In lieu of traditional training of examiners to identify cerebral palsy on a neurologic examination at age 1 year, we proposed an alternative approach using a multimedia training video and CD-ROM we developed after a two-step validation process. We hypothesized that use of CD-ROM interactive training will lead to reliable and valid performance of the neurologic examination by both pediatric neurologists and nonpediatric neurologists. All examiners were asked to take one of six interobserver variability tests found on the CD-ROM on two occasions. In the first interobserver variability evaluation, 89% (531 of 594) of the responses agreed with the gold standard responses. Following annotated feedback to the examiners about the two items that had a 60% correct rate, the correct response rate rose to 93% (114 of 123). In the second interobserver variability evaluation, 88% (493 of 560) of the responses agreed with the gold standard responses. Following annotated feedback to the examiners about the four items that had a 70% correct rate, the correct response rate rose to 96% (104 of 108). Interactive CD-ROM examination training is an efficient and cost-effective means of training both neurologists and non-neurologists to perform structured neurologic examinations in 1-year-old children. It provides an effective means to evaluate interobserver variability, offers a route for feedback, and creates an opportunity to reevaluate variability, both immediately and at periodic intervals.
Assessment of early feeding skills of vulnerable infants is common practice in neonatal care centers. However, assessment is often merely an identification of feeding outcomes, rather than a description of the infant's capacities and methods of adapting to the feeding challenge. Descriptive assessment of the feeding process takes into account the dynamic nature of feeding and notes changes that occur as the infant matures and gains feeding experience. Assessment of the variability that occurs during the feeding as the challenge changes, due to fatigue or physiologic instability, are critical to understanding the infant's feeding skills. As individual components of the feeding are assessed, such as sucking, swallowing and breathing, a reflective process builds understanding of the patterns of coordination of system components in relation to one another. Taking the whole into account and considering the dynamics of the process is necessary if we are going to select appropriate interventions targeted to the individual infant's feeding skills. Using a very preterm infant case, this paper will illustrate assessment of early feeding skills and demonstrate how reflection on and integration of the components of the assessment identifies potential targets for co-regulated, cue-based feeding. KeywordsFeeding; Preterm; Feeding Skill; Assessment; Reflection; Intervention; Early Feeding Skills © 2013 Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved. * Corresponding author: Carrington Hall, CB #7460, The University of North Carolina at Chapel Hill, Chapel Hill, NC 25799-7460, thoyre@email.unc.edu, T 919-966-8418, F 919-843-9969. Conflict of interest statement: There are no conflicts of interest with any of the authorsPublisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Selecting appropriate feeding interventions requires assessment that facilitates identification of the infant's feeding difficulties. Too often, feeding interventions are applied generically. As examples, when infants have poor feeding endurance we might limit the number of feedings offered or use a pre-set feeding schedule rather than identify potential reasons for poor endurance within the feeding itself. When we assess low intake or poor feeding efficiency we may assume the infant has weak oral motor functioning and provide chin and cheek support, oral stimulation prior to feeding, or another intervention aimed at enhancing oral-motor functioning, rather than considering alternatives, such as the impact of the infant's breathing on their ability to engage in sucking. While any of a numbe...
The correspondence of stuttering and linguistic characteristics of utterances has led to speculations that a source factor for stutter events is a speaker’s inadequate formulation of the speech code. In this study, the effects of word frequency and syllabic stress pattern on stuttering frequency were evaluated using specially designed sentences read orally by 10 adult stutterers and 10 adult nonstutterers. Results revealed statistically significant differences in stuttering frequency between sentences with low and high frequency words, but not between sentences with regular and irregular syllabic stress patterns. The significant rank order correlation between stutterers’ word recognition vocabulary scores and amount of stuttering on sentences with high versus low frequency words affirmed that word familiarity , not simply word prominence , is an important factor contributing to the word frequency effect. The outcomes are discussed in relation to current psycholinguistic theories of stuttering, proposing that word access and phonological encoding difficulties could be a source factor that underlies the occurrence of stutter events.
Purpose The purpose of this study is to describe implementation of the Co-Regulated Feeding Intervention (CoReg), when provided by mothers and guided by intervention nurses trained in methods of guided participation (GP). CoReg aims to prevent stress during feeding and ease the challenge very preterm (VP) infants experience coordinating breathing and swallowing during the early months. Guided participation is a participatory learning method to guide the complex learning required of mothers. Study Design and Methods Sixteen mothers of 17 VP infants participated. Each mother received a median of five intervention sessions during the infant’s transition to oral feeding. Intervention field notes, audio-recordings of the sessions, and video-recordings of the nurse-guided feedings were reviewed, organized, and content analyzed to evaluate implementation. Results The co-regulated feeding intervention was well received by mothers; enrollment, participation, and retention rates were high. Most mothers chose to spread out the intervention sessions across the transition period. Scheduling sessions was the greatest barrier. Mothers had competing demands and infant readiness to eat could not be predicted. The top five issues identified as needing attention by the mother or nurse included reading cues, co-regulating breathing, providing motoric stability, regulating milk flow, and providing rest periods. Main GP strategies included joint attention with the mother to the dyad’s feeding challenges, auditory assessment of breathing and swallowing, and reflection with planning for future feedings using video playback. Clinical Implications Nurse presence while mothers feed affords rich opportunities to guide co-regulated, cue-based feeding. Co-Regulated feeding interventions would be enhanced if mothers are guided by the bedside nurse.
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