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It's a changing landscape: Complexity and innovation in cognitive-communication rehabilitation for people with acquired brain injury (ABI) 这是一个不断变化的世界:后天性脑损伤(ABI)患者认知交流康复的复杂性与创新。
IF 2.4 3区 医学 Q1 Arts and Humanities Pub Date : 2024-02-23 DOI: 10.1111/1460-6984.13022
Rachael Rietdijk, Melissa Brunner, Paul Conroy, Mark Jayes, Leanne Togher
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引用次数: 0
Using Conversation Analysis to explore assessments of decision-making capacity in a hospital setting 使用对话分析法探讨医院环境中的决策能力评估。
IF 1.5 3区 医学 Q2 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY Pub Date : 2024-02-20 DOI: 10.1111/1460-6984.13020
Jessica Foulkes, Anna Volkmer, Suzanne Beeke

Background

Healthcare professionals (HCPs) have a responsibility to conduct assessments of decision-making capacity that comply with the Mental Capacity Act 2005 (MCA). Current best-practice guidance, such as the Mental Capacity Code of Practice and National Institute for Health and Care Excellence decision-making and mental capacity guidance, does not stipulate how to accomplish this in practice, for example, what questions should be asked, how options and information should be provided. In addition, HCPs struggle to assess the capacity of individuals with communication difficulties.

Aims

This study was a service evaluation that aimed to objectively analyse, using Conversation Analysis (CA), how real-life capacity assessments were conducted in a hospital setting with patients with acquired brain injury (ABI)-related communication difficulties. A second aim was to establish the feasibility of using CA to advance knowledge of the conduct of capacity assessment.

Methods & Procedures

Four naturally occurring capacity assessments were video-recorded. Recordings involved speech and language therapists, occupational therapists, neuropsychologists and patients with communication difficulties as a result of ABI. The methods and findings of CA were used to investigate the interactional behaviours of HCPs and patients during assessments of decision-making capacity. The analysis was informed by our knowledge of the MCA best practice guidance.

Outcomes & Results

An overall structure of capacity assessment that enacted some of the best-practice MCA guidance was identified in one recording, consisting of six phases: (i) opening, (ii) preparation, (iii) option-listing, (iv) test, (v) decision, and (vi) close. The preparation phase consisted of two sub-components: information gathering and information giving. Variation from this structure was observed across the dataset, notably in the way in which options were (or were not) presented.

Conclusions & Implications

CA is a feasible empirical method for exploring the structure and conduct of capacity assessments. CA identifies and provides ways of describing interactional behaviours that align with and diverge from best-practice MCA guidance. Future CA studies including a wider range of health and social care professionals and p

背景:医疗保健专业人员(HCPs)有责任按照 2005 年《心智能力法》(MCA)的规定对患者的决策能力进行评估。目前的最佳实践指南,如《心智能力行为准则》(Mental Capacity Code of Practice)和《国家健康与护理卓越研究所决策与心智能力指南》(National Institute for Health and Care Excellence decision-making and mental capacity guidance),并没有规定如何在实践中做到这一点,例如,应该提出哪些问题,如何提供选择和信息。目的:本研究是一项服务评估,旨在利用会话分析法(Conversation Analysis,CA)客观分析在医院环境中如何对与后天性脑损伤(ABI)相关的交流障碍患者进行真实的行为能力评估。第二个目的是确定使用会话分析推进能力评估知识的可行性:对四次自然发生的能力评估进行录像。录制者包括言语和语言治疗师、职业治疗师、神经心理学家以及因缺血性脑损伤而有交流障碍的患者。CA 的方法和结果被用于调查在决策能力评估过程中 HCP 和患者的互动行为。该分析参考了我们对MCA最佳实践指南的了解:在一份记录中确定了能力评估的整体结构,该结构采用了 MCA 最佳实践指南的部分内容,由六个阶段组成:(i) 开始,(ii) 准备,(iii) 选项列表,(iv) 测试,(v) 决定,(vi) 结束。准备阶段包括两个子部分:信息收集和信息提供。在整个数据集中可以观察到与这一结构不同的地方,特别是选项的展示(或不展示)方式:能力评估是探索能力评估结构和实施的一种可行的实证方法。CA识别并提供了描述互动行为的方法,这些方法与MCA最佳实践指南既有一致之处,也有不同之处。未来的CA研究将包括更广泛的医疗和社会护理专业人员及患者,有可能为进行决策能力评估的医疗和社会护理专业人员的循证培训提供信息:关于此主题的已知信息 《心智能力法案》(MCA)在实践中执行不力。医疗保健专业人员(HCPs)发现,对有沟通障碍的人进行决策能力评估具有挑战性,而在能力评估过程中,有沟通障碍的人往往被排除在外或得不到足够的支持。研究仅限于自我报告方法。需要对能力评估进行观察研究。本研究的新增内容 这是第一项使用会话分析法(Conversation Analysis,CA)探讨在医院环境中,医护人员如何对后天性脑损伤导致的沟通障碍者进行能力评估的研究。其中一个能力评估视频录像分为六个阶段,与 MCA 最佳实践指南保持一致。然而,其他能力评估则偏离了这一结构。其中一个阶段,即选项列表,在实践中存在差异,选项并不总是呈现出来。这项工作的临床意义是什么?行为能力评估揭示了与 MCA 最佳实践指南相一致和相背离的互动行为。未来有必要开展 CA 研究,以便为开展行为能力评估的医疗和社会护理专业人员的培训提供信息。
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引用次数: 0
The impact of PD Check-In on self-management skills for maintenance of speech after intensive treatment PD Check-In 对强化治疗后保持言语能力的自我管理技能的影响。
IF 1.5 3区 医学 Q2 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY Pub Date : 2024-02-20 DOI: 10.1111/1460-6984.13024
Ann Finnimore, Deborah Theodoros, Anna F. Rumbach

Background

Maintenance of speech outcomes following speech-language therapy (SLT) in Parkinson's disease (PD) is an unmet expectation of people with PD (PWPD) and poorly defined in SLT practice. PD Check-In, a model for supported self-managed maintenance of speech following Lee Silverman Voice Treatment (LSVT) LOUD was investigated.

Aims

To investigate the impact of the semi-structured component of PD Check-In on the adoption of self-management concepts and behaviours and the identification of facilitators, barriers and strategies for speech maintenance by PWPD over 24 months post-treatment.

Methods and procedure

Following LSVT LOUD, 16 PWPD participated in individual PD Check-In semi-structured discussions with a SLT at 6 and 12 weeks, and 6, 12 and 24 months post treatment. A two-stage qualitative content analysis was applied: directed content analysis using categories from the theoretical framework of PD Check-In followed by inductive content analysis to identify subcategories.

Outcomes and results

Statements from PWPD indicated adoption of seven concepts of self-management across participants and across time. Six concepts from the theoretical framework of PD Check-In (partnerships, self-reflection, maintenance barriers and facilitators, revision of LSVT LOUD skill, goal setting and maintenance strategies), and one new category, participation, emerged from the analysis. Self-reflection, maintenance facilitators and barriers and participation were most prevalent in discussions. PWPD identified facilitators, barriers and strategies for maintenance across time points.

Conclusions and implications

Statements from PWPD indicated a positive impact of SLT-supported self-management of speech using self-tailored strategies for sustainable maintenance according to their individual circumstances and needs.

WHAT THIS PAPER ADDS

What is already known on this subject

  • People with Parkinson's disease (PWPD) have expressed their need for speech-language therapy (SLT) service
背景:帕金森病(Parinson's disease,PD)患者在接受言语治疗(SLT)后,其言语能力的维持是他们的期望,但在 SLT 实践中却没有得到很好的定义。目的:调查帕金森病患者在治疗后 24 个月内采用自我管理概念和行为以及识别语言维持的促进因素、障碍和策略的情况:在进行LSVT LOUD治疗后,16名残疾人分别在治疗后6周和12周、6个月、12个月和24个月参加了由一名语言康复师主持的半结构化个人PD Check-In讨论。我们采用了两阶段定性内容分析:利用 "PD Check-In "理论框架中的类别进行定向内容分析,然后进行归纳内容分析,以确定子类别:结果和成果:PWPD 的陈述表明,不同参与者在不同时期采用了七种自我管理概念。通过分析,我们得出了 "PD Check-In "理论框架中的六个概念(伙伴关系、自我反思、维持的障碍和促进因素、LSVT LOUD 技能的修订、目标设定和维持策略)和一个新的类别--参与。在讨论中,自我反思、维持的促进因素和障碍以及参与最为普遍。公共工程专业人员确定了不同时间点的促进因素、障碍和维持策略:PWPD的发言表明,在SLT的支持下,根据个人情况和需求使用自我定制的可持续维护策略进行言语自我管理具有积极影响:帕金森病患者(PWPD)表示,他们需要在患病期间都能获得语言治疗(SLT)服务,并能满足他们在治疗后保持言语能力的期望。李-西尔弗曼嗓音治疗法(LSVT)LOUD治疗后的疗效维持情况各不相同。本文对现有知识的补充 本研究介绍了残疾人在接受LSVT LOUD治疗后24个月内,通过与SLT进行半结构化讨论,采取五项PD Check-In干预措施,培养自我管理技能和行为的结果。残疾人根据自己的情况和需要,采用自我定制的策略,积极进行自我管理,以实现可持续的维持。这项工作有哪些潜在或实际的临床影响?随着时间的推移,残疾人对自我管理技能和行为的个人发展做出了积极回应。个性化和灵活响应是 "PD Check-In "的特点,这些特点引起了残疾人的共鸣,也说明了 SLT 支持的自我管理言语维护是治疗 PD 的一种长期模式。
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引用次数: 0
Factors influencing speech pathology practice in dysphagia after stroke: A qualitative focus group study 影响中风后吞咽困难言语病理学实践的因素:焦点小组定性研究。
IF 1.5 3区 医学 Q2 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY Pub Date : 2024-02-19 DOI: 10.1111/1460-6984.13017
Jacinda Choy, Fereshteh Pourkazemi, Hans Bogaardt, Caitlin Anderson, Shing Yee Chai, Roxanna N. Pebdani

Background

Dysphagia affects over half of adults after stroke. Dysphagia rehabilitation aims to improve swallowing and reduce negative outcomes for these adults. However, significant variability exists in dysphagia rehabilitation. Research is needed to explore the underlying clinician-specific and workplace factors that contribute to variability in dysphagia rehabilitation after stroke.

Aim

To explore factors influencing speech pathology practice in dysphagia rehabilitation after stroke.

Methods & Procedures

We used a phenomenological approach with an interpretivist perspective. Twenty speech pathologists working in dysphagia rehabilitation participated from different workplace settings around Australia. Five semi-structured focus groups were conducted online. Data were inductively analysed using thematic analysis with a coding reliability method.

Outcomes & Results

Four themes were discussed within focus groups: (1) relationship between experienced and less experienced clinicians: ‘Following what other people have done’, (2) need for collaborative learning: ‘A safe space to share and train’, (3) variation between settings impacts on continuity of care: ‘There's a difference between community and acute’, and (4) working effectively with multidisciplinary teams (MDT): ‘An MDT which can listen to the voice of speech pathology’.

Conclusions & Implications

Relationships between senior and junior speech pathologists, within speech pathology and MDT, and across inpatient and community settings influenced speech pathology practice. Flattened hierarchies in speech pathology, collaborative learning in workplaces, mutual respect within teams and connection across inpatient and community settings could improve the quality and consistency of dysphagia rehabilitation after stroke.

WHAT THIS PAPER ADDS

What is already known on this subject

  • Dysphagia rehabilitation can improve swallowing after a stroke. However, dysphagia rehabilitation is characterised by variabi
背景:一半以上的成年人在中风后会出现吞咽困难。吞咽困难康复旨在改善这些成年人的吞咽功能,减少不良后果。然而,吞咽困难康复存在很大的差异。目的:探讨影响中风后吞咽困难康复的语言病理学实践的因素:我们采用了解释学视角的现象学方法。来自澳大利亚不同工作场所的 20 名从事吞咽困难康复工作的语言病理学家参与了研究。我们在网上进行了五次半结构化焦点小组讨论。采用主题分析法和编码可靠性法对数据进行归纳分析:焦点小组讨论了四个主题:(1) 经验丰富的临床医生与经验不足的临床医生之间的关系:"遵循其他人的做法";(2) 合作学习的需要:"分享和培训的安全空间";(3) 不同环境对护理连续性的影响:"社区和急诊之间存在差异";(4) 与多学科小组(MDT)有效合作:结论与影响:高级和初级言语病理学家之间、言语病理和 MDT 内部以及住院和社区环境之间的关系影响了言语病理实践。语言病理学中扁平化的等级制度、工作场所中的协作学习、团队内部的相互尊重以及住院和社区环境之间的联系可以提高中风后吞咽困难康复的质量和一致性:关于此主题的已知信息 吞咽困难康复可改善中风后的吞咽功能。然而,吞咽困难康复的特点是临床实践的多变性。临床医生和工作场所的特定因素会影响临床实践,并可能导致吞咽困难康复的差异性。本研究的补充内容 专业关系会影响言语病理学家的临床实践,包括高级和初级临床医生之间的关系、住院和社区环境之间的关系以及与同行和多学科团队之间的关系。工作场所的规范和等级制度、不同环境之间护理的连续性差以及来自其他学科的优先事项相互竞争,都会阻碍吞咽困难的康复。然而,协作学习、积极的工作场所文化和相互尊重的跨学科护理可以提高临床实践的质量和一致性。这项工作的临床意义是什么?扁平化的工作场所等级制度可以营造一个安全的学习空间。此外,对工作场所规范提出质疑,并在内部和跨机构寻求同行学习,可以培养临床技能和信心。发展支持持续发展的积极工作场所文化,可能是增强语言病理学家提供高质量、持续性吞咽困难康复服务能力的关键。
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引用次数: 0
Exploring concepts of friendship formation in children with language disorder using a qualitative framework analysis 利用定性框架分析法探讨语言障碍儿童建立友谊的概念。
IF 1.5 3区 医学 Q2 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY Pub Date : 2024-02-14 DOI: 10.1111/1460-6984.13021
Lenka Janik Blaskova, Jenny L. Gibson

Purpose

Sociometric studies and adult reports have established that children with Language Disorder (LD) are at risk of peer relationship difficulties. However, we have limited knowledge of how children with LD understand friendship, whom they deem as a good or bad friend, and what role their friendship concepts play in their relationships with peers. This exploratory study aimed to conduct a qualitative investigation into the friendship concepts that children with LD hold and to explore their strategies for making friends.

Methods

We conducted multiple, art-informed interviews on the topic of friendship with 14 children with LD at the age of 6–8 years. Participating children were based in the United Kingdom and Republic of Ireland. They attended enhanced provision, specific speech and language classes and mainstream classrooms. We used framework analysis to map children's responses to Selman's (1979) developmental model of interpersonal understanding, which espouses a theory of children's social development within the context of peer relationships.

Results

The understanding of friendship formation in children with LD varied from physical presence to mutual support and sharing. Children's ideas about a good/bad friend represented the lowest developmental stage. Participants from the mainstream classroom demonstrated the highest stages of interpersonal understanding. Children with LD did not mention their language abilities as a barrier to making friends.

Conclusion

There are limited studies exploring friendship directly from children with LD, and this study provides insights into this gap, by utilising art-informed interviews. Children's immature understanding of a good/bad friend points towards a potential susceptibility to false friends, which we suggest needs further empirical validation. We also found that children with LD did not pay attention to their language difficulties when making friends, which raises questions about the ways diagnoses are shared with children.

WHAT THIS PAPER ADDS

What is already known on the subject

  • Children with Language Disorder (LD) are at risk of peer relationship
目的:社会计量学研究和成人报告已经证实,语言障碍(LD)儿童有可能在同伴关系方面遇到困难。然而,我们对语言障碍儿童如何理解友谊、他们认为谁是好朋友或坏朋友,以及他们的友谊观念在他们与同伴的关系中所起的作用了解有限。这项探索性研究旨在对患有 LD 的儿童所持有的友谊观念进行定性调查,并探索他们的交友策略:我们以友谊为主题,对 14 名 6-8 岁的 LD 儿童进行了多次艺术性访谈。参与访谈的儿童来自英国和爱尔兰共和国。他们就读于强化班、特殊言语和语言班以及主流班级。我们采用框架分析法将儿童的反应与塞尔曼(Selman,1979 年)的人际理解发展模型相联系,该模型支持儿童在同伴关系背景下的社会发展理论:结果:患有 LD 的儿童对建立友谊的理解各不相同,从身体上的存在到相互支持和分享。儿童对好朋友/坏朋友的认识处于最低发展阶段。主流班级的参与者对人际关系的理解达到了最高阶段。有语言障碍的儿童没有提到他们的语言能力是交朋友的障碍:直接从 LD 儿童的角度探讨友谊的研究非常有限,本研究通过利用以艺术为基础的访谈为这一空白提供了见解。儿童对 "好朋友"/"坏朋友 "的理解尚不成熟,这表明他们可能容易交到假朋友,我们认为这需要进一步的实证验证。我们还发现,患有 LD 的儿童在交朋友时并没有注意到自己的语言障碍,这就提出了关于如何与儿童分享诊断结果的问题:对这一主题的已有认识 有语言障碍(LD)的儿童有可能在同伴关系方面遇到困难。迄今为止的研究都是基于社会计量学和成人报告。只有少数研究采用了儿童参与式研究方法,直接让有语言障碍的儿童参与探讨他们的友谊关系。 本文补充:本文直接询问有语言障碍的儿童对友谊的理解和交友策略。身体接近和游戏对儿童理解友谊很重要,尤其是在识别好朋友和坏朋友方面。此外,患有 LD 的儿童并不认为语言和交流是交友的障碍。这项研究的潜在或实际临床意义是什么?应定期评估有关友谊和好/坏朋友的概念,并(在适当的情况下)有针对性地采取干预措施。本研究强调,有必要继续讨论与患有 LD 的儿童分享诊断结果的做法。
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引用次数: 0
‘Communication is difficult’: Speech, language and communication needs of people with young onset or rarer forms of non-language led dementia 沟通很困难":年轻痴呆症患者或较罕见的非语言性痴呆症患者的言语、语言和交流需求。
IF 1.5 3区 医学 Q2 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY Pub Date : 2024-02-08 DOI: 10.1111/1460-6984.13018
Anna Volkmer, Lisa Cross, Lily Highton, Connie Jackson, Chloe Smith, Emilie Brotherhood, Emma V. Harding, Cath Mummery, Jonathan Rohrer, Rimona Weil, Keir Yong, Sebastian Crutch, Chris J. D. Hardy

Background

People with behavioural variant frontotemporal dementia, Lewy body dementia, posterior cortical atrophy and young onset Alzheimer's disease may experience language and communication difficulties. However, the role of speech and language interventions for people with these non-language led dementias has received little attention.

Aims

This study aimed to explore the experiences and perspectives of people living with these conditions, and their families, regarding their language and communication difficulties and how speech and language therapy could address these needs.

Methods

This study employed a qualitative design to explore the experiences of people living with or caring for somebody with behavioural variant frontotemporal dementia, Lewy body dementia, posterior cortical atrophy or young onset Alzheimer's disease, and to understand their opinions about speech and language therapy. Participants were recruited from a support service connected to a dementia clinic to attend one of five focus group meetings. Videorecorded focus groups and interviews were transcribed, and reflexive thematic analysis was used to analyse data from people affected by each type of dementia.

Results

A total of 25 participants were recruited to the study, with representation across the different forms of non-language led dementias. The four main themes identified were: (1) communication difficulties as a key difficulty, (2) loss and loneliness, (3) speech and language therapy, and (4) the role of the caregiver. Sixteen subthemes were also identified which highlighted individual issues across disease types.

Discussion

Although all the forms of dementia studied here are not considered to be language-led, people with these conditions and/or their care partners identified speech, language and communication as common challenges. These communication difficulties were reported to have a negative impact on their social participation and mental health and participants felt speech and language interventions could help. There is a need for research exploring speech and language interventions developed for and with people with non-language led dementias and their care partners, to ensure they meet the needs of the people they are designed for.

背景:行为变异性额颞叶痴呆症、路易体痴呆症、后皮质萎缩症和年轻阿尔茨海默氏症患者可能会遇到语言和交流障碍。目的:本研究旨在探讨这些疾病的患者及其家人在语言和交流障碍方面的经验和观点,以及言语治疗如何满足这些需求:本研究采用定性设计,探讨行为变异型额颞叶痴呆症、路易体痴呆症、后皮质萎缩症或年轻阿尔茨海默氏症患者或其护理人员的经历,并了解他们对言语和语言治疗的看法。参与者是从一家与痴呆症诊所相关的支持服务机构招募的,他们将参加五次焦点小组会议中的一次。焦点小组会议和访谈的录像均已转录,并采用反思性主题分析法对来自各类痴呆症患者的数据进行了分析:本研究共招募了 25 名参与者,涵盖了不同形式的非语言性痴呆症。确定的四大主题是(1) 沟通困难是主要困难,(2) 失去亲人和孤独感,(3) 言语治疗,(4) 照顾者的角色。此外,还确定了 16 个次主题,强调了不同疾病类型的个别问题:讨论:尽管本文研究的所有痴呆症形式都不被认为是由语言导致的,但这些疾病的患者和/或他们的护理伙伴认为言语、语言和交流是共同面临的挑战。据报告,这些交流困难对他们的社会参与和心理健康造成了负面影响,参与者认为语言和交流干预措施可以起到帮助作用。有必要开展研究,探索针对非语言性痴呆症患者及其护理伙伴的言语和语言干预措施,以确保这些措施能够满足他们的需求:有关该主题的已知信息 原发性进行性失语症患者存在言语、语言和交流障碍,目前已开发出多种言语和语言干预措施来满足这类人群的需求。然而,非语言性痴呆症患者也可能出现言语、语言和交流障碍,而人们对解决这些障碍的干预措施知之甚少。本文对现有知识的补充 与行为变异型额颞叶痴呆症、路易体痴呆症、后皮质萎缩症和年轻发病型阿尔茨海默氏症患者共同生活或照顾这些患者的人报告说,他们会遇到言语、语言和交流障碍,这些障碍会影响痴呆症患者的社会参与和情绪。本研究的参与者还分享了他们对如何从疾病的最初阶段开始进行言语和语言干预的看法。这项工作有哪些潜在或实际的临床意义?言语和语言治疗师需要满足痴呆症患者在言语、语言和交流方面的个人需求,即使是那些不被认为是由语言导致的需求。目前提供的言语和语言治疗服务无法满足非语言主导型痴呆症患者的需求,因此需要开展进一步研究,以开发满足这些需求的干预措施和服务。
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引用次数: 0
The risk factors for silent aspiration: A retrospective case series and literature review 无声吸入的风险因素:回顾性病例系列和文献综述
IF 1.5 3区 医学 Q2 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY Pub Date : 2024-02-01 DOI: 10.1111/1460-6984.13013
Barbara Jamróz, Maria Sobol, Joanna Chmielewska-Walczak, Magdalena Milewska, Kazimierz Niemczyk

Aim

Evidence shows that 20%–30% of patients who aspirate do so silently. Research to date has not demonstrated clear evidence to indicate which patients are at higher risk of silent aspiration. Our aim was to use univariate logistic regression analysis of retrospective case review to determine potential patterns of silent aspiration.

Materials and methods

We conducted a retrospective analysis of 455 fiberoptic endoscopic evaluation of swallowing (FEES) reports. The patients were divided into four groups: G1 – neurological diseases (n = 93), G2 – head and neck surgery (n = 200), G3 – gastroenterological diseases (n = 94) and G4 – other patients (n = 68). Data included the occurrence or absence of saliva penetration or aspiration, of silent fluid/solid food penetration or aspiration, type of penetration or aspiration, occurrence of cranial nerve paresis, radiotherapy and tracheostomy. Univariate logistic regression was used to evaluate independent risk factors of silent aspiration in the study population. Three models with different independent variables were considered.

Results

There is a statistically significant difference in the frequency of occurrence of silent penetration and aspiration within the groups (p < 0.001), with intraglutative being most frequent. Fluid and food penetration and aspiration correlated with saliva penetration and aspiration in all groups (p < 0.001). Cranial nerve paresis (IX and X), radiotherapy and tracheostomy correlate with saliva penetration and aspiration (p = 0.020 for cranial nerve paresis; p = 0.004 for radiotherapy; p < 0.001 for tracheostomy). One hundred and fifteen patients (45.81%) in the subgroup of patients with intraglutative aspiration had cranial nerve paresis (IX, X or IX–X).

Conclusions

Patients who should be prioritised or considered to be at a higher need of instrumental swallowing evaluation are those with IX and X cranial nerve paresis, tracheostomy and those who have had radiotherapy, with saliva swallowing problems, especially after paraganglioma, thyroid and parathyroid glands and middle and posterior fossa tumour surgery.

WHAT THIS PAPER ADDS

What is already known on the subject

  • Clinical signs of p
有证据显示,20%-30% 的吸入患者是无声吸入。迄今为止的研究还没有明确的证据表明哪些患者发生无声吸痰的风险较高。我们的目的是通过对回顾性病例进行单变量逻辑回归分析,确定无声吸痰的潜在模式。
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引用次数: 0
A randomised controlled trial of the effectiveness of parent-based models of language intervention for 2- to 3-year-old children with speech, language and communication needs (SLCN) in areas of social disadvantage 针对社会贫困地区 2-3 岁有言语、语言和交流需求(SLCN)的儿童,开展一项以家长为基础的语言干预模式有效性随机对照试验。
IF 1.5 3区 医学 Q2 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY Pub Date : 2024-01-29 DOI: 10.1111/1460-6984.13016
Deborah Gibbard, Sue Roulstone, Ngianga II Kandala (Shadrack), Lydia Morgan, Sam Harding, Clare Smith, Chris Markham

Background

Early language delay is exacerbated by social disadvantage. Factors such as parents’ low levels of literacy, confidence and self-perception can affect the capacity to act on advice received, critical to empowerment. Methods used to achieve successful health outcomes in socially disadvantaged clinical populations may need enhancing.

Aims

To compare the impact of standard parent-based intervention (PBI) to enhanced PBI for young children with speech, language and communication needs (SCLN) and their families living in more socially disadvantaged populations.

Methods and Procedures

A multicentre clustered blind randomised controlled trial was used to compare the effect of parent-based group interventions to improve early language development with children (mean age 27.5 months) from more socially disadvantaged populations with an expressive vocabulary of 40 or less single words. Intervention sessions were delivered by a speech and language therapist, over a 20-week period. Participants received one of two interventions: (1) Standard Care – indirect group PBI – (PBI) (2) Enhanced Care: indirect group enhanced PBI – (EPBI). Both standardised and non-standardised measures were used as outcomes. Parent engagement in the intervention was captured through analysis of attendance and the Parent Activation Measure – Speech & Language Therapy (PAM-SLT) (Insignia Health, 2014). The PAM measures a person's knowledge, skills and confidence to manage their own health and well-being (NHS England, 2018). In this study, activation referred to parents’ knowledge, skills and confidence to manage their child's language development.

Outcomes and Results

One hundred fifty-five participants were randomised at baseline. Children in both groups made significant improvements in the outcome on MacArthur-Bates Communicative Development Inventories Sentence Length, from pre-intervention to post-intervention and 6 months post-intervention (p < 0.05). Changes in vocabulary and expressive language skills were more equivocal, showing wide variation in confidence intervals for both groups. Where parents attended at least one intervention session almost all effect sizes were in favour of the EPBI intervention. Parents’ activation levels significantly increased for both groups (EPBI p < 0.001, PBI p = 0.003), with a moderate effect size in favour of EPBI (Hedges’ G 0.37, confidence interval –0.02 to 0.76), although wide variation was found.

<
背景情况社会弱势加剧了早期语言发育迟缓。家长的文化水平、自信心和自我认知水平较低等因素会影响其根据所获建议采取行动的能力,而这对增强能力至关重要。目的:比较标准家长干预(PBI)和强化家长干预(PBI)对有言语、语言和沟通需求(SCLN)的幼儿及其生活在社会弱势人群中的家庭的影响:采用多中心聚类盲法随机对照试验,比较以家长为基础的小组干预对社会处境较差、单词表达能力在 40 个或以下的儿童(平均年龄 27.5 个月)早期语言发展的改善效果。干预课程由言语和语言治疗师提供,为期 20 周。受试者接受两种干预中的一种:(1)标准护理--间接小组PBI(PBI)(2)强化护理:间接小组强化PBI(EPBI)。结果采用标准化和非标准化测量。家长参与干预的情况通过分析出勤率和家长激活测量--言语和语言治疗(PAM-SLT)(Insignia Health,2014)来获取。PAM 衡量一个人管理自身健康和福祉的知识、技能和信心(英国国家医疗服务系统,2018 年)。在本研究中,激活指的是父母管理其子女语言发展的知识、技能和信心:155 名参与者在基线时被随机分组。从干预前到干预后以及干预后 6 个月期间,两组儿童在麦克阿瑟-贝茨沟通发展量表句子长度方面均有明显改善(p < 0.05)。词汇量和语言表达能力的变化则较为模糊,两组的置信区间差异较大。如果家长至少参加了一次干预课程,几乎所有的效应大小都有利于 EPBI 干预。两组家长的激活水平均有明显提高(EPBI p < 0.001,PBI p = 0.003),EPBI的效应大小适中(Hedges' G 0.37,置信区间为-0.02至0.76),但两组之间的差异较大:这项试验提供了一些证据,证明通过支持照顾者,可以促进社会贫困地区患有 SLCN 儿童的语言发展。然而,我们发现结果存在差异;一些儿童取得了很好的进步,而另一些则没有。进一步探讨家长的参与及其与儿童语言成果之间的关系,对于进一步了解有家长参与的干预措施的变化机制很有价值:关于该主题的已有知识 言语、语言和沟通需求(SLCN)对儿童的情绪健康、入学准备、识字率和学业成绩都有影响,使儿童面临更高的长期风险,如识字率低、心理健康问题和失业。在贫困地区,语言障碍的发生率高于其他地区。父母的文化水平、自信心和自我认知水平较低等因素会影响他们根据所收到的建议采取行动的能力,而这对提高能力至关重要。本文对现有知识的补充 社会处境较为不利地区的 SLCN 儿童可以通过父母的干预改善其语言发展,尽管个体差异很大。有证据表明,采用机构间合作方法的 EPBI 可使儿童获得更好的结果。随着干预时间的推移,家长的参与度(激活水平)显著提高,而 EPBI 的提高幅度是 EPBI 的两倍。这项工作有哪些潜在或实际的临床意义?这项试验提供了一些证据,表明通过支持照顾者,有可能促进来自社会处境较差地区的儿童的语言发展。进一步的研究将有助于确定家长参与度的提高是否与坚持干预和儿童结果的变化有关。
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引用次数: 0
Developmental language disorder and neurodiversity: Surfacing contradictions, tensions and unanswered questions 发育性语言障碍和神经多样性:揭示矛盾、紧张和未解之谜。
IF 1.5 3区 医学 Q2 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY Pub Date : 2024-01-26 DOI: 10.1111/1460-6984.13009
Hannah M Hobson, Umar Toseeb, Jenny L Gibson

Background

Neurodiversity is increasingly discussed in relation to autism research and practice. However, there is a lack of scholarship concerning the neurodevelopmental condition of Developmental Language Disorder (DLD) and the neurodiversity movement. While this movement may hold opportunities for the DLD community, the application of the concept of neurodiversity to DLD research and practice needs consideration, as DLD and autism have very different levels of public and professional awareness and understanding.

Aims

In this article, we discuss what the concept of neurodiversity and the associated neurodiversity movement could mean for DLD research and practice. We aim to critique some assumptions that may arise from the application of neurodiversity principles (or assumed principles) to the field of DLD.

Methods

This is a discussion paper, drawing on the personal experiences and reflections of the author team.

Main Contributions

We make the case for why DLD should be included in discussions about neurodivergence and outline considerations for doing so, and why some issues and applications may be particular to DLD. We outline points of similarity and contrast with autism in relation to our understanding of neurodiversity. We consider the issues around diagnosis and terminology and urge practitioners to continue to diagnose DLD using currently agreed terminology, so as not to undermine recent awareness efforts. We note that a neurodiversity-informed perspective challenges us to offer interventions that operate at the level of our environments, not just at the level of an individual. Indeed, neurodiversity offers a platform to argue for better rights and more inclusive spaces in mental health settings, education and work for children and adults with DLD.

Conclusions

DLD should be considered from a neurodiversity-informed perspective, and it is our hope that this will lead to neurodiversity-affirming practice that will afford young people with DLD better understanding from members of the public and the professionals who work with them. Further work is needed to better support children, young people and adults with DLD to have a voice in the neurodiversity movement.

WHAT T

背景:有关自闭症研究和实践的神经多样性讨论日益增多。然而,有关发育性语言障碍(DLD)的神经发育状况和神经多样性运动的学术研究还很缺乏。虽然这一运动可能会为 DLD 社区带来机遇,但由于 DLD 和自闭症在公众和专业人士的认识和理解程度上存在很大差异,因此需要考虑将神经多样性的概念应用到 DLD 的研究和实践中。我们旨在批判将神经多样性原则(或假定原则)应用于 DLD 领域时可能产生的一些假设:本文是一篇讨论性论文,借鉴了作者团队的个人经历和思考:我们论证了为何应将 DLD 纳入有关神经变异的讨论,并概述了这样做的考虑因素,以及为何某些问题和应用可能是 DLD 所特有的。在我们对神经多样性的理解方面,我们概述了与自闭症的相似点和对比点。我们考虑了与诊断和术语有关的问题,并敦促从业人员继续使用当前商定的术语来诊断 DLD,以免破坏最近的宣传工作。我们注意到,以神经多样性为基础的观点要求我们在环境层面而不仅仅是个体层面提供干预措施。事实上,神经多样性提供了一个平台,可以为患有 DLD 的儿童和成人在精神健康环境、教育和工作中争取更好的权利和更具包容性的空间:应从神经多样性的角度来考虑 DLD 问题,我们希望这将导致神经多样性的实践,从而让公众和与他们一起工作的专业人员更好地理解患有 DLD 的年轻人。需要进一步开展工作,以便更好地支持患有 DLD 的儿童、青少年和成人在神经多样性运动中发表意见:有关该主题的已知信息 神经多样性方法正越来越多地被用于与自闭症有关的研究和实践中,这意味着我们对自闭症的理解以及如何为自闭症患者提供支持正越来越多地借鉴神经多样性原则。然而,自闭症并不是唯一的神经多样性人群。发育性语言障碍(DLD)是另一种神经发育性疾病;然而,与自闭症相比,发育性语言障碍在专业人士和公众中的认知度较低。目前还没有学术研究通过神经多样性的视角对 DLD 进行研究,或考虑将肯定神经多样性的方法应用于 DLD。本文对现有知识的补充 在本文中,我们探讨了神经多样性运动对 DLD 研究和实践的意义。特别是,我们考虑了自闭症领域的神经多样性可能给我们带来的启示,以及神经多样性在 DLD 领域的应用,并强调了我们认为这两种人群之间存在重要差异的地方。我们思考了神经多样性对于干预、诊断、术语和倡导无障碍需求(尤其是在心理健康支持、教育和就业方面)的意义。这项工作的潜在或实际临床意义是什么?神经多样性凸显了考虑在个人环境层面进行干预的必要性(例如,我们如何才能让这个空间更具包容性?我们对 "肯定神经多样性的方法意味着不对 DLD 进行诊断或改变 DLD 的术语 "这一观点提出质疑:我们认为这不符合最初的神经多样性运动的精神,而且对于一种公众认知度如此之低的疾病来说,这些行动对受 DLD 影响的家庭来说可能弊大于利。我们呼吁围绕神经多样性方法在 DLD 中的应用开展更深入的学术研究和讨论,并认为神经多 样性运动提供了一个重要的机会,可在多个领域提高人们对 DLD 的认识和理解,包括(但不限 于)心理健康、教育和就业领域。
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引用次数: 0
Speed of processing in Developmental Language Disorder (DLD): The case of real-time grammatical processing 发育性语言障碍(DLD)的处理速度:实时语法处理案例。
IF 1.5 3区 医学 Q2 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY Pub Date : 2024-01-24 DOI: 10.1111/1460-6984.13014
Hannah Witherstone

Background

Developmental Language Disorder (DLD) impacts various aspects of children's language abilities, including the processing of inflectional morphology. Prior research suggests that children with DLD exhibit deficits in processing speed and sensitivity to grammatical inflections, yet the relationship between these deficits remains unclear.

Aims

This study aimed to investigate the relationship between processing speed and sensitivity to inflectional morphology in children with DLD, focusing on their real-time processing abilities in response to regular past tense, third person singular, and regular plural inflections at different rates of sentence articulation.

Method

Eighteen children with DLD and 18 age-matched controls underwent word monitoring tasks that assessed sensitivity to grammaticality of inflections in sentences presented at normal and slow rates of articulation.

Results

At a normal rate of articulation, children with DLD demonstrated slower response times and reduced sensitivity to grammaticality across all inflections compared to controls. When the articulation rate was slowed, children with DLD showed improved sensitivity, particularly to regular plural and third person singular inflections, although deficits in processing the regular past tense persisted.

Conclusions

The findings suggest a significant relationship between processing speed and inflectional morphology sensitivity in children with DLD. Slower articulation rates improved grammatical sensitivity for certain inflections, highlighting the potential of tailored interventions that consider processing speed limitations. Persistent difficulties with the regular past tense inflection indicate the need for targeted support for children with DLD in this area.

WHAT THIS PAPER ADDS

What is already known on this subject

  • Children with Developmental Language Disorder (DLD) have a wide range of language difficulties, but deficits in inflectional morphology are regarded as a ‘hallmark’ of the
背景:发育性语言障碍(DLD)对儿童语言能力的各个方面都有影响,包括对语法转折词的处理。研究目的:本研究旨在调查发育性语言障碍儿童的处理速度和对词形变化的敏感性之间的关系,重点研究他们在不同句子衔接速度下对常规过去式、第三人称单数和常规复数词形变化的实时处理能力:方法:18 名患有 DLD 的儿童和 18 名年龄匹配的对照组儿童接受了单词监测任务,以评估他们对以正常和较慢的衔接速度呈现的句子中转折词的语法敏感性:与对照组相比,在正常衔接速度下,DLD 儿童的反应时间较慢,对所有转折词的语法敏感度也较低。当发音速度减慢时,DLD 儿童的敏感度有所提高,尤其是对常规复数和第三人称单数转折词的敏感度,但在处理常规过去时方面仍存在缺陷:结论:研究结果表明,处理速度与 DLD 儿童对屈折词形态的敏感性之间存在重要关系。较慢的发音速度提高了对某些语气词的语法敏感性,突出了考虑处理速度限制的定制干预的潜力。对一般过去时转折词的持续困难表明,有必要在这一领域为患有 DLD 的儿童提供有针对性的支持:对这一主题的已有认识 发育性语言障碍(DLD)儿童有各种各样的语言障碍,但屈折词形态方面的缺陷被认为是这一障碍的 "标志"。患有发育性语言障碍的儿童在处理速度方面也很可能存在缺陷,但 "处理速度缓慢 "是否能解释这些儿童所经历的语言障碍,目前尚不得而知。本研究对现有知识的补充 当使用在线实时任务测量语法敏感性时,当以正常对话速度说句子时,患有 DLD 的儿童表现出广泛的语法缺陷。当句子的发音速度减慢时,DLD 儿童的语速更快、更准确,对结构的语法性也更敏感。然而,即使在这种慢速条件下,正规过去时的缺陷仍然持续存在。这项研究的临床意义是什么?本研究对临床和教育实践都有影响,这些临床和教育实践旨在帮助患有 DLD 的儿童提高语言技能。研究结果表明,如果给 DLD 儿童更多的时间来处理接收到的信息,他们的语法技能就会得到显著提高。本研究还表明,常规过去时的缺陷是长期存在的,儿童很可能需要在这一特定语法特征方面得到广泛而深入的支持。
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International Journal of Language & Communication Disorders
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