1.
Lindeberg, Sophia, 1985-
(författare)
Dementia, Sense-making and Evaluations : Implications for Communication
2021
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
In Sweden, the dementia assessment takes place within primary health care or specialized care. From a clinical perspective, there are many factors to consider in the assessment process, and for the families entering the diagnostic pathways, the process can be uncertain and arduous. However, many aspects of how the assessment process is experienced by those involved, is unknown. This thesis aims at shedding light on the diagnostic pathways in dementia, by investigating the experience of clinical professionals and families living with dementia, and experiences of cognitive testing by older adults without a dementia diagnosis or documented cognitive decline. Furthermore, the thesis aims at exploring how these experiences relate to interactional abilities and challenges in daily life.Study I explored the views and experiences of clinical professionals working in Memory Clinics, General Practitioners in primary health care and Speech Language Pathologists, in regard to clinical practices in dementia diagnosis, as well as team collaborations. Resources and barriers for good practice included clinical collaboration, guidelines, knowledge, staff-continuity, and time. For example, the clinical collaboration between the different professionals was important for a holistic view of the patient. During the diagnostic pathways, both informal (e.g. observations) and formal (e.g. cognitive tests) information was obtained. What was seen as obligatory for a diagnosis varied between clinicians and clinics, in particular when there were contradictions between the different information sources. Communication did not stand out as a clinical priority, even though all clinical professionals acknowledged communication as affected in dementia.Study II investigated how persons with dementia, and their family members, make sense of the diagnostic pathways, including their encounters with health care professionals. Experiences of cognitive and communicative abilities in daily life, and potential cognitive- communicative change, were also studied, as well as how these experiences of daily function related to the clinical testing. The testing process gave rise to feelings of uncertainty, and it could be difficult to make sense of the purpose of the testing, as well as the outcomes of the testing (such as a participant being told by his physician that he could no longer drive). The participants’ experiences of function in daily lives sometimes contrasted with the experiences of the decontextualised testing in the clinical setting. In Dementia, sense-making and evaluations 2 everyday life, the participants would draw upon collaborative resources in order to address functional change, at the same time balancing their self-image and wish to be seen as competent communication partners.Study III examined how conceptualizations of ageing and cognition were manifested in evaluations and accounts during interviews with persons over 65 years of age, after testing with a cognitive screening tool. The sequential contexts of the evaluations and accounts were explored, as well as how these were related to social face-work. The evaluations and accounts were collaboratively built between the participant and the interviewer in order to manage potential face-threats. Evaluations included downplaying one’s own competence, while accounts included attributing difficulties to the test task being inherently difficult, or to lived experiences affecting the test performance, as well as cognitive change due to the normal ageing process. Participants’ reflections after completion of the screening test also revealed manifestation of dementia worry in varying degrees.Study IV investigated conversations with one married couple, where the husband had been diagnosed with dementia with Lewy bodies. Through standard clinical testing, interviews and a video recording of casual conversation, different conversation settings were explored. In the testing, the husband obtained high scores across a variety of test task. The interviews shed light on the resources and barriers, and the challenges the couple experienced in conversation, regarding for example the husband’s descriptions of difficulties in entering conversations, and the wife’s descriptions of misunderstandings. Through video-recorded observations, turn-taking practices were explored, showing how the wife would be in charge of the storytelling, whereas the husband would be in charge of monitoring the content and supporting the wife in providing details.The four studies’ results reveal how clinicians, families living with dementia, and persons over 65 years of age without suspected dementia, engage in complex sense-making processes in which they, during and after the assessment process and testing, evaluate the performances in relation to circumstances that may explain the results. For clinical professionals, both informal and formal considerations take place, in which they weigh the various information sources gathered during the assessment process. For the families in receipt of a dementia diagnosis, they may struggle in making sense of the process of the testing, the outcomes, and consequences. Regarding interaction in daily life, descriptions of change vary between families, and conversational patterns, barriers and facilitators are highly context dependent.
2.
Norén, Niklas, 1966-, et al.
(författare)
Dialogical Perspectives on Aided Communication
2013
Ingår i: Aided Communication in Everyday Interaction. - Guildford : J&R Press Ltd. - 9781907826115 - 1907826114 ; , s. 1-22
Bokkapitel (övrigt vetenskapligt/konstnärligt) abstract
This articile is an introduction to a research anthology on aided communication, and argues for a dialogical approach to challenged interaction i research and clinical practise.
3.
Samuelsson, Christina, 1966-, et al.
(författare)
Prosodic problems in Swedish children with language impairment : Towards a classification of subgroups.
2004
Ingår i: International journal of language and communication disorders. - : Wiley. - 1368-2822 .- 1460-6984. ; 39:3, s. 325-344
Tidskriftsartikel (refereegranskat) abstract
BACKGROUND: Symptoms of prosodic problems have been found in Swedish children with language impairment at word and phrase level and possibly also at discourse level. AIMS: The aim was twofold. First, to characterize a group of children with prosodic problems compared with children with normal language development. Second, to investigate the possibilities to classify subgroups of prosodic problems. METHODS & PROCEDURES: A new Swedish assessment procedure for prosody that captures prosodic features at word, phrase and discourse level was used. Twenty-five children with prosodic problems and 25 children with typically developing language matched by age, gender and regional dialect participated in the study. Pretesting included tests of language comprehension, grammatical skills and oral motor skills. OUTCOMES & RESULTS: The difference between the experimental and control groups was highly significant in all parts of the procedure. The total score of the procedure significantly correlated with grammatical abilities measured in the pretesting procedure, but there was no correlation with the other linguistic abilities measured in the pretesting procedure. CONCLUSIONS: The results indicate a possible differentiation into two different subgroups, one with primarily phonetic and/or linguistic problems, the other with prosodic problems at discourse level possibly related to pragmatic problems.
4.
Samuelsson, Christina, 1966-, et al.
(författare)
The role of Swedish tonal word accents in children with language impairment
2006
Ingår i: Clinical Linguistics & Phonetics. - : Informa UK Limited. - 0269-9206 .- 1464-5076. ; 20:4, s. 231-248
Tidskriftsartikel (refereegranskat) abstract
The present study was designed to examine the production of the Swedish tonal accents in children with language impairment and normal controls in order to verify previous findings. The productions of 25 children with linguistic impairment and their matched controls, aged 4;4-10;0 (mean age 5;11) were evaluated by ratings of fundamental frequency patterns, and by perceptual analysis by ten linguistically naive listeners to assess the distinctiveness of the accents. These methods give a more detailed description of the children's productions of tonal word accents. The results show that 60.8% of the children with language impairment have difficulties to produce the contrast of tonal word accents according to the F(0) patterns. The difference in the rating of the F(0) curves between the children with LI and their matched controls was significant. There is a significant positive correlation between the perceptual results and the F(0)-rating, indicating that the better a child was perceived, the better his/her F(0) production was rated. We conclude that the distinction between the tonal word accents is a difficult feature to acquire for Swedish children, which is shown both by acoustic and perceptual evaluations.
5.
6.
Sundström, Simon, 1985-
(författare)
Prosodic and Phonological Ability in Children with Developmental Language Disorder and Children with Hearing Impairment : In the Context of Word and Nonword Repetition
2018
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Many children with developmental language disorder (DLD) exhibit difficulties with phonology, i.e. the sounds of language. Children with any degree of hearing impairment (HI) are at an increased risk of problems with spoken language, including phonology. The cause of these difficulties is unknown in children with DLD, and is often assumed to result from reduced hearing acuity in children with HI. Variability in terms of language outcomes is large in both groups, and determining if a child’s language ability is within normal limits or not is problematic. A task that has proven useful in differentiating typical from atypical language development is nonword repetition, in which the child listens to a word form without meaning and repeats it back immediately. Performance in nonword repetition tasks is a potential indicator of language ability in both children with DLD and children with HI. However, it has not been established exactly what the task measures.In the present thesis, the ability to repeat prosodic and segmental features of real words and nonwords was investigated in Swedish-speaking four- to six-year-old children with DLD and HI, as well as in children with normal hearing and typical language development (TLD) (papers I, II and III). Further, relations of word and nonword repetition ability to language and hearing were explored (papers II and III), along with comparisons of phonological and grammatical production between the groups (paper IV).The findings indicated that the prosodic features stress and tonal word accent affect repetition performance in children with DLD, HI, and TLD. In general, the children with DLD and HI achieved lower results than the children with TLD on repetition of segments (consonants and vowels) and prosodic features, but tonal word accent was repeated with relatively high accuracy. Tonal word accent 1 was more accurately repeated than tonal word accent 2 by the DLD and HI children. The children with TLD repeated tonal word accent with few errors, but segments in nonwords with tonal word accent 2 were easier to repeat than segments in nonwords with tonal word accent 1.The results further revealed that the ability of children with DLD to repeat stress in real words is related to expressive grammar, but repetition of prosodic features does not reflect general language knowledge. In contrast, repetition of both segmental and prosodic nonword features may be indicative of receptive vocabulary, phonological production during naming of familiar words, and expressive grammar in children with HI. Repetition performance might be related to the degree of HI before cochlear implantation or fitting of hearing aids.Children with DLD and children with HI demonstrate similar strengths and weaknesses in phonological and grammatical production, despite the fact that they develop language under different conditions—with and without normal hearing. Tonal word accent use and syntax are relatively unimpaired in DLD and HI children.This thesis highlights prosodic and phonological strengths and weaknesses in children who have, or are at risk of, deficits in language and communication abilities. It also supports word and nonword repetition as potential predictors of some aspects of language ability in children with DLD and HI. Further, it emphasizes the importance of taking prosody into account when constructing, or interpreting results from, repetition tasks. Future research aiming to investigate the relationship between prosody in repetition and language, cognition and hearing, should use longitudinal study designs, and include younger children. Studies comparing prosodic and phonological ability in children with DLD and children with HI should employ both quantitative and qualitative analyses.
7.
Sundström, Simon, 1985-, et al.
(författare)
Prosodic aspects of repetition in Swedish-speaking children with developmental language disorder
2019
Ingår i: International Journal of Speech-Language Pathology. - : Taylor & Francis. - 1754-9507 .- 1754-9515. ; 21:6, s. 623-634
Tidskriftsartikel (refereegranskat) abstract
Purpose: To examine repetition of stress and tonal word accents in real words and non-words in Swedish-speaking children with developmental language disorder (DLD), and to investigate the relation of prosodic repetition to measures of language ability.Method: A cross-sectional study was undertaken with 30 monolingual Swedish-speaking children with DLD, mean age 4;11 (years;months) and 29 age-matched controls, mean age 5;1, who repeated words and non-words with systematically varying prosody. Group differences for the repetition of prosodic features, and correlations between repetition and phonology, grammar, and vocabulary, were explored.Result: Children with DLD performed below controls on repetition of prosodic features of words and non-words. Repetition of stress and tonal word accent was not correlated with phonological production or receptive vocabulary, but a significant correlation was found between stress repetition in words and expressive grammar.Conclusion: Repetition of stress and tonal word accents is challenging for children with DLD acquiring Swedish as their first language, but may not be a good indicator of general language ability. Prosody should be taken into account when interpreting results from clinically used word repetition (WR) and non-word repetition (NWR) tasks.
