Speech Therapy Research Articles

How do speech language pathologists use the Schwarz et al. (2015) rubric for read-aloud storybook selection?

ABSTRACT Reading storybooks aloud to prereaders helps them develop oral language skills; but educators struggle to select appropriate storybooks for read alouds. To better understand this selection process, we evaluated how experienced speech language pathologists (SLPs) apply the storybook selection rubric in Schwarz et al.'s (2015). A read-aloud storybook selection system for prereaders at the preschool language level: A pilot study. Journal of Speech, Language, and Hearing Research, 58(4), 1273-1291. doi:10.1044/2015_JSLHR-L-15-0056. That rubric includes: eight book characteristics, one four-level difficulty scale, and exemplar storybooks for each scale level. Using this rubric, 38 SLPs—who had served children at the preschool language level—rated 63 storybooks based on how difficult they thought the storybooks would be for children at the preschool language level to understand when the storybooks were read aloud to them. A principal component analysis identified-among the original eight characteristics a subset of five highly correlated characteristics related to overall text difficulty: vocabulary, story structure, sentence length, book length, and density. We revised the original rubric to include only four storybook characteristics: (a) text difficulty, (b) amount of inferencing, problem-solving, and abstract concepts, (c) familiarity of activities/experiences, and (d) level of support provided by the illustrations. Using quartile values of the text difficulty characteristic, we derived a four-level difficulty scale for the 63 storybooks. The revised storybook selection rubric simplifies the process of selecting appropriate storybooks for read alouds. The revised rubric and SLPs' difficulty ratings of 63 storybooks provide clinicians with a resource ready-made for clinical practice.

Early intervention speech-language pathologists’ beliefs and practices related to assessing dual language learners

IntroductionEarly intervention (EI) speech-language pathologists (SLPs) are required to provide culturally and linguistically responsive assessments for dual language learners (DLLs). However, SLPs consistently report feeling underprepared to assess DLLs and research demonstrates gaps in implementation of best practices in pediatric outpatient and school-based settings. This study was designed to understand EI SLPs’ beliefs and practices related to assessing DLLs referred to early intervention programs. MethodsA total of 132 EI SLPs completed a survey in which they were asked to describe their assessment procedures for a DLL case scenario and were further asked to identify the degree to which they agreed with a variety of assessment practices for assessing DLLs. ResultsResults revealed that EI SLPs’ beliefs aligned with best practices for assessing DLLs. However, substantial gaps exist between EI SLPs’ beliefs and their self-reported practices for assessing DLLs. ConclusionsThese results suggest DLLs may not be receiving evidence-based EI assessments, leading to the potential perpetuation of both over- and under-diagnosis of speech and language delays within this population. Implications include the need to increase the quality of EI SLPs assessment practices through additional training, the removal of systems-level barriers, and the continued need for increased training within preprofessional training programs.

UNNIGSA: A Unified Neural Network Approach for Enhanced Stutter Detection and Gait Recognition Analysis

Stuttering, also known as stammering, is a speech disorder characterized by involuntary disruptions or disfluencies in a person's flow of speech. These disfluencies may include repetitions of sounds, syllables, or words; prolongations of sounds; and interruptions in speech known as blocks. This paper introduces Unified Neural Network for Integrated Gait and Speech Analysis (UNNIGSA), methodology that synergizes stutter detection (SD) and gait recognition through a unified neural network architecture. UNNIGSA is engineered to address two distinct yet interrelated challenges: the accurate detection of stuttering for enhanced beneficial interventions and the precise identification of individuals based on gait analysis. The system integrates a global attention mechanism to meticulously highlight salient features within speech patterns, thereby improving the accuracy of stutter classification and offering a potential leap forward in speech therapy practices. Additionally, UNNIGSA incorporates novel data processing techniques to manage the class imbalance prevalent in stuttering speech datasets, resulting in significantly enhanced performance over existing models. The methodology also extends the functionality of automatic speech recognition (ASR) systems, fostering greater inclusivity for individuals with speech disorders and enabling their more seamless interaction with virtual assistant technologies. Overall, UNNIGSA sets a new standard in the domains of speech disorder treatment and biometric identification, offering innovative solutions to long-standing challenges and paving the way for more inclusive and secure applications.

Moving Beyond Rapport: The Importance of Active Facilitation of Therapeutic Alliance in Adult Acquired Brain Injury Rehabilitation.

Therapeutic alliance (TA) is critical to rehabilitation outcomes for adults with acquired brain injuries (ABIs). The purpose of this viewpoint article is to review factors that contribute to TA and to suggest ways speech-language pathologists (SLPs) can integrate these factors into their ABI rehabilitation practice. We evaluated literature describing client and clinician factors shown to affect-or not affect-TA in ABI rehabilitation and mapped findings onto suggested practices that SLPs may use to actively promote TA with their clients. Informed by our findings and TA frameworks, we integrated findings into a novel clinician self-reflection tool: the Therapeutic Alliance Reflection Checklist. TA is a key ingredient in ABI rehabilitation. We contend that SLPs can, and should, actively facilitate TA with clients; the self-reflection checklist can assist. We advocate for continued TA research and improved measurement across rehabilitation settings. We further contend that training in active TA-promoting skills is a critical component of speech-language pathology education.

Deployment of professional expertise during a period of disruption: A phenomenological study of rehabilitation clinicians.

Practice context is known to influence the deployment of competencies. The COVID-19 pandemic created a major disruption in many practice contexts. The objective was to understand the lived experience of rehabilitation clinicians during a major disruption of their practice context, namely, the COVID-19 pandemic. We used a longitudinal phenomenological design. Eligible clinicians were occupational therapists (OT), physical therapists (PT), physiotherapy technologists (Phys T.), speech-language pathologists (S-LP) and audiologists (AUD), working in the same rehabilitation workplace for at least 2 years before March 2020 (the pandemic). Clinicians who were reassigned to roles outside the field of rehabilitation were excluded. We conducted individual online interviews using a guide developed by the team with expertise and knowledge of the phenomenon. An interpretative phenomenological analysis was carried out. Results were discussed until the research team reached a consensus. A total of 32 clinicians participated in the study (12 OT, 5 PT, 5 Phys T., 7 S-LP, 3 AUD), working with a variety of clienteles and work settings, for an average of 11.7 ± 7.6 years in the same practice setting. A wide range of emotions (e.g. anger, sadness, guilt, fear, pride) reflected clinicians' experience during disruption. Professional expertise was perceived as being enhanced by disruption as clinicians stepped out of their comfort zone; this encouraged reflective practice and a recognition of the need to be more explicit about their decision-making process. Collaboration with colleagues was perceived as key for effective coping and deployment of adaptative expertise. A disruption in the practice context may have positive effects on professional expertise through the mobilization of reflective practice.

Student and graduate perceptions of a ‘clients as teachers’ experiential learning program on development of family-centered practice

ABSTRACT Family-centered practice (FCP) is a healthcare framework which prioritizes the voices of clients and their families to allow them to achieve their goals and optimize quality of life. However, current research evidence indicates weaknesses in the education of university students to develop skills in FCP. An Australian university’s Parent Tutor Program (PTP) is a ‘clients as teachers’ experiential learning program which aims to improve students’ understanding of FCP in their first year as speech-language pathology (SLP) students. This study aimed to investigate the impact of the PTP on (1) SLP students’ perceptions of their understanding of FCP and (2) SLP graduates’ perceptions of the long-term implementation of FCP. Two focus groups, one with SLP students, and one with SLP graduates, were conducted. Data were analysed inductively through open coding, followed by synthesis into themes and subthemes. Participants believed that the PTP instilled a strong value of FCP. The participants conveyed that the PTP was part of a larger experiential journey in learning FCP. The immediate and long-term impacts of the program were identified within the student and graduate reflections. The findings of this study will inform tertiary educators of the value of ‘clients as teachers’ programs in higher education.

A survey of speech-language pathology service delivery in Australian schools

Purpose Speech-language pathologists (SLPs) work in Australian schools yet, little is documented about their service delivery practices. This study therefore explores Australian speech-language pathology service delivery in schools, inclusive of work activities, caseloads, and assessment and intervention practices. Method An online survey comprising multiple choice, constant sum, Likert scale, and open text questions was completed by 105 SLPs. Quantitative data was analysed using descriptive statistics while open-text responses were analysed using content analysis. Result Participants were predominantly government education department employees working in multiple schools, and caseloads ranged from 10 to 240 students for full-time SLPs. While responses varied considerably, some general trends emerged. Most time was spent on intervention, followed by non-contact tasks, and assessments, with differences across employment sectors. Language was the most common student need, followed by literacy and speech. Frequently reported factors contributing to client complexity and intervention frequency were co-occurring presentations, severity of student needs, caseload size, and impact on learning. Caseload manageability was a concern for participants who reported larger caseloads, spent more time in assessment or less time in therapy than others, and worked in education departments. Conclusion Findings have implications for policy makers, professional bodies and employers, and provide direction for future systematic data collection.

Skilled Nursing Facility Rehabilitation Intensity and Successful Discharge in Persons with Dementia

ObjectivesSkilled therapies (STs), including audiology, speech-language therapy, occupational therapy, and physical therapy, can address functional deficits in dementia. This study aims to quantify the association between ST and successful discharge after heart failure (HF) hospitalization in persons living with dementia. DesignRetrospective cohort study. Setting and ParticipantsWe included veterans with dementia (VwD) hospitalized for HF in Veterans Affairs (VA) medical centers and then admitted to non-VA skilled nursing facilities (SNFs) from January 2011 to June 2019. MethodsFollow-up continued 120 days after SNF admission. We measured ST hours per week using MDS admission assessments. We defined successful discharge as SNF discharge occurring within 90 days of SNF admission with MDS discharge status not hospital or institutional setting, and 30 days’ survival after discharge without Medicare or VA-paid rehospitalization or reinstitutionalization. We estimated relative risk using multiple variable regression to adjust for measured sources of confounding. ResultsOur final sample included 8255 VwD. The mean (SD) age was 80 (10) years, and 8074 (98%) were male. Successful discharge occurred in 2776 (34%) of the sample. The median (IQR) weekly hours of ST was 10.4 (7.1–12.1). Sextile 1 received less than 5.2 hours per week of ST. The adjusted relative risk (95% CI) for sextiles 2–6 compared with sextile 1 were, respectively, 2.20 (1.85–2.62), 2.48 (2.09–2.94), 2.52 (2.12–2.99), 2.62 (2.21–3.11), and 2.69 (2.27–3.19). DiscussionDuring SNF care after HF hospitalization, 5.3 or more hours of STs per week was associated with a higher rate of successful discharge, in a roughly dose-dependent fashion, up to a 170% increase in the highest sextile of ST hours. Conclusions and ImplicationsHigher ST hours are associated with successful discharge from SNF after HF hospitalization.

Systematic approach for organizing correctional, developmental and speech therapy work

Systematic approach for organizing correctional, developmental and speech therapy work

Developing a care bundle for children who are eating and drinking with acknowledged risk: A Delphi study with speech and language therapists.

There is minimal research and no formal written guidance for speech and language therapists (SLTs) managing children eating and drinking with acknowledged risks (EDAR). Many SLTs lack confidence due to the complexity of these cases medically, ethically and emotionally. Guidance is recommended to aid paediatric EDAR management. To establish consensus amongst expert paediatric SLTs regarding core components of a care bundle guiding the management of children who are EDAR. A two-round online modified Delphi technique was used. An expert panel of UK SLTs working across paediatric settings (education, hospital, community) were recruited using snowball sampling. Both rounds comprised 36 statements related to potential components of a care bundle, which participants rated on a 7-point scale (strongly agree to strongly disagree), and one open-box question. Consensus was calculated using predetermined criteria (percentage, median and interquartile range) and the final list was ranked by level of importance (mean). A total of 35 participants completed round 1, with 31 completing round 2 (88.6% response rate). Thirty out of 36 statements achieved high to very high consensus. The nine statements reaching very high consensus covered topics such as documentation, capacity, safeguarding and person-centred care. There is a high level of consensus amongst SLTs about core components for a paediatric EDAR care bundle. This study provides a useful starting point for the future development of a care bundle to manage children who are EDAR. What is already known on the subject There is limited research and guidance for SLTs managing children who are EDAR. In adult populations, care bundles have been introduced with positive effects (e.g., better patient outcomes, increased standardisation of care and clinician confidence) and are seen as a promising avenue for paediatrics. What this study adds to the existing knowledge To the research team's knowledge, this is the first published Delphi study on SLT opinion around a care bundle for paediatric EDAR. There were high levels of consensus amongst UK SLTs and the results highlighted documentation, capacity, safeguarding and person-centred care as key areas in practice. Finally, the results provide a ranked list of components UK SLTs felt are important for developing a care bundle. What are the practical and clinical implications of this work? This study could be a useful starting point for creating a care bundle to support the management of children who are EDAR.

“Staying connected”: Speech-language pathologists’ perspectives on the communication needs of people with primary progressive aphasia and their family members

Purpose The research objectives were to explore the communication needs pertaining to (a) people with primary progressive aphasia (PwPPA); (b) family members of PwPPA; and (c) the different variants of primary progressive aphasia (PPA), from the perspectives of speech-language pathologists (SLPs). Method This investigation used a qualitatively driven concurrent mixed methods research design. Data collection involved semi-structured interviews and mixed methods questionnaires with 14 SLPs. Qualitative content analysis of interview and questionnaire data was used to identify codes and categories related to the research objectives. Quantitative analysis of questionnaire data involved single item summaries and cross item tabulations. Result Analysis revealed eight categories of communication need pertaining to PwPPA and six pertaining to their family members. Results regarding communication needs according to variant of PPA revealed limited findings. Conclusion SLPs perceived several important areas of communication need for PwPPA and their family members, highlighting key clinical implications for proactive communication care across the continuum of care. Future research can build on the current findings and integrate the perspectives of PwPPA and their family members on this topic, to develop interventions and explore models of service delivery to meet their progressive and complex communication needs.

Factors Related to Rehabilitation Adherence in Pediatric Cancer: A Systematic Review

Background: Rehabilitation is crucial for improving the functional outcomes of children and adolescents with cancer. An understanding of factors related to rehabilitation adherence is needed to improve intervention design and effectiveness, and decrease healthcare costs. Therefore, this systematic review aims to identify factors related to pediatric cancer rehabilitation adherence. Methods: Based upon the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a search of MEDLINE and CINAHL was completed in January 2023, including terms of pediatrics, cancer, rehabilitation, and adherence. Study eligibility included: (1) published after 2011, (2) English language, (3) a physical therapy, occupational therapy, speech-language pathology, cognitive or exercise intervention or service, (4) mean age ≤18 years old, within 5 years of a cancer diagnosis, and (5) measurement and reporting of adherence factors. Study quality was evaluated using the Joanna Briggs Critical Appraisal Tools. Results: The review included 13 studies providing interventions to 318 children. Most of the interventions were related to exercise. Adherence levels of supervised sessions ranged from 61% to 91%. Unsupervised intervention adherence was not a common outcome, but the reported measurements ranged widely (<1-72%). The classification of factors associated with adherence included organizational, treatment, and personal factors. Common barriers to adherence were fatigue, illness, time and motivation. Facilitators of adherence included peer or caregiver support and supervision. Conclusion: Additional research is needed to investigate the factors related to rehabilitation intervention adherence, especially factors beyond exercise and those associated with unsupervised interventions. Standardized measures are crucial to ensure the reliability and comparability of findings.

Clinical efficacy and therapeutic mechanism of active ‘five-tone’ speech therapy compared with conventional speech-language therapy for treatment of post-stroke aphasia: protocol for a randomised controlled trial

IntroductionAphasia is a common dysfunction among patients with stroke that can severely affect daily life. Listening to the ‘five-tone’ melodies of traditional Chinese medicine can improve some of the language...

Mandalas as a Source of Self-Expression

The article is a presentation of the meaning and characteristics of mandalas that derive from Sanskrit symbolism. The Kabbalistic overtones of their compositions intrigued early psychoanalysts. They have been assimilated to treat and calm patients suffering from neurosis, psychosis, depression. They were seen as expressive, diagnostic and therapeutic. The article presents different views on the values and effects of the use of mandalas in education, relaxation and therapy. Due to the lack of scientific premises for use, relaxation use is encouraged during rehabilitation, after-school and speech therapy classes. A substantive approach to the subject encourages the search for applications in education in various fields, but this requires undertaking scientific research and verification of applications. The article is an exhaustive analysis of the literature on the use of mandalas.

Factors Influencing the Translation of Evidence Into Clinical Practice for Hospital Allied Health Professionals in Terms of the Domains of Behaviour Change Theory: A Systematic Review.

This systematic review provides an overview of the unique challenges allied health professions face in the translation and implementation of evidence into practice, which remain relatively under reported and uninformed by a theoretical basis of behaviour change. MEDLINE, EMBASE, CINAHL and Scopus databases from 2010 to 2022 were searched for primary study designs resulting in 21 articles included in this review (PROSPERO: 2022 CRD42022314996). Allied health disciplines reported in the review were mainly from occupational therapy, physiotherapy, dietetics, and speech pathology. The most frequently reported implementation determinants across the Theoretical Domains Framework were identified as 'environmental context and resources', and 'knowledge'. The results also identified a greater influence of 'social influences' and 'beliefs about consequences' in implementation. Implementing evidence into clinical practice is a multifaceted, complex process, and the use of the Theoretical Domains Framework provided a systematic approach to understanding the drivers behind the target behaviours. However, there is a paucity of studies across the allied health professions that describe implementation strategies used and their impact. Many of the studies focused on implementation by the individual clinician rather than the role organizations can play in the translation of evidence into practice.

Preoperative variables affecting outcome of cochlear implant

BackgroundCochlear implants made a great impact in the management of severe-to-profound hearing loss in both children and adults. Its greatest impact is in helping children born with a profound hearing loss and implanted early to attend mainstream education and using spoken language to communicate. However, the final outcome in pediatric implantation is not predictable as there are large number of factors which will affect the outcome of cochlear implantation. Studying these determinants increases the ability of clinicians to offer educated preoperative prognosis and might potentially allow for manipulation of variables in an attempt to achieve the best possible outcome.ObjectiveThe aim of this study was to assess the preoperative factors affecting the audiological, speech, and language outcomes achieved by the recipients of cochlear implants.MethodologyA total of 39 children with severe-to-profound sensory neural hearing loss were implanted with cochlear implants. Children had received their implants before age of 5 years. Tests of receptive, expressive language quotient, aided cortical auditory-evoked potential using speech stimulus, aided free field audiometry, and aided speech reception thresholds were administered. Characteristics of the child and the family (age before implant and duration of implant use, cause of hearing loss, preimplant use of hearing aids and language therapy, and sociodemographic characteristics of their families) were the preoperative variables. These variables were considered predictors of audiological and language outcomes achieved by children and were determined using statistical analysis by univariate and multivariate analyses.ResultsAge of the studied children at time of cochlear implantation was statistically significant predictor for CI outcome as regard receptive language quotient and also for N1 latency. Hearing age of the studied children was a statistically significant predictor for CI outcome as regards P1 latency.ConclusionBased on our findings, two most important factors affecting outcome of cochlear implantation were the age at implantation and the hearing age. Other factors were important but did not affect the outcome significantly.

Mothers of Children with Stuttering and Their Daily Concerns: A Qualitative Study

Background: Stuttering is one of the most important speech disorders in children, which causes anxiety and worry in parents, especially mothers. The present study sought to investigate and identify the types of anxiety experienced by mothers of children with stuttering. Methods: This qualitative study adopted reflexive thematic analysis (Brown & Clark) to investigate the anxiety and concerns experienced by mothers of children with stuttering. The participants were 15 mothers of children with stuttering who visited speech therapy centers in Isfahan and were selected through homogenous purposive sampling. The data were collected through interviews with the participants for 45 days and analyzed by the thematic analysis method. Results: Data analysis revealed two core categories, four organizing themes, and nineteen subthemes. The two core categories identified in this study were mother-centered anxiety (anxiety about public judgments on the mother and anxiety about the appropriateness of the mother’s behavior with the child who stutters) and child-centered anxiety (concerns about public reactions to the child’s stuttering and the concerns about the child’s future life and treatment). Conclusion: The findings indicated that the mothers of children with stuttering were mostly concerned about public reactions to the stuttering child and their judgments about the mother. Thus, promoting a sense of self-worth in these mothers can reduce such concerns. Moreover, raising public awareness about how to treat children with stuttering and their parents can make social life easier for such children and their mothers.

Correction of Grammatical Structure Disorders in Older Preschoolers with Severe Speech Disorders Using Children’s Fiction

Introduction. Currently, one of the most urgent problems of special education is the development of effective approaches to the correction of violations of grammatical structure of speech in older preschool children with severe speech disorders. The leading activity of this age period is play. It allows the formation of all important mental neo-formations. Thisnecessitates the use of game methods in the process of corrective-developmental activities for older preschool children. Objective. To select a set of correctional techniques, including the use of reading children’s fiction, for the correction of grammatical structure disorders in older preschoolers with severe speech disorders. Materials and Methods. To assess the formation of grammatical skills in older preschoolers, we used an adapted “Methodology of Psycholinguistic Research of Oral Speech Disorders in Children” by R. I. Lalaeva and “Comprehensive Educational Program of Preschool Education for Children with Severe Speech Disorders” by N. V. Nishcheva. Results. The experimental study was conducted with the involvement of 10 children (6 boys and 4 girls) of preschool age with the speech therapy conclusion “erased dysarthria” at the age of 5.5 to 6 years, attending kindergarten No. 52 in Taganrog. The results of the study showed that the use of the developed methods and techniques of speech therapy allowed to develop concentration of attention, diligence in classes and to correct the revealed violations of the grammatical structure of speech, which were manifested at the beginning of the work. Discussion. It was revealed that the use of a large number of visual teaching aids, taking into account individual and age-specific features of older preschool children with severe speech disorders allowed to bring the level of development of children’s speech skills closer to the age norm: they built their answers consistently and logically, and also learned to operate independent speech.

Technology for Young Adults with Stroke: An Australian Environmental Scan.

Technology has the potential to address the unique needs of young stroke survivors. Despite this, little is known about the technological resources available to support young adults with stroke. This study aimed to identify and compile available technological resources that cater to the specific needs of young adults (18-30 years) with stroke in Australia. An environmental scan was conducted from December 2023 to March 2024. Sources included websites, app stores, rehabilitation centres, hospitals, organisations, technology developers, and healthcare professionals. Of the 114 resources identified, 11% were for re-training limb movement, 40% for speech rehabilitation, 20% for medication reminders, and 29% were social media posts offering peer mentoring and support. Most limb movement (75%) and medication reminder (87%) apps were free. However, most speech therapy apps (78%) had associated costs. Social media posts were hosted on Facebook (64%), Instagram (21%), TikTok (9%), YouTube (3%), and other websites (3%). Forty-six percent of the social media posts targeting young stroke survivors did not specify the age group. These resources were identified as available to young people with stroke. Although the resources found focused on young stroke survivors, it was difficult to ascertain the specific age group that was being targeted.

Dynamic Changes Toward Reflective Practice: Documented Shifts in Speech-Language Pathologists' Evaluation Practices

Dynamic Changes Toward Reflective Practice: Documented Shifts in Speech-Language Pathologists' Evaluation Practices