Speech Therapy Research Articles

Every Speech and Language Therapist Can Be an Ethical Leader: Revisiting the Language of Ethics (Part 1 of 2)

Speech and language therapists (SLTs) are generally aware of and skilled in managing ethical issues in providing services to individual clients and families. However they may struggle with ethical concerns as they strive to deliver the best possible services in the context of increasing caseload volume and complexity, changing models of service delivery, service restructures and changes in support and professional development. This paper overviews the language of ethics, approaches to ethics and ethical decision-making, as tools for SLTs to analyse, articulate and manage ethical concerns associated with changing services and professional supervision contexts, in order to advocate for their clients and services and demonstrate ethical leadership in their workplaces.

Mini-strokes within Broca-caudate connections during left insular glioma awake surgery cause transient severe naming deficits.

To provide an explanation for the intraoperative onset of severe naming deficits in the course of awake resection of left insular glioma. We retrospectively reviewed a series of 14 patients operated on in awake conditions for a left insular IDH-mutated glioma. Preoperative MRI included high-resolution diffusion sequences, to which constrained spherical deconvolution pipeline was applied, to obtain a whole brain tractogram. Whole brain T1 parcellation was obtained by Freesurfer, allowing to dissect the tractogram and identify the connections between the caudate nucleus and Broca's area. Postoperative MRI standard diffusion the day after surgery was performed, allowing to delineate and register to the preoperative MRI any area of hyperintense diffusion with low apparent diffusion coefficient. The pathway between pars triangularis (resp. opercularis) and Broca's area were considered as damaged whenever more than 50% of streamlines were passing through the mini-strokes. Patients' language abilities (including a picture naming task) were assessed and reported before, during and after surgery by certified speech therapists. Severe postoperative naming deficits were defined as a score lower than 40/80 items. Contingency tables were analyzed with Fisher exact test (statistical significance set at 0.05). Out the 14 patients, 8 patients had a mini-stroke on the immediate postoperative MRI. None of the 6 patients without any stroke had postoperative naming severe deficits. Five out the 8 patients with a mini-stroke had a severe postoperative naming deficit, characterized by strong verbal perseverations. This difference was statistically significant (exact Fisher test, p = 0.03). For the five patients with a deficit, the mini-stroke damaged either the pars triangularis - caudate pathway or the pars opercularis - caudate pathway, whenever the pars triangularis was resected after negative cortical mapping. For the three patients without severe postoperative naming deficit, the mini-stroke spared the Broca-caudate pathway. All patients recovered quasi-normal naming abilities at the 4-month postoperative evaluation. The occurrence of mini-strokes within the connections between Broca's area and the caudate nucleus explains the sudden naming deficits observed intraoperatively in some patients during awake resection of IDH-mutated insular glioma. Further studies are needed to better predict such event and to assess its impact on other cognitive functions.

Does Generalization Occur Following Speech Therapy? A Study in Children With a Cleft Palate.

This study compared the occurrence of different types of generalization (within-class, across-class, and total generalization) following motor-phonetic speech therapy and linguistic-phonological speech therapy in children with a cleft palate ± cleft lip (CP ± L). Thirteen children with a CP ± L (Mage = 7.50 years) who previously participated in a block-randomized, sham-controlled design comparing motor-phonetic therapy (n = 7) and linguistic-phonological therapy (n = 6) participated in this study. Speech samples consisting of word imitation and sentence imitation were collected on different data points before and after therapy and perceptually assessed using the Dutch translation of the Cleft Audit Protocol for Speech-Augmented. The percentages within-class, across-class, and total generalization were calculated for the different target consonants. Generalization in the two groups was compared over time using linear mixed models (LMMs). LMM revealed significant Time × Group interactions for the percentage within-class generalization in sentence imitation and total generalization in sentence imitation tasks indicating that these percentages were significantly higher in the group of children who received linguistic-phonological intervention. No Time × Group interactions were found for the percentages across-class generalization. Generalization can occur following both motor-phonetic intervention as well as linguistic-phonological intervention. A linguistic-phonological approach, however, was observed to result in larger percentages of within-class and total generalization scores. As children with a CP ± L often receive yearlong intervention to eliminate cleft-related speech sound errors, these findings on the superior generalization effects of linguistic-phonological intervention are important to consider in clinical practice.

Assessment of speech sound disorders: Clinical experiences of Speech-language pathologists in Iran.

Speech-language pathologists (SLPs) in non-English speaking countries face challenges when assessing children for speech sound disorders (SSD). Exploring their clinical challenges in service delivery-along with their problem-solving approaches-may contribute to the development of instruments for clinical use in such settings. The study aimed to explore assessment methods used by Iranian SLPs to identify children with SSD. A cross-sectional survey took place with 113 SLPs working with children with SSD. The survey comprised 36 items grouped into four main themes-service delivery, types of assessments procedures, challenges of evaluating SSD, and ways of keeping up to date. Results were analysed based on participants' levels of education and experience. Participants used Persian as the primary language in their work, and over 70% provided services in a private setting. Most participants reported having between 10-30% of clients with SSD in their caseload. Most (73.5%) SLPs involve parents in completing the history form. They favour informal traditional articulation tests, with approximately half the sample selecting this approach from the 14 options presented to them, especially those with bachelor's degrees and minimal experience. More experienced SLPs (62.7%) chose the Polysyllabic Words Test. Assessment, whether formal or informal, was found to be time-consuming by the majority of respondents (18.6% always, 42.5% often). Self-study (65.5%) and taking part in workshops/webinars/journal clubs (60.1%) were ways to keep their knowledge current. Our findings are similar to other international survey results on SSD evaluation. Although many Iranian SLPs use informal traditional articulation tests, such assessments are limited in their analysis and the diagnostic information provided. The findings emphasise the need for clear phonological assessment guidelines, valid and reliable 'clinician friendly' instruments, equitable distribution of tools across the country, and suitable tools for bi/multilingual communities.

Every Speech and Language Therapist can be an Ethical Leader: Demonstrating Ethical Leadership in Childhood Disability Services (Part 2/2)

The aim of the paper is to facilitate speech and language therapists to reclaim agency and demonstrate ethical leadership as they advocate for their clients, services and profession. Building on the language of ethics introduced in the first of these two linked papers (anonymised for peer review), we apply the language of ethics to two hypothetical scenarios situated in childhood disability services in Ireland; we discuss three levels of ethical leadership: ethical leadership in, ethical leadership of and ethical leadership for. We argue that the use of an ethical approach may be valuable for the speech and language therapist, especially in a context of resource limitations. We hope that use of ethical approaches will facilitate speech and language therapists to embed ethical leadership in everyday practice and that the speech and language therapy community and service providers consider ethics more explicitly in service planning and delivery.

Abstract and Acoustic Targets in Phonetic Imitation

ABSTRACTPhonetic imitation (also called convergence or accommodation) occurs when talkers alter their pronunciation towards speech they hear. This can happen spontaneously with only a few minutes of exposure in a laboratory experiment even without instruction to imitate. While there is considerable evidence for spontaneous imitation, in many cases it is not clear exactly which aspects of the model talker are being imitated. It is possible to imitate the raw acoustics of the model's voice or more abstract targets like normalised acoustics of the model's voice, phonological patterns the model exhibits, or speech style. Although there is substantial literature demonstrating convergent speech behaviour, existing work typically does not distinguish between these different types of targets. This has theoretical implications for accounts of imitation and normalisation, methodological significance for analysis of imitation studies, and potential applied significance for how imitation is used in language teaching and clinical speech therapy. This paper will review these issues, discuss the statistical challenges associated with measuring convergence to competing targets, and make methodological recommendations for future studies.

Qualitative study on the influence of mealtime screen exposure on children’s feeding practices: perspectives from paediatricians and speech-language pathologists in Chennai, Tamil Nadu

ObjectiveThis qualitative research study investigates perspectives on the influence of mealtime screen exposure (MTSE) on feeding practices in children through semi-structured interviews with paediatricians and speech-language pathologists (SLPs).DesignThis study used...

How occupational therapists, physiotherapists, and speech and language therapists can benefit from precision teaching

Purpose This paper aims to discuss how precision teaching holds great promise in enhancing the skills of occupational therapists, physiotherapists and speech and language therapists. Precision teaching plays a significant role in developing fluency in foundational motor and speech skills, leading to improved performance in complex skills. Design/methodology/approach This paper reviews research focusing on precision teaching’s effectiveness in enhancing oral motor and fine motor skills, such as the Big 6 + 6, and its potential application in related skills. Findings Precision teaching provides a measurable and efficient approach to skill development, assisting therapists in improving the daily living and communication abilities of individuals with intellectual and developmental disabilities. Originality/value The broader implications of precision teaching’s application in therapeutic settings are discussed.

Cross-cultural validation in Greek and reliability of the Eating and Drinking Ability Classification System in children with cerebral palsy.

To investigate the reliability and validity of the Greek version of the Eating and Drinking Ability Classification System (EDACS) in children with cerebral palsy (CP). The sample of the study included children with CP, aged 3-18 years and classified into Levels I-V of the Gross Motor Function Classification System (GMFCS). Parents of children with CP and speech and language therapists (SLTs) with a minimum of 5 years of clinical experience were recruited. Inter-rater reliability (IRR) between SLTs and between SLT and parent was evaluated using intraclass correlation coefficient (ICC). Validity was evaluated by investigating the potential association between the EDACS and Communication Function Classification System (CFCS) and GMFCS, using ordinal logistic regression. One hundred twenty-one children with CP (mean age 8.2 ± 4.1), 72 males, GMFCS Levels I-V were included in the study. Ninety-one parents of children with CP (mean age 8.8 ± 4.2), 54 males and 8 experienced SLTs, assessed the eating and drinking abilities of the children. The IRR between SLTs was excellent (ICC = 0.94), and between SLTs and parents was high (ICC = 0.90). Both CFCS and GMFCS were positive predictors for EDACS. The Greek version of EDACS is a valid and reliable tool and it can be used to classify eating and drinking ability in Greek children with CP.

Trajectories of language development, cognitive flexibility and phoneme awareness knowledge in early childhood.

Early childhood is a critical period of language development. Yet less is known about how language growth relates to the development of phoneme awareness and cognitive flexibility during this period. To examine the longitudinal associations between growth in phonological awareness and cognitive flexibility from 4 to 5 years in relation to three patterns of child language development: early, intermediate and late. A sample of 439 four-year-old children were recruited and underwent repeated language, phonological awareness and cognitive flexibility testing to age 5. Children were classified into three language development groups based on their listening comprehension: early, intermediate and late. Group-based trajectory modelling was then used to examine the relations between cognitive flexibility and phonological awareness over time in relation to language outcome. Early language developers were characterized by higher levels and greater improvement in language and phonological awareness skills between 4 and 5 years. Late language developers exhibited slower growth in expressive language development (in addition to lower receptive language at age 4). Intermediate and late language developers showed steeper growth in cognitive flexibility over the study. Findings affirm the interconnected nature of phoneme awareness, cognitive and language skill development in early childhood. Results suggest the importance of targeting skills across literacy and executive functioning/regulatory domains for children with language difficulties. What is already known on the subject It is already known that language skills are related to self-regulation and phoneme awareness skills. However, it is also important to examine how different patterns of language growth are related to the timing and level of growth in self-regulation and phoneme awareness. Further, it is important to examine the relationship between language development and cognitive flexibility (one component of self-regulation) to understand this relationship more fully. What this paper adds to the existing knowledge This study is novel in its examination of the trajectory of language development and other key foundational literacy variables along with modelling the timing of development across the constructs included in the study. The findings have implications for optimizing the content and timing of approaches designed to enhance literacy development in children with language difficulties. What are the potential or actual clinical implications of this work? The findings suggest that interprofessional approaches across speech-language therapy, education and psychology are important for enhancing literacy outcomes of children with language difficulties. Results also provide support for language intervention approaches to be developed and trialled that target language, cognitive flexibility and phonological awareness in an integrated manner.

Multifaceted Treatment and Therapies in the Care of Children with Cerebral Palsy – A Literature Review

Introduction and Purpose: Cerebral palsy (CP) is a prevalent neurological disorder in children, characterized by movement, muscle tone, and posture impairments. This article reviews the clinical and therapeutic management of CP, focusing on spasticity, musculoskeletal disorders, and holistic rehabilitation. It examines evidence-based interventions, including onabotulinumtoxinA, intrathecal baclofen pumps, and surgical options for orthopedic deformities. Key rehabilitation techniques such as neurodevelopmental therapies, gait training, and speech therapy are discussed to enhance motor skills and cognitive development. Additionally, the management of associated conditions like epilepsy and intellectual challenges is addressed, emphasizing psychological support for patients and families. The purpose of this article is to provide a comprehensive overview of the current state of knowledge regarding the management of cerebral palsy. Material and Methods: We utilized English databases such as PubMed, Google Scholar, Cochrane, and PubMed Central, selecting articles based on keywords like cerebral palsy, spasticity, physical therapy, and rehabilitation. State of Knowledge: Effective CP management requires a multidisciplinary approach to tackle motor impairments, spasticity, deformities, and psychosocial challenges. Therapeutic interventions, including pharmacological treatments, surgical options, and innovative rehabilitation techniques, are essential for improving mobility and quality of life. Summary: Comprehensive care for children with CP is crucial. Evidence supports combining multiple therapeutic approaches tailored to each child’s needs and involving family preferences to optimize development and well-being.

The potential of cognitive remediation therapy for improving the communication capabilities of adults with schizophrenia and other psychotic spectrum disorders.

Impairment in aspects of communication is a core diagnostic feature of schizophrenia and other psychotic spectrum disorders. These communication difficulties inhibit participation in a range of daily activities and affect relationships and quality of life. There has been little research focussed on communication outcomes in relation to cognitive remediation therapy within this population. Data collected as part of an implementation trial of the Computerised Interactive Remediation of Cognition and Thinking Skills (CIRCuiTS) program provided an opportunity to examine the potential for changes in communication capability to support activities of daily living. To survey changes in ratings of aspects of communication capability of adults with schizophrenia who completed the CIRCuiTS cognitive remediation therapy program. Thirty adults with schizophrenia and other psychotic spectrum disorders completed the CIRCuiTS therapy program as part of an implementation trial in 2018 and 2019. Most participants were male (93%) and inpatients at Bloomfield Hospital (73%) in Orange, New South Wales. Ratings on the Adaptive Behaviour Assessment System, Third Edition (ABAS3) were returned before and after completion of the CIRCuiTS program. The magnitude of changes in ABAS3 indices, the Communication scale and Functional academics scales were assessed between time points. Participants' mean adaptive functioning indices prior to the CIRCuiTS program were in the extremely low range (∼second percentile) and increased to the low range (∼seventh percentile) following this therapy, achieving large mean effect sizes (Cohen's d = 0.92-1.24). Significant improvements in functioning were observed on the ABAS3 Communication and Functional Academics scales, with large mean effect sizes on both scales (Cohen's d = 1.09 and 0.99 respectively). Improvements in ratings occurred on items including initiating conversations, talking and listening over longer periods, explaining more complex information, using lists and reminders and a schedule or diary, completing written forms and personal money management. Most participants were observed to make gains in aspects of communication. The results point to these aspects of communication as potential future targets for therapy with people with schizophrenia and other psychotic spectrum disorders. This study highlights the value and role of Speech and Language Therapists in cognitive remediation therapy. Further research seems warranted with participants with a broader range of demographic, clinical and functional capabilities, that controls for the effects of medications and other therapeutic interventions and utilises a more comprehensive assessment of communication. What is already known on the subject People with schizophrenia and other psychotic spectrum disorders experience impairment in cognitive functioning as well as communication capability that affects their daily functioning and quality of life. Cognitive remediation therapy has been shown to improve aspects of the daily functioning of people with schizophrenia and other psychotic spectrum disorders and is recommended in international treatment guidelines. However, very little research has been conducted to investigate the effectiveness of this therapy in addressing communication difficulties. What this paper adds to existing knowledge The present study found participants with schizophrenia and other psychotic spectrum disorders made significant improvements in important aspects of communication after completing the Computerised Interactive Remediation of Cognition and Thinking Skills cognitive remediation therapy program. The results point to the potential of cognitive remediation therapy as a therapeutic approach that is likely to improve communication capability. What are the potential or actual clinical implications of this work? Cognitive remediation therapy is likely to be an important treatment for improving the communication capabilities of people with severe mental illness. This relatively new area of clinical practice and research highlights the value and potential of speech and language therapy in improving the communication capabilities of people with schizophrenia and other psychotic spectrum disorders.

A Conceptual Model of Dysphagia in Older Adults

A conceptual model was developed to create a basis for understanding the risk factors and outcomes associated with dysphagia and to hypothesize the nature of the relationship between certain factors. The conceptual model was developed by two academic speech-language pathologists with ≥10 years research and clinical experience in swallowing and dysphagia in older adults. A comprehensive review of English-language literature was conducted, and relevant, evidence-informed factors associated with dysphagia in older adults were identified. The synthesis of clinical expertise and theoretical underpinnings complemented the literature review, incorporating the socio-ecological model. Discussion and brainstorming of the identified factors and their potential and/or proven relationships with dysphagia were conducted. All the factors identified were initially organized using a thematic approach, then were further structured into overarching categories, guided by the inherent relationships between the factors. The arrangement of the conceptual model framework was undertaken once these categories had been optimized, and consensus had been achieved among the authors with support from the literature. Factors were identified to increase the risk of dysphagia, be an outcome of dysphagia, or both. The conceptual model illustrates the complex multifactorial relationship between dysphagia and individual, relationship, community, and societal factors. The proposed conceptual model improves our understanding of the risk factors and outcomes associated with dysphagia in older adults. Future work should focus on empirically testing the relationships among the factors presented, so the model can ultimately be used by members of the dysphagia community to target modifiable risk factors for dysphagia, as well as identify effective treatments that optimize overall patient well-being.

An update on pharyngeal assessment by the modified barium swallow.

The modified barium swallow study (MBSS) is a diagnostic examination that visualizes the functional anatomy and physiology of the oral pharyngeal swallowing mechanism in real time. The MBSS, a videofluoroscopic imaging method, is indicated for patients with known or suspected oropharyngeal dysphagia and ideally involves the combined expertise of a radiologist and speech pathologist. The MBSS provides critical diagnostic insights that help in identifying and assessing the type and severity of physiological swallowing impairments, evaluating the safety of oral intake, testing the effectiveness of evidence-based interventions, and developing treatment plans. This manuscript aims to present an overview of MBSS standards from an interdisciplinary perspective, emphasizes key areas of best practices, and reviews the common morphologic abnormalities seen on MBSS exams.

Clinical prognostic factors in patients with diffuse gliomas of the brain

BACKGROUND: Diffuse gliomas of the brain represent a heterogeneous group, which differs in age of the disease onset, histologic characteristics, tumor grade, molecular genetic markers and prognosis. AIM: of the present study is to identify the factors, which affect the duration of the relapse-free period and life expectancy in patients with diffuse brain gliomas, based on a comprehensive analysis of clinical syndromes and symptoms. MATERIALS AND METHODS: The study was carried out at the Departments of Neurosurgery and Nerve Diseases of the S.M. Kirov Military Medical Academy (Saint Petersburg, Russia). It included 390 in-patients with diffuse brain gliomas who underwent treatment over the periods of 2014–2022 and 2004–2006. Age at time of diagnosis was 45.26 ± 15.72 years old. The study included 218 (55.9%) male and 172 (44.1%) female patients. It was a single-centre prospective study. RESULTS: of the author’s research. Favourable demographic factors include the age range of 18–39 (relapse-free period duration p 0.01, life expectancy p 0.001) and female sex (relapse-free period p = 0.02, life expectancy p = 0.03). Prognostically favourable clinical manifestations include epileptic seizures before surgery (relapse-free period p 0.01, life expectancy p 0.02); unfavourable clinical manifestations are pyramidal syndrome (relapse-free period p 0.01, life expectancy p 0.001), sensitive disorders (relapse-free period p = 0.045–0.12, life expectancy p = 0.09–0.17), speech pathology (relapse-free period p 0.02, life expectancy p = 0.02–0.12) and cerebellar syndrome (relapse-free period p 0.02, life expectancy p 0.001). Clinical signs such as headache, nausea and vomiting, asthenia, diffuse neurological symptoms, craniocerebral nerve involvement and visual impairment do not affect (p 0.05) the outcomes of the patients with diffuse brain gliomas. CONCLUSION: Thus, favourable demographic prognostic factors include female sex and age range of 18–39, favourable clinical prognostic factors include epileptic seizures before surgery. Unfavourable clinical prognostic factors include presence of motor, sensory disorders, speech impairment and cerebellar syndrome.

Exploring multidisciplinary team members’ experiences of supporting eating and drinking with acknowledged risk in healthcare and aged care settings

Purpose Dysphagia is a swallowing condition which has significant health and quality of life implications. Speech-language pathologists provide assessment and support shared decision making to optimise swallowing safety. Many people elect to eat and drink with acknowledged risk. This study aimed to explore multidisciplinary team members’ perceptions and experiences supporting eating and drinking at acknowledged risk decision-making and practice, and to determine resources needed to support teams in this area. Method Semi-structured focus groups and one interview were facilitated with multidisciplinary team members (N = 32) from across the continuum of care at a regional health service to explore perceptions and experiences in supporting eating and drinking at acknowledged risk and identify needs to implement best practice. Result Four themes were constructed from the data highlighting the complexity and cyclical nature of supporting eating and drinking at acknowledged risk decision-making and practice. Themes included dynamic shared decision-making, communicating effectively to support and inform eating and drinking at acknowledged risk decision-making, enabling eating and drinking at acknowledged risk in practice, and risks and implications for clinicians and staff. Conclusion Best practice eating and drinking at acknowledged risk decision-making and implementation in healthcare and aged care settings is complex. Effective communication and appropriate support for staff working in this area is crucial, given the clinical, ethical, and moral implications that arise when supporting people who elect to eat and drink at acknowledged risk.

Good practice in lactation counseling for Ukrainian refugee mothers to ensure the health and mental benefits of breastfeeding - an observational study.

The study presents a cross-sectional analysis of the population of Ukrainian women who received maternity care in 11 Polish hospitals. Multidirectional lactation counseling was implemented from March to November 2023 by the Human Milk Bank Foundation in cooperation with UNICEF Refugee Response Office in Poland. Medical data were collected using questionnaires prepared for the study. When the mother indicated that she had mental problems or the health care personnel spotted problems, she was she referred to a psychologist for diagnostics, who used questionnaires appropriate to the patient's situation such as: Patient Health Questionnaire-9 for depression assessment and Generalized Anxiety Disorder Questionnaire-7 for anxiety assessment. In total, 1203 consultations were carried out, of which 542 were lactation counseling, 305 - were physiotherapy, 227 - were psychological, and 129 - were with speech-language pathologists. Two hours of skin-to-skin contact (SSC) and latching on the breast within the 1st hour postpartum occurred in more than half of the participants. In the rest of the population, shortened or lack of SSC was associated with breastfeeding delayed by at least one day. 53% of the population required lactation counseling, of which 242 were one-time visits. Continued support was 98% effective in achieving breastfeeding goals. 167 mothers required psychological support, of which only 53 women continued treatment beyond one-time counseling. Only about 1% of women experienced mental disorders based on a psychological interview. The use of lactation counseling more often than psychological counseling by refugee mothers could be related to the beneficial effects of breastfeeding on maternal well-being through hormonal self-regulation and empowerment as a mother. However, focused research is needed on the impact of breastfeeding on the mental health of refugee women.

A comparison of two dynamic assessment situations for detecting development language disorder in monolingual and bilingual children

ABSTRACT Bilingual children’s language skills are strongly influenced by exposure to each of their languages, among other linguistic, environmental, and cognitive factors. In the speech and language therapy clinic, it is difficult to disentangle developmental language disorders from insufficient exposure. Dynamic assessment, which directly tests the learning potential of children, offers a promising solution for this dilemma. This study compares the clinical potential of two dynamic assessment situations, varying amount of adult mediation (autonomous computer game vs. interactive story reading with graduated cues), as well as item types (nouns, verbs, and inflections in sentences) and linguistic modalities and tasks (comprehension – word picture matching and acceptability judgement, production – free recall and picture naming). Forty-nine French monolingual and French-Portuguese bilingual children with and without developmental language disorder, aged 5;0 to 7;11 years, were include in the final analyses. Using Lasso regressions, we were able to determine which variables best explain the presence of disorder. A combination of all item types and predominantly receptive tasks, mostly from the interactive situation, was retained for very high classification accuracy (up to 100% sensitivity and 96% specificity). Language status showed no influence, which encourages the use of dynamic assessment in the context of speech and language assessment with bilingual children. This study adds to evidence that dynamic assessment is a promising task for identifying bilingual and monolingual children with developmental language disorder, particularly when the situation involves interaction with graduated cues.

Differential Diagnosis of a Pharyngeal Fricative and Therapeutic Monitoring of Velopharyngeal Function Using Magnetic Resonance Imaging.

Speech disorders associated with velopharyngeal dysfunction (VPD) are common. Some require surgical management, while others are responsive to speech therapy. This is related to whether the speech error is obligatory (passive) or compensatory (active). Accurate identification of speech errors is necessary to facilitate timely and appropriate intervention. Recent studies have supported the role of magnetic resonance imaging (MRI) in the assessment process for VPD. The purpose of this study was to utilize MRI to support differential diagnosis and treatment planning in a child presenting with inconsistent nasal air escape, mild hypernasality, and compensatory speech errors. A nonsedated, fully awake, velopharyngeal (VP) MRI protocol was implemented to acquire anatomic data at rest and during phonation. Segmentations and visualization of the tongue, palate, adenoids, and nasopharyngeal airway were completed. Anatomic linear measurements were obtained for VP variables to assess VP function, establish a baseline, and monitor change over time. VP anatomy was successfully visualized on MRI in multiple imaging planes. All anatomic measurements fell within normative expectations. Elevation and retraction of the soft palate occurred against the adenoid pad. A pharyngeal fricative was documented, resulting a small VP gap during speech. In contrast, adequate VP closure was obtained for vowels and other oral consonant sounds. Quantitative assessment and visualization of the anatomy demonstrated adequate VP closure capabilities and a pharyngeal fricative substitution that had not been adequately perceived during routine clinical assessments. This study suggests a promising additive role for VP MRI for enhanced differential diagnosis and therapeutic monitoring in children with VPD and concomitant speech disorders. https://doi.org/10.23641/asha.27905451.

Building a Community for Clinical Fellows in Voice and Upper Airway Disorders

Purpose: The clinical fellowship (CF) in speech-language pathology may be a challenging experience as graduate students transition to clinicians. A grassroots committee of experts in voice and upper airway disorders (VUAD)—called Pathway for Advanced Voice Education and Service (PAVES)—organized community-building groups for clinical fellows. This article assesses the opportunities that PAVES offered clinical fellows specializing in VUAD to connect and build community with each other. Method: A survey about CF experiences was administered online to individuals who completed a CF in speech-language pathology, where at least 75% of their caseload included VUAD. The questions focused on a social media group and lecture series offered by PAVES that were aimed at building a community for clinical fellows. Survey respondents included individuals who participated in PAVES activities and those who did not. Results: Thirty-two respondents completed the survey: 44% of respondents participated in the Facebook group and 75% participated in the lecture series. Using a 10-point visual analog scale, respondents who participated in both groups rated greater feelings of community ( M = 5.08, SD = 1.50) than those who did not participate in the groups ( M = 3.14, SD = 2.12). Ratings for overall CF experience ( M = 8.16, SD = 1.95) were not associated with feelings of community ( r = .067, p = .716). Several other benefits from participating in the community-building groups were also reported. Conclusions: PAVES provided new opportunities for clinical fellows to connect with each other across the United States. This article presents a survey that assessed feelings of community in clinical fellows who participated in the community-building groups and those who did not. Results indicate that the groups were successful in enhancing feelings of community, and future directions are discussed to further benefit VUAD CF cohorts.