American Journal of Speech-Language Pathology最新文献

Purpose: Research has shown that caregiver burden is compounded by dysphagia experienced by the care recipient. However, little is known about the caregiver perception of the caregiving experience, highlighting both the positive and negative experiences. As such, the purpose of this clinical focus article was to provide a first-person account of an adult caregiver of an aging parent with dysphagia and relate their experiences to current literature to inform clinical practice.

Method: The caregiver provided a detailed account of her experiences caring for her father with dysphagia. Her account was analyzed to identify recurring themes in the literature regarding the caregiving experience and to identify gaps in dysphagia-related caregiver support. The caregiver's story is organized into seven main sections: (a) life before dysphagia, (b) dysphagia onset and diagnosis, (c) dysphagia management and support, (d) community support, (e) impact on family relationships, (f) social and emotional health, and (g) current perspectives on the caregiving experience.

Conclusions: The challenges associated with caregiving clearly impact the caregiver's overall well-being, but she received abundant support from her family, community-based speech-language pathologist, and caregiver support groups. The caregiver's experiences, while not applicable to every caregiver caring for a loved one with dysphagia, can offer valuable insights to clinicians and other caregivers facing similar situations.

Purpose: The current study revisits our previous research, delving deeper into microaggressions (MAs) and interpersonal conflict (IC) in speech, language, and hearing sciences (SLHS) training programs. Participants came from both marginalized and nonmarginalized backgrounds.

Method: A 39-item electronic survey based on our previous research was distributed online to 236 participants of current and former SLHS students through social media and e-mail listservs.

Results: Students that identified as belonging to marginalized and nonmarginalized groups reported high levels of MAs and IC, respectively. Linear regression revealed that the more marginalized identities a participant reported, the more aggression they experienced. Analyses also suggest that specific cultural and linguistic identities more likely predicted experiencing specific types of MAs than others. MAs and IC were largely underreported.

Conclusions: This study highlights the quantifiable prevalence of MAs and IC in SLHS training programs. It underscores the urgent need for targeted interventions to address systemic inequities. Overall, these findings emphasize the importance of fostering an inclusive and equitable environment in SLHS, promoting cultural competence, and social justice in the professions.

Supplemental material: https://doi.org/10.23641/asha.27105613.

Purpose: Assessing fluency in aphasia is diagnostically important for determining aphasia type and severity and therapeutically important for determining appropriate treatment targets. However, wide variability in the measures and criteria used to assess fluency, as revealed by a recent survey of clinicians (Gordon & Clough, 2022), results in poor reliability. Furthermore, poor specificity in many fluency measures makes it difficult to identify the underlying impairments. Here, we introduce the Flu-ID Aphasia, an evidence-based tool that provides a more informative method of assessing fluency by capturing the range of behaviors that can affect the flow of speech in aphasia.

Method: The development of the Flu-ID was based on prior evidence about factors underlying fluency (Clough & Gordon, 2020; Gordon & Clough, 2020) and clinical perceptions about the measurement of fluency (Gordon & Clough, 2022). Clinical utility is maximized by automated counting of fluency behaviors in an Excel template. Reliability is maximized by outlining thorough guidelines for transcription and coding. Eighteen narrative samples representing a range of fluency were coded independently by the authors to examine the Flu-ID's utility, reliability, and validity.

Results: Overall reliability was very good, with point-to-point agreement of 86% between coders. Ten of the 12 dimensions showed good to excellent reliability. Validity analyses indicated that Flu-ID scores were similar to clinician ratings on some dimensions, but differed on others. Possible reasons and implications of the discrepancies are discussed, along with opportunities for improvement.

Conclusions: The Flu-ID assesses fluency in aphasia using a consistent and comprehensive set of measures and semi-automated procedures to generate individual fluency profiles. The profiles generated in the current study illustrate how similar ratings of fluency can arise from different underlying impairments. Supplemental materials include an analysis template, extensive guidelines for transcription and coding, a completed sample, and a quick reference guide.

Supplemental material: https://doi.org/10.23641/asha.27078199.

Purpose: This pilot study investigated delivering enhanced milieu teaching tailored for children with Down Syndrome (EMT-DS) through hybrid telepractice.

Method: In this multiple-baseline design across behaviors study, a speech-language pathologist (SLP) taught EMT-DS to three caregivers and their children with DS (22-40 months) using a hybrid service delivery model. Sessions were conducted in person and via telepractice. The SLP taught caregivers EMT-DS, emphasizing the use of (a) four target EMT strategies: matched turns, expansions, time delays, and milieu teaching episodes; (b) augmentative and alternative communication (AAC; manual signs, speech-generating device); and (c) aided AAC modeling. The SLP provided caregiver instruction following the teach-model-coach-review approach. Caregiver outcomes were the accuracy (primary) and frequency (secondary) of EMT strategy use. Child outcomes were exploratory and included the rate of symbolic communication acts, weighted number of communication acts, and number of different words (NDW).

Results: There was a functional relation between the intervention and the accuracy and frequency of EMT strategy use for all three caregivers. All caregivers showed an increase in the accuracy for all four target strategies. Caregivers also increased the frequency of the three EMT strategies: expansions, time delays, and milieu teaching episodes. There were no changes in the frequency of matched turns. Caregiver use of EMT strategies maintained for 6 weeks post-intervention. After caregivers learned EMT strategies, gradual increases in the rate of symbolic communication acts and NDW occurred for all three children.

Conclusion: Results demonstrate the preliminary efficacy of using a hybrid service delivery model to teach caregivers EMT-DS.

Supplemental material: https://doi.org/10.23641/asha.27115252.

Purpose: Determining the prognosis of aphasia recovery is an important task for clinicians in the rehabilitation of persons with aphasia. Although there are many variables identified as impactful to aphasia recovery, it is less clear (a) how clinicians perceive causality in aphasia rehabilitation and (b) how prognostic variables interact with each other. This study aimed to understand causal relations between prognostic variables from the clinician perspective.

Method: Ratings of perceived causality were obtained from 11 clinicians serving people with aphasia. Participants were presented with 255 directed causal relations (e.g., depression → aphasia severity), representing a total of 18 demographic, diagnostic, and psychosocial variables. Participants rated the perceived causality on a Likert scale from 0 (no causal effect) to 10 (strong causal effect). We also obtained ratings about frequency of access to information about each of the 18 variables.

Results: A perceived causal network showed differences among variables in their perceived causality. There were many causal relations identified, particularly between diagnostic and psychosocial variables. The variables with the strongest perceived causality were predominantly psychosocial variables, including depression, social support, and participation. However, these psychosocial variables were also the variables that clinicians had the least frequent access to information about. There were also notable differences between participants in their perceived causal networks.

Conclusions: Clinicians hold valuable information about aphasia rehabilitation, including what variables are important to aphasia recovery. Understanding the complexity of interaction among prognostic variables and obtaining data from clinicians about prognostic variables and causality will advance the rehabilitation of aphasia.

Supplemental material: https://doi.org/10.23641/asha.27105865.

Purpose: The purpose of this study was to compare the novel word learning skills between Cantonese-English bilingual children at risk for developmental language disorder (DLD) and their typically developing (TD) peers.

Method: Participants were 24 Cantonese-English bilingual preschool children at risk for DLD and 38 TD children. Each participant was presented with eight novel words in Cantonese (first language [L1]) and eight in English (second language [L2]) over eight weekly sessions. Children's existing lexical knowledge was measured using the moving-average number of different words in language samples in L1 and L2.

Results: Bilingual children at risk for DLD were scored lower than their TD peers for both languages over time. The role of lexical knowledge in children's word learning differed between the TD and DLD groups: Lexical knowledge in L1 was a predictor of L1 word learning in TD children, while lexical knowledge in L2 predicted L2 word learning in children at risk for DLD. In addition, significant cross-linguistic effects were found from L2 to L1 for both groups.

Conclusions: This study underscores the complexity of novel word learning in bilingual children at risk for DLD. Clinically, these findings suggest the value of tracking learning trajectories in bilingual children across both languages.

Purpose: This study aimed to investigate the macro- and microstructural features of language in patients with ischemic stroke without aphasia.

Method: Participants were grouped according to arterial system damage and given the Aphasia Language Assessment Test (ADD) to detect aphasia. A narrative sample was obtained and analyzed for macrostructural and microstructural features of the language. The study sample consisted of 31 participants with ischemic stroke (15 vertebrobasilar system [VBS] involvement and 16 carotid system [CS] involvement) and 31 healthy participants, totaling 62 individuals.

Results: The healthy control group scored higher than the stroke group on the microstructural feature type-token ratio and mean length of utterance in the narrative analysis and on the auditory comprehension, repetition, naming, grammar, speech act, and writing subtests in ADD. Effort behavior, errors, edits, repetitions, and pauses among microstructural features and uncertainty, filler expression, and anomia among macrostructural features were significantly higher in the vertebrobasilar and CS groups than in the healthy control group. The total ADD score and speech fluency and reading subtest scores were significantly higher in individuals with VBS damage than in individuals with CS lesions (p < .05).

Conclusions: Language components may be impaired differently in patients with carotid and vertebrobasilar lesions. Speech and language disorders in individuals who have experienced cerebrovascular accidents should be evaluated in the subacute and chronic phases, and the therapeutic needs of patients with ischemic stroke should be determined, regardless of the presence of a clinical aphasia diagnosis.

Purpose: The current study is a Phase I clinical study with the goal of determining feasibility and the effectiveness of the Kaufman Speech to Language Protocol (K-SLP) for children with childhood apraxia of speech (CAS) and comorbidities. We hypothesized that K-SLP intervention would result in improved outcomes and maintenance of treatment effect at 3-4 months postintervention.

Method: Single-subject experimental design with multiple baselines across behaviors was replicated across a group of six children. Five out of six participants completed the study. The K-SLP intervention was administered in dyads four times a week for three consecutive weeks. Outcomes included assessment of word/syllable shapes, articulation accuracy, speech intelligibility, and functional communication. Treatment progress was measured through: (a) the administration of custom probe word lists and (b) assessments carried out at pretreatment, immediately following intervention and approximately 3-4 months after the study period.

Results: Four out of five participants demonstrated significant improvements to words targeted in treatment and three out of five generalized these to untreated words. Furthermore, three out of five participants showed immediate and clinically significant posttreatment improvements in speech intelligibility and functional outcomes, and this increased to four out of five participants at 3-4 months follow-up.

Conclusions: The study provides preliminary support for the effectiveness of the K-SLP program when delivered in dyads to children with CAS with comorbidities. The study replicates earlier findings and reaffirms the positive outcomes of K-SLP for children with CAS.

Purpose: A well-established set of language-specific norms for phonological development is imperative in the assessment of child speech sound difficulties. Currently, English norms are used clinically (in the absence of norms for local languages) to determine if a child displays age-appropriate, delayed or disordered speech patterns in Sinhala. This preliminary exploratory study aimed to document phonological processes observed in typically developing Sinhala-speaking children aged 3;0-6;11 (years;months).

Method: The Test of Articulation and Phonology-Sinhala, a picture-based assessment, was devised by the researchers and administered to 102 Sinhala-speaking children from three geographical locations (Colombo, Kandy, and Gampaha). The quantitative measures included percent consonants correct, percent vowels correct, and percent phonemes correct, while the qualitative analysis identified phonological processes.

Results: The quantitative results showed a marked influence of age on phoneme production accuracy with over 75% consonants correct by 3 years 6 months. The qualitative findings demonstrate common typical phonological processes and less common phonological processes in Sinhala compared to the speech pathology and cross-linguistic literature. Common phonological processes included fronting, stopping, and weak syllable deletion widely documented in linguistic and speech-language pathology literature. Many shared phonological processes were observed between Sinhala and Sri Lankan Tamil, the two main local languages, including fronting of retroflex sounds and lateralization. The phonological process of denasalization of prenasalized stops was observed in Sinhala, with no documentation of the phonological process found within the mainstream speech-language pathology literature.

Conclusion and implications: These findings reinforce the need to document and use language-specific typical phonological processes in Sinhala given the implications for early and accurate identification of speech difficulties and intervention.

Supplemental material: https://doi.org/10.23641/asha.27068173.

Purpose: This study investigated treatment-induced performance gains in memory function following therapy through the Intensive Cognitive Communication Rehabilitation (ICCR) program for young adults with acquired brain injury (ABI). We aimed to determine the utility of a novel approach to measuring memory performance improvement across semesters of therapy using (a) systematic treatment tasks called Individualized Quantitative Protocols (IQPs) as compared to (b) standardized measures of memory function.

Method: Retrospective IQP data spanning five consecutive ICCR semesters were collected from patients (N = 13) with ABI. Raw task-accuracy data were scaled to account for task difficulty gradation. Linear mixed-effects models (LMMs) were used to evaluate the degree of memory improvement-measured by scaled IQP scores-as a function of therapy duration, age, time postinjury, and aphasia; pre- to posttreatment effect sizes were also calculated. For comparison, similar LMMs were run using standardized metrics of memory abilities as the outcome measure.

Results: Results showed significant treatment-induced improvements, with gains at the session level (β = 2.76; t = 2.23; p = .047), when improvement was measured using IQP scaled scores. Standardized metrics did not show significant improvement as a function of therapy. Effect size analysis mirrored LMM results, with a large (d = 0.92, 95% confidence interval [0.35, 1.49]) pre- to posttreatment effect when change was measured using IQP scaled scores and a small effect for standardized measures.

Conclusions: This preliminary study demonstrates the utility of a granular, individualized metric to index significant impairment-based performance gains following ICCR treatment. These results introduce promise for future analysis of complex treatment data. Additionally, they provide another lens with which to assess treatment progress and its significance.

Supplemental material: https://doi.org/10.23641/asha.27045937.