American Journal of Speech-Language Pathology最新文献

Purpose: Disordered airway protection, including both disordered swallowing (dysphagia) and disordered cough (dystussia), is highly prevalent among persons with Parkinson's disease (pwPD). A comprehensive understanding of the perspectives of pwPD as it relates to airway protection is currently lacking and is necessary to provide relevant, person-centered care. Therefore, this study used a parallel-convergent mixed methods design to quantitatively and qualitatively investigate pwPD's perspectives on airway protection.

Method: Thirteen pwPD were consecutively recruited from a cough training trial. Quantitative data (obtained from the Swallowing Quality of Life questionnaire [SWAL-QOL] and the modified Canadian Occupational Performance Measure [mCOPM]) and qualitative data (obtained from semistructured interviews) were integrated to define participant knowledge, perceived importance, perceived performance, and psychosocial implications of airway protective deficits.

Results: All participants reported basic knowledge about airway protection, which centered around four themes-physiology, the interconnectedness between bulbar functions, danger, and impaired airway protection as a consequence of PD. All participants believed that airway protection was important (median mCOPM score = 10), with three primary themes related to importance-survival, anticipated future decline, and maintaining oral intake. We identified a split between participants who perceived themselves to have "a swallowing problem" and those who did not, with three themes relating to perceived impairment-use of eating strategies, unpredictable and inconsistent symptom experience, and vigilance required to mitigate symptoms. Psychosocial ramifications centered on three key themes that aligned with three SWAL-QOL domains-overall burden, fear of future decline, and social embarrassment.

Conclusion: The integration of quantitative and qualitative data in this study highlights the importance of considering unique patient perspectives to develop personalized and relevant management plans for each unique pwPD that integrate objective and clinical findings with patient priorities and needs.

Supplemental material: https://doi.org/10.23641/asha.28489280.

Purpose: The current qualitative study aimed to explore the experiences and challenges reported by United States (U.S.)-educated international clinicians practicing outside of the U.S. upon graduate degree completion. Identification of strategies for international practice was sought.

Method: Nine participants, including seven speech-language pathologists (six women, one man) and two male audiologists practicing in 10 countries, were interviewed. Content analysis was used to systematically structure interview data, and a phenomenological orientation with qualitative analyses was adopted to explore the value and significance of the international practitioners' experiences.

Results: Data analysis revealed three overarching themes that emphasized the influence of local context on clinical practice, professional autonomy, and navigating strategies for professional success. These thematic results were supported by several subthemes addressing a range of topics, such as evidence-based practice, colonialism, encroachment, resilience, and self-care. Analysis and interpretation of themes led to specific outcomes, including (a) suggestions for curricular and clinical changes within graduate programs, (b) optimal personal skills and strategies professionals utilize to achieve success during international engagements, and (c) recommendations for universities and professional organizations to enhance graduate personnel preparation of clinicians.

Conclusions: Study implications offered recommendations that graduate programs and professional organizations could use to optimize the preparation of the audiology and speech-language pathology workforce internationally. The implications include advising, mentoring, curriculum, service provision coaching, clinical placement, and alumni relations that benefit international graduate degree candidates, departments, and universities. Insights from this study are an invaluable resource for academicians and future graduate students planning to work internationally.

Purpose: This is a qualitative analysis of speech-language pathology and occupational therapy documentation of bedside assessments of infants orally feeding on noninvasive respiratory support (NRS).

Method: Data were extracted from speech-language pathology and occupational therapy electronic health record documentation of bedside feeding/swallowing assessment and treatment of infants on NRS. These data included the rate of documentation of objective metrics, as well as themes in feeding safety, quality, and therapeutic interventions.

Results: Notes from 37 speech-language pathologist and occupational therapist bedside visits were included. Data on the amount of NRS during oral feeding were inconsistently documented, but reported flow rate ranged from 0.2 to 5.0 l per minute. Approximately 57% of notes indicated some type of overt feeding problem. Objective data were inconsistently documented, but common metrics included signs of possible aspiration (cough in 16.2% and congestion in 13.5% of notes), liquid viscosity (43.2% of notes), feeding modality (94.6% of notes), volume offered (56.8% of notes) and consumed (81.1% of notes), and feeding time (56.8% of notes). Documentation themes include assessment of both safety and quality, implied stability and success rather than explicit documentation of such, infrequent instrumental assessment referral, differences between assessment versus follow-up treatment notes, differences in structured/templated notes versus unstructured narratives, and missing data.

Conclusions: Missing data limited our ability to draw conclusions regarding safety and quality of oral feeding during NRS use. We make recommendations for documentation, including prioritizing objective data, clarifying clinical interpretations, patient responses to interventions trialed, and use of structured narratives and flowcharting.

Purpose: Chronic refractory cough (CRC), defined as cough lasting over 8 weeks despite medical intervention, is a prevalent condition with a number of associated comorbidities. Cough suppression therapy (CST) has been demonstrated to be a promising avenue for treating CRC by improving airway control and coordination. However, little is known about the effects of CST in CRC patients diagnosed with comorbid oropharyngeal dysphagia (DYS) despite a large subset of patients with both conditions. The purpose of this study was to determine if CST affects self-assessment of DYS severity in patients diagnosed with both CRC and oropharyngeal DYS.

Method: The charts of 106 patients with a primary diagnosis of CRC who completed CST were reviewed. A total of 30 age- and gender-matched individuals, 15 with CRC and oropharyngeal DYS (CRC + DYS) and 15 with CRC only, were identified. All patients underwent stroboscopic examinations by an otolaryngologist and completed the Cough Severity Index and Eating Assessment Tool-10 surveys. Statistical analyses were conducted to compare pre- and posttreatment symptom severity, gender, age, race/ethnicity, and comorbidities.

Results: Self-reported severity of DYS decreased in all 15 CRC + DYS patients, and their average post-treatment score was statistically similar to that of patients with only CRC. Both groups had comparable reductions in their self-assessment of cough severity. The two groups presented no statistically significant difference in pretreatment cough severity, treatment duration, number of treatment sessions, comorbidities, age, and gender.

Conclusion: These findings suggest that CRC patients with oropharyngeal DYS and no evidence of aspiration had statistically significant improved self-assessment of swallowing disorder severity when treated with CST.

Purpose: Severity is a qualitative judgment typically made by speech-language pathologists (SLPs) to represent the impact of speech sound disorder (SSD) on a child's functional communication. Despite the influence of severity on clinical practice, there is no gold standard as to how SLPs should determine such a rating. The purpose of this study was to explore SLPs' perceptions regarding the concept of severity of SSD.

Method: An embedded mixed-methods research design was selected for this study to support the collection and analysis of both quantitative and qualitative data. An online survey of 30 closed-ended and 10 open-ended questions was created using Research Electronic Data Capture and disseminated to currently practicing SLPs across the United States. A total of 296 surveys were completed, and data were analyzed using descriptive statistics for the quantitative data and inductive content analysis for the qualitative data.

Results: The majority of SLPs reported that they determine severity when assessing children with SSD. However, the mixed-methods analysis showed that SLPs disagreed in their decision making on whether to use severity ratings. The top five factors SLPs consider when judging severity are types of errors, intelligibility, perceptual judgment, normative data for speech sound development, and standardized percentile rankings with the addition of stimulability through qualitative responses.

Conclusions: SLPs need a standard biopsychosocial model for determining severity that truly evaluates the "impact" of SSD on a child's communicative participation and attitudes. Recommendations for clinical use of holistic assessments and future research on currently established severity rating scales are discussed.

Purpose: This study aimed to examine the effects of a computer-delivered morphology instruction on morphological knowledge (MK) of students in third grade and test whether the treatment had similar effects across students who differed in their initial MK performance.

Method: We employed a randomized trial with randomization blocked within classrooms. Students (N = 263) in 14 third-grade classrooms in three schools were randomly assigned to a 6-week treatment or a wait-list comparison group that received business-as-usual instruction. The modules provided explicit instruction on derivational morphemes, roots and bases, and the meanings of derived words. Students assigned to treatment received individual log-ins to access the online program within their classrooms at least 3 times a week for 15-20 min per session. MK outcomes based on the Morphological Awareness Test for Reading and Spelling were assessed at the student level, using a gain score multilevel model approach to examine treatment effects.

Results: The treatment had significant positive effects on MK skills for students in the treatment condition with an effect size of 0.33 for affix identification and 0.24 for suffix choice. Students with low MK performance at pretest demonstrated similar gains from the treatment as students who were high performing at the onset of the study.

Conclusions: Computer-delivered supplemental instruction that includes explicit instruction on derivational morphology is associated with positive effects on students' MK. This finding has practical implications for minimizing the burden on teachers for implementation and enhancing language and literacy outcomes of students.

Supplemental material: https://doi.org/10.23641/asha.28439768.

Purpose: This study aimed to investigate the accuracy and reliability of subjective intelligibility estimates of young children's speech made by speech-language pathologists (SLPs) compared to naive listeners, and to examine how the severity of the child's speech impairment influences SLPs' intelligibility estimates.

Method: Eighteen certified SLPs and 18 naive listeners provided intelligibility ratings of single-word speech samples produced by six preschoolers with speech disorders. All listeners rated intelligibility using two different methods: orthographic transcription and subjective estimation of the percentage of words understood. Absolute differences between estimated and transcription intelligibility scores were used to examine accuracy of intelligibility estimates in both listener groups, and intraclass correlations were used to evaluate interrater reliability.

Results: Subjective intelligibility estimates differed from orthographic transcription-based intelligibility scores by 12.4% in the SLP listener group and 18.9% in the naive listener group. Interrater reliability of estimated intelligibility was substantially lower than transcription intelligibility in both listener groups.

Conclusion: Results of this preliminary study suggest that subjective intelligibility estimates by SLPs are not adequately accurate or reliable for measurement of children's speech intelligibility.

Purpose: Few clinicians report incorporating error type in their assessment of speech sound disorders, despite research reporting differences between children who produce typical and atypical phonological errors. The purpose of this scoping review was to map what is currently known about the related skills of English-speaking children who produce typical versus atypical phonological errors in order to summarize currently available evidence for clinical decision making concerning atypical phonological errors.

Method: A systematic search of databases was completed, including PubMed, Scopus, and APA PsycInfo. Studies that were published between 1985 and 2023, were peer-reviewed, and reported on a related skill for typical and atypical phonological errors were included. The scoping review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.

Results: Twenty-seven studies were included in the review. These studies were organized into six themes: persistence of speech errors, emergent literacy difficulties, executive function difficulties, language skills, speech perception and auditory processing, and motor skills. Atypical but not typical phonological errors were related to persistence of speech errors. Emergent literacy difficulties, particularly phonological awareness difficulties, and executive function difficulties were frequently reported to be associated with atypical but not typical phonological errors. Motor skills were similar for children who produced typical and atypical errors. More research is needed for speech perception, auditory processing, and language skills.

Conclusions: Children who produce atypical phonological errors have different strengths and weaknesses in related skills than children who produce typical phonological errors. Children who produce atypical phonological errors may benefit from phonological awareness and/or early literacy assessments and intervention.

Purpose: The aim of this study was to explore posttraumatic growth (PTG) in people with aphasia.

Method: As part of a larger multisite study, 23 people with aphasia (12 females, 11 males) each completed a 60-min semistructured interview during which they expanded on previously given questionnaire responses and then answered five additional open-ended questions about communication in their daily life. Interviews were transcribed orthographically, coded using reflexive codebook analysis, and synthesized into themes and categories by team members that included a person with aphasia.

Results: Reflexive codebook analysis revealed two themes. The first theme, "Moving Toward Growth" described the process of PTG, which included categories of "Grappling With New Reality," "Acceptance," "Goals and Effort," and "Improvement." The second theme identified "Perceived Areas of Growth," which included categories of "Perception of Self," "Relatedness," and "General Philosophy of Life."

Conclusions: Findings suggest that people with aphasia experience PTG across all three primary domains: (a) changed perception of self, (b) changed relationship with others, and (c) changed general philosophy of life and that the challenging circumstances associated with aphasia were integral to the development of PTG. Findings also highlight that PTG does not necessarily develop in a linear trajectory for people with aphasia and that processes such as acceptance, exerting effort, striving for continued improvement, and slowing down may contribute to the overall development of PTG in this population. Overall, the construct of PTG is relevant to people with aphasia, and the process by which PTG is developed in people with aphasia involves similar components to what has been described in other populations.

Supplemental material: https://doi.org/10.23641/asha.28394993.

Purpose: People who have an acquired brain injury (ABI) experience challenges in using social media. However, rehabilitation clinicians report feeling inadequately prepared to support them in its use. We aimed to evaluate the outcomes of a multicomponent, peer-moderated social media skills intervention for people with ABI.

Method: This study utilized a mixed-methods, pre-post intervention design. Two people with ABI were invited to be research co-investigators and participated as peer moderators. A total of seven adults with an ABI were recruited to participate in the intervention and completed a short self-guided course about social media skills (social-ABI-lity course) and then took part in a private, peer-moderated Facebook group over an 8-week period (social-ABI-lity Facebook group). Data were analyzed with mixed methods, collected via observation of group activity, weekly surveys, social media use and quality of life questionnaires (pre-intervention, postintervention, and after 3 months), and postintervention interview.

Results: Small improvements in social media skills were observed, although no significant changes were noted on quantitative measures for quality of life or confidence and enjoyment of Facebook use. Following a thematic analysis of interview data and incorporating reflections from peer moderators, we generated eight themes: loss, isolation, return, confidence, choice, identity, connection to community, and the "peer" effect. The intervention was identified as being feasible, acceptable, and engaging for all, with the role of the peer moderators perceived as being highly relevant and relatable by the participants. The peer moderators reported a positive influence on their confidence and sense of self-identity following the intervention.

Conclusions: The intervention was feasible and acceptable, with peer moderators also benefitting from their involvement. Future research is warranted to determine the fidelity and efficacy of this intervention on a larger scale and to develop clinical resources to support goal setting and individualized approaches to support people with ABI to use social media safely and meaningfully.