This is a critical appraisal of an article that can answer the question formed based on a case study. In this critical appraisal, the question was formed based on the patient's interaction with the health care professional and an article is selected for its critical appraisal. The methodology, type of article and everything related is critiqued and then a rebuttal article is selected that helped in forming an argument. The argument from the rebuttal article is given in a way that it proves high applicability of this evidence that will prove the effectivity. The client's question is based on the effectiveness of intervention of facilitated communication so the crucial appraisal assisted in drawing a relevant conclusion based on the rebuttal article. This conclusion will be conveyed to the client for his query.
Keywords: Facilitated communication, autism, communication, effectivity
This is the case of brown family group in which paul (the son) had come to inquire on to the effectiveness of intervention of facilitated communication that is used with the patients with the developmental disorder for communication. In this case, his sister racheal uses facilitated communication with her husband who has acquired brain injury followed by a bicycle accident and also with her granddaughter kyra who has some developmental disorder. Kyra's mother brittany always takes the help of racheal (her mother) and in turn, she takes the help of her brother (paul) who has been using facilitated communication technique with his wife's brother (edward).
Critical appraisal of the first article
This is an article on "communication unbound: autism and praxis" that gives insight on the facilitated communication techniques that are used with the patients having autism. This is a qualitative study in which the method of facilitated communication was developed by rosemary crossley and her colleagues in australia. This is a cohort study because the qualitative data is obtained from the observation of the student's communication abilities when the intervention of facilitated communication was applied. This is an observational study in which the observation of the students was made by the colleagues of crossley and then they came to a conclusion of the communication technique.
This is a low evidence article because such studies are at the level IV evidence thus is a weak evidence source (burns, rohrich & chung, 2011). there is no proper methodology as crossley and her colleagues tried various communication techniques to observe children with the technique that holds maximum effectiveness. They deduced that communication is not always very easily facilitated thus the use of facilitators is effective in carrying out communication with the students who are autistic. The facilitators that assist in communication includes speech therapist, parents, teachers and so on. the interventions used in this study concluded that every autistic child is unique and it all depends on the circumstances.
The conclusion drawn from this article is on the effectiveness of an "education- through- dialogue approach” intervention (biklen, 1990). in this approach, the teachers and the students learn from each other and the school is responsible for validation of the personal expression (ganz, katsiyannis & morin, 2018). this is one way of facilitated communication that can be used for communicating with the children having autism but this is not highly effective because this is an education-based approach that is not effective to be used at home when parents converse with the child. Thus, this is a piece of weak evidence of facilitated communication. Thus the conclusion drawn based on this paper is that facilitated communication is a better way of communication with the children but the weak methodology part does not make it a reliable source
Critical appraisal for the second article
This is a systematic review that aims to review many secondary sources for the effectiveness of the intervention of facilitated communication among the children who are autistic or among the people who have developmental disorders (schlosser et al., 2014). in this article, the multi-faceted search was conducted that makes it a highly reliable source for evidence. This is a level i evidence search because it has secondary data and is a systematic review (elessi et al., 2019). in this article, the results are obtained based on both qualitative and quantitative study that makes it a highly reliable source of information on the effectiveness of facilitated communication. The methodology section is strong that provides the rationale for the conclusion obtained in this study. The introduction section mentions the aim and objective that makes the purpose of the article clear for the reader.
The methodology section is very well mentioned in detail that covers all the aspects of the multi-faceted search and it also mentions the keywords that were used for literature search because "facilitated communication" is not an indexed term so the words like " supported typing" and "assisted typing" were searched. It set four levels of written documents for setting the eligibility criteria thus extended sources of information was reviewed in this study. This evidence is a highly reliable source thus is highly applicable to answer the question of the client. The conclusion from this article is that facilitated communication is not a valid method of communication with the people having developmental disorders.
The findings of both the selected articles that is the original article and rebuttal article are very different. The reliability of the source of evidence can be best made based on the level of evidence. The rebuttal article has the highest level of evidence and is a systematic review so the findings of this article can be said to be more acceptable. The critical appraisal thus helps in finding the more reliable, high applicable source of evidence (horsley et al., 2011). the health care professional will educate paul on none- effectiveness of facilitated communication intervention and would suggest some other methods of communication that are highly reliable and effective to be used with people having developmental disorders (tostanoski et al., 2014). paul needs more clarification on the effectiveness of this method of communication that is facilitated communication so the health care professional can give evidence from the findings of this systematic review that gives highly reliable evidence from various articles.
The conclusion drawn is that facilitated communication is not a highly reliable and effective method of communication with the people having developmental disorders. The messages generated through facilitated communication are not authored by people with disabilities but are authored by the facilitators. Thus, this is not an effective method as suggested by the systematic review method article. The systematic review has is a higher level of evidence and this is the best source that can be used to educate the client on the effectiveness of the intervention of facilitated communication. The original research article fails to prove its applicability and reliability when compared with the rebuttal article thus, it is not a reliable source of information.
Biklen, d. (1990). communication unbound: autism and praxis. Harvard education review, 60(3), 291
Burns, p. b., rohrich, r. j., & chung, k. c. (2011). the levels of evidence and their role in evidence-based medicine. Plastic and reconstructive surgery, 128(1), 305.
Elessi, k., albarqouni, l., glasziou, p., & chalmers, i. (2019). promoting critical appraisal skills. The lancet, 393(10191), 2589-2590.
Ganz, j. b., katsiyannis, a., & morin, k. l. (2018). facilitated communication: the resurgence of a disproven treatment for individuals with autism. Intervention in school and clinic, 54(1), 52-56.
Horsley, t., hyde, c., santesso, n., parkes, j., milne, r., & stewart, r. (2011). teaching critical appraisal skills in healthcare settings. Cochrane database of systematic reviews, (11).
Schlosser, r. w., balandin, s., hemsley, b., iacono, t., probst, p., & von tetzchner, s. (2014). facilitated communication and authorship: a systematic review. Augmentative and alternative communication, 30(4), 359-368.
Tostanoski, a., lang, r., raulston, t., carnett, a., & davis, t. (2014). voices from the past: comparing the rapid prompting method and facilitated communication. Developmental neurorehabilitation, 17(4), 219-223.
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