Action Picture Test (The Renfrew Language Scales)

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The socioeconomic burden of care for postoperative rehabilitation of TJA is an emerging widespread issue. The adoption of proper measures is required to correctly allocate resources with respect to the patient needs, avoiding disparities, and containing the costs sustained by the health care system. Parents were given the opportunity to comment on their child’s abilities during the parent workshops. U.S. Department of Health & Human Services, ASPE, Office of the Assistant Secretary for Planning and Evaluation. State of the science for pragmatic trials of non-drug interventions to improve outcomes among persons with dementia and their caregivers [Online]. https://aspe.hhs.gov/pdf-report/state-science-pragmatic-trials-non-pharmacological-interventions-improve-outcomes-among-persons-dementia-and-their-caregivers. Accessed 26 Mar 2018. It is presented, via computer, with 4 pictures to choose from, the target picture, a grammatical error, a lexical error and a distracter. All the figures here are a result of the dedication and hard work of the staff in the Foundation Stages at each school as well as the added input of Spirals. Teaching Assistants and other staff members who observe Spirals are able to transfer the principals and skills that they have learned in the group into the main classroom. Collaborative working between Speech and Language Therapist and school staff is essential to these results.

Baier RR, Mitchell SL, Jutkowitz E, Mor V. Identifying and supporting nonpharmacological dementia interventions ready for pragmatic trials: results from an expert workshop. J Am Med Dir Assoc. 2018;19:560–2. National Institutes of Health Collaboratory. Rethinking clinical trials: a living textbook of pragmatic clinical trials. http://rethinkingclinicaltrials.org/. Accessed 1 Aug 2018.

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Laura Halstead, a Speech and Language Therapist from Oxfordshire County Council has evaluated Spirals at a setting in Oxford. Discharge destination was correctly predicted in approximately 75% of cases, in particular, in patients at highest risk for the need of extended rehabilitation, the accuracy is 89%.

Assessment measures will be changed to something that is able to say more accurately, the level a child’s skills are at if they are below 3:0 or 3:6. Although they made no statistically significant progress, all were rated as having made progress in the classroom, either in thinking, language, social, listening or confidence, by their Teacher. The case study of Tom (appendix 2) is a good example of this. If parents get involved with their child’s learning in Spirals, they could help to make the impact much greater, therefore, Laura will endeavour to build relationships with parents sooner by being around at drop-off and collection times, giving out home sheets to parents, putting on a workshop before the end of the school year and writing to parents more often to say how their child is getting on in Spirals. Is it known how safe the intervention is? PCTs often involve providers implementing interventions as a new standard of care with all patients. An intervention should therefore be of minimal risk, with careful consideration given to potential adverse events and unintended consequences. This is particularly true when an intervention targets people who are vulnerable, such as those with ADRD or residing in nursing homes and other residential care settings. FeasibilityThese aspects underline the necessity to develop a transcultural model and validation in other countries as Coudeyre et al made in France. Widely used by Speech and Lang Some authors advocate for the use and the identification of other instruments in addition to RAPT for improving predictive accuracy such as some performance-based functional tests like TUG and 10MW or health status scores like the American Society of Anesthesiologists score, made between one month and 8 months progress (see purple portion of pie chart). This area includes some children who may have made more progress than the assessment was able to measure as it is only able to measure up to 8:0 years and 5:0 years for one subtest. The children to whom this applies were chosen to participate due to low levels of confidence rather than suspected language difficulties. The RAPT was created to be a valid instrument for predicting the discharge destination for patients after an elective hip or knee arthroplasty. During its development this tool has shown significant benefits as well as some limitations. The really interesting aspect is represented not only in its capacity to influence LOS of patients but more importantly in its ability to stratify patients' postoperative risks to individualize the appropriate rehabilitation program and setting according to actual patient necessity while reducing health care costs. All analyzed studies demonstrated that RAPT could reduce LOS and accurately predict discharge disposition especially for high- and low-risk patients while some doubts still remains for those in the intermediate risk category as well as for the range that should be used to classify this risk category, 6 to 9 or 7 to 10. To reduce the uncertain outcome associated with increasing home discharged of medium risk patients, a targeted intensive postoperative rehabilitation program has demonstrated good results.

The TROG assesses understanding of grammatical structures, e.g. “The boy is running” as opposed to walking/not running. The CELF (Clinical Evaluation of Language Fundamentals) assessment was used to assess the comprehension level of each child pre and post intervention. Only two subtests were used as the assessment is very long. The subtests used were ‘sentence structures’ and ‘basic concepts’ as these were deemed areas that may have been improved following Spirals input. These scores were also calculated as an age-equivalent with the lowest score being 3:0. Many of the settings had identified that these children would benefit from participation in a small group, but were unable to offer this themselves due to staffing, time or space constraints.

The RAPT produced a raw score of 23 ½ for information, age equivalent 3yrs 6mths, where 24 is the mean of the range19-27 and a raw score of 20 for grammar, age equivalent 4 yrs 0mths Each weekly session lasts between 20 – 30 minutes and consists of approximately six activities. Ideally, each session should involve six children and be run by two adults in a quiet room with few distractions. The sessions are similar each week, creating a familiar structure for children to feel comfortable within. Dinky was assessed at the request of her mother. The assessments were undertaken in her own home and completed in one session.