Browsing by discipline "Logopedia"

Objectives. The ability to detect and to resolve disturbances of interaction is an important conversational skill. In the field of conversation analytic research, the practices of repairing troubles of speaking, hearing and understanding are known as repair sequences. Individuals with Alzheimer's disease have growing difficulties to recognize their own linguistic deficiencies and to understand the interactional intensions of others. As the disease progresses, the repair initiations made by the demented individuals decrease, and their healthy conversation partners are given a central role in maintaining mutual understanding. Using conversation analytic approach, this qualitative research describes repair sequences caused by different kinds of conversational trouble sources in institutional group conversations between individuals with middle to late-stage Alzheimer's disease and their healthy conversation partners. Methods. The database of the study consisted of videotaped meetings of a conversation group held by speech and language pathology students in a day care center for demented people. Two individuals with middle to late-stage Alzheimer's disease and 15 healthy conversation partners took part in the study. Four group meetings from both demented individuals were chosen for the analysis. The conversation sessions were transcribed using conversation analytic conventions. Repair initiators and the attempts to repair following them were used to identify the repair sequences caused by the troubles of speaking of the individuals with Alzheimer's disease. Every repair sequence was then analysed according to the type of the trouble source and the progression of the repair. Results and conclusions. Three main trouble source categories were recognised from the conversations. The most common trouble type resulting in repair was problems of the content of the language while problems of the form and the use of language were less prominent. The lexico-semantic troubles of the content of the language, such as word finding problems, were dealt with collaborative but often ineffective repair efforts. Repair sequences dealing with troubles of the form of the language (e.g. phonological paraphasias and morpho-syntactic distortions) were quick and successful self-initiated self-repairs, whereas the responsibility of clarifying wider troubles with language use was left solely to the healthy conversation partners. The results of this study emphasise healthy conversation partners' active role in maintaining mutual understanding while conversing with individuals with Alzheimer's disease.

Objective. Hearing loss is one of the most common chronic health problems, and the number is increasing as a result of population aging. Hearing aids are regarded as the main rehabilitation method for hearing loss. The goal of this follow-up study was to review the experiences of working aged new hearing aid adopters. The focus was to map out the expectations and satisfaction towards the hearing aid, and the disability experiences caused by hearing loss. This thesis is a part of Minna Laakso, Eila Lonka, Johanna Ruusuvuori and Tarja Aaltonen's research project "Communication with Hearing Aid". Also the data was collected as a part of the project. Methods. The population consisted of 42 working age hearing aid first time users (37 64 years). 16 of them were women. Before the hearing aid fitting the participants filled up two self-assessment questionnaires: Denver Scale and Expectations towards hearing aids. Two to three weeks after implementation of the hearing aid the participants filled up the second Denver Scale questionnaire and also IOI-HA questionnaire. Thus it was possible to compare the expectations, disability experiences and satisfaction. The research also studied the construct of Denver scale by using statistical principal component analysis. The model was then utilized in the other statistical analyses. Three participants were also interviewed. Half-structured interviews provided more detailed information about the experiences towards the hearing aid and the hearing loss. The contents of the interviews were then compared to the questionnaire data. Results and conclusions. The expectations towards the hearing aid were high in the study population, although there wasn t any correlation between expectations and short-range satisfaction. Changes in the disability as the result of hearing aid intervention weren t statistically significant. Principal components of the Denver Scale didn't follow the model introduced in previous studies. The contents of the interviews were moderately consistent with the questionnaire data. In this research it was noticed, that the high disabilities due to hearing loss can also be seen after the hearing aid intervention.

Aim: People with severe and profound intellectual disabilities communicate with early communication skills through their life. It is difficult for them to interact with other people in their daily life and that is why they usually end up on the edge of interaction. Usually people with severe and profound intellectual disabilities communicate mainly with staff members. Staff members' abilities and time determine how the interaction will work between the communication partners. The purpose of this study was to find out how the HYP model, developed for supporting interaction, works. The aim was also to find out which are the benefits of the use of HYP model and opportunities for the staff members to support the interactions between them and persons with intellectual disabilities by using the HYP model. The aim of this study is also to produce information that people with intellectual disabilities would get more opportunities for interaction. Methods: This research data were collected in the Communication and Technology Center of the Finnish Association on Intellectual and Developmental Disabilities (Tikoteekki). The data were collected during autumn 2013 and spring 2014 in three different Finnish units where the first trials of the HYP model were accomplished. Participants of this study were staff members and clients. Staff members were altogether 48, 2 to 7 per client. They were, for example, teachers and school assistants. The clients were people with intellectual disabilities and people with autism. The data consisted of different HYP forms, which the staff members had filled in during the HYP periods. These data were analyzed using the Grounded Theory methodology. Results and conclusions: The core category from the data forms through Grounded Theory methodology to be reciprocal interaction. The main categories were cooperation, presence, contact and initiative. The core category collected the whole data and all the different categories together. It was, for example something what the staff members tried to reach during the HYP interaction or it was a wish to achieve with their clients. By using the HYP model the staff members got to know their clients' different interaction styles better. Because of these elements reciprocal interaction was easier to be accomplished during the HYP moments.

The aim of the study. A need to involve customers in decision making, planning, implementation and evaluating quality regarding their services has been identified in health care since 1990s'. According to ecological theories, communication should be rehabilitated by impacting both the communication disabled person and his/her communication partners and environments. For communication interventions, ICF classification offers a framework that emphasizes individual's functioning and participation. In speech therapy, community –based rehabilitation has become a common working method beside and even ahead direct ways of working with a customer. Community –based approach means collaborating with communication partners to enable development of communication. Parents have taken part in their children's speech therapy, but up until the beginning of the millennium their perceptions about the received services had not been explored. The effectiveness of speech therapy can be studied from different perspectives with qualitative and quantitative measures. The aim of this study was to explore parental views and experiences of the impact of the speech therapy their child has received on daily communication and interaction. Method. Data was collected by a questionnaire. Questionnaire was sent to those parents of medical and therapy clinic Contextia's speech therapy customers, whose child had received speech therapy for at least six months. 25 respondents filled in the questionnaire. Data was analyzed by using key statistic figures and cross tabulation plus qualitatively classifying the answers of open questions. Results and conclusions. The impact of the received speech therapy was considered significant relative to development of child's communication skills and parents were satisfied with the guidance received. The role of spontaneous development was viewed minor and the role of therapy major. Cross-tabulation did not reveal dependency between the perceived impact and potential explanatory variables, since the perceived impact was large and variation was minor. Practicing linguistic skills was considered the most significant content area of speech therapy. Practicing with computer or mobile applications was considered least efficient relative to daily communication. Utilizing their use in practicing has also been guided least to parents and kindergarten/school personnel. Respondents perceived kindergarten's/school's role more significant than family's role in supporting rehabilitation. The result challenges professionals and decision makers to consider how to ensure families' commitment and support to the goals and the implementation of therapy.

Aims. Every person with aphasia has some kind of problems with finding words. The aim of this multi-case study was to find out how people with aphasia (PWA) and their conversation partners (CP) adapt to aphasic conversation and collaboratively participate in word search. The emphasis was on the ways the CPs act on the word searches. Word finding difficulties are highlighted in aphasic interaction which can lead to problems with maintaining self-esteem and social relationships in life. Conversation is always a collaborative phenomenon which is why it is important to examine the actions of the CPs of PWA. Methods. This study was a combination of qualitative and quantitative analysis. The participants were 3 dyads: 53 years old man with fluent moderate aphasia and his conversation partners (wife and daughter) and 61 year old woman with fluent severe aphasia and her husband. The data consisted 105 minutes of video material where the aphasic people were having everyday conversation with their CPs. The videos were transcripted and all the word searches were identified. Word searches that expanded into collaborative activity were analyzed with conversation analysis and the ways of CPs participated in them were categorized. The most commonly used categories of participation in conversation were analyzed more in detail. Results and conclusions. Altogether 82 word searches were identified from the data from which 50 of them were analyzed as collaborative word searches. Nine categories of participation were identified from the turns of CPs from which completion, interrogative word offer and specified question were the most commonly used. Also actions that enhanced the asymmetry of the conversation were identified and one dyad had more of those than the other dyads. Both of the PWAs used verbal and nonverbal behavior in the word searches. This shows that it is important to offer as addition to indirect therapy, also interaction based therapy for the PWA and the CP for them to learn and practice communication skills in everyday life. In the field of language and speech therapy PWA are the biggest group of adults who need rehabilitation. Because of the great need of rehabilitation it is important for the individual and for the society that we develop intervention methods and increase the knowledge about aphasia.

The Objective. Two persons with severe chronic non-fluent aphasia had received repetitive transcranial magnetic stimulation (rTMS) and Intensive language action therapy (ILAT) interventions. The aim of this multiple-case study was to analyze if their possibly improved language skills also improved social-functional communication abilities in every day life. Another objective of the study was to analyze the adaptation to impaired speech by a person with aphasia and the significant other. Previous research has shown that aphasic people communicate better with their close relatives than their success in clinical tests may predict. Several studies have shown that persons with aphasia and the significant others can give reliable assessment of aphasic speaker's linguistic and communicative skills in every day life. Even though the mutual adaptation to impaired speech aims at improving the interaction, it can in fact cause asymmetry between aphasic speaker and his/her significant one. Data and Methods.The participants comprised two persons with aphasia and their significant others. The first participant was a 52 year old man who had had a stroke 2 years earlier and another 72 years old man, 4 years after stroke onset. Both participants had a chronic severe Broca's aphasia. The quantitative data of the study consisted of Communicative Activity Log (CAL) ratings of patients and their significant others given before and after the interventions. The qualitative data consisted of 20 videotaped conversations (about 7 hours of raw data). Focus of the analysis was on changes in communicative activity of the participants and there were identified through conversation analysis (e.g. initiating new topics or how different kinds of repair initiatives were used). Also signs of asymmetry between a person with aphasia and the significant other were identified. Results and Conclusions. The CAL evaluations revealed that 52 year old participant's performance in everyday life situations improved significantly. The participant reported a significant increase of 38% in the quality and 14% in the amount of communication in everyday life after the interventions. Consistent with this result, his significant other reported also increase of 33% in the quality and 38% in the amount of his communication. Also signs of changes in his communication into more symmetric direction were identified in conversation analysis. He aimed at producing more detailed and lengthier utterances, asking questions and initiating new topics in conversation. For the 72 year old participant the self evaluating index revealed a qualitative improvement of 27% and quantitative improvement of 38% in communicative activities. Conversely, his significant other reported hardly any improvement in his quality of communication and decrease of 9% in the amount of his communication. Changes in 72 year old participant's communication weren't that clear in conversation analysis data either. He however showed more active role in interaction initiating new topics in conversation, and producing lengthier utterances and details like names. Some noteworthy changes in both participants' repair initiatives were identified after the interventions: both participants made repair initiations to their conversation partners, they also expressed the trouble source if they could't hear or understand their conversation partner's turn. Both of the participants also made self-repairs after unsuccessful attempt to articulate the missing word. Self-repair was non-existent feature in their conversation before. These changes reveal e.g. that the linguistic competence of the participants had improved and the interaction with their significant others appeared more symmetric and harmonic compared to conversations before the interventions.

Aims. In Finland there is only a limited amount of research on the development of the lexicon after toddler age. There is also a need for valid and comprehensive assessment tools for children. The assessment tools help for example in identifying the children who need support in their linguistic development or with reading and writing skills. This study is a part of a research project conducted in the University of Oulu (Kunnari & Välimaa, 2011). The aim of the project is to gather Finnish normative data to make the vocabulary tests valid for the use in Finnish. In the present study, the vocabulary skills of the school starters were investigated using Finnish versions of The Receptive One-Word Picture Vocabulary Test 4- and The Expressive One-Word Picture Vocabulary Test 4 (Martin & Brownell, 2011). The connections between the test results and different background variables were studied. The results were compared to earlier research data. Methods. The study subjects were Finnish speaking 1. and 2. grade pupils. In order to take part to the study it was required that the subjects were born full-term and that their overall development had been normal. 53 children from three schools in Helsinki participated in the study. There were 26 boys and 27 girls and the age varied between 7;0 and 9;0 years. The test results were inserted anonymously into a program (SPSS) for statistical analysis. Non-parametric methods were used for the data. Results and conclusions. 7;0–7;11 -year-old subjects had significantly smaller test scores in both tests than the 8;0–9;0 -year-old subjects. The standard deviation was greater in the receptive vocabulary test than in the expressive vocabulary test. There was a strong correlation between the scores of the two tests. In the younger age group the boys had greater scores in both tests than the girls. In the expressive vocabulary test the boys' results were significantly better. In the older age group the girls had greater scores in both tests, but the scores weren't significantly better than the boys'. None of the background factors (parental education level, family size, birth order, amount of ear infections) were connected to the scores in the vocabulary tests. Difficult and easy test words were mostly the same within both the girls and the boys, although there was a few interesting exceptions. The results of the study can be considered only indicative due to the small sample size. The comparations of the scores between the boys and the girls are not reliable partly because of the younger age of the girl subjects in this study.

Aim of the study. Continuous vocal loading strains the vocal cords, which can lead to voice symptoms. Especially for professional voice users like teachers, voice symptoms may cause psychosocial harm. However, the amount of psychosocial harm is not linked directly to the amount of voice symptoms, but varies according to individual's vocal needs and requirements. Teaching of some subjects is more linked to vocal risk factors and voice symptoms are more common among teachers of certain substances. Previous studies have found that teacher students have more voice symptoms than other university students, but there hasn't been any comparative research about the differences between teacher students studying different subjects. The aim of this study is to investigate the prevalence of voice symptoms of Helsinki University teacher students and examine the psychosocial harm caused to them by voice symptoms. In addition this study investigates how voice symptoms and psychosocial harm influences the assessment of ones voice. Voice symptoms and the amount of psychosocial harm of students of different subjects are being compared in order to see whether there are differences already before graduating. Methods. The data was gathered by electronical questionnaire during spring 2015. The questionnaire was sent out to all students of the department of teacher education in Helsinki University who were on any of the mailing lists of student organizations. A total of 190 students from all classes and training fields participated the study. The questionnaire consists of background information form and questionnaires about vocal symptoms (voice screening test) and the psychosocial impacts of voice disorders (VHI). The data was analyzed mainly by using quantitative methods. Results. The results show that voice symptoms are quite common among teacher students and about 40 % of them reported frequently occurring voice symptoms. This study shows a clear association between voice symptoms and psychosocial harm and the self-assessment of voice. However, one of the main discoveries of this study is that almost 90 % of the students did not have notable psychosocial impacts and almost 80 % actually considered their voice normal. Surprisingly this research shows that students can regard their voice normal despite the fact that they have voice symptoms. The amount of voice symptoms and psychosocial harm was equally high among students of all different subjects.

Aims: Public health care in Finland has the main responsibility of rehabilitation, which means that public health care has to provide for persons with the severe disabilities the therapy or the rehabilitation needed. If a person fulfills the criteria of having severe disablity he is admitted Disability Allowance at its middle or highest rate. This is required for getting medical rehabilitation for persons with severe disabilities, which in Finland is financed by KELA. The speech therapy for the severely disabled organized by KELA is mainly carried out by private sector. There were approximately 500 private speech therapists under the contract of KELA during 2011-2014. Altogether 7439 persons were receiving speech therapy by KELA in 2014. The speech therapists under the contract of KELA are divided somewhat unevenly in Finland, therefore the availability of speech therapy is not equal in the whole land. Particularly areas with less inhabitants seem to suffer from inequality. The UN Convention on the Rights of Persons with Disabilities in 3.5.2008 was aimed at guaranteeing equal human rights to disabled people and to promote and support their human value. Methods: This Master's thesis looks at the availability of speech therapy in Finland both quantitatively based on open statistics by KELA and qualitatively on the nature of positive and negative decisions in the Medical District of Kanta-Häme. Results and Conclusions: The availability of speech therapy for persons with severe disabilities is not by KELAs statistics fully equal in Finland. The uneven division of speech therapists has lead to the fact that there are for example, at the insurance district of Oulu considerably more speech therapists than at the insurance district of Satakunta.The speech therapists under contract of KELA are like many other highly educated people situated close by the universities and other schooling areas, By U.N agreement the persons with disabilities should have rehabilitation near where they live and timing it optimally.The severity of language impairment was the main reason in positive decisions in the Medical District of Kanta-Häme and the insufficiency of arguments in the negative ones, which seem to refer to the fact that there, with an adequate application, speech therapy is guaranteed for the persons with most severe disabilities. One of the aims of the future social welfare and health care reform is to improve the availability of speech therapy in Finland. It remains to be seen how successfully it will answer the growing need.

Objective: Previous studies suggest that outcomes in aphasia therapy are not often routinely measured in the clinical practice. On the other hand, there has been little research on the views of speech and language therapists (SLT) on the outcome evaluation. The objective of this study was to gather information about the opinions of SLT's when it comes to the role, need and value of the outcome evaluation in the clinical practice. Methods: A conceptual framework called theory of alignment was used in this study. The data were collected by interviewing ten SLTs practicing aphasia therapy. The interviews were transcribed and the data were analyzed using qualitative content analysis. Results and conclusions: According to the results SLTs evaluate the outcomes of aphasia therapy for themselves, for the patients and their significant others and for external stakeholders. The role of the outcome evaluation is different depending on the stakeholder needing evaluation. SLTs may consider routine evaluation of the outcomes unnecessary since the different stakeholders do not always create a need for the outcome evaluation. When it comes to the outcomes of aphasia therapy, STLs found it important to get information on their patient's improvement in different contexts. SLTs also valued other persons' opinions of the outcomes as well as information on the patient's symptoms and their further need for aphasia therapy. Furthermore, SLTs considered that the extent and form of information were important when assessing outcomes. Acknowledging the views of SLTs on the outcome evaluation may help to develop the evaluation practices by resolving some problems relating to the evaluation. In case the routine evaluation of outcomes is desired nationally in aphasia therapy, the SLTs should find that there are different stakeholders needing evaluation for a certain reason. When new tests and assessment tools are developed and translated into Finnish language, it should be considered that they will provide information SLTs find worth collecting.