American Journal of Speech-Language Pathology最新文献

Purpose: Co-design of research and services alongside end users is increasingly required by funding bodies and governments. To enable a meaningful inclusion of people with communication disability, planning and modification are required, as standard co-design procedures involve extensive spoken and written language. Experience-based co-design (EBCD) is one co-design approach that is gaining popularity; however, there are few detailed reports to date on adapting EBCD for communication disability. This article outlines our modifications of EBCD to co-design a technology-enabled self-management platform (Communication Connect) for people living with poststroke aphasia and cognitive-communication disability from traumatic brain injury.

Method: Participants included individuals with communication disabilities (n = 8), care partners (n = 3), and health professionals (n = 20) across three Australian states. Data collection involved video-recorded interviews, focus groups, and structured prioritization workshops. This study describes the first four stages of EBCD (project setup, two experience-gathering stages, and identifying priorities).

Results: This article presents a detailed account of the practical decisions and modifications made throughout the EBCD process. Key adaptations are outlined, including the use of text-based video editing to efficiently create touchpoint films, nonlinear presentation of challenges to facilitate engagement, and visual aids to support prioritization and ranking. These modifications supported the meaningful participation of co-designers, including people with communication disability.

Conclusion: This method article contributes to the growing knowledge on adapting EBCD for communication disability, which may be of use to future EBCD projects and for improving the meaningful inclusion of people with communication disability in co-design research.

Purpose: The purpose of this study was to investigate the communication success of partners with matched or mixed neurotypes and to explore how these differences influence the identification of neurotypes during interactions.

Method: Thirty-three autistic adults and 37 non-autistic adults were paired in either a matched-neurotype or mixed-neurotype condition and were not told their assigned condition. The pairs completed two structured communication tasks (20 questions and tangram identification), for which accuracy and efficiency of completion were measured. Participants completed a survey about rapport in their interactions and their perception of their partner's neurotype.

Results: Matched autistic pairs communicated significantly more accurately (p = .037) but significantly less efficiently (p = .047) than matched non-autistic pairs. Mixed-neurotype pairs reported significantly lower rapport than the matched-neurotype pair conditions (p = .023), which did not differ significantly from one another. Matched autistic pairs were significantly more accurate (p = .009) and more confident (p = .035) in their guesses about their partner's neurotype than participants in other conditions. However, participants' guesses were not significantly related to their communication success in the experimental tasks.

Conclusions: Neurotype-matching is associated with stronger rapport development and greater communication success, suggesting that autistic and non-autistic communication styles differ. Autistic participants demonstrated strengths in perceiving others' neurotypes, but communication success factors were not associated with neurotype perceptions.

Purpose: The aim of this study was to reach consensus among researchers, clinicians, and service managers on the most important outcomes of cognitive-communication treatments for children and adolescents (ages 5-18 years) with traumatic brain injury, in the postacute stage of rehabilitation and beyond.

Method: This is an international three-round e-Delphi study. In Round 1, participants answered three open-ended questions, generating important treatment outcomes at three stages of development (5-11, 12-15, and > 15-18 years). Results were analyzed using qualitative content analysis and combined with outcomes from a previous scoping review. In Rounds 2-3, outcome importance was ranked on a 9-point scale. Consensus was defined a priori with outcomes rated as being "essential" (7-9) by at least 70% of respondents and rated 1-3 by less than 15% of respondents. Consensus outcomes were linked to the International Classification of Functioning, Disability and Health (ICF).

Results: A total of 360 outcomes met consensus for all age groups. For 5- to 11-year-old children, important outcomes linked almost equally to the Body Functions (n = 52, 13.1%) and Activity/Participation (n = 50, 12.6%) components of the ICF. Outcomes of "successful start to school," "return to school," and "school functioning" were uniquely important. For older children and adolescents, outcomes linked to the Activity/Participation component of the ICF most frequently (12-15 years: n = 62, 15.6%; > 15-18 years: n = 73, 18.4%). For older cohorts, unique outcomes of "emotional safety," "employment," and "life skill development" met consensus.

Conclusions: Participants consider many outcomes, spanning most of the ICF, to be important for children and adolescents with cognitive-communication disorders (CCDs). As children and adolescents age, the importance of ICF components shifts, and distinct outcomes emerge, highlighting the necessity of developmentally relevant rehabilitation. The broad range of outcomes reaching consensus reflects pediatric CCD complexity and the need for holistic, person-centered care. Future research should explore the priorities of children and adolescents with CCDs and their families.

Purpose: This viewpoint explores the idea that a neurodiversity-affirming social model and a medical model of stuttering health care are not mutually exclusive. In all cases, they should be used in combination. For any client, the only way to attain an optimal clinical outcome is to apply a combined medical and social health care perspective. The two models have a changing contribution across the lifespan, according to the client's requirements, age, and presenting complaints and the viability of neuroplastic change of the speech mechanism.

Conclusions: The benefits of neurodiversity applied to stuttering are a "feast" that is "moveable" according to the developmental stage of stuttering and the personal needs of clients. A less flexible view of the matter may prevent the best treatment outcome for clients. In the case of early stuttering, an inflexible approach may cause serious, long-term harm to children.

Purpose: This qualitative study explored the perspectives of parents of young children with childhood apraxia of speech (CAS) in terms of (a) long-term desired outcomes for their child and (b) experiences of early intervention (EI). Although parent and client perspectives are recognized as a key component of evidence-based practice (EBP), there is currently sparse information about parent experiences to direct speech-language pathologists' clinical practice.

Method: The parents of 14 children with a confirmed CAS diagnosis participated in this study. Participants were from Australia and the United States. Online semistructured interviews were used to explore parents' desired long-term aspirations for their child as well as their experience of EI. Reflexive thematic analysis was used to analyze the data.

Results: Three themes described the long-term desired outcomes, with participants aspiring for their child to communicate effectively, participate in everyday life, and experience feelings of well-being. There were four main themes related to parents' experiences of EI with their child with CAS: (1) finding and maintaining access to EI services is time consuming and complex; (2) quality CAS services are about therapist skills, frequency, and do-ability; (3) the wider context: EI is not just about what is happening for the child and family in speech-language pathology; and (4) children improve, but at what cost?

Conclusions: Parents have clear long-term aspirations for their child to be able to communicate effectively and to participate in and have a good quality of life, despite acknowledging the long-term nature of CAS. Experiences of EI indicate complexities in receiving appropriate intervention and the impact on the child and family as a whole. Clinicians are encouraged to consider these findings in implementing EBP.

Supplemental material: https://doi.org/10.23641/asha.30179068.

Objective: Clinical voice quality assessments typically use external microphones meeting technical standards for instrumental assessment of voice. As smartphones advance, this study aimed to determine their suitability for voice recordings through a systematic review with meta-analysis.

Method: Three database searches were conducted, ranging from their inception to December 2024, as well as a manual search. Cross-sectional studies were included on widely used clinical acoustic voice quality measures of the software Praat (i.e., jitter, shimmer, harmonics-to-noise ratio [HNR], smoothed cepstral peak prominence [CPPS], and acoustic voice quality index [AVQI]).

Results: We found 10 eligible research studies with a total of 379 participants who were simultaneously compared between a clinical recording system (CRS) and different smartphones by Apple and Samsung products. All included studies focused on individuals with vocally healthy voices, while four of the studies also included those with voice disorders. In comparison with CRS, iPhones revealed significant differences and large effect sizes in HNR (mean difference of 2.20, 95% CI [0.59, 3.82], p = .008, Cohen's d = 2.54) and in AVQI (mean difference of -0.53, 95% CI [-1.00, -0.06], p = .027, Cohen's d = -1.99), but in the direct comparison between Apple and Samsung mobile device recordings, significant differences and large effect sizes were found in jitter (mean difference of -0.17, 95% CI -0.27, -0.08, p < .001, Cohen's d = -1.18) and CPPS (mean difference of 0.87, 95% CI [0.20, 1.53], p = .011, Cohen's d = 1.26). Recordings with Samsung products showed only significant differences and a large effect size with CRS in jitter (mean difference of -0.16, 95% CI [-0.29, -0.03], p = .019, Cohen's d = -0.84).

Conclusions: The present meta-analysis indicated some inconsistency in the outcomes of acoustic voice quality parameters between smartphone recordings and CRS. While acoustic measurements are frequently used in clinical voice assessments and smartphones are widely available, it is important to note that for certain parameters, current smartphone recordings may not yet match the precision of CRSs for voice quality analyses.

Supplemental material: https://doi.org/10.23641/asha.30200029.

Purpose: The aim of this study was to determine the age at which children with voice disorders can complete videostroboscopy, acoustic, and aerodynamic voice assessments. Factors predicting videostroboscopy tolerance were examined.

Method: A retrospective observational cohort design was used. Three hundred twelve children with voice disorders were divided into the following age groups: 3-4, 5-6, 7-9, 10-12, and 13-17 years. Videostroboscopy was considered complete if patients produced enough phonation during the exam to allow for stroboscopic ratings of vocal fold oscillation (i.e., mucosal wave, amplitude) to be performed. Patient demographics, voice-related diagnoses, voice symptoms, vocal fold oscillation ratings, clinician experience level, and acoustic and aerodynamic voice measures were collected from the medical record.

Results: All children tolerated laryngeal imaging under steady-state halogen light. Almost 17% of 3- to 4-year-olds tolerated videostroboscopy. This number significantly increased to 55% in 5- to 6-year-olds (p < .01) and to 60% in 7- to 9-year-olds. Success rates again significantly increased to 85% in 10- to 12-year-olds (p < .01) and 93.1% in children ≥ 13 years old. Age (p = .03) and ability to perform the voice range profile (p < .01) and aerodynamic voice assessment (p < .01) tasks significantly predicted which patients could tolerate videostroboscopy. Half of 3- to 4-year-old children produced sustained phonation for acoustic analyses compared to 91.7% of 5- to 6-year-olds (p < .01). The majority of children ≥ 5 years old completed the voice range profile task (63.3%) and aerodynamic voice assessments (66.7%).

Conclusions: Videostroboscopy is viable for young children with voice disorders. The ability to complete aerodynamic and voice range profile tasks may serve as a preliminary indicator of how well a patient will tolerate videostroboscopy. Future prospective study may determine the most effective approach to help children tolerate instrumental voice assessments.

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.