Pediatric Speech-language Pathologist Research Articles

"They Can't Believe They're a Tiger": Insights from pediatric speech-language pathologists mobile app users and app designers.

Children with communication disorders experience difficulty in one or more areas of articulation and speech, language, fluency, voice and social communication, and they work with speech-language pathologists (SLPs) to improve their communication. With the rise of adoption and use for mobile applications among special education and healthcare service providers, SLPs also have implemented, and for some, contributed to the design of, mobile applications (apps) during clinical practice. However, how these mobile apps are designed and implemented for clinicians to facilitate their clients' communication and learning experiences during therapy remains underinvestigated. This qualitative research study investigates how mobile apps were designed for clinicians to target assessment and intervention goals. Additionally, it focused on how clinicians adopted these apps while integrating therapy techniques to facilitate their clients' learning. Informed by the Research, Practice, and Design for iPad Apps (iRPD) framework and the Consolidated Framework for Implementation Research (CFIR), semi-structured interviews were conducted with 37 licensed pediatric SLPs, including 23 SLPs who have used apps and 14 SLPs who have contributed to the design of their own mobile apps. Two rounds of qualitative coding via template analysis and thematic analysis were then used to analyse client and clinician characteristics, clinical practice, therapy tools, app characteristics, influential factors and app design and use recommendations. Results showed SLPs utilise different genres of assistive, educational and recreational game apps to support children's communication development when working with children who have diverse disorders and therapy needs across different age groups. SLPs who have designed their own apps emphasised the importance of following evidence-based practice, well-researched teaching methods and learning theories. Additionally, multiple financial, sociocultural, political and ethical factors contributed to the design, adoption and implementation of mobile apps during services. By understanding the clinician's app use practices situated in various therapy activities and techniques, we specified a list of design recommendations for app designers who are interested in creating mobile apps for supporting children's speech and language development. By bringing insights from both clinical practitioners as well as those with additional technical design backgrounds, this study contributes to the understanding of clinical practice needs and strategies and will lead to the most optimal app design and adoption practice to support the well-being of children with communication disorders. What is already known on the subject Speech language pathologist (SLPs) implement mobile apps for clients with diverse therapy needs, and their app adoption and use are influenced by multifaceted factors. Although prior studies have reported SLPs' mobile app use, additional information is still needed. For example, the research literature does not include how specific technology is used during therapy practice, or specific details about challenges and needs in implementing and utilising the technology. Additional research also needs to include influential factors (e.g., financial, sociocultural, political, ethical) that are considered when selecting, implementing, assessing and designing an app. The lack of research in these areas directly affects the understanding of clinical mobile technology practices and further hinders clinicians' abilities to advocate for better clinical and design decisions towards identifying and implementing effective mobile apps that facilitate children's communication. What this study adds to existing knowledge This qualitative study is the first known empirical research that interviewed pediatric speech-language pathologists who have used and designed mobile apps for children who receive speech-language therapy across different clinical settings. By investigating experiences from clinician stakeholders to illustrate a holistic overview of app design and development to deployment, this study reported finding on (1) how clinicians use mobile apps to help children to participate in different therapy activities, and (2) a list of recommended design and development guidelines that informs the design and use of mobile apps that best support and motivate children to engage in therapy. What are the potential or actual clinical implications of this work? This study disseminates clinician-reported practices of app design and use with pediatric clients across different speech-language disorders, and identifies gaps and needs for clinicians and researchers who are interested in understanding the role of mobile technology in relationship to human communication and interaction. Additionally, the paper demonstrates that SLPs have instrumental roles rather than passive users in influencing the design and implementation of different genres of mobile apps through evidence-based clinical practice, and call for partnerships across clinicians, special educators and technologists to support children's communication development.

Clinical practice of childhood apraxia of speech in Hong Kong: A web-based survey study.

A survey study on clinical practice not only provides insight into the implementation of knowledge, but also informs future investigations. There is a limited understanding of childhood apraxia of speech (CAS) in Cantonese speakers. This study examined the clinical practice of CAS in Hong Kong and discussed future directions of research for better evidence-based practice. Qualified Hong Kong pediatric speech-language pathologists (SLPs) completed the online questionnaire, which had a total of 48 questions regarding their knowledge of and experience with CAS in Cantonese speakers, including assessment, diagnosis, and treatment. Seventy-seven responses were received from Hong Kong SLPs. Most of the SLPs (83.2%) rated their understanding of CAS as either "a little" or "fair". About half (53.2%) of the respondents had worked with children with CAS. No standardized assessment or objective/quantitative measures were used clinically. Instead, seven assessment tasks, including imitation of polysyllabic words and speech and language samples were used commonly. Perceptual judgment of clinical features is still the most popular approach for diagnosis, with a variety of lists in use. Of concern was that, in addition to using some evidence-based approaches, local SLPs treated CAS using approaches that have limited evidence, in the context of less treatment frequency, targeting both speech and language skills within the same session, and with only partial implementation of the approaches. The results suggest that the understanding of CAS among local SLPs requires attention. One reason for this is that evidence regarding the assessment, diagnosis, and treatment of Cantonese speakers with CAS is still limited. Future investigations are needed.

Managing the child born preterm after hospital discharge

ABSTRACT Given the prevalence of preterm birth, all pediatric speech-language pathologists (SLPs) will work with children who were born preterm. Although most children born preterm do not experience developmental problems, more will experience feeding and language problems, and, to a lesser extent, voice, and speech problems, than children born at term, often in the context of broader developmental and medical concerns. As SLPs examine, assess, and treat children who are preterm post-hospital discharge and into the early years of life and beyond, they will benefit from a more holistic understanding of this population’s developmental challenges across domains. In this review, we will discuss the medical, social, and developmental underpinnings to working with a child born preterm in addition to describing the background and current evidence for assessing and treating feeding, language, speech, voice, and fluency disorders in this population.

A Tool for Differential Diagnosis of Childhood Apraxia of Speech and Dysarthria in Children: A Tutorial.

While there has been mounting research centered on the diagnosis of childhood apraxia of speech (CAS), little has focused on differentiating CAS from pediatric dysarthria. Because CAS and dysarthria share overlapping speech symptoms and some children have both motor speech disorders, differential diagnosis can be challenging. There is a need for clinical tools that facilitate assessment of both CAS and dysarthria symptoms in children. The goals of this tutorial are to (a) determine confidence levels of clinicians in differentially diagnosing dysarthria and CAS and (b) provide a systematic procedure for differentiating CAS and pediatric dysarthria in children. Evidence related to differential diagnosis of CAS and dysarthria is reviewed. Next, a web-based survey of 359 pediatric speech-language pathologists is used to determine clinical confidence levels in diagnosing CAS and dysarthria. Finally, a checklist of pediatric auditory-perceptual motor speech features is presented along with a procedure to identify CAS and dysarthria in children with suspected motor speech impairments. Case studies illustrate application of this protocol, and treatment implications for complex cases are discussed. The majority (60%) of clinician respondents reported low or no confidence in diagnosing dysarthria in children, and 40% reported they tend not to make this diagnosis as a result. Going forward, clinicians can use the feature checklist and protocol in this tutorial to support the differential diagnosis of CAS and dysarthria in clinical practice. Incorporating this diagnostic protocol into clinical practice should help increase confidence and accuracy in diagnosing motor speech disorders in children. Future research should test the sensitivity and specificity of this protocol in a large sample of children with varying speech sound disorders. Graduate programs and continuing education trainings should provide opportunities to practice rating speech features for children with dysarthria and CAS. https://doi.org/10.23641/asha.19709146.

The Evolution of Telepractice Use during the COVID-19 Pandemic: Perspectives of Pediatric Speech-Language Pathologists.

The study investigated how pediatric speech-language pathologists (SLPs) applied telepractice to compensate for the loss of in-person services and the dynamics of telepractice use during the COVID-19 pandemic in a rural state. We conducted interviews with 10 SLPs and then a statewide survey in which 51 SLPs participated. The qualitative interviews revealed themes including changes in service environment due to the pandemic (e.g., transition to telepractice, losing clients), challenges in the transition to telepractice (e.g., limited training, difficulty engaging clients), worsening wellbeing of clinicians and clients, and SLPs’ perspectives and suggestions towards telepractice in the future. Survey results showed service disruptions and transition dynamics during the pandemic. SLPs’ weekly caseloads reduced from an average of 42.3 clients prior to the pandemic to 25.9 and 23.4 from March to May and from June to September 2020, respectively, and then recovered to 37.2 clients from October to December 2020. In contrast, the number of telepractice caseloads sharply increased from 0.2 clients per week prior to the pandemic to 14.8 from March to May 2020. The weekly telepractice caseloads then declined to 5.5 clients from June to September and 7.9 clients from October to December 2020. In the months right after the pandemic outbreak (i.e., March to May), client children struggled with treatment gains and behavioral wellbeing. However, their outcomes gradually improved by October to December and approached pre-pandemic levels. About one-third of the SLPs reported that they would be more likely or much more likely to use telepractice in the future regardless of the pandemic. However, only about a quarter perceived telepractice as comparable to in-person services. We concluded that the transition from in-person services to telepractice substantially mitigated service disruptions right after the pandemic outbreak and that telepractice’s substitute role evolved over time.

Factors associated with frenotomy after a multidisciplinary assessment of infants with breastfeeding difficulties

ObjectiveFrenotomy for ankyloglossia has increased nearly 10-fold over the past few decades despite insufficient evidence that the procedure improves breastfeeding outcomes. There is no universally accepted method for identifying patients who may benefit from the procedure. The objective of this study is to determine if comprehensive feeding evaluations and targeted interventions can identify children who should undergo procedures, and to identify factors associated with lip or tongue frenotomy to treat breastfeeding difficulties. MethodsThis observational quality improvement study followed infant-mother dyads between March 2018 and December 2019 referred to our tertiary care center for breastfeeding difficulties. Speech and language pathologists performed comprehensive feeding evaluations on infants prior to surgical consultation for frenotomy. Infants’ oral anatomy and function and their ability to breast and bottle feed were assessed, and techniques for mothers to address feeding difficulties without a procedure were offered prior to surgical consultation. Infants either found success over a short observation period or underwent procedures (lip and/or tongue frenotomy). Results153 patients (mean age 47.0 days (stdev 39.0 days, 56.2% male) were referred for surgical division of the lingual frenulum. Following development of a program utilizing pediatric speech language pathologists to perform feeding evaluations prior to surgical consultation, 69.9% of patients subsequently did not undergo surgical procedures. 11 (23.9%) underwent labial frenotomy alone and 30 (65.2%) underwent both labial and lingual frenotomies. Frenotomy was associated with significantly increased worry subscale of the Feeding Swallow Impact Survey (FSIS) and decreased mean Breastfeeding Self Efficacy Scale score (p = 0.0001, p = 0.006, respectively). Tongue appearance was significantly associated with having a procedure, while lip appearance was not. The Bristol Breastfeeding Assessment Tool (BBAT) was lower in children undergoing tongue and/or lip frenotomy (p = 0.0006), while the Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) appearance and function scores were lower in children undergoing lingual frenotomy with or without lip frenotomy (p = 0.0008, p = 0.0009, respectively). ConclusionsThe majority of patients referred for ankyloglossia may benefit from nonsurgical intervention strategies based on findings from comprehensive feeding evaluation. Frenotomy is associated with higher maternal feeding-related worry and reduced breastfeeding self-efficacy scores. While tongue appearance is associated with frenotomy, functional assessment is critical for identifying patients who may also benefit from lip frenotomy.

Toward a paradigm shift from deficit-based to proactive speech and language treatment: Randomized pilot trial of the Babble Boot Camp in infants with classic galactosemia.

Background: Speech and language therapy is typically initiated reactively after a child shows delays. Infants with classic galactosemia (CG), a metabolic disease with a known high risk for both speech and language disorders, hold the keys towards evaluating whether preventive treatment is effective when the risks are known at birth.We present pilot data from a randomized parallel trial of an innovative proactive speech and language intervention program, the Babble Boot Camp (BBC). Method: Five children with CG, otherwise healthy, participated in the study from approximately 2 to 24 months of age. One of these was randomly selected as control receiving conventional management, which typically starts at age 2-3 years. A pediatric speech-language pathologist met weekly via telepractice with the parents in the treatment cohort. Parents implemented the prespeech, speech, and language stimulation and expansion activities according to the intervention protocol. The control child was still too young for conventional treatment. Primary outcome measures were speech sound production complexity in babble and speech and expressive vocabulary size. Secondary outcome measures were vocalization rates and developmental milestones in communication, motor, and cognition. The trial is ongoing. Results: All four treated children had higher speech sound skills in babble, three had higher speech sound skills in meaningful speech, two had higher expressive vocabularies, three had higher global developmental scores, and two had higher vocalization rates, compared to the control child with CG. Discussion: Given the high risk for speech and language delays in children with CG, finding on-schedule abilities in two or more of the treated children but not the untreated child is unexpected under random conditions. The trends toward beneficial effects of the BBC on speech sound production, expressive language, and communication milestones warrant appropriately powered larger clinical trials with full randomization. Trial registration: ClinicalTrials.gov NCT03838016 (12 th February 2019).

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

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

Toward a paradigm shift from deficit-based to proactive speech and language treatment: Randomized pilot trial of the Babble Boot Camp in infants with classic galactosemia

Background: Speech and language therapy is typically initiated reactively after a child shows delays. Infants with classic galactosemia (CG), a metabolic disease with a known high risk for both speech and language disorders, hold the keys towards evaluating whether preventive treatment is effective when the risks are known at birth. We present pilot data from a randomized parallel trial of an innovative proactive speech and language intervention program, the Babble Boot Camp (BBC). Method: Five children with CG, otherwise healthy, participated in the study from approximately 2 to 24 months of age. One of these was randomly selected as control receiving conventional management, which typically starts at age 2-3 years. A pediatric speech-language pathologist met weekly via telepractice with the parents in the treatment cohort. Parents implemented the prespeech, speech, and language stimulation and expansion activities according to the intervention protocol. The control child was still too young for conventional treatment. Primary outcome measures were speech sound production complexity in babble and speech and expressive vocabulary size. Secondary outcome measures were vocalization rates and developmental milestones in communication, motor, and cognition. The trial is ongoing. Results: All four treated children had higher speech sound skills in babble, three had higher speech sound skills in meaningful speech, two had higher expressive vocabularies, three had higher global developmental scores, and two had higher vocalization rates, compared to the control child with CG. Discussion: Given the high risk for speech and language delays in children with CG, finding on-schedule abilities in two or more of the treated children but not the untreated child is unexpected under random conditions. The trends toward beneficial effects of the BBC on speech sound production, expressive language, and communication milestones warrant appropriately powered larger clinical trials with full randomization. Trial registration: ClinicalTrials.gov NCT03838016 (12 th February 2019).

Toward a paradigm shift from deficit-based to proactive speech and language treatment: Randomized pilot trial of the Babble Boot Camp in infants with classic galactosemia

Background: Speech and language therapy is typically initiated reactively after a child starts showing delays. Infants with classic galactosemia (CG), a metabolic disease with a known high risk for both speech and language disorders, hold the keys towards evaluating whether preventive treatment is effective when the risks are known at birth. We present pilot data from a randomized parallel trial of an innovative proactive speech and language intervention program, the Babble Boot Camp (BBC). Method: Five children with CG, otherwise healthy, participated in the study from approximately 2 to 24 months of age. One of these was randomly selected as control receiving conventional management, which typically starts at age 2-3 years. A pediatric speech-language pathologist met weekly via telepractice with the parents in the treatment cohort. Parents implemented the prespeech, speech, and language stimulation and expansion activities according to the intervention protocol. The control child was still too young for conventional treatment. Primary outcome measures were speech sound production complexity in babble and speech and expressive vocabulary size. Secondary outcome measures were vocalization rates and developmental milestones in communication, motor, and cognition. The trial is ongoing. Results: All four treated children had higher speech sound skills in babble, three had higher speech sound skills in meaningful speech, two had higher expressive vocabularies, three had higher global developmental scores, and two had higher vocalization rates, compared to the control child with CG. Discussion: Given the high risk for speech and language delays in children with CG, finding on-schedule abilities in two or more of the treated children but not the untreated child is unexpected under random conditions. The trends toward beneficial effects of the BBC on speech sound production, expressive language, and communication milestones warrant appropriately powered larger clinical trials with full randomization. Trial registration: ClinicalTrials.gov NCT03838016 (12 th February 2019).

Bridging the gap in mobile interaction design for children with disabilities: Perspectives from a pediatric speech language pathologist

Speech language pathologists (SLPs) work with children with diverse types of disabilities. Their clinical knowledge and experience using mobile technology can inform child–computer researchers novel design techniques to facilitate communication and learning for children with disabilities. This paper presents perspectives from an SLP through an overview of design challenges and opportunities for children with communication impairments across disciplines such as instructional design, game design, and therapy design. By illustrating two clinical decision-making models and implementing a design-based research framework, designers and researchers may benefit from collaborating with SLPs for clinically-informed participatory design practices. Preliminary results from an ongoing case study and future research agenda is also described.

Pediatric Speech-Language Pathologists' Use of Mobile Health Technology: Qualitative Questionnaire Study.

BackgroundWhile technology use in pediatric therapies is increasing, there is so far no research available focusing on how pediatric speech-language pathologists (SLPs) in the United States use technology.ObjectiveThis paper sought to determine if, and to what extent, pediatric SLPs are using mobile apps, to determine what purpose they are using them for, and to identify gaps in available technology to provide guidance for future technological development.MethodsPediatric SLPs completed an online survey containing five sections: demographics, overall use, use in assessment, use in intervention, barriers, and future directions.ResultsMobile app use by 485 pediatric SLPs in the clinical setting was analyzed. Most (364/438; 83.1%) pediatric SLPs reported using technology ≤50% of the time in their clinical work, with no differences evident by age group (<35 years and ≥35 years; P=.97). Pediatric SLPs are currently using apps for intervention (399/1105; 36.1%), clinical information (241/1105; 21.8%), parent education (151/1105; 13.7%), assessment (132/1105; 12%), client education (108/1105; 9.8%), and other uses (55/1105; 5.0%). Cost (46/135; 34.1%) and lack of an evidence base (36/135; 26.7%) were the most frequently reported barriers. Most SLPs (268/380; 70.7%) desired more technology use, with no difference evident by age group (P=.81).ConclusionsA majority of pediatric SLPs are using mobile apps less than 50% of the time in a pediatric setting and they use them more during intervention compared to assessment. While pediatric SLPs are hesitant to add to their client’s screen time, they would like more apps to be developed that are supported by research and are less expensive. Implications for future research and app development are also discussed.

Toward a paradigm shift from deficit-based to proactive speech and language treatment: Randomized pilot trial of the Babble Boot Camp in infants with classic galactosemia

Background: Speech or language therapy is typically initiated reactively after a child starts showing delays. Infants with classic galactosemia (CG), an inborn error of metabolism with a known high risk for both speech and language disorders, hold the keys towards evaluating whether preventive treatment is effective when the risks are known at birth. We present pilot data from a randomized parallel trial of an innovative proactive speech and language intervention program, the Babble Boot Camp (BBC). Method: Five children with CG, otherwise healthy, participated in the BBC from approximately 2 to 24 months of age. One of these was randomly selected as control receiving conventional management. A pediatric speech-language pathologist met weekly via telepractice with the parents in the treatment cohort. Parents implemented the prespeech, speech, and language stimulation and expansion activities according to the protocol. The control child was still too young for conventional treatment. Primary outcome measures were speech sound production complexity in babble and speech and expressive vocabulary size. Secondary outcome measures were developmental milestones in communication, motor, and cognition. Outcomes in the treatment cohort were compared to typical children and the control child and to typically developing children represented in test norms and cases described in the literature . The trial is ongoing. Results: All four treated children had higher speech sound skills in babble, three had higher speech sound skills in meaningful speech, two had higher expressive vocabularies, and three had higher communication and personal-social skills, compared to the control child with CG. Discussion: Given the high risk for speech and language delays in children with CG, finding on-schedule abilities in two or more of the treated children but not the untreated child is unexpected under random conditions. The trends toward beneficial effects of the BBC on speech sound production, expressive language, and communication milestones warrant appropriately powered larger clinical trials with full randomization. Trial registration: ClinicalTrials.gov NCT03838016 (12th February 2019).

Communication and Feeding/Swallowing Disorders in 22q11.2 Deletion Syndrome: A Primer for the Pediatric Speech-Language Pathologist

Purpose Communication disorders are a hallmark feature of 22q11.2 deletion syndrome (22q11DS). Complex feeding and swallowing difficulties are also frequently present in children with this syndrome. Every speech subsystem may be affected in 22q11DS, leading to a variety of speech sound, motor speech, resonance, and/or voice disorders. Language delays and persisting social/pragmatic deficits are also common. Conclusion The speech-language pathologist is key to both the diagnosis and treatment of speech-language difficulties and feeding/swallowing disorders in children with 22q11DS, from birth through adulthood. This tutorial provides a current overview of communication and feeding/swallowing disorders associated with 22q11DS and strategies for assessment and treatment. The role of the pediatric speech-language pathologist in the management of children with this syndrome across a variety of settings is discussed.

Toward a paradigm shift from deficit-based to proactive speech and language treatment: Randomized pilot trial of the Babble Boot Camp in infants with classic galactosemia

Background: Speech and language therapy is typically initiated reactively after a child shows delays. Infants with classic galactosemia (CG), a metabolic disease with a known high risk for both speech and language disorders, hold the keys towards evaluating whether preventive treatment is effective when the risks are known at birth. We present pilot data from a randomized parallel trial of an innovative proactive speech and language intervention program, the Babble Boot Camp (BBC). Method: Five children with CG, otherwise healthy, participated in the study from approximately 2 to 24 months of age. One of these was randomly selected as control receiving conventional management, which typically starts at age 2-3 years. A pediatric speech-language pathologist met weekly via telepractice with the parents in the treatment cohort. Parents implemented the prespeech, speech, and language stimulation and expansion activities according to the intervention protocol. The control child was still too young for conventional treatment. Primary outcome measures were speech sound production complexity in babble and speech and expressive vocabulary size. Secondary outcome measures were vocalization rates and developmental milestones in communication, motor, and cognition. The trial is ongoing. Results: All four treated children had higher speech sound skills in babble, three had higher speech sound skills in meaningful speech, two had higher expressive vocabularies, three had higher global developmental scores, and two had higher vocalization rates, compared to the control child with CG. Discussion: Given the high risk for speech and language delays in children with CG, finding on-schedule abilities in two or more of the treated children but not the untreated child is unexpected under random conditions. The trends toward beneficial effects of the BBC on speech sound production, expressive language, and communication milestones warrant appropriately powered larger clinical trials with full randomization. Trial registration: ClinicalTrials.gov NCT03838016 (12 th February 2019).

Toward a paradigm shift from deficit-based to proactive speech and language treatment: Randomized pilot trial of the Babble Boot Camp in infants with classic galactosemia.

Background: Speech or language therapy is typically initiated reactively after a child starts showing delays. Infants with classic galactosemia (CG), an inborn error of metabolism with a known high risk for both speech and language disorders, hold the keys towards evaluating whether preventive treatment is effective when the risks are known at birth. We present pilot data from a randomized parallel trial of an innovative proactive speech and language intervention program, the Babble Boot Camp (BBC). Method: Five children with CG, otherwise healthy, participated in the BBC from approximately 2 to 24 months of age. One of these was randomly selected as control receiving conventional management. A pediatric speech-language pathologist met weekly via telepractice with the parents in the treatment cohort. Parents implemented the prespeech, speech, and language stimulation and expansion activities according to the protocol. The control child was still too young for conventional treatment. Primary outcome measures were speech sound production complexity in babble and speech and expressive vocabulary size. Secondary outcome measures were developmental milestones in communication, motor, and cognition. Outcomes in the treatment cohort were compared to typical children and the control child. The trial is ongoing. Results: All four treated children had higher speech sound skills in babble, three had higher speech sound skills in meaningful speech, two had higher expressive vocabularies, and three had higher communication and personal-social skills, compared to the control child with CG. Discussion: Given the high risk for speech and language delays in children with CG, finding on-schedule abilities in two or more of the treated children but not the untreated child is unexpected under random conditions. The trends toward beneficial effects of the BBC on speech sound production, expressive language, and communication milestones warrant appropriately powered larger clinical trials with full randomization. Trial registration: ClinicalTrials.gov NCT03838016 (12 th February 2019).

Feeding and Swallowing Issues in Infants With Craniofacial Anomalies

The problems with feeding and swallowing that occur as a result of clefts and craniofacial anomalies range in severity. The extent of clefting, as well as other structural, airway, and neurologic issues, are factors that contribute to potential difficulty with oral feeding mechanics and with the integrity of airway protection during swallowing. Oral motor dysfunction in conjunction with obstruction in the upper airway secondary to anatomic or physiologic anomalies has the potential to cause serious disruption to the necessary coordination of respiration and swallowing. Timely identification of problems is necessary to address threats to nutritional status and/or respiratory health. The pediatric speech-language pathologist has a primary role in the clinical assessment of oral motor/feeding skills, and in the recognition of clinical signs and symptoms of swallowing dysfunction that may warrant referral for instrumental assessment of swallowing function and airway protection. The objective of this article is to summarize the potential feeding difficulties and feeding strategy options for patients with Craniofacial Microsomia, 22q11.2 Deletion Syndrome, Treacher Collins Syndrome, and Pierre Robin Sequence. Awareness of the factors that impact upon the success of feeding and the efficacy of compensatory feeding strategies is key to best practice and successful patient outcomes.

The Rainmaker

You have accessThe ASHA LeaderGlimpses1 Sep 2014The Rainmaker Nahal A. PapehnMS, CCC-SLP Nahal A. Papehn Google Scholar More articles by this author , MS, CCC-SLP https://doi.org/10.1044/leader.GL.19092014.10 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In I often incorporate water play during my summer treatment sessions. One day I decided to make rain. I squeezed a few drops of blue dye into a bowl of water. Using a shovel with a few holes, we scooped the water and let the rain pour through. This simple activity went on for 20 minutes, during which we repeated the words “rain” and “pour,” introducing a new selection of words with a consonant-vowel-consonant pattern. My young client was having fun, learning these words in the appropriate context, and finally producing those final consonants. This activity helped show her that essentially anything can be “poured,” whether it’s juice, cereal or just pretend rain. About me: I am a pediatric speech-language pathologist in Thousand Oaks, California, in home and clinical settings. I am most passionate about early intervention and prevention. I love connecting with families, so I started Coos, Babble, & Talk in 2013 to offer parents and caregivers classes on how to stimulate their baby’s speech and language development through play. I blog for various websites, including my own. My motto is and always will be, “Learning language through play.” Author Notes —Nahal A. Papehn, MS, CCC-SLPwww.coosbabbletalk.com@coosbabbletalk Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 19Issue 9September 2014 Get Permissions Add to your Mendeley library History Published in print: Sep 1, 2014 Metrics Current downloads: 78 Topicsasha-topicsleader_do_tagasha-article-typesleader-topicsCopyright & Permissions© 2014 American Speech-Language-Hearing AssociationLoading ...

Validity and Responsiveness of VELO: A Velopharyngeal Insufficiency Quality of Life Measure

Test the Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) instrument for validity, reliability, and responsiveness. Observational cohort. Academic tertiary medical center. Children with VPI (n = 59) and their parents (n = 84) were prospectively enrolled from a pediatric VPI clinic. Pediatric speech language pathologists diagnosed VPI using perceptual speech analysis and rated VPI severity and speech intelligibility deficit (each as minimal, mild, moderate, or severe). All parents and youth 8+ years old (n = 24) completed the VELO instrument and other quality-of-life questionnaires at baseline; the first 40 subjects completed the VELO instrument again 2 weeks later. Treatments included Furlow palatoplasty (n = 20), sphincter pharyngoplasty (n = 14), or an obturator (n = 2), and 29 of 36 (81%) subjects completed the questionnaires 3 months posttreatment. VELO was tested with correlations for criterion validity against VPI severity, construct validity against speech intelligibility and velopharyngeal gap size, and concurrent validity against other quality-of-life measures (r > .40 demonstrating validity); for test-retest reliability using intraclass correlation (>.6 demonstrating reliability); and for responsiveness with the 3-month posttreatment measure using the paired t test. Parental responses are reported; youth responses showed similar results. The VELO instrument did not meet criterion validity (r = -.18, P = .10), or functional construct validity (r = -.37, P = .001), but did meet anatomic construct and concurrent validity (each r > .50, P < .01). VELO scores demonstrated excellent test-retest reliability (r = .85, P < .001) and responsiveness (baseline 54 ± 14 to posttreatment 70 ± 18, P < .001). VELO provides a VPI-specific quality-of-life instrument that demonstrates concurrent validity, test-retest reliability, and responsiveness to change in quality of life with treatment.

International Service That Really Serves

International Service That Really Serves