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Case 9
Published in Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta, Clinical Cases, 2021
Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta
A cranial nerve examination is performed with the following findings:CNI: mild reduced olfactory sensation since operation, but recovering.CNII: not formally tested with Snellen chart. She reports normal far and near vision but ongoing significant diplopia. No visual field defect.CNIII/IV/VI: full range of movement L eye. No abduction of R eye. No nystagmus or eye pain on movement. Mild right-sided ptosis.CNV: normal sensory perception bilaterally in V1,2,3. Mild paraesthesia in R V1 ~0.5/10 in pain over R eyebrow.CNVII: Full range of facial movement. No loss of taste.CNVIII: Reports reduction in hearing in L ear. Normal hearing on whispering numbers.CNIX/X/XI: No tongue fasciculations/weakness. No palatal/tongue deviation. Normal tongue movement and swallow (reported). Intact head turning and shoulder shrugging.
Complex scenarios
Published in Peter Tate, Francesca Frame, The Doctor's Communication Handbook, 2019
Remember the duty of confidentiality that is owed to your patient. This tends to go out of the window as soon as serious illness is suspected. Doctors have become used to ushering spouses into darkened corners and whispering terrible intimate details of their loved one's condition without a by-your-leave to the unfortunate sufferer. This has always been assumed to be for the patient's well-being. Almost all patients, however ill, want to know their diagnosis, and most of them want to know about the prognosis, treatment options and side effects. Patients dislike unconditional disclosure of information without their consent; their own needs take priority over those of their family.
Clinical Examination of the Ears and Hearing
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
George G. Browning, Peter-John Wormald
When the tester is standing behind the subject at arm’s length from their head and the subject cannot repeat more than 50% of the number–letter combinations spoken in a whispered voice, they will have a hearing impairment of at least 30 dB HL in both ears (Table 73.1).13 The main variable to ensure control for is the level of the whispered voice. Some suggest that fully exhaling before whispering gives more consistent voice levels. It must also be remembered that testing has to be in a quiet environment.
Effectiveness of an Eight-Week Multidisciplinary Selective Mutism Treatment Group
Published in Evidence-Based Practice in Child and Adolescent Mental Health, 2023
Jaclyn T. Aldrich, Jennifer B. Blossom, Ashley Moss, Brenda Ray, Marcy Couckuyt, Tracey Ward, Andrew R. Fox, Kendra L. Read
Examination of outcome measures demonstrated significant improvements in functioning and reduced impairment related to speaking difficulty. In eight weeks, youth demonstrated increases in verbal behavior as exemplified by caregiver and teacher report, as well as observational data collected across treatment sessions. In addition to serving as a method of contingency management and immediate positive reinforcement, monitoring nonverbal and verbal communication during sessions allowed us to examine the change in speaking behaviors week to week in session. Over the course of treatment, youth appeared to engage in more verbal communication, at volume levels appropriate to the situation, while also utilizing less avoidance behaviors such as nonverbal gestures. The lack of significant change in whispering across treatment was not unexpected, given that whispering is often utilized as a transitional stage between nonverbal and more typical volume communication. Observational changes were supported by caregiver and teacher report of SM symptomology, which focused on verbal engagement with teachers, peers, and non-familial adults in social settings outside of treatment, suggesting that gains made in treatment generalized to other environments.
Investigating voice differences in teachers with and without self-reported voice disorders, and healthcare workers without self-reported voice disorders
Published in Logopedics Phoniatrics Vocology, 2021
The vowel /a/ was used for phonating. The participants started at a habitual fundamental frequency gliding downwards to the softest and lowest phonation. Thereafter, participants were requested to keep the soft phonation and glide to the highest possible frequency. The procedure was then repeated in a loud voice. Respondents were asked to produce physiologically acceptable sounds without whispering and shouting, and at the end of the procedure, respondents were asked to fill out blank spots and try to “connect” the contours of the phonetogram [25]. Each participant was coached by the examiner during the task. Minimum and maximum intensity, the highest and lowest intensity were determined for each recording. The intensity range (dB) and frequency range (semitones, ST) were calculated by the VRP software.
Whispering Hypnosis: Phylogenetically Programmed Behavior and a Pluralistic Understanding of Hypnosis
Published in American Journal of Clinical Hypnosis, 2020
The idea of whispering hypnosis is meant to inspire new thinking about hypnotic interpersonal influence stemming from phylogenetically programmed behaviors (i.e., instinct). Merriam-Webster dictionary defines animal whisperer as a person who excels at calming or training usually hard-to-manage animals using noncoercive methods based especially on an understanding of the animals’ natural instincts. The whisperer’s interactions with other living creatures has a hypnotic quality because of the strength of rapport that develops and the automaticity of the animal’s responses. What is often overlooked when we marvel at the accomplishments of animal whisperers is the fact that humans are another species of animal and, like all other animals, are subject to autoshaping (i.e., a conditioned response that does not require reinforcement by reward or punishment because it is a modified instinctive response to certain stimuli; see Pithers, 1985) as well as instinctual drift (i.e., the tendency of an animal to revert to unconscious and automatic behavior that interferes with operant conditioning and the learned responses that come with it; see Breland & Breland, 1961). An interesting question for general psychology is whether or not the same species specific, nonverbal communication strategies used by an animal whisperer are applicable to the human animal. This line of investigation seems especially relevant to researchers of hypnosis because of its focus on the strategic utilization of automaticity and non-volitional behaviors. This prompts us to ask whether we have paid enough attention to the role of instinct during hypnotism.