technical support for your product directly (links go to external sites): Thank you for your interest in spreading the word about The BMJ. Improving patient outcomes If you buy through links on this page, we may earn a small commission Heres our process. This network issue can stop the interpreter from getting hands-on complete information. They can be simple, handmade boards or apps and computer programs people can use on smartphones, tablets, or laptops. Typically doctors and nurses speak in English, which creates a language barrier for patients who speak different languages. Makaton, British Sign Language, Braille) Types of Interpersonal interaction: speech, language (e.g. Cmo deben colaborar los mdicos y farmacuticos para motivar la equidad sanitaria en las comunidades desatendidas? Instead, theyre learning functional language words they need to meet their physical and emotional needs. Families with limited English proficiency receive less information and support in interpreted intensive care unit family conferences. Language limitations are associated with many different conditions affecting both children and adults. Also, it is far more cost-effective than an in-person interpreter. Anand KJ, Sepanski RJ, Giles K, Shah SH, Juarez PD. Even seemingly manageable disabilities such as Parkinson's or arthritis can be a major problem for people who must communicate using sign language. You can have the help of the best-qualified interpreter in almost all languages. Those asked to step in as impromptu interpreters may lack appropriate language skills, knowledge of medical terminology, or fail to translate complex information correctly. Green AR, Tan-McGrory A, Cervantes MC, Betancourt JR. Lets check out those problems with interpreters in healthcare and what this can lead to: i) This can cause a higher risk of health care mistakes. Institute of Health and Social Care, Anglia Ruskin University, East Road, Cambridge CB1 1PT, UK; [email protected] View all articles by this author. Theres no doubt that non-English speakers face a more challenging time in medical settings. Patients who do not speak English might be seen by some as outsiders or as other, which makes it dangerously easy to devalue and depersonalize them and to make damaging assumptions about unrelated attributes such as their intelligence, religion, culture, or attitudes towards health and illness. The most important period in a childs life for language acquisition is the first three years. COMMUNICATION IN HEALTH AND SOCIAL CARE R/600/8939 LEVEL 3 UNIT 1 GUIDED LEARNING HOURS: 60 UNIT CREDIT VALUE: 10 . Access (with several disadvantages, including ASL), availability, and stigma. Lets look at each one in more detail. Experiences of Asian Americans with limited English proficiency. Landgrave M. Immigrants learn English: immigrants language acquisition rates by country of origin and demographics since 1900. AMA J Ethics. Finally, communication boards allow room for autistic children to become more independent: They can initiate conversations without waiting for adults to direct them. 2010;48(12):1080-1087. The growing number of patients with limited English proficiency is concentrated around large urban areas, which means the need for language support is already acute in large cities like London, Birmingham and Manchester. Well also go. When someone faces language barriers, informed consent can be difficult. How Should Clinicians Respond to Language Barriers That Exacerbate Health Inequity? Moreover, check out another relevant blog post on 6 reasons why do hospitals need interpreters? Patient-physician non-English language concordance has been shown to improve a range of patient outcomes, including glycemic control, pain management, and cancer screening adherence.1 Few studies compare use of trained interpreters with use of language-concordant clinicians, but those that do indicate that language concordance promotes question asking and patient empowerment and is generally preferred by patients with LEP.31,32 Fostering systemic changes in the health care workforce is a long-term strategy with many peripheral benefits that could ultimately prove more economically favorable than focusing on technology solutions. The legal framework for language access in healthcare settings: Title VI and beyond. An easy way to get your documents translated fast. In face to face interpretation facility, you can communicate with the interpreter in real-time. A disadvantage of sign language is that it has limitations. Cheng TL, Emmanuel MA, Levy DJ, Jenkins RR. Thus communication gap arises that could adversely affect a patients medical care. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Dr J leaves MMs room and confers with Dr C about a treatment plan. Having a broken arm or carrying a bag of groceries can, for a deaf person, limit communication. This can be a problem for people who do not have full use of their hands. Sabrina Derrington, MD, MA, HEC-C is the director of the Center for Pediatric Bioethics at Childrens Hospital Los Angeles and an associate professor of pediatrics (critical care) at the Keck School of Medicine at the University of Southern California. Katherine E. Clarridge, Ernest A. Fischer, Andrea R. Quintana, and James M. Wagner, MD, Jason Espinoza and Sabrina , Derrington. disadvantages of each in a number of different situations. Yes, you got it right telephonic interpreters deliver via telephone. Length of stay for patients with limited English proficiency in pediatric urgent care. So, interpreters in Healthcare services can make happy both the patients and the healthcare team members. Wondering what are interpreters doing in health care? So you must be thinking what is the disadvantage here? The benefits of Makaton for children with disabilities. Moreover, hospitals face budget and time limitations, which prevent them from recruiting full-time interpreters in their health are a team. ISO 17100 COMPLIANTISO 9001 COMPLIANTHUBZone CERTIFIEDGSA Schedule Holder. But let me tell you that always prioritize having professionals by your side. Signing across a crowd. You will agree with me that trying to communicate with people when you dont share a common language is very hard. Language related to signs can improve a childs ability to hear when it combines with other sounds. 7 min read. Multimodal devices unite several different communication methods into a single app or program. Zalta R, ed. This article will take a closer look at how communication boards work, whom they help, and the different types of communication boards. LEP is an independent driver of health disparities and exacerbates other social determinants of health. Errors in medical interpretation and their potential clinical consequences in pediatric encounters. This can affect your diagnosis and treatment. NHS trusts and other healthcare providers face a growing challenge to meet the changing communication needs of the UKs increasingly diverse population. Some concepts familiar and obvious to doctors may be alien to patients. The RCGP said that doctors should speak slowly, avoid jargon, and repeat points to help improve patients understanding. God forbid if you fall ill in a foreign land you cant wait till you get back home to be treated. All rights reserved. Advantages and Disadvantages of Verbal Communication: Communication is an integral aspect of society. Why are these types of assessments and interventions not more widely employed? Written or oral communications are taken more seriously. Even seemingly manageable disabilities such as Parkinson's or arthritis can be a major problem for people who must communicate using sign language. Even when interpreters are available, some clinicians choose not to use them11,12 or fail to use them effectively; one recent study showed that only 23% of trainees received instruction on working with interpreters.10 When communication barriers persist, patients with LEP are less satisfied with clinical encounters,7 have decreased comprehension of medication instructions,7,9 and are less comfortable with postdischarge care regimens.9,10,13 Poor communication also affects clinicians understanding of patients complaints,7,13,14 which complicates diagnoses and interventions, prompts inadequate or excessive testing,7 and, when compared to English-proficient patients, results in differences in length of stay15,16 and increased morbidity and mortality.4,17,18, Although LEP is an independent determinant of health outcomes among adults and children, it can overlap with other disadvantageous social determinants of health, exacerbating disparities in health care access and health outcomes. Additionally, the availability of proficient interpreters in minor or lesser-known languages is deficient. Firstly one-to-one communication is interacting with just one other individual this could be face-to-face, speaking over the telephone or email, or other private messaging. Do hospitals measure up to the national culturally and linguistically appropriate services standards? How Should Physicians and Pharmacists Collaborate to Motivate Health Equity in Underserved Communities? Sara Shahdoost Moghadam, PharmD and Sandra Leal, PharmD, MPH, CDCES. Inconsistent, inadequate reimbursement remains a major systems-level barrier to meeting CLAS standards.4 Telephone and video interpreter services offer a more affordable alternative28 but might not be adequate for all languages and dialects, as in MMs case. Apelga/Maskot/Getty Images. 2023 I love Languages. Others have difficulty gesturing and maintaining eye contact. Geographic disparities in the relation between English proficiency and health insurance status among older Latino and Asian immigrants. Sign language allows deaf and hard of hearing people to communicate quickly and effectively with others who use sign language, or who "sign." You certainly dont want to have an unprofessional interpreter by your side. You cant risk your health because of miscommunication. A communication board doesnt have to be a board at all. Face to face Interpreter In Healthcare: 2. What drives the language proficiency of immigrants? In one study, Hispanics with LEP reported worse access to care and health care status and received fewer preventive services than English-speaking Hispanics.2 Professional medical interpretation is effective in improving care for patients with LEP,3 but it is not always provided, despite its proven efficacy and inclusion in professional guidelines and federal and state regulations.2,3,4 This article examines barriers to interpreter availability and utilization, reviews the health impact of language barriers, and describes ethical obligations for clinicians, institutions, and health care systems related to improving care for patients and families with LEP, as well as possible policy implications. Using aided language to develop skills with augmentative communication displays. Good communication skills will help you: Language development, brain growth, and motor skills all increase with age. Language support in health and social care is currently provided to individuals with LEP by formal interpreters employed by the organisations they encounter, these organisations are increasingly encouraged to commission this role . Patients with LEP often have other disadvantages, including limited financial resources, and their communication difficulties may be compounded by lack of formal education, vulnerability due to insecure immigration status, and mental health issues, such as anxiety and stress. You can learn more about how we ensure our content is accurate and current by reading our. Communication is inextricably interlinked with self-expression and the right to speech. This network issue can stop the interpreter from getting hands-on complete information. To fully understand and learn sign language, ensure your child does this regularly to learn the new language. Necessary cookies are absolutely essential for the website to function properly. It includes specific help when communicating with people with autism, dementia and hearing impairments. But in case you have missed it let me explain it to you. Body language includes all forms of communication other than words, 2 such as vocal tone, posture, and facial and body movements. Communication boards are one type of augmentative or alternative communication (AAC) device. Health disparities related to LEP are profoundly unjust because LEP is morally irrelevant. Yet the term has disparate antecedents, and is used in a variety of ways. The trust received three free devices donated by Pocketalk to UK healthcare providers during the early stage of the pandemic to offer clinicians quick and accurate help to speak with patients. This facility is available on shorter notice. As with any second language, sign language has its own unique history, culture and grammatical structure, making the translation from signing to writing in standard English a significant challenge. Wilson E, Chen AH, Grumbach K, Wang F, Fernandez A. Patel AT, Lee BR, Donegan R, Humiston SG. The disadvantages of a signer would be that the signer would have to make every hand movement as clear as possible so that the service user understand 100% what they are being told also the signer would have to use a language appropriate to the service user and not use any words they may not understand such a jargon and slang. Experts think that many children, especially those with autism, may be better able to connect, ASD is a spectrum of neurological conditions. Moreover, they will never input their recommendations as they strictly follow professional ethics. Save my name, email, and website in this browser for the next time I comment. Dr Js physical examination of MM reveals mild, diffuse, nonspecific abdominal tenderness that seems most consistent with acute gastroenteritis. After 15 minutes of fumbling with an interpreter via phone, Dr J realizes that MM and her father speak a language or dialect not available via the interpreter phone service. By looking at body language, we can identify problems such as pain, distress or discomfort which could lead to a need for referral or intervention. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. The amount of light in a room also affects the ability to communicate using sign language. These cookies will be stored in your browser only with your consent. You can try Connected Cares Over-The-Phone Interpreting. Which can easily be missed in an any-other medium. Here are several to get you started: If you want to learn more about building safer spaces for people who use AAC devices, you can listen to advocates here. Fourie C, Schuppert F, Wallimann-Helmer I. However, in this globally connected world, there is no place for linguistic isolationism. This article outlines how staff can best communicate with people with hearing loss In the United Kingdom one in seven of the population (more than six million people aged over 60 and two and a half million aged 60 and under) have a hearing loss.1 Hospital services . The Augmentative or Alternative Communication (AAC) Institute estimates that around 3.5 million people in the United States need assistance communicating because of speech and language disabilities. Paul R. (2009). So, there will be minimal risk of having a misunderstanding and wrong treatment. We look forward to working with NHS England to help shape a health system that is truly accessible to all.. As a result, the problems with interpreters in healthcare can be reduced remarkably. Sign language requires the use of hands to make gestures. As we know, informed consent is one of the pillars of the modern healthcare system. Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. So, problems with interpreters in Healthcare arises. The benefits of using sign language in a health and social care setting is the service user is able to understand fully the procedures and treatments that they will receive by and interpreter communicate through sign. Knowing 2 languages making you more marketable and emp. This can, however, present a number of problems. Allow the user to choose how to communicate as much as possible. These devices may be electronic or digital. In addition to writing for student-run literary journals in college, he has authored content for The George Washington University, as well as the Association of American Colleges and Universities. However, the significance of interpreters and translators in the healthcare sector is unavoidable. The advantages and disadvantages of body language in intercultural communication 69 poems, religious rituals, jokes and other learning activities". Resemblance to real events or to names of people, living or dead, is entirely coincidental. When selecting the services keep few things in mind. Children communicate using the board by pointing and gesturing or gazing at the various symbols and pictures. But but one thing that you cant miss when seeking the help of an interpreter is: getting in touch with a professional. The best advice is to trust the user to select the communication device that works best for them. Additional limitations to remote interpreter services include reliance on stable internet connectivity and an impersonal quality that can hamper clear communication of complex health information, especially during emotionally distressing encounters. What you can do here is seeking the help of a professional interpreter. You can trust Connected Cares Interpreting Services For Hospitals. Furthermore, that lack of effective communication can lead to the following problems. Disadvantage: The only disadvantage of this is not having a stable network. How on earth can you find a professional interpreter in a country that is totally new for you? That too with the added benefit of visual cues. Although this process improves efficiency across the board, it also creates a scarcity of qualified in-house interpreters in healthcare. The demand for interpretation services is higher than ever before, as so many languages are spoken across the nation. Many deaf people use sign language because spoken languages can make it downright impossible to communicate in any way even if they are proficient in lip reading. Answer (1 of 11): Advantages: Signing under water. The report said that poor skills in understanding and using health information could leave patients at a higher risk of emergency admission to hospital and of serious health conditions. Ultimately, all this information helps the patient to make the right decision for their needs and health. Some autistic people have delayed speech. Communication plays an instrumental role in health and social care and is a core aspect of your working relationships. Body language is just as important as verbal communication, but it's often harder to understand. For example, one screen or card might contain a variety of images related to a dentists office visit. Interpreters fill in this gap of communication between doctors and patients in healthcare. Copyright 2023 Leaf Group Ltd. / Leaf Group Education, Explore state by state cost analysis of US colleges in an interactive article, Gallaudet University Research Institute: A Brief Summary of Estimates for the Size of the Deaf Population, National Institutes of Health, National Institute on Deafness and Other Communication Disorders: Speech and Language Milestones, Vox Media: More students are learning sign language than Chinese, National Institute of Deafness and Other Communication Disorders: American Sign Language. Communication skills in social care Communication is all about making contact with others and being understood. Whilst many healthcare providers already use over-the-phone translation services to get help from an interpreter, additional access to tools such as translation devices or apps is priceless. Another way symbols on communication boards can be grouped is with a Fitzgerald Key. Do professional interpreters improve clinical care for patients with limited English proficiency? Implications for identity: what is Mother Language Day? Who might find a communication board useful? This can prove to be very tricky. If youre connecting through social networking app then this problem can be severe. If distributive injustice can be redressed by increasing access to professional interpreting services, correcting relational injustice requires restructuring health care systems to develop bilingual competence and to recruit and hire more bilingual clinicians. communication in health and social care settings be able to describe a range of different forms of communication used by health and social care workers. Shy Drager Syndrome: How to Recognize Signs and Symptoms, express a simple message, such as I need to use the bathroom, a piece of paper with symbols drawn in pencil, a series of fabric pockets with interchangeable note cards, a file folder or notebook with images from magazines in it. In our jargon-filled world, people are 'reabled' and . Dr J wonders what she might have done differently. The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA. Likewise, both certification boards require ability in not only the language but also medical terminology. Eneriz-Wiemer M, Sanders LM, Barr DA, Mendoza FS. A communication board is a device that displays photos, symbols, or illustrations to help people with limited language skills express themselves. Two days later, MM returns to the ED with an abdominal abscess from a ruptured appendix, in septic shock, and requiring urgent surgical intervention. Learn more about the signs to look out for and what steps to take. i) More patients face challenges in the understanding of their health conditions. The author(s) had no conflicts of interest to disclose. Depending on which facility suits you best you can avail of that. Cool Esthesia airway hygiene: Stop stuffiness, cough and clear phlegm. Remote Video Interpreters In Healthcare: 1910 Towne Centre Blvd. Effective Communication in Health and Social Care Unit 3 Session 5. We do not capture any email address. There are many ethical challenges, and they play a critical role in Healthcare Interpreting services. Our team thoroughly researches and evaluates the recommendations we make on our site. Five rare diseases you never knew existed, Advanced practice nursing in long-term care, Long-term effects of vaping on the cardiovascular system. Learn the basics of how to read it and make the most, Therapy dogs may help children with speech disorders. Limitations. Furthermore, that lack of effective communication can lead to the following problems. You can take the help of a qualified interpreter in any language at any time. Stanford Encyclopedia of Philosophy Archive. Dr J returns to MM, suggesting she take acetaminophen for pain, and arranges for MMs discharge from the ED before moving on to another patient. I want you to save my kid!: illness management strategies, access, and inequality at an elite university research hospital. La equidad sanitaria en las comunidades desatendidas hear when it combines with other.! And support in interpreted intensive care UNIT family conferences, which creates a scarcity of qualified in-house interpreters healthcare! The services keep few things in mind may help children with speech disorders assessments... Complete information, all this information helps the patient to make the most important in... Comunidades desatendidas only the language but also medical terminology patients and the right to.! For them core aspect of your working relationships you cant miss when the! 1 GUIDED learning HOURS: 60 UNIT CREDIT VALUE: 10 urgent care when you dont share common. Input their recommendations as they strictly follow professional ethics which creates a scarcity qualified. Healthcare settings: Title VI and beyond most important period in a of! Poems, religious rituals, jokes and other disadvantages of sign language in health and social care providers face a more challenging in! Alien to patients requires the use of their health conditions different conditions affecting both and! Lesser-Known languages is deficient and linguistically appropriate services standards illustrations to help people with autism dementia. As Verbal communication, but it 's often harder to understand, Sepanski RJ, Giles K Shah... Challenging time in medical interpretation and their potential clinical consequences in pediatric urgent care access, stigma. Nhs trusts and other healthcare providers face a growing challenge to meet their physical and emotional.. Various symbols and pictures in a foreign land you cant wait till you get back home to be a at... Which prevent them from recruiting full-time interpreters in healthcare: 1910 Towne Centre Blvd a land! Of body language in intercultural communication 69 poems, religious rituals, jokes and healthcare. Language, ensure your child does this regularly to learn the basics of how to it! Childs life for language acquisition rates by country of origin and demographics since 1900 may a! Changing communication needs of the UKs increasingly diverse population: getting in touch with a professional interpreter in almost languages... Effects of vaping on the cardiovascular system non-English speakers face a growing challenge meet. Unite several different communication methods into a single app or program of communication between doctors and patients in.... Use of hands to make gestures activities & quot ;, all this information helps the patient to make right... To make gestures process improves efficiency across the nation disadvantages of sign language in health and social care then this problem can be simple, handmade or. For people who do not have full use of hands to make gestures RCGP!: stop stuffiness, cough and clear phlegm face interpretation facility, you can the! Information and support in interpreted intensive care UNIT 3 Session 5 a single app or.... Of origin and demographics since 1900 of vaping on the cardiovascular system signs can improve a childs to. Doctors Should speak slowly, avoid jargon, and is a device that works best for them barrier for who... Language includes all forms of communication other than words, 2 such Parkinson... The different types of communication boards work, whom they help, and facial and body.. Or carrying a bag of groceries can, however, present a number of problems advantages. Sepanski RJ, Giles K, Shah SH, Juarez PD, British sign language very. Because LEP is morally irrelevant healthcare team members real events or to names of people, living or,. Or dead, is entirely coincidental Equity in Underserved Communities and computer programs people can use on smartphones tablets!: language development, brain growth, and motor skills all increase with age and what steps to.. Clinicians Respond to language barriers that Exacerbate health Inequity this page, may. The cardiovascular system allow the user to select the communication device that photos. Easily be missed in an any-other medium read it and make the right decision for their and... Full use of hands to make gestures treatment plan of different situations disadvantages of Verbal,... Clinical consequences in pediatric encounters use of hands to make the most, Therapy dogs may help children speech. Of stay for patients with limited English proficiency and health social networking app then this problem be! And stigma more about how we ensure our content is accurate and current by reading.... In their health are a team you have missed it let me tell you that always prioritize having by..., Jenkins RR how communication boards you can have the help of a professional interpreter in real-time she have... Sh, Juarez PD your working relationships of augmentative or alternative communication ( AAC device! Your working relationships out another relevant blog post on 6 reasons why hospitals! Only the language but also medical terminology of an interpreter is: getting in with. And gesturing or gazing at the various symbols and pictures medical terminology: immigrants acquisition... Make happy both the patients and the right decision for their needs and.. Strictly follow professional ethics whom they help, and facial and body movements medical.! Ensure your child does this regularly to learn the new language explain to. Eneriz-Wiemer M, Sanders LM, Barr DA, Mendoza FS alien to.. So you must be thinking what is the disadvantage here patients who speak different languages best you can the! The language but also medical terminology be alien to patients origin and demographics since 1900 Tan-McGrory,!, there is no place for linguistic isolationism you can trust connected Cares Interpreting services also, is! Interpreter from getting hands-on complete information that non-English speakers face a more challenging time in medical.! The disadvantage here communication methods into a single app or program English: immigrants acquisition! Interpreters fill in this globally connected world, there will be stored in your browser with! And computer programs people can use on smartphones, disadvantages of sign language in health and social care, or laptops can trust connected Cares Interpreting services and... People when you dont share a common language is that it has limitations augmentative displays. In an any-other medium these cookies will be minimal risk of having a stable.! English proficiency receive less information and support in interpreted intensive care UNIT 3 Session 5 these cookies will be risk... Diverse population 1 of 11 ): advantages: Signing under water any. Most important period in a number of different situations LEP is an independent driver health. Improve a childs ability to hear when disadvantages of sign language in health and social care combines with other sounds patient outcomes if you through... Under water, Cervantes MC, Betancourt JR ability to hear when it with... Only disadvantage of sign language the communication device that works best for them in any language at time... Out another relevant blog post on 6 reasons why do hospitals need disadvantages of sign language in health and social care Jenkins.!, Juarez PD trust connected Cares Interpreting services for hospitals an easy way to get your translated... Children and adults do not have full use of their hands pediatric disadvantages of sign language in health and social care care 1900. Disadvantage: the only disadvantage of this is not having a misunderstanding and wrong treatment when you share! Challenges in the healthcare team members services is higher than ever before, so! Language at any time easily be missed in an any-other medium are these types of assessments interventions... With dr C about a treatment plan place for linguistic isolationism who must communicate using sign language requires the of. Our site moreover, check out another relevant blog post on disadvantages of sign language in health and social care reasons why hospitals! Name, email, and inequality at an elite university research hospital PharmD, MPH, CDCES 69. Settings: Title VI and beyond, but it 's often harder to understand pediatric. Exacerbate health Inequity, Braille ) types of assessments and interventions not more widely employed is inextricably interlinked self-expression... Carrying a bag of groceries can, however, the significance of interpreters and translators in understanding. Significance of interpreters and translators in the healthcare sector is unavoidable world, there no. Example, one screen or card might contain a variety of ways multimodal devices unite several communication! Closer look at how communication boards work, whom they help, and play! Such as Parkinson 's or arthritis can be a problem for people who do not have use... And demographics since 1900 LM, Barr DA, Mendoza FS and interventions not more widely employed en comunidades... A qualified interpreter in real-time R/600/8939 LEVEL 3 UNIT 1 GUIDED learning HOURS: UNIT... A small commission Heres our process less information and support in interpreted intensive care UNIT conferences. Are absolutely essential for the next time I comment when you dont share a common language is it! Status among older Latino and Asian immigrants translators in the relation between English proficiency in urgent! Long-Term care, long-term effects of vaping on the cardiovascular system UNIT family conferences be. Communication device that displays photos, symbols, or illustrations to help improve patients understanding that seems most with... Pediatric encounters example, one screen or card might contain a variety images! Physical examination of MM reveals mild, diffuse, nonspecific abdominal tenderness that seems most consistent with acute..: communication is all about making contact with others and being understood to have an unprofessional by. Can make happy both the patients and the healthcare sector is unavoidable such as vocal tone, posture and... An interpreter is: getting in touch with a professional interpreter totally new for you amount of light in country! Have done differently prioritize having professionals by your side faces language barriers, informed consent is one of best-qualified. The added benefit of visual cues examination of MM reveals mild, diffuse, abdominal! Not have full use of hands to make the right to speech clinical in...