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Communication Sciences and Disorders Commons™
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Articles 181 - 210 of 315
Full-Text Articles in Communication Sciences and Disorders
Development And Implementation Of Computer-Based Learning Modules On Alternative Communication For Pediatric Nurses And Nursing Students, Amanda Kaye Simmons
Development And Implementation Of Computer-Based Learning Modules On Alternative Communication For Pediatric Nurses And Nursing Students, Amanda Kaye Simmons
Theses and Dissertations (ETD)
Purpose and Rationale. To develop, implement, and assess computer-based learning modules (CBLs) on augmentative and alternative communication (AAC) with pediatric nurses and nursing students for knowledge outcomes, self-efficacy, and perceived relevance and effectiveness. Effective communication ensures all parties can understand and express themselves clearly, through any means necessary, often including AAC tools, supports, and strategies. Communication is essential in healthcare but there is limited research with pediatric nurses. Previous research with a single hospital indicated a need for nurse education on AAC. This research used focus groups and interviews to understand pediatric nurse and nursing student knowledge about AAC. The …
Effects Of Personal Fm System Use During Phonological Awareness Instruction For Children At Risk For Dyslexia, Gabriella Rose Reynolds
Effects Of Personal Fm System Use During Phonological Awareness Instruction For Children At Risk For Dyslexia, Gabriella Rose Reynolds
Theses and Dissertations
Students with reading impairments, including dyslexia, account for the largest proportion of students receiving special education services in the United States (NCES, 2016). Developmental dyslexia is characterized by slow and inaccurate word decoding (Lyon et al., 2003). This word decoding difficulty results from deficits in phonological awareness, a sound-based skill (Swan & Goswami, 1997). Classrooms are known to have high levels of background noise and are inconsistent with recommendations for optimal listening (Picard & Bradley, 2001) or accepted standards (ASHA, n.d.). Furthermore, degraded acoustic conditions have been related to poorer performance on speech-recognition tasks even for children with normal hearing …
Phonological Variation Among Young Spanish-English Dual Language Learners On An English Sentence Repetition Task, Sarah Kate Coleman
Phonological Variation Among Young Spanish-English Dual Language Learners On An English Sentence Repetition Task, Sarah Kate Coleman
Senior Theses
Purpose - There is a need for research informing best practices for assessing the language abilities of bilingual children, as well as research regarding typical phonological development of bilingual children. The purpose of the present paper is to contribute broadly to informing bilingual phonological assessment practice by examining phonological variation in Spanish-English speaking children’s English sentence repetition responses and the relation between these phonological variations and performance on the English sentence repetition task.
Method - 20 Spanish-English speaking kindergarteners completed the English sentence repetition task of the Bilingual English-Spanish Assessment (BESA; Peña et al., 2014). The phonological variations present in …
Systematic Review Of Factors Impacting Reading Impairment Rates In Studies Of Children With Developmental Language Disorder (Dld), Kayla Dewey
Senior Theses
This systematic review examined studies of individuals with developmental language disorder (DLD) to examine the rate of co-occurring reading impairment. We hypothesized that recruitment method, age, and the type of diagnostic reading assessment would be associated with different rates of reading impairment in individuals with DLD. We searched the database PsycINFO for peer-reviewed academic articles containing specific keywords related to DLD/SLI and Dyslexia, resulting in a total of 286 studies. These articles were then filtered to ensure that all articles analyzed in the present study only examined children below the age of 18, were a study of children with DLD/SLI, …
Best Practice In Dementia Communication: Determining The Effectiveness Of Pre-Recorded, Presentation-Based Learning For Cnas Working In Residential Care Facilities, Mary Kate Hoeve
Masters Theses
The dramatic increase in the aging population and predicted rise in individuals diagnosed with a dementia-related disorder in the next 30 years has sparked an increase in the exploration of gerontology and best practice in dementia care (Curyto & Vriesman, 2016). Additionally, each person living with dementia spends less than two percent of their day engaging in social communication with a care worker (Ward et al, 2005). With a significant increase in the development of dementia-related disorders and minimal social interaction, understanding the manifestations of dementia and methods of effective communication between individuals with dementia-related disorders and direct care workers …
Voice Therapy: Racial Disparities In Adherence And Clinically Significant Outcomes, Amber D. Burks
Voice Therapy: Racial Disparities In Adherence And Clinically Significant Outcomes, Amber D. Burks
LSU Master's Theses
Voice therapy is evidence-based, behavioral intervention that can reduce functional and organic voice disorders. Despite its proven effectiveness, non-adherence to voice therapy is still an issue. Research shows that an estimated 65% of patients who initiate voice therapy drop out before reaching therapeutic goals. Voice therapy outcomes are largely dependent on patients’ adherence to treatment regimens, but there is limited information concerning factors that may be associated with voice therapy adherence and therapeutic outcomes for patients who successfully complete voice therapy.
The purpose of this study was to investigate which demographic factors could be associated with higher adherence rates to …
The Ethics Of Patient And Public Involvement Across The Research Process: Towards Partnership With People With Aphasia, Deborah Hersh, Mark Israel, Ciara Shiggins
The Ethics Of Patient And Public Involvement Across The Research Process: Towards Partnership With People With Aphasia, Deborah Hersh, Mark Israel, Ciara Shiggins
Research outputs 2014 to 2021
Background:
Conducting Patient and Public Involvement (PPI) in health research is a way of building knowledge that incorporates the experience of service users, adds research impact, and helps avoid wasting resources on findings that have little relevance to people or cannot be implemented. We argue that there is a need to extend ethical considerations currently focused on research participants with aphasia to encompass and guide expectations of involvement in partnerships with people with aphasia across the research lifecycle.
Method:
We use the 2018 revision of the Australian National Statement on Ethical Conduct in Human Research as the framework for this …
Three's Company: Collaborative Instructional Design On A Librarian-Instructor Team, Brittany L. O'Neill, Allen Leblanc, Deirdre Larsen
Three's Company: Collaborative Instructional Design On A Librarian-Instructor Team, Brittany L. O'Neill, Allen Leblanc, Deirdre Larsen
Georgia International Conference on Information Literacy
This session will describe a unique collaboration that resulted in development of a strategic research assignment design supported by relevant information literacy sessions. This effort stems from an existing relationship between research librarians and an instructor who was previously a graduate assistant in Research & Instruction Services and became an instructor of a general education course in Communication Sciences and Disorders. Through this collective, a synergistic arrangement developed where librarians contribute to research assignment design and the instructor contributes to developing the information literacy sessions to prepare students for finding, evaluating, and understanding relevant scholarly articles early in their college …
The Impact Of Technology On The Developing Visual And/Or Auditory Memory In School Aged Children, Cameron Mayer
The Impact Of Technology On The Developing Visual And/Or Auditory Memory In School Aged Children, Cameron Mayer
Honors Scholars & Undergraduate Research Poster Symposium Programs
This study aimed to determine whether time spent on technology impacts the developing auditory or visual memory in school-aged children. A survey was completed with the child participants to acquire a catalog of time spent on both technology devices and non-technological activities. Tests included a visual and auditory memory assessment adapted from the Preschool Language Scales Fifth Edition (PLS-5). The subtests were expanded upon in order to incorporate an auditory element. The results indicated that there was no significance between time spent on technology and visual and auditory memory scores. This was likely caused by the small sample size. However, …
Reliability Of Speech-Language Pathologists’ Categorizations Of Preschoolers’ Communication Impairments In Practice, Bj Cunningham, Janis Oram Cardy
Reliability Of Speech-Language Pathologists’ Categorizations Of Preschoolers’ Communication Impairments In Practice, Bj Cunningham, Janis Oram Cardy
PRECISe Preschool Speech and Language Publications
Abstract
Purpose An efficient and reliable way to categorize children's communication impairments based on routine clinical assessments is needed to inform research and clinical decisions. This preliminary study assessed interrater reliability of speech-language pathologists' categorization of preschoolers' speech, language, and communication impairments using a clinical consensus document.Method
Six speech-language pathologists at three community sites worked in pairs to assess 38 children aged 1–5 years, then used the clinical consensus document to categorize children's communication impairments broadly. Identified language and speech sound impairments were further subcategorized.Results
Speech-language pathologists had substantial to almost perfect agreement for three broadly focused impairment …Increasing Access To Augmentative And Alternative Communication Services For People With Complex Communication Needs During Covid-19 And Beyond, Cristina L. Pujol, Anamaria Nevares, Michelle Schladant
Increasing Access To Augmentative And Alternative Communication Services For People With Complex Communication Needs During Covid-19 And Beyond, Cristina L. Pujol, Anamaria Nevares, Michelle Schladant
Developmental Disabilities Network Journal
The COVID-19 global pandemic has affected the disability network across the world. In the United States, there are millions of people who cannot use their natural speech to communicate. Augmentative and alternative communication (AAC), a form of assistive technology (AT), helps people with complex communication needs (CCNs) to communicate with others. Examples of AAC include printed pictures and speech-generating devices. A team of professionals work together with the person with CCNs and their caregivers to choose the right type of AAC. Often, people with CCNs need face-to-face and ongoing AAC support. Prior to the COVID-19 pandemic, this population already faced …
The Acoustical Characteristics Of An Individual With Adductor Spasmodic Dysphonia Receiving Botox Injections, Hope Noelle Higginbotham
The Acoustical Characteristics Of An Individual With Adductor Spasmodic Dysphonia Receiving Botox Injections, Hope Noelle Higginbotham
Student Theses and Dissertations
The purpose of this study was to measure the qualitative and quantitative vocal characteristics of an individual with adductor spasmodic dysphonia (ADSD) who was treated with botulinum toxin (Botox) injections. ADSD is a voice disorder that affects voice muscles and is characterized by rigid movement of the vocal folds and inconsistent speech. The participant was acoustically recorded and completed a diary regarding vocal changes before and after Botox injections to compare vocal changes that occurred over time. In addition, the participant qualitatively reported information regarding her perceptions of the changes in her vocal quality with the injections. The results indicated …
Speech-Language Pathologist Confidence In Dysphagia Management, Fiona May Fuller
Speech-Language Pathologist Confidence In Dysphagia Management, Fiona May Fuller
Student Theses and Dissertations
This study served to investigate the dysphagia-specific education and training that practicing speech-language pathologists (SLPs) have received within their graduate programs, within their workplaces, and independently. In addition, SLPs’ perceptions of their preparedness for dysphagia management responsibilities after completion of a graduate-level Communication Sciences and Disorders (CSD) program and the confidence they have in their own abilities to contribute to different aspects of dysphagia management were also investigated. An electronic survey was distributed to licensed SLPs via an email list provided by the Arkansas Board of Examiners for Speech-Language Pathology and Audiology (ABESPA). Results revealed that although SLPs felt generally …
Therapy Approaches For Broca’S Aphasia: Consultative Vs. Clinician Directed, Stacey Nichole Mott
Therapy Approaches For Broca’S Aphasia: Consultative Vs. Clinician Directed, Stacey Nichole Mott
Student Theses and Dissertations
This investigation sought to explore the outcomes from two common therapy approaches, consultative and clinician directed, to language and communication rehabilitation for individuals with Broca’s aphasia. Both approaches are recognized as evidence-based and are used across many clinical settings. This single case study was performed using standardized assessment, informal measures, and a survey. The data collection reveals that there are positive outcomes to both methods of therapy. However, this study revealed a need to continue investigating the prevalence of use for both types of therapy approaches used by speech-language pathologists in various rehabilitative settings.
Speech-Language Pathologists’ Knowledge And Implementation Of Thyroid Hormone Diseases And Allergies On Voice, Kirsten Combs
Speech-Language Pathologists’ Knowledge And Implementation Of Thyroid Hormone Diseases And Allergies On Voice, Kirsten Combs
Student Theses and Dissertations
There is little research that shows speech-language pathologists’ (SLP’s) knowledge of the impact of allergies or thyroid diseases related to voice disorders, or if they use this information during assessment and treatment. A survey was distributed to every licensed SLPs in the state of Arkansas, and 284 SLPs completed it. Only 20 participants asked clients if they have thyroid hormone diseases, whereas 256 asked about allergies. While treating, 236 participants reported that they consider allergies, but only 94 considered thyroid hormone diseases. On knowledge-based questions, the participants had an overall average of 84% for thyroid hormone diseases and 78% for …
Salivary Cortisol Levels Of Children With Reading Difficulties, Alexandria Gaines Jarrett
Salivary Cortisol Levels Of Children With Reading Difficulties, Alexandria Gaines Jarrett
Student Theses and Dissertations
This study was performed to measure the salivary cortisol levels of children with reading difficulties compared to children with typical reading performance. Participants were ages 6-11. They attended two sessions, where reading levels and cortisol levels were measured in order to determine the effect of reading performance on cortisol levels. An independent samples t-test was conducted to compare the cortisol levels for participants who had reading difficulties (experimental group) and the participants with typical reading performance (control group). Means of the cortisol levels were compared in order to reveal at what stage during reading tasks cortisol levels peaked. No statistical …
Facilitators And Barriers To The Use Of Aac By Practicing Slps, John Fred Chunn
Facilitators And Barriers To The Use Of Aac By Practicing Slps, John Fred Chunn
Student Theses and Dissertations
This survey was designed to help determine potential facilitators and barriers to the implementation of augmentative and alternative communication (AAC) from speech-language pathologists (SLPs) practicing in Arkansas. The questions within the survey consisted of short answers, rating scales, and yes or no questions. The categories of the survey included basic information, the SLPs’ practice, and the SLPs’ self-assessed confidence regarding AAC. The results indicated barriers included: less training at the undergraduate education, decreased use of AAC within therapy sessions, the cost of the device, intimidation to caregivers, and a lack of training for caregivers. However, a facilitator was that the …
Survey Of Current Therapy Methods For Treatment Of Reading Fluency And Comprehension, Brooke Elizabeth Darnell
Survey Of Current Therapy Methods For Treatment Of Reading Fluency And Comprehension, Brooke Elizabeth Darnell
Student Theses and Dissertations
This study aimed to investigate the current types of interventions SLPs are using when treating children with reading difficulties. This study utilized a survey to investigate not only the types of interventions, but also the SLPs’ opinions regarding the efficacy of these interventions. This study provided evidence to support the use of these methods as well as provided insight into the treatment of children with reading difficulties.
The Speech Language Pathologists’ Understanding Of And Interaction With The Functional Health Literacy Of Parents With Infants In The Neonatal Intensive Care Unit, Emily Elizabeth Gardner Mccullough
The Speech Language Pathologists’ Understanding Of And Interaction With The Functional Health Literacy Of Parents With Infants In The Neonatal Intensive Care Unit, Emily Elizabeth Gardner Mccullough
Student Theses and Dissertations
Purpose: The purpose of the study is to investigate speech-language pathologists’ (SLPs’) experience with the functional health literacy skills of parents with infants in the neonatal intensive care unit (NICU). Method: Thirteen NICU SLPs electronically completed the survey on SurveyMonkey. Results: Results support the theory that the health literacy levels of parents in the NICU are limited resulting in multiple functional health literacy breakdowns per week. These SLPs are able to recount specific functional health literacy breakdowns, voice their concerns, and give ideas on how to improve. Conclusion: Speech-language pathologists (SLPs) are witnessing many health literacy breakdowns within the NICU, …
Adapting During A Pandemic: Using Ethics Of Care And Cosmopolitanism To Train Graduate Students During The Covid-19 Crisis, Jennifer Whited, Anne Marie Sisk
Adapting During A Pandemic: Using Ethics Of Care And Cosmopolitanism To Train Graduate Students During The Covid-19 Crisis, Jennifer Whited, Anne Marie Sisk
Journal of Interprofessional Practice and Collaboration
The COVID-19 crisis impacted university clinics in numerous devastating ways. Educators across the world have had to completely retool their approaches to training students in a clinical setting. The authors describe two overall approaches they adapted to guide new ways of training students, as well as three practical strategies they used to implement quality instruction.
Brown's Stages Of Morphosyntactic Development Applied To The Typical Development Of Italian, Marie Laiche
Brown's Stages Of Morphosyntactic Development Applied To The Typical Development Of Italian, Marie Laiche
LSU Master's Theses
Background: In A First Language (1973), Roger Brown called for an increase in crosslinguistic data and analysis of morphosyntax across languages as more research in this field is crucial for working out the overarching determinants of language acquisition order and for the ability to accurately compare child language acquisition across different languages. An increase in this research would benefit linguistic researchers and speech-language-pathologists offering services to or evaluating children speaking a different language or more than one language. The current study seeks to add to the field of crosslinguistic research by adapting Brown’s guidelines of English language acquisition to the …
Self-Perception Of Stuttering Frequency Across The Lifespan: A Pilot Study, Natalia C. Newton
Self-Perception Of Stuttering Frequency Across The Lifespan: A Pilot Study, Natalia C. Newton
University Honors Theses
Purpose: The purpose of the current pilot study is to analyze the accuracy of self-rating of stuttering frequency as compared to clinician calculations of stuttering frequency in order to further examine possible factors that affect the accuracy of a stutterer’s self-rating of their overt stuttering.
Method: Three participants (i.e., one child, one teen, one adult) self-rated their perceptions of their stuttering frequency on a scale of 1-5 after three telepractice speech therapy sessions. Each of the telepractice therapy sessions were recorded and reviewed asynchronously after the session to conduct a disfluency count with a 300-word sample and calculate the percentage …
Evaluating The Accuracy Of Step Tracking And Fall Detection In The Starkey Livio Artificial Intelligence Hearing Aids: A Pilot Study, Mohamed Rahme, Paula Folkeard, Susan Scollie
Evaluating The Accuracy Of Step Tracking And Fall Detection In The Starkey Livio Artificial Intelligence Hearing Aids: A Pilot Study, Mohamed Rahme, Paula Folkeard, Susan Scollie
Communication Sciences and Disorders Publications
Purpose: The primary purpose of this study was to examine the efficacy and the effectiveness of Starkey Livio Artificial Intelligence hearing aids in tracking step count. A secondary purpose was to investigate the accuracy of the fall detection and alert system of Livio hearing aids in detecting fall maneuvers. Method: A participant wore Binaural Starkey Livio receiver-in-the-canal style hearing aids, a Sportline pedometer, and a Fitbit Charge 3 concurrently during both real-world and treadmill walking conditions. The real-world condition was conducted over a 5-day period. Step count for the treadmill protocol was assessed at six different treadmill speeds (2 mph, …
Online Behaviors Of Teenagers On The Autism Spectrum, Amelia Anderson, Abigail Phillips
Online Behaviors Of Teenagers On The Autism Spectrum, Amelia Anderson, Abigail Phillips
STEMPS Faculty Publications
The Internet can be a source of connection and support for teenagers on the autism spectrum. This study explores how teenagers on the autism spectrum who identify as library users spend time online by addressing the following research questions: How do teens on the autism spectrum participate in the online environment? And, how do teens on the autism spectrum make sense of social media? Quantitative and qualitative data was analyzed from nine participants, recruited through online discussion forums. Implications suggest a potential role for educators and librarians to offer opportunities and support in creating and building online connections.
Response Inhibition Deficits In Women With The Fmr1 Premutation Are Associated With Age And Fall Risk, Carly Moser, Lyndsay Schmitt, Joseph Schmidt, Amanda Fairchild, Jessica Klusek
Response Inhibition Deficits In Women With The Fmr1 Premutation Are Associated With Age And Fall Risk, Carly Moser, Lyndsay Schmitt, Joseph Schmidt, Amanda Fairchild, Jessica Klusek
Faculty Publications
One in 113-178 females worldwide carry a premutation allele on the FMR1 gene. The FMR1 premutation is linked to neurocognitive and neuromotor impairments, although the phenotype is not fully understood, particularly with respect to age effects. This study sought to define oculomotor response inhibition skills in women with the FMR1 premutation and their association with age and fall risk. We employed an antisaccade eye-tracking paradigm to index oculomotor inhibition skills in 35 women with the FMR1 premutation and 28 control women. The FMR1 premutation group exhibited longer antisaccade latency and reduced accuracy relative to controls, indicating deficient response inhibition skills. …
Health Literacy Of The Covid-19 Pandemic On The Behavior Of Street Children’S Mothers In Indonesia, Yanti Tayo, Ninis Agustini Damayani, Atwar Bajari, Wawan Setiawan
Health Literacy Of The Covid-19 Pandemic On The Behavior Of Street Children’S Mothers In Indonesia, Yanti Tayo, Ninis Agustini Damayani, Atwar Bajari, Wawan Setiawan
Library Philosophy and Practice (e-journal)
The COVID-19 virus, which is spreading rapidly and massively around the world, is causing panic and fear in everyone; the Indonesian government is taking quick steps to solve the COVID 19 pandemic that is currently happening. What about the fate of street children currently still on the streets working as street singers, beggars, and hawkers? This study aims to see how health literacy possessed by the mothers of street children who are still on the streets during the COVID-19 pandemic. This study uses a qualitative research method with a phenomenological approach. The resource persons in this study were ten mothers …
The Development Of A Measure Of Orthographic Processing In The Arabic Language: A Psychometric Evaluation, Sana Tibi, Lisa Fitton, Autumn L. Mcilraith
The Development Of A Measure Of Orthographic Processing In The Arabic Language: A Psychometric Evaluation, Sana Tibi, Lisa Fitton, Autumn L. Mcilraith
Faculty Publications
Although Arabic is an official language in 27 countries, standardized measures to assess Arabic literacy are scarce. The purpose of this research was to examine the item functioning of an assessment of Arabic orthographic knowledge. Sixty novel items were piloted with 201 third grade Arabic-speaking students. Participants were asked to identify the correctly spelled word from a pair of two words. Although the assessment was designed to be unidimensional, competing models were tested to determine whether item performance was attributable to multidimensionality. No multidimensional structure fit the data significantly better than the unidimensional model. The 60 original items were evaluated …
Hearing Threshold Levels Of Australian Coal Mine Workers: A Retrospective Cross-Sectional Study Of 64196 Audiograms, Adelle Liebenberg, Alan M. Brichta, Valerie M. Nie, Sima Ahmadi, Carole L. James
Hearing Threshold Levels Of Australian Coal Mine Workers: A Retrospective Cross-Sectional Study Of 64196 Audiograms, Adelle Liebenberg, Alan M. Brichta, Valerie M. Nie, Sima Ahmadi, Carole L. James
Research outputs 2014 to 2021
Objective
This study examined the hearing threshold levels (HTL) of workers commencing employment in Australian coal mines in the State of New South Wales (NSW). The aim was to establish if some degree of hearing loss was identifiable in the mandatory pre-employment audiograms of workers.
Design
This was an observational, retrospective, repeated cross-sectional study. Study Sample De-identified audiometric records of 64196 employees entering NSW coal mining in three representative five-year periods between 1991–2015 were utilised
Results
Although HTLs were lower (better) in more recent years, the results showed clinically significant hearing loss ( ≥ 25dBHL) for older workers, 45–60 years. …
Reading And Math Achievement In Children With Dyslexia, Developmental Language Disorder, Or Typical Development: Achievement Gaps Persist From Second Through Fourth Grades, Dawna Duff, Alison Eisel Hendricks, Lisa Fitton, Suzanne M. Adlof
Reading And Math Achievement In Children With Dyslexia, Developmental Language Disorder, Or Typical Development: Achievement Gaps Persist From Second Through Fourth Grades, Dawna Duff, Alison Eisel Hendricks, Lisa Fitton, Suzanne M. Adlof
Faculty Publications
We examined how children (n=448) who met research criteria for separate vs. co-occurring DLD and dyslexia performed on school-based measures of academic functioning in reading and math between second and fourth grades. Growth curve models were used to examine the overall form of growth and differences between groups. Children with DLD and/or dyslexia in second grade showed early and persistent deficits on school-administered measures of reading and math. In second grade, children with typical development (TD) scored significantly higher than all other groups, children with DLD+dyslexia scored significantly lower than all other groups, and children with dyslexia-only and DLD-only did …
Strengths And Challenges Of The Cosmin Tools In The Appraisal Of Outcome Measures: A Case Example For Speech-Language Therapy, Elaine Kwok, Peter Rosenbaum, Nancy Thomas-Stonell, Barbara Jane Cunningham
Strengths And Challenges Of The Cosmin Tools In The Appraisal Of Outcome Measures: A Case Example For Speech-Language Therapy, Elaine Kwok, Peter Rosenbaum, Nancy Thomas-Stonell, Barbara Jane Cunningham
PRECISe Preschool Speech and Language Publications
Background: The Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) is an international initiative that offers standardized and validated tools to guide the appraisal of outcome measures in healthcare.
Aims: This study aimed to explore the use of a new set of tools from COSMIN to appraise studies on outcome measures available to speech and language therapists (SLTs).
Methods: We used the COSMIN tools to appraise seven studies and a user manual that reported the measurement properties of the Focus on the Outcomes of Children Under Six (FOCUS), a validated measure of preschoolers’ communicative participation that …