Speech-language Pathology Practice Research Articles

A systematic review of evidence relating to the use of telesupervision for speech-language pathology students on clinical placements.

The use of telepractice in delivering speech-language pathology services is increasing and speech-language pathologists are providing supervision to students on clinical placements through telesupervision. The review examined literature on telesupervision for speech-language pathology students on a clinical placement. To systematically review the literature on how, when, and why telesupervision is used by speech-language pathologists supervising students; and the views and experiences of students, practice educators, and clients on telesupervision. A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines through searches in six databases (CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science and Educational Resources Information Center). Quality of the studies was examined using the Quality Assessment Tool for Studies with Diverse Designs. In total, the eight studies included in the review described the use of telesupervision with speech-language pathology students. The studies revealed that telesupervision is considered an effective supervision model for speech-language pathology students, as an adjunct to in-person supervision. Multiple aspects of telesupervision in the studies related to workplace settings, access to and training of technology, type of caseload, practice educator attributes, and the student-educator supervisory relationship. Speech-language pathology educators and students consider telesupervision to be a useful and effective model of supervision, when used as an adjunct to in-person supervision. Although there is limited research to date examining the use of telesupervision in speech-language pathology, the findings of this review can be used to guide support of educators and students as well as inform future research in this area. What is already known on this subject Telesupervision in speech-language pathology allows for an extension of clinical placement opportunities into a wider variety of locations including rural and remote settings and where a practice educator might not be available in person. Telesupervision can reduce costs and travel time and increase the time in the day available for supervision. What this study adds to existing knowledge Considering the potential for telesupervision to expand placement opportunities, this review provides important insights into educator and student views on its implementation and outcomes. All studies in this review occurred prior to COVID-19 restrictions on placements and so provide a context for any developments since and inform future research on telesupervision. What are the clinical implications of this work? While there is some evidence that practice educators and students alike consider that telesupervision can be effective, no studies were found to report on telesupervision as a standalone supervision method. Review findings could be used by speech-language pathology student placement co-ordinators and practice educators in (a) deciding if telesupervision holds potential for the specific work setting and clinical caseload, (b) determining if they have suitable technology and support in the use of the technology, and (c) identifying ways to support the educator-student relationship when using telesupervision.

Critical reflection on speech-language pathology practices in a Majority World context: journeying toward equitable and culturally responsive services

Critical reflection on speech-language pathology practices in a Majority World context: journeying toward equitable and culturally responsive services

Perceptions of Artificial Intelligence and ChatGPT by Speech-Language Pathologists and Students.

This project explores the perceived implications of artificial intelligence (AI) tools and generative language tools, like ChatGPT, on practice in speech-language pathology. A total of 107 clinician (n = 60) and student (n = 47) participants completed an 87-item survey that included Likert-style questions and open-ended qualitative responses. The survey explored participants' current frequency of use, experience with AI tools, ethical concerns, and concern with replacing clinicians, as well as likelihood to use in particular professional and clinical areas. Results were analyzed in the context of qualitative responses to typed-response open-ended questions. A series of analyses indicated participants are somewhat knowledgeable and experienced with GPT software and other AI tools. Despite a positive outlook and the belief that AI tools are helpful for practice, programs like ChatGPT and other AI tools are infrequently used by speech-language pathologists and students for clinical purposes, mostly restricted to administrative tasks. While impressions of GPT and other AI tools cite the beneficial ways that AI tools can enhance a clinician's workloads, participants indicate a hesitancy to use AI tools and call for institutional guidelines and training for its adoption.

Engaging with injustices: progressively re-orienting our practices in speech-language pathology toward community development

Engaging with injustices: progressively re-orienting our practices in speech-language pathology toward community development

Collaborative approaches with stakeholders in speech-language pathology: Narrative literature review.

Collaborative approaches in speech-language pathology (SLP) aim to integrate the experience of clients and people important to them by including these stakeholders actively in decision making. This inclusion can lead to more effective, engaging, and safer SLP practice. A variety of collaborative approaches have evolved in response to sociocultural contexts, and as a result, there are many different approaches currently in use such as co-design, co-production, and co-creation. However, despite widening acceptance and utilisation of collaborative approaches, the use and evidence for these in SLP literature have not been considered collectively. The current study aims to explore how collaborative approaches, used to develop products or services in SLP, are reported in literature. Using narrative review methodology, a systematic search of three databases and hand searching were conducted to explore how collaborative approaches, used to develop products or services, are reported in SLP. Search terms reflected the breadth of collaborative approaches and the diverse nature of SLP across clinical practice. Following screening of initial data, 59 articles were identified for data extraction and narrative synthesis. An internationally recognised reporting checklist for stakeholder involvement called the Guidance for Reporting Involvement of Patients and the Public, Version 2 (GRIPP2), informed the reviewing process in addition to qualitative description. Collaborative approaches across SLP practice were found to be diverse as were the terminology and tools used for collaboration. Two-thirds of the studies were published after 2020. The timing and involvement of stakeholders in collaborative approaches varied greatly; however, most stakeholder involvement was found in the conducting of research activities, compared to other areas such as planning, analysis, and reporting. The GRIPP2 review indicated strengths and opportunities in reporting of stakeholder involvement. When stakeholder involvement was rigorously reported it could include reflection on how stakeholders contributed within their communication abilities and how this contribution benefited the study. Collaborative approaches reported in SLP focused on valuing and respecting people with living experience of communication and swallowing difficulties. This narrative review contributes to the resources available to support decision-making and working together with stakeholders, encouraging SLPs to reflect, consider the context and respond. Future research could continue to strengthen consistency in terminology for collaborative approaches, use frameworks to plan and report stakeholder involvement and carefully consider involvement across the research continuum. What is already known on this subject There is an expectation that health services include stakeholders in development and evaluation of services. Collaborative approaches in speech-language pathology (SLP) aim to integrate the lived experience of people with communication and swallowing difficulties and those important to them. These approaches, including but not limited to, co-design, co-production and participatory action research, have shared philosophies of being community-driven, strengths based and inclusive (Loeffler & Bovaird, 2021). What this paper adds to existing knowledge This study contributes information about current SLP practice when collaborative approaches have been employed to develop a product or service. The study maps diverse collaborative approaches and their frequency in the literature, as well as the various stakeholders involved, using the Guidance for Reporting Involvement of Patients and the Public, Version 2 (GRIPP2) checklists to guide the review of reporting stakeholder involvement. What are the potential or actual clinical implications of this work? This synthesis of literature supports researchers and clinicians in making intentional decisions in implementation and reporting of collaborative approaches. This decision-making can strengthen the implementation of collaborative approaches, which has implications for person-centred care in SLP.

Validated patient reported outcome measures in speech-language pathology: A scoping review of adult practice

Purpose Patient reported outcome measures (PROMs) are increasingly used to inform value-based healthcare. Within speech-language pathology (SLP), there is no synthesis of validated PROMs to guide professional practice. This scoping review systematically identifies and evaluates condition-specific PROMs across adult SLP practice. Method A literature search was performed to identify studies published until 18th February 2022 from MEDLINE, Embase, CINAHL, PsycInfo, Scopus, Cochrane Collaboration, and Web of Science. s and full texts were screened in Covidence. Relevant studies that validated PROMs in English were extracted and assessed using the “Checklist to operationalise measurement characteristics of PROMs” by two independent reviewers. Result Ninety-seven articles provided validation data for 71 PROMS across seven SLP practice areas. These included voice (n = 18), swallowing (n = 14), language (n = 11), fluency (n = 8), speech (n = 4), laryngectomy (n = 3), and cognitive-communication (n = 2). No PROMs were identified for augmentative and alternative communication (AAC) (n = 0). Quality ratings were variable on the Francis et al. checklist. Conclusion A range of validated PROMs were identified to guide SLP practice in measuring patient perceptions across a range of practice areas in adults. Opportunities for further development in SLP practice areas with limited PROMs, such as speech, cognitive-communication, and AAC are also highlighted.

Approaches towards pragmatic language assessment in Indian pre-schoolers: A survey among speech-language pathologists.

Pragmatic language assessment in children is performed in line with standard protocols, guidelines, and best practices. The absence of these aspects in the Indian context has resulted in the quest to explore the approaches used by speech-language pathologists (SLPs) to assess pragmatic language impairments. This survey explored the current practices of SLPs towards the assessment of pragmatic language among preschool children in India. It also aimed to identify the barriers, facilitators and identify the level of knowledge, skill and overall practice of SLPs towards their practices using self-appraisal. A total of 100 SLPs(94 females and 6 males) working with preschool aged children (three-to-six-year-olds) from across different Indian states participated in the survey. Participants were enquired about the aspects of pragmatic language assessed, methods used for assessment, awareness and use of Indian tools, the settings, members, and language used for the assessment. Additionally, they were asked to mention the specific tools used, informal methods used, barriers and facilitators, and self-appraise their knowledge, skill and overall practice. Majority of participants assessed multiple aspects of pragmatic language. All used a combination of different assessment methods, with the participants commonly using informal compared to formal approaches. Preschoolers were assessed at multiple settings, along with different communication partners. Lack of awareness on assessment tools developed in India was the major barrier, while the use of informal tasks or activities were the major facilitators influencing pragmatic language assessment to a greater extent. The knowledge and skills for the assessment of pragmatic language obtained poorer scores compared to practices. The assessment practices of the SLPs were largely influenced by the unavailability of developed or adapted tools for Indian preschoolers, leading to the need to develop indigenous assessment tools. Certain considerations for further assessment practices have been identified and discussed.

Awareness and practices of Speech Language Pathologists (SLPs) working with chronic cough in India: a call for action.

A cough persisting beyond eight weeks is referred as chronic cough (CC) and is a common symptom of many respiratory conditions and non-respiratory conditions. The role of a speech language pathologist (SLP) in CC is emerging and this study aimed to profile the awareness and practice patterns of SLPs practicing in India. Cross-sectional study. An online survey was used to profile the assessment, treatment and counselling practices in CC among SLPs working in India. It sought to identify the awareness levels among SLPs regarding their role and availability of behavioural interventions for CC. Only SLPs who dealt with CC could complete the entire survey while other SLPs, filled regarding awareness and availability of behavioural interventions. 127 eligible responses obtained from SLPs working across clinical settings in India were analysed. 75.59% (n=96) of them had not seen patients with CC in their career. 47.24% (n=60) of them were aware that behavioural interventions were available for CC. Thirty-one SLPs completed the entire survey and their practice patterns indicated that few clinicians used cough-specific protocols while largely relying on voice and swallowing related assessment and treatment for CC. This survey the lack of awareness of SLPs' role in CC and that their practices are dominated by existing procedures for voice and swallowing disorders. Increasing the awareness of SLP's role in CC may increase the caseload of patients referred and expand the SLP's scope of practice. Development of guidelines in CC practice and inclusion in coursework/curriculum are future considerations.

Clinical practices in Swedish speech-language pathology for children with (developmental) language disorder

ABSTRACT In Sweden, treatment for children with (developmental) language disorder ((D)LD) is traditionally carried out at a speech-language pathology (SLP) clinic, and based on formal language tests, which may not entirely represent the child’s everyday language and communication skills. SLP services that include video recordings have shown positive outcomes in terms of providing information about children’s linguistic and communicative abilities in everyday life, but little is known about the use of video in clinical practice. The aim of this study is therefore to investigate how Swedish SLPs link their clinical practices (assessment, treatment, and evaluation of treatment outcome) to the everyday language and communication abilities of children with (D)LD. A further aim is to explore SLPs’ utilisation of video recordings as a part of their clinical practices with the target group. A web-based questionnaire was distributed to SLPs in Sweden, who work with children with (D)LD. Results demonstrate that Swedish SLPs perceive that their intervention is in alignment with children’s everyday language and communication needs to a fairly high degree. However, an exception is assessment, which is considered to have a weaker alignment with children’s everyday communication abilities. The use of video recordings for clinical purposes is very limited. It is suggested here that incorporating video recordings from children’s everyday life would be an easy and time-efficient way to strengthen the ecological validity of SLP practices for children with (D)LD.

A Goal-Writing Framework for Motor-Based Intervention for Childhood Apraxia of Speech.

There are multiple frameworks for goal writing that are applicable to the practice of speech-language pathology. Motor-based speech disorders are a subset of speech sound disorders that are thought to require specific elements of intervention that are typically not addressed in the traditional frameworks used in the clinical setting. The purpose of this tutorial is to review general approaches of goal writing and suggest additional elements that may be used to improve the efficiency and effectiveness of treatment for childhood motor speech disorders, specifically childhood apraxia of speech (CAS). Existing models of goal writing were reviewed to ascertain elements common to most of these models. A basic framework was chosen and modified to include behaviors, conditions, and approaches to goal measurement tailored to the clinical needs of children with CAS. A resource for clinical decision making for children with CAS was developed to inform goal writing at the onset of treatment and adaptations that occur over the course of treatment. Case studies are presented to demonstrate how the presented framework can be applied to writing goals for motor-based treatment for two different children with CAS. Children with CAS require a specialized approach to intervention, which requires goals to reflect the unique clinical needs of this population. This tutorial offers resources that use the best available research evidence and current understanding of effective treatment practices for CAS to guide clinical decision making for motor-based intervention and goal writing. This tutorial is intended to guide treatment planning across varied settings to facilitate progress and optimize treatment outcomes for children with CAS.

Amplifying the voices of underrepresented speech-language pathologists: A scoping review using the transformative research paradigm

Purpose To investigate the characteristics of studies that included underrepresented speech-language pathologists (SLPs) as research participants. Method A scoping review was conducted using the principles of the transformative research paradigm, which promotes the meaningful involvement and empowerment of marginalised groups. Co-production with minority SLPs was facilitated. The search strategy was run in six databases, and the transformative checklist used for analysis. Result Twenty studies were included. Bilingual and male SLPs were among the most commonly included underrepresented SLPs. Most studies were conducted in the USA (n = 16), and used survey methods. The studies provided valuable insights into the experiences and practices of underrepresented SLPs, and yielded practical solutions to foster inclusion and diversity in the profession. Most studies demonstrated a transformative potential, but the active engagement of underrepresented SLP participants in the research cycle was rarely demonstrated. Conclusion This review calls for a shift in how and why research is conducted when including underrepresented SLP participants. Through the lens of the transformative research paradigm, we can rethink the broader aim of research and the role of researchers and participants. Using research as a platform to give visibility, voice, and agency to minority groups can stimulate change and equity in the profession.

Augmentative and alternative communication: the experience of Malaysian speech-language pathologists and caregivers of individuals with aphasia

ABSTRACT Background Augmentative and Alternative Communication (AAC) serves as a compensatory intervention approach for individuals with aphasia and is often introduced by speech-language pathologists (SLPs) after outcomes from restorative approaches plateau. Communication partners (i.e., caregivers) have a pivotal role in ensuring the successful use of AAC by adults with aphasia. Despite there being a large body of research on the use of AAC by adults with aphasia little is known about the experience of caregivers of individuals with aphasia who use AAC in supporting its use. Aims This study conducted in Malaysia was aimed to (a) explore the practices of Malaysian SLPs when introducing AAC to adults with acquired communication disorders (ACD) including aphasia and (b) describe the experience of caregivers regarding the use of AAC by adults with aphasia under their care. Method & Procedures This mixed-methods study had two phases. In Phase 1, a survey was distributed to 200 SLPs throughout Malaysia. Thirty-seven SLPs who met the inclusion criteria of having a caseload of more than 80% adults and at least 20% adults with aphasia responded to the survey and provided information about their use of AAC. For Phase 2, eight caregivers of adults with aphasia who had been introduced to AAC were interviewed to obtain information about their experience using AAC. Outcomes & Results Findings from Phase 1 indicated that Malaysian SLPs most often introduced unaided and low-tech AAC to adults with ACD (including aphasia). Most of them felt that they lacked knowledge and skills in the provision of AAC services to adults and hoped for more training. Three themes emerged from the qualitative content analysis conducted on interview transcripts from Phase 2: (a) the positive impact of the use of AAC, (b) challenges faced when using AAC, and (c) hopes for the future. The findings of this study suggest that both SLPs and caregivers recognize the importance of AAC for adults with ACD including aphasia and need to work together closely to promote inclusion of adults with aphasia who use AAC and acceptance of AAC as a form of aphasia rehabilitation.

Examining the Family-Centeredness of Speech-Language Pathologists Working With Children Who Use Augmentative and Alternative Communication.

Family-professional partnerships are important for youth learning to use aided augmentative and alternative communication (AAC). This study examined the family-oriented beliefs and practices of speech-language pathologists (SLPs) working with preschool and school-aged children learning to use aided AAC (aged 3-21 years), specifically during the COVID-19 pandemic. Participants were 25 SLPs who participated in an individual semistructured interview. Qualitative analysis was used to identify and describe groups of SLPs based on commonalities and differences in their beliefs and practices working with families. The characteristics of SLPs in each group was also explored descriptively (e.g., race/ethnicity, work setting, caseload). SLPs clustered into three groups based on their beliefs and practices: (a) professionally centered, (b) family-allied, and (c) family-focused. SLPs varied across these groups in how they planned services, offered training/coaching, communicated, shared resources, offered emotional support, and adapted to and with different families. Findings indicate the need to support greater family-centeredness in AAC services by building on the strengths of SLPs in the field. Promoting strong family-professional partnerships could in turn improve outcomes for students who use AAC. https://doi.org/10.23641/asha.25044125.

Designing a Module on Stuttering and Cluttering: A Guide for Speech-Language Pathology Educators.

Due to the scope of practice of speech-language pathology (SLP) expanding considerably in recent times, there is reduced emphasis on certain communication conditions within the curricula of SLP university programs. Stuttering and cluttering are neglected components of such curricula, despite the complex clinical skill set required to work with these client groups. Evaluation of the content and quality of modules on stuttering and cluttering is warranted to ensure that SLP students are graduating with adequate competence and confidence for supporting people with these conditions. This tutorial, based on a review of the literature, aims to provide guidance to educators who are designing or revising such modules. The All Ireland Society for Higher Education (AISHE) model for module design provides a practical and theoretically underpinned guide to educators in higher education on the design of a new module or the review of an existing one. The model's seven key components are discussed, and their application to a module on stuttering and cluttering is outlined. The AISHE model provides a systematic and user-friendly approach to module design in SLP university programs. It supports educators who are designing a new module or revising a module currently being taught on stuttering and cluttering. Educators are encouraged to familiarize themselves with the seven components of the AISHE model and to use it as a tool to design or revise modules on stuttering and cluttering. This will ensure that SLP students are graduating with increased competence and confidence in working with these client groups.

Patient Characteristics and Treatment Patterns for Speech-Language Pathology Services in Skilled Nursing Facilities.

Skilled nursing facility (SNF) care has historically been influenced by systemic issues that could impact speech-language pathology (SLP) service provision. However, there has been little study specifically on factors associated with SLP service provision in SNFs. Large administrative data sets are rarely analyzed in SLP research but can be used to understand real-world SLP services. This study investigated associations between patient and facility characteristics and SLP services. Mixed-effects logistic regression models were used to evaluate factors associated with SLP service provision in 2018 Medicare administrative data representing 833,653 beneficiaries. Beneficiaries had higher odds of receiving SLP services when they had neurologic diagnosis (odds ratio [OR] = 3.32), had SLP-related functional impairments (ORs = 1.19-3.41), and received other rehabilitative services (ORs = 3.11-3.78). Beneficiaries had lower odds of receiving SLP services when they received care from SNFs located in hospitals versus freestanding (OR = 0.45), with need for interpreter services (OR = 0.76) and with thresholding (OR = 0.68), a financially motivated practice. Direction of association varied across racial and ethnic groups and measures of location. Odds of being provided SLP services decreased with increasing communication impairment severity. The results suggest that clinicians are identifying patients with diagnoses most likely to warrant SLP services. However, association disparities and weakening association of service provision with increasing impairment severity have concerning clinical implications. Health services research methods can be used to further explore SLP practices in SNFs to support equitable service provision.

Development of a Comprehensive Cough Therapy Program (CCTP) for chronic cough in India: a qualitative study.

Chronic Cough (CC) is an emerging area of practice in speech language pathology. Behavioral treatment for managing CC has gained attention in the recent past. This study aimed to devise a comprehensive behavioural therapy program for CC by involving allied health professionals (AHPs), who are typically involved in management of CC. A qualitative methodology was used to devise a behavioral treatment module for CC. Practice patterns of medical professionals, AHPs and yoga practitioners for CC were gathered through semi-structured interviews. A constant comparative framework was used to recruit participants until data saturation was achieved. The interview transcripts were analyzed to identify relevant components for the module. A post-interview survey was conducted to finalize the module through a consensus-based approach. Three themes and respective sub-themes were identified from analysis. The module was developed based on the treatment strategies followed by professionals and was labeled 'Comprehensive Cough Therapy Program (CCTP)'. This comprised four components - similar to what is available in literature - patient education, breathing exercises, laryngeal hydration, and cough control strategies. This was devised using inputs from the interviews and evidence in the literature. In line with global guidelines, this behavioral treatment module can serve as a possible management option for CC.

Status of prosody in the practices of speech-language pathologists in France: A survey on theoretical and clinical dimensions

PurposeMany populations in the scope of speech and language pathologists (SLPs) are at risk of prosodic disorders that can impact communicative ability. While a few studies have examined the importance of prosody in the clinical practice of English-speaking SLPs, there is a lack of similar research in non-English-speaking countries. The current study aimed to establish an overview of the situation in France and to determine factors that might be associated with assessing and treating prosody. MethodWe collected data about the theoretical and clinical dimensions related to prosody from SLPs in France using an online survey. ResultsOne hundred and twenty-eight valid responses were analyzed. Results suggest that both emotional and linguistic prosodies are examined by SLPs. Some aspects of prosody seem to be mastered better than others. While they are aware of the major prosodic difficulties in various pathologies and their negative impact, most SLPs in France rarely or never assess prosody. They feel more uncomfortable with it than with other speech-language domains and often do not consider it as a therapeutic target. Importantly, the perception of prosody as a therapeutic tool is associated with the frequency of assessing and addressing prosodic impairment. ConclusionsFurther studies should focus on identifying the factors that could improve practices and developing comprehensive assessment tools and evidence-based intervention methods in French. Providing better training in prosody and setting up more collaborations between SLPs and researchers in linguistics and psycholinguistics would be keys in developing this field.

Go Beyond Compliance: Use Individualized Education Programs to Answer Strategic Questions and Improve Programs.

The most significant document to ensure effective and compliant design, implementation, monitoring, and enforcement of a program of special education services in the United States is the Individualized Education Program (IEP). Although IEPs have been used to document procedural compliance with the Individuals with Disabilities Education Act (IDEA) for individual students, IEPs also provide extensive data that can and should be used by a variety of stakeholders including speech-language pathologists (SLPs), school administrators, and state education agencies to design targeted professional development and collectively improve programs, processes, and outcomes in special education. We summarize existing literature on the use of IEP data and describe opportunities to use IEP data to analyze individual student service patterns and SLP practice patterns. Aggregated IEP data also provide a robust view of district-wide and state trends in eligibility rates and least restrictive environment settings. Information on current and potential IEP data uses, reflection questions for substantive compliance, and lessons learned from a large-scale analysis of IEP data are provided. These lessons include potential software adjustments to enhance usability as a data source for substantive compliance; program improvement; and monitoring individual, school-wide, and district-wide outcomes. IEP data are a rich data source of information that may be used to (a) identify trends; (b) assist schools, districts, and states with ensuring substantive compliance with IDEA; (c) examine service equity and efficacy; (d) identify professional development needs; and (e) identify promising practices and provide opportunities to use real-time data to improve models and address public policy.

Vocabulary Selection and Implementation in Vocabulary Interventions for Speech-Generating Devices: A Scoping Review

Purpose: Intervention studies contribute to evidence-based practice in speech-language pathology. With individuals who use speech-generating devices (SGDs), it is important to determine what vocabulary to teach during intervention. However, it is unclear whether researchers are reporting the vocabulary selection techniques they used in intervention studies so that they may be replicated in clinical practice. The purpose of this scoping review was to examine the vocabulary selection techniques and other aspects of intervention studies focused on vocabulary acquisition in early symbolic communicators who use SGDs. Method: Eight databases (PsycINFO, PubMed, Scopus, Web of Science, Educational Resources Information Center, Linguistics and Language Behavior Abstracts, Educational Research Complete, and CINAHL) were systematically searched for articles that were intervention studies targeting single-word vocabulary acquisition in early symbolic communicators who use SGDs. Data were extracted from each article and charted in Excel. Results: We found 5,405 unique articles, 18 of which met the inclusion/exclusion criteria for this review. All of the studies used a single-case design with three participants on average. Approximately half took place in the child's school, and most of the interventions were conducted by members of the research team. Eight studies targeted requesting or manding, six studies used preference assessments to select vocabulary, and seven articles used adults as informants to select the vocabulary. Conclusions: There are a limited number of studies investigating vocabulary acquisition in early symbolic communicators who use SGDs. Furthermore, the studies inconsistently used a range of methods that align with best practices for vocabulary selection.

Alterations and Preservations: Practices and Perspectives of Speech-Language Pathologists Regarding the Intervention of Thickened Liquids for Swallowing Problems.

The intervention of thickened liquids (TL) is commonly used to reduce aspiration in people with dysphagia. Speech-language pathologists (SLPs) have traditionally believed it is an effective intervention. Recent articles highlight limited evidence, poor acceptance, and a variety of unintended consequences. This study explores if current debates have been reflected in SLP practices and perspectives. An e-survey was developed. Participants were recruited via professional associations in Australia, New Zealand, Ireland, the United Kingdom, and the United States. Descriptive and inferential statistics were used to explore the data. Principal component analysis was used to summarize SLP practices and perspectives. The 370 respondents represented mainly experienced, confident, hospital-based clinicians. While 20% of respondents frequently recommend TL, 61% believe it to be a burdensome treatment. "Best treatment" and "It works" beliefs continue to underpin decision making. Those who recommend TL most often are most influenced by penetration, coughing, and their own clinical experience. They are more likely to believe TL is evidence based and effective, reduces aspiration, and improves hydration. Person-centeredness is important among all respondents, although significant numbers would implement TL against patient wishes. Improvements in aspiration status and quality of life rank highly as reasons to discontinue TL. The results of this study suggest that fewer respondents are regularly using TL. Divergent groups are evident with those frequently employing and believing in the efficacy of TL and those who do not. While current debates are influencing practice, there clearly remains a significant number of SLPs continuing to recommend TL. This study's findings highlight both alterations and preservations in the discipline's approach to TL and calls for SLPs to reframe our thinking regarding this intervention as well as consider alternative options in this treatment space. https://doi.org/10.23641/asha.24317110.