American Journal of Speech-Language Pathology最新文献

Purpose: Traumatic brain injury (TBI) is a life-altering event that can abruptly and drastically derail an individual's expected life trajectory. While some adults who have sustained a TBI go on to make a full recovery, many live with persisting disability many years postinjury. Helping patients adjust to and flourish with disability that may persist should be as much a part of rehabilitative practice as addressing impairment, activity, and participation-level changes after TBI. Living with a sense of purpose in daily life has been shown to provide numerous health and psychological benefits in the general population, especially in the face of major life transitions. In this article, we argue that rehabilitative professionals across disciplines can fruitfully leverage the construct of purpose in life to lend structure, meaning, and intrinsic motivation to TBI rehabilitation and to the recrafting of lives in the aftermath of unexpected change.

Method: We provide a narrative review of the literature relevant to recovery and long-term well-being after TBI and of the role of purpose in daily life in promoting well-being in the general population. We then outline avenues for, and potential benefits of, incorporating a focus on purpose in life into TBI rehabilitation and discuss future directions in purpose-in-life rehabilitation research.

Conclusion: We propose that an overarching rehabilitative focus on purpose in daily life could improve well-being after TBI by grounding therapeutic services in a construct that meaningfully connects traditional rehabilitation targets to patients' broader lives, while concurrently addressing injury-related purpose disruption, in order to promote flourishing after brain injury irrespective of a person's degree of functional recovery.

Introduction: Evidence-based practices (EBPs) use evidence (external and internal), clinician expertise, and client/caregiver perspectives to deliver effective, individualized care. Each component of EBP is highly relevant and most effective when implemented together. Families with cultural or linguistic backgrounds different from the mainstream experience inequitable treatment across all disciplines. As the United States' population becomes increasingly diverse, it is paramount for speech-language pathologists (SLPs) to obtain education and support to provide evidence-based, culturally responsive care.

Method: This study conducted a scoping review to determine what is known regarding SLPs' perspectives and experiences working with families or children with different cultural or linguistic backgrounds. Articles were included if they (a) contained empirical novel data, were available in English, were peer-reviewed, and were published; (b) included experiences of SLPs who self-reported that they work with children and/or families with cultural and/or linguistic backgrounds different from themselves or the regional mainstream; and (c) reported effects of cultural or linguistic difference on SLP service provision.

Results: Results indicated that SLPs encounter many barriers but often exhibit culturally responsive clinical decision making through the consideration of evidence (external and internal) and their clinical expertise and opinion. Multiple strategies for increasing culturally responsive care and areas that would benefit from further research and systemic change were identified.

Discussion: Barriers and solutions to culturally responsive care represented two areas of needed change: personal and within system. Though not all change may occur immediately, the present study offers suggested solutions for SLPs to implement in their clinical practice for increased culturally responsive care.

Supplemental material: https://doi.org/10.23641/asha.28119836.

Purpose: The purpose of this scoping review was to understand what is known about the friendships of individuals who use augmentative and alternative communication (AAC) devices. Because communication is important to friendship, severe communication impairment may impact the establishment or maintenance of friendships in unique and important ways.

Method: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews and Covidence software using an established set of operationally defined inclusion criteria supported the identification of the 46 papers included in this review. Included papers presented original data on the friendships of individuals with disabilities (acquired and developmental) who could benefit from AAC across the lifespan. Data were extracted to identify features of the body of literature and to identify themes that could inform future research and clinical practice.

Results: Themes identified from the included studies related to how friendship is defined, supports for friendship formation and maintenance, help and care in friendships, positive outcomes, barriers, the impact of AAC, and recommendations for moving clinical practice and research forward.

Conclusions: Friendships are chosen relationships that stem from congruences in perspectives between two individuals. People who use AAC, like the broader population, are likely to seek out and maintain friendships with people who are similar to them: people who share personality traits, past experiences (including experiencing disability), interests, and activities. Creative solutions are needed to increase the independence of disabled children and adults to meet and engage with new people with a variety of lived experiences.

Supplemental material: https://doi.org/10.23641/asha.28119857.

Background: Preterm and low-birth-weight infants often experience discoordination of the suck-swallow-breathe pattern, leading to dysrhythmic feeding, inefficient feeding skills, and swallowing dysfunction, increasing the risk of aspiration and respiratory morbidity. While videofluoroscopic swallowing study is commonly utilized to assess swallow function in neonates, flexible endoscopic evaluation of swallowing (FEES) has been an emerging modality and has been utilized routinely at our institution since 2018.

Method: A single-center, retrospective study including 90 infants admitted to the neonatal unit between 2018-2023 who underwent FEES procedure. Our objective was to evaluate the utility of FEES for evaluating functional and anatomical abnormalities, secretions, penetration/aspiration, and residue in infants in the Neonatal Intensive Care Unit. Our secondary objective was to observe whether clinical feeding decisions were changed based on FEES and describe progress in oral feeding.

Results: A majority of infants (85.5%) were reported to have abnormal FEES findings, with aspiration below the vocal cords noted in 37.7% and laryngeal penetration reported in 34.5% of the infants. Anatomical abnormalities were reported in 39% of infants including predominantly laryngomalacia (27.7%). Ten infants were noted to have unanticipated anatomical abnormalities, of which four went on to require surgical interventions. Changes in nipple or bottle were the most frequent recommendations (68.8%) with thickening of feeds recommended in 35% of infants. The percentage of oral feedings increased from median of 45% to 75% with a decrease in infants with apneic, bradycardic, and desaturation events in the 7 days after FEES guided interventions were introduced.

Conclusions: Majority of the infants with clinical concerns of swallow dysfunction were noted to have abnormalities on FEES, with one third of infants reported to have aspiration and anatomical abnormalities. Changes in feeding practices were recommended to majority of the infants based on FEES evaluation. Four of the five infants with anatomical abnormalities referred urgently for specialist evaluation required interventions.

Purpose: The purpose of this pilot investigation was to identify formative feedback to guide the development of a North American version of the TBIconneCT program. A secondary purpose was to examine the feasibility of delivering the intervention by graduate students.

Method: Two cohorts of individuals with chronic brain injuries and their communication partners were recruited for a 10-week, modified TBIconneCT program delivered by graduate student clinicians via telehealth. Eight dyads were recruited for the first cohort, but only four dyads completed the investigation. Ten dyads participated in the second cohort, but only seven dyads completed the investigation. Along with pre and post self-reported measures of communication and participation, participants completed an interview about their experiences. Interviews were transcribed and qualitatively coded using reflexive thematic analysis.

Results: Participants from both cohorts improved in all pre- and postmeasures of communication and participation; however, gains were modest across the cohorts. Qualitative analyses were conducted separately by cohort, as results from the first cohort informed modifications that were implemented in the second cohort, primarily to address Australian English dialects. Across both contexts, overarching constructs included "participant perspectives regarding outcomes," "assessments of the effectiveness of specific portions of the program," and "suggestions for improvement."

Conclusions: The modified TBIconneCT program (North American pilot version) produced modest gains in measures of social communication, participation, and quality of life. Qualitative analyses provided insights into the strengths and weaknesses of the modified program, along with suggestions for refinement of the pilot version.

Purpose: Joint attention predicts later language in Down syndrome (DS) and autism. The co-occurrence of autism in children with DS is 6%-19%, which is higher than in the general population. However, little is known about how co-occurring autism in DS impacts the development of joint attention. This study compared mother-child and father-child interactions in families of children with DS. Our purpose was to investigate differences in caregiver joint-attention bids and whether caregiver and child joint attention were associated with autistic traits and receptive language in children with DS.

Method: Fifteen children with DS (M_age = 39.67 months) and their biological caregivers participated in the current study. We collected mother-child and father-child interactions in participant's homes. Using Wilcoxon signed-ranks tests, we examined if there were differences in mothers' and fathers' joint attention bids and if children responded differently to their bids. We used Spearman correlations to examine the associations between child autistic traits, receptive language, and caregiver and child joint attention.

Results: We found that mothers initiated more joint-attention bids than fathers but did not find differences in child responsiveness or initiations based on communication partner. Mothers used more bids when children had more autistic traits. Child autistic traits were negatively correlated with child responsiveness to father joint-attention bids. Children with more autistic traits produced fewer joint-attention bids with both caregivers.

Conclusions: Findings suggest mothers and fathers may use differing approaches to support their child's language development. Regardless of communication partner, children with more autistic traits engaged in fewer instances of joint attention.

Purpose: Effective self-management is key for older adults with and without traumatic brain injury (TBI) to maintain their health, safety, and independence. Self-regulation is one method of promoting self-management. However, it is essential to examine effective methods of self-regulation interventions to maximize the use of such health promotion.

Method: Forty-one older adults (19 with TBI; 22 without TBI) participated in an in-person or telepractice health education intervention for fall prevention with 15 speech-language pathology student clinicians. The intervention was a self-regulation strategy, mental contrasting with implementation intentions (MCII), for promoting fall prevention. This mixed methods study explored treatment adherence and evaluated implementation outcomes through acceptability, appropriateness, feasibility, modifications to treatment, and therapist adherence and client participation.

Results: All participants demonstrated some behavior change. Participants without TBI evaluated the MCII protocol as more acceptable, F(1, 39) = 5.88, p = .018; appropriate, F(1, 39) = 5.34, p = .023; and feasible, F(1, 39) = 9.56, p = .003, than participants with TBI, although all ratings were perceived as neutral or positive. From clinician data, protocol adherence, F(1, 39) = 1.57, p = .22, and client participation, F(1, 39) = 0.10, p = .92, were similar across injury groups, but participants with TBI required more fidelity-consistent modifications to treatment, F(1, 39) = 6.88, p = .012. There were no differences between settings except that those in telepractice had more client participation, F(1, 39) = 21.02, p < .001. Clinicians felt MCII was equally appropriate for both groups in all settings, acceptability: F(1, 48) = 0.082, p = .78; appropriateness: F(1, 48) = 0.554, p = .46; feasibility: F(1, 48) = 0.197, p = .66.

Conclusion: MCII may be a feasible tool to provide health education as it offers enough structure and individualization to be considered appropriate and relevant for older adults, and for novice clinicians to administer and modify as needed based on client needs.

Supplemental material: https://doi.org/10.23641/asha.28074443.

Purpose: Pseudostuttering, or the act of voluntarily stuttering or stuttering on purpose, has been both regularly used by clinicians alongside clients in stuttering therapy and taught to students in stuttering courses for decades. However, in recent years, teaching speech-language pathology students how to pseudostutter in stuttering courses has been increasingly questioned by students on grounds that pseudostuttering may be ableist, a disability simulation, and of questionable clinical value. The purpose of this article is to discuss the value and ethics of pseudostuttering assignments as part of graduate clinical education for speech-language pathologists (SLPs).

Method: The history of pseudostuttering and the pseudostuttering assignment within speech-language pathology pedagogy, disability studies literature, and community perspectives are reviewed. In so doing, we incorporate views from the broader disability rights community, the stuttering community, and stuttering research and clinical literature.

Results: Stuttering literature and community perspectives not only confirm the value of pseudostuttering assignments but also underscore the critical importance of assignment purpose, framing, structure, and scope.

Conclusions: Pseudostuttering continues to be a critical clinical skill for SLPs who work with people who stutter, and pseudostuttering assignments are an invaluable learning experience for speech-language pathology graduate students. However, assignments must be designed and implemented according to a specific set of principles and best practices. Assignment design that does not follow these principles and best practices is likely to perpetuate ableist constructs and inadequately prepare students to work with individuals who stutter. Graduate course instructors should educate themselves on these principles and engage with students who express concerns with the assignment.

Purpose: People who stutter experience societal misconceptions and negative stereotypes due to cultural prejudices. The present study aimed to compare attitudes toward stuttering of Indian teachers, students, and members of the public and to further compare their attitudes to comparable samples regionally and internationally.

Method: Five hundred eighteen adults completed the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S), translated into Kannada, which was analyzed according to standard protocol. Summary and selected item scores were compared from samples of teachers (n = 125), students (n = 233), and the public (n = 160). Additionally, the scores were compared to those from South Asian samples and an international POSHA-S database.

Results: Teachers in the current study had the most positive stuttering attitudes, followed by the public and then by students. The summary attitude scores obtained by all three groups were more positive attitudes compared to other South Asian samples and either similar to or slightly less positive than the international POSHA-S database average sample rating. Education and income were small but significant predictors of more-or less-positive attitudes, but gender, age, and familiarity with stuttering were not.

Conclusions: While teachers demonstrated a greater understanding of stuttering compared to the public and students, the lack of understanding among the latter groups highlights the need for increased awareness and education about stuttering across various segments of society. Negative social reactions toward stuttering, observed in different cultural contexts, further emphasize the need for awareness about stuttering.

Supplemental material: https://doi.org/10.23641/asha.27855195.