American Journal of Speech-Language Pathology最新文献

Purpose: The purpose of the current study was to gain insight on augmentative and alternative communication (AAC) interface designs for children with cortical visual impairment (CVI). Children with CVI frequently require AAC and specific interface supports, and customization may be necessary to support access and use of speech-generating devices.

Method: A focus group methodology was selected to gain feedback from vision professionals on helpful AAC features for children with CVI. Participants included eight teachers of the visually impaired and one optometrist. Two virtual 1-hr focus group sessions were conducted and recorded for thematic analysis.

Results: Three primary themes and eight subthemes emerged from the transcripts of the focus groups. Themes included characteristics of the AAC interfaces such as background, high contrast, and symbolic representation; characteristics of children with CVI (preferred colors, visual field preference); and the development of AAC interfaces over time.

Conclusions: Vision professionals have identified characteristics of AAC interfaces that should be considered when working with children with CVI. Future collaboration with such professionals is needed to further inform the design of current and future AAC technologies to allow speech-language pathologists to meet the unique needs of this population.

Supplemental material: https://doi.org/10.23641/asha.28279184.

Purpose: Cerebral palsy (CP) is the most prevalent motor disability affecting children. Many children with CP have significant speech difficulties and require augmentative and alternative communication (AAC) to participate in communication. Despite demonstrable benefits, the use of AAC systems among children with CP remains constrained, although research in Canada is lacking.

Method: Data were collected as part of an exploratory survey of Canadian caregivers and clinicians (N = 60) who shared their perspectives on children's need for, access to, and use of AAC systems. Quantitative data were summarized using descriptive statistics. Qualitative data were analyzed using inductive content analysis.

Results: Caregivers and clinicians reported high rates of need for AAC systems (> 75%) among children with CP. Both groups reported that access was roughly equivalent to need, although caregiver reports were lower. Despite high rates of need and access, only 38% of children used AAC systems. Children who used AAC primarily used high-tech systems, mostly to make choices, rather than engaging in meaningful reciprocal interactions and conversations.

Conclusions: Canadian children with CP who required AAC systems generally received them. However, AAC systems were not used to their full potential, suggesting limited participation in social and learning situations. Like reports on other pediatric populations, barriers to obtaining AAC systems related to service, family, and child-specific factors. Although our sample captured the complexity present in the CP population, sample sizes were small and unlikely to be representative of the population of Canada, indicating the need for further research on a national scale.

Supplemental material: https://doi.org/10.23641/asha.28229720.

Purpose: The purpose of this study was to determine the sensitivity and specificity of the Yale Swallow Protocol (YSP) in detecting aspiration in recently extubated patients.

Method: One hundred fifty-four participants referred for swallowing evaluation underwent the YSP and fiberoptic endoscopic evaluation of swallowing (FEES) in random order within 48 hr of extubation. The YSP included orientation questions, an oral motor exam, and a 3-oz water swallow test. Failure was defined as interrupted drinking or immediate cough after drinking. FEES exams were rated using the Penetration Aspiration Scale. Fisher's exact test and t test were used to test for association between failure on the YSP and participant factors (sex, age, reason for admission/intubation, duration of intubation, number of intubations, and time post-extubation of exam), aspiration on FEES and participant factors, and a false negative on the YSP and participant factors.

Results: Fifty-seven percent (88 of 154) failed the YSP. Fifty percent (77 of 154) of participants aspirated on at least one trial during the FEES. Sensitivity of the YSP was 75%, and specificity was 61%. Participants who failed the YSP were older (M = 61 years; p = .0030). More women failed the YSP than men (p = .0007). No patient factors were associated with aspiration on FEES. Participants admitted for respiratory etiologies (pneumonia, chronic obstructive pulmonary disease exacerbation) were most likely to have a false negative on the YSP (p = .02). False negatives were also more likely in participants with a size ≥ 8 of endotracheal tube (p = .03).

Conclusions: The YSP has suboptimal sensitivity and specificity for detecting aspiration in recently extubated patients. More data are needed on predictors of false negatives in order to improve sensitivity and specificity in this critically ill patient population.

Purpose: Vocabulary access is important for individuals who use augmentative and alternative communication (AAC), especially for children in the early stages of language learning. This study sought to understand how accurate speech-language pathologists (SLPs), teachers, and parents are in predicting the vocabulary needed by early symbolic communicators who use AAC in three contexts.

Method: Ten groups, each with a child who used AAC as their primary mode of communication and who was classified as an early symbolic communicator and their parent, teacher, and SLP, participated. The parents, teachers, and SLPs predicted a vocabulary list of words children who use AAC needed to participate in a dinner, a math lesson, and a speech session using the blank page method and categorical inventories technique. Children were then recorded in 15-min videos participating in the three contexts. Words were recorded and compared to the words predicted.

Results: There was large variability in the accuracy of percentage of words the children used that were predicted by the adults out of all the words the children used. The adults were significantly more accurate predicting the vocabulary for the math lesson than the dinner.

Conclusions: Parents, teachers, and SLPs predicted much of the vocabulary of early symbolic communicators who use AAC. Implications for early vocabulary selection and alternatives to predicting vocabulary are discussed.

Purpose: The aim of this study was to describe the development of and pilot feasibility outcomes for a strategy-based, brief, intensive cognitive rehabilitation intervention delivered to U.S. service members and veterans with mild traumatic brain injury in a recently completed 3-year pragmatic clinical trial: Symptom-Targeted Approach to Rehabilitation for Concussion (STAR-C).

Method: To develop STAR-C, we used the Rehabilitation Treatment Specification System to identify core elements and principles from a previous randomized clinical trial of cognitive rehabilitation, and incorporated principles of neuroplasticity (e.g., high-dose spaced practice of personally meaningful tasks), best clinical practices (e.g., client-centered goal setting), health psychology (e.g., a focus on self-efficacy and motivation), and community-based participation research (e.g., the protocol was co-designed by clinicians and researchers). Treatment was based on a resource-allocation theory of everyday cognitive challenges, which predicted that automatic strategy use would reduce cognitive demands of everyday activities and therefore reduce cognitive symptoms. Treatment was delivered by speech-language pathologists (SLPs) and occupational therapists (OTs), using a protocol that included a problem-focused intake questionnaire, manualized treatment, and clinician resources. Therapy was delivered individually in six to 10 virtual or in-person sessions over 3-4 weeks. Therapy focused on desired changes in function, scaled using Goal Attainment Scaling.

Results: Trained SLPs and OTs delivered STAR-C to 53 U.S. service members and veterans, with treatment fidelity > 95%. Participants and clinicians rated STAR-C as acceptable, feasible, and appropriate, and most participants attained and maintained targets.

Conclusion: STAR-C appears to be a feasible method for improving everyday cognitive performance and efficacy should be tested in a controlled study.

Supplemental material: https://doi.org/10.23641/asha.28222613.

Introduction: Though the research on the quality of life of people who stutter is extensive, there is minimal research on cluttering's life impact. Anecdotal reports from people who clutter¹ and their significant others have described some elements of cluttering's impact and advocated for these components to be addressed in treatment. Three formal studies have used semistructured interviews to document cluttering's impact. These non-peer-reviewed studies make important contributions; however, more research is needed to add to this existing information. The current study adds perspectives of adults who clutter related to cluttering's impact upon the specific contexts of work, school, and social situations.

Method: In this phenomenological study, 10 adults who clutter participated in a semistructured interview. Through grand tour, mini tour, and example questions, participants were asked to provide their perspective on the life impact of cluttering. Each interview was orthographically transcribed, and transcripts were coded for themes. Triangulation and member checking were conducted to establish reliability and validity of themes.

Results: Results revealed the following themes: Social impact of cluttering leads to avoidance, misunderstanding, and feelings of isolation; cluttering impacts natural tendencies; educational impact of cluttering results in misunderstanding and struggle; occupational impact of cluttering leads to role entrapment and difficulty maintaining employment.

Conclusions: This study adds perspectives of adults who clutter regarding specific aspects of quality of life such as social isolation, frequent misunderstandings, and negative educational and occupational impact. As more voices are heard within the cluttering community, more support is presented for the importance of understanding the negative life impact cluttering can have. Further understanding of these perspectives adds to the information needed to inform holistic cluttering assessment and treatment.

Purpose: There is a scarcity of language assessment tools properly adapted for use with minimally speaking autistic children. As these children often use nonspoken methods of communication (i.e., augmentative and alternative communication [AAC]), modification of traditional assessment tools is needed to capture the full range of their communicative repertoires. We modified the MacArthur-Bates Communicative Development Inventories (CDI) to explore how vocabulary size and composition are impacted by considering nonspoken, as well as spoken, expressive vocabulary (AAC-modified CDI: Words and Gestures).

Method: Our initial sample consisted of 16 minimally speaking autistic children, 3-9 years old, whose caregivers completed our modified CDI after taking part in an AAC intervention. Our final sample included 15 participants, after removing an outlier.

Results: Accounting for both spoken and nonspoken communication significantly increased participants' reported expressive vocabulary by an average of 14 words (z = -2.61, p = .009, r = .75). Verbs made up a sizable portion (13.3%) of vocabulary when accounting for all modalities, while nouns made up the majority (51.5%).

Conclusions: We demonstrated the value of including both spoken and nonspoken modalities of communication when assessing the expressive vocabulary of minimally speaking autistic children. Prior work has shown that minimally speaking autistic children's spoken vocabulary was prominent in verbs (i.e., contained proportionally more verbs than that of vocabulary-matched typically developing children). In our sample, which used a broader definition of minimally speaking, we found that the proportions of verbs and nouns were consistent with what has been reported for typically developing children with similar-sized productive vocabularies.

Purpose: Swallowing difficulties have a substantial impact on the burden experienced by care partners of individuals with neurodegenerative disease. Given this, there is a clear need to easily identify and quantify the unique aspects of swallowing-related burden. The purpose of this study was to establish the validity and reliability of the Caregiver Analysis of Reported Experiences with Swallowing Disorders (CARES) screening tool in care partners of individuals with neurodegenerative disease.

Method: Survey data were collected from an international sample of 212 individuals caring for family members with amyotrophic lateral sclerosis (n = 49), dementia (n = 110), or Parkinson's disease (n = 53). Respondents completed the CARES, Eating Assessment Tool-10, International Dysphagia Diet Standardisation Initiative-Functional Diet Scale, and Zarit Burden Interview. Reliability and validity of the CARES were evaluated via internal consistency alpha coefficients, Spearman's rho correlations, and logistic regression analyses with receiver operating characteristic (ROC) curves.

Results: CARES scores demonstrated excellent internal consistency (α = .90-.95) and high test-retest reliability (r = .86-.91). The CARES was found to be valid, as increased swallowing-related burden was associated with increased severity of swallowing difficulties (r = .79 to .84), diet restrictiveness (r = -.50 to -.54), and general caregiver burden (r = .36 to .40). The CARES had excellent discrimination between care partners with and without self-reported swallowing-related burden, with a score of ≥ 4 suggesting a heightened risk of experiencing this burden.

Conclusions: Results establish the CARES as a valid and reliable screening tool that can detect burden related to swallowing difficulties among care partners of individuals living with neurodegenerative disease (score ≥ 4). Clinical implementation of the CARES requires the concerted efforts of the larger multidisciplinary team who can collaboratively identify the presence of burden and target the multifaceted sources of burden that a care partner may be experiencing.

Purpose: Management of discourse is acknowledged as a critical component of speech-language pathology practice with cognitive communication after traumatic brain injury (TBI). This scoping review aimed to collate the visual materials that are being used in empirical research for spoken narrative elicitation post-TBI, in both assessment and treatment contexts. We aimed to examine the format, structure, and sources for visuals used. Discourse analyses were also investigated.

Method: The research was conducted and reported as per the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews between September 26, 2023, and March 1, 2024. Four electronic databases were searched for peer-reviewed original research studies reporting spoken narrative tasks using visual elicitation stimuli after TBI. Secondary searches of backward and forward citations were also undertaken.

Results: Of the 1,461 studies found in the search, 60 studies were eligible for data extraction. Eleven visual stimuli were used in 51 of the studies to elicit narratives. The visual stimulus reported in the highest number of studies was The Flowerpot Incident, a six-picture black-and-white picture sequence. Overall, the most frequently used format was a wordless storybook, analyzed most frequently at the macrostructural level.

Conclusions: Research studies are using picture sequences or wordless storybooks to elicit discourse samples after TBI. This contrasts with a recent survey of clinical practice with discourse post-TBI, where The Cookie Theft picture was most reported in use (Steel et al., 2024). We discuss the relevance of findings in relation to recent INCOG 2.0 guidelines (Togher et al., 2023) and speech-language pathology practice, and make recommendations for clinical and research future directions.

Supplemental material: https://doi.org/10.23641/asha.28098113.

Purpose: Research has shown that prolonged endotracheal intubation can increase risk of aspiration following extubation. This study examined the relationship between swallowing and intubation among patients with COVID-19. We investigated the association between the duration of intubation and time until an oral diet was safely initiated and the correlation between the length of intubation and reduced sensation with aspiration as seen on flexible endoscopic evaluation of swallowing (FEES)/videofluoroscopic swallowing study (VFSS).

Method: This study is a retrospective analysis of all intubated patients admitted with the primary diagnosis of COVID-19 between April 2020 and March 2021 who received an inpatient speech-language pathology consultation. We utilized univariate linear regressions to investigate the dose-response relationship between duration of intubation and time until cleared for oral diet post-extubation. Dysphagia outcomes were analyzed, including results from 39 instrumental evaluations (VFSS and FEES).

Results: During this 1-year period, 94 extubated patients were examined by a speech-language pathologist (SLP). We observed a near-exponential increase in the days until cleared for oral diet from 3% versus 69% when intubated for 10-16 days versus 17-34 days, respectively. Second, 39 patients received a VFSS/FEES evaluation. Of those who aspirated on an instrumental swallow study, there was a 78% rate of silent aspiration.

Conclusions: Prolonged intubation has a near exponential dose-response on the time until a patient becomes cleared for an oral diet after extubation. Prolonged intubation also increases the rate of aspiration observed on VFSS/FEES evaluations. Thus, SLP evaluation of oropharyngeal swallow physiology is important to minimize complications and improve patient outcomes.

Supplemental material: https://doi.org/10.23641/asha.28165631.