Language Therapy Services Research Articles

Professional Training and Therapeutic Resources Needed for the Adoption of Telepractice in the Philippines

With the COVID-19 pandemic necessitating the adoption of telepractice for providing speech and language therapy services, this study investigated the factors affecting the perceptions and the implementation of telepractice for school-age children by speech-language pathologists (SLPs) in the Philippines. Sixty-four SLPs completed a 36-item online survey assessing the adoption of telepractice, implementation concerns, student candidacy, continuous training in telepractice, and the SLPs’ demographics. The SLPs reported that they quickly adopted telepractice in their services for school-age students at the start of the pandemic. Multiple linear regression analyses revealed that SLPs’ perceptions of the effectiveness of telepractice were significantly affected by implementation difficulties while SLPs’ future use of telepractice was significantly predicted by training and resource availability. These results suggest that professional training and other therapeutic resources are needed to alleviate SLPs’ concerns about difficulties in implementing and continuing use of telepractice.

935 Case of Bad Breath in a Child

Abstract 4-year-old girl with a two-year history of speech and language delay was referred to the Speech and Language Therapy Service by her health visitor. Additionally, she had a history of asthma, recurrent glue ears, head lice, poor dentition, a persistent malodorous nasal discharge, and halitosis. Her hyper-nasal speech sounds indicated soft palate dysfunction. Subsequent assessment in the cleft clinic resulted in a diagnosis of non-cleft velopharyngeal insufficiency. At the time of her elective pharyngoplasty, the anaesthetist and surgeon were overwhelmed by the foul smell emanating from her nose and mouth. As such, an intraoperative nasal endoscopy was undertaken to examine her vestibules. A calcified cigarette filter (Figure 1) was found impacted deep within the patient's right nostril and was removed prior to the pharyngoplasty. It was later discovered that the malodorous nasal discharge and halitosis had plagued the child since the age of 18 months. Moreover, she had undergone a number of clinical assessments within the primary care setting. However, the combination of head lice, foul smell, and her uncooperative demeanour made examination difficult, and her symptoms were inappropriately attributed to tooth decay and periodontal disease.

Effectiveness of intervention focused on vocational course vocabulary in post-16 students with (developmental) language disorder.

People with language disorders (including developmental language disorder-DLD) often struggle to learn new words and, for young adults, this could affect their success in future work. Therefore, it is crucial to support their learning of career-specific vocabulary. However, little published evidence exists regarding the effectiveness of speech and language intervention for older adolescents and young adults with (developmental) language disorder (D)LD within a post-16 provision. To investigate whether for students with (D)LD in a post-16 environment, the addition of direct individual intervention from a speech and language therapist (SLT) teaching course-specific vocabulary leads to more progress than just in-course teaching on bespoke vocabulary measures. A total of 28 college-aged students (11 female and 17 male) with (D)LD (aged 16.0-19.9) participated in a within-participant study comparing progress with explicit vocabulary intervention plus in-course teaching versus in-course teaching alone. The participants were assessed at four time points (3 months pre-intervention, immediately pre- and post-intervention, 3.5 months after intervention) using bespoke vocabulary assessments with an equal number of nouns, verbs and adjectives. All participants received one-to-one vocabulary intervention from their usual SLT for 30 min per week for 9 weeks. The intervention had four main components: (1) to identify intervention focus, (2) to recap previously taught terms (using an online flashcard program), (3) to explicitly teach new words using word maps to help with: creating definition and pictorial representation, identification of word class and investigation of phonological and morphological properties, and (4) to add new words, with their definition and pictorial representation to online flashcard program. The results showed a stable baseline, then during the intervention term significant progress on words targeted only in lessons and significantly greater progress on words targeted both in lessons and SLT sessions. Progress was maintained for 14 weeks. Individuals with initially lower scores showed smaller intervention effects. In general, performance was higher on verbs and on the definition recognition task and lower on the production tasks, but all tasks improved with intervention. Direct one-to-one vocabulary intervention with an SLT can lead to significant gains in knowledge of course-specific terminology for college-aged students with (D)LD. The effectiveness of speech and language therapy services for this age group in a wider range of areas of language and social communication should also be investigated. What is already known on this subject Very few services exist for young adults with DLD, despite their persisting language difficulties and the detrimental impact of these on their academic attainment and employment prospects. Most careers involve specific vocabulary which is crucial to executing a role successfully and these need to be learned by those looking to move into these careers. However, children, adolescents and adults with DLD struggle to learn new words and may need help in this area. What this study adds to existing knowledge The young adults with (D)LD received 9 weeks of intervention targeting individualized course-specific vocabulary (nouns, verbs and adjectives), using word maps to focus on word forms, definitions, morphologically related words and syntactic information such as word class and how to use the word in a sentence. An online learning tool provided regular spaced retrieval practice of previously taught words and their definitions. The participants showed significant progress with learning course-specific vocabulary from attending lessons. However, they made significantly greater progress on those words which were also targeted in individual SLT sessions, regardless of word class. Progress was maintained over 14 weeks. What are the potential or actual clinical implications of this work? Direct one-to-one vocabulary intervention with an SLT can lead to significantly greater gains in the acquisition of targeted course-specific terminology for young adults with (D)LD than the vocabulary teaching available in lessons. Individual intervention delivered by SLTs should therefore be offered to this age group of students with (D)LD to maximize their ability to access the academic curriculum and their future careers. Indeed, the broader role of SLTs in helping these young adults to access the world of work and independent living should be further investigated and supported.

Telepractice application for the overt stuttering assessment of children aged 6-15 years old.

Despite the importance of delivering speech and language therapy services to children who stutter (CWS), there are barriers to accessing speech and language therapy. One way to improve access for those who may otherwise be deprived of speech and language therapy services, including CWS, is through telepractice (TP). However, there is currently no evidence as to the viability of TP stuttering assessments for CWS. To investigate the validity and reliability, and acceptability of using a TP application to assess overt stuttering behaviour children aged 6-15 years. A total of 30 CWS, aged between 6 and 15 years, were recruited from a speech therapy clinic in King Abdulaziz University Hospital in Riyadh, Saudi Arabia. Children were divided into two testing conditions, either face-to-face (f2f)-led or TP-led testing, and the Stuttering Severity Instrument (SSI-IV) was administered, percentage of syllables stuttered (%SS) was calculated, and severity ratings (SR) assigned, either via f2f or via TP using two laptops with webcams, video conference software and a broadband internet connection. Agreement and reliability of scoring in the two testing conditions were reported in addition to findings from questionnaires exploring children's and their caregivers' perceptions both before and immediately after the TP assessment was carried out. A total of 30 sessions were successfully carried out, with results revealing unsatisfactory levels of agreement when applying the Bland and Altman method. However, when discrepancies were found, these were comparable with those from traditional f2f studies. Generally, parents and children exhibited high levels of satisfaction and held a positive view regarding TP pre- and post-assessment. The results of the study suggest that conducting an overt stuttering assessment via TP for 6-15-year-olds CWS is reliable and valid. Although the TP model posed some (mainly technical) challenges for executing the assessment, high levels of satisfaction were recorded by parents and children alike. The TP system and equipment chosen in this study has provided a basis for the delivery of TP overt stuttering assessment in a clinical setting, thus addressing the barriers to access that are present for CWS. These results are preliminary, but they can be seen as a building block for future research in TP assessment studies for CWS. What is already known on the subject Stuttering treatment via TP has been proven to be feasible and successful across a variety of treatment programs (e.g., Lidcombe, Camperdown). However, the viability of assessing stuttering via videoconferencing has never been explored in children. What this paper adds to existing knowledge Preliminary support for the assessment of overt stuttering in CWS aged 6-15 years via video conferencing. The results justify larger scale studies of this service delivery method. What are the potential or actual clinical implications of this work? The TP system and equipment chosen in this study has provided a basis for the delivery of TP overt stuttering assessment in a clinical setting, thus addressing the barriers to access that are present for CWS aged 6-15 years.

A feasibility study of teleassessment for people with aphasia in Saudi Arabia and Kuwait

ABSTRACT Purpose The outbreak of COVID-19 impacted the delivery of outpatient services by various healthcare systems, including speech and language therapy services for people with aphasia (PWA). One possible solution here is telepractice (TP). Previous studies have shown TP to be comparable to the traditional face-to-face (FTF) delivery method for the assessment of PWA. However, these studies have largely been conducted in Western, English-speaking countries. This study evaluates the feasibility of TP to assess PWA using the Short Aphasia Test for Gulf Arabic speakers (SATG). Method The feasibility study adopted a within-subject cross-over study design, involving 19 individuals with post-stroke aphasia aged 25–64. Each participant was assessed twice using the SATG, once with each delivery method (FTF and TP) and the scores were compared. We collected a number of feasibility measures, including a comparison of the scores for FTF and TP. Anecdotal cultural influences on participant preferences for TP were noted by researchers. Results The Wilcoxon rank-sum tests showed a non-significant difference between the two methods in the overall scores and the subsection scores, except for the auditory comprehension task which showed significantly lower scores for TP delivery. High satisfaction with TP was reported, and practical considerations for implementing TP are discussed. Conclusion This study provides evidence of the feasibility of adopting TP to assess PWA in Saudi Arabia and Kuwait and highlights the influence of cultural aspects on the use of videoconferencing. Participants reported a preference for some FTF contact to support setting up TP and prior to the first TP session.

Barriers in Collaborative practice among SLP/Ts and Special Educationists Working in Special Education Settings.

Background: This study was conducted as an attempt to understand the pattern of collaborative behavior and the possible hurdles that Special Education (SE) teachers and school-based Speech-Language Pathologists/Therapists(SLP/Ts) might face, keeping them from efficiently meeting the Speech Language and Communication Needs(SLCN) of individuals in Special Education settings. 
 Objective(s): To investigate the needs of speech and language therapy service in special education settings.. To specify that the particular speech language and communication needs of an individual cannot be sufficiently met by one clinician alone. 
 Methodology: A comprehensive survey questionnaire was employed to attain a clear view of the similarities and differences between the groups of professionals, their understandings of terminology, spoken language indicators of SLCN, associated academic needs, behavioral challenges, and professional barriers to meeting the children’s needs.
 Results: Fluctuations in the response pattern for both groups were observed when it came to understanding of latest terminologies associated with SLCN, SLP/Ts were predominantly more aware of the terms than special educationists. Special education teachers were unexpectedly more aware of the academic and behavior features related to speech and language difficulties. However, training, advice as well as resource availability saw special educationists lacking whereas slp/ts showed a consistent pattern of having received the necessary training and resources. 
 Conclusion(s): A special education environment is designed to fulfill an individual’s needs, whether they be physical, sensory, cognitive or communicative and to achieve that goal, a compatible team of healthcare professionals and special educators is crucial. In this particular scenario, there is an impending need for both speech language pathologists/therapists and special educators to understand the prerequisites of each other’s role and more importantly how they can assist to provide better Individualized Education Plans(IEPs)(5), improve peer and staff interactions, prevent undesired behavioral interactions, evolve the academic experience and the therapeutic intervention necessary to enhance the quality of life of an individual with speech-language and communication needs.

Interventions for pre-school children with co-occurring phonological speech sound disorder and expressive language difficulties: A scoping review.

Recent evidence suggests that pre-school children with co-occurring phonological speech sound disorder (SSD) and expressive language difficulties are at a higher risk of ongoing communication and literacy needs in comparison with children with these difficulties in isolation. However, to date there has been no systematic or scoping review of the literature specific to interventions for children with this dual profile. To explore the evidence regarding interventions for pre-school children with co-occurring phonological SSD and expressive language difficulties, including the content/delivery of such interventions, areas of speech and language targeted, and a broad overview of study quality. A scoping review methodology was used in accordance with the guidance from the Joanna Briggs Institute. Following a systematic search of Ovid Medline, Ovid Emcare, OVID Embase, CINAHL, Psychinfo and ERIC, 11 studies were included in the review. A researcher-developed data extraction form was used to extract specific information about each intervention, with the JBI appraisal tools used to provide a broad overview of the quality of each study. Included papers consisted of six randomized controlled trials (RCTs), two cohort studies, two case studies and one case series. Interventions fell into two main categories: (1) integrated interventions that combined content for both speech and language targets and/or explicitly used the same type of technique to improve both domains; and (2) single-domain interventions that explicitly included content to target speech or language only, but also aimed to improve the other domain indirectly. Study quality varied, with detail on the content, context and delivery of interventions often underspecified, hampering the replication and clinical applicability of findings. Early emerging evidence was identified to support both integrated speech and language interventions as well as single-domain interventions. However, caution should be exercised due to the variation in the quality and level of detail reported for the interventions. Future intervention studies may seek to address this by reporting in accordance with Template for Intervention Description and Replication (TIDieR) reporting guidelines. This approach would enable clinicians to consider the applicability of the intervention to individual children within differing settings. What is already known on the subject Pre-school children with co-occurring phonological SSD and expressive language difficulties frequently present within speech and language therapy services. These children are at a higher risk of long-term communication and literacy difficulties compared with children with these needs in isolation. Some emerging evidence suggests that interventions for children with this co-occurring profile may exist within the literature; however, this evidence may not be known to clinicians in everyday practice. What this paper adds to existing knowledge This review is the first to systematically examine evidence of interventions for pre-school children with co-occurring phonological SSD and expressive language difficulties. The review identified a small number of intervention studies that varied in research quality and level of detail provided regarding the content and delivery of interventions. What are the potential or actual clinical implications of this work? The findings of this study highlight published evidence for interventions for pre-school children with co-occurring phonological SSD and expressive language difficulties. These may take the form of integrating techniques for speech/language into a single intervention, or the explicit targeting of one domain with the aim of also influencing the other. However, there is a need for further high-quality research in this area. Such studies should provide sufficient detail to enable replication. This would enable clinicians to understand the relevance and applicability of such intervention findings to the individual children they see within their clinical practice.

Electropalatography (EPG) activities in Japan and the impact of the COVID‐19 pandemic on EPG research and therapy: A report of presentations at the 7th EPG Symposium

BackgroundAt the 7th Electropalatography Symposium in Japan, held online on the 24 January 2021, a few speakers were invited to talk about how the COVID‐19 pandemic had impacted their research and/or speech therapy that involved the use of electropalatography (EPG) as well as the procedures adopted in order to continue their work in a safe manner. The information on protective measures when using instrumental techniques in speech research and therapy may be useful for colleagues in research and the clinic.AimsThe primary aims are: (1) to find out whether there are any published recommendations regarding protective measures for using EPG in research and clinic settings; (2) to discuss the impact of the pandemic and the corresponding restrictions and general protective measures directed (or advised) by local government and professional bodies at each stage of EPG work; and (3) to share experiences in using modified procedures for face‐to‐face EPG therapy sessions and combined EPG teletherapy. In addition, a brief overview of EPG and a summary of EPG research and clinical activities in Japan presented by one of the symposium organizers at the symposium are included.Methods & ProceduresA review of the literature regarding protective measures recommended for using EPG for speech assessment and treatment or research, supplemented by a discussion of our own experiences.Main ContributionThe literature review showed that there are no guidelines regarding protective measures for using EPG, but there is some advice regarding speech recording using microphones. Most published articles related to speech and language therapy (SLT) service during COVID‐19 are about telepractice or general clinical guidelines for face‐to‐face speech therapy sessions. The protective measures for using EPG developed based on the general guidelines recommended by local government and professional bodies (e.g., using visors, transparent acrylic board) were described. Using EPG in telepractice was discussed as well.ConclusionsIt has been challenging to continue EPG research and therapy during the pandemic. In order to deal with this crisis, available knowledge regarding infection control and recommendations from local government and professional bodies were applied to design methods and procedures that allowed EPG research and therapy to continue.What this paper addsWhat is already known on the subject There are general protective measures recommended by local government and professional bodies regarding speech therapy sessions (e.g., using personal protective equipment (PPE), social distancing), but little is known about the measures for using instrumental techniques in speech research and therapy, particularly EPG. The equipment of each instrumental technique is different, so measures that are appropriate for one may not be suitable for others. Hence, specific recommendations are needed for EPG. What this paper adds to existing knowledge This paper provides pointers to information about recommendations regarding protective measures for speech research and therapy, supplemented with suggestions specific to EPG provided by experienced users based on actual experience. What are the potential or actual clinical implications of this work? In evaluating the impact of the COVID‐19 pandemic on EPG research and therapy, an analytical approach was taken to break down the steps involved in carrying out those activities, and the challenges we faced and the possible alternatives for completing the tasks were discussed. A similar approach can be applied to evaluate other aspects of speech therapy service.

The ASCEND study: protocol for a feasibility study to evaluate an early social communication intervention for young children with Down syndrome

BackgroundDown syndrome is the most common cause of learning disability, affecting approximately 1 in every 700 babies. Children with Down syndrome have particular difficulties with speech and language. This makes it challenging for them to participate fully in life, access healthcare services and educational opportunities. Improving the language skills of young children with Down syndrome is vital for their future social and emotional well-being and behaviour, and consequently contribution to society. As Down syndrome is detected before or at birth, we can provide support from early on. There are currently no standard interventions for improving the language skills of children with Down syndrome under the age of 36 months. Evidence suggests that early parent-based interventions may be effective in improving language outcomes. In partnership with parents and speech and language therapists, we have co-developed an intervention focusing on early social communication skills and our preliminary work shows that it can lead to better language in children with Down syndrome. Our aim is to carry out a feasibility study which will inform a future pilot/full trial to test whether the intervention is effective in improving language skills before children with Down syndrome start school.MethodsThis is a two-arm feasibility randomised controlled trial (RCT), with 1:1 randomisation stratified by trial site comparing the intervention (plus standard NHS speech and language therapy) with no intervention (standard NHS speech and language therapy only). We aim to recruit between 25 and 30 children with Down syndrome aged between 11 and 36 months. Sites are defined by the geographical boundaries of three National Health Service (NHS) Trusts. Recruitment is from NHS Speech and Language Therapist caseloads within the 3 Trusts, and self-referral. In the intervention arm, parents/guardians will receive brief training on the parent-based intervention and a manual to follow with their child for 10 weeks. The children’s language and early communication skills and family health outcomes will be assessed by a blinded assessor at baseline, post-intervention and 6 month follow-up. Questionnaire and semi-structured interviews will explore the acceptability of the intervention to parents and SLTs.DiscussionThe feasibility study’s outcomes will determine whether it would be viable to progress to a full-trial and whether adjustments need to made to the procedures, data collection methods, intervention delivery and the intensity of support needed. We want to assess whether our early intervention can be delivered and rolled out through NHS Speech and Language Therapy (SLT) Services. We anticipate that NHS SLT Services will need to make ongoing changes due to the COVID-19 pandemic, so it is likely that we will need to make adjustments for the definitive trial. We will also calculate descriptive statistics of the language outcome measure which we will use for any future sample size calculation.Trial registrationISRCTN13902755. Registered on 25 August 2020. http://www.isrctn.com/ISRCTN13902755

Speech and language therapy services for people with Down syndrome: The disparity between research and practice

AbstractThe need for speech and language therapy (SLT) for people with Down syndrome (DS) is well documented. However, there is a significant disparity between research and practice. This study addresses two of the three pillars of evidence‐based practice by 1) quantitatively profiling some key features of the 2019 public SLT service in Ireland, and referencing this against current best evidence; 2) asking parents, and adults with DS what supports they need in relation to an adequate SLT service. Adults with DS (n = 33) and parents of those with DS (n = 557), completed an anonymous survey online. The function of the survey was to collect information on: SLT service provision; levels of satisfaction with services; and SLT supports required. Based on parent responses, only 44% of participants (n = 253) were offered public SLT services in 2019. The mode waiting time was 1–2 years and the average number of sessions across the age groups was 5 per year. There was a strong association between age and number of sessions. Individual therapy was the most common model of service. A total of 40% of parents reported a 0 level of satisfaction. Seven key themes emerged from the qualitative support data. None of the participating adults received public SLT services in 2019. Our aspiration for evidence‐based SLT practice is far from being realized. The average number of sessions reported, does not in any way approximate the intervention intensity specified in evidence‐based interventions. Our limited service, at all ages, has detrimental implications for people with DS and our negligible adult service is in breach of human rights. Targeted, strategic investment is needed to allow practice to be aligned with best evidence; to support and treat people with DS effectively; to allow them to reach their maximum potential; and to exercise their right to communicate.

Mental capacity legislation and communication disability: A cross-sectional survey exploring the impact of the COVID-19 pandemic on the provision of specialist decision-making support by UK SLTs.

Mental capacity legislation in the UK is designed to safeguard the rights of people who may need support, or may be unable, to make autonomous decisions. Very limited evidence has been published about the impact of the COVID-19 pandemic on the application of mental capacity legislation and, to our knowledge, none on the ability of speech and language therapists (SLTs) to support people with communication disabilities to engage in decision-making. To describe how UK SLTs supported people with communication disabilities to make decisions and participate in mental capacity assessments, best interests decision-making and advance care planning during the COVID-19 pandemic. This descriptive, cross-sectional study used an online survey to collect quantitative and qualitative data about SLTs' practice experiences between August and November 2020. SLTs working with a range of adult clinical populations in different care settings were sampled purposively from all UK jurisdictions. Participants were recruited through professional networks and social media. Quantitative data were summarized using descriptive statistics. Qualitative data were analysed thematically. Data were collected from 107 SLTs working in a range of settings across all four UK nations. The sample included SLTs working with people with neurological conditions, learning disabilities, mental health conditions and acute confusion. The need for SLT support appeared to increase during the pandemic. Most respondents were still able to offer support; however, the amount and nature of support varied. Quality of support was impacted by adjustments associated with social distancing and infection control restrictions. Personal protective equipment (PPE) was identified as a barrier to communication. Indirect working methods (e.g., telehealth) were inaccessible to some people with communication disabilities. Most respondents felt confident that legal requirements were upheld, but suggested this group was less able to engage in decision-making and had reduced access to support to manage their own health conditions. Some SLT services were limited in their ability to meet the decision-making support needs of people with communication disabilities during the COVID-19 pandemic due to structural and systemic barriers. This suggests that existing inequities in the provision of care for people with communication disabilities in the UK were amplified during the pandemic. What is already known on the subject People with communication disabilities may require support from healthcare professionals, including SLTs, to make decisions and communicate their wishes and preferences about their care, in line with mental capacity legislation. There is a lack of published evidence relating to how changes in staff deployment and resource during the COVID-19 pandemic may have impacted on the ability of SLTs to provide this support. What this paper adds to existing knowledge This study provides novel evidence about the ways in which UK SLTs supported people with communication disabilities to engage in mental capacity assessments, best interests decision-making and advance care planning during the COVID-19 pandemic. In some cases, the amount and quality of decision-making support available was affected negatively due to changes in healthcare delivery and resource management and SLT working practices. What are the potential or actual clinical implications of this work? This study suggests that some people with communication disabilities experienced greater barriers to receiving professional support to maximize their autonomy and manage their health conditions during the COVID-19 pandemic. Speech and language therapy services and healthcare commissioners should consider how best to ensure equitable service delivery to this population in resource-limited situations.

86 CELEBRATING TEN YEARS OF COMMUNITY LIAISON SPEECH AND LANGUAGE THERAPY SERVICE: BETTER PATHWAYS BETWEEN THE ACUTE HOSPITAL AND NURSING HOMES

Abstract Background The Community Liaison Speech and Language Therapy (CL SLT) service was established in July 2010. The aim of this new model of care was to provide a fast track home visit service to older persons with communication and swallowing difficulties living in one of the 27 nursing homes in the region. The service facilitates a safer discharge from hospital and admission avoidance with aspiration pneumonia due to rapid SLT follow up in the nursing home. Methods This is a retrospective analysis of the CL SLT service over the last ten years. Activity data, key performance indicators (KPIs) and staff and service user feedback were reviewed both quantitatively and qualitatively. How the service operated during the COVID- 19 pandemic was also examined to explore if new creative ways of working emerged. Results Analysis of the data showed a total of 5,699 SLT visits over the ten year period. Review of the KPIs showed that priority 1 referrals were seen within the ten working day target which meant that in some incidences residences were not kept on overly modified diets unnecessarily and in other cases the Speech and Language Therapist could respond rapidly to support decision making around quality of life feeding. User feedback showed high satisfaction with the service. Virtual clinics provided an adjunct to the service during COVID-19 and of note, face to face service was only stopped for two 6 week periods in the first and third waves of the pandemic. Conclusion The CL SLT model provides a quality, person centred service for older persons living in a nursing home. The care pathways from the acute hospital have allowed for admission avoidance with effective SLT management decisions, including around end of life feeding being made in the nursing home so that residences receive the right service in the right place and time.

124 OUTCOME OF SPEECH AND LANGUAGE THERAPY CLINICAL DYSPHAGIA ASSESSMENT FOLLOWING AN INTERDISCIPLINARY SWALLOW SCREEN

Abstract Background A 7 question non-validated swallow screen (Any reported swallowing difficulties? Any coughing with food or fluids? Any choking? Does food get stuck when eating? Any recurrent chest infections? Any pain when swallowing? Any difficulty swallowing tablets?) is used by an integrated care team for older persons to prioritise referrals to the Speech and Language Therapy (SLT) service. This study identified the proportion of patients screened who appropriately required a clinical dysphagia assessment and intervention. Methods This was a retrospective study from September 2020 to June 2021. Patients were assessed by the Clinical Specialist SLT who determined if swallow impairment was present and whether intervention was required. Age, gender and clinical frailty score were documented. Patients who resided out of the catchment area or who had already received an SLT service were excluded. Results The average age was 80 years, range 67–103. The male to female ratio was 2:1 and the average clinical frailty score (CFS) was 5. N = 42(32%) screened positive. N = 29(69%) attended for SLT assessment. N = 27(93.1%) had a swallow impairment identified. N = 20 were discharged following a single intervention and 9 required further SLT intervention. Conclusion Presbyphagia is generally asymptomatic and results from age related anatomical and physiological changes, reduced functional reserve and sarcopenia. Older adults compensate for these difficulties and do not seek assistance. Presbyphagia may progress to dysphagia, resulting in adverse outcomes. The high rate of SLT confirmed swallow impairment and need for SLT intervention highlights a need to prospectively refine and validate this 7 question swallow screen.

Speech and Language Therapy Service for Multilingual Children: Attitudes and Approaches across Four European Countries

Educational equality and the reduction of discrimination are among the UN’s Sustainability Goals. Previous studies as well as policy recommendations suggest that the extent to which these are implemented in the field of speech and language therapy for multilingual children depends on sufficient knowledge and material. To this end, an online survey was carried out with 300 Speech and Language Therapists (SLTs) from Austria, Germany, Italy, and Switzerland, investigating their attitudes and approaches regarding the service provision for multilingual children. Their responses were analyzed taking the SLTs’ language background, experience, and country of origin into account. Results were interpreted in the context of country-specific SLT service-related policies and SLT training as well as migration history. There seems to be a gap between the SLTs’ knowledge about the specific requirements for providing Speech Language Therapy (SLT) for multilingual children and their common practice, which—despite the continuous need of further training—points to sufficient awareness but a lack of materials or resources. We found experience in working with multilingual children to be the most influential factor on attitudes and approaches towards multilingualism. This suggests the importance of improving pre-exam and early-career professional experience to foster SLTs’ development of mindful attitudes and appropriate approaches towards multilingualism in their clinical practice.

Successes and challenges of speech language therapy service provision in Western Kenya: Three case studies.

BackgroundThe need for communication-related services in sub-Saharan Africa to support individuals experiencing communication disability is a longstanding and well-documented situation. We posit the inequities highlighted by coronavirus disease 2019 (COVID-19) make this a relevant time for speech language therapists and the professional bodies that govern us to broadly consider our roles and practices in education, health and disability in local, national and global contexts.ObjectiveTo illustrate what services developed with local knowledge can look like in Kenya in order to promote dialogue around alternative speech language therapy models, particularly in contexts where there are insufficient services, few trained speech language therapists and limited structures to support the emerging profession.MethodThis article examines three clinical case studies from Western Kenya, using a conceptual framework for responsive global engagement.ResultsService needs in Western Kenya well exceed a direct one-on-one model of care that is common in the minority world. The service delivery models described here emphasise training, skills sharing and engaging the myriad of communication partners available to individuals with communication disabilities.ConclusionWe offer up these case studies of collaborative practice as contextual realities that may be present in any speech language therapy programming in under-resourced communities. We dispel the idea that success in this work has been linear, progressed on planned time frames or come to fruition with targeted goal attainment. The fact that our relationships have endured in these communities since 2007 is our primary success.

Speech and language therapy service provision in spinal injury units compared to major trauma centres in England: Are services matched?

National UK guidance makes recommendations for speech and language therapy staffing levels in critical care and rehabilitation settings. Traumatic spinal cord injury patients often require admission primarily to critical care services within a major trauma centre prior to transfer to a specialist spinal injury unit but may not receive similar levels of care. Dysphagia and communication difficulties are recognised features of cervical spinal cord injury; however, little is known about access to speech and language therapy services to provide rehabilitation and improve outcomes. The aim of this study was to compare the workforce and clinical practices of speech and language therapy services in eight spinal injury units and four major trauma centres in England through an online survey. An online survey was created with 26 multiple-choice questions across seven sub-sections, with options for free-text comments. These were sent to a named speech and language therapy contact at each of the specified units. Responses were uploaded into Excel for analyses, which included descriptive statistics and analysis of themes. Responses were received from 92% (11/12) speech and language therapy services invited, which included seven out of eight spinal injury units and all four major trauma centres. No units met national staffing recommendations. Staff in spinal injury units provided an average of 27h per week input to the unit compared to 80h in a major trauma centre. Despite caseload variations, speech and language range of therapy involvement and prioritisation process were equivalent. Access to instrumental assessment varied, with less use of Fibreoptic Endoscopic Evaluation of Swallowing in spinal injury units despite its clinical value to the spinal cord injury caseload. Speech and language therapy services delivering post-acute and long-term rehabilitation to spinal cord injury patients are limited by their resources and capacity, which restricts the level of therapy delivered to patients. This may have an impact on clinical outcomes for communication and swallowing impairments. Further evidence is needed of the interventions delivered by speech and language therapists and outcomes will be beneficial alongside benchmarking similar services. What is already known on this subject In England, people who sustain a spinal cord injury are admitted to a major trauma centre prior to transfer to a specialist spinal injury unit. Dysphagia and communication impairments are recognised as a complication of cervical spinal cord injury and benefit from speech and language therapy intervention. National recommendations exist for staffing levels, expertise and competencies for speech and language therapists working in critical care and rehabilitation units. What this study adds This study identified variations in the levels of speech and language therapy staffing, seniority, service delivery and access to instrumental assessments for dysphagia between major trauma centres and spinal injury units. None of the services complied with national staffing recommendations. Clinical implications of this study Speech and language therapy services in spinal injury units are often available part-time or have limited access to diagnostic tools which limits the range and intensity of rehabilitation input available. This has clinical implications for outcomes for swallowing and communication as well as long-term consequences for integrating back into community.

A Subtle Profile With a Significant Impact: Language and Communication Difficulties for Autistic Females Without Intellectual Disability.

The presentation of autism in females is poorly understood, which is thought to contribute to missed or later- age diagnosis, especially for those without intellectual disability. Dedicated research into social and behavioral differences has indicated a specific female phenotype of autism. However, less has been done to explore language and communication profiles, despite known sex/gender differences in typically developing populations. This article provides a synthesis of recent work from this small but emerging field. It focuses on a series of four preliminary and explorative studies conducted by the authors and embeds this within the wider literature. Findings suggest a specific profile of language and communication strengths and weaknesses for autistic females without intellectual disability (compared to autistic males and typically developing females). Furthermore, despite the relatively subtle presentation of difficulties (compared to autistic males), the impact on functionality, social inter-relations and emotional well-being, appears to be equitable and significant. The discussion highlights the need for further empirical research and proposes areas for investigation. Implications for clinical practice include the need for better recognition, testing and provision of interventions dedicated to the language and communication difficulties for autistic females. This has relevance for diagnostic, mental health and speech and language therapy services.

Happy Talk: A pilot effectiveness study of a targeted-selective speech-language and communication intervention for children from areas of social disadvantage.

Despite the public health implications of language difficulties associated with social disadvantage, there is a dearth of effectiveness studies investigating the effects of targeted speech and language programmes in this area. To determine the effects of a targeted selective community-based child language intervention programme (Happy Talk), which simultaneously engaged with parents and early childhood educators, in the Republic of Ireland. A mixed methods methodology was applied with quantitative outcome and qualitative process data collected. Effectiveness was examined using a quasi-experimental single blind study design comparing Happy Talk with 'usual care' across four preschools. Qualitative process data were also gathered to examine the acceptability and feasibility of the Happy Talk approach in practice, and to identify factors to improve the probability of successful wider implementation. Child language (PLS-5) and quality-of-life measures were administered pre- and immediately post- the 11-week intervention. Responsiveness was assessed as the parental outcome, and the oral language environment of preschools was measured using the Communication Supporting Classroom Observation Tool (CSCOT). Retrospective acceptability was analysed with reference to the theoretical framework of acceptability (v 2). Pre-/post-expressive and composite language scores were collected for 58 children, and receptive scores for 54 children. Multiple linear regression revealed significant intervention effects for comprehension and total language with large and moderate effect sizes, respectively (0.60 and 0.46 SD). No significant effect was shown for parental responsiveness. No effects were found for the preschool environment or children's quality of life. Preschool staff deemed the programme to be an acceptable method of enhancing children's speech and language skills and rated the intervention positively. The Happy Talk pilot effectiveness trial shows that comprehension can be improved (with a large effect) in preschool children from areas of social disadvantage, following an 11-week intervention, in which parents and preschool staff are simultaneously engaged. The ecological validity of the programme, as well as feasibility and acceptability to staff, make it a suitable programme to be delivered at scale. What is already known on the subject Up to 50% of children from socially disadvantaged areas enter preschool with speech and language difficulties. The majority of intervention studies are (1) researcher led; (2) efficacy trials carried out in ideal conditions; and (3) focus on working with parents or early childhood educators rather than engaging with both groups simultaneously. Many studies omit child language outcomes, and those that include them tend to show relatively modest effects for expressive language and negligible effects for receptive language. What this paper adds to existing knowledge This pilot study shows that the Happy Talk programme, which is embedded in the community and which simultaneously engages with parents and early childhood educators, is highly effective in improving children's receptive language skills. These findings are particularly important in the context of (1) the study taking place in real world conditions; and (2) the programme being designed and refined by speech and language therapy services, rather than one which is researcher led. What are the potential or actual clinical implications of this work? Implementing an 11-week targeted selective community-based language intervention can result in a large positive effect on receptive language for children from areas of social disadvantage. The study findings highlight the importance of embedding intervention programmes in the community and of simultaneously engaging with parents and preschool staff.

Oral and Written Language Abilities of School-Age Internationally Adopted Children from Eastern Europe

Purpose: Children adopted from Eastern Europe were assessed at ages 6 to 7 years and results were compared to the same children when they were 8 years. Patterns of relative strengths and weaknesses in language, verbal memory and literacy were analyzed. Variables that predicted reading and writing were determined. Method: Children adopted from Eastern Europe between 1;0 and 4;11 years of age were assessed at ages 6 to 7 years and age 8 years on a variety of tests that measured language, verbal memory and literacy. Results were compared across ages, and language, verbal memory and literacy domains. Results: Group means for all measures fell within the average range at both ages. The children's scores were not significantly different from test norms except for measures of rapid naming and number repetition. However, a larger than expected percentage of children scored -1SD below the mean on decontextualized measures of verbal working memory and reading fluency. At age 8 years 24% of children received speech language therapy services and 26% had repeated a grade level. Vocabulary, expressive syntax, verbal short-term memory and writing were areas of relative strength. Higher level vocabulary knowledge was strongly correlated with all literacy measures. Conclusion: As a group, Eastern European adoptees scored average on measures of language and literacy at 6 or 7 years and again at age 8 years. However, 26% of the children had repeated a grade and 24% were still receiving speech and language services. Vocabulary was an area of strength reflecting the children's enriched adopted home environments. In-depth knowledge of vocabulary was the best predictor of reading and writing. Some aspects of working memory were a strength but others were not. Rapid naming was also a weakness.

Achieving \u2018coherence\u2019 in routine practice: a qualitative case-based study to describe speech and language therapy interventions with implementation in mind

BackgroundImplementation depends on healthcare professionals being able to make sense of a new intervention in relation to their routine practice. Normalisation Process Theory refers to this as coherence work. However, specifying what it takes to achieve coherence is challenging because of variations in new interventions, routine practices and the relationship between them. Frameworks for intervention description may offer a way forward, as they provide broad descriptive categories for comparing complex interventions. To date such frameworks have not been informed by implementation theory, so do not account for the coherence work involved in holding aspects of routine practice constant while doing other aspects differently. Using speech and language therapy as an empirical exemplar, we explored therapists’ experiences of practice change and developed a framework to show how coherence of child speech interventions is achieved.MethodsWe conducted a retrospective case-based qualitative study of how interventions for child speech problems had changed across three NHS speech and language therapy services and private practice in Scotland. A coherence framework was derived through interplay between empirical work with 42 therapists (using in-depth interviews, or self-organised pairs or small focus groups) and Normalisation Process Theory’s construct of coherence.FindingsTherapists reported a range of practice changes, which had demanded different types of coherence work. Non-traditional interventions had featured for many years in the profession’s research literature but not in clinical practice. Achieving coherence with these interventions was intellectually demanding because they challenged the traditional linguistic assumptions underpinning routine practice. Implementation was also logistically demanding, and therapists felt they had little agency to vary what was locally conventional for their service. In addition, achieving coherence took considerable relational work. Non-traditional interventions were often difficult to explain to children and parents, involved culturally uncomfortable repetitive drills and required therapists to do more tailoring of intervention for individual children.ConclusionsThe intervention coherence framework has practical and theoretical applications. It is designed to help therapists, services and researchers anticipate and address barriers to achieving coherence when implementing non-routine interventions. It also represents a worked example of using theory to make intervention description both user-focused and implementation-friendly.