International Journal of Speech-Language Pathology最新文献

Purpose: Increasingly, videofluoroscopic swallow studies are being conducted without a radiologist. This study explored current assessment of structural dysphagia in adults during videofluoroscopic swallow studies, both internationally and within the Australian context.

Method: A document analysis of available international videofluoroscopic swallow studies guidance regarding the use of videofluoroscopic swallow studies for structural dysphagia was performed, followed by an online survey of Australian speech-language pathologists seeking information regarding roles, practices, training, and self-perceived competence specific to interpreting structural abnormalities.

Result: Eleven international guidelines agreed that: a) identification of structural abnormalities is one purpose of videofluoroscopic swallow studies, b) radiologists are responsible for diagnostics, however, c) 55% conceded videofluoroscopic swallow studies takes place without a radiologist if unavailable. Of 139 Australian speech-language pathologists surveyed, only 11% reported constant radiologist presence with 84% requesting radiologists' input to review images. Fifty eight percent had received training to identify structural abnormalities. Self-perceived competence in identifying structural dysphagia was positively correlated with videofluoroscopic swallow studies experience (r = 0.43, p < 0.05).

Conclusion: International guidance varies in its advocacy for speech-language pathologist led videofluoroscopic swallow studies. Speech-langauge pathologists in Australia are often conducting videofluoroscopic swallow studies without a radiologist present and may need to determine when to request radiologist review of potential structural abnormalities. Speech-language pathology training and multidisciplinary clinical pathways are needed to mitigate the risk of missed structural diagnoses.

Purpose: This study compared the effects of Lee Silverman Voice Treatment and Expiratory Muscle Strength Training on swallow, cough, and voice function in individuals with Parkinson's disease.

Method: Fifty-eight individuals with mild-moderate Parkinson's disease (male = 45, M = 69 years, SD = 8) were enrolled in a two-treatment clinical trial and completed four consecutive weeks of either Lee Silverman Voice Therapy or Expiratory Muscle Strength Training. All participants completed standard protocol videofluoroscopic swallow study, spirometry-cough tests, acoustic-voice assessment, and self-rated questionnaires pre- and post-therapy. Data were analysed by masked clinicians using specialised software. Mixed-model repeated measures and t-tests were performed.

Result: Lee Silverman Voice Treatment resulted in greater effects in acoustic aerodynamic voice measures (loudness, pitch-range, and aerodynamic-efficiency; p < .05) compared to the Expiratory Muscle Strength Training group. There were significant effects on pharyngoesophageal segment maximum opening (p =.01) following Lee Silverman Voice Treatment. Expiratory Muscle Strength Training resulted in significantly greater change in maximum hyoid displacement (Hmax; p = .04) and decreased Hmax duration (p < .01) compared to Lee Silverman Voice Therapy group. No cough measures and self-reported questionnaires significantly differed between groups with both groups improving post-treatment.

Conclusion: Both Lee Silverman Voice Therapy and Expiratory Muscle Strength Training improved specific swallow efficiency and airway defence capacity despite differences in task and therapeutic dose. Only Lee Silverman Voice Thearpy improved vocal intensity. Both treatments are feasible options for individuals with mild-moderate Parkinson's disease.

Purpose: Few resources are available to support speech-language pathologists (SLPs') dynamic assessment of vocabulary with school-aged children. We developed the Word Learning Dynamic Assessment Protocol (currently undergoing pilot testing). Framed by implementation science, in the current study we worked with speech-language pathologists to explore their perspectives on the acceptability of the Word Learning Dynamic Assessment Protocol.

Method: Eight speech-language pathologists who work with school-aged children watched a video demonstration of the Word Learning Dynamic Assessment Protocol being administered with a 6-year-old child and were then interviewed to share their thoughts on the Word Learning Dynamic Assessment Protocol's acceptability.

Result: Six themes were generated using reflexive thematic analysis: 1) Structure, scripting, and resourcing builds confidence in speech-language pathologists, 2) gaining important insight into the learning process, 3) flexible assessment supports child engagement and diversity, 4) family buy-in is created with clear communication, 5) a worthwhile investment of time?, and 6) building a more tailored assessment.

Conclusion: The speech-language pathologists who took part in this study valued the structure and resourcing of the Word Learning Dynamic Assessment Protocol as a way of supporting their ability to evaluate a child's strengths and challenges in vocabulary development in an engaging and individually tailored manner. Suggestions for further development will guide task refinement to meet the needs of speech-language pathologists.

Purpose: Urdu is the lingua franca and national language of Pakistan, and is the 10th most-spoken language worldwide with over 230 million speakers. The Urdu phonological system has been examined over the past decades. However, the system has been evolving. This paper aimed to review the available studies investigating various aspects of the Urdu phonological system and to reveal the variations noted among these studies.

Method: Twenty-one studies examining the phonological system of Urdu were located. The studies were reviewed in terms of consonants, geminates, consonant clusters, vowels, diphthongs, syllable structure, phonotactic constraints, and stress.

Result: The findings indicated that 38 consonants, 23 vowels, and 15 diphthongs are used in contemporary Urdu. Most consonants exist as geminates word medially. There are six syllable structures. The consonant clusters are constrained to the coda position only, and short vowels cannot exist in the word-final position. Like other syllable-timed languages, stress is not prominent in Urdu.

Conclusion: Based on this review, a contemporary Urdu phonemic and syllable structure inventory has been proposed. This will serve as a reference for use in further acquisition research and clinical practice.

Purpose: The purpose of this study was to explore the perspectives of qualified and student speech-language pathologists (SLPs) on the clinical utility of informant report and observation tools following a 1-day workshop using a decision tree.

Method: Each participant group (qualified [n = 4] or student SLP [n = 8]) attended a 1-day workshop where they engaged with informant report and structured observation tools using video case studies. Each workshop concluded in a focus group conducted by an independent researcher. NVivo 12 software supported inductive coding and subsequent thematic analysis of transcribed data.

Result: Thematic analysis revealed that participants' perceptions of tools' clinical utility could be conceptualised as three themes (a) tool characteristics, (b) external clinical work demands, and (c) clinician preparedness.

Conclusion: Participants' views on the utility of informant report and structured observation were influenced by tensions between their desires, the realities of clinical practice, and their own capabilities. This has implications for workforce development in the field in providing clinician guidance, training, and support.

Purpose: This study reported the experiences of New Zealand caregivers of children with language and literacy difficulties in having their child's needs identified.

Method: The participants were 14 mothers of children with idiopathic language and literacy difficulties, recruited through social media language and literacy difficulties support groups. Two mothers identified as Māori and 12 New Zealand European. Data were collected through semi-structured interviews. A phenomenological approach using reflexive thematic analysis was used.

Result: These mothers had learned about language, literacy, and the education system to advocate for their child and perceived a lack of knowledge on the part of schools. Nearly all had sought a diagnosis, with understanding and access to support reported as positive consequences and stigma as a negative. Some preferred labels emphasising difference rather than disorder, consistent with traditional Māori and neurodiversity views. The mothers described their experience as a fight, due to their concerns being ignored, the need to pay for private diagnostic assessments and difficulty accessing services. They appreciated assessors who gave useful, comprehensible information and supported school liaison.

Conclusion: These mothers wanted improved teacher training and publicly funded diagnostic assessment services to improve access to best practice language and literacy instruction for their children.

Purpose: The aims of this project were to explore how youth justice staff perceive the speech-language pathology role and provision in an Australian youth justice setting, including the speech-language pathologist's role in supporting young people to participate in the activities of the youth justice service studied.

Method: A narrative inquiry approach was employed to guide semi-structured interviews with youth justice staff. Perceptions and experiences were analysed via reflexive thematic analysis, with member checking and inter-rater coding utilised for rigour.

Result: Seven semi-structured interviews were conducted. Interviewees worked in either the custodial setting (n = 3) or the community setting (n = 4) for the youth justice service studied, though most had worked in both settings. Six themes and six subthemes were identified from the interview data and related to factors that supported improved participation in the activities of the youth justice service studied. These factors were the speech-language pathology skillset and approach, and that there were systemic barriers within the service. All participants perceived speech-language pathology input as valuable for the young people in the service studied. There was also acknowledgement by the participants of how speech, language, and communication needs of the young people impacted their participation in the activities of the service studied. These findings were despite the perceived need for organisation-wide education on the speech-language pathologist role and offering.

Conclusion: Increased understanding of how youth justice staff perceive the role and benefits of speech-language pathology in supporting young people in contact with the youth justice system will assist with service planning, inform education strategies, and may support policy change.

Purpose: To explore the thoughts and feelings of novice Australian speech-language pathology students about undertaking their first therapy placement.

Method: Data was collected with Australian novice graduate-level speech-language pathology students immediately prior to their first therapy placement via open-ended responses to two questions on a questionnaire. The data was analysed using inductive qualitative content analysis.

Result: 265 students participated in the study. Data analysis led to the construction of two themes: "I hope that my placement will support me on my way to becoming a confident speech-language pathologist" and "I hope my clients do well, but I fear that I might be inadequate". The analysis of these results led to the development of guidelines for supporting novice students on clinical placement.

Conclusion: Novice speech-language pathology students are keen to apply their knowledge to authentic clinical cases but are concerned about their own personal circumstances and whether they will receive sufficient support during their placement. An enhanced understanding of students' concerns and hopes may help practice educators implement appropriate support strategies.

Purpose: The purpose of this systematic review was to examine safety-related outcomes for patients with tracheostomy after flexible endoscopic evaluation of swallowing (FEES) to assess and manage their swallow, when compared to other non-instrumental swallow assessments such as clinical swallowing examination (CSE) and/or a modified Evans blue dye test (MEBDT).

Method: Three databases were searched for articles referring to safety-related outcome data for adults with a tracheostomy, who underwent FEES and CSE and/or MEBDT. Articles were screened using predefined inclusion/exclusion criteria.

Result: The search strategy identified 2097 articles; following abstract and full-text screening, seven were included for review. The summary of evidence found low to very low certainty that FEES was associated with improved outcomes across swallow safety, physiological outcomes, tracheostomy cannulation duration, functional outcomes, and detection of upper airway pathologies.

Conclusion: This systematic review demonstrated low to very low certainty evidence from seven heterogeneous studies with low sample sizes that incorporating FEES may be associated with improved safety-related outcomes. There is less evidence supporting the accuracy of other swallow assessments conducted at the point of care (i.e. CSE and MEBDT). Future research requires studies with larger sample sizes and routine reporting of safety-related outcomes with use of FEES.

Purpose: The aim of the present study was to investigate whether term infants with feeding difficulties who received either a 5-minute premature infant oral motor intervention (PIOMI) or a 15-minute Fucile treatment had different outcomes, compared to term infants in a nontreatment group.

Method: Stable term infants (N = 51) born between 37-41 weeks of gestational age with feeding difficulties were randomly assigned into one of two intervention groups and a control group. One intervention group received PIOMI and the other group received Fucile treatment once a day for seven consecutive days; the control group received usual care only. The volume of milk intake, the amount of weight gain, and the length of hospital stay were compared across all groups.

Result: Findings indicated that the volume of milk intake and weight gain showed significant improvement in all three groups. However, pairwise comparison revealed that infants in the Fucile group had significantly higher volume of milk intake and weight gain compared to infants in both the control and PIOMI groups. Length of hospital stay was not significantly different amongst all groups.

Conclusion: The effects of Fucile treatment were more considerable than for usual care or PIOMI. This finding raises the possibility that prolonged exercise may facilitate improvement in feeding skills for term infants with feeding difficulties.