American Journal of Speech-Language Pathology最新文献

Purpose: Disparities in health care utilization are modifiable drivers of disparities in health outcomes but have not been explored regarding speech-language pathology utilization for patients with dysphagia. This study explores racial and ethnic disparities in the utilization of speech-language pathology services among adult patients diagnosed with oropharyngeal dysphagia during acute care hospitalizations.

Method: We analyzed New York State Inpatient Data on acute care hospitalizations in 2019. We identified adults with a diagnosis of oropharyngeal dysphagia and determined whether they received speech-language pathology services via revenue center codes, which indicate receipt of a speech-language pathology evaluation or treatment. Using generalized estimating equations, we estimated the effect of race/ethnicity (White, Black, Hispanic, and Other race) on speech-language pathology utilization (yes, no) during the acute care hospitalization, controlling for patient clinical characteristics (e.g., acute diagnoses and clinical comorbidities), demographic characteristics (e.g., insurance status, rural-urban status), and health system factors (e.g., hospital size). Subgroup analyses were conducted for select primary diagnoses (i.e., stroke, sepsis, and aspiration pneumonia).

Results: We identified 56,198 individuals with a diagnosis of oropharyngeal dysphagia; 60.7% received speech-language pathology services. In the full sample analysis, the adjusted odds of speech-language pathology utilization were lower in Black relative to White individuals (odds ratio [OR] = 0.87 [0.76, 0.98], p = .026). Racial and ethnic disparities were present in the subgroup analyses, most notably for sepsis, where speech-language pathology utilization was significantly lower for Black, Hispanic, and Other race individuals (ORs from 0.61 to 0.77) relative to White individuals.

Conclusions: We found evidence of racial and ethnic disparities in the utilization of speech-language pathology services for patients with oropharyngeal dysphagia in the acute care setting that varied by primary diagnosis. Further research is needed to replicate these findings and to begin to understand the reasons behind these disparities.

Supplemental material: https://doi.org/10.23641/asha.26791741.

Purpose: Participation is an integral focus of services to people with aphasia and is considered best practice within the scope of practice for speech-language pathology. The Life Participation Approach to Aphasia encourages meaningful participation in life for people living with aphasia. In theory, providing participation-based services to people with aphasia seems logical; however, embedding these constructs of participation into practice can be challenging for speech-language pathologists (SLPs). Project-based intervention (PBI) provides an authentic opportunity to target participation and support identity reformulation in aphasia intervention. Historically, projects have been provided primarily in group-based settings, which may be difficult for the majority of SLPs who primarily offer individual sessions due to reimbursement. This tutorial provides a framework for using PBI in individual sessions for clients with aphasia using five evidence-based components: (a) shared decision making, (b) patient-reported outcomes, (c) goal setting, (d) the project, and (e) ongoing evaluation. Evidence-based tools and a case example are provided to support each component.

Conclusions: Projects and PBI provide tangible means of placing participation at the center of intervention while also providing opportunities to target language impairments, identity reconstruction, and various environments in a meaningful and personalized way. Projects can be scaled to the client's needs and abilities as well as to the constraints and options of the service delivery setting.

Purpose: Voice and swallowing are distinct functions that share anatomical and physiological properties; however, research investigating their intersection is limited. The purpose of this scoping review was to explore the literature surrounding the relationship between voice and swallowing measures in healthy adults and those with non-degenerative disorders. Specifically, we aimed to elucidate whether objective voice measures could be used as correlates of swallowing function.

Method: We systematically searched four databases (Embase, PubMed, CINAHL, and Web of Science) for relevant literature using a combination of key words and controlled vocabulary generated from the Yale Mesh Analyzer. The inclusion criteria consisted of peer-reviewed studies in the English language that reported on healthy adults and/or patients with non-degenerative neurological disorders and pulmonary diseases and contained instrumental and/or objective voice and swallowing measures. Two raters completed the abstract screening process followed by independent full-text reviews. Case studies, review studies, gray literature, or abstract-only studies were excluded.

Results: Among 5,485 screened studies, 182 were fully reviewed, with only 11 studies meeting the inclusion criteria. Eight studies found an association between voice and swallowing objective measures, whereas the other three did not. Significant voice measures that were related to swallowing safety and/or physiology included maximum fundamental frequency (F0), F0 range, maximum phonation time, biomechanics of effortful pitch glides, and voice onset time.

Conclusions: Although there was heterogeneity in the measures used, specific objective voice measures showed promise in clinical practice as a screening tool for dysphagia. Further investigations are needed to validate the clinical utility of these measures across diverse patient populations.

Purpose: The current study delineated a clinical and theoretical framework that clinicians and researchers can use to guide the assessment of bilingual aphasia at morphosyntactic, lexical-semantic, and phonological levels of language processing.

Method: This tutorial outlines cross-linguistic and multicultural considerations that should be addressed in evaluating bilingual adults with aphasia (BWAs).

Results: At the morphosyntactic level, we presented three features that should be taken into account when evaluating linguistic symptoms in languages considering whether they are typologically similar or dissimilar: word order, pro(noun)-drop, and morphological inflections of verbs. We suggest that clinicians need to conduct additional error analyses that reflect typological differences in syntactic templates, argument-deletion phenomena, and morphological inflections to better understand linguistic characteristics of impairments arising from the interactions of the two languages that may differ in many ways. At the lexical-semantic level, we addressed three cross-linguistic features that may impact naming performance in BWAs: cognates, lexical frequency, and semantic typicality. The presence of cognates between the two languages can lead to differential interpretations of naming performance. In addition, the same lexical items may exhibit varying lexical frequency and typicality across languages due to cultural and linguistic differences. We suggest that clinicians should thoroughly prepare the testing items considering the linguistic distance. Finally, we emphasized differences in segmental and suprasegmental features of phonology that could contribute to cross-linguistic phenomena during assessment of two or more languages.

Conclusions: This cross-linguistic assessment framework contributes to a better understanding of linguistic impairments and communication difficulties experienced by BWAs. This framework can be utilized in current clinical practice to facilitate culturally and linguistically appropriate assessment and treatment approaches for BWAs.

Purpose: The current study used behavioral measures of discourse complexity and story recall accuracy in an expository discourse task to distinguish older adults testing within range of cognitive impairment according to a standardized cognitive screening tool in a sample of self-reported healthy older adults.

Method: Seventy-three older adults who self-identified as healthy completed an expository discourse task and neuropsychological screener. Discourse data were used to classify participants testing within range of cognitive impairment using multiple machine learning algorithms and stability analysis for identifying reliably predictive features in an effort to maximize prediction accuracy. We hypothesized that a higher rate of pronoun use and lower scores on story recall would best classify older adults testing within range of cognitive impairment.

Results: The highest classification accuracy exploited a single variable in a remarkably intuitive way: using 66% story recall as a cutoff for cognitive impairment. Forcing this decision tree model to use more features or increasing its complexity did not improve accuracy. Permutation testing confirmed that the 77% accuracy and 0.18 Brier skill score achieved by the model were statistically significant (p < .00001).

Conclusions: These results suggest that expository discourse tasks that place demands on executive functions, such as working memory, can be used to identify aging adults who test within range of cognitive impairment. Accurate representation of story elements in working memory is critical for coherent discourse. Our simple yet highly accurate predictive model of expository discourse provides a promising assessment for easy identification of cognitive impairment in older adults.

Supplemental material: https://doi.org/10.23641/asha.26543824.

Purpose: Diagnosis of language impairments after stroke is important to optimizing stroke outcomes. After right hemisphere brain damage (RHD), apragmatism can impact the comprehension and production of pragmatic language. However, despite decades of empirical evidence, there is no International Classification of Diseases (ICD) code for RHD pragmatic language impairments. The absence of an ICD code has far reaching ramifications that impact patient outcomes, including reduced clinical and public awareness, limited curricular content, and underdiagnosis. This viewpoint justifies the need to appropriately classify the pragmatic language symptomology after RHD with an ICD code.

Conclusion: An ICD code can positively influence health care practitioner knowledge, education, and practice while informing public health considerations vital to epidemiological analyses.

Purpose: Oropharyngeal swallowing exercise-based interventions are frequently utilized to target physiologic mechanisms with the goal of improving swallowing function. However, study replicability and evidence synthesis regarding effects of interventions are limited due to inconsistent reporting on factors known to influence treatment delivery. In order to promote consistency of reporting factors associated with replicability, the authors constructed a set of preferred parameters focused on dysphagia as part of the initial version of the larger tool (Framework for RigOr aNd Transparency In REseaRch on Swallowing or FRONTIERS).

Method: Thirty-eight initial questions were assembled by the authors as part of the treatment subsection. Questions were then reviewed by individuals in the FRONTIERS collaborative who have expertise in research, clinical practice, or both.

Result: Twenty-four questions were removed following review, reducing the final set of treatment-focused questions to 14 questions.

Conclusions: The revised set of questions provides users of the exercise-based treatment section of the FRONTIERS checklist with an initial checklist to promote transparency and rigor to improve study replicability and evidence synthesis. We intend for this treatment section of FRONTIERS to undergo further refinement following commentary and feedback.

Purpose: Patient-reported outcome measures (PROMs) are an important tool both in clinical practice and research involving patients with swallowing disorders. There are several challenges to be overcome and methodological details to be adequately reported to ensure rigor and transparency in studies utilizing PROMs in dysphagia research. For this reason, the Framework for RigOr aNd Transparency In REseaRch on Swallowing (FRONTIERS), a critical appraisal tool developed to ensure rigor and transparency in dysphagia research, has devoted a domain to PROMs. The aim of this current article, as part of a larger forum of articles, is to present the PROM section of FRONTIERS and describe its development.

Method: A literature review was carried out on PROMs in the field of dysphagia by three members of the FRONTIERS collaborative to identify items that were necessary for the rigorous application and transparent reporting of PROMs utilized in research of swallowing disorders in human subjects. Framework items were then subjected to an iterative process of feedback and consensus among the three members of the working group as well as all members of the FRONTIERS collaborative. Items were flagged for review and revised as needed until consensus was achieved on the final list. The final item list was compared to existing critical appraisal tools for PROMs.

Results: The final checklist for the PROMs domain included 20 "Yes/No" questions that can be broadly divided into three categories: (a) development and validation, (b) patient population, and (c) PROM administration method. Each item is presented with a rationale for its inclusion.

Conclusions: The use of the FRONTIERS Framework will serve researchers and those appraising quality of research involving PROMs. More broadly, the FRONTIERS Framework will facilitate improved rigor and transparency across dysphagia research. Special considerations and future goals are discussed.

Purpose: Flexible endoscopic evaluation of swallowing (FEES) is not only a well-recognized and ubiquitous tool in dysphagia research but also possesses features that make the assessment vulnerable to shortcomings in transparency and rigor in published literature. Therefore, FEES was considered an important addition to the Framework for RigOr aNd Transparency In REseaRch on Swallowing (FRONTIERS), a multisite collective effort to establish a tool for the critical appraisal of reporting in all forms of dysphagia and swallowing-related research on human subjects.

Method: From the FRONTIERS collective, a team of three clinician researchers completed a review of FEES-related literature to determine all components crucial for generalizable and reproducible reporting of FEES research. These components were developed and refined through an iterative process.

Results: This review culminated in a 26-item series of "yes/no" questions, forming the FEES section of FRONTIERS. These questions are grouped into the following five components: (a) Equipment, (b) Rater(s), (c) Rating Process, (d) Outcome Metrics, and (e) Miscellaneous Factors.

Conclusion: The results of this review support that FEES possesses unique characteristics to other aspects of dysphagia research and is consequently a crucial addition to FRONTIERS to ensure that clinical researchers have access to critical appraisal of FEES-related research inquiry.