American Journal of Speech-Language Pathology最新文献

Purpose: Flexible endoscopic evaluation of swallowing (FEES) is widely used to assess dysphagia in acute care settings; however, there are currently no broadly accepted FEES standardized procedure and interpretation protocols. We identified a need to harmonize FEES practice across one acute care hospital speech-language pathology team with goals to improve consistency, interrater reliability, and clinical decision making.

Method: The Translating Evidence Into Practice model was used as a guide for harmonization. This model includes summarizing the evidence, identifying barriers to implementation, measuring performance, and ensuring all patients receive the interventions. Through a review of the literature, we identified validated outcome measures focused on swallow safety, swallow efficiency, and secretion management. Selected outcome measures were integrated into the harmonized FEES procedures, and structured documentation tools were developed to enhance consistency and efficiency. Baseline practices and perceived barriers were assessed through unstructured interviews with SLPs. Training sessions, mentorship, and audits were conducted to support protocol adherence and interrater agreement.

Results: Throughout implementation, interrater agreement for outcome measures exceeded 80%. Following the implementation phase, audits revealed the entire procedure was followed 86% of the time, with use of the abbreviated protocol 9% of the time due to safety concerns. Documentation tools were utilized in 100% of cases. SLPs reported improved ease in comparing studies and no significant increase in assessment time. Feedback prompted minor refinements, including updates to documentation tools and a quick-reference guide.

Conclusions: Harmonizing FEES practice through a structured approach improved reliability and workflow efficiency and reduced variability. The protocol may facilitate interdisciplinary communication and treatment planning. We suspect that strong stakeholder involvement contributed to successful implementation and adherence. Future efforts could assess the feasibility of implementing this approach at additional institutions.

Supplemental material: https://doi.org/10.23641/asha.30482438.

Purpose: This study investigated the effects of teletraining on parents' use of a target strategy to support communication by young children with multiple disabilities using augmentative and alternative communication (AAC) within a shared storybook reading context using digital storybooks within visual scene display AAC systems.

Method: A single-case multiple baseline design was implemented remotely with six parent-child dyads, including parents of children with concomitant speech and motor difficulties (i.e., multiple disabilities). The independent variable was the instruction in the target strategy provided to parents via teletraining. The main dependent variable was parent accuracy implementing the target strategy. Data were also collected on the resulting effect on the total number of child communication turns during the shared storybook reading.

Results: All parents learned to implement the target strategy with > 80% accuracy, given instruction, feedback, and opportunities to role-play during two teletraining sessions (a total of 50-90 min total). Parents' use of the strategy following teletraining was associated with increased communication turns, increased use of aided AAC as a communication modality, and increased expression of unique vocabulary concepts by their children with multiple disabilities.

Conclusions: This study extended the prior communication partner training research to include parents of young children with multiple disabilities who used AAC. The study also demonstrated the effectiveness, efficiency, and appropriateness of telepractice as a format for AAC intervention for geographically dispersed individuals with significant speech challenges.

Supplemental material: https://doi.org/10.23641/asha.30676292.

Purpose: This study investigated how speech-language pathologists (SLPs) observe and address variability in stuttering assessment and treatment. Variability was examined in observable overt stuttering behaviors and beyond, encompassing the emotions, beliefs, and behaviors associated with stuttering, as well as speakers' ability to engage in daily activities and participate fully in their lives. The overarching goal of the study was to identify strategies for ensuring that variability is appropriately accounted for in clinical work related to stuttering.

Method: The study employed a mixed-methods approach, combining quantitative and qualitative data collected through an online survey from 143 U.S.-based SLPs, including generalists (n = 116) and self-reported stuttering experts (n = 27). Quantitative data were analyzed using descriptive and inferential statistics to compare observations across aspects of stuttering, while qualitative data were analyzed using thematic analysis to identify patterns in clinical practices.

Results: Both generalists and stuttering experts reported that they consistently observe variability across all aspects of stuttering. For overt behaviors, 100% of both groups noted variability. In reactions to stuttering, 96.3% of generalists and 100% of stuttering experts observed variability. Variability in daily participation was reported by 91.3% of generalists and 96% of stuttering experts. Thematic analysis revealed that stuttering variability is highly individualized, influencing overt behaviors, emotional responses, and daily participation, with SLPs emphasizing comprehensive assessments, tailored treatments, and education to address its challenges and opportunities. While both groups observed and addressed variability, generalists focused more on observable behaviors, whereas experts emphasized other aspects of the stuttering experience using a more holistic approach.

Conclusions: Effectively addressing the variability of stuttering requires comprehensive, context-sensitive strategies that address the broad experience of stuttering. By tailoring interventions to individual needs and fostering resilience related to variability, clinicians can improve outcomes for people who stutter.

Purpose: This exploratory study investigates whether social network characteristics are associated with adult cochlear implant (CI) outcomes. Specifically, it examines how both social network size and diversity, including the ages and accents of frequent communication partners, relate to word and sentence recognition, subjective communication abilities, and hearing-related quality of life (QoL) in adult CI users.

Method: Twenty-six adult CI users (M_age = 67 years) with over 1 year of CI experience participated. Social network metrics were derived from responses to a lab-developed questionnaire. Participants completed word and sentence recognition tasks in quiet and multi-talker babble (MTB) conditions and self-reported measures of communication abilities (Speech, Spatial, and Qualities of Hearing Scale [SSQ]) and QoL (Cochlear Implant Quality of Life-35 Profile questionnaire). Auditory spectro-temporal resolution was evaluated with the Spectral-Temporally Modulated Ripple Test (SMRT). Partial Spearman correlations were used to examine associations between social network characteristics and outcomes, controlling for SMRT. Exploratory subgroup analyses were also conducted based on high versus low auditory spectro-temporal resolution.

Results: Greater age diversity within participants' social networks was moderately associated with more accurate word recognition (in both quiet and MTB), sentence recognition in MTB, and higher SSQ and Cochlear Implant Quality of Life global scores. Exploratory analyses suggested stronger associations between age diversity and word recognition for participants with higher auditory spectro-temporal resolution. No consistent associations were observed for social network size or accent diversity.

Conclusions: Findings suggest that exposure to age diversity among everyday communication partners in the social network may be associated with more successful communication and QoL outcomes in adult CI users, particularly for those with better auditory spectral resolution. While causality cannot be inferred, social networks may represent a modifiable and clinically relevant factor for supporting adult CI users in real-world settings.

Purpose: The American Speech-Language-Hearing Association (ASHA) includes advocacy in a list of five professional practice areas within the scope of practice for speech-language pathologists (SLPs), yet few SLPs report self-efficacy and preparedness to advocate. The purpose of this viewpoint article is to discuss advocacy within the context of the current disability and stuttering discourse and offer a structured advocacy assignment as one method of fostering graduate students' agency and action to advocate for the stuttering community.

Method: We provide an overview of advocacy within ASHA's scope of practice, disability frameworks, and self-advocacy as they relate to stutter-affirming therapy. Then, we introduce an advocacy assignment for graduate students enrolled in a semester-long stuttering course.

Results: The advocacy assignment introduced in this viewpoint article has been incorporated into four distinct stuttering courses. Here, we explain the different types of advocacy students may pursue through the assignment and example products of each advocacy type.

Conclusions: We recommend that graduate programs, course instructors, and clinical supervisors/preceptors consider opportunities to build graduate students' confidence in advocacy, particularly advocacy completed in collaboration with the stuttering community. Future research will assess the effectiveness of a stuttering advocacy assignment in increasing students' preparedness to advocate as part of their professional practice.

Purpose: Children attend to speech variation to inform a variety of linguistic and social judgments about a talker. Communication impairments, such as speech sound disorders (SSDs), can impact social judgments made by older typically developing (TD) children and adult listeners. However, less is known about young children's perceptions of speakers with SSDs.

Method: Four-, five-, and six-year-old TD children's (n = 37) social judgments of TD talkers and talkers with SSDs were examined in two tasks: (a) a two-alternative forced choice friendship selection task, in which listeners heard contrasting speaker types and selected a preferred friend, and (b) a scalar rating task, in which listeners rated talkers on five social dimensions: intelligence, niceness, friendliness, similarity to the listener, and likability. Social judgments were examined in relation to intelligibility and pronunciation edit distance, which were combined into a composite severity score.

Results: Clear preferences for TD talkers were observed in both tasks with older children's preferences being stronger than that of younger children. Severity scores also contributed significantly to models of both behavioral tasks. As severity increased, the likelihood of being selected as a friend and perceived social valence decreased.

Conclusions: This study underscores the social impact of SSD by highlighting how both the presence and severity of SSDs influence children's social judgments. Negative social judgments could have lasting impacts on interpersonal relationships, academics, and vocational success for children with SSDs. The interaction between disorder and other sources of variation that influence social judgments, such as accent and race, should be explored.

Supplemental material: https://doi.org/10.23641/asha.30544727.

Purpose: This study aimed to examine the Turkish version of the Short Behavioral Inhibition Scale (SBIS-TR) and to investigate its validity and reliability.

Method: The original Short Behavioral Inhibition Scale (SBIS) was translated into Turkish in accordance with the prescribed procedures for the cross-cultural adaptation of self-report measures. This translated version was administered to 227 children and their parents, including children who stutter (CWS) and children who do not stutter (CWNS). After 7-14 days, a random sample of 98 children completed the SBIS again. Reliability and validity were assessed using statistical analyses. Reliability was assessed using Cronbach's alpha and the test-retest method. Validity was evaluated through confirmatory factor analysis, mean score comparisons between CWS and CWNS, and correlations with the Behavioral Inhibition Questionnaire Parent Form-Turkish version (BIQ-TR) and the Communication Attitude Test for Preschool and Kindergarten Children Who Stutter-Turkish version (KiddyCAT-TR).

Results: SBIS-TR demonstrated high internal consistency, with a Cronbach's alpha of .86 and a test-retest correlation coefficient of .96. Structural validity analysis confirmed that the single-factor model fits the data well, with all fit indices meeting the accepted thresholds. SBIS-TR scores showed significant negative correlations with BIQ-TR and KiddyCAT-TR scores. No significant difference was found in SBIS-TR scores between CWS and CWNS groups (p = .235), with a median SBIS score of 15 for both groups.

Conclusion: The SBIS-TR demonstrated strong reliability and evidence of convergent validity; however, the results did not fully support its construct validity due to the absence of the predicted group differences between CWS and CWNS.

Purpose: This study aims to examine the association between communication impairments and strategies with the receipt of physiotherapy (PT) and occupational therapy (OT) in long-term care (LTC) residents with dementia.

Method: LTC residents with dementia from Ontario, Canada, who were assessed by the Resident Assessment Instrument 2.0 between 2015 and 2019 were included in a cross-sectional analysis of secondary data. Adjusted odds ratios and 95% confidence intervals were obtained from a series of multivariable logistic regressions for each individual communication variable with the PT and OT variables.

Results: We included 79,769 Ontario LTC residents with dementia, where 98% were over the age of 65 years and 70% were female. Residents with dementia were less likely (Cohen's d) to receive PT if they had impaired hearing (-0.07), had an impaired ability to make oneself understood (-0.17), or had an impaired ability to understand others (-0.21). Conversely, residents with dementia were more likely to receive PT with communication strategies in place, including using a hearing aid (0.19), other receptive communication techniques (e.g., lipreading, physical contact, LTC staff writing messages; 0.10), or other modes of expression (e.g., flash cards and electronic devices; 0.13). In contrast, residents with dementia and impaired ability to be understood (0.26), to understand others (0.40), to speak clearly (0.15), or to use speech (0.15) were more likely to receive OT.

Conclusions: Residents with dementia and communication impairments were less likely to receive PT but were more likely to receive OT. When strategies to aid communication were used, residents with dementia were more likely to receive PT. Our work highlights important communication barriers and potential facilitators that must be analyzed to ensure equitable access to rehabilitation in LTC.

Background: With the increasing reliance on big data analytics in poststroke dysphagia research (which drives related health care decisions), accurate classification of large, complex data sets is crucial. Although medical coding is commonly used to define patient cohorts, there is no administrative-level instrument for classifying poststroke dysphagia severity. Thus, we aimed to develop a novel classification framework for poststroke dysphagia severity.

Method: We used data from 445 patients diagnosed with acute ischemic stroke and dysphagia from the 2017 Medicare 5% Limited Data Set to develop our poststroke dysphagia severity classification framework. For our exploratory analysis, we used unsupervised k-means clustering to categorize patients based on dysphagia indicators constructed from International Classification of Diseases, Tenth Revision, codes. The resultant clustering solution was applied to three random 60% samples of the data set to verify the stability of the dysphagia severity clusters.

Results: Cluster analysis resulted in a three-cluster algorithm characterizing mild, moderate, and severe dysphagia severity. Inspection of the clusters revealed that dysphagia severity categories were not analogous to stroke severity categories.

Conclusions: We developed a novel framework to classify poststroke dysphagia severity using administrative data. We also found discordance between stroke severity and dysphagia severity, which has implications for classification methodologies in administrative poststroke dysphagia research. Future studies are needed to validate this classification framework.