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Validating dynamic assessment of triadic gaze for young children with severe disabilities.

ABSTRACT: PURPOSE:This research investigated the use of a dynamic assessment (DA) to identify differences among young children with severe disabilities, which would predict progress in learning behaviors indicating coordinated joint attention (CJA). METHOD:Six children 10-24 months of age were enrolled in a 16-week treatment for behaviors indicating CJA, specifically triadic gaze (TG), which is a 3-point gaze shift between object and adult. An initial static assessment documented the children's eligibility for the study and their baseline performance of TG. DA procedures were then implemented to determine each child's performance with examiner support in producing behaviors suggesting joint attention (i.e., tracking, gaze toward an object or an adult, scanning between objects, scanning an object and adult, and TG). RESULTS:Results demonstrated differences among children during the DA via a DA score and a behavioral profile. These results were predictive of differences among children in subsequent learning of TG. CONCLUSION:These data support the validity of DA for describing heterogeneity among young children with severe disabilities who look similar on static assessment but appear differentially ready to learn behaviors associated with joint attention. This knowledge will assist clinicians in planning more efficacious services for young children who struggle to communicate and are at risk for extended therapeutic needs.

SUBMITTER: Olswang LB

PROVIDER: S-EPMC3841076 | biostudies-literature | 2013 Aug

REPOSITORIES: biostudies-literature

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Validating dynamic assessment of triadic gaze for young children with severe disabilities.

Olswang Lesley B LB Feuerstein Julie L JL Pinder Gay Lloyd GL Dowden Patricia P

American journal of speech-language pathology 20130628 3

<h4>Purpose</h4>This research investigated the use of a dynamic assessment (DA) to identify differences among young children with severe disabilities, which would predict progress in learning behaviors indicating coordinated joint attention (CJA).<h4>Method</h4>Six children 10-24 months of age were enrolled in a 16-week treatment for behaviors indicating CJA, specifically triadic gaze (TG), which is a 3-point gaze shift between object and adult. An initial static assessment documented the childr ...[more]

PMID: 23813200

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Project description:Background and aimsIntracranial compliance refers to the relationship between a change in intracranial volume and the resultant change in intracranial pressure (ICP). Measurement of compliance is useful in managing cardiovascular and respiratory failure; however, there are no contemporary means to assess intracranial compliance. Knowledge of intracranial compliance could complement ICP and cerebral perfusion pressure (CPP) monitoring in patients with severe traumatic brain injury (TBI) and may enable a proactive approach to ICP management. In this proof-of-concept study, we aimed to capitalize on the physiologic principles of intracranial compliance and vascular reactivity to CO2, and standard-of-care neurocritical care monitoring, to develop a method to assess dynamic intracranial compliance.MethodsContinuous ICP and end-tidal CO2 (ETCO2) data from children with severe TBI were collected after obtaining informed consent in this Institutional Review Board-approved study. An intracranial pressure-PCO2 Compliance Index (PCI) was derived by calculating the moment-to-moment correlation between change in ICP and change in ETCO2. As such, "good" compliance may be reflected by a lack of correlation between time-synched changes in ICP in response to changes in ETCO2, and "poor" compliance may be reflected by a positive correlation between changes in ICP in response to changes in ETCO2.ResultsA total of 978 h of ICP and ETCO2 data were collected and analyzed from eight patients with severe TBI. Demographic and clinical characteristics included patient age 7.1?±?5.8 years (mean?±?SD); 6/8 male; initial Glasgow Coma Scale score 3 [3-7] (median [IQR]); 6/8 had decompressive surgery; 7.1?±?1.4 ICP monitor days; ICU length of stay (LOS) 16.1?±?6.8 days; hospital LOS 25.9?±?8.4 days; and survival 100%. The mean PCI for all patients throughout the monitoring period was 0.18?±?0.04, where mean ICP was 13.7?±?2.1 mmHg. In this cohort, PCI was observed to be consistently above 0.18 by 12 h after monitor placement. Percent time spent with PCI thresholds?>?0.1, 0.2, and 0.3 were 62% [24], 38% [14], and 23% [15], respectively. The percentage of time spent with an ICP threshold?>?20 mmHg was 5.1% [14.6].ConclusionsIndirect assessment of dynamic intracranial compliance in TBI patients using standard-of-care monitoring appears feasible and suggests a prolonged period of derangement out to 5 days post-injury. Further study is ongoing to determine if the PCI-a new physiologic index, complements utility of ICP and/or CPP in guiding management of patients with severe TBI.

Dataset Information

Validating dynamic assessment of triadic gaze for young children with severe disabilities.

Publications

Validating dynamic assessment of triadic gaze for young children with severe disabilities.

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