International Journal of Speech-Language Pathology最新文献

Purpose: To examine referral pathways, clinical demographics, and timeliness of dysphagia management within an emergency department (ED) setting utilising both ED staff and speech-language pathology (SLP) initiated referral pathways.

Method: Six-month retrospective service review of patients who received dysphagia assessment by SLP within a major Australian ED. Data were collected on demographics, referral information, and SLP assessment and service outcomes.

Result: Three hundred and ninety-three patients were assessed by SLP staff in the ED, consisting of 200 stroke and 193 non-stroke referrals. In the stroke cohort, 57.5% of referrals were initiated by ED staff, while 42.5% were SLP initiated. ED staff initiated 91% of non-stroke referrals, with few (9%) proactively identified by SLP staff. SLP staff identified a higher proportion of non-stroke patients within 4 hr of presentation compared to ED staff. Stroke patients identified by SLP staff were more likely to have assessments completed within 8 hr compared to the ED referral pathway. Collectively, 51% of patients required ongoing dysphagia management following initial assessment.

Conclusion: Findings provide an overview of SLP services and referral pathways in an ED context. The SLP initiated referral pathway facilitated early assessment of stroke patients, and collaboration with ED staff was integral in referring other at risk populations. SLP/ED synergy is needed for appropriate and timely dysphagia management practices in an ED.

Purpose: A Phase I study was conducted to examine the treatment effectiveness of the Kaufman Speech to Language Protocol using a research-operationalised protocol. It was hypothesised that articulatory accuracy would improve as a result of the treatment and that these improvements would be maintained after treatment was discontinued.

Method: A single case experimental design was used to evaluate the effectiveness of the Kaufman Speech to Language Protocol. Four children with a confirmed childhood apraxia of speech diagnosis were included in this study. Each child received 12 individual 1 hr treatment sessions that each consisted of an approximation setting phase and a practice phase. Probe data was collected during treatment and at post-treatment time points to measure treatment effectiveness and to measure changes in the untreated words. Untreated (control) sounds were included to test whether recorded improvements in articulatory accuracy could be attributed to the Kaufman Speech to Language Protocol.

Result: Two of the four children demonstrated a response to the intervention and maintenance of these changes, while the two remaining children demonstrated some generalisation in the absence of improved target (treatment) words. No specific child factors were clearly associated with positive treatment outcomes.

Conclusion: This study replicated the findings of an earlier pilot study and found that the operationalised protocol for the Kaufman Speech to Language Protocol is effective in improving articulatory accuracy for some children with childhood apraxia of speech. Additional replication with a further refined treatment protocol and a larger sample size is needed to support a recommendation of clinical use of the Kaufman Speech to Language Protocol.

Purpose: To discuss among neuroscientists and community speech-language pathologists what brain imaging research means to clinicians.

Method: Two university neuroscientists and two speech-language pathologists in private practice discussed the matter. Written conversational turns in an exchange were limited to 100 words each. When that written dialogue was concluded, each participant provided 200 words of final reflection about the matter.

Result: For now, neuroscience treatments are not available for clinicians to use. But sometime in the future, a critical mass of neuroscientists will likely produce such treatments. The neuroscientists expressed diverse views about the methods that might be used for that to occur.

Conclusion: Neuroscience does have practical clinical application at present and, in a way, that does not exclude a concurrent influence of the social model of disability. As such, the current practices of clinicians are supported by basic neuroscience research.

Purpose: This study examined the early efficacy of a new theory-driven principle of grammar intervention, graduated input type variation (GITV).

Method: Three Cantonese-speaking children, aged between 4;01 and 5;10, with oral language difficulties participated in this single baseline within-participant single case experimental study. The children received a total of 300 teaching episodes of the target serial verb construction via focused stimulation and recast over 10 30- to 45-minute sessions. The 30 exemplars of the target included low type variation of the verbs in each of the first five sessions, followed by high type variation in the remaining sessions.

Result: Visual analysis revealed that all children improved their performance in the target construction but not the control vocabulary in the probes, suggesting a treatment effect. Maintenance of treatment effects was also observed in all children. Positive results in across-behaviour generalisation to the untrained construction were observed in all children. Generalisation to other less structured linguistic contexts and to the narrative retell discourse context was minimal and observed in one child only.

Conclusion: Preliminary evidence suggested early efficacy of GITV as a principle for grammar intervention. Modifications in the research methodology are recommended for future studies involving children with developmental language disorder.

Purpose: The identification of developmental language disorder (DLD) is challenging for clinicians who assess bilinguals. This paper introduces a protocol-based approach, the Bilingual Multidimensional Ability Scale (B-MAS), for expert raters to identify DLD in bilinguals.

Method: Three bilingual speech-language pathologists (SLPs) reviewed 166 Spanish-English bilingual children's profiles, which included performance on direct (morphosyntax, semantics, and narrative tasks) and indirect (parent/teacher survey) measures in both languages. A multidimensional scale (0-5) was adopted to rate children's performance. A diagnosis of DLD was made if at least two raters assigned a summary rating of ≤2.

Result: Analysis of the scores on the B-MAS resulted in the identification of 21 children as having DLD. Though different strategies were employed to make decisions, the three SLPs demonstrated high inter-rater agreement across different ratings (intraclass correlation coefficient values ranged from .83 to .90).

Conclusion: For bilingual populations that are understudied and for which gold standards of assessment are not available, the B-MAS can be adopted as a starting point to study DLD or as a reference standard to develop new assessment tools in that population. Clinically, this protocol could be tailored and evaluated by a group of SLPs serving a large population of a particular bilingual group for diagnostic purposes.

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.

Purpose: Early intervention based on principles of cross-situational statistical learning (CSSL) for late-talking children has shown promise. This study explored whether parents could be trained to deliver this intervention protocol with fidelity and if they found the intervention to be acceptable.

Method: Mothers of four English-speaking children aged 18-30 months who scored <10th centile for expressive vocabulary were recruited to an 8-week group training program. Parents were taught principles of CSSL and asked to perform 16 home treatment sessions (30 minutes each) in total, providing auditory bombardment of target words in full sentences at high dose number and syntactic variability, using a range of physical exemplars. Home diaries and two videotaped sessions measured treatment fidelity. Pre- and post-treatment questionnaires measured acceptability.

Result: One parent discontinued the study after the second group training session. Three parents completed 15/16 group training sessions and reported completing 87% of home sessions. Two parents demonstrated implementing the intervention as per the target dose number by the first fidelity session (Weeks 2/3), and the third parent was very close to meeting target dose number by the second fidelity session (Weeks 7/8).

Conclusion: Parents can be trained to deliver an intervention based on cross-situational statistical learning principles.

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 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: Optimising dysphagia service delivery is crucial to minimise personal and service impacts associated with dysphagia. However, limited data exist on how to achieve this in Singapore. This study aimed to develop prioritised enhancements that the speech-language pathology workforce perceived as needed to improve dysphagia services in Singapore.

Method: Using a concept mapping approach, 19 speech-language pathologists (SLPs) and 10 managers listed suggestions for dysphagia service optimisation. Within their groups, the collated suggestions were sorted based on similarity, and individually rated on a 5-point scale based on importance and changeability. Using cluster and bivariate analysis, clusters of similar suggestions and prioritised suggestions for service optimisation were identified.

Result: The SLPs and managers proposed 73 and 51 unique suggestions respectively. Six clusters were identified for each group, with similar themes suggesting agreement of service improvements. All clusters were rated as more important than changeable. The managers perceived services as easier to change. The SLPs and managers rated 37% (27/73) and 43% (22/51) of suggestions, respectively, as high priority, with similarities relating to workforce capacity and capability, support and services access, care transitions, and telehealth services.

Conclusion: Prioritised enhancements identified by SLPs and managers provide direction for dysphagia service optimisation in Singapore.