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Purpose: Research suggests that rates for autism may be higher in cerebral palsy than in the general population. For those with severe bilateral physical impairment (GMFCS level IV and V) and little or no speech, describing a profile of social communication skills has been difficult because there are currently no assessments for early social communication specifically tailored for these children. Our aim was to explore the assessment of aspects of joint attention and social reciprocity in this group of children with CP., Methods: We compared the performance of children with bilateral CP on carefully designed assessments of joint attention and social responsiveness with groups of children with Down syndrome and autism. All three groups were matched for chronological age and mental age., Results: Approximately 30% of the children with bilateral CP had early social communication scores similar to the autistic children. The remaining 70% of children with CP had a range of early social communication scores similar to the children with Down syndrome., Conclusion: It is possible to assess key early social communication skills in non-speaking children with bilateral motor disability. This could provide insights to help clinicians and caregivers as they discuss abilities and explore potential areas for intervention.

The relationships between the use of nouns and verbs, and other word classes have been well established in the typical language development literature. However, questions remain as to whether the same relationships are seen in the language use of individuals who use graphic symbol-based augmentative and alternative communication (AAC). The aim of the study was to examine relationships between the use of verbs and nouns, and the use of prepositions, adverbs, and adjectives through a secondary analysis of language transcripts taken from 12 children and adolescents who used aided AAC in conversation with an adult. A series of multiple linear mixed-effect regression analyses showed a positive predictive association between the use of verbs and the use of prepositions and adverbs, as well as a positive predictive relationship between the use of nouns and the use of adjectives. The theoretical and practical implications of these findings are discussed.

The present study investigated the relationship between lexicon and grammar in individuals who use graphic symbol-based aided augmentative and alternative communication (AAC). Data came from 60 transcripts of generalization sessions that were part of two previous intervention studies, aimed at improving the expressive vocabulary and grammar of 12 children and youth who used graphic symbol-based AAC. The specific aims of the current study were to (a) describe vocabulary composition across different levels of expressive vocabulary and (b) analyze the relationship between global measures of expressive vocabulary and the use of grammar in individuals who use aided AAC. A series of multiple linear mixed effect regression analyses showed a positive predictive association between overall vocabulary size and the use of closed-class words, and a positive relationship between the use of verbs and the use of closed-class words. Additionally, the use of verbs had a significant positive association with the use of inflectional morphology, while the use of nouns did not. Theoretical and practical implications of these findings are discussed.

Purpose: The aim of this study was to develop and test a new classification scale to describe looking behaviours (gaze fixations and gaze shifts) in relation to eye-pointing., Methods: The Eye-pointing Classification Scale (EpCS) was developed and tested following established procedures for the construction and evaluation of equivalent scales, and involved 2 phases: Drawing on research literature, Phase 1 involved initial drafting of the scale through a series of multi-disciplinary group discussions; evaluation of the scale through a survey procedure, and subsequent expert group evaluation. Phase 2, was an examination of scale reliability and relationships between child characteristics and level of EpCS classification., Results: In Phase 1, an initial draft of the scale was developed and then evaluated by 52 participants in 10 countries, leading to its refinement. Subsequent expert evaluation of content, style and structure indicated that no further refinement was required. In Phase 2, the scale achieved excellent levels of reliability in clinical testing. A significant relationship was identified between level of child motor ability and EpCS classification, and level of child language understanding and EpCS classification.Implications for rehabilitationNon-speaking children with severe bilateral cerebral palsy who have limited upper limb movement may communicate by using controlled looking behaviours to point to objects and people, referred to as eye-pointing.However, there is little consensus as to which looking behaviours represent eye-pointing and which do not.The Eye-pointing Classification Scale (EpCS) was developed to describe looking behaviours related to eye-pointing in this population of childrenThe EpCS provides a new robust tool for clinical management and research with children with cerebral palsy.

Conversational repair has been found to play a fundamental role in the acquisition of language. This paper describes existing research on conversational repair and its relationship to language learning, whether a first language or a second language, as well as its relevance to augmentative and alternative communication (AAC). A case is made for incorporating prompts to repair in conversation-based language interventions with children learning to use AAC. We argue that interventions targeting linguistic complexity should encourage self-repair in conversation in order to develop linguistic and operational competency as well as increase automaticity when using AAC. Clinical implications and directions for future research are discussed.

This study evaluated the effects of a conversation-based intervention on the use of verbs, personal pronouns, bound morphemes and spontaneous clauses in adolescents with cerebral palsy who use augmentative and alternative communication (AAC). Four teenage girls aged from 14 to 18 years participated in the study. After a baseline period, a conversation-based intervention was provided for each participant in the context of a personal collage-building activity. The conversations were videotaped, transcribed, and analyzed using the Systematic Analysis of Language Transcripts (SALT™) . While the results are mixed, all four participants increased their use of at least one linguistic target, three increased their use of verbs and grammatically correct spontaneous clauses, two increased their use of personal pronouns, and one produced more bound morphemes during intervention than in baseline. These findings, and future research needs, are discussed.

For children with typical development, language is learned through everyday discursive interaction. Adults mediate child participation in such interactions through the deployment of a range of co-constructive strategies, including repeating, questioning, prompting, expanding, and reformulating the child's utterances. Adult reformulations of child utterances, also known as recasts, have also been shown to relate to the acquisition of linguistic structures in children with language and learning disabilities and children and adults learning a foreign language. In this paper we discuss the theoretical basis and empirical evidence for the use of different types of recasts as a major language learning catalyst, and what may account for their facilitative effects. We consider the occurrence of different types of recasts in AAC-mediated interactions and their potential for language facilitation, within the typical operational and linguistic constraints of such interactions. We also consider the benefit of explicit and corrective forms of recasts for language facilitation in conversations with children who rely on AAC. We conclude by outlining future research directions.

Background: Many organisms that are responsible for low-grade infection after total hip replacement (THR) are not recognized by routine culture., Patients and Methods: We examined wound contamination during primary total hip replacement performed in standard and ultra-clean operating theaters. 20 THRs were performed in each type of theater. Paired tissue specimens taken at the beginning and end of surgery were analyzed by bacterial culture and for the presence of bacterial DNA by the polymerase chain reaction (PCR). In total, 160 specimens (80 for culture, 80 for PCR) from 40 THRs were tested., Results: In standard theaters, none of the 20 specimens taken at the start of surgery were positive by culture, but 3 were positive by PCR (15%). Of the 20 specimens taken at the end of surgery, 2 were positive by enriched culture and 9 were positive by PCR. All specimens positive by culture were also positive by PCR. In ultra-clean theaters, none of the 20 specimens taken at the start of surgery were positive by culture, but 2 were positive by PCR. Of the 20 specimens taken at the end of surgery, none were positive by culture, but 6 were positive by PCR. All specimens that were positive by culture were positive by PCR., Interpretation: Wound contamination of primary THR occurs frequently in both standard and ultra-clean operating theaters and contamination is greater at the end of surgery than at the beginning (p=0.04). In this small series, we found no differences in wound contamination between standard and ultra-clean theaters (p=0.1).