Focus Article Research Articles

Motivation, Rapport, and Resilience: Three Pillars of Adolescent Therapy to Shift the Focus to Adulthood

PurposeThe purpose of this clinical focus article is to encourage speech-language pathologists (SLPs) to shift their operational framework as students grow from childhood to adulthood by focusing on three pillars of interaction: motivation, rapport, and resilience. We need to foster greater independence and interpersonal skills in older students, but researchers have not explained how to help SLPs successfully transition their intervention strategies. Here, we identify three pillars of adolescent therapy—motivation, rapport, and resilience—to help clinicians shift their perspective from childhood to adulthood. We rely on social constructivism to guide practice and argue that client-centered models of therapy are more appropriate than therapist-centered models for adolescent students. For each pillar, we discuss clinician behaviors, student results, and clinical implications.ConclusionsBy strengthening these three pillars of interaction, clinicians can shift their focus toward client-centered therapy models and facilitate skills students need in adulthood. Strengthening skills related to motivation, rapport, and resilience will help support more symmetrical and flexible clinical partnerships in adolescent students with communication disorders.

Testing for exclusion of avian notifiable disease: six-year review.

This focus article has been prepared by Scott Reid of the APHA's virology department with Sharon Brookes, Rowena Hansen, David Welchman, Richard Irvine and Ian Brown of the APHA.

Concentration, cellular exposure and specificity of organelle selective fluorescent dyes in fungal cell biology

This technical focus article discusses the importance of concentration, cellular exposure and specificity for the application of organelle selective fluorescent dyes in fungi using DNA, membrane and cell wall stains as examples. Nonetheless, the presented considerations are generally applicable to all fluorescent dyes applied to living cells.The association of a fluorescent dye with its target molecule generally impairs molecule and consequently organelle function. Effective dye concentration, cellular exposure time and specificity to the target molecule are key factors that influence the biocompatibility of any fluorescent dye. Prominent molecules frequently used as fluorescent staining targets in fungal cell biology are: (i) DNA for nuclear labelling, (ii) α-/β-glucans and chitin for cell wall labelling, and (iii) phospholipids for plasma membrane and endomembrane labelling. In combination with live-cell imaging settings that reduce light stress, i.e. excitation intensities and exposure times set to the minimum that still achieves good signal-to-noise ratios, is the low dosage application of fluorescent markers as so called “vital dyes” essential for visualising cellular processes in an artefact-free fashion.

An Overview of Tracheostomy Tubes and Mechanical Ventilation Management for the Speech-Language Pathologist

PurposeThe speech-language pathologist (SLP) plays an integral role when working with patients who have tracheostomy tubes and are on mechanical ventilation. The patients and the clinical team depend on our expertise to make critical decisions on speaking valve use, introduction of food by mouth (per os), weaning off of the ventilator, weaning from the feeding tube, and tracheostomy tube decannulation.ConclusionsWhile not expected to be experts on the cardiopulmonary function of patients, SLPs must have a solid foundation of knowledge when it comes to patients with highly complex disease processes and care plans. This clinical focus article is meant to serve as an overview for the SLP working with tracheostomy tubes and ventilators and for those SLPs interested in entering this area of practice.

APHA thin ewe investigation project

This focus article has been prepared by Suzi Bell, Amanda Carson, Rachael Collins, Lizzy Dunnett, Rudolf Reichel and Moyna Richey of the APHA Small Ruminant Expert Group.

Adolescent Language Therapy: Syntax and Semantics for Reasoning and Planning

Purpose: Adolescent students face increased expectations to successfully navigate academic, social, and vocational transitions. As demands increase and support systems fade, adolescents with developmental language disorder and concomitant deficits in executive functions are particularly vulnerable to these high-stakes transitional moments. Limited language systems are not well suited for navigating the subtleties of social nuance, the abstraction of academic and vocational language, and the unfamiliarity of complex planning necessary for self-regulation. Conclusions: This clinical focus article proposes a clinical model of language therapy for adolescents with developmental language disorder and concomitant deficits in executive functions. Therapy emphasizes eliciting the most complex syntactic and semantic skills available to the student as they work to formulate specific, reasoned, predictive, strategic plans. Therapy takes place in small group contexts where pairs of students collaborate to use their language and reasoning to solve unfamiliar, challenging, scientific-like problems.

Communicating With Patients and Families During COVID-19

Purpose The COVID-19 pandemic has emphasized the need for clear communication between health care providers and patients and families in many ways. Issues such as mask use and social distancing impact everyone's communication and may have a particularly devastating effect on those with communication disorders. In addition, communicating about the virus and necessary precautions has challenged health care providers and patients alike. The pandemic has spotlighted the need for not only health literacy but also digital and scientific literacy, and has amplified the impact of health disparities on health care interactions and outcomes. This clinical focus article reviews these issues, describes what is known about the skills of adults in the United States, and provides resources for communities, organizations, providers, and patients. Conclusion Speech-language pathologists and audiologists working with older adults need to consider how the issues described affect patients and families, and work on their own communication skills to help bridge gaps that may have widened during these turbulent times.

Autonomic dysfunction and heart rate variability with Holter monitoring: adiagnostic look at autonomic regulation.

Heart rate variability (HRV) refers to the beat-to-beat variation of the cardiac cycle. Since heart rate is modulated on abeat-to-beat basis by the combined influence of the sympathetic and parasympathetic nervous system at the sinus node level, HRV has been considered an indirect biomarker of cardiac autonomic control and widely exploited for the assessment of autonomic function in many pathological subjects. This focus article summarizes the main findings derived from HRV analysis applied to 24‑h Holter monitoring in both cardiac and non-cardiac diseases as well as in physiological conditions in the healthy population. Even if the prognostic role of HRV indices is well recognized and its use ever more widespread, its implementation in the diagnostic and prognostic processes in routine clinical practice remains limited. Several reasons for these limitations can be identified: first the lack of reliable reference values, and secondly, the low specificity of HRV indices in particular when considering the constant evolution of clinical practice and therapeutic approaches, making it difficult to refer to aspecific and stable combination of clinical and HRV markers. Therefore, the clinical use of HRV should be further investigated. Finally, HRV represents asubstantial tool for investigating the physiological conditions in healthy people that can have important implications in primary prevention and the understanding of gender differences, as well as in sport and occupational medicine.

Congenital heart defects in calves.

This focus article describes some of the cardiac anomalies detected in calves submitted to APHA Veterinary Investigation Centres and other postmortem examination providers.

Interprofessional Collaborative Management of Postconcussion Cognitive Symptoms.

Purpose The purpose of this clinical focus article is to illustrate an interprofessional cognitive rehabilitation approach. Invited experts representing physical medicine and rehabilitation, clinical neuropsychology/rehabilitation psychology, registered nurse care coordination, and speech-language pathology share viewpoints from their discipline to engage in collaborative interventions with the goal of enhancing treatment outcomes. Conclusions Treating the multifactorial symptoms of concussion requires expertise from an interdisciplinary team (IDT) of professionals, contributing unique perspectives and providing integrative services to optimize rehabilitation outcomes for patients. Speech-language pathologists serve an important role on IDTs to deliver personalized, targeted therapies for prolonged or persistent postconcussion cognitive impairment.

The Supine Superior Semicircular Canal Dehiscence Test.

Purpose The purpose of this clinical focus article is to describe a new method for assessment of superior semicircular canal dehiscence by laying the patient supine during Valsalva-induced nystagmus testing. Method The traditional Valsalva-induced nystagmus test is described, followed by a new method for assessment of superior semicircular dehiscence conducted by laying the patient supine during testing. A case study is presented to illustrate this new testing technique known as the Supine Superior Semicircular Canal Dehiscence Test. Results It is hypothesized that during Valsalva-induced nystagmus testing performed in the upright, seated position, the dura mater could potentially seal the superior semicircular canal fistula, thereby concealing a defect in the bony labyrinth and yielding a false-negative test. To circumvent this, the patient should be placed in the supine position during Valsalva-induced nystagmus testing in order to prevent the dura mater from inadvertently sealing itself against the petrous portion of the temporal bone. The Supine Superior Semicircular Canal Dehiscence Test may reveal the defect in the bony labyrinth and improve the sensitivity of the Valsalva-induced nystagmus test. Conclusions The Supine Superior Semicircular Canal Dehiscence Test may be more sensitive for identifying superior semicircular canal dehiscence in patients with traditional symptoms and a negative Valsalva-induced nystagmus test in the seated position. While a case study is presented to illustrate the potential benefits of including the Supine Superior Semicircular Canal Dehiscence Test in the battery of diagnostic tests, further research is needed in larger samples.

Clinical Study of the Effectiveness of Constant Therapy in the Treatment of Clients With Dementia: Implications for Telepractice

Purpose The purpose of this clinical focus article was to advance interventions for person living with dementia by exploring the implications of integrating technology through telepractice to strengthen memory in clients with dementia. This study focused on individualized treatment plans using the software Constant Therapy (CT) for clients with dementia. Method This study utilizes an exploratory research design with nonprobability sampling of existing data analyzing the frequency, duration, and percent correct of CT exercises completed from two case studies of persons living with dementia. This study received exempt status for institutional review board approval from the Florida Department of Health, since it is secondary research. One participant had been diagnosed with Alzheimer's disease, and the other participant had vascular dementia. Both clients utilized CT as part of the clinical services provided by the University of Central Florida's Communication Sciences and Disorders Clinic at Brain Fitness Academy. Results The results of this exploratory research study indicate that both participants demonstrated an increase in percentage correct on CT exercises from baseline to current (Participant 1, 70%, and Participant 2, 50%). A substantial disparity of exercises completed confirms the necessity of an individualized treatment plan based on a specific type of dementia. Both participants demonstrated a 631% and 632% increase respectively in exercises completed at home versus in the clinic. This finding is especially significant as it relates to telepractice. Conclusion This study adds to the literature that clients with dementia demonstrate substantial improvement in global cognitive function when speech-language pathologists provide skilled individualized services using the digital software CT, whether in traditional or remote clinic settings.

Ecological Intervention for Stuttering in School-Age Children: A Collaborative Approach for School-Based Speech-Language Pathologists and Mental Health Providers

Purpose Stuttering can have a significant detrimental effect on the overall well-being of children, including anxiety, stigma, and adverse impact on the development of healthy social relationships. This clinical focus article proposes a collaborative, ecological model of stuttering intervention consistent with interprofessional practice that combines the expertise of the speech-language pathologist and school-based mental health provider to support fluency and social–emotional health for school-age children who stutter. The literature in the fields of speech pathology and mental health interventions was summarized to provide the underlying evidence base for such a collaborative approach. Conclusions While collaborative approaches are recommended as best practice for stuttering, there is scant evidence in the literature of such approaches being used. An ecological, collaborative framework will enable practitioners to help teachers, parents, and others address speech disfluency as well as the accompanying anxiety and avoidance that are pervasive in the lives of many children who stutter. Such an approach will help ensure that gains in the treatment room are carried across settings (i.e., transfer/generalization of skills) and will help children be better able to manage the challenges associated with stuttering to find success in the real world.

Common conservative treatments for lymphoedema post breast cancer: A focus article

Breast cancer is the most common type of cancer in women worldwide (J. Ferley et al., 2015). Breast cancer-related lymphoedema (BCRL) is a disabling complication with a long term impact on quality on life after breast cancer treatment, with an incidence of 2–5% in patients post sentinel node procedures (M. King et al., 2012) up to 40% following axillary lymph node dissection (A.C. Pereira et al., 2017). BCRL results in swelling of the arm, hand, and trunk which can lead to limb pain, heaviness, and altered sensation (Y.J. Sim et al., 2010). These symptoms can result in functional limitations, psychosocial distress and an overall reduction in quality of life (S.J. Merchant et al., 2015). The aim of this review is to evaluate the effects of some of the more common conservative rehabilitation interventions in BCRL. Conservative interventions reviewed include early physiotherapy and exercise, complex decongestive therapy, manual lymphatic drainage, compression, electrotherapy & acupuncture, self-treatment & weight management. The review may inform policies for treatment within the health service.

Brachyspira hyodysenteriae isolate multilocus sequence type dashboard.

This focus article has been prepared by Susanna Williamson, Emma Stubberfield and Anna Brzozowska of the APHA and Jill Thomson of SRUC - Veterinary Consulting Services, Edinburgh.

Undergraduate Student Success Initiatives in Communication Sciences and Disorders

Purpose Undergraduate students are faced with an extremely competitive application process when applying for graduate studies in communication sciences and disorders (CSD). This clinical focus article describes initiatives created by faculty within a CSD program at a medium-sized public university, with the goals of helping undergraduate students engage in high-impact practices and increase their competitiveness when applying for graduate school. Conclusions This clinical focus article describes a framework for four initiatives geared toward undergraduate student success in CSD, as follows: (a) self-actualization, (b) leadership development, (c) increased student–faculty interaction, and (d) collaboration. To achieve the goals of these initiatives, an undergraduate orientation, a peer-mentoring program, faculty-led research opportunities, and leadership development were implemented. After the implementation of the framework, we observed that the number of students entering the graduate program at the University of West Georgia and in other institutions increased over the past 3 years.

The ezSpectra suite: An easy‐to‐use toolkit for spectroscopy modeling

AbstractA molecule's spectrum encodes information about its structure and electronic properties. It is a unique fingerprint that can serve as a molecular ID. Quantum chemistry calculations provide key ingredients for interpreting spectra, but modeling the spectra rarely ends there; it requires additional steps that entail combined treatments of electronic and nuclear degrees of freedom and account for specifics of the experimental setup (light energy, polarization, averaging over molecular orientations, temperature, etc.). This Software Focus article describes the ezSpectra suite, which currently comprises two stand‐alone open‐source codes: ezFCF and ezDyson. ezFCF calculates Franck–Condon factors, which yield vibrational progressions for polyatomic molecules, within the double‐harmonic approximation. ezDyson calculates absolute cross‐sections for photodetachment/photoionization processes and photoelectron angular distributions using Dyson orbitals computed by a quantum chemistry program.This article is categorized under: Electronic Structure Theory > Ab Initio Electronic Structure Methods Theoretical and Physical Chemistry > Spectroscopy Software > Simulation Methods

How Can Speech-Language Pathologists Think About Sensation During Swallowing Evaluation and Intervention?

Purpose Both the enjoyment of foods and safe swallowing revolve around incorporating multiple streams of sensory feedback to form a positive sensory experience; these include information about the taste, smell, texture, temperature, and even the sight of food. Traditional swallowing assessment and treatment paradigms have primarily focused on the motor aspects of swallowing. However, sensory information is vital for not only enjoying foods while eating but also coordinating safe and efficient swallow behaviors. The purpose of this clinical focus article is to discuss the clinical importance of sensation in swallowing evaluation and intervention. Conclusions During their clinical assessments of swallowing, speech-language pathologists are already documenting the functional results of oropharyngeal sensorimotor impairments (e.g., residue). A combination of sensory and motor aspects is already integrated within current behavioral treatment strategies for dysphagia. Focused attention to the salient sensory features of swallowing has the potential to improve swallowing evaluation and intervention efforts. A discussion of potential future research in improved measurement and documentation of altered sensation is provided.

Optimizing Long-term Outcomes of Exposure for Chronic Primary Pain from the Lens of Learning Theory

Exposure in vivo is a theory-driven and widely used treatment to tackle functional disability in people with chronic primary pain. Exposure is quite effective; yet, in line with exposure outcomes for anxiety disorders, a number of patients may not profit from it, or relapse. In this focus article, we critically reflect on the current exposure protocols in chronic primary pain, and provide recommendations on how to optimize them. We propose several adaptations that are expected to strengthen inhibitory learning and/or retrieval of the extinction memory, thus likely decreasing relapse. We summarize the limited, but emerging experimental data in the pain domain, and draw parallels with experimental evidence in the anxiety literature. Our reflections and suggestions pertain to the use of the fear hierarchy, reassurance, positive psychology interventions, exposure with a range of stimuli and within different contexts, and the use of safety behaviors during treatment, as well as associating the fear-inducing stimuli with novel outcomes. In addition, we reflect on the importance of specifically tackling (the return of) pain-related avoidance behavior with techniques such as disentangling fear from avoidance and reinforcing approach behaviors. Finally, we discuss challenges in the clinical application of exposure to improve functioning in chronic primary pain and possible avenues for future research. PerspectiveInspired by recent advances in learning theory and its applications on the treatment of anxiety disorders, we reflect on the delivery of exposure treatment for chronic primary pain and propose strategies to improve its long-term outcomes.

Sex estimation based on the analysis of enamel peptides: False assignments due to AMELY deletion

Recently, proteomic analysis of sex-specific amelogenin peptides in tooth enamel has been proposed as a promising new method for the assignment of sex to human skeletal remains in archaeological and forensic settings. The method was initially based on the surface acid etching of tooth enamel and subsequent identification of a marker peptide that could be attributed to sex-chromosome specific amelogenins via mass spectrometry. The previous three years have brought forth several technical improvements that increased sensitivity of the method, notably development of new enamel protein extraction techniques, advanced bioinformatic data processing for the detection of multiple sex-specific amelogenin peptides and statistical framework for the estimation of both male and female sexes. This focus article shows that the proteomic method, even after these technical improvements, has the same limitation as the PCR-based amelogenin sex tests do, which directly use amelogenin alleles as markers for the sex chromosomes. The fact is that tooth enamel in some phenotypically normal males lacks Y amelogenin-specific peptides as a result of the Y amelogenin allele (AMELY) deletion. The prevalence of AMELY negative males is generally lower than 1% but may approach 10% in Indian subcontinent populations. Genetic studies indicate that the alteration might be several thousand years old. Using a proteomic approach to sex estimation, these individuals would be falsely identified as females with a potentially significant impact on forensic investigations or archaeological work. Therefore, this possibility should be taken into consideration even in populations with a low frequency of AMELY deletion and regardless of the female sex probability predicted by the existing statistical model. Unfortunately, no proteomics-based control measures exist because the genes for non-amelogenin proteins (ameloblastin, enamelin, and tuftelin) are located on autosomal chromosomes.