Delivery Of Speech-language Pathology Services Research Articles

Rehabilitation of post-stroke aphasia in Ghana.

Aphasia, a common consequence of stroke, which affects both communication and social functioning, and in turn, quality of life, is on the rise due to increases in stroke prevalence and survival rate. The rehabilitation of post-stroke aphasia primarily falls within the purview of speech-language pathology and research supports the effectiveness of such services. However, provision of aphasia rehabilitation services in sub-Saharan Africa is associated with challenges. This study aimed to examine rehabilitation services for individuals with post-stroke aphasia in Ghana by exploring the roles of the stakeholder groups involved in the assessment and treatment of post-stroke aphasia in Ghana, as well as the challenges they encounter in providing or identifying services. The stakeholder groups included educational institutions, interdisciplinary healthcare professionals, and family caregivers of individuals with post-stroke aphasia. A qualitative case study approach was used to collect and integrate from multiple sources data such as demographic information, interview responses and program syllabi to develop a holistic image. Fifteen respondents from the stroke and speech therapy units at Komfo Anokye and Korle-Bu Teaching Hospitals, University of Ghana, and University of Health and Allied Sciences, Ghana were purposively sampled. Interview questions were developed and centred on aphasia education and training, knowledge of speech-language pathology services, speech-language pathology service delivery, access to speech-language pathology services, challenges in both delivery and access to speech-language pathology services and suggestions for improving speech-language pathology services. In-person and virtual interviews were conducted after demographic information was collected. Interviews were analysed thematically, and demographic information and program syllabi were triangulated with the interview data collected. All stakeholder groups identified concerns with current aphasia services in Ghana. Issues raised included the insufficient number of speech-language pathologists, lack of awareness of speech-language pathology services for post-stroke aphasia (among healthcare professionals and the public), absence of aphasia management information and clinical training in educational programming, lack of interest in speech-language pathology training programs, financial challenges, spiritual and traditional beliefs and geographic barriers (i.e., speech-language pathology services are currently available in only a few cities). These findings emphasised the need to improve post-stroke aphasia rehabilitation in Ghana. The process of data collection itself educated respondents on the importance of post-stroke aphasia rehabilitation, and by identifying barriers, strategies to improving services, such as designing standardised aphasia assessments for the Ghanaian context, can now be initiated. What is already known on the subject To address post-stroke aphasia, evidence-based speech-language pathology services are provided. However, there is a paucity of studies on post-stroke aphasia services in Ghana, preventing an accurate report of services and practices in the country. What this study adds This study provides an overview of the existing rehabilitation services for post-stroke aphasia in Ghana. It highlights challenges facing the existing services and suggested strategies to improve post-stroke aphasia services. What are the clinical implications of this work? The study created awareness among healthcare professionals and general public (study participants) about the importance of rehabilitation services for post-stroke aphasia. Based on the study findings, appropriate stakeholders such as policy makers, researchers, and healthcare professionals can further design assessments and interventions to improve rehabilitation, including speech-language pathology services, for post-stroke aphasia in Ghana.

Language Intervention for Late Talkers: The Experiences of Speech-Language Pathologists in Malaysia

A few studies have investigated the practise patterns of Malaysian speech-language pathologists (SLPs) when working with children with speech and language problems whose language intervention is necessary. However, these studies did not provide in-depth information about the SLPs' experiences as the studies were conducted quantitatively. Moreover, none of the studies focus on late-talkers (LTs), in which intervention for them can vary along a continuum from a wait/watch-and-see approach to direct intervention. Thus, this study aimed to explore SLPs’ experiences in managing LTs in Malaysia. Twelve SLPs participated in individual, semi-structured phone interviews. They were asked about their experiences in managing LTs. The interviews were recorded, transcribed, and a content analysis was performed. Two themes were identified; a) practises of SLPs and b) challenges faced by SLPs in managing LT cases. The practises of SLPs included conducting assessments, developing intervention plans, providing intervention, sharing information, giving homework, providing support, and managing appointments. The challenges faced were related to parents, other individuals close to LTs, LTs themselves, and resources. Although the SLPs’ practises aligned with the international standard of speech-language pathology service delivery, there is room for improvement, especially in collaborating with parents, as one-to-one direct interventions for LTs might not be suitable due to the challenges related to resources. In addition, a few suggestions related to centred-based care and trusted social media pages can be provided to parents to assist them outside therapy sessions besides initiating the development of awareness programs and information resources for parents and other caregivers. Keywords: Late talkers, language intervention, Malaysian speech-language pathologist, practise, challenges

Designing equitable speech-language pathology services in the Maldives to achieve Sustainable Development Goals 10 and 4

Purpose The United Nations adopted 17 Sustainable Development Goals (SDGs) in 2015 as a universal plan to address challenges experienced around the globe. SDG 4 focuses on inclusive and equitable education while SDG 10 aims to reduce inequality within and among countries. To achieve these goals for children with communication disabilities living in underserved communities, equitable access to services is required. Service delivery should be tailored to the unique characteristics of specific communities to best cater to the needs of the population. This commentary presents the Context-specific Service Delivery Framework (CSDF) that can be used to explore contexts systematically and identify suitable speech-language pathology service delivery approaches. CSDF focuses on the three dimensions of sustainability that are emphasised in the SDGs: environmental, social and economic. Result We present how CSDF was developed in the case of one Majority world country, the Maldives. Five studies were conducted to complete CSDF and the findings were used to derive recommendations for service delivery approaches that could help achieve SDG 4 and SDG 10. These included, building capacity by using asset-based approaches, collaborating with service providers and the community, using population-based methods to focus on prevention of communication disabilities and using available technology to provide support. Conclusion Other underserved communities could also benefit from using CSDF to design equitable services for children with communication disabilities in their countries. This commentary paper focuses on SDG 4 and SDG 10.

Effect of Behavioral Cough Suppression Therapy Delivered via Telehealth

Behavioral cough suppression therapy (BCST) has demonstrated up to 88% effectiveness at treating refractory chronic cough (RCC). With onset of the COVID-19 pandemic, along with many other medical services, BCST shifted to telehealth delivery. Our group hypothesized that BCST delivered via telemedicine by a specialized Speech-Language Pathologist would be comparable to previously reported response to treatment for in-person settings. Retrospective review. An Emory IRB approved, retrospective review of electronic medical records was completed for RCC patients who received BCST via telehealth from March 2020 through January 2022 at Emory Voice Center. Patients were included in the study if they had a diagnosis of RCC, were referred for BCST, were seen for at least one therapy session in the telehealth setting, and provided Cough Severity Index (CSI) data pre and post-treatment. Patients were excluded if they had incomplete datasets, a known pulmonary condition, structural laryngeal disorders, smoking history, dysphagia, and ACE-inhibitor use. Change in CSI score pre- and post-treatment was calculated to determine treatment effect. Paired-samples t-tests were conducted to compare pre-and post-treatment CSI score change. Fifty-one RCC patients were included in this study; 88% were female with an average age of 60 years (SD=12.68). Post-treatment CSI scores were significantly lower than pretreatment CSI scores (P < 0.0001). These findings are comparable to historical documented CSI change achieved with in-person BCST. This study provides preliminary evidence of the efficacy of BCST via telehealth for treating RCC. The findings of this study support the continued flexibility in speech-language pathology service delivery to include in-person and telehealth platforms for RCC beyond the COVID-19 pandemic.

Understanding barriers and facilitators to speech-language pathology service delivery in the emergency department

Purpose Timely speech-language pathology (SLP) involvement with dysphagic patients in the Emergency Department (ED) may improve patient outcomes. This study utilised qualitative interviews to understand current models and explore factors which have influenced establishment and current dysphagia service provision in Australian EDs. Method Semi-structured interviews were conducted with representatives from 12 acute hospital facilities with a SLP ED service. Interview transcripts were analysed using plain content analysis to identify key themes. Sub-analysis using the Consolidated Framework for Implementation Research (CFIR) model was undertaken for facilities with more “expanded” models (n = 4). Result SLP ED service models ranged from referral-only services, to models with referral-only and proactive SLP-led screening procedures (classified as “expanded”). Patient-related factors, the ED setting, SLP service factors and perceptions of dysphagia management were key themes reported to impact service delivery. With expanded models, 14 CFIR constructs (innovation source, external policy and incentives, networks and communications, stakeholders and relative priority) were identified as facilitators, while four constructs (adaptability, cost, compatibility, available resources) were barriers to services. Conclusion There are service-specific issues with providing SLP care within the ED. Factors related to the unique ED environment must be considered by SLP departments when establishing/optimising dysphagia management within the ED.

Patient Satisfaction with Virtual vs In-Person Voice Therapy

ObjectiveTo determine whether there is a difference in patient satisfaction between in-person and virtual voice therapy. MethodsPatient satisfaction answers to the National Research Corporation (NRC) Health patient survey were retrieved for two separate 11 month periods. The first was for an in-person cohort, from April 2019 to February 2020. The second was for a virtual cohort between April 2020 and February 2021. Two group t tests or Wilcoxon rank sum tests were used to compare responses between the in-person and virtual cohorts. The effect of modality of therapy by gender, age, and race was examined by testing interactions with separate ANOVA models. ResultsResponses were compared between 224 patient satisfaction surveys for the virtual cohort and 309 patient satisfaction surveys for the in-person cohort. Overall, responses were highly favorable in all categories. There were no differences between the in-person and virtual cohorts’ responses with respect to three main categories: likelihood of future referral of clinic or provider; communication with provider; and comprehension of the treatment plan. The interaction between modality of therapy delivery and age was significant for the question, “Did you know what to do after your visit,” with 18-44 year olds in the in-person group reporting a better understanding of the treatment plan compared to the 18-44 year olds in the virtual therapy cohort (P = 0.004). There were no interactions between modality of therapy and gender, or race. ConclusionVirtual delivery of voice therapy was associated with comparable visit satisfaction scores to in-person delivery, with both delivery modalities demonstrating very high satisfaction. Future studies are needed to identify which patients and conditions are most suited for virtual versus in-person delivery of speech-language pathology services in voice clinics.

“Are we…providing them with an equal service?”: Speech-language pathologists’ perceptions of bilingual aphasia assessment of Samoan-English speakers

Purpose: Speech-language pathologists are more often providing services to clients from a different cultural and/or linguistic background from their own. It can be particularly challenging to conduct language assessments with individuals with bilingual aphasia, especially given the limited research in this area. This investigation explored speech-language pathologists’ perspectives on: the challenges that impede the assessment of language in Samoan-English speakers with bilingual aphasia; and the facilitators that support the assessment of language in Samoan-English speakers with bilingual aphasia. Methods: The study used a qualitative descriptive approach, underpinned by a constructivist paradigm. A focus group was conducted with four speech-language pathologists who had experience working with Samoan-English speakers with bilingual aphasia, including one clinician with extensive knowledge of the Samoan language. Results: The focus group yielded rich data relevant to the research questions. Analysis revealed 29 codes within eight categories of challenges related to: the Samoan language and culture; the SLP’s background; using interpreters; family involvement; the logistics of the assessment; determining which language(s) to assess; assessment tasks and resources; and obtaining an initial impression of and building rapport with the individual. The analysis also identified 14 codes within five categories of facilitators related to: the SLP’s background; using interpreters; family involvement; determining which language(s) to assess; and assessment tasks and resources. Conclusions: The investigation provides valuable insights into the experience of conducting language assessments with Samoan-English speakers with bilingual aphasia. The findings may also be useful for informing the delivery of speech-language pathology services to other individuals with bilingual aphasia.

Challenges and solutions in speech-language pathology service delivery across Australia and Canada

Background, aims and objectives: This study aimed to compare the perception of barriers to service delivery among speech-language pathologists (SLPs) in Canada and Australia and the extent to which they used parent or carer training to overcome these barriers. Methods: Participants were 81 Australian and 63 Canadian SLPs who completed an online survey. Questions comprised open ended and forced choice questions with some ranking of questions also required. Chi-square analyses were conducted comparing Canadian and Australian SLPs. Results: Few differences existed among the respondents. Respondents overwhelmingly selected “not enough speech-language pathology positions to meet demand” as their main barrier. This barrier along with “parents/carer’s lack of knowledge about the need for speech-language pathology”, “lack of parent/carer engagement” and “lack of awareness of role of speech-language pathologist” were the principal barriers. Training parents and carers to conduct therapy at home was the most used strategy among both Canadian and Australian SLPs. Discussion: The finding that the SLPs perceive low engagement from parents both in the training sessions and when working with their child may suggest that there is a need for speech-language pathologists to determine more effective ways to train and engage parents and carers. Conclusion: More research into the efficacy of parent or carer training across a wider range of speech-language pathology practice areas and across a more diverse range of parents or carers needs to be undertaken.

Speech pathology as the MasterChef: Getting the right ingredients and stirring the pot

The purpose of this paper is to consider the many influences that have an impact on appropriate speech-language pathology service delivery. The competitive cooking and entertainment television program, MasterChef, is used as an analogy to consider the ingredients, blend and approach required to improve speech-language pathology services. Speech-language pathologists (SLPs) enter the profession with the aim of assisting those with communication and swallowing disorders to have a better quality of life. Thus, we should be restless to continue to improve our services in order to achieve the best influence and outcomes by changing our recipes and ingredients. However, having good technical skills as a SLP is not sufficient in ensuring that the services are the best they can be. We have to consider available resources, customers and service users, who it is that judges our services, whether we are as good as we could or should be, what can help us improve our services, what the appetite is for our services, and how we incorporate evidence-based practice. This paper considers the value of understanding and using information on incidence and prevalence, evidence-based practice and outcome measurement. Blending technical, clinical and academic abilities with personal skills will result in an award-winning menu.

Small Steps Towards a Speech Therapy Profession in Cambodia: Lessons Learned So Far

This paper provides a contemporary overview of speech language pathology services and professional training in Cambodia. The unique national context, including Cambodia's conflict-ridden past, its resource-poor and underdeveloped health sector institutions, and the proliferation of many international non-governmental organizations (NGOs) operating in the country, all serve to make the delivery of speech-language pathology services and establishment of a local speech-language pathology profession challenging and complex. The increasing numbers of international speech-language pathology professionals volunteering their services on a short-term basis in Cambodia is given focus, and the subsequent impact on establishing sustainable local services. We profile the efforts of one NGO, OIC Cambodia, and its “Exit Strategy,” aimed at developing a local speech-language pathology professional infrastructure through local training, a more robust Cambodian government policy framework, establishing local career pathways and professional network, and public awareness raising of speech-language pathology needs and services. The paper concludes that there will be more significant and ongoing benefits for the Cambodian health and education sectors and general population by focussing efforts on establishing a local speech-language pathology profession and institutional presence.

Book Review - Telepractice in Speech-Language Pathology

This article presents a review of the book: Telepractice in Speech-Language Pathology, authored by K. Todd Houston, PhD, CCC-SLP, LSLS Cert. AVT and 20 contributing authors. This is the first book entirely devoted to the delivery of speech-language pathology services at a distance. It provides practical information including technical requirements, policy and regulatory issues, current applications in speech-language pathology, international perspectives on practice, and tele-supervision. Reviewer Dr. Jean Blosser highly recommends the work as a comprehensive resource on the topic of telepractice.

The World Report on Disability in relation to the development of speech-language pathology in Viet Nam

argue that recommendations made within the World Report on Disability provide an opportunity for speech-language pathologists to consider new ways of developing services for people with communication and swallowing disorders. They propose that current approaches to the delivery of speech-language pathology services are largely embedded within the medical model of impairment, thereby limiting the ability of services to meet the needs of people in a holistic manner. In this paper, the criticality of selecting an appropriate service delivery model is discussed within the context of a recently established post-graduate speech therapy education programme in Viet Nam. Driving forces for the implementation of the program will be explored, as will the factors that determined the choice of service delivery. Opportunities and challenges to the long-term viability of the program and the program's potential to meet the needs of persons with communication and swallowing disorders in Viet Nam will be considered.

Paediatric speech-language pathology service delivery: An exploratory survey of Australian parents

Consideration of client values and preferences for service delivery is integral to engaging with the evidence-based practice triangle (E3BP), but as yet such preferences are under-researched. This exploratory study canvassed paediatric speech-language pathology services around Australia through an online survey of parents and compared reported service delivery to preferences, satisfaction, and external research evidence on recommended service delivery. Respondents were 154 parents with 192 children, living across a range of Australian locations and socio-economic status areas. Children had a range of speech and language disorders. A quarter of children waited over 6 months to receive initial assessment. Reported session type, frequency, and length were incongruent with both research recommendations and parents’ wishes. Sixty per cent of parents were happy or very happy with their experiences, while 27% were unhappy. Qualitative responses revealed concerns such as; a lack of available, frequent, or local services, long waiting times, cut-off ages for eligibility, discharge processes, and an inability to afford private services. These findings challenge the profession to actively engage with E3BP including; being cognisant of evidence-based service delivery literature, keeping clients informed of service delivery policies, individualizing services, and exploring alternative service delivery methods.

A comparison of rural speech-language pathologists' and residents' access to and attitudes towards the use of technology for speech-language pathology service delivery

This paper reports results and implications of two related studies which investigated (a) access of residents and speech-language pathologists (SLPs) of rural Australia to information and communication technologies (ICT) and (b) their attitudes towards the use of ICT for delivery of speech-language pathology services. Both studies used mail out questionnaires, followed by interviews with a subset of those who completed the questionnaires. Data were obtained from 43 questionnaires from rural residents and 10 interviews with a subset of those residents, and from questionnaires returned by 49 SLPs and 4 interviews with a subset of those SLPs. Results show a mismatch between rural residents' and SLPs' access to and attitudes towards use of ICT for speech-language pathology service delivery. Rural residents had better access and more positive attitudes to the use of ICT for speech-language pathology service delivery than expected by SLPs. The results of this study have important implications for education and professional development of SLPs and for research into the use of ICT for telespeech-language pathology.

“It's not everyday that parents get a chance to talk like this”: Exploring parents' perceptions and expectations of speech-language pathology services for children with intellectual disability

Tailoring the delivery of disability services to the preferences and requirements of service users allows for more effective partnerships. The aim of this research was to explore parents' perceptions and the expectations of their child's speech-language pathology (SLP) within an intellectual disability service. Parents of school-aged children with intellectual disability who received a SLP service in Ireland participated in the research: 17 parents participated in focus groups and 103 parents answered questionnaires. The core themes from the focus groups, which subsequently informed the questionnaire design, were: experience of the SLP service, communication difficulties, expectations of the SLP service, and future developments. The key questionnaire results indicated that parents viewed their SLP as the “expert” and viewed school-based and clinic-based services differently. Parents were more likely to believe that their child would always need therapy if they received a school-based service. Whereas, parents were more likely to think that their child's speech was improving as they got older and were more likely to be aware of therapy activities if therapy was clinic-based. The findings have implications for the delivery of SLP services suggesting that clarification of parents' roles and expectations are required.

Making Decisions About Service Delivery in Early Childhood Programs

This article presents a rationale for specialized services personnel to use fluid models of service delivery and explains how specialized services personnel make decisions about the blend of service delivery methods that will best serve a child. The literature on occupational therapy, physical therapy, and speech-language pathology service delivery in early childhood programs is reviewed, synthesized, and applied to current practice. The literature explains that direct and consultative services provide unique benefits to children and should be flexibly scheduled based on each child's current priorities. Flexible service delivery models allow therapists to meet the evolving needs of children within dynamic environments. To establish fluid service delivery models, therapists need to (a) plan collaboratively with teachers so that the model selected meets the teacher's preferences, (b) design flexible scheduling systems that emphasize inclusive practice, and (c) maintain precise documentation about when and how services are provided.

Patients Feel the Pressure of PPS

Patients Feel the Pressure of PPS

Leading the Change Effort

The landscape of service delivery is changing. By adopting an ordered, systematic approach to any change in service delivery, speech-language pathologists can facilitate needed changes, take leadership roles, and gain the necessary team and administrative support for collaborative and functional intervention under varied service-delivery models. This article proposes such a systems approach for dealing with change in the delivery of speech-language pathology services, particularly as it relates to implementing service delivery with speech-language pathology assistants.

The Outlook for Long-Term Care

The Outlook for Long-Term Care