Are sucking skills in a specific period (in weeks post menstrual age, PMA) associated with an abnormal development at age 2?Do preterm infants with abnormal sucking patterns in the early post term period differ in motor skills at age 5 from preterm infants with normal sucking patterns in the same early post term period?
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The studies reported on in this thesis addressed the development of suckingpatterns in preterm newborns. Preterm infants often have problems learningto suckle at the breast or to drink from a bottle. It is unclear whether this isdue to their preterm birth or whether it is the consequence of neurologicaldamage. From the literature, as well as from daily practice, we know thatthere is much variation in the time and in the way children start suckingnormally. Factors such as birth weight and gestational age may indeed berisk factors but they do not explain the differences in development. A smallspot-check proved that most hospitals in the Netherlands start infants onoral feeding by 34 weeks’ post-menstrual age (pma). By and large the policyis aimed at getting the infant to rely on oral feeding entirely as soon aspossible. The underlying rationale is to reduce the stay in hospital, and theidea that prolonged tube-feeding delays or even hampers the development ofsucking.
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AIM: To determine the association between sucking in infants born preterm and developmental outcomes at 5 years.METHOD: Thirty-four infants were included (mean gestational age 30wks 4d, mean birthweight 1407g). The Neonatal Oral-Motor Assessment Scale was used longitudinally from 37 to 50 weeks postmenstrual age. At 5 years, we assessed motor skills, intelligence, language, verbal memory, and behavioural problems. Linear regression analyses were performed to test whether aspects of sucking behaviour predicted these developmental outcomes. Where linear regression was not appropriate, Spearman's correlation coefficients were calculated between sucking and developmental outcomes.RESULTS: Sucking was associated with total motor skills (B [unstandardized correlation coefficient for normally distributed data]=22.66, 95% confidence interval [CI] 6.61 to 38.71), balance (Spearman's ρ=0.64, p<0.001), total intelligence (B=-1.16, 95% CI -1.89 to -0.44, B=10.48, 95% CI 0.39 to 20.71, B=-2.22, 95% CI -3.42 to -1.02), verbal intelligence (B=-0.95; 95% CI -1.83 to -0.07, B=-2.02; 95% CI -3.55 to -0.49), performance intelligence (B=-1.34, 95% CI -2.13 to -0.54, B=12.36, 95% CI 1.13 to 23.60, B=-2.37, 95% CI -3.75 to -0.96), and language (B=-1.78, 95% CI -3.36 to -0.19). All associations were in the same direction: the better the sucking, the higher the test scores. Verbal memory and behavioural problems were not associated with sucking.INTERPRETATION: Abnormal sucking between 42 weeks and 50 weeks postmenstrual age may reflect abnormal neurological functioning in children born preterm.
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OBJECTIVE: To examine the association between sucking patterns and the quality of fidgety movements in preterm infants.STUDY DESIGN: We studied the sucking patterns and fidgety movements of 44 preterm infants (gestational age <35 weeks) longitudinally from 34 weeks' postmenstrual age up to 14 weeks postterm. We used the Neonatal Oral-Motor Assessment Scale during feeding and scored the sucking patterns as normal or abnormal. Abnormal sucking patterns were categorized into arrhythmic sucking and uncoordinated sucking. At 14 weeks postterm, we scored the quality of fidgety movements from videotapes as normal, abnormal, or absent.RESULTS: The postmenstrual age at which sucking patterns became normal (median, 48 weeks; range, 34 to >50 weeks) was correlated with the quality of fidgety movements (Spearman ρ = -0.33; P = .035). The percentage per infant of normal and uncoordinated sucking patterns was also correlated with the quality of fidgety movements (ρ = 0.31; P = .048 and ρ = -0.33; P = .032, respectively). Infants with uncoordinated sucking patterns had a higher rate of abnormal fidgety movements (OR, 7.5; 95% CI, 1.4-40; P = .019).CONCLUSION: The development of sucking patterns in preterm infants was related to the quality of fidgety movements. Uncoordinated sucking patterns were associated with abnormal fidgety movements, indicating that uncoordinated sucking, swallowing, and breathing may represent neurologic dysfunction.
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OBJECTIVES: Sucking problems in preterm infants can be specified by means of visual observation. The Neonatal Oral-Motor Assessment Scale (NOMAS) is the visual observation method most commonly used to assess the non-nutritive sucking (NNS) and nutritive sucking (NS) skills of infants up to approximately 8 weeks postterm. During the first 2 min of a regular feeding the infant's sucking skill is assessed, either immediately or on video. Although NOMAS has been used since 1993, little is known about the method's reliability. The aim of our study was to determine the test-retest and inter-rater reliability of NOMAS.METHODS: The 75 infants included in this study were born at 26-36 weeks postmenstrual age (PMA). Four observers participated in the study. They were trained and certified to administer NOMAS in the Netherlands by M.M. Palmer between 2000 and 2002.RESULTS: We found the test-retest agreement of NOMAS to be 'fair' to 'almost perfect' (Cohen's kappa [kappa] between 0.33 and 0.94), whereas the inter-rater agreement with respect to the diagnosis was 'moderate' to 'substantial' (Cohen's kappa, between 0.40 and 0.65). As a diagnostic tool, however, the current version of NOMAS cannot be used for both full-term and preterm infants. For a measuring instrument such as NOMAS, one should aim at reliability coefficients for inter-rater and test-retest agreement of at least 0.8. A Cohen's kappa of 0.6 or less we find unacceptable. Nonetheless, by observing sucking and swallowing according to a protocol much useful information can be gathered about the development of an infant's sucking skills. For instance, whether the infant is able to co-ordinate sucking and swallowing, whether the infant can maintain sucking, swallowing and breathing during the continuous phase and whether the infant is able to suck rhythmically with equally long bursts. In addition, NOMAS offers useful aids for intervention.CONCLUSIONS: NOMAS should be re-adjusted in order to improve inter-rater agreement, and at the same time current insights into the development of sucking and swallowing should be incorporated in the method.
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De maat is vol: jonge mensen spijbelen voor het klimaat. Maar de ecologische crisis is een crisis in ons denken, en daarmee ook een crisis in ons onderwijs. Het aangaan van de grote ecologische en economische uitdagingen is niet geholpen met ‘oud denken’. Ze vragen om mensen die minder atomistisch en meer ecologisch kunnen denken over hoe zaken elkaar beïnvloeden en met elkaar verbonden zijn. Leren kritisch te denken is niet genoeg. Ontwerpgericht leren denken en samen nieuwe kennis construeren, is cruciaal. Velen zien leren als een neurologisch of cognitief informatieverwerkingsproces. Leren is vooral een psychologisch proces waarbij kennis in-ter-actie ontstaat. In de rede wordt deze stelling conceptueel besproken en onderbouwd met semantische, sociale netwerkanalyses van student-interacties. De rede eindigt met handreikingen voor studenten en docenten voor responsief en kennisconstruerend leren.
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Background: Goal setting is an essential step in the clinical reasoning process of speech and language therapists (SLTs) who provide care for children, adolescents and adults with communication disorders. In the light of person-centred care, shared or collaborative goal setting between the SLT and client is advised in (inter)national guidelines. SLTs face challenges in implementing (shared) goal setting as theoretical frameworks and practical interventions are scarce and less applicable to use with a wide range of communication vulnerable populations. Aims: A first step in developing theory and practical interventions is to explore first-hand experiences of SLTs and clients about day-to-day goal-setting practice. This study was guided by the following research question:What are the perspectives and needs of SLTs and persons with communication disorders regarding (shared) goal setting in routine SLT services? Methods & Procedures: The qualitative study was carried out in the setting of routine speech–language therapy services in community practices, primary education and neurological rehabilitation in the Netherlands. Data collection followed the principles of video-reflexive ethnography, using video footage of goal-setting conversations to facilitate semi-structured, reflexive interviews.Data analysis was based on reflexive thematic analysis. A total of 12 interviews were conducted with client–SLT dyads, covering perspectives from children, parents and adults with a range of communication difficulties and their SLTs. Outcomes & Results: Data analysis resulted in four themes, of which two contain subthemes. Each theme represents a central organizing concept found in SLT and client interviews. The themes were identified as: (1) goal setting is a complex process; (2) goal talk needs to be communication accessible; (3) communicative participation goals are hard to grasp; and (4) the importance of relationships. Topics such as power imbalance, communication vulnerability, effective communication strategies, and motivation and trust are explored under these themes. Conclusions & Implications: SLTs are encouraged to view shared goal setting as a process that needs to be explicitly planned and communicated with clients regardless of their age or communication vulnerability. SLTs have expert knowledge and skills when it comes to supporting communication and applying these skills during goal talks might strengthen shared goal setting and foster a therapeutic relationship. There is a need to concretely conceptualize and embed shared goal setting in policy and clinical guidelines. The themes reported have tentative clinical implications for developing such policy, and shared goal-setting interventions for SLT practice, under the condition that SLTs and people with communication disorders are continuously involved.
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Background: Patient Reported Experience Measures are promoted to be used as an integrated measurement approach in which outcomes are used to improve individual care (micro level), organisational quality (meso level) and external justification (macro level). However, a deeper understanding of implementation issues of these measures is necessary. The narrative Patient Reported Experience Measure “Dit vind ik ervan!” (English “How I feel about it!”) is used in the Dutch disability care sector, but insight into its’ current use is lacking. We aimed to provide insight into experiences with the implementation and current ways of working with “Dit vind ik ervan!” as an integrated measurement strategy. A descriptive qualitative study was done at a disability care organisation. Data were collected by nine documentations, seven observations, 11 interviews and three focus groups. We applied deductive content analysis using the Consolidated Framework for Implementation Research as a framework. Results: Our analysis revealed facilitators and barriers for the implementation of “Dit vind ik ervan!”. We found most barriers at the micro level. Professionals and clients appreciated the measure’s narrative approach, but struggled to perform it with communication vulnerable clients. Some clients, professionals and team leaders were unfamiliar with the measure’s aim and benefit. On the meso level, implementation was done top-down, and the management’s vision using the measure as an integrated measurement approach was insufficiently shared throughout the organisation. Conclusions: Our study shows that Patient Reported Experience Measures have the potential to be used as an integrated measurement strategy. Yet, we found barriers at the micro level, which might have influenced using the measurement outcomes at the meso and macro level. Tailored implementation strategies, mostly focusing on designing and preparing the implementation on themicro level, need to be developed in co-creation with all stakeholders.
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Background: The importance of clarifying goals and providing process feedback for student learning has been widely acknowledged. From a Self-Determination Theory perspective, it is suggested that motivational and learning gains will be obtained because in well-structured learning environments, when goals and process feedback are provided, students will feel more effective (need for competence), more in charge over their own learning (need for autonomy) and experience a more positive classroom atmosphere (need for relatedness). Yet, in spite of the growing theoretical interest in goal clarification and process feedback in the context of physical education (PE), little experimental research is available about this topic. Purpose: The present study quasi-experimentally investigated whether the presence of goal clarification and process feedback positively affects students’ need satisfaction and frustration. Method: Twenty classes from five schools with 492 seventh grade PE students participated in this quasi-experimental study. Within each school, four classes were randomly assigned to one of the four experimental conditions (n = 121, n = 117, n = 126 and n = 128) in a 2 × 2 factorial design, in which goal clarification (absence vs. presence) and process feedback (absence vs. presence) were experimentally manipulated. The experimental lesson consisted of a PE lesson on handstand (a relatively new skill for seventh grade students), taught by one and the same teacher who went to the school of the students to teach the lesson. Depending on the experimental condition, the teacher either started the lesson explaining the goals, or refrained from explaining the goals. Throughout the lesson the teacher either provided process feedback, or refrained from providing process feedback. All other instructions were similar across conditions, with videos of exercises of differential levels of difficulty provided to the students. All experimental lessons were observed by a research-assistant to discern whether manipulations were provided according to a condition-specific script. One week prior to participating in the experimental lesson, data on students’ need-based experiences (i.e. quantitatively) were gathered. Directly after students’ participation in the experimental lesson, data on students’ perceptions of goal clarification and process feedback, need-based experiences (i.e. quantitatively) and experiences in general (i.e. qualitatively) were gathered. Results and discussion: The questionnaire data and observations revealed that manipulations were provided according to the lesson-scripts. Rejecting our hypothesis, quantitative analyses indicated no differences in need satisfaction across conditions, as students were equally satisfied in their need for competence, autonomy and relatedness regardless of whether the teacher provided goal clarification and process feedback, only goal clarification, only process feedback or none. Similar results were found for need frustration. Qualitative analyses indicated that, in all four conditions, aspects of the experimental lesson made students feel more effective, more in charge over their own learning and experience a more positive classroom atmosphere. Our results suggest that under certain conditions, lessons can be perceived as highly need-satisfying by students, even if the teacher does not verbally and explicitly clarify the goals and/ or provides process feedback. Perhaps, students were able to self-generate goals and feedback based on the instructional videos.
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