Measures Of Functional Communication Research Articles

An exploratory prospective study of the association between communication skills and employment outcomes after severe traumatic brain injury

Primary objective: The aim of this pilot study was to explore possible correlations between measures of functional communication skills in the first year post-injury and later employment outcome.Design: A preliminary observational study employing a prospective longitudinal design.Methods: Fourteen adults with traumatic brain injury completed an assessment involving two functional communication measures: an objective test of cognitive communication skills (Functional Assessment of Verbal Reasoning and Executive Strategies, FAVRES) and self-ratings of communication impairment (LaTrobe Communication Questionnaire, LCQ). Follow-up of participants’ employment outcome was conducted 9–18 months after the initial assessment.Results: At follow-up, eight participants had returned to employment (working a similar number of hours to their pre-injury status), five were unemployed and one was lost to follow-up. Employment status at follow-up was strongly correlated with both FAVRES Total Accuracy scores (r = 0.833) and Total Rationale scores (r = 0.837), but there were no correlations with FAVRES Time and Reasoning scores or with the LCQ.Conclusions: The FAVRES shows initial promise as an assessment that may be associated with successful employment outcome following traumatic brain injury. Further research with larger samples is required to provide further information on the prognostic utility of measures such as the FAVRES and the LCQ.

A randomized, rater‐blinded, parallel trial of intensive speech therapy in sub‐acute post‐stroke aphasia: the SP‐I‐R‐IT study

There is conflicting evidence regarding the benefits of intensive speech and language therapy (SLT), particularly because intensity is often confounded with total SLT provided. A two-centre, randomized, rater-blinded, parallel study was conducted to compare the efficacy of 100 h of SLT in a regular (RT) versus intensive (IT) treatment in sub-acute post-stroke aphasia. Consecutive patients with aphasia, within 3 months of a left hemisphere ischemic stroke, were randomized to IT (2 h per day × 5 days per week, 10 weeks) or RT (2 h per week × 50 weeks). Evaluations took place at 10, 50 and 62 weeks. Primary outcome was the frequency of responders, defined by 15% increase of Aphasia Quotient (AQ) from the baseline to 50 weeks. Secondary outcomes were changes from the baseline in AQ and functional communication profile (FCP) at 50 and 62 weeks and improvement stability between 50 and 62 weeks. Thirty patients were randomized and 18 completed the study. No significant differences were found between groups in primary or secondary outcomes, although IT patients (N = 9) obtained higher scores in language measures between 10 and 62 weeks in per protocol analysis. The number of non-completions was identical between groups. This study suggests that, in the sub-acute period following stroke and controlling for the number of hours of SLT provided, there is a trend for a greater improvement in language and functional communication measures with IT compared with RT. The lack of statistical significance in results was probably due to the small sample size.

Modified Response Elaboration Training: A systematic extension with replications

Background: Response Elaboration Training (RET; Kearns, 1985) has been found to consistently result in increased production of content in discourse with persons with aphasia. Positive treatment effects have been reported for persons representing a variety of aphasia types and severities. RET was modified for application with persons with acquired apraxia of speech and aphasia and positive outcomes were also associated with the modified treatment (Wambaugh & Martinez, 2000). Although RET has received systematic study, its stimulus generalisation effects are not well understood. Aims: This investigation was designed to measure the stimulus generalisation effects of modified RET (M-RET) in a variety of conditions as well as to further study the effects of M-RET applied to a personal recount condition. Methods & Procedures: Multiple baseline designs (across behaviours and participants) were utilised to examine treatment effects. Treatment was applied sequentially to picture sets and a personal recount condition with six persons with chronic aphasia. Production of correct information units (CIUs) was measured in the following conditions: (1) discourse production in response to sets of trained and untrained pictures, (2) home conversations, and (3) production of discourse in structured tasks. Formal measures of functional communication were also completed prior to and following treatment. Outcomes & Results: Increases in production of CIUs in response to pictures were observed for 11 of the 12 applications of M-RET to picture sets. Response generalisation to untrained picture sets was associated with M-RET applied to pictures sets; increases were slight and were greater for untrained sets that were probed more frequently. Maintenance of gains was generally strong for the participants with nonfluent aphasia, but was minimal for the participant with fluent aphasia. Gains were not evident for M-RET applied to personal recounts; only one participant evidenced changes possibly associated with treatment in the personal recount condition. Improvements in structured discourse samples and a functional communication measure were observed for the majority of the participants following treatment. Lack of compliance in completion of recordings of home conversations limited the utility of that measure. Conclusions: M-RET applied to pictures resulted in improvements in production of content in treated and untreated picture conditions for the majority of the participants. Treatment effects extended to additional outcome measures. Although some positive changes were observed for the participant with fluent aphasia, maintenance was problematic. Application of M-RET to a personal recount condition was not associated with improved performance for most of the participants.

2013 Medicare Proposal Outlines New Reporting Rules

2013 Medicare Proposal Outlines New Reporting Rules

Health Care Change Ahead: Are You Ready?

Health Care Change Ahead: Are You Ready?

BCBS Drops Cognitive Rehabilitation Report

You have accessThe ASHA LeaderOn the Pulse1 Nov 2011BCBS Drops Cognitive Rehabilitation Report Janet McCartyMEd, CCC-SLP Janet McCarty Google Scholar More articles by this author , MEd, CCC-SLP https://doi.org/10.1044/leader.OTP.16142011.3 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In http://www.asha.org/Publications/leader/2011/111122/BCBS-Drops-Cognitive-Rehabilitation-Report.htm A 2008 report that deemed cognitive rehabilitation treatment as “investigational” has been removed from the Blue Cross and Blue Shield Association (BCBSA) public website. The removal, coupled with the lack of a replacement, may signal a change in the policy on coverage of cognitive rehabilitation services for BCBSA, whose companies provide health care coverage to 98 million people (one in three) in America. “Cognitive Rehabilitation for Traumatic Brain Injury in Adults,” an assessment report issued by the BCBSA Technology Evaluation Center, indicated that data were insufficient to determine whether cognitive rehabilitation results in beneficial health outcomes. ASHA disputed that position, providing supportive evidence for the treatment, including data from ASHA’s National Outcomes Measurement System. These data demonstrate that a large percentage of patients with traumatic brain injury (TBI) who received speech-language treatment made significant gains on four functional communication measures in key cognitive-communication skill areas: attention, memory, pragmatics, and problem-solving. BCBSA posts assessment reports on its public website for three years, and recently removed the cognitive rehabilitation report. BCBSA policies are made available to the 39 independently owned and operated BlueCross BlueShield plans, which may choose whether or not to adhere to them when creating or updating their individual medical policies. Speech-language pathologists can view BCBSA’s removal of its policy on cognitive rehabilitation for treatment of TBI as a signal to advocate for coverage with local and regional BlueCross BlueShield plans. In requesting coverage of these services, SLPs are encouraged to use information assembled by ASHA, including the rationale for coverage and published reports and research supporting treatment (e-mail [email protected] to receive this information). Each regional BlueCross BlueShield plan operates independently and coverage contracts differ among the plans. Lack of coverage may be due to a contractual requirement (e.g., the contract specifies that cognitive rehabilitation is not covered) rather than a medical necessity decision. Nevertheless, the removal of the BCBSA assessment report on cognitive rehabilitation from its public website may provide an opportunity for SLPs and consumers to advocate for improved coverage of medically necessary cognitive rehabilitation for TBI patients. Author Notes private health plans advisor, can be reached at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 16Issue 14November 2011 Get Permissions Add to your Mendeley library History Published in print: Nov 1, 2011 Metrics Current downloads: 73 Topicsasha-topicsleader_do_tagasha-article-typesleader-topicsCopyright & Permissions© 2011 American Speech-Language-Hearing AssociationLoading ...

2012 Revisions to Medicare Fee Schedule Proposed

2012 Revisions to Medicare Fee Schedule Proposed

Prediction of Outcome in Neurogenic Oropharyngeal Dysphagia within 72 Hours of Acute Stroke

Stroke is the most frequent cause of neurogenic oropharyngeal dysphagia (NOD). In the acute phase of stroke, the frequency of NOD is greater than 50% and, half of this patient population return to good swallowing within 14 days while the other half develop chronic dysphagia. Because dysphagia leads to aspiration pneumonia, malnutrition, and in-hospital mortality, it is important to pay attention to swallowing problems. The question arises if a prediction of severe chronic dysphagia is possible within the first 72 hours of acute stroke. On admission to the stroke unit, all stroke patients were screened for swallowing problems by the nursing staff within 2 hours. Patients showing signs of aspiration were included in the study (n = 114) and were given a clinical swallowing examination (CSE) by the swallowing/speech therapist within 24 hours and a swallowing endoscopy within 72 hours by the physician. The primary outcome of the study was the functional communication measure (FCM) of swallowing (score 1-3, tube feeding dependency) on day 90. The grading system with the FCM swallowing and the penetration-aspiration scale (PAS) in the first 72 hours was tested in a multivariate analysis for its predictive value for tube feeding-dependency on day 90. For the FCM level 1 to 3 (P < .0022) and PAS level 5 to 8 (P < .00001), the area under the curve (AUC) was 72.8% and showed an odds ratio of 11.8 (P < .00001; 95% confidence interval 0.036-0.096), achieving for the patient a 12 times less chance of being orally fed on day 90 and therefore still being tube feeding-dependent. We conclude that signs of aspiration in the first 72 hours of acute stroke can predict severe swallowing problems on day 90. Consequently, patients should be tested on admission to a stroke unit and evaluated with established dysphagia scales to prevent aspiration pneumonia and malnutrition. A dysphagia program can lead to better communication within the stroke unit team to initiate the appropriate diagnostics and swallowing therapy as soon as possible.

Are You Ready to Shape the Future of Health Care?

Are You Ready to Shape the Future of Health Care?

Special Education Eligibility: When Is a Speech-Language Impairment Also a Disability?

Special Education Eligibility: When Is a Speech-Language Impairment Also a Disability?

Effect of Verb Network Strengthening Treatment in Moderate-to-Severe Aphasia

This Phase II treatment study examined the effect of Verb Network Strengthening Treatment (VNeST) on individuals with moderate-to-severe aphasia. Research questions addressed (a) pre- to posttreatment changes and pretreatment to treatment phase changes on probe sentences containing trained verbs (e.g., "The carpenter is measuring the stairs") and semantically related untrained verbs (e.g., "The nurse is weighing the baby"); (b) lexical retrieval changes in single-word naming, sentence, and discourse measures; (c) functional communication by way of proxy and participant report; and (d) error evolution. A multiple-baseline approach across participants was used. Effect sizes were calculated for pre- and posttreatment and maintenance probe responses. A C statistic was used to determine changes from the baseline to treatment phases. One participant exhibited improvement on all generalization measures, whereas the other participant exhibited more limited generalization. Both participants showed improvement on the functional communication measure. As predicted, the participants did not show the same extent of improvement that was observed in participants with more moderate aphasia (Edmonds, Nadeu, & Kiran, 2009). Nonetheless, the findings suggest that VNeST may be appropriate for persons with moderate-to-severe aphasia, especially with a small adaptation to the treatment protocol that will be retained for future iterations of VNeST.

Neuropsychological and Behavioral Outcomes of Extremely Low Birth Weight at Age Three

Preterm (PT) birth is an established risk factor for high mortality and morbidity rates. Infants and school-aged children have been well-studied, but few have described neuropsychological and behavioral outcomes at preschool age. We compared a 2004–2006 preterm/extremely low birth weight (ELBW) cohort (PT/ELBW; N = 60) born ≤33 weeks gestation and <1,000 g with term-born participants (N = 90) at age 3. PT/ELBW subgroups (<26 weeks; 26–33 weeks) performed more poorly than the term-born group on verbal, nonverbal, fine motor, visual-motor, visual attention, noun fluency, early number concepts, and functional communication measures prior to age correction; PT/ELBW children born <26 weeks additionally performed more poorly on action-verb fluency. Those born 26–33 weeks had executive and adaptive deficits on parental behavioral report. Age correction significantly improved preterm scores without masking relative verbal, nonverbal, motor, and behavioral weaknesses that may require early intervention. In conclusion, subtle delays in emergent neuropsychological and behavioral functions are measurable at age 3, and neurobiological immaturity remains a prepotent influence on outcome in the preschool years. Further study should enhance our understanding of the trajectory of brain development and the limits of neuroplasticity in these highly at-risk children.

Using voice recognition software to treat dysgraphia in a patient with conduction aphasia

Background: Augmentative and alternative communication (AAC) has primarily been utilised for motor speech deficits or as an aid for communicating basic needs in the acute stages of aphasia rehabilitation. However, AAC strategies can be employed for individuals with aphasia across a wide range of severity levels and at different stages of recovery. For individuals with chronic impairments in language, voice recognition software can further enhance communication by providing an alternative means for written expression. Aims: To investigate the functional and linguistic effects of a treatment program that used voice recognition software to improve written communication in an individual with chronic aphasia. Methods & Procedures: A 65-year-old woman with conduction aphasia participated in a prospective case study. During baseline testing the individual was evaluated on measures of language (i.e., Boston Diagnostic Aphasia Examination, 3rd edition, Goodglass, Kaplan, & Baressi, 2001; Boston Naming Test, Kaplan, Goodglass, & Weintraub, 2001), computer skills, and functional communication (i.e., ASHA FACs, Frattali et al., 1995; Quality of Communication Life Scales, Paul et al., 2004). A cursory examination of the oral peripheral structure was administered. Treatment consisted of 10 one-hour sessions of training on the Dragon NaturallySpeaking© Program. Following treatment, measures of language, computer skills, quality of life, and functional communication were re-administered. Further, to evaluate if skills in written expression could be utilised to communicate via e-mail, a distance-learning program was implemented. Outcomes & Results: Findings revealed that, with intensive instruction, the participant was able to independently access the computer and the Dragon NaturallySpeaking© Program. At the conclusion of the treatment phase, functional writing abilities approximated spoken communication. Some minor changes in reading, repetition, and conversation were suggested on formal and informal assessment measures. The participant made substantial gains in using the program in her activities of daily living, but only achieved minor success in demonstrating her skills during distance learning. Conclusions: The potential benefits of AAC devices may change throughout the course of recovery from aphasia. New technologies may facilitate gains in communication in individuals with aphasia throughout their lifespan. This study demonstrated that intensive training in the use of voice recognition software can enhance functional writing in an individual with chronic aphasia. Although marked progress in written expression was achieved, transfer of skills for use on the Internet was limited. Clinical management should include assessment of various assistive technologies across different modalities of communication for people at different stages of recovery from aphasia.

Health Care Reform and Speech-Language Pathology Practice

Health Care Reform and Speech-Language Pathology Practice

Medicare Quality Reporting Available: Audiology and Speech-language Pathology Measures Added to Program

You have accessThe ASHA LeaderIn Private Practice1 Nov 2009Medicare Quality Reporting Available: Audiology and Speech-language Pathology Measures Added to Program Kate Romanow, JD Rob Mullen, andMPH Anne OylerMA, CCC-A Kate Romanow Google Scholar More articles by this author , JD, Rob Mullen Google Scholar More articles by this author , MPH and Anne Oyler Google Scholar More articles by this author , MA, CCC-A https://doi.org/10.1044/leader.IPP.14152009.1 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In In 2010, private-practice audiologists and speech-language pathologists who are enrolled as a Medicare providers will be able to participate in the Medicare Physician Quality Reporting Initiative (PQRI) program. PQRI is a voluntary program designed to improve the quality of care to Medicare beneficiaries. Private-practice health care professionals who participate in PQRI by reporting on approved quality measures are eligible for a 2% incentive payment. The final 2010 Medicare Physician Fee Schedule contains three audiology measures and eight speech-language pathology measures. Audiology Measures The three audiology PQRI measures are the result of research and advocacy efforts by ASHA and the Audiology Quality Consortium (AQC), a coalition of 10 audiology organizations. Audiologists will be able to report on three quality measures that call for referral of patients of any age to a physician after an audiological evaluation finds one of three conditions: Congenital or traumatic deformity of the ear A history of active drainage from the ear within the previous 90 days (for patients who have disease of the ear and mastoid processes) A history of sudden or rapidly progressive hearing loss. Audiology measures are reportable via claims. The AQC will develop educational materials on PQRI and how to report on these measures. Further information on the audiology measures and the AQC audiology organizations is available at Audiology PQRI. Speech-Language Pathology Measures The eight PQRI measures for speech-language pathology are outcome measures (function is measured before and after services are delivered). Eight of ASHA’s functional communication measures (FCM) were approved as PRQI measures in large part because these measures have been validated and used for more than 10 years through ASHA’s National Outcome Measurement System (NOMS). The speech-language pathology measures are among the first approved PQRI measures that report outcomes as opposed to process measures, which indicate only that a procedure was or was not implemented but not how it affected the patient’s health and functional status. In 2010, private-practice SLPs may report outcomes in eight functional domains that compare the number of Medicare Part B patients aged 16 and older with a diagnosis of cerebrovascular disease (stroke) being treated by the provider to the number who make progress on one or more FCMs: spoken language comprehension, reading, spoken language expression, writing, motor speech, swallowing, attention, and memory. The speech-language pathology measures will be reportable only through registries approved by the Centers for Medicare and Medicaid Services (CMS); ASHA has applied for the inclusion of NOMS on the list of approved registries. Further information on these measures and on how members can participate in NOMS is available at ASHA’s Web site. CMS also has information on PQRI (click on “Educational Resources” and “Measure Codes”). Author Notes Kate Romanow, JD, director of health care regulatory advocacy, can be reached at [email protected]. Rob Mullen, MPH, director of the National Center for Evidence-based Practice, can be reached at [email protected]. Anne Oyler, MA, CCC-A, associate director of audiology professional practices, can be reached at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 14Issue 15November 2009 Get Permissions Add to your Mendeley library History Published in print: Nov 1, 2009 Metrics Current downloads: 106 Topicsasha-topicsleader_do_tagasha-article-typesleader-topicsCopyright & Permissions© 2009 American Speech-Language-Hearing AssociationLoading ...

The National Outcomes Measurement System for Pediatric Speech-Language Pathology

The American Speech-Language-Hearing Association's (ASHA's) National Outcomes Measurement System (NOMS) was developed in the late 1990s. The primary purpose was to serve as a source of data for speech-language pathologists (SLPs) who found themselves called on to provide empirical evidence of the functional outcomes associated with their clinical services for child and adult clients who were exhibiting various speech-language pathologies. The present discourse focuses on data that were collected in school settings from the prekindergarten NOMS and the K-12 NOMS. This initial account describes how the data collection systems were developed and the data were collected as well as an overview of the information contained in these databases. ASHA's Functional Communication Measures (FCMs) were used to describe the disorder-specific communicative dysfunction(s) of each student. These data were obtained at the initiation of a child's speech-language pathology services and again at the time of discharge from these treatments by the SLP. As of December 2007, data on more than 2,000 preschool students and 14,000 K-12 students have been reported to these 2 NOMS components by SLPs working in school settings. The availability of these data has proven to be a very valuable tool with respect to the efforts of school-based SLPs and administrators to document the beneficial impact of speech-language pathology services in school settings.

Answers to Questions About Medicare Changes

You have accessThe ASHA LeaderIn Private Practice1 Nov 2008Answers to Questions About Medicare Changes Mark Kander and Ingrida Lusis Mark Kander Google Scholar More articles by this author and Ingrida Lusis Google Scholar More articles by this author https://doi.org/10.1044/leader.IPP.13152008.21 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In Since the July passage of the federal Medicare Improvements for Patients and Providers Act (MIPPA), ASHA staff has sought to equip members interested in serving Medicare patients. As first described in the Sept. 2 issue of The ASHA Leader, MIPPA takes effect July 1, 2009. On that date, private-practice speech-language pathologists who have enrolled as Medicare providers will be able to bill Medicare directly for services delivered to beneficiaries under Medicare Part B. Selected questions from a Sept. 23 ASHA teleseminar on MIPPA implementation are excerpted here. The full text of the Q&A is available at The Leader Online, along with other articles on the countdown to Medicare. Q: Is the National Provider Identifier (NPI) portable? Yes. Once you have received an NPI, it is your number to be used for all health plan payers. Q: I have an NPI for my private practice. Will I be able to use that for Medicare? Yes. Your NPI can be used for both private insurance and Medicare. Remember that applying for an NPI does not automatically enroll you in the Medicare program; that is a separate process. Information on Medicare enrollment can be found on ASHA’s Web site. Q: I am a Medicare provider under my audiology number—do I need to enroll again? Yes. You need to enroll separately in the program as an SLP. Your NPI application/record should include the audiology and speech-language pathology taxonomy codes. Q: Can I bill independently and also as part of a corporation where my benefits are reassigned? Yes. The reassignment of payment only applies when the claim form identifies that corporation as the “billing provider.” Q: How do I verify Medicare eligibility on patients? To verify Medicare eligibility, contact your Medicare administrative contractor. For Medicare contractor contact information, visit the HHS Web site [PDF]. Q: Will a physician still be able to bill “incident to” for speech-language pathology services? Yes. Whether or not an SLP enrolls in Medicare, his/her services can be billed as an employee or contractor of a physician practice. Q: Do we know yet if SLPs will be able to see patients in home settings or must patients come to an office? SLPs will have the option of seeing patients in an office or the patient’s home. ASHA has requested that CMS include in its draft regulations a third patient care setting—“patient’s natural environment”—when there is a need to treat patients in the locations where they participate in daily activities. Q: How soon after I submit my claims can I expect payment from Medicare? The Medicare contractor is expected to process “clean” claims within 30 days. A claim that is incomplete or contains an error does not satisfy the “clean” definition. Please note that the payment process is shortened if claims are submitted electronically. Q: Does the change in speech-language pathology private-practice status change the therapy caps? No, the legislation does not change the therapy caps, and SLPs continue to share a cap with physical therapy. The legislation did, however, call for the continuation of the therapy cap exceptions process that allows beneficiaries to receive additional therapy services above the cap if they are medically necessary. Q: What is the Physician Quality Reporting Initiative (PQRI)? PQRI allows physicians or other professionals to receive a bonus payment when they report recognized quality measures to Medicare. SLPs are one category of providers eligible for this bonus payment. ASHA is working with the Centers for Medicare and Medicaid Services to recognize functional communication measures from ASHA’s National Outcomes Measurement System for reporting purposes. Author Notes Mark Kander, director of health care regulatory analysis, can be reached at [email protected]. Ingrida Lusis, director of political and federal advocacy, can be reached at [email protected]. Additional Resources FiguresSourcesRelatedDetails Volume 13Issue 15November 2008 Get Permissions Add to your Mendeley library History Published in print: Nov 1, 2008 Metrics Downloaded 54 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2008 American Speech-Language-Hearing AssociationLoading ...

E2399: Correlation of objective and self report measures of swallowing function after concurrent chemoradiation (CCR) for head and neck cancer (HNC)

6022 Background: We conducted a correlative study for E2399, a function preservation trial, to assess the acute and long-term effects of CCR on swallowing and the relationship of “gold standard” objective measures to self-report measures. Methods: Swallow evaluations were done at baseline, 3, 12 and 24 months post treatment. Self report measures consisted of the PSS- HN and FACT-G/HN. Objective measures include the modified barium swallow (MBS) scored using a physiologic measure, the Dysphagia Outcome Severity Scale (DOSS) and a functional measure, the Functional Communication Measure (FCM), which is the accepted Medicare standard for assessment of swallow function. Results: Statistically significant correlations were found between the DOSS or FCM and the swallow items for the HN subscale and the PSS-HN. Associations for the FCM were stronger than for the DOSS. At 3-months post-treatment the average correlation of the FCM with the FACT-HN and PSS swallow items was 0.585 (Maximum r =0.746, p < 0.001, Minimum r =0.297, p = 0.074), while the respective average correlation for the DOSS was 0.379 (Maximum r =0.556, p < 0.001, Minimum r =0.078, p = 0.644).There were poor correlations between the DOSS or FCM with the FACT-G at all time points. DOSS scores were lower than FCM scores at all time points (p < 0.05) and the discrepancy between the DOSS and the FCM scores increased post-treatment from an average of 0.43 at 3-months to ∼1.13 at the 24-month assessment. Both the DOSS and the FCM scores at baseline (p < 0.03) and at 3-months (p < 0.01) were associated with overall survival. Conclusions: The DOSS reflects physiologic abnormalities that may not be indicative of clinical dysfunction and therefore demonstrated lower associations with self-report measures of swallowing function than the FCM. The FCM correlated well with the FACT-HN and the PSS-HN swallow items. These findings suggest that PROs have practical utility in assessing swallowing function outcome and may be used in clinical trials as a surrogate for objective measures of swallow function. No significant financial relationships to disclose.

Equivalence of functional communication assessment in speech pathology using videoconferencing

We examined the equivalence of videoconferencing assessment of communication by speech-language pathologists (SLPs). Using a randomized, double-crossover agreement study, 24 post-stroke patients were randomized to a remote or face-to-face administration of a subset of the Boston Diagnostic Aphasia Examination and to remote or face-to-face assessment of speech comprehension, speech expression and motor speech. The videoconferencing equipment was operated at a transmission speed of 384 kbit/s. Each patient was simultaneously scored by both the face-to-face and the remote SLPs. SLPs were blind to each other's results. Percentage agreement within the 95% limits of agreement ranged from 92% to 100% for each functional communication measure, regardless of assessment site and administration of the aphasia examination. The results suggest that assessment of a patient's functional communication using videoconferencing is equivalent to a face-to-face encounter.

Swallowing function for patients treated on E2399: A phase II trial of function preservation with induction paclitaxel/carboplatin followed by radiation plus weekly paclitaxel

5524 ECOG 2399 is a phase II organ preservation study using induction chemotherapy followed by concomitant chemoradiation in unresectable patients with squamous cancer of the larynx or oropharynx. A correlative study was undertaken to assess acute and long-term swallowing. Methods: Swallow evaluations were done at baseline, 3, 12 and 24 months posttreatment. Self-report measures consisted of the PSS-HN and FACT-HN. Objective measures include the Modified Barium Swallow (MBS) scored using a physiologic measure, the Dysphagia Outcome Severity Scale (D) and a functional measure, the Functional Communication Measure (F). Both D and F are graded on a 7-point scale (7 = normal through 1 = absent swallow/unable to take p.o). Results: The number of evaluable D and F assessments at each time point: baseline 97/99, 3 months 72/73, 12 months 40/41, 24 months 24/26. The scores presented in the table are expressed in percentages. Conclusions: The majority of patients presented with objective abnormalities on MBS, but swallow function remained largely intact. At 3 months, swallowing was markedly impaired (severe 18 and 24%, moderate 20 and 21%). By 12 months, swallowing had improved for most patients; however, a significant percentage of patients had persistent mild deficits (5–6). Severe swallowing abnormalities were found in less than 10% of patients at 12 and 24 months. Sponsored, in part, by Bristol-Myers-Squibb. [Table: see text] [Table: see text]