American Journal of Speech-Language Pathology最新文献

Purpose: To quantify variability in external stuttering and other stuttering symptoms and reactions within adults who stutter (AWS) across three fluency states.

Method: A total of 130 AWS responded to an online survey that first asked them to rate their external stuttering severity when least fluent (LF), most naturally fluent (MNF), and when using fluency shaping (FS) techniques using a 9-point semantic differential scale. Fourteen subsequent questions probed a wide range of stuttering symptoms and listener reactions in reference to each of the three states.

Results: High intra- and interindividual variability was observed across all items probed. Within AWS, for 13 of 14 symptoms and reactions, LF was associated with the most negative ratings and MNF with the most positive ratings. FS ratings consistently fell between LF and MNF. Importantly, many symptoms continued to be prominently displayed even in the MNF state.

Conclusions: Findings provide a unique view of intra-individual variability in stuttering symptoms in reference to external stuttering severity. In addition, these data highlight the costs and benefits associated with using FS. Other clinical implications are discussed.

Purpose: The purpose of the current study was to investigate the impact of a teletraining to teach adult communication partners the "Communicating Choices-Cortical Visual Impairment (CVI)" strategy to support participation for students with multiple disabilities.

Method: A nonconcurrent, multiple-probe, across-participants design was implemented with four adult communication partner (i.e., speech-language pathologist, paraeducators, and parent) and student dyads to determine the effects of a teletraining administered over a video-calling platform on the partner's implementation of the substeps from the Communicating Choice-CVI strategy. Dyads completed a randomly predetermined number of baseline sessions, two teletraining sessions to instruct the partners in the strategy, and five intervention probes.

Results: Results of the study indicated that communication partners successfully implemented an increased number of the strategy substeps following two short teletraining sessions and that all students communicated choices in every opportunity when they were provided with a structured opportunity. Communication partners reported that the strategy was successful for the students and that the strategy could be applied to other contexts or students.

Conclusions: This study provides evidence for the importance of communication partner training for students with complex needs in domains such as vision and communication. Furthermore, the Communicating Choices-CVI strategy may lead to increased opportunities for academic participation, social engagement, and self-determination for students whose opportunities to take on active roles in educational settings are often severely restricted.

Supplemental material: https://doi.org/10.23641/asha.28108139.

Purpose: Perceptual training offers a promising, listener-targeted option for improving intelligibility of dysarthric speech. Cognitive resources are required for learning, and theoretical models of listening effort and engagement account for a role of listener motivation in allocation of such resources. Here, we manipulate training instructions to enhance motivation to test the hypothesis that increased motivation increases the intelligibility benefits of perceptual training.

Method: Across two data collection sites, which differed with respect to many elements of study design including age of speaker with dysarthria, dysarthria type and severity, type of testing and training stimuli, and participant compensation, 84 neurotypical adults were randomly assigned to one of two training instruction conditions: enhanced instructions or standard instructions. Intelligibility, quantified as percent words correct, was measured before and after training.

Results: Listeners who received the enhanced instructions achieved greater intelligibility improvements from training relative to listeners who received the standard instructions. This result was robust across data collection sites and the many differences in methodology.

Conclusions: This study provides evidence for the role of motivation in improved understanding of dysarthric speech-increasing motivation increases allocation of cognitive resources to the learning process, resulting in improved mapping of the degraded speech signal. This provides empirical support for theoretical models of listening effort and engagement. Clinically, the results show that a simple addition to the training instructions can elevate learning outcomes.

Purpose: The purpose of this study was to determine the most efficient approaches to measuring the intelligibility of people with Parkinson's disease (PD) when considering the estimation method, listener experience, number of listeners, number of sentences, and the ways these factors may interact.

Method: Speech-language pathologists (SLPs) and inexperienced listeners estimated the intelligibility of people with and without PD using orthographic transcription or a visual analog scale (VAS). Intelligibility estimates were based on 11 Speech Intelligibility Test sentences. We simulated all combinations of listeners and sentences to compare intelligibility estimates based on fewer listeners and sentences to a speaker-specific benchmark estimate based on the mean intelligibility across all sentences and listeners.

Results: Intelligibility estimates were closer to the benchmark (i.e., more accurate) when more listeners and sentences were included in the estimation process for transcription- and VAS-based estimates and for SLPs and inexperienced listeners. Differences between the benchmark and subset-based intelligibility estimates were, in some cases, smaller than the minimally detectable change in intelligibility for people with PD.

Conclusions: The intelligibility of people with PD can be measured more efficiently by reducing the number of listeners and/or sentences, up to a point, while maintaining the ability to detect change in this outcome. Clinicians and researchers may prioritize either fewer listeners or fewer sentences, depending on the specific constraints of their work setting. However, consideration must be given to listener experience and estimation method, as the effect of reducing the number of listeners and sentences varied with these factors.

Purpose: Multidimensional Individualized Stuttering Therapy (MIST) is based on proactive collaborative work and shared decision making between client and clinician with the goal of identifying individual case-appropriate procedures and therapy elements in a manner that is meaningful and context-sensitive for each person. MIST combines value- and awareness-based elements from acceptance and commitment therapy (ACT) with stuttering and speech modification interventions. In keeping with the principles of ACT, we locate mindfulness as part of an embodied practice facilitated through a collaboration between the person who stutters and the speech-language therapist.

Method: The aim of this study was to see whether the positive results of MIST recorded at 12 months post-therapy remained stable at 24 months post-therapy and to consider the role of embodiment and awareness within MIST. Fifteen of 18 adults already enrolled in a treatment study (2015/FO12451) took part in a single-group repeated-measures design. They completed measures of stuttering severity, impact of stuttering, unhelpful thoughts and beliefs about stuttering, general anxiety symptoms, and fear of negative evaluation.

Results: There was a significant reduction of stuttering severity and negative impact of stuttering from pre-therapy to 24 months post-therapy. Unhelpful thoughts and beliefs about stuttering, symptoms of general anxiety, and fear of negative evaluation were reduced at 12 months post-therapy, and these values remained stable at 24 months post-therapy.

Conclusions: MIST was associated with positive outcomes at 24 months post-therapy, suggesting a possible connection between the person-centered approach and longer-term benefit. Findings are discussed within the context of mindfulness and embodied adjustment, and shared client-clinician decision making. The absence of a control group is a limiting factor regarding certainty of interpretation. Future research is therefore needed on collaborative and individualized approaches to stuttering therapy that include embodiment and awareness perspectives.

Purpose: Despite several decades of research focused on improving early symbolic communication for individuals with multiple disabilities, relatively limited focus has been placed on individuals who also have visual impairments. To establish what is currently known about aided language adaptations for this population, a meta-analysis was conducted to examine augmentative and alternative communication (AAC) intervention approaches for individuals with multiple disabilities that include visual impairments.

Method: Six relevant databases were systematically searched. Seven hundred eighty-nine articles were narrowed to eight intervention studies that met the design standards set for this review.

Results: Of the eight intervention studies that met design standards, five used modified versions of the Picture Exchange Communication System and three used a combination of approaches such as communication partner instruction plus environmental arrangement. Most studies used low-tech AAC such as tangible symbols, photo cues, and communication books, and most focused on improving independent requesting. Overall, the studies indicated positive findings for increasing pragmatic language skills such as requesting, turn-taking, and student-to-peer interactions. However, the total number of participants across studies was extremely limited (i.e., 19 participants total). Clearly, much additional research is required to devise adequate accommodations for individuals with multiple disabilities, including visual impairments, and to expand communicative functions beyond simple requests.

Conclusions: The use of visual impairment accommodations appeared largely effective for the included aided AAC interventions, although consultation with visual impairment specialists was not consistently reported across the included studies. More rigorous research must occur within this population to better inform clinical practice and future studies.

Purpose: Speech disorders associated with velopharyngeal dysfunction (VPD) are common. Some require surgical management, while others are responsive to speech therapy. This is related to whether the speech error is obligatory (passive) or compensatory (active). Accurate identification of speech errors is necessary to facilitate timely and appropriate intervention. Recent studies have supported the role of magnetic resonance imaging (MRI) in the assessment process for VPD. The purpose of this study was to utilize MRI to support differential diagnosis and treatment planning in a child presenting with inconsistent nasal air escape, mild hypernasality, and compensatory speech errors.

Method: A nonsedated, fully awake, velopharyngeal (VP) MRI protocol was implemented to acquire anatomic data at rest and during phonation. Segmentations and visualization of the tongue, palate, adenoids, and nasopharyngeal airway were completed. Anatomic linear measurements were obtained for VP variables to assess VP function, establish a baseline, and monitor change over time.

Results: VP anatomy was successfully visualized on MRI in multiple imaging planes. All anatomic measurements fell within normative expectations. Elevation and retraction of the soft palate occurred against the adenoid pad. A pharyngeal fricative was documented, resulting a small VP gap during speech. In contrast, adequate VP closure was obtained for vowels and other oral consonant sounds.

Conclusions: Quantitative assessment and visualization of the anatomy demonstrated adequate VP closure capabilities and a pharyngeal fricative substitution that had not been adequately perceived during routine clinical assessments. This study suggests a promising additive role for VP MRI for enhanced differential diagnosis and therapeutic monitoring in children with VPD and concomitant speech disorders.

Supplemental material: https://doi.org/10.23641/asha.27905451.

Introduction: Naming difficulties are commonly reported in the acute and subacute stages of recovery of traumatic brain injury (TBI) and across severity levels. Previous studies, however, have used samples of mixed chronicity (acute and chronic) and severity (mild and severe) and then aggregated data across individuals from these distinct groups. Thus, we have little knowledge about the persistence of naming difficulties into the chronic stage of recovery in individuals with moderate-severe TBI.

Purpose: To increase the rigor and reproducibility of naming research in TBI, the present study sought to determine the presence and profile of naming disruptions into the chronic stage of moderate-severe TBI using a confrontation naming assessment.

Method: Thirty-three individuals aged 24-55 years in the chronic epoch of moderate-severe TBI and 33 demographically matched noninjured comparison (NC) participants completed the Philadelphia Naming Test (PNT). A mixed-effects logistic regression model predicting the probability of a correct response as a function of group was fit to the data.

Results: Participants with TBI performed well on the PNT (all participants with TBI had over 90% accuracy). However, participants with TBI were statistically less likely to correctly name an item relative to demographically matched NC participants.

Conclusions: This study provides empirical evidence that naming difficulties persist into the chronic epoch of moderate-severe TBI. Despite high accuracy on the PNT, nearly 60% of these individuals with TBI reported continued difficulty with word finding in their daily lives. This discrepancy leaves open the possibility that, at this stage of injury, word-finding issues may be more reliably evoked and studied when the assessment is embedded within cognitively demanding and ecologically valid contexts (i.e., discourse, conversation). Further investigation of naming deficits in chronic moderate-severe TBI using a more naturalistic assessment is warranted.

Purpose: Cognitive-communication intervention (CCI) service gaps compromise quality of life for individuals with acquired brain injuries. Speech-language pathologists (SLPs) must examine barriers to care and develop solutions to address current problems in awareness of cognitive-communication disorders, understanding of SLP services, access and referral mechanisms, and care pathways. They must also adapt CCI to the complexities and constraints of daily life. In this article, we explore actions that clinical SLPs can take to overcome service barriers and advocate for fair, timely, and evidence-based CCI.

Method: This clinical focus article examines barriers to CCI and provides a set of tools and strategies SLPs can employ to address them. These strategies are organized into a framework called the Life Integration Approach (LIA), which has 10 elements to guide clinical service planning: (a) evidence application, (b) communication education and assertiveness, (c) access and referral, (d) assessment, (e) therapeutic engagement, (f) cognitive-communication goal setting, (g) instructional practices, (h) life integration, (i) communication partner collaboration, and (j) resource allocation. Resources are provided to demonstrate how the LIA can integrate advocacy with clinical service while adapting to complex conditions of life, competing priorities, and service constraints.

Results and conclusion: Although barriers to provision of quality SLP CCI may seem formidable, there are practical actions SLPs can take to advocate for and adapt CCI services to life demands for individuals living with the devastating effects of brain injury.

Purpose: Flexible endoscopic evaluation of swallowing (FEES) is a common component of a comprehensive dysphagia assessment. Endoscopy-related musculoskeletal symptoms resulting from clinician, environment, or equipment factors have been reported among health care professionals. The purpose of this work was to uncover the prevalence and nature of physical discomfort among speech-language pathologists (SLPs) who perform FEES. Investigators also explored SLPs' strategies to reduce endoscopy-related discomfort and their perceived benefit of ergonomics training.

Method: A survey was distributed electronically to SLPs to gather information about demographics, work environment, FEES practice, ergonomics, and physical discomfort. Data were analyzed using logistic regression and Spearman rank correlations.

Results: One hundred sixty SLPs who conduct FEES completed the survey. The majority of participants (73%) experienced physical discomfort, at least sometimes, when performing FEES, most notably in the shoulder, back, and neck. Participants who reported suboptimal ergonomics demonstrated fivefold increased odds of experiencing discomfort, indicating insight into physical challenges. Participants with fewer years of experience, less frequent ability to achieve optimal positioning, and increased frequency of physical discomfort were more likely to anticipate benefit from training.

Conclusions: Physical discomfort was common and was not predicted by demographics, work environment, years of FEES practice, or dose. Further studies are needed to identify factors that predict discomfort and strategies to support comfort and well-being.