American Journal of Speech-Language Pathology最新文献

Purpose: Sentence production is impaired in many persons with aphasia (PWA). However, few effective treatments for sentence production exist. Recent research has advanced structural priming as a promising treatment for aphasia, but the underlying mechanisms of priming remain unclear. This study examined contributions of abstract syntactic and lexically boosted priming to sentence production improvements in PWA and underlying memory mechanisms.

Method: Twenty-four PWA and 16 age-matched controls completed baseline testing, three to six sessions of sentence production priming training, and 1-day and 1-week posttesting. Trained structures were passives and double-object datives. Participants were trained with same-verb and different-verb priming to assess lexical boost and abstract syntactic priming effects on treatment outcomes. The serial reaction time, fragmented picture, and picture pointing span tests were administered to assess contributions of implicit and explicit memory in predicting treatment gains.

Results: PWA and controls showed lasting improvements to both trained and untrained sentences following training. Critically, controls improved more strongly following same-verb priming, while PWA showed stronger gains following different-verb priming. High implicit memory scores facilitated greater treatment effects in both PWA and controls. Only controls showed positive effects of explicit memory.

Conclusions: These results support structural priming as an effective sentence production treatment for PWA, especially when verbs are not matched between primes and target. We suggest lexical differentiation supports priming in PWA by allowing more efficient access and learning of abstract syntactic representations, which appears crucial to successful sentence production.

Purpose: Thickening liquids is a common intervention to minimize aspiration despite limited understanding of how two different consistencies impact swallow physiology in babies. This investigation used the BaByVFSS Impairment Profile (BaByVFSSImP) to examine the influence of different liquid consistencies on validated physiological components of swallowing during bottle feeding.

Method: Participants were bottle-fed thin and nectar-thick barium liquid (Varibar) during clinically indicated videofluoroscopic swallowing studies (VFSSs) at two study sites. Swallowing impairments were scored using the BaByVFSSImP. Demographic and clinical data, maximum Penetration-Aspiration Scale (PASmax) scores, Feeding/Swallowing Impact Survey (FS-IS) scores, and pre- and post-VFSS levels of feeding were collected.

Results: Two hundred twenty-five babies (median age = 2.9 months, interquartile range = 1.1-7.1 months) with heterogeneous conditions participated. On the BaByVFSSImP, mildly thick liquid was associated with lower (better) impairment scores than thin for Domain 2 (Palatal-Pharyngeal Approximation, p = .02), Domain 3 (Airway Invasion/Laryngeal Closure, p < .0001), and Domain 4 (Aspiration, p < .0001). Domain 1 (Lingual Motion/Pharyngeal Swallow Initiation) and Domain 5 (Pharyngeal Transport and Clearance) did not differ by consistency. However, impairment scores with thick liquid were higher (worse) for Component 2 and lower (better) for Component 5. With mildly thick liquid, Domain 3 (r_s = .82, p < .001) and Domain 4 (r_s = .74, p < .001) had strong positive correlations with PASmax, while Domain 2 (r_s = .15, p = .02) and Domain 5 (r_s = .20, p = .003) had weak positive correlations with PASmax. Correlations between post-VFSS feeding recommendations and mildly thick liquid impairment scores for Domain 3 (r_s = .24, p < .001), Domain 4 (r_s = .31, p < .001), and Domain 5 (r_s = .13, p = .05) were significant. Domain scores did not significantly correlate with FS-IS subscales. Significantly greater volumes of thin liquid barium were administered compared to mildly thick barium at both study sites (p < .001).

Conclusions: Our findings demonstrate improved swallow physiology and airway protection with mildly thick compared with thin liquids in bottle-fed children with diverse diagnostic conditions. Additional studies are needed to guide clinical decisions about thickening liquids for individual and well-defined populations of children that take into account their diagnostic conditions and physiological impairment profiles and move beyond the limitations associated with Penetration-Aspiration Scale findings alone.

Purpose: Family-centered care is necessary to deliver high-quality health care services. It is especially critical that family members are included in augmentative and alternative communication (AAC) service provision in the inpatient setting. AAC can be overwhelming to families and requires accommodations for it to effectively integrate into daily communicative interactions. Currently, there is minimal guidance for family-centered care by speech-language pathologists (SLPs) working with children with limited functional speech in the inpatient pediatric setting. The purpose of this clinical focus article is to apply principles from family systems theory to the inpatient pediatric setting to guide effective family-centered clinical practice and improve outcomes.

Method: This clinical focus article describes a family systems framework to guide the development and use of supports to families during the extended hospitalization of a child with limited speech who may benefit from AAC in the inpatient rehabilitation setting. Two case studies are used to illustrate the application of a family systems approach in the pediatric inpatient setting.

Results: Recommendations are provided for the inclusion of primary caregivers in service delivery by SLPs in the inpatient hospital context. Clinical implications and future directions are discussed.

Conclusions: The hospitalization of a child who uses AAC can be a stressful experience for the entire family system. By using a family systems framework, SLPs may improve AAC service delivery outcomes by working collaboratively with family members and offering supports for both AAC implementation and general well-being. SLPs may also benefit from this approach to AAC service delivery as families may be more actively engaged in sessions, leading to increased uptake of intervention strategies and AAC.

Purpose: Paraeducators (i.e., speech-language pathology assistants and paraprofessionals) are often primary service providers who can engage in shared book reading (SBR) activities with young children. However, paraeducators do not typically have extensive training in supporting early language and literacy skills. We examined the effect of virtual practice-based coaching (PBC) on paraeducators' ability to implement print referencing strategies during SBR.

Method: A multiple-baseline-across-behaviors design was used to evaluate the effects of virtual PBC on paraeducators' implementation of three specific print referencing strategies: print concepts (e.g., title, author, print direction), print meaning (e.g., speech bubbles, changes in font size, color, or shape), and letter and word knowledge (e.g., features of letters, letters make up words). Three paraeducator/child dyads participated (one speech-language pathology assistant and two paraprofessionals).

Results: All three paraeducators increased their use of the three targeted print referencing strategies, after PBC was implemented. For all three, these strategies continued to be employed during the maintenance phase, once coaching support was faded.

Conclusions: Our results indicate that, preliminarily, virtual PBC may be an effective method for training paraeducators on the implementation of print referencing strategies. Future work can consider various SBR strategies, such as expanding vocabulary or phonological awareness, with larger samples.

Supplemental material: https://doi.org/10.23641/asha.30067345.

Purpose: This study aims to describe how a multi-tiered multimodal narrative intervention program was developed by integrating research and real-life professional practice through a participatory co-creation process using multiple methods.

Method: A total of 24 preschool teachers, 69 therapists, and three researchers working in Catalonia participated in a five-session iterative co-creation process. First, the initial narrative intervention prototype was presented. Then, using the nominal group technique, practitioners generated ideas associated with narrative-based training. These ideas underwent qualitative and quantitative analyses to ensure that practitioners' needs were reflected in the prototype's design, with corrections made when necessary. Participants then piloted the intervention in their professional contexts and provided feedback. This led to the final revision of the narrative intervention program, approved by all participants.

Results: Qualitative and quantitative analyses led to a few changes in the intervention protocols but essentially confirmed the practicability of the multi-tiered intervention prototype, which might therefore ensure the intervention's feasibility and effectiveness.

Conclusions: This study aligns with the implementation science approach where educational interventions must be based on science and informed by contextual factors affecting their implementation in real life. Our results underline the importance of following co-creation processes that systematically accommodate practitioners' perspectives to improve educational and clinical outcomes.

Purpose: Measures of coping that are accessible to persons with aphasia in both clinical and research environments are lacking. The current article takes a step toward solving this problem by presenting a coping questionnaire, the Aphasia Brief COPE, standardized on persons with aphasia.

Method: Thirty-three persons with aphasia and 32 care partners participated in this study. Persons with aphasia completed the Aphasia Brief COPE, Simple Aphasia Stress Scale, modified Perceived Stress Scale, Stress Rating, Self-Assessment Manikin, and the Connor-Davidson Resilience Scale 10 to compare psychometric features. Care partners completed the Aphasia Brief COPE.

Results: The Aphasia Brief COPE demonstrated excellent internal consistency, reasonable reliability for adaptive and maladaptive coping, and both convergent and concurrent validity for persons with aphasia. Low reliability for care partners suggested that the measure is better suited for persons with aphasia.

Conclusions: The Aphasia Brief COPE is a psychometrically sound questionnaire that can be used with persons with aphasia. We believe that this questionnaire will contribute to better understanding the psychological and mental health of persons with aphasia, therefore advancing our care of these individuals.

Background: Speech-language pathologists (SLPs) evaluate and treat swallowing and communication impairments in individuals with amyotrophic lateral sclerosis (ALS). Standardized clinical practice guidelines for the evaluation and management of bulbar dysfunction in ALS have not yet been established. This study aimed to describe current international practice patterns of SLPs evaluating and treating bulbar dysfunction in ALS.

Hypothesis: Significant variability in practice patterns will exist across SLPs working in different clinical settings with varied resources.

Method: A 26-item Qualtrics survey was electronically distributed to SLPs via e-mail, social media, and professional discussion boards.

Results: Data from 245 respondents across 20 countries and 32 states within the United States were collected, with the final analysis including 214 respondents. Most respondents practiced in metropolitan areas (69%) and worked in multidisciplinary ALS clinics (41%), outpatient clinics (16%), and home health settings (17%). Cranial nerve examination (91%), swallow trials (79%), speech intelligibility tasks (85%), and diadochokinetic speech rates (65%) were frequently included in evaluations. Although 81% of clinics had access to instrumental swallowing evaluations, 32% reported performing them in fewer than 25% of patients. Communication evaluations were offered directly by 58% of clinicians, while 26% referred to an outside SLP and 16% collaborated with device representatives. Most clinicians provided patient education on swallowing (87%) and oral health (83%). However, managed practice varied widely, revealing no standardized treatment that is routinely offered. Barriers to optimal ALS care included time constraints, relevant clinical training, timing of treatment, addressing psychosocial components of care, access to resources, interdisciplinary communication, and insurance coverage (United States only).

Discussion: Findings reveal little consensus on symptomatic bulbar management and intervention timing. Results emphasize the urgent need for the development of a standardized minimal data set to best guide the evaluation and management of bulbar dysfunction in ALS.

Supplemental material: https://doi.org/10.23641/asha.30249997.

Purpose: This study examined the effects of a multimodal verb-centered noun retrieval treatment in three individuals with logopenic variant primary progressive aphasia (lvPPA). The intervention aimed to improve naming accuracy for trained nouns and promote generalization to untrained nouns.

Method: Three individuals with lvPPA participated in a multiple-baseline design study. Treatment was based on thematic relationships between verbs and nouns, incorporated self-cueing strategies, and orthographic homework practice, adapted from the Copy and Recall Treatment. Naming accuracy for treated and untreated nouns was assessed pretreatment and posttreatment to evaluate gains on the treated items and generalization effects.

Results: All participants demonstrated statistically significant improvements in naming accuracy for treated nouns, with large effect sizes. Generalization to untrained nouns was also observed in all participants but varied across participants, with the greatest gains observed in the individual with milder baseline impairments. The intervention, centered on verbs and their thematic roles, appeared to support lexical access of nouns and homework practice reinforced retrieval. The treatment effects and generalization were most robust for the individual with less-affected phonological manipulation and semantic processing abilities of nouns and verbs.

Conclusions: Findings support the efficacy of a structured lexical retrieval intervention in lvPPA that leverages verb-noun thematic relationships and self-cueing strategies. Individual differences in baseline cognitive-linguistic skills and performance on sematic association tasks may influence treatment responsiveness. Future research should explore predictors of treatment response and assess long-term maintenance of gains to refine intervention approaches for lvPPA.

Supplemental material: https://doi.org/10.23641/asha.30082309.

Purpose: The purpose of this article is to encourage the adoption of five grammar terms within the field of speech, language, and hearing sciences. The terms are needed to accurately describe and distinguish between the grammars of children with and without grammar weaknesses across the many dialects of English children learn as either a monolingual, multilectal, or multilingual speaker.

Conclusion: Adopting the five grammar terms transforms how one provides clinical services to children across dialects of English and changes how one guides preservice students in speech, language, and hearing sciences to inclusive practices related to the assessment and treatment of grammar.

Purpose: This study aimed to explore how speech-language pathologists (SLPs) visually assess videofluoroscopic swallow studies (VFSS) as reflected in eye-tracking data and to discuss challenges and barriers when using eye-tracking methodology to better understand VFSS review.

Method: Thirteen SLPs reviewed two swallows of a 5-ml thin liquid swallow while their eye movements were recorded. Fixation counts were analyzed across anatomically relevant areas of interest (AOIs). Data were analyzed descriptively, and statistical comparisons were made between the two swallows using the Wilcoxon signed-ranks test.

Results: Key findings included an overall decline in fixation count rate in the second swallow, significant variability in eye-gaze behavior across participants, and AOI-specific changes. The bolus received the highest fixation count rate in both swallows, and visual attention shifted from anterior-superior structures in the first swallow to more posterior-inferior structures in the second swallow. Methodological challenges included but were not limited to drawing the constantly changing AOI boundary and the lack of guidelines for missing gaze data.

Conclusions: Eye tracking offers exploratory insights into SLPs' visual attention during VFSS review, revealing variable gaze patterns and methodological challenges. Future research should further explore the link between gaze behavior and VFSS interpretation, possibly revealing patterns that may influence clinical decision making about a patient's swallowing physiology and shape clinical training accordingly.

Supplemental material: https://doi.org/10.23641/asha.30104632.