable challenges and enduring triumphs of caregiving. This discovery further sub-divided into four themes. Two themes focused on traversing a fragmented system of care and managing the burden of caregiving. The remaining two entailed finding supports in family and friends and leveraging professional skillset(s) to optimize caregiving. The recommendations garnered from the women's experiences included enhanced caregiver education with follow-up post-medical care, expanding services into the community to support caregivers and their family members appropriately, and building compassionate networks of women living the caregiving experience. Consistent with a desire-based paradigm, leveraging relationships to triumph over the challenges provided this group of women a voice to promote effective care for self, loved ones, and others.
Asunto(s)
Lesiones Encefálicas , Familia , Humanos , Femenino , Cuidadores , Empatía , NarraciónRESUMEN
Mental practice using motor imagery (MP-MI) has been shown to improve motor outcomes of upper and lower extremities especially when combined with physical exercise. Here, we studied community-dwelling, healthy older adults to determine the effects of including an MP-MI component with lingual strengthening exercise. In this pilot study, twenty-nine typically aging participants were assigned to an intervention group: physical lingual exercise (n = 7), physical and MP-MI lingual exercise (n = 8), MPMI lingual exercise (n = 7), or a control group (placebo exercise) (n = 7). All participants completed the assigned exercise regimen with three sessions per day, three days a week, for 6 consecutive weeks. Maximum isometric pressure (MIP) and regular effort saliva swallowing (RESS) pressure were collected at baseline and weeks 2, 4, and 6. A post hoc Bonferroni corrected treatment effect from baseline to week 6 was shown for only participants in the MP-MI/Physical exercise group for MIP (p = 0.003 MPMI/ Physical group; p = 0.11 Control group; p = 0.32 Physical only group; p = 0.14 MP-MI only group) and RESS (p = 0.009 MP-MI/Physical group; p = 0.14 Control group; p = 0.10 Physical only group; p = 0.04 MP-MI only group). Findings also indicate spontaneous carryover of significantly increased swallowing pressure when mental and physical exercise are combined. In conclusion, the potential effect of including an MPMI lingual exercise component in preventative and rehabilitative frameworks with older persons to possibly enhance functional swallowing improvement is promising and should be investigated.
Asunto(s)
Trastornos de Deglución , Ejercicio Físico , Anciano , Anciano de 80 o más Años , Deglución , Terapia por Ejercicio , Humanos , Proyectos Piloto , LenguaRESUMEN
The challenges of providing optimal healthcare for individuals with brain injuries are heightened by the unique complexity of the injury itself. Survivors with long-term needs often encounter precarious situations where they struggle to receive services in health systems focused on cost containment driven by medical necessity and managed care. This article draws inductively from the rehabilitation experiences of 2 survivors to highlight neuroethical considerations representing the person, the rehabilitation system, and the medical model. Drawing upon our experience studying the provision of care in the Commonwealth of Virginia, we seek to explicate the challenge of providing longitudinal services. Three diverse and intersecting ethical considerations are applied: (1) teleological implications within rehabilitation medicine; (2) a care ethics framework, nested in the scholarship of feminist and disability ethics; and (3) the literature on pragmatism and dehumanization. This article uses these frameworks to explore the challenge posed by current healthcare practices and the needs of individuals with chronic brain injury.
Asunto(s)
Lesiones Encefálicas , Personas con Discapacidad , Promoción de la Salud , Accesibilidad a los Servicios de Salud , Humanos , SobrevivientesRESUMEN
OBJECTIVE: Systematic evaluation and meta-analysis of the effects of digital noise reduction (DNR) algorithms on speech intelligibility, sound quality and listening effort in adult populations. DESIGN: Systematic review and meta-analysis. STUDY SAMPLE: Six databases were searched for experimental studies published from 2000 to 2017 in English using the following search terms: "hearing aid" and "noise reduction". A total of 264 unique hits were obtained; out of which, 16 studies were included. RESULTS: The population effect was estimated for speech intelligibility and other subjective measures. From six studies, the population effect estimated for speech intelligibility measures was small (r = 0.28) with zero population variance. Sample size variance accounted for all the effect size variations found across studies. The population effect for subjective measures was medium (r = 0.46 ± 0.10) as calculated from seven studies. CONCLUSIONS: Based on a criterion of moderate evidence, this meta-analysis did not reveal a consistent improvement in speech intelligibility with DNR in adult population. The subjective outcome measures (e.g., acceptable noise level and sound quality judgment) showed a moderate positive effect of DNR.Implications for RehabilitationThe findings of the study will provide useful clinical information in follow up visits in audiologic rehabilitation.The meta-analysis of DNR informs clinicians to create realistic expectations in hearing aid users.This paper summarizes the available data on different outcome measures such as speech intelligibility, listening effort and sound quality.The results of this meta-analysis will help clinical audiologists in devising hearing aid orientation and counseling.
Asunto(s)
Audífonos , Pérdida Auditiva/rehabilitación , Ruido/prevención & control , Diseño de Prótesis , Inteligibilidad del Habla , HumanosRESUMEN
Purpose The aim of the study was to determine the effects of a 6-week progressive resistance tongue exercise protocol in mental practice form on tongue strength. Investigation begins in typically aging adults, a population susceptible to reduced tongue strength and dysphagia secondary to age-related changes in the swallowing mechanism. It was hypothesized that typically aging adults who perform a 6-week progressive resistance tongue exercise protocol in mental practice form would increase tongue strength. Method A prospective, case series intervention study was used. Six healthy women aged 53-78 years completed a 6-week mental practice tongue resistance exercise program utilizing motor imagery to imagine completion of tongue exercises. The main outcome was mean isometric maximum tongue pressures (tongue strength), which were collected at baseline and Weeks 2, 4, and 6 using the Iowa Oral Performance Instrument ( IOPI Medical, 2013 ). Results By Week 6 of the study, all participants had significantly increased their tongue strength compared to baseline. Conclusions The findings indicate that mental practice using motor imagery for tongue exercise may improve tongue strength in healthy individuals at risk for dysphagia and may thus represent a promising direction warranting further investigation in typically aging individuals and patients with dysphagia and decreased tongue strength.
Asunto(s)
Trastornos de Deglución/prevención & control , Imágenes en Psicoterapia/métodos , Entrenamiento de Fuerza/métodos , Lengua/fisiología , Anciano , Estudios de Factibilidad , Femenino , Voluntarios Sanos , Humanos , Persona de Mediana Edad , Fuerza Muscular/fisiología , Estudios Prospectivos , Desempeño PsicomotorRESUMEN
As the number of speech-language pathologists (SLPs) responsible for swallowing and feeding services in the educational setting increases, guidance informing this specialized practice continues to emerge. Although SLPs have provided dysphagia management for children in medical settings for many years, the extension of dysphagia services to the schools is comparatively new. This shift in care delivery for what was previously a hospital-based practice is now occurring more frequently, and in an environment void of extensive medical supports (i.e., the schools). With this transition, evidence-based approaches tailored to children with dysphagia receiving intervention in the school setting are paramount. Components that appear critical to this evolving specialty area include research, best practice guidelines, knowledge and skills training, and collaboration across professionals. This article addresses these pertinent issues by reflecting upon the past, reviewing the present, and planning for the future.
Asunto(s)
Trastornos de Deglución/terapia , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Servicios de Salud Escolar , Niño , Atención a la Salud/tendencias , Predicción , Humanos , Comunicación Interdisciplinaria , Colaboración Intersectorial , Grupo de Atención al Paciente/tendencias , Servicios de Salud Escolar/tendencias , Patología del Habla y Lenguaje/tendencias , Estados UnidosRESUMEN
BACKGROUND: The psychological impact of TBI is vast, leading to adverse effects on survivors and their caregivers. Unhealthy family functioning may be mitigated by therapeutic strategies, particularly interdisciplinary family systems approaches like the well-documented Brain Injury Family Intervention (BIFI). Little is known about the experience of providers who offer such interventions. OBJECTIVE: This mixed methods study aims to demonstrate that a structured three-day training on the BIFI protocol improves providers' knowledge and confidence in working with survivors and families, and that this outcome is sustainable. METHODS: Participants were 34 providers who participated in an intensive training and completed a web-based survey at four points of time. Quantitative data were analyzed via Wilcoxon signed-rank tests and binomial test of proportions. Qualitative data were analyzed according to rigorous coding procedures. RESULTS: Providers' knowledge of brain injury and their ability to conceptualize treatment models for survivors and their families increased significantly and mostly remain consistent over time. Qualitative data point to additional gains, such as understanding of family systems. CONCLUSIONS: Past studies quantify the BIFI as an evidence-based intervention. This study supports the effectiveness of training and serves as first to demonstrate the benefit for providers short- and long-term.
Asunto(s)
Lesiones Encefálicas/rehabilitación , Cuidadores/educación , Rehabilitación Neurológica/educación , Adulto , Lesiones Encefálicas/psicología , Cuidadores/psicología , Familia/psicología , Femenino , Humanos , Masculino , Rehabilitación Neurológica/métodos , Rehabilitación Neurológica/psicología , Encuestas y CuestionariosRESUMEN
The role of various sensory stimuli for stimulating swallowing in infants may be of importance for assisting infants to develop oral feeding. We evaluated the swallowing mechanism response to two devices for increasing the rate of nonnutritive swallowing in two typically developing infant age groups, ages 2-4 mo and 7-9 mo. One device was a pacifier familiar to the infant; the other was a small vibrator placed on the skin overlying the thyroid cartilage. The rate of nonnutritive swallowing while infants were awake was compared in three 10-min conditions: at rest without stimulation (spontaneous); during nonnutritive sucking with a pacifier; and over 10 min containing 18 epochs of vibratory stimulation for 10 s each. To assess whether vibration on the throat over the laryngeal area altered respiration, the mean cycle length was compared between 10-min intervals either containing vibratory stimulation or without stimulation at rest. Both the pacifier and laryngeal vibration stimulation doubled the rate of swallowing in the infants with a mean age of 3 mo 16 days and infants with a mean age of 8 mo 8 days. No differences occurred in the mean respiratory cycle length between intervals with and without vibration in either age group. Results suggest that nonnutritive sucking, vibration, or both might be beneficial in enhancing swallowing in young infants. Because vibration on the neck would not interfere with oral transfer of liquid, it might provide additional stimulation for swallowing during oral feeding. Both stimulation types should be evaluated for enhancing swallowing in infants with immature swallowing skills.
Asunto(s)
Deglución/fisiología , Sistemas Microelectromecánicos/instrumentación , Chupetes , Estimulación Física/instrumentación , Conducta en la Lactancia/fisiología , Vibración , Diseño de Equipo , Análisis de Falla de Equipo , Femenino , Humanos , Lactante , MasculinoRESUMEN
PURPOSE: To understand empirically the perceived barriers to accessing crisis intervention services for individuals with acquired brain injury. METHOD: This action research design encompassed two phases of mixed methods data collection and analysis. Phase one consisted of the electronic distribution of a survey comprised primarily of quantitative items, launched to a nonrandom sample of 226 providers with a response rate of 49% (n = 110). Phase two entailed seven focus group interviews with 25 participants, designed to add explanatory power to phase one results. RESULTS: Quantitative results revealed an array of major barriers significant to persons with brain injury, such as funding for services, coexisting diagnoses, and limited self-advocacy. Organizationally specific barriers included funding for services, limited training and education, and systems resources (e.g., personnel). Adding depth and insight, qualitative findings triangulated with these results, also highlighting the prevalence of the funding barrier and pointing to additional barriers relative to the individual, the family, and external stigma. CONCLUSIONS: The need for convenient, cost-effective, and applicable training and education is paramount. Opportunities for interagency cross training and education, particularly around risk assessment, psychosocial adjustment symptoms, and the biomechanical causes of psychiatric symptoms may alleviate perceived disconnections, improve provider confidence, and mitigate crises. Developing interprofessional teams of providers to maximize access to services, either face-to-face or virtual, is integral. These perspectives highlight opportunities to improve access to services and to strengthen relationships across providers and agencies.
Asunto(s)
Lesiones Encefálicas/rehabilitación , Intervención en la Crisis (Psiquiatría)/métodos , Encuestas de Atención de la Salud/métodos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Trastornos Mentales/terapia , Adulto , Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/economía , Intervención en la Crisis (Psiquiatría)/economía , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , Grupos Focales , Encuestas de Atención de la Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/economía , Humanos , Entrevistas como Asunto/métodos , Masculino , Trastornos Mentales/complicaciones , Trastornos Mentales/economía , Encuestas y CuestionariosRESUMEN
PURPOSE: The number of children requiring dysphagia management in the schools is increasing. This article reports survey findings relative to speech-language pathologists' (SLPs') training and self-rated confidence to treat children with swallowing and feeding disorders in the schools. METHOD: Surveys were completed by 222 SLPs representing Virginia and its contiguous states. Queries on dysphagia training targeted formal education, on-the-job experiences, and current caseload information. In addition, participants self-rated their confidence to treat dysphagia. RESULTS: Statistically significant relationships between training and self-confidence levels were demonstrated. Specifically, participation in continuing education and currency of educational activities revealed significant and moderately strong correlations to self-reported confidence to treat children with dysphagia in the school setting. CONCLUSION: Findings support continuing education as a correlate to self-reported confidence to treat dysphagia in the school setting among SLPs in Virginia and its contiguous states. Further research is merited to ascertain if these findings reflect national trends. Quantifiable, cost-effective, and evidenced-based dysphagia training, consultancy, and management models are needed if school-based SLPs are to meet the increasing challenges of their diverse caseloads.