http://theses.ncl.ac.uk/jspui/handle/10443/5255 Tue, 03 Feb 2026 19:50:01 GMT 2026-02-03T19:50:01Z http://theses.ncl.ac.uk/jspui/handle/10443/6659 Title: Personalised Speech and Language Therapy for Children with Cerebral Palsy and Dysarthria Authors: McConnellogue, Carol-Ann Abstract: Background: Cerebral Palsy (CP) is the most common childhood motor disorder, with a prevalence of around 1.5-2 per 1000 live births. Approximately half of individuals with CP have speech difficulties, most of whom have dysarthria. Dysarthria disrupts the subsystems underpinning speech and reduces intelligibility. Aim: To examine the effect of personalised dysarthria therapy on the intelligibility of children with CP and dysarthria using perceptual and acoustic speech outcomes. Method: Fifteen children with CP and dysarthria received individualised online therapy. Intelligibility was measured at 6- and 1-week pre-therapy and 1- and 12-weeks post-therapy. Generalised linear mixed models determined whether children made statistically significant gains in the intelligibility of single words (SWs) and connected speech (CS). Acoustic profiling was used to explore acoustic speech changes. Results: Group results showed that SW and CS intelligibility significantly improved from 1-week pre- to 12-weeks post-therapy. Clinically significant gains of greater than 10% words understood were mainly observed in those with a higher intelligibility at baseline. More children made clinically significant gains in SWs than in CS. No single factor explained the change in intelligibility, but better perception of polysyllabic words and word-initial and word-final consonants was observed post-therapy. Acoustic profiling showed no obvious relationship between changes in articulatory precision and vocal cues. Acoustic changes specific to individual children occurred post-therapy, but were not necessarily perceived by ear, e.g., evidence of word-final consonants being produced. Interpretation: Personalised intervention seems to be effective at improving the intelligibility of children with CP and moderate-to-severe dysarthria. Those with profound dysarthria made little change, suggesting that support for their communication should focus on augmentative and alternative communication. Future research should further evaluate personalisation of the intervention to establish the best cues for individual speech characteristics. Description: PhD Thesis Wed, 01 Jan 2025 00:00:00 GMT http://theses.ncl.ac.uk/jspui/handle/10443/6659 2025-01-01T00:00:00Z http://theses.ncl.ac.uk/jspui/handle/10443/6656 Title: Understanding the Role of Hunger in Dietary Cognition and the Food Insecurity-Obesity Paradox Authors: Neal, Courtney-Jai Georgie Abstract: Food insecurity (FI) can be defined as limited or uncertain access to food of adequate nutritional quantity or quality and is often assumed to cause increased hunger levels. FI is associated with an increased risk of obesity in women in high income countries. In recent years, the prevalence of FI has increased in higher income countries where diet-related disease burden remains a significant public health challenge. Therefore, it is important to characterise the experience of hunger in FI and explore the potential effects that hunger has on the psychological processing of food to better predict the downstream effects on eating behaviour. I first report the results of a descriptive ecological momentary assessment study (EMA) that investigated the experiences of hunger across the day in two groups of women: one experiencing food security (FS) and one FI (Chapter 2). There was no difference between groups in average hunger and hunger variability within a day. However, in the FI group, there was greater variation in daily average hunger and within-day hunger variability between days. I then present two pieces of research focusing on how acute hunger impacts food-related cognition, as these mechanisms may underpin decision-making processes during food selection. In Chapter 3, I report two conceptual replications of a well-cited paper, which found that participants experienced greater attentional capture by food cues when hungry than when they were sated. However, the effect was not replicated. In Chapter 4, I explore the impact of hunger on the memory of food-related information in two studies, which comprised an image recognition and a price recall task. Hunger did not impact the memory of food-related stimuli in either study. Finally, I discuss the broader implications of my findings and consider future research directions (Chapter 5). Description: PhD Thesis Wed, 01 Jan 2025 00:00:00 GMT http://theses.ncl.ac.uk/jspui/handle/10443/6656 2025-01-01T00:00:00Z http://theses.ncl.ac.uk/jspui/handle/10443/6653 Title: Market shaping and the supply of home care for older adults in England: a qualitative study Authors: McDonald, Ruth Abstract: Local authorities (LAs) in England have a duty to ensure that there is a wide variety of good quality home care services available for older adults who need them. However, workforce shortages, which are especially acute in rural areas, make this challenging. LAs are expected to participate in ‘market shaping’, collaborating closely with relevant partners to encourage and facilitate the whole home care market in their area. The aim of this thesis was to explore how LAs were approaching their market shaping duties and to examine differences between them and between rural and urban settings. Analysing 117 interviews, I identified three themes: care as a problem (as opposed to an enabler); care as quantity (with ‘problems’ and therefore, ‘solutions’ conceptualised in terms of quantity); and market shaping as maintaining dysfunction (with care rushed and unfulfilling and staff pressurised and leaving, creating more pressure for those remaining). There were exceptions to this where care provision departed from the industry standard model of care agencies contracting with LAs to deliver ‘time and task’ care. In some predominantly rural settings, LA staff had supported implementation of alternative models. The rural context initially helped reduced resistance from care agencies, many of whom could not deliver services in these settings. Applying Bourdieu’s concepts of field, capital and habitus I suggest that the structures of the home care field encourage care agencies and LA commissioners to engage in reproduction of field rules and regularities. However, some LAs implemented changes which departed from these rules. LA staff actions were key to disrupting expectations and practices associated with a gendered class- based habitus, which might have otherwise constrained carers’ access to sources of capital. This enabled paid carers to accumulate economic, social, cultural and symbolic capital in a way which facilitated personalised and fulfilling care delivery. Description: Ph. D. Thesis. Wed, 01 Jan 2025 00:00:00 GMT http://theses.ncl.ac.uk/jspui/handle/10443/6653 2025-01-01T00:00:00Z http://theses.ncl.ac.uk/jspui/handle/10443/6570 Title: Unequal Vaccines? A Mixed Methods Study Exploring Socioeconomic Inequalities in Routine Vaccination Uptake in a Post-COVID-19 Era Authors: Sacre, Amber Abstract: Introduction: The COVID-19 pandemic heightened global attention on vaccination and exacerbated health inequalities, particularly among those experiencing socioeconomic disadvantage. However, existing literature has not adequately explored the pandemic’s impact on socioeconomic inequalities in routine vaccination uptake. Aim: To understand and map the narrative and state of socioeconomic inequalities in vaccination uptake in a post-COVID-19 era. Methods: This project comprised two components: (1) an umbrella systematic review of global socioeconomic inequalities in routine vaccination uptake, and (2) a mixed methods study in England, focused on childhood vaccinations. The quantitative element used piecewise regressions to analyse the effects of COVID-19 and socioeconomic deprivation on MMR and pre-school booster uptake. The qualitative aspect involved interviews with professionals commissioning, supporting, and monitoring the childhood vaccination programme in the North East of England, focusing on areas of high socioeconomic deprivation. Transcripts were analysed using a framework approach. Findings: The umbrella review findings were complex. Lower routine vaccination uptake was identified across both advantaged and disadvantaged socioeconomic groups. Mechanisms, such as knowledge and confidence in vaccination and/or providers) were often understood to vary by level of education. The mixed methods study found complementary evidence. A COVID-19-associated decline in childhood vaccination uptake was identified, although rates were declining beforehand. The North East of England, an area of high socioeconomic deprivation, often achieved higher uptake levels than other regions. Despite this, interviewees spoke of pockets of low uptake within the North East and greater challenges faced by vaccination providers in socioeconomically deprived areas. Families with challenging personal lives were reportedly at a greater risk of low uptake. Conclusion: Vaccination uptake manifests differently from other healthcare interventions. Vaccination services that reflect the needs of the target population are required to improve uptake, regardless of socioeconomic position. Equitable funding that acknowledges the complexities of provision in underserved communities is warranted. Description: PhD Thesis Wed, 01 Jan 2025 00:00:00 GMT http://theses.ncl.ac.uk/jspui/handle/10443/6570 2025-01-01T00:00:00Z