Speech Therapy Research Articles

An Innovative Approach To Increasing Speech And Language Therapy Intensity For Stroke Patients

Abstract Background Different national guidelines exist for the provision of Speech and Language Therapy (SLT) intensity for stroke patients. The National Institute for Health and Care Excellence (NICE) guidelines on stroke rehabilitation in Adults (2023) advises 3 hours of multidisciplinary therapy a day, five days a week. The National Clinical guideline for Stroke for the UK and Ireland (2023) does not include SLT in this 3-hour provision of motor therapy, but advises 45 minutes of SLT a day, 5 days a week. Poor SLT staffing levels are commonplace, more recently exacerbated by the HSE recruitment embargo, posing significant challenges to rehabilitation provision. Methods A Speech and Language Therapist in a stroke service assessed whether the use of Therapy assistants could add to the delivery of the targeted 45 minutes of SLT. Training was provided in the execution of speech, language and swallow rehabilitation exercises, using patient specific exercise packs. A month of data collection started on 8 patients. Intensity was measured in 3 percentage groups: Results When rehabilitation was provided by SLT alone, 7 patients received insufficient therapy intensity. One patient scored in the moderate group. With the added input of stroke assistants, 4 patients received sufficient therapy time, 3 patients scored in the moderate group and only one patient received insufficient therapy. Conclusion Use of Stroke assistants for the provision of SLT rehabilitation exercises, can be an effective tool in increasing SLT intensity. Training is time intensive, but essential to make assistants knowledgeable and competent in their abilities. All rehabilitation should be under direct supervision of SLT. However, we should not use stroke assistants to mask or minimise the need for adequate SLT resourcing, as specified in international standards.

Can A Swallow Screen Score Be Used To Prioritise Dysphagia Assessments By A Speech And Language Therapist?

Abstract Background Dysphagia refers to any difficulty or discomfort associated with eating or swallowing. The prevalence is 10-50% in older persons and is associated with increased dependency and mortality. A non-validated Swallow Screen (SwSc) is used by a Community Specialist Team (CST) for older persons during Comprehensive Geriatric Assessment (CGA) to identify patients requiring Speech and Language Therapy (SLT) referral. The SwSc comprises 7 questions with “yes” or “no” answers. “Yes” answers score 1 point and “no” score 0. The SwSc score is the sum of these points. Higher scores indicate the presence of more symptoms of dysphagia. Patients with a SwSc score ≥1 are referred to an SLT. This study aimed to investigate if a higher SwSc score might indicate more severe dysphagia requiring more urgent assessment by an SLT. Methods This was a retrospective cohort study of patients ≥64 years referred to SLT by a CST from June 2023 to April 2024 inclusive. The SLT assessment included a Dysphagia Outcome Severity Scale (DOSS) score. The DOSS score ranges from 1-7, a lower score indicating a more severe dysphagia. Data was entered onto an Excel database and analysed. Biographical and CGA data was analysed using descriptive statistics. The SwSc and DOSS scores were ranked and compared using Spearman’s Rank Correlation Coefficient. Results Thirty-nine patients attended an SLT assessment. The mean age was 78, (SD=8.04). The mean Clinical Frailty Score 5 (SD=1.16) and mean modified Barthel Index score 16 (SD=3.75). There was a negative correlation between the SwSc and DOSS scores, r (37) = -.438, p=.005. Higher SwSc scores were associated with lower DOSS scores, indicating more severe dysphagia. Conclusion The SwSc can be easily administered by non-SLT clinicians. It may be used by an SLT to aid prioritisation of patients for assessment. Further research with a larger sample is required to establish its validity.

Combining low-technology augmentative and alternative communication with regular aphasia treatment: interim findings of a hospital-based RCT in post-stroke patients

ABSTRACT Background Previous research indicates that low-technology (low-tech) augmentative and alternative communication interventions (AACT) can enhance communication skills in individuals with post-stroke aphasia in China. However, there is limited evidence for low-tech AACT in inpatient settings. Aim This study aims to evaluate the impact of low-tech AACT combined with speech-language therapy (SLT) on communication skills related to basic needs, quality of life, and spoken language function among individuals with post-stroke aphasia in an inpatient setting. Methods & Procedures Twelve participants with aphasia having difficulty in daily communication were randomly assigned to an experimental group, receiving 30 minutes of SLT and 30 minutes of low-tech AACT per session (AACT + SLT), or a control group, receiving 60 minutes of SLT per session (SLT), over ten sessions in two weeks. Primary outcomes were measured using the basic needs (CBN) domain of the functional assessment of communication skills for adults (FACS). Secondary outcomes included scores from the Chinese version of the stroke-specific quality of life scale (SS-QOL) and subtests of spoken language production and comprehension from the aphasia battery of Chinese (ABC). The study was registered in the Chinese clinical trial registry (ChiCTR2000028870). Results The results indicated a significant improvement in the CBN domain of FACS in the AACT + SLT group, with larger clinically significant changes compared to the SLT group. The AACT+ SLT group also showed significantly higher overall scores on the SS-QOL and more significant improvements in the content of spontaneous speech than the SLT group after intervention. Comparable improvements were observed in other subtests of the ABC between the two groups. Conclusions Incorporating low-tech AACT into regular SLT in inpatient settings can improve communication for basic needs in an in-patient setting, facilitate language recovery, and potentially support the overall quality of life, compared to SLT alone, for people with post-stroke aphasia. This combined approach demonstrates preliminary feasibility in hospital settings, suggesting the value of low-tech AACT in aphasia rehabilitation.

All On One Page: Getting Daily Meal Ordering Right In A Rehabilitation Setting

Abstract Background Recently the rehabilitation hospital expanded to over 100 beds providing improved access to rehabilitation for older persons in the area. During this time, an increase in incident report forms occurred due to the incorrect provision of diet/fluid to patients at ward level. In collaboration with relevant stakeholders, the Speech and Language Therapy (SLT) and Dietetic teams reviewed the current hospital meal ordering form and process in order to standardise a new system. The aim of this project was to reduce risk for patients and improve collaborative team working and communication. Methods A multidisciplinary team (MDT) approach was adapted involving; SLT, dietitians, catering department, nursing team and the patient quality and safety department. The HSE change framework provided scaffolding for this work. A new Daily Meal Order form was created and approved by the Nutrition Steering Committee and the process was agreed using input from all stakeholders. A pilot was carried out, reviewed and rolled out across the campus. The number of incidents recorded at ward level was used to measure if risk was reduced. A staff survey was conducted to gather feedback on the new system. Results The new Daily Meal Order form is now being used across the campus. Additional checks are completed each day via email to reduce the risk of errors. No incident reports were filed since launching the new form and process. A staff survey showed that all staff feel the new system and form constitutes an improvement, that it saves clinical time and that they would recommend it to others. Conclusion The project aims have been met in reducing patient risk, in line with the HIQA Safer Better Healthcare Programme. It has also improved MDT working and communication. This project is easily replicable to other settings and staff would recommend this approach to others.

Frailty Screening and Assessment in the Emergency Department: Meeting the Growing Demand with an Expanded Acute Frailty Team

Abstract Background Frailty screening and early comprehensive geriatric assessment (CGA) in the emergency department (ED) is recommended to deliver optimal care for older adults with frailty and to reduce associated pressures on hospital systems.1 Interdisciplinary acute frailty teams (AFT) are best placed to lead these specialist assessments and a newly-expanded AFT was launched in February 2024.2 Activity data from the initial months of the AFT’s operations was analysed to understand the patient profile, service demand vs capacity and the impact of the team expansion. Methods A newly-expanded interdisciplinary AFT was launched, including Speech and Language Therapy (SLT) for the first time. Aims were to screen all those aged >70 years in ED for frailty using Clinical Frailty Scale (CFS) and commence CGA where appropriate, during core working hours. Additionally, the team expanded their remit from usually seeing patients pre disposition decision to include those referred for admission. Data reports for AFT activity in the first 55 working days and all-ED >70s presentations in the same time period, including weekends (78 days) were generated and analysed using excel. Results N = 920 patients were seen in the first 55 working days, n=513(53%) female, mean age 79.2 (6.7 SD, range 70-100), 65.4% living with frailty (CFS ≥4), admitted n=581(63%) vs discharged n=339(36%). The AFT saw 36% of all >70s ED presentations. On weekdays, there is a mean demand of n=35.9 (1.4 SD) >70s, and the AFT met 42% of this demand (mean n=15 (2.1 SD)). Compared to the same period in 2023, n=622 (313%) more patients were assessed or screened. Novel services provided were CGA and interdisciplinary team assessments commencing in ED for admitted patients and a SLT ED service. Conclusion An expanded AFT has increased capacity to screen for frailty and commence CGA. Future work will focus on hospital-wide frailty pathways.

Community Flexible Endoscopic Evaluation Of Swallowing (FEES): A Prospective Cohort Study Of Clinical, Process And Patient-Reported Outcomes

Abstract Background Dysphagia prevalence increases with age, impacts on quality of life and increases healthcare utilisation and cost (Atrill 2018). Instrumental swallowing assessment is essential for accurate diagnosis and treatment of dysphagia but can be difficult to access in the community. FEES is a gold-standard instrumental assessment delivered by speech and language therapists (SLTs). The aim of this abstract is to report clinical, process and patient-reported outcomes of participants who had a community FEES over a 6-month period. Methods A prospective cohort study recruiting adults who accessed community FEES in Ireland's Mid-West. Baseline assessment data (demographics, a range of validated tools and process data) were recorded at index visit. A structured phone interview was completed at six months. The primary outcome was the rate of medical complications potentially caused by dysphagia at follow-up. Secondary outcomes included healthcare utilisation, dysphagia severity, functional status and quality of life. Results 62 participants were recruited: mean age: 70.98 (SD=15.01), 55.4% were female. At follow-up, 27.42% reported medical complications potentially attributable to dysphagia, 27.4% had attended general practice, 3.23% attended medical assessment units, 6.45% attended emergency departments. 82.26% were diagnosed with dysphagia or modified independence: Dysphagia Outcome Severity Scale (DOSS) ≤6, (M=5.2, SD=1.53). Changes to dysphagia care plans were recommended in 60.94% of cases. There was significant difference in Functional Oral Index Scale (FOIS) scores across time, F (1.75, 106.78) = 5.38, p = 0.008. FOIS scores at 6 months (M=5.92, SD=1.50) were significantly higher than pre-FEES (M=6.42, SD=1.37). Significant differences in quality of life (EQ5D5L-VAS) scores p<0.001 were detected: higher scores at 6-months (M=69.35; SD=20.42) compared to index visit (M=64.52; SD=19.44). Conclusion Access to community FEES for older persons may improve outcomes by reducing the frequency of dysphagia-related complications and healthcare utilisation, improving functional swallowing status, enhancing quality of life and contribute to evidence-based dysphagia diagnosis and care planning.

Providing A ‘Helping Hand’ To ‘Get to Know Me’ And What ‘I Can’ Do For People With Dementia

Abstract Background In November 2020 the referral rate for residents with dementia for communication assessment was only 18% of all referrals. The Speech and Language Therapy (SLT) Department had no standard pathway for assessment and intervention of communication for those residents. Part of the aim of devising this pathway was to empower our fellow Health Care Workers (HCWs) to have meaningful, successful and satisfying conversations and facilitate positive, person-centred communication. Methods Results Qualitative feedback received from staff and families highlight our residents' “personhood” and how the tools help preserve residents' memories. The tools are available in resident's files for all HCWs to use. SLTs continue to complete the cognitive and language screens but student nurses complete the Getting To Know Me questionnaire. Since commencement of this initiative there have been more than 230 residents whom have at least 1 of the tools is completed. Conclusion These tools can help reveal the personhood of our residents and can empower all HCWs in conversation with residents. They help to provide comfort and attachment to people with dementia by helping us maintain their identity and foster inclusion by empowering residents and staff in conversations. This project is easily replicated and practical.

A Summary of Videofluoroscopy Findings Compared with Chest X-Rays of Older Persons in a Model 3 Hospital

Abstract Background Oropharyngeal dysphagia (OD) is increasingly prevalent among the older population. OD may give rise to complications such as aspiration pneumonia, malnutrition and/or dehydration. Videofluoroscopy is a gold standard tool for the management of dysphagia. Videofluoroscopy is a moving x-ray of the swallow in which aspiration can be directly visualised. Videofluoroscopy is only a ‘snapshot’ and the swallow function can improve or decline over time. Not every aspiration event leads to respiratory complications. There is a lack of diagnostic criteria for the diagnosis of Aspiration Pneumonia. It is challenging for Speech and Language Therapists (SLTs) to determine clinical outcomes. Despite this, the primary reason for referral to SLT in acute care is to assess for aspiration risk. The aim of this review is to compare patients’ Chest X-ray findings with Videofluoroscopy results. Methods Results Conclusion Aspiration pneumonia is a diagnostic challenge - further research in the area of dysphagia associated aspiration pneumonia in Older persons is required. The focus of dysphagia management in Older Persons should move towards the person's nutrition, hydration, oral hygiene, quality of life as well as possible dysphagia related respiratory implications.

Quality Of Care In Parkinson's Disease: Lessons From A National Audit

Abstract Background It is recommended that people with Parkinson’s disease (PD) are treated within specialised services. As part of a research project mapping and evaluating PD services nationally, the first audit of PD services in the Republic of Ireland was conducted. Methods A de novo audit tool was developed by an expert group, based on a rigorous review of existing international standards, guidelines and audit tools, with extensive stakeholder input (including people with PD). All 14 specialist PD services in the Republic of Ireland were eligible; up to 30 case-notes were randomly selected per service in 2022/2023, looking at the most recent 2 visits (new patient) or 3 visits (established patient). Results In total, 261 case-notes were included, from 11 specialist PD services, led by a geriatrician (n=5) or neurologist (n=6). Overall, 16.8% of patients were seen less often than annually. Motor and mobility assessments were well performed (>75%); but cognition (70%) and pain assessments (64%), saliva management (50%), and bone density determination (18%) were inadequate. Access to PD nurses (65%), physiotherapy (69%), speech and language therapy (53%), and occupational therapy (50%) was inadequate; PD nurses were mainly in Dublin. However, specialist nurse and MDT access was better than reported by people attending generic services for PD care (1). Providing written information following diagnosis (24%), and communication with the carer were infrequently documented (financial support discussion: 12%; availability of support locally: 26%). Gerontology-led services more often screened for malnutrition (99% v 78%) or orthostatic hypotension (94% v 52%). Conclusion PD care relating to assessment, multidisciplinary involvement, and information sharing was sub-optimal in some areas, with the caveat that documentation may not reflect actual practice. Reference 1. O’Shea E, et al. Experiences of Health Service Access and Use for People Living with Parkinson’s Disease in Ireland: A National Survey. Health & Social Care in the Community. 2023 Aug 9;2023.

Engaging with First Line Nutrition Information - Insights from Health Care Professionals and Older Persons

Abstract Background Health care professionals (HCPs) working with older persons are often asked nutrition related questions. This study explored how first line nutrition information such as general leaflets are accessed and used by HCPs and older persons. Is there a role for video-based nutrition education? Methods HCPs working with older persons completed an online survey. An older person’s reference group participated in a virtual focus group. Participants were asked about knowledge seeking, accessing and providing nutrition information, and engaging with videos on nutrition topics. Results were analysed using descriptive statistics and thematic analysis. Results Ninety five HCPs completed the survey (44% Nursing, 27% Physiotherapy, 14% Occupational Therapy, 6% Speech & Language Therapy and 9% other (doctors, social worker, pharmacist and care needs facilitator).Eighty-eight (90%) HCPs reported being asked nutrition related questions, topics included poor appetite (n=77, 83%), weight loss (n=68, 75%) and constipation (n=66, 72%).Twenty HCPs (21%) reported confidence answering questions, while 28 (29%) reported low confidence. Forty-three (44%) had little or no awareness of available first line information and 37 (39%) rarely or never provided information. Eighty-two (86%) HCPs agreed that nutrition education videos would be used if available. Three themes emerged from the HCPs survey: (i) importance of nutrition for HCPs (ii) barriers to use of first line information and (iii) support systems. Fourteen persons (64% women, 36% men) attended the focus group. Two themes were identified: (i) access to health information and (ii) barriers to access. Discussions included difficulty in proactively seeking information, joined up sharing and that education videos would be beneficial, but the distribution needed consideration. Conclusion Timely access to information is empowering for the older person. HCPs were identified as a resource for seeking nutrition advice. The communication of and access to nutrition information merits consideration. Following these findings, nutrition videos are currently being developed.

Evaluation of New Frailty at the Front Door Service in a Model 3 Hospital

Abstract Background Frailty at the Front Door (FFD) is a key component of integrated care for frail older persons who attend an Emergency Department (ED). This service was established in a model 3 hospital in 2023. Variable Indicative of Placement (VIP) was used to screen patients aged ≥70 years for frailty. Interdisciplinary assessments and interventions were provided by a Senior Physiotherapist and Senior Occupational Therapist (OT). Methods All assessments by the FFD team from June 2023 to February 2024 inclusive, were included. The variables analysed were age, gender, modified Barthel Index (mBI) score, 4AT score, Clinical Frailty Scale (CFS) score, discharge status, length of stay (LOS), referral pathways and re-presentation within 28 days. Data was analysed in Excel. Results There were 490 assessments over the 9-month period, 217 (44%) male and 273 (56%) female, with a mean age of 80 (SD±7.77) years. The median CFS was 5 (range 2-8) and median mBI was 17 (range 4-20). The 4AT score was ≥4 in 44 (9%) cases (indicating possible delirium and possible cognitive impairment). One hundred and eighty-four (38%) patients were discharged home from ED. Seventy (14%) patients re-presented to ED within 28 days. Acute hospital admission was required for 306 (62%) with a mean LOS of 11 (SD±0.5) days. There were 213 referrals to community services for those patients discharged home. These included Dietetics (36%), Physiotherapy (22.5%), ALONE (18%), Delirium Clinic (9.4%), OT (6%) and others (8.1%). There were 238 referrals to acute services for admitted patients, including Physiotherapy (59%), Dietetics (18.5%), OT (17%) and Speech and Language therapy (5.5%). Conclusion This evolving FFD service is a positive step towards improving older persons’ care in ED. Recognition of frailty in ED leads to early identification of care needs and timely referral to alternative pathways in the community and acute services as appropriate.

“Understanding Dementia Together”: The Design, Delivery and Evaluation of a Collaborative Inter-professional Dementia Workshop for Healthcare Students

Abstract Background A collaborative, multi-disciplinary team input is crucial for the optimal management of a person with dementia. Interprofessional learning (IPL) has benefits at undergraduate level. Allowing students to engage in IPL pre-qualification enables them to understand the value of a collaborative approach in improving patient care, and this insight may cultivate future collaboration. The aim of this study was to develop, deliver and evaluate an IPL dementia workshop for healthcare students across a broad range of relevant disciplines. A secondary aim was to determine the extent of perceived clinical application of learned knowledge in students who completed the workshop and subsequently underwent clinical placement. Methods This study adopted a social constructivist pedagogical approach. A steering group was formed which included faculty members from 11 healthcare disciplines. Disciplines represented included medicine, nursing, dentistry, physiotherapy, radiography, radiation therapy, audiology, speech and language therapy, pharmacy, occupational therapy and paramedicine. Kern's map for the development of a curriculum in medical education informed the development of the intervention. The Alzheimer's Disease Knowledge Scale questionnaire was used to assess students’ knowledge. Results 102 students completed the pre and post workshop surveys. There was a statistically significant increase in student's knowledge (t (11) = -5.251, p≤0.001) and communication scores (Z=-7.792, p≤0.001) post workshop. The follow up of students on clinical placement showed a perceived behavioural change in communication modification, with 79% of students stating that they have changed the way they communicate with a person with dementia. Conclusion The findings of this study provide insight into the optimum modes of design and delivery of an IPL dementia workshop, state of knowledge, confidence, and role recognition across a broad spectrum of healthcare students. The longitudinal follow up of students on clinical placement established perceived behavioural change due to the training.

Assessing Adherence to Acute Stroke Therapy Guidelines: An Audit Study

Abstract Background The 2023 National Clinical Guidelines for stroke for the UK and Ireland recommended that people with motor recovery goals post stroke should receive at least 3 hours (180 minutes) of rehabilitation per day on at least 5 out of 7 days a week. This is a significant change to previous guidelines that recommended that patients receive at least 45 minutes of each therapy for a minimum of 5 days (NICE 2013). In 2022, the UK Sentinel Stroke National Audit Programme found that only 11.9% received more than 45 minutes of physiotherapy. This highlights that many services were not achieving previous recommendations. Methods In an Irish hospital, two new stroke assistant posts were funded with the aim to maximise therapy time. An audit was performed on compliance with the 2023 national guidelines on an acute stroke unit in august 2023 for patients that were identified as having motor goals post stroke. Data was collected in the form of minutes of direct patient contact time by each therapy –physiotherapy, occupational therapy, speech and language therapy and therapy assistants. This data was compared against recommended therapy time and presented as a percentage of this. Results 9 acute stroke patients who were identified as having motor goals were randomly selected. It was found that none of these patients were meeting current therapy guidelines. When compared to the recommendations, the average amount of therapy that patients received per day ranged from 44 minutes – 132 minutes. On average, patients received 49.1% of recommended therapy. It was also found that therapy assistants were providing, on average, 59.3% of the actual therapy received. Conclusion Stroke patients are not receiving the recommended amount of therapy as per the most recent guidelines. Although the addition of stroke assistants significantly increased therapy time, guidelines were still not achieved.

Establishing The Role Of The Clinical Nurse Specialist For The Older Adult In A Model 2 Hospital

Abstract Background On average 87.5% of inpatients in our Model-2 Hospital are aged sixty-five years or above. Equally 57.5% of inpatients have medium to maximum dependency care needs. In order to meet the needs of this cohort of patients a new post “Clinical Nurse Specialist (CNS) For The Older Adult” was established in September 2023. Methods Using an online referral system, criteria for referral included i) new onset confusion or delirium, ii) clinical frailty score (CFS) of six or greater, iii) known Parkinson’s disease and iv) nursing or medical team clinical judgement. All reviewed patients received a comprehensive geriatric assessment using the Geriatric 5M framework (Mobility, Medications, Multi-Complexities, Mind and Matters Most) ensuring all aspects of patient care were assessed and promoting timely input from our multi-disciplinary team (Physiotherapy, Dietitian, Speech and Language Therapy, Occupational Therapy and Pharmacy). Results Over a period of 207 days the newly established CNS service received a total of 317 referrals. Two thirds (n=206, 65%) received CNS review, one third (n=111, 35%) did not; 45 (14%) were under the care of a consultant Geriatrician and not reviewed to avoid duplication and 66 (21%) were discharged before review could occur. Conclusion Referral numbers received since the established of the CNS post emphasises the need for the service in our hospital inpatient population. Development of the post has ensured that two-in-three referred patients receive a CNS lead CGA. Results from this pilot highlights the need to further develop and expand the service to target the one-in-five who missed review and further extension of the referral criteria.

Implementation Of A Novel And Integrated Community Flexible Endoscopic Evaluation Of Swallowing (FEES) Service Model For Older Persons

Abstract Background FEES is a gold standard Speech & Language Therapy (SLT) led diagnostic instrument that facilitates evidence-based dysphagia care. A novel community-based FEES service for older persons’ services was recently established in Ireland's Mid-West. New pathways, integrated across divisions, were designed and implemented to complement existing dysphagia pathways within Integrated Care Programme for Older Persons (ICPOP), inpatient rehabilitation for older persons and primary care. An integrated pathway was also established with acute services (Otolaryngology). The aim of this abstract is to describe the implementation process for this novel community FEES service. Methods An SLT-led FEES team engaged with a range of community- and acute-based stakeholders across policy and practice: SLTs, Otolaryngologists, management teams, ICPOP teams, Gerontology Consultants, General Practitioners, Infection Prevention and Control (IPC) teams. Normalisation Process Theory (NPT), an empirically tested and theoretically-sound implementation science framework, scaffolded discussion across a range of implementation and consultation activities including co-design workshops and educational presentations and training, using Health Service Executive (HSE) Change Management tools. Results Stakeholders co-developed a shared understanding of current and new pathways to identify and enact implementation strategies at individual, discipline and system-levels. The project involved stakeholder mapping, communication/engagement planning, risk management, resource planning, and large-scale targeted education/training across settings and disciplines. A FEES working group was formed to coordinate, sustain, monitor, and futureproof implementation activities. Conclusion This collaborative project generated interdisciplinary vision and action to enact an innovative dysphagia care pathway for older people in the community. Articulated through an NPT lens, the project provides insights into the collaboration needed to implement truly integrated care and to identify enablers at individual, disciplinary, and organisational levels. Such knowledge is essential for enhancing integrated care and enacting change and innovation in the Irish health service.

Recent advances in the diagnosis and treatment of dysphagia in neurological diseases

Swallowing disorders are common in many neurological diseases, especially in stroke, Parkinson’s disease, amyotrophic lateral sclerosis, dementia, and multiple sclerosis. Neurogenic dysphagia is associated with an increased risk of death and serious complications, including aspiration pneumonia, dehydration, and malnutrition, which points to the importance of implementing recent advances in the diagnosis and treatment of swallowing disorders into neurological practice. If the initial screening for swallowing disorders is positive, further workup includes a combination of bedside tests and ancillary investigations, such as comprehensive clinical, videofluoroscopic and endoscopic swallowing evaluation. These measures allow to determine the type and degree of dysphagia severity, which is necessary for choosing the optimal therapeutic strategy. Treatment of patients with neurogenic dysphagia requires multidisciplinary approaches involving a team of specialists, including neurologists, speech and language therapists, gastroenterologists, and dietitians. Therapeutic strategy should include providing adequate nutritional support by diet modification and/or enteral nutrition through a nasogastric tube or gastrostomy, appropriate management of underlying and concomitant diseases, prevention and treatment of complications as well as rehabilitation interventions. Future directions to reduce swallowing disorders in neurological diseases will probably comprise a combination of rehabilitation measures with pharmacotherapy and non-invasive stimulation/neuromodulation. Early detection and effective treatment of dysphagia is crucial for achieving better outcomes and improving the quality of life in patients with neurological diseases.

Supporting Complex Severely Frail Patients at Home with Community Specialist Team Intervention

Abstract Background The Community Specialist Team for Older Persons (CST-OP) was created to support older people to live well at home. The team primarily aims to reduce ED presentations and admissions into acute facilities for over 65s. The team became the first fully staffed CST-OP in Q3 2022. Referrals are responded to within 24-48 hours and each referral has a comprehensive geriatric assessment completed. Interdisciplinary assessment is used to identify interventional needs which the team then addresses. This abstract specifically examines the success of supporting people with a Clinical Frailty Score (CFS) of 7 and above to remain at home. Methods The team consists of a senior 1 WTE Social Worker, Physiotherapist, Therapy Assistant, Consultant Geriatrician, Advanced Nurse Practitioner and Clinical Nurse Specialist. The team also has 0.5 WTE Senior Speech and Language Therapist and Dietician. Referrals are accepted from the FIT team, GPs and Older Persons OPD clinic. The team operates on a 100% domiciliary based assessment. A comprehensive geriatric assessment is completed with each referral. A care plan is generated, and interdisciplinary intervention carried out. Results From September 2022 to December 2023 69 patients with a CFS of 7 or above were reviewed by the CST-OP. 60 remained at home, 7 transitioned to LTC and 2 RIP. These figures represent an 86% success rate. Conclusion Evidence suggests older people living with severe frailty can be supported to live well at home by Community Specialist Teams via timely interdisciplinary assessment and intervention and appropriate utilisation of community supports.

A Review of the Concurrent Incidence and Evidence for Dysphagia and Constipation in Acute Stroke Patients

Abstract Background Dysphagia post-acute stroke is a commonly reported complication. It can effect up to 80% of the post stroke population (Banda et al., 2022). Constipation is a well-recognised complication in all hospital admissions. The cause of which is thought of as multifactorial, change in diet and fluid intake, reduced mobility, change in routine etc. A scoping review has found that despite both conditions being prevalent in a stroke population, their concurrent incidence has not been studied or reported. Methods A scoping literature review was carried out to investigate the incidence of these conditions concurrently in stroke. Databases used were CINAHL, EMBASE and MEDLINE. Inclusion criteria for the review included 1) Stroke population over 18 years 2) published in English 3) any measure taken of constipation. Opinion pieces and non-peer reviewed papers were excluded. An audit of our current inpatient cohort on the stroke unit was also carried out to identify if these concurrent conditions are being documented and acted upon. Results The literature review resulted in an empty review. There was no clearly defined literature that reported on the concurrent incidence of dysphagia and constipation in an acute stroke population. The supportive audit on the ward included 29 patients on the inpatient acute stroke unit. 2 of 29 had documented constipation, while 21 of 29 (72%) patients were prescribed laxatives. 15 of 29 (51.7%) had been commenced on a modified diet by speech and language therapy secondary to dysphagia. Conclusion Dysphagia and constipation have been identified as common post stroke complications. 72% of the inpatient cohort have been commenced on laxatives, this indicates the recognition and pre-emptive management off this prevalent complication. Dysphagia was documented in over 50% of patients. Continued research needs to be carried out on the concurrent incidence and management of these post stroke complications.

Features of culturally and linguistically relevant speech-language assessments for Indigenous children: A scoping review.

Indigenous children may be at higher risk of being misdiagnosed with speech-language difficulties due to Eurocentric practices in health care and education. The use of conventional speech pathology assessment practices contributes to inappropriate disorder identification, further stigmatising a vulnerable population. Few resources are available for speech pathologists, which examine the cultural and linguistic relevance of assessments for this population. To provide important features for speech pathologists to account for when building assessment plans for Indigenous children. This comprehensive scoping literature review was completed using the Arksey and O'Malley 6-step methodological framework, including the optional consultation exercise, and reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. To be included, studies needed to have been published since 2000, discuss speech-language assessments and involve a significant proportion of Indigenous participants under 7 years old. Three features were extracted from 32 studies that discussed First Nations, Métis, Inuit, Native American, Aboriginal and Torres Strait Islander communities: using a battery of resources including alternative approaches, ensuring authenticity and cultural relevance, and considering a child's linguistic characteristics. While there remains a need to adapt according to a specific child's reality, this study provides a guideline for all allied health clinicians when they are building their culturally and linguistically relevant assessment plans.

Homeward Stroke Recovery: Results of a Home Rehabilitation Program

Evaluate the feasibility of a homeward stroke recovery (HSR) program by measuring functional outcomes, intervention fidelity, and Profit & Loss. A retrospective observational analysis of 23 stroke survivors discharged to a home healthcare (HHC) program offering early and intensive rehabilitative therapy within 24 hours of index hospitalization. Functional outcomes include timed up-and-go, transfer functional independent measures, and Barthel Index. Clinical outcomes are mortality, all-cause 30-day hospital readmission, and fall rates. Process measures consist of time-to-first HHC visit, number of physical therapy (PT) and occupational therapy (OT) visits from initial evaluation, and total number of visits by clinician type. Financial outcomes include average daily gross HSR revenue compared with an inpatient rehabilitation facility (IRF) stay and average daily net HSR profit. Functional outcomes significantly improved across all measures ( p < .001) without reported falls, deaths, and only one unrelated readmission. On average, HSR began within 1.6 days from hospital discharge including 4.2 PT and 3.7 OT visits within 5 days of respective initial evaluation. Patients received an average of 9.4 nursing, 9.2 PT, 6.4 OT, and 2.2 speech therapy visits. Exploratory analyses demonstrated similar functional recovery despite longer hospitalization (rs = 0.43; p = .039). Revenue per day was lower for HSR than IRF services but costs exceeded the reimbursement rates for this program. The HSR program is feasible given that patients realized significant functional improvement with negligible consequences. Reimbursement reform is necessary to sustain and scale the program. Further studies with larger sample sizes are warranted.