American Journal of Speech-Language Pathology最新文献

Purpose: Most common treatments for stuttering offer advice that parents modify temporal features of conversational interaction to assist children who stutter (CWS). Advice includes but is not limited to slowing of adult speech, increasing turn-taking/response-time latencies (RTLs), and reducing interruptions. We looked specifically at RTL and parental speech rate in a longitudinal data set that included baseline behaviors.

Method: We used data from baseline recordings (CWNS = 13 CWS-persistent, 28 CWS-recovered, 21 children who did not stutter) of the Illinois International Stuttering Research Project at FluencyBank, using CLAN software with audio linkage to Praat.

Results: Group differences in speech rate and RTL at baseline were nonsignificant; parents of CWS-persistent spoke most slowly pre-advisement. No relationships between speech rate or RTL and child fluency were detected.

Conclusions: This is a retrospective, observational study, and caution must be used in interpreting our findings. However, current results do not add evidentiary support for common advice to adjust temporal parameters of their interactions made to parents of CWS, in terms of therapeutic outcome or concurrent fluency. We are analyzing subsequent samples, after advisement, to determine potential benefits of such guidance not evident in this analysis. Suggestions for future research and implications for clinical focus and practice are offered.

Purpose: This scoping review aimed to explore the use of volitional voice tasks in assessing swallowing-related outcomes and to evaluate their therapeutic impact on swallowing disorders, including their effects on swallowing biomechanics.

Method: This scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A literature search was performed across multiple databases (PubMed, Web of Science, and Scopus), and additional records were identified through manual searches. After screening and eligibility assessment, 36 studies were included for data extraction and analysis. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies was employed to evaluate the quality of the included studies.

Results: The review identified various volitional voice tasks, such as maximum phonation time and pitch glides, as potential assessment tools for predicting swallowing-related outcomes. Additionally, voice tasks targeting pitch modulation, increased vocal loudness, and squeezed voice quality showed promising therapeutic benefits for swallowing disorders across different populations, especially individuals with neurological conditions and head and neck cancer.

Conclusions: While methodological limitations were found in current literature, volitional voice tasks demonstrate potential as complementary tools for assessing and treating swallowing disorders, leveraging their interconnected neurological and biomechanical mechanisms underlying functions. Further research with more robust methodologies is needed to establish the efficacy of these integrated interventions, facilitate their translation into clinical practice, and test new possibilities.

Purpose: In light of COVID-19, telepractice for speech therapy has been increasingly adopted. Telepractice promotes accessibility to therapy services for those in rural environments, lowers the frequency of missed appointments, and reduces the costs of rehabilitation. The efficacy of telepractice has been scarcely explored in the aphasia literature. Preliminary research has demonstrated comparable results of telepractice and in-person therapy for people with aphasia, but the current scope of research is insufficient to guide clinical practice. The present study examined whether the virtual administration of a picture-naming therapy paradigm was as effective as in-person administration.

Method: The treatment effects of two similar clinical trials, one completed in-person (n = 13) and one completed virtually (n = 13), are compared. Participants were adults with chronic (> 6 months) poststroke aphasia. Both clinical trials administered Cued Picture-Naming Therapy 4 days a week for 2 weeks (eight treatment sessions). Treatment outcomes were analyzed using Tau-U effect sizes and Mann-Whitney U tests.

Results: Weighted Tau-U averages showed an advantage of telepractice over in-person treatment in the acquisition effects of trained words, with participants demonstrating a very large effect (0.84, p < .01) following telepractice and a large effect (0.75, p < .01) following in-person treatment. Both telepractice and in-person rehabilitation demonstrated significant treatment effects and were not significantly different from each other per Mann-Whitney U independent-samples t tests.

Conclusions: The present study demonstrated that telepractice of a picture-naming paradigm is as effective as in-person treatment administration. This justifies the use of telepractice to overcome accessibility and cost barriers to speech therapy administration and justifies taking patient preference into account. Future research should explore the efficacy of telepractice for treatments that promote greater generalizability to functional communication.

Supplemental material: https://doi.org/10.23641/asha.27641031.

Purpose: Previous literature has proposed barriers to speech-language pathologists (SLPs) using standard clinical labels; however, the perspectives of SLPs have been studied to a lesser extent. This quality improvement project reports on SLPs' perceived barriers and facilitators to using currently recommended clinical labels for preschool communication disorders and identifies next steps to support implementation in one preschool communicative health system.

Method: This project aimed to establish the consistent use of clinical labels in one large Canadian preschool speech and language program. After completing a web-based training and a 3-month trial period, 387 SLPs completed an exit survey to share their perceived barriers and facilitators to label use. Qualitative survey data were analyzed using a hybrid codebook inductive/deductive thematic analysis approach.

Results: Six themes were identified, which aligned with the diffusion of innovations theory. SLPs identified several facilitators and barriers to using the recommended clinical labels within each theme. Major facilitators included improved communication, better caregiver understanding of children's communication, positive feedback from caregivers, SLPs' increased confidence in sharing labels, and improved access to services for children. Major barriers related to additional time required to share labels, SLPs' perceptions of caregivers' values, SLPs' views surrounding the recommended labels, lack of comfort using some labels, and limited opportunity to practice label use or observe successful label use by others.

Conclusions: Contextual barriers continue to impact SLPs' use of the recommended clinical labels. Ongoing collaboration with SLPs and caregivers will be critical for supporting implementation. Further research examining SLPs' perspectives across other clinical settings and geographic areas is needed.

Supplemental material: https://doi.org/10.23641/asha.27296970.

Purpose: Rodent models suggest that when respiratory demands increase during an exercise program, tongue and thyroarytenoid muscles engage to maintain a patent airway, leading to increased muscle strength. This suggests that nonspecific exercises that increase respiratory rate may improve swallowing. As such, the purpose of this proof-of-principle study was to determine the potential for whole-body exercise to improve tongue strength, cough strength, and self-reported swallowing function in older adults with Parkinson's disease (PD).

Method: Nine community-dwelling adults with PD (six men, three women; M ± SD age = 73 ± 7 years) were enrolled in a 10-week (30 min/session, three sessions/week, for a total of 30 sessions) virtual, whole-body exercise program, designed to increase respiratory rate. Demographic, frailty (Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls [SARC-F]), mobility (Schwab & England Activities of Daily Living Scale), and swallowing (tongue strength, cough strength, Eating Assessment Tool 10 [EAT-10]) measures were collected. Data were analyzed using descriptive statistics and linear mixed models.

Results: Baseline frailty and mobility severity scores indicated mild PD severity. Post-exercise, four of nine participants demonstrated improvement in either anterior or posterior tongue strength, as well as cough strength. Three participants with higher exercise heart rate or rating of perceived exertion scores reported a decrease in EAT-10 scores to a level of below clinical concern (< 3). Results from linear mixed models demonstrated no statistically significant effects on any measures of swallowing function.

Conclusions: Findings from this pilot study suggest potential signal for a higher intensity whole-body exercise program to improve self-reported swallowing function, given that heart rate and/or exertion intensity that met or exceeded the target was associated with positive changes in self-reported swallowing function, but not tongue or cough strength. Future research including a larger sample size and intervention controls is needed to further elucidate a relationship between whole-body exercise and swallowing.

Purpose: The purpose of the study was to evaluate Verb Network Strengthening Treatment (VNeST) paired with the transcranial direct current stimulation (tDCS) of the left inferior frontal gyrus, which was compared to VNeST paired with a sham stimulation in primary progressive aphasia (PPA).

Method: A double-blind, within-subject, sham-controlled crossover design was used. Eight participants with PPA were enrolled. Participants were enrolled in two treatment phases, one with VNeST plus real tDCS and one with VNeST plus sham. Participants received fifteen 1-hr sessions of VNeST in each phase. Linear mixed-effects models were used to compare changes between baseline and two follow-up time points (1 week and 8 weeks posttreatment) in naming trained verbs, untrained verbs, and untrained nouns; sentence production and comprehension; and producing content units and complete utterances in discourse.

Results: VNeST was effective for significantly improving naming trained verbs and producing more complete utterances in discourse at 1 week posttreatment in both tDCS and sham conditions. A significant tDCS advantage yielded generalization of treatment effects to untrained verbs (at 1 week and 8 weeks posttreatment), sentence production (at 1 week posttreatment), and sentence comprehension (at 8 weeks posttreatment). Untrained verb naming and sentence comprehension declined when VNeST was not augmented with tDCS.

Conclusions: Our findings provide emerging evidence that VNeST paired with tDCS can improve word finding, and other language abilities, in people with PPA. VNeST without neuromodulation can improve trained verb naming, but untrained verbs will likely decline faster when VNeST is not augmented with tDCS. Future research is required with a larger sample size to continue investigating the potential of treating word finding with VNeST and tDCS in PPA.

Supplemental material: https://doi.org/10.23641/asha.27914325.

Purpose: This project explores the perceived implications of artificial intelligence (AI) tools and generative language tools, like ChatGPT, on practice in speech-language pathology.

Method: A total of 107 clinician (n = 60) and student (n = 47) participants completed an 87-item survey that included Likert-style questions and open-ended qualitative responses. The survey explored participants' current frequency of use, experience with AI tools, ethical concerns, and concern with replacing clinicians, as well as likelihood to use in particular professional and clinical areas. Results were analyzed in the context of qualitative responses to typed-response open-ended questions.

Results: A series of analyses indicated participants are somewhat knowledgeable and experienced with GPT software and other AI tools. Despite a positive outlook and the belief that AI tools are helpful for practice, programs like ChatGPT and other AI tools are infrequently used by speech-language pathologists and students for clinical purposes, mostly restricted to administrative tasks.

Conclusion: While impressions of GPT and other AI tools cite the beneficial ways that AI tools can enhance a clinician's workloads, participants indicate a hesitancy to use AI tools and call for institutional guidelines and training for its adoption.

Purpose: Patients and caregivers in Singapore experience issues managing dysphagia care at home following hospital discharge, and they prioritized improving access to postdischarge dysphagia care and support. Hence, a postdischarge dysphagia telehealth service was developed. This study aimed to evaluate the feasibility of this service by examining patient and service outcomes, preliminary costs, and consumer satisfaction.

Method: Patients with dysphagia and their caregivers attended one or more telehealth sessions over the initial month post-hospital discharge. Reviews of dietary adherence and preparation, swallowing function, and therapy progress were conducted. If needed, clinical support and intervention were provided. Data related to patient and service outcomes, preliminary costs, and consumer satisfaction were collected and analyzed using descriptive statistics and content analysis.

Results: Twenty patients attended 42 telehealth sessions. No support was provided during 10 sessions, minor support was provided during 13 sessions, and major support and intervention were provided to address patient and swallowing safety during 19 sessions. Out of 20 patients, 19 required support and intervention during the first week postdischarge, but they experienced fewer issues with each subsequent session. They were highly satisfied with the service. The average session duration was 29.6 min. No sessions were cancelled. This service can be delivered with minimal additional health service resources and at a low cost to consumers.

Conclusions: This service is feasible, cost-effective, and well accepted by consumers. It facilitates early identification and management of swallowing and patient safety during the initial month post-hospital discharge. Wider implementation of this service model should be considered.

Supplemental material: https://doi.org/10.23641/asha.27327345.

Purpose: There are few evidence-based speech interventions designed to alter speech production in a way that ultimately results in increased speech intelligibility in adolescents with Down syndrome (DS). The primary purpose of this study was to examine the impact of clear and loud speech cues on acoustic and perceptual features of speech production in adolescents with DS.

Method: Eight adolescents diagnosed with DS repeated sentences of varying lengths in three conditions: habitual, big mouth (i.e., clear speech), and strong voice (i.e., loud speech). Four hundred eighty adult listeners (20 listeners per adolescent per condition) provided orthographic transcriptions of adolescent's speech, which were used to calculate intelligibility scores. Acoustic measures of speech rate, articulation rate, proportion of time spent pausing, vocal intensity, and fundamental frequency were calculated for each sentence.

Results: The big mouth condition resulted in significantly increased intelligibility, slowed speech and articulation rates, increased pauses, increased vocal intensity, and increased fundamental frequency. The strong voice condition resulted in significantly increased vocal intensity and fundamental frequency, but no other changes. Speech rate was the only variable that explained any of the variance in intelligibility.

Conclusions: Adolescents with DS respond differently to clear and loud speech cues. In particular, clear speech cues resulted in significant increases in intelligibility, but loud speech cues did not. Clear speech cues hold promise as an intervention strategy for adolescents with DS.