American Journal of Speech-Language Pathology最新文献

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.

Purpose: The purpose of this study was to describe the evolution and prevalence of parent-reported problematic feeding behaviors and eating skills in infants born prior to 34 weeks at the time of eating solid foods between 8 and 24 months of age, and to explore the associations between problematic feeding and the impact on the parent and family.

Method: Parents of eligible children (N = 35) completed an online survey when their child was 8, 10, 12, 18, and 24 months corrected age. The survey included the Pediatric Eating Assessment Tool (PediEAT), Child Oral and Motor Proficiency Scale (ChOMPS), and the Feeding Impact Scales-Family and Parent.

Results: The prevalence of problematic feeding behaviors, as measured by the PediEAT, decreased from 63% at 8 months to 29% at 24 months. The prevalence of problematic eating skills, as measured by the ChOMPS, ranged from 30% to 56% between 8 and 24 months, with the highest prevalence between 10 and 18 months. The impact of feeding on the family and parent, as measured by the Feeding Impact Scales, was higher in families of children with problematic feeding than those without problematic feeding; however, given the small sample size, this was only statistically significant at 10 and 24 months.

Conclusions: The prevalence of problematic feeding in this population of infants under 34 weeks was 43%-44% over the first 2 years of life. Infants born preterm should be considered at elevated risk for problematic feeding and monitored closely with timely referrals. Identifying prevention strategies in the neonatal intensive care unit will be critical.

Purpose: Individuals with aphasia commonly experience reading and writing difficulties, negatively impacting everyday communication and life participation. Using mixed methods, this study aimed to understand literacy experiences described by individuals with aphasia and explore how their perspectives are related to test performance and other demographic factors.

Method: Twenty-one stroke survivors with aphasia completed reading and writing testing and shared their perspectives through a close-ended survey and an open-ended interview about literacy abilities and experiences. Quantitative methods were used to compare pre- and poststroke self-ratings and explore associations between self-ratings and demographic factors. Qualitative methods were used to identify themes in the interviews. The data sets were merged to derive mixed-methods results for a more in-depth view of participants' perspectives.

Results: Significant decreases in perceived literacy abilities were found; however, there were no differences in literacy importance or enjoyment pre- to poststroke. Reading and writing test scores were correlated with self-rated abilities but not with importance, enjoyment, or frequency of reading and writing. The thematic analysis process identified four main themes: Feelings about literacy, Literacy challenges, Literacy supports, and Literacy goals.

Conclusions: The data indicate that individuals with aphasia highly value reading and writing and are heavily invested, despite recognized challenges, in using and improving these skills. Therefore, assessments and treatments addressing literacy in aphasia are critical, and individuals with aphasia should be invited to share their literacy experiences and goals, allowing for more person-centered clinical resources to be collaboratively constructed.

Supplemental material: https://doi.org/10.23641/asha.25893049.

Purpose: The Western Aphasia Battery is widely used to assess people with aphasia (PWA). Sequential Commands (SC) is one of the most challenging subtests for PWA. However, test items confound linguistic factors that make sentences difficult for PWA. The current study systematically manipulated semantic plausibility and word order in sentences like those in SC to examine how these factors affect comprehension deficits in aphasia.

Method: Fifty Korean speakers (25 PWA and 25 controls) completed a sentence-picture matching task that manipulated word order (canonical vs. noncanonical) and semantic plausibility (plausible vs. less plausible). Analyses focused on accuracy and aimed to identify sentence types that best discriminate the groups. Additionally, we explored which sentence type serves as the best predictor of aphasia severity.

Results: PWA demonstrated greater difficulties in processing less plausible sentences than plausible ones compared to the controls. Across the groups, noncanonical and less plausible sentences elicited lower accuracy than canonical and plausible sentences. Notably, the accuracy of PWA and control groups differed in noncanonical and less plausible sentences. Additionally, aphasia severity significantly correlated with less plausible sentences.

Conclusion: Even in languages with flexible word order, PWA find it challenging to process sentences with noncanonical syntactic structures and less plausible semantic roles.

Purpose: Supporting psychological well-being in persons with aphasia (PWA) can improve social and health outcomes; however, PWA and their care partners (CPs) are often not receiving mental health support. Previous research explores this from the perspective of health care professionals.

Aims: The aim of this study was to examine knowledge, beliefs, and experiences related to mental health services directly from PWA and CPs.

Method: The study included 11 PWA and 11 CPs. Participants completed a guided survey (virtual) with opportunities for elaboration related to the knowledge, beliefs, and experiences of mental health.

Results: There was variability in personal preferences for referrals, types of coping strategies, and confidants for general thoughts and feelings and those specific to aphasia. PWA identified health care professionals as people to share thoughts and feelings, whereas CPs chose family and friends more often. Both CPs and PWA reported communication difficulty and finding a counselor as "sometimes" preventing access to services but cited fear and trust as "always" preventing access.

Conclusions: Knowledge, beliefs, and experience with help-seeking and mental health services are personal and variable. Assessing barriers unique to living with aphasia, such as communication challenges and locating a suitable counselor, must also be considered within more complex and personal barriers of fear and trust that are consistently reported in the general public. Health professionals across the continuum of aphasia care need to understand the communication challenges of living with aphasia in tandem with understanding individual differences to personalize approaches to mental health services and help-seeking.