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Each year 152,000 people in the UK have a stroke. Almost all have an initial facial weakness. Many resolve in the first few days but it is estimated that 26,000 people experience some kind of long-term paralysis in their face. A survey of 107 United Kingdom based clinicians found that routine treatment of facial weakness was provision of exercises with a written instruction sheet. A multidisciplinary team, which includes patients, researchers and therapists have produced a working prototype system to improve facial weakness. It is called Face to Face and includes a Kinect sensor, a small form PC and a monitor. Patients follow exercises given by a therapist on the screen; the system records and simultaneously gives feedback, with a facial recognition algorithm providing tracking data for each captured frame of the user's face. Results from our small clinical trial indicate that the system is more successful at getting patients to complete their exercises than using a mirror, patients liked it, and they said it had helped improve their facial symmetry. Therapists said Face to Face encouraged patients to exercise daily, they liked the fact that it could be individually programmed and could record how much the patient had exercised. Based on the initial project work and positive outcomes Face to Face aims to help patients practice their facial muscle exercises to speed their recovery, providing direct benefits in terms of costs and time, and offering patients significant improvements. [ABSTRACT FROM AUTHOR]

A quarter of UK acute hospital beds are occupied by people living with dementia (PLWD). Concerns have been raised by both policy makers and carers about the quality of communication between hospital staff and PLWD. PLWD may experience communication impairments such as word finding difficulties, limited ability to construct coherent narratives and difficulties understanding others. Since much healthcare delivery occurs through talk, healthcare professionals (HCPs) and PLWD are likely to experience increased communication barriers. Consistent with this, HCPs report stress and reduced job satisfaction associated with difficulty communicating with PLWD. HCPs face these challenges whilst striving to deliver person-centred care, respecting the autonomy and wishes of the patient before them. However, best practice recommendations in the field tend not to be based on actual interactional evidence. This paper investigates recurring interactional difficulties around HCP requests to carry out health and social care tasks and subsequent reluctance or refusal on the part of PLWD. Using conversation analysis, we examined 41 video recordings of HCP/PLWD interactions collected across three acute inpatient wards. We identify both the nature of the refusals, and any mitigation offered, and explore the requests preceding them in terms of entitlement and contingency. We also explore the nature of HCP requests which precede PLWD agreement with a course of action. We conclude that several features of requests can be seen to precede acceptance, principally the use of higher entitlement requests, and the lowering of contingencies. Our findings underline the importance of examining the contextual interactional detail involved in the negotiation of healthcare, which here leads to an understanding of how design of HCP requests can impact on an important healthcare activity being carried out. They also emphasise the power of conversation analytic methods to identify areas of frequent interactional trouble in dementia care which have not previously been articulated. • Acute hospital staff need to make requests of their patients living with dementia (83). • Hospital patients living with dementia may refuse important requests in direct ways (85). • This creates a dilemma for staff wishing to deliver respectful and effective care (83). • Some forms of requesting made direct refusal more interactionally relevant (77). • High entitlement requests with lowered contingencies supported request acceptance (83). [ABSTRACT FROM AUTHOR]

Around a quarter of hospital beds in the UK are occupied by patients living with dementia (PWD), and communication impairments are common across all types of dementia, often exacerbated by the hospital environment. Unsurprisingly, healthcare professionals (HCPs) report particular challenges in caring for this patient group, whilst trying to recognise and value their personhood as per the underpinning ethos of person-centred care. However, whilst there is a growing body of research that underlines the importance of communication in dementia care, there is far less that actually examines this communication in real time interaction. Suggestions and pointers for good communication do exist, but these do not tend to be empirically derived, and sometimes conflict with empirical findings. This paper focuses on a specific area of interaction which has previously received very little attention: the way in which healthcare encounters are ended or closed. There is potentially a conflict between a pressure to manage a patient as efficiently as possible, and endeavouring to ensure person-centred care and deal with communication difficulties arising from dementia. Using conversation analysis, we examined forty-one video recordings of HCP/PWD interactions collected from an acute inpatient ward. We identify three phenomena around which there were recurring troubles in our dataset: ‘open-ended pre-closings’, ‘mixed messages’ and ‘non specifics and indeterminate terms’. We conclude that moves towards closing an encounter that appear intuitive to HCPs as competent interactants, and that may represent best practice in other healthcare settings, may in fact serve to confuse a PWD and create difficulties with closings. Our findings underline the importance of examining best practice guidance as it is actually talked into being, using approaches which can unpack the interactional detail involved. They also emphasise the importance of context in the analysis of healthcare delivery, to avoid a ‘one size fits all’ approach. [ABSTRACT FROM AUTHOR]