Focus Article Research Articles

Measure What You Treat: Using Language Sample Analysis for Grammatical Outcome Measures in Children With Developmental Language Disorder

Purpose Language sample analysis (LSA) is commonly used to monitor progress for children with language disorders (Pavelko et al., 2016). For children with grammar goals, pediatric speech-language pathologists report mean length of utterance (MLU) and type–token ratio (TTR) as the two LSA measures most commonly used (Finestack & Satterlund, 2018). For focused grammatical intervention, these measures may be ineffective in capturing treatment growth. In this clinical focus article, we provide a preliminary comparison of four measures that could be considered as progress monitoring tools following intervention for one finiteness marker. Method Pre- and posttreatment spontaneous language samples from six children with developmental language disorder who underwent treatment for the third-person singular –s ( –3s ) morpheme were analyzed qualitatively. Four measures are reported: MLU, TTR, percent accuracy of –3s , and Tense and Agreement Productivity score of –3s (cf. Hadley & Short, 2005). Results Increases were most common across participants in measures that examined use of the treatment target (i.e., percent accuracy and Tense and Agreement Productivity score of –3s ). Changes in MLU were not always congruent with measures of the treatment target. Change was mostly not appreciable for TTR. Conclusions For preschool-aged children with developmental language disorder, MLU and TTR may not be effective as the sole outcome measures following treatment of –3s. Our six case studies highlight the benefit of measuring the treated skill as discretely as possible and with multiple measures. More research is needed into the use of LSA for outcome measures in children with language disorders.

Palliative Care in Dysphagia and Dementia

Purpose The purpose of this clinical focus article is to discuss palliative care for patients with dysphagia who also have a comorbid condition of dementia. It reviews the nature of palliative care as encompassing important aspects of patient/resident choice and comfort, which are important regardless of the cognitive status of the patient or the terminal nature of the diagnosis. It provides a comparison of palliative care, hospice care, and rehabilitative care. It then discusses issues that are specific to dementia and dysphagia for patients who are approaching the end of life. Conclusion The philosophy of palliative care need not be limited to end-of-life cases in dysphagia management as considerations for comfort, and patient's wishes should always be part of care planning. Clinicians working with cognitively impaired patients at the end of life must be particularly sensitive to their communication efforts and be willing to work cooperatively with family members and other stakeholders in developing plans of care using shared decision making.

The Power of Story in Identity Renegotiation: Clinical Approaches to Supporting Persons Living With Aphasia

PurposeThis clinical focus article provides an overview of the relationship between narrative, identity, and social co-construction for persons with aphasia and of narrative treatment approaches targeting identity renegotiation. The intent is to provide speech-language pathologists (SLPs) with background on how these key concepts fit within the Life Participation Approach to Aphasia and to empower them to consider engaging in personal narrative co-construction with their clients. The idea of narrative identity is supported by the Living with Aphasia: Framework for Outcome Measurement, particularly within the Personal domain. A focus on identity through the co-construction of small and big stories can help SLPs prioritize supporting those living with aphasia in moving on with aphasia as part of their story. Emphasis is placed upon the interaction and relationship between the SLP and the client as critical to the social reconstruction and validation of identity through support of shared personal narratives. The PULSE framework is introduced as a foundation for supporting narrative and identity in clinical work with individuals living with aphasia. Evidence-based life story–focused interventions are reviewed.ConclusionStories are powerful tools in moving life forward post stroke and aphasia. Supporting the development of personal narratives that allow identity reconstruction falls within the scope of Life Participation Approach to Aphasia and the Living with Aphasia: Framework for Outcome Measurement. SLPs are well suited to support identity renegotiation in persons with aphasia through narrative construction.

Spotlight on the Clinician in the Life Participation Approach to Aphasia: Balancing Relationship-Centered Care and Professionalism

Background Speech-language pathologists make clinical decisions informed by evidence-based theory and “beliefs, values and emotional experiences” ( Hinckley, 2005 , p. 265). These subjective processes, while not extensively studied, underlie the workings of the therapeutic relationship and contribute to treatment outcomes. While speech-language pathologists do not routinely pay attention to subjective experiences of the therapeutic encounter, social workers do. Thus, the field of social work makes an invaluable contribution to the knowledge and skills of speech-language pathologists. Purpose This clinical focus article focuses on the clinician's contribution to the therapeutic relationship by surfacing elements of the underlying subjective processes. Method Vignettes were gathered from clinicians in two community aphasia programs informed by the principles of the Life Participation Approach to Aphasia. Results and Discussion By reflecting on and sharing aspects of clinical encounters, clinicians reveal subjective processing occurring beneath the surface. The vignettes shed light on the following clinical behaviors: listening to the client's “whole self,” having considerations around self-disclosure, dealing with biases, recognizing and surfacing clients' identities, and fostering hope. Speech-language pathologists are given little instruction on the importance of the therapeutic relationship, how to conceptualize this relationship, and how to balance this relationship with professionalism. Interprofessional collaboration with social workers provides a rich opportunity to learn ways to form and utilize the benefits of a strong therapeutic relationship while maintaining high standards of ethical behavior. Conclusion This clinical focus article provides speech-language pathologists with the “nuts and bolts” for considering elements of the therapeutic relationship. This is an area that is gaining traction in the field of speech-language pathology and warrants further investigation.

The (in)adequacy of translational research in dentistry.

Translational research, as the name suggests, "translates" research findings into clinical practice to improve the health of human beings. The translational process builds on information from experiments conducted at a basic level (i.e., in vitro and/or animal studies) and progresses over experimental human studies for efficacy, efficiency, and safety to implementation. Therefore, all steps in the process should be based on studies conducted with the highest methodological quality possible in order to provide accurate and useful information. Furthermore, the systematic dissemination of new procedures/techniques should be done only when they have been proven to be effective and safe. This focus article describes examples of new techniques/procedures in dentistry that have not resulted from an adequate translational research process since the initial evidence was published. These procedures are generally characterised by lack of good evidence, particularly on their potential harms, and lack of adequate chronological order, regarding the translational research process (i.e., human research being conducted before animal research). Even so, they seem to be widely disseminated, and their promotion involves a wide range of sources, including social media. Some guidance is proposed to improve the quality of the translational research process in dentistry, as well as the level of awareness of all parties involved with the use of this research: clinicians, researchers, and patients. By improving the translational research process, optimization of the application and use of these resources, with less risk to the patients, is expected.

Lessons Learned From Coaching Postsecondary Students With Traumatic Brain Injury

Purpose The purpose of this clinical focus article is to provide speech-language pathologists with a brief update of the evidence that provides possible explanations for our experiences while coaching college students with traumatic brain injury (TBI). Method The narrative text provides readers with lessons we learned as speech-language pathologists functioning as cognitive coaches to college students with TBI. This is not meant to be an exhaustive list, but rather to consider the recent scientific evidence that will help our understanding of how best to coach these college students. Conclusion Four lessons are described. Lesson 1 focuses on the value of self-reported responses to surveys, questionnaires, and interviews. Lesson 2 addresses the use of immediate/proximal goals as leverage for students to update their sense of self and how their abilities and disabilities may alter their more distal goals. Lesson 3 reminds us that teamwork is necessary to address the complex issues facing these students, which include their developmental stage, the sudden onset of trauma to the brain, and having to navigate going to college with a TBI. Lesson 4 focuses on the need for college students with TBI to learn how to self-advocate with instructors, family, and peers.

How to Provide Accessible Hearing Health Information to Promote Patient-Centered Care

Purpose This clinical focus article focuses on accessible hearing health information and is written in twofold. First, it outlines the connection between factors of patient-centered care, shared decision making, and health literacy on health outcomes. Second, it provides some practical strategies for providing and assessing accessible health information to promote patient-centeredness and shared decision making. Conclusion Health information accessibility will positively influence the treatment choices made by patients and the way in which they self-manage their health. Hearing health care professionals need to take proactive measures to ensure that the information provided in different mediums have easily readable language, adequate quality, suitability, understandability, and actionability to ensure accessibility of hearing health information.

The Use of the Nasometer and Interpretation of Nasalance Scores

Purpose The acoustic characteristics of oral–nasal coupling (nasalization) have clinical implications for speech-language pathologists because excessive oral–nasal coupling results in a resonance disorder referred to as hypernasality . Nasometry is a tool that allows clinicians to measure the effect of oral–nasal coupling in the clinical setting. This clinical focus article summarizes the large volume of research on nasometry and clarifies its clinical application. Conclusion Although the precise relationship between the acoustics of oral–nasal coupling and the perception of hypernasality remains unclear, measuring the acoustic effects of oral–nasal coupling is useful in the evaluation and treatment of resonance disorders.

Clinical Lessons From Studies of Children With Specific Language Impairment

PurposeThis clinical focus article addresses a current debate contrasting the long-standing label of “specific language impairment” (SLI) with a recent alternative, “developmental language disorders” (DLDs); the criteria for SLI yields a subset of children defined as DLD. Recent social media advocacy for DLD asserts that the two categories of children are clinically equivalent, and therefore, DLD can be used as a label for which SLI criteria would hold. Coupled with DLD advocacy is the assumption that research on SLI has not yielded clinically relevant outcomes. This clinical focus article challenges those assumptions. The clinical focus article is framed as parallels between precision medicine and evidence-based practice. The purposes of this clinical focus article are as follows: (a) revisit the legacy of research on SLI; (b) describe language development in children with SLI into adulthood; (c) address widespread but erroneous assumptions about relationships between speech impairments and language impairments, and relationships between nonverbal IQ and language impairments; (d) briefly review evidence for causal pathways; and (e) present clinical lessons from research on children with SLI.MethodNarrative review is the method used in the study.ConclusionsThe purposes of the clinical focus article were met by reviews, commentary, and supporting arguments in each section. The conclusions are that the research and clinical category of SLI is needed for accurate and precise clinical practice, including diagnosis, prognosis, clinical goals, sequencing of tasks for success, and consideration of language disorders in the context of a broad thicket of related consequences.

Voice Rehabilitation and Resilience Work With the Commercial Singer: A Concept Piece

Purpose This clinical focus article presents a perspective on an approach in scaffolding vocal recovery and rehabilitation for commercial singers. The expectation in vocal performance is sound production that is repeatable, reliable, and relatable. When an artist cannot meet those standards, failure is experienced in three locations: the Body, the Head, and the Heart. Referencing each of these areas of intelligence provides a metalanguage for structuring vocal recovery and rehabilitation that goes beyond physical voice work alone. This clinical focus article discusses standards of voice production specific to commercial music, expectations of use, and what vocal demands look like on and off tour. Indirect and direct voice therapy within this niche group of professional voice users can be better tailored within this context of use and need. They need intervention that is specific to individual voice demands and uses a methodology that cultivates self-efficacy and resilience in singers as athletes. The path to vocal rehabilitation and stability extends beyond work with body mechanics and extends beyond the specific tools the voice pathologist and artist have to choose from to return to performance level production. Cultivating resilience involves intentional accessing of the Body, Head, and Heart in the moments of disintegration with the goal of meeting and bridging physical, emotional, and mental barriers for the commercial artist. The end goal is resilience when the artist returns to performance level production. Conclusions This clinical focus article explores the interplay between these three centers of intelligence for commercial singers within the framework of indirect and direct voice rehabilitation. This Body work can lead to maturation and resilience to support a long career using a feeling that is mechanically efficient, portable, and repeatable. The transfer of gains outside that treatment room may be more consistently realized through the incorporation of Head and Heart in early stages of intervention.

Cover Image, Volume 7, Issue 2

AbstractThe cover image is based on the Focus Article Evaluation of barrier lake breach floods: Insights from recent case studies in China, by Zuyu Chen, Qiang Zhang, Shujing Chen, Lin Wang, and Xingbo Zhou. https://doi.org/10.1002/wat2.1408 image

Audiological Considerations for Managing Mild Bilateral or Unilateral Hearing Loss in Infants and Young Children.

Purpose This clinical focus article describes considerations for recommending assistive hearing technology to infants and young children who have mild bilateral or unilateral hearing loss. These conditions present special challenges compared to bilateral permanent hearing losses that are moderate to profound in their degree in that the recommendation to proceed with technology is not as clear. Conclusion Current clinical practice guidelines and protocols for pediatric hearing aid fitting recommend managing these conditions on a case-by-case basis. Descriptions of key considerations for recommending assistive hearing technology for infants and young children with mild bilateral hearing loss or unilateral hearing loss are offered herein.

It’s about Process: Who Draws up the List of Capabilities and How?

ABSTRACT I agree with the focus article that, in theory, ‘capabilities’ represent the most ethically appropriate informational space for evaluating housing outcomes. My concerns with the article are twofold. First, it overestimates the practical utility of the capabilities approach for qualitative and quantitative housing research. Second, it leaves unanswered the more pressing and pertinent procedural question of “who decides on the list of capabilities and how?”. In line with Sen, I argue that the list of capabilities (or any alternative framework for evaluating housing outcomes) should be determined from the bottom-up through a process of deliberative democracy.

The Promise and Problems of Applying the Capabilities Approach to Housing Policy and Research

ABSTRACT Kim’s paper (the main focus article) provides an insightful discussion of how the capabilities approach may be used to reorient housing policy towards the human and social dimensions of housing. I raise three key issues in response to Kim's piece. The first is that the process for deriving and specifying any housing-related capabilities must be clear and defensible. The second is that there must be a clear line of argument between the concept of justice and any housing-related capabilities. The third is the need for discussion on the different ways to think about the causes of capability deprivation, as any such understanding has implications for policy to address these causes. These three issues require nuanced debate and resolution. However, I am confident that the debate generated by Kim's important article will bring housing scholars closer to the promise of the capabilities approach — of greater human flourishing through equality of capability.

The Evolution of Work: Best Practices for Avoiding Social and Organizational Isolation in Telework Employees

Background: Research has found that social interaction and the perception of support increases satisfaction. Identifying best practices can give organizations a tool to help avoid isolation in telework employees. The purpose of this research is to identify the best practices for avoiding social and organizational isolation within telework employees. The question guiding this research is: What best practices can organizations implement to preclude telework or remote employees from social and organizational isolation? This paper will review the existing literature via a systematic literature review to explore the best practices for avoiding social and organizational isolation with telework employees to ensure that the telework arrangement is most effective for the employee and employer. This will enable the organization to implement a successful telework program and ensure positive organizational outcomes. Method of Inquiry: The method of inquiry is a Qualitative Systematic Literature Review Data Collection Method: Articles were identified via bibliographic library search and snowball method from a focus article. Data Analysis Method: Data was extracted using thematic coding in 2 cycles via Excel to extract relevant themes from 20 articles chosen. Results: Providing face to face interactions, inclusion in information exchange, and leaders with specialized training will give telework programs some of the tools necessary for avoiding social and organizational isolation among their telework employees. Conclusions: Social and organizational isolation can be avoided or at least minimized by implementing best practices like providing face to face interactions, inclusion in information exchange, and leaders with specialized training.

Ultrasmall Au nanoclusters for bioanalytical and biomedical applications: the undisclosed and neglected roles of ligands in determining the nanoclusters' catalytic activities.

Significantly different from conventional Au nanoparticles, ultrasmall Au nanoclusters (NCs) consisting of several to about a hundred Au atoms with a size below 2 nm exhibit a strong quantum confinement effect, and possess an intriguing molecular-like highest occupied molecular orbital (HOMO)-lowest unoccupied molecular orbital (LUMO) transition, quantized charging, intrinsic chirality, and special fluorescence properties, as well as high catalytic activities. In virtue of their unique molecular-like electronic structure, remarkable physicochemical properties, mild preparation conditions and good biocompatibility, Au NCs have been having a profound impact on bioanalytical and biomedical applications, such as biosensing, biological imaging, cell markers, drug delivery, photodynamic/photothermal therapy, and biomedical toxicology. As an indispensable part of Au NCs, shell ligands not only stabilize and protect the structure of Au NCs, but also have an important influence on the structure and biocatalytic activities of Au NCs. Nevertheless, the effect of shell ligands on the biocatalytic activities of Au NCs has not been paid much attention or even ignored. In this Focus article, thus, the structure and biocatalytic activities of Au NCs are discussed from the perspective of the shell ligands. Particular emphasis is directed to the discussion and exploration of the undisclosed and neglected roles of shell ligands in the biocatalytic activities of Au NCs, which are of fundamental importance to the unraveling of charge transfer behaviors and biocatalytic processes of Au NCs. In addition, the future directions to explore the mechanism of shell ligands affecting the biocatalytic activities of Au NCs, such as surface ligand engineering of Au NCs, advanced surface/interface in situ characterization techniques, theoretical analysis, and the nanobiology of Au NCs, are also put forward.

Hollow multishelled structures revive high energy density batteries.

Hollow structures have been shown to be fruitful in addressing the cycling-stability problem of high-capacity electrode materials. However, we have noticed that there exist misconceptions toward the energy density of hollow-structured electrodes. In this Focus Article, the indispensability of hollow structures for stable high energy density batteries is discussed. Additionally, the merits of hollow multishelled structures (HoMSs) superior to their single-shelled counterparts mainly including optimizing the volumetric energy density, improving the mechanical robustness and enabling smart safe energy-storage behaviors have also been highlighted. The goal of the current article is to clarify that a HoMS-based electrode is indispensable to realize a practically high energy density in addition to lengthening the cycling lifespan and guide the future development of HoMSs to further improve the performance of rechargeable batteries.

Vestibular and Balance Dysfunction Following Sport-Related Concussion

Purpose Sport-related concussion is a significant public health concern that requires a multidisciplinary team to appropriately manage. Athletes often report dizziness and imbalance following concussion, and these symptoms can predict increased time to recover. Vestibular diagnostic evaluations provide important information regarding the athlete's oculomotor, gaze stability, and balance function in order to identify deficits for rehabilitation. These measures also describe objective function helpful for determining when an athlete is ready to return to play. The purpose of this clinical focus article is to provide background on the current understanding of the effects of concussion on the peripheral and central vestibular system, as well as information on a protocol that can be used for acute concussion assessment. Case studies describing 3 common postconcussion presentations will highlight the usefulness of this protocol. Conclusion Sport-related concussion is a highly visible disorder with many symptoms that may be evaluated in the vestibular clinic. A thoughtful protocol evaluating the typical presentation of these patients may help guide the multidisciplinary team in determining appropriate management and clearance for return to sport.

The Importance of the Working Alliance in the Treatment of Cluttering

It is expected that the quality of the working alliance between speech-language pathologists (SLPs) and persons who clutter matters. The termworking allianceis an important concept in cluttering and stuttering treatment and can be described as the degree to which the therapy dyad is engaged in collaborative, purposive work. The concept includes, among other factors, a shared understanding of therapy goals and the relevance of the therapy approach to achieving those goals. There has been an increasing interest regarding research that supports the therapeutic relationship as an evidence-based component of interventions in speech-language pathology, and recent research (Sønsterud et al., 2019) supports that a critical element for successful stuttering therapy lies, among other factors, in the concept of the working alliance.PurposeAlthough there is consensus that SLPs should openly and honestly discuss the individual's goals and expectations for therapy, personal motivation and the impact of the working alliance for people who clutter have not been investigated. This clinical focus article highlights the importance of open and honest discussion around not only the individual's goals for treatment but also the tasks or activities to be incorporated in that treatment. Relevant and specific quantitative and qualitative assessments for measuring the working alliance are required to investigate the concept of the working alliance in more detail. The Working Alliance Inventory–Short Revised version is regarded to be one useful tool to evaluate this client–clinician relationship. The Working Alliance Inventory–Short Revised version is quick and easy to use and explores the working alliance across the 3 processes of bond, goal, and task.ConclusionThis clinical focus article contains no research results. Anyhow, some considerations on this concept, both from a person who clutters and SLP perspectives, are included in this clinical focus article. Research is required to investigate whether shared understanding of treatment goals, agreement on tasks, and a respectful and trustful bond may become important predictors for successful therapy outcome also for people who clutter.

The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.