Speech-language Pathology Graduate Students Research Articles

Improving the Clinician-Client Relationship in Children’s Speech-Language Treatment: An Exploratory Online Training Study

Introduction: Clinician-client relationships impact treatment outcomes in speech-language pathology. Training clinicians to improve these relationships might therefore improve treatment outcomes but has not been examined in the field. This study is a preliminary investigation of whether training student clinicians can enhance clinician-client relationships in children’s speech-language treatment. Methods: The study followed a single-subject multiple baseline design. Five graduate student clinicians completed a web-based training on clinician-client relationships, which was implemented as a series of three modules discussing goals, tasks, and bond. The training’s impact on the student’s relationships with their child clients was examined through weekly ratings completed by the students, their supervisor, and some parents and children. Intervention effects were measured by visual analysis of baseline versus intervention phases and by Tau-U effect sizes. Results: Visual analyses supported change in just under half the possible opportunities, but improvements in the relationship were also present in many of the baseline phases. Tau-U effects that corrected for baseline trend reached significance in 18 of 29 instances, providing support for the effects of the intervention. Conclusions: This study provides initial evidence that clinician-client relationship training can be effective for speech-language pathology graduate students. Clinician-client relationship training is a promising area for future investigation.

Speech-Language Pathology Graduate Students' Perception of Satisfaction, Confidence, and Interpersonal Skill Development During Simulated Experiences Amid COVID-19

Purpose: This quantitative survey correlational study aimed to examine the satisfaction, confidence, and interpersonal skills of speech-language pathology (SLP) graduate students after participating in simulated learning experiences (SLEs) during the COVID-19 pandemic. The research questions addressed (a) How do SLP graduate students perceive satisfaction, confidence, interpersonal skills, and strengths and challenges of this learning after participating in SLEs? and (b) How do SLP graduate students perceive satisfaction, confidence, and interpersonal skills across the number of hours of the SLE, the number of courses that utilize simulation, and the types of simulation experiences? Method: We invited a total of 72 Midwest clinic directors to distribute the survey to students in their respective programs. The final sample included 327 SLP students. Participants responded to questions on satisfaction, confidence, and interpersonal skills after participating in SLEs. Results: Key findings included a positive correlation among student perceptions, including satisfaction, confidence, and interpersonal skills, but no correlations between student perceptions and the number of courses that integrated SLEs and number of hours of simulation experience. Simulation types were analyzed and showed significant differences in interpersonal skill development such that virtual patient simulation is associated with more positive interpersonal skills among all types. A summary of strengths and challenges from the SLP graduate student perspective was also synthesized. Conclusions: Findings necessitate further exploration as they relate to the SLP graduate clinical experiences. This study revealed moderate to positive feedback on SLEs (instead of overall positive feedback) regarding satisfaction, confidence, and interpersonal skill development; however, previous studies noted positive outcomes. Further research should include comparing face-to-face experiences with SLEs and replicating this survey after the COVID-19 pandemic subsides and graduate programs can return to normal operations.

“Getting Back Into School Mode”: Experiences of Former Speech-Language Pathology Assistants in Graduate School

Purpose: The purpose of this article is to describe the speech-language pathology master's program experience for two groups of students: students with former speech-language pathology assistant (SLPA) experience (fSLPA) and students without SLPA experience (nSLPA). Results are relevant to current SLPAs who are considering attending graduate school and university faculty members involved in program design. Method: A survey was distributed electronically to students nationwide. The survey included both Likert-style questions and open-ended responses. A total of 85 student responses were included in data, 43 fSLPAs and 42 nSLPAs. Qualitative and quantitative results were analyzed separately and then synthesized together in a mixed-methods analysis. Results: Although the study was not designed to directly measure stressors, bottom-up qualitative analysis resulted in a framework of internal and external stressors, internal and external supports, and learning and growing. Stressors and supports were described by participants as intertwined, and a given event (e.g., the start of clinical rotations) did not map neatly to stressors or supports for all participants. fSLPAs reported higher perceptions of clinical success, feeling different than their peers, and the perception that fSLPAs were more successful in graduate school. Taken together, these results converged to develop seven findings. For instance, one finding was that, although both groups reported external and internal stressors, the specific stressors somewhat varied by group. Conclusions: Findings are discussed in relation to transformational learning theory and prior works on stress within the field. Implications for program development and prospective speech-language pathology graduate students are discussed.

Speech Impairment in Cerebellar Ataxia Affects Naturalness More Than Intelligibility.

The purpose of this analysis was to document intelligibility and naturalness in ataxia, a neurological condition that results from cerebellar damage. The cerebellum is important for normal speech production to scale and coordinate articulatory and laryngeal movements. The disruption of these cerebellar mechanisms has unique implications for how intelligibility and naturalness are affected in ataxia. The results of research on speech in ataxia have important clinical implications for assessment and treatment of individuals with ataxic dysarthria. Speech samples from 27 participants with ataxia and 28 age- and sex-matched control participants were assessed by nine speech-language pathology graduate students for intelligibility and naturalness. Intelligibility was measured as the percentage of words transcribed correctly, and naturalness was assessed as a subjective rating on a seven-point interval scale. Both intra- and inter-rater reliability were moderate to high for both intelligibility and naturalness. Speech intelligibility and naturalness were robustly decreased in the ataxia group compared to the control group; however, the difference was greater for measures of speech naturalness. There were robust relationships among dysarthria severity, length of diagnosis, and speech naturalness in speakers with ataxia, but there were no other robust effects for age, sex, or impact on quality of life for intelligibility or naturalness. Speech naturalness was more impaired than intelligibility in speakers with ataxia. Impaired naturalness can have debilitating consequences for communicative participation, effectiveness, and quality of life. Assessment and treatment for ataxic dysarthria should include aspects of prosodic control for speech naturalness.

Perception of Children’s Productions of /l/: Acoustic Correlates and Effects of Listener Experience

Introduction: The aim of the current study was to examine the effect of listeners’ experience with child speech and phonetic training on perceptual judgment of children’s word-initial /l/ productions. The acoustic correlates of acceptable and misarticulated productions of /l/ and their relation to listeners’ experience with child speech were explored. Methods: Three listener groups listened to children’s word-initial /l/ productions embedded in monosyllabic words and judged the “/l/-likeness” of the productions using a Visual Analog Scale (VAS). Three listener groups included (a) speech-language pathologists with at least 10 years of experience (SLP group), (b) graduate students in speech-language pathology (GS group), and (c) naïve listeners with no clinical phonetics experience (NL group). Acoustic correlates (both static and dynamic measures) of listeners’ perception of /l/ sounds were also investigated. Results: While mean VAS ratings did not differ significantly by listener group, the SLP group used a wider range of the VAS than the GS and NL groups. Correlational analysis between the static measure (F2-F1 values) and mean listener ratings showed that listeners tend to perceive sounds with the highest F2-F1 values more as /j/ than /l/, while those with the lowest F2-F1 value were perceived more as /w/ than /l/, especially for sounds that are in between phonemic categories. Listener ratings were not highly correlated with dynamic measures. Conclusion: These results suggest that experienced listeners use the VAS more continuously than less experienced listeners to indicate perception of subphonemic features of children’s productions of /l/, and that their ratings correlate with acoustic measures. Furthermore, listeners with experience with child speech and phonetic training are more sensitive to subphonemic features of children’s productions of /l/, especially for misarticulated productions. This supports the clinical use of VAS for perceptual judgments of children's /l/ productions.

Empathy, Post-Stroke Aphasia, and Speech-Language Pathology Students

ABSTRACT Background Empathy is a multidimensional construct potentially important in communicating with an individual with aphasia and for students pursuing a career in speech-language pathology. Unfortunately, little is known about empathy towards someone with aphasia among the general public and speech-language pathologists. Aims The aims of the current study are to explore whether (1) prior knowledge of aphasia predicts state and dispositional empathy after viewing a video of an adult with post-stroke aphasia; (2) state and dispositional empathy differs between a group of individuals seeking a profession in speech-language pathology and those who are not; (3) state and dispositional empathy differ between speech-language pathology undergraduate and graduate students. Methods Two hundred-six participants viewed a video of a male with aphasia engaged in three language tasks and then rated themselves with the Batson Empathy Adjectives (BEA) and the Interpersonal Reactivity Index (IRI; empathic concern and perspective taking). Results State empathy is not influenced by prior knowledge, however, knowledge does predict type of dispositional empathy. Furthermore, state and dispositional empathy does not differ between a group of individuals seeking a profession in speech-language pathology and those who are not seeking this profession. Additionally, state and dispositional empathy do not differ between undergraduate and graduate students in speech-language pathology. Conclusions These findings have implications for programs designed to increase public awareness of post-stroke aphasia as well as speech-language pathology graduate programs.

Preparing Speech–Language Pathology Graduate Students for Effective Telepractice

Telepractice has been recognized as an efficacious service delivery model for more than 15 years. Yet, most speech-language pathologists found themselves ill-prepared to transition in-person clinical services to a digital format in response to the pandemic. Confusion regarding telepractice regulatory, reimbursement, technology, and delivery requirements stemmed from a lack of formal training, as most practicing clinicians lacked graduate preparation in this arena. Graduate speech–language pathology programs were stymied as to specific telepractice knowledge and skills that should be incorporated into a preparatory program. This article outlines a set of telepractice competencies to guide graduate programs and to promote self-evaluation among practicing clinicians. The specified competencies are clustered into three domains: (1) regulatory, reimbursement, and ethics; (2) telecommunications technology; and (3) clinical telepractice. Examples of knowledge and skills specific to each competency are provided. Infusion of the telepractice competencies within the curriculum of three accredited graduate programs is illustrated.

Increasing Student Confidence With Medically Complex Infants Through Simulation: A Mixed Methods Investigation.

The purpose of this study was to compare student knowledge and confidence, related to the assessment and management of oral feeding readiness in medically complex infants, following a written case study versus a high-fidelity human patient simulation (HPS). A sequential, two-phase, embedded mixed methods design was conducted. Participants were two sequential cohorts of second-year speech-language pathology graduate students enrolled in a didactic Pediatric Dysphagia course. At the end of the course, students completed the same case scenario presented as a written case study (control group; N = 28) or as an HPS (experimental group; N = 24). Pre- and post-knowledge assessment results and self-assessments of confidence conducted at three time points were compared. All students made gains in knowledge, regardless of intervention (written case study or HPS). Despite different baselines, the percent change in knowledge was significant with the control group improving 33% and the experimental group improving 76% from baseline. Students in the experimental group demonstrated significantly greater gains in confidence with skills enhanced by the hands-on, immersive experience of HPS. Qualitative analysis further identified factors contributing to increased confidence with all students reporting that experience significantly contributes to their confidence in their ability to treat patients. While knowledge outcomes were similar between the groups, the confidence that the experimental group gained through the hands-on experiences of HPS fosters student development as confident professionals in assessing feeding readiness and managing medically complex infants. Results support integration of simulation into the graduate curriculum to support student learning. https://doi.org/10.23641/asha.19233504.

Speech-Language Pathologist's Role in Understanding and Promoting Self-Advocacy in Autistic Adults.

This tutorial introduces speech-language pathologists (SLPs) to strategies that promote and support self-advocacy among autistic college students. The discussion for this tutorial is grounded within the framework of the social model of disability and the need for addressing environmental barriers to communication and self-advocacy. We provide a self-advocacy framework to guide SLPs in developing programs for autistic adults. We describe factors that impact self-advocacy in autistic college students and the role of university-based SLPs and speech-language pathology graduate students in program implementation. Scenarios and examples are included to aid SLPs in implementing the recommendations. Self-advocacy is a predictor of retention, adaptation, and graduation of autistic postsecondary students. Prior research on autistic self-advocacy is minimal, and guidance for SLPs on promoting and supporting self-advocacy of their autistic clients is limited. SLPs play a very important role as they can increase understanding and appreciation for autistic social communication differences among nonautistic peers and professors and address autistic stigma through meaningful engagement of autistic individuals in planning and program development.

A Survey of Speech-Language Pathology Graduate Students' Perceptions of Telepractice Pre- and Posttraining During the COVID-19 Pandemic

Purpose: Many university programs in speech-language pathology that offer clinical training as part of their graduate training transitioned to a telepractice service delivery model in response to the COVID-19 pandemic. The purpose of this study was to survey speech-language pathology graduate student clinicians on their knowledge of and comfortability with telepractice before and after participation in a telepractice training program. Method: Graduate students in a speech-language pathology distance program participated in a remote summer clinical internship that included a 5-week telepractice training. Pre- and posttraining surveys were completed by 27 graduate students. Results: Results of a Wilcoxon signed-ranks test indicated that posttest telepractice knowledge question scores were significantly greater than pretest telepractice knowledge question scores. Likewise, posttest telepractice comfort question scores were significantly greater than pretest telepractice comfort question scores. Conclusions: These findings support the need to integrate a telepractice component to clinical education for speech-language pathology programs at the graduate level. Offering a specifically designed and hands-on telepractice training to graduate students in speech-language pathology can be an effective pedagogical piece to university degree programs.

What Do You Expect? A Comparison of Perceptions on the Roles of Clinical Educators and Graduate Clinicians

In addition to explicitly defined pedagogical roles and responsibilities, shared perceptions of clinical educator and graduate clinician roles across both parties are essential for an effective supervisory relationship. Previous findings suggest subtle differences in expectations that could potentially impact the learning process. This study was designed to enable a within and across group comparison on perceived roles of supervisors and supervisees. A survey consisting of open-ended prompts, Likert-rating scale questions, and attribute rankings regarding their own and the others’ roles was completed by 90 clinical educators and 63 graduate students in speech-language pathology. Thematic analysis was the primary method of analysis; findings were compared with quantitative results. Although many perceptions were in agreement, subtle differences emerged regarding clinical educators’ role in facilitating learning and graduate clinicians’ role in promoting their own success. The findings in this study highlight subtle differences in expectations, that are useful for clinical faculty, educators and directors, as well as researchers in scholarship of teaching and learning for preparing graduate students to fully benefit from the clinical experience.

The Cranial Nerve Exam: Effectiveness of Peer-to-Peer Teaching and Experiential Learning in Speech-Language Pathology Graduate Students

This study sought to determine if speech-language pathology graduate students found peer-to-peer teaching and experiential learning beneficial in learning how to assess the cranial nerves. Graduate students in a motor speech disorders course completed an in-class cranial nerve examination in which they either portrayed clinicians or patients. Student groups utilized a reflective practice approach by teaching their peers how to assess the cranial nerves. Intensive practice sessions were offered almost daily for two weeks prior to the exam. Thirty-seven students completed an online survey about their knowledge and confidence in assessing cranial nerves and identifying diagnoses before starting the training for the exam; 36 participants completed the same survey post-exam training. Students reported feeling more confident and less anxious in evaluating the cranial nerves, assessing damages, and identifying diagnoses. This preliminary study indicates peer-to-peer teaching could be an effective strategy for learning how to evaluate cranial nerves.

Self-Care with Self-Compassion (SC2): A Program to Foster Well-Being in Graduate Speech-Language Pathology Students

This article describes elements of Self-Care with Self-Compassion (SC2), a novel program designed to foster well-being in graduate speech-language-pathology (SLP) students. Graduate SLP students experience elevated levels of perceived stress, which can ultimately impact their professional competence. University programs, faculty, and staff are uniquely positioned to help students learn to cope with stress. Self-care and self-compassion may buffer some of the effects of stress, and at the same time foster qualities in students that facilitate learning and promote healthy clinical practice. Twenty-five incoming SLP graduate students participated in SC2, a required, two-part workshop. Levels of perceived stress and self-compassion were collected, along with program evaluations and perceptions of/engagement with self-care pre- and post-program. Results confirm that graduate SLP students experience elevated levels of stress, along with moderate levels of self-compassion. Students value self-care, and most want to maintain or increase their engagement in self-care practices. However, students face several barriers in implementing and maintaining self-care plans. Students provided positive reviews of the program. Program limitations and possible future modifications of the program are discussed.

A Practice-Based Interprofessional Emergent Writing Intervention: Impacts on Graduate Students and Preschoolers

Despite the importance of collaboration in schools, few studies have examined interprofessional education (IPE) interventions for graduate speech-language pathology (SLP) students designed to prepare them with the skills necessary to effectively work on school-based teams. The current pilot study implemented a five-week practice-based IPE intervention with six SLP graduate students and three occupational therapy (OT) graduate students. Three SLP students were randomly assigned to the ‘unpaired’ condition and delivered emergent writing activities independently to a small group of preschoolers (n = 10). The other three SLPs were each randomly assigned an OT student to collaborate with in a ‘paired’ condition and conducted the same activities together with their assigned small groups of preschoolers (n = 11). Graduate students’ emergent writing knowledge and interprofessional competencies were supported throughout the study by facilitated discussions and structured debrief sessions with their clinical educators using the DEAL model of critical reflection. Results indicated that SLP students from both conditions demonstrated positive gains in emergent writing knowledge, but the paired SLP students had a greater gain in self-reported interprofessional competencies. Preschoolers in both conditions demonstrated improvement on emergent writing tasks. Implications of practice-based IPE interventions for both graduate students and children are discussed.

Positioning SLP Graduate Students to Meet the Needs of Vulnerable Children Virtually: Lessons from a Service Learning Project Implemented in the Fall of 2020

Service-learning is increasingly regarded as a high-impact pedagogy strategy in the field of speech-language pathology. It has been shown to mutually benefit speech-language pathology (SLP) graduate students and the communities they serve. The purpose of this study is to describe the process and impact of a service-learning-oriented assignment completed as part of a graduate-level class on school-age language disorders during the fall of 2020. Each of the 12 SLP students enrolled in the class volunteered to virtually tutor a child at risk for school failure for 10 hours. This role was a novel context for the graduate students. Analysis of student reflection papers suggested the SLP graduate students felt this experience positively influenced their ability to apply the course content and ultimately resulted in increased confidence entering the field as new clinicians.

The Flipped Classroom Model as Applied to an Augmentative and Alternative Communication Course

The Flipped Classroom Model (FCM) is an andragogical approach where students complete content-related work outside of the class and engage in activities related to this content during the class period. This approach has garnered recent attention in the field of speech-language pathology, but its implementation has not been studied in an augmentative and alternative communication (AAC) course and there is limited information on student perspectives of the experience. This study presents the results of a qualitative investigation designed to investigate the preferences and experiences of preservice speech-language pathology graduate students in an AAC course utilizing the FCM. Semi-structured interviews with eight students were transcribed and analyzed utilizing a phenomenological framework. The themes that emerged from the data included course design, course delivery, instructor characteristics, student preferences, student characteristics, online versus in-person learning, and career relevance. Recommendations for implementing the FCM in teaching AAC are discussed in light of the results presented.

Perceptions and Effects of Online Clinical Preparation Modules for First-Semester Speech-Language Pathology Graduate Students

Students begin graduate school with varying backgrounds and experiences from their undergraduate program, which can result in different degrees of competence as they begin clinical work. This study investigated the effects of a series of seven online modules designed to review foundational clinical skills and enhance students’ clinical success. A cohort of 39 incoming graduate students at a midwestern university participated in the study and completed the modules during program orientation. Mixed methods were used to evaluate the effects and perceptions of the modules, including surveying students and the clinical faculty, comparing students’ clinical evaluations to those of previous students who did not use the modules, and facilitating a focus group with the clinical faculty. The findings indicated that students perceived the modules to be helpful, but there were not significant changes in faculty ratings of students’ clinical performance. Both faculty and students responded positively to the use of online modules, but they were challenged in integrating them into the clinical practicum experience, resulting in minimal use of the modules beyond program orientation. Faculty and students made notable suggestions for improvement. Implications for how graduate programs prepare and support students in their clinical experiences are discussed.

Engaging Graduate Students in Cultural Experiences Early: The Development, Implementation, and Preliminary Student Perceptions of a Community Engagement Clinical Experience.

Speech-language pathologists and audiologists are called to serve an increasingly diverse patient population in the United States. This increased diversity highlights the need for clinicians to be educated early in their careers about best practices to serve patients and clients from diverse backgrounds. In this clinical focus article, the authors present the development, implementation, and preliminary perceptions of a culturally responsive clinical experience for speech-language pathology graduate students designed to engage them early in their learning career. The pilot program was based on pillars of experiential learning and community engagement. Graduate students attended trainings aligned with a model of culturally relevant care to prepare them to conduct speech and language screenings and small group language enrichment in English and Spanish. Preliminary analyses of student reflections indicated themes of positive perceptions about the experience and provided preliminary support for students learning about working with culturally and linguistically diverse populations in an early, intentional, and focused experience. Early personnel preparation to culturally responsive care is crucial to meet the needs of future caseloads. Further research into the effectiveness of this kind of program is necessary to identify which variables may have the most impact on a student's cultural sensitivity, awareness, knowledge, and skills.

How Graduate Students With Vocal Fry Are Perceived by Speech-Language Pathologists

Purpose: Vocal fry (VF), a low-pitched, grating voice quality, appears to be trending among young women. Current research lacks consensus of listeners' perceptions associated with VF. This study investigated practicing speech-language pathologists' (SLPs) perceptions of graduate speech-language pathology students who speak with VF. Method: Thirty-two graduate students were recorded reading the Rainbow Passage and providing a brief monologue. VF was detected perceptually and acoustically for all 32 students' recordings. For the 127-syllable passage, percent of VF (%VF) ranged from 2.36% (three syllables) to 40.16% (51 syllables) with an average of 12.25% (15 syllables). Twelve recorded passages were selected and sorted into two statistically significant groups ( p = .001; seven with the most %VF and five with the least). Passage samples were randomly uploaded into a Qualtrics survey. Practicing SLPs listened to each sample and provided categorical and visual analog ratings for voice pleasantness and perceived speaker competence, education, hirability, and professionalism. Results: The online survey was completed by 150 experienced SLPs who spanned differing geographical locations, work settings, and years of experience. Chi-square tests of independence and independent-samples t tests revealed statistically significant findings for all rated characteristics, indicating that VF samples were less pleasant, and their users less competent, hirable, educated, and professional. Conclusions: These findings support those of Gottliebson et al. (2007), whereby 32% of our cohort had ≥ 15 instances of VF during passage reading, and those of Anderson et al. (2014), that VF negatively impacts how a speaker is perceived. Speech-language pathology graduate students should be cognizant of VF use, as they seek to secure competitive externships and jobs.

Mentoring Underrepresented Students in Speech-Language Pathology: Effects of Didactic Training, Leadership Development, and Research Engagement.

The purpose of this study was to implement and track the outcomes of a yearlong, structured mentoring program aimed at enhancing the retention and success of underrepresented graduate and undergraduate students in speech-language pathology. Student participants were recruited following an open application process and based on meeting eligibility requirements and committing to program completion. The focus of this program was to provide didactic training on leadership development, culturally responsive practice, and research methods used in speech-language pathology. This program emphasized participant needs assessments and goal-setting, access to one-on-one and group mentoring by peers and professionals, and a culminating experience in which participant teams completed a supervised clinical research project or a community outreach and education project. Forty-six participants in three cohorts completed the yearlong program in three consecutive years. Positive outcomes included program completion, degree completion, student perceptions of program benefit, completion of innovative community-engaged and research projects, and dissemination of scholarly work. Our findings from implementing this program and tracking its outcomes have implications for using innovative, equity-minded, and evidence-based strategies for retaining and mentoring minoritized students in speech-language pathology.