Seminars in Speech and Language最新文献

This research was designed to deepen the understanding of contributing factors to disparities in speech-language pathology (SLP) service delivery to children of diverse backgrounds with language and communication delays, as well as to initiate community connections. We sought to understand the perspectives and experiences of those who provide or oversee SLP services to children with communication disorders in early intervention settings in Washington State. Individual semistructured interviews were completed with six SLPs and three administrators across five organizations. The interviews were designed to understand both individual- and systems-level contributing factors to service delivery challenges. Interviews were analyzed using an iterative coding process with multiple rounds of coding and multiple coders. In addition to synthesizing participants' understandings of, and preparation for, culturally responsive practice, three overarching themes are presented: (1) assets of early intervention as a service delivery model, (2) the distance between families and the practitioners and systems that serve them, and (3) compromised access and quality of services due to a predominantly monolingual-English system. Findings inform the next steps for building community partnerships with early intervention organizations. The long-term goal of this work is to collaboratively develop a participatory research program on equitable service delivery that addresses children's, families', and SLPs' needs.

Millions of individuals who have limited or no functional speech use augmentative and alternative communication (AAC) technology to participate in daily life and exercise the human right to communication. While advances in AAC technology lag significantly behind those in other technology sectors, mainstream technology innovations such as artificial intelligence (AI) present potential for the future of AAC. However, a new future of AAC will only be as effective as it is responsive to the needs and dreams of the people who rely upon it every day. AAC innovation must reflect an iterative, collaborative process with AAC users. To do this, we worked collaboratively with AAC users to complete participatory qualitative research about AAC innovation through AI. We interviewed 13 AAC users regarding (1) their current AAC engagement; (2) the barriers they experience in using AAC; (3) their dreams regarding future AAC development; and (4) reflections on potential AAC innovations. To analyze these data, a rapid research evaluation and appraisal was used. Within this article, the themes that emerged during interviews and their implications for future AAC development will be discussed. Strengths, barriers, and considerations for participatory design will also be described.

Autistic adults report communication access barriers related to the prioritization of speech over all other forms of communication. Our participatory research team, including autistic adults who use augmentative and alternative communication (AAC) both part- and full-time, designed and administered a 35-question online survey to examine school-based professionals' knowledge, training, and practices related to AAC and autism. The current study reports a portion of the larger data set specific to participants' definitions of speech terms related to autistic speech. A total of 567 participants completed the survey. Thematic analysis of participants' responses to speech definitions revealed multiple themes, including a focus on speech without implying or suggesting other forms of communication, speech production (mechanics), communication functions (intentionality), deficits, and definitions that were exclusionary in nature (e.g., identifying what the term did not define). Quantitative analysis of definitions of autistic speech revealed the need for increased exposure to these internal speech states for professionals working with autistic children. Increasing school-based professionals' knowledge, including community-sourced knowledge, related to autism and AAC, can improve access to AAC for speaking autistic students who may benefit from AAC.

For half a century, Dr. Audrey Holland investigated, developed, and implemented ways to extend the assessment of adult language and cognitive-communication disorders beyond traditional impairment-based approaches. This article summarizes Dr. Holland's many groundbreaking contributions to assessment practices by describing and exemplifying major conceptual and measurement innovations that have emerged from her research of both formal and informal assessment techniques. Dr. Holland's assessment contributions encompass the development of many widely used measures of functional communication, discourse, and cognitive-communication abilities. She also contributed to the development of assessment principles that have become part of best-practice standards of care. Some of her most significant contributions include: Drawing attention to assessment within authentic functional contexts; highlighting connections between language, communication, related cognitive abilities, and broader aspects of health including quality of life; raising psychometric standards; and emphasizing the value of implementing multiple person-centered measurement techniques spanning formal and informal as well as quantitative and qualitative approaches. Dr. Holland's career-long commitment and contributions to developing more meaningful and authentic assessment practices have transformed our field and substantively elevated the quality of care and services that we are able to provide to all persons who are impacted by language and cognitive-communication disorders.

Audrey Holland (1982) compared test scores to observers' ratings of conversational communicative success in people with aphasia (PWA). This springboarded a body of evidence employing observers to rate discourse. We review the utility of those ratings for assessing PWA's communication success. A traditional literature review identified 16 articles involving naive or trained raters assessing PWAs' communicative success across discourse genres. Another 10 articles reported ratings over time. Collectively, these studies evaluated 349 PWAs. Four studies utilized observers to rate the success of PWA's conversations. Eight studies that reported observers' ratings on other discourse genres found that multimodal communication and facilitative contexts improved success, and ratings of informativeness and comfort related to objective discourse analysis measures. Nine of 10 studies examining treatment effects found that communicative success ratings captured improvements. Observers' ratings provide social validity by reliably assessing the discourse-level communicative success of PWA. Ratings correlated with standardized diagnostic and objective discourse metrics but provided a window into factors that affect communicative success, including the degree to which communication is interactive, multimodal, and contextual. Integrating observers' ratings of discourse success at pretreatment may help identify supports or barriers to successful communication, facilitate individualization of treatments, and offer social validity of change.

This article acknowledges Audrey Holland's influence on aphasiology as it specifically relates to the emergence of a strengths-based perspective on the everyday communication of people with aphasia. We explore a historical perspective, as well as current ways in which everyday communicative events are approached in both clinical and research practice. The term "functional communication" is synonymous with Audrey's work, with linguistically-based discourse analysis and therapy both viewed as natural companions and extensions of the concept within aphasiology. Audrey's focus on the interactional side of communication and psychosocial impacts of aphasia, as well as her expertise in analysis and measurement, contributed to the coalescing of impairment-based and social communication approaches, encompassing a true sense of humanity and connectedness. Her application of these in international contexts was also noteworthy. In this article, we hope to capture principles of aphasia management that underpin current clinical practice, and also move beyond the traditional clinic context to consider aphasia groups that have had such a key role in promoting successful social communication by and with people with aphasia. We suggest future directions to further promote the principles advocated by Audrey Holland in assisting people with aphasia to move forward with confidence with their conversation partners, friends, and communities.

Audrey Holland was a leading innovator and speech-language pathologist (SLP) in adult neurological communication disabilities for over five decades. She was a pioneer in the involvement of SLPs with people with dementia, inspiring both knowledge development and clinical practice regarding language, functional communication, and quality of life in persons living with dementia. Dr. Holland was also an extraordinary mentor who has impacted many generations of researchers and clinicians. Here, four researchers in the area of dementia and communication discuss the lessons they learned from Dr. Holland that fundamentally shaped their careers and the field of dementia and speech-language pathology. Lessons learned include the following: (1) do not be afraid to stand out when you have a novel idea that will help people; (2) look for strengths to support functional communication; (3) use communication strategies to support identity, quality of life, and self-determination in adults with acquired communication disabilities, including those with dementia; (4) shift from pathologizing to coaching; and (5) challenge the status quo. This article concludes by discussing Dr. Holland's lasting legacy.

Throughout her career, Audrey Holland advocated for persons with aphasia, urging clinicians and others to view each person in the context of their needs and desires in navigating daily life. In this article, we acknowledge her ideas about functional treatment, and consider their influence on contemporary, activity-focused aphasia treatment. Three criteria define activity-focused treatment: (1) activity-specific goals, (2) personally relevant targets, and (3) near-real-life practice settings. Elements of treatment design, activities, and outcome measurement described here exemplify Audrey's beliefs in person-centered clinical aphasiology. Operationalizing treatment elements and designing a context as close to real life as possible are clinical actions that support these beliefs. Activity-focused treatment and other life participation approaches have often been relegated to the last phase of treatment; following Audrey's example, we advocate beginning with activity-focused treatment based on a client's communication needs and desires. Activity-focused treatment benefits persons with aphasia, their families, clinicians, and other stakeholders by presenting outcomes that reflect communication change in a real-life context and that are individually relevant. Such outcomes foster an individual's inclusion in their communication environments, respect the WHO platform of functional treatment, and prepare a clinician to present outcome data relevant to that individual.