Speech-language Pathology Services Research Articles

Mind–Body Practices and Exercise in the Rehabilitation of Poststroke Aphasia, Mild Cognitive Impairment, and Dementia

Purpose: The purpose of this article is to provide speech-language pathologists (SLPs) with a background in mind–body practices and exercise to prevent and treat cognitive, language, and cognitive communication disorders from a healthy aging viewpoint. Method: An online database search was conducted using a narrative review of mind–body interventions recommended by SLPs and other rehabilitation specialists. Conclusions: Mind–body practices and exercise are a low-cost, accessible, nonpharmacological intervention that may promote beneficial outcomes for individuals who are at risk for neurologic disease. Recent research on risk factors for mild cognitive impairment and dementia suggests that the underlying disease progression may be slowed or stopped with lifestyle modification (e.g., increased physical activity). Additionally, individuals recovering from stroke could potentially experience better outcomes with lifestyle modification (e.g., stress reduction). There has been increased popular interest in mindfulness as a component of a healthy lifestyle, which suggests that both patients and therapists may be receptive to incorporating it into traditional rehabilitation practices, provided there is reasonable support for its benefits. The aim of this article is to provide a rationale for integrating mind–body practices and exercise into speech-language pathology services to decrease levels of unhealthy stress, increase physical activity, and enhance cognition and communication.

Cultural Perceptions of Language Development in a Population Sample of 54-Month-Old Children From Aotearoa New Zealand.

There is a dearth of information on cultural perceptions of children's language development for ethnic minorities in New Zealand to guide service provision. The current study explored differences across ethnicities in mothers' report of language concern and child language scores within a complex cultural, social, educational, and political context. Data from the antenatal and 54-month waves of Growing Up in New Zealand were utilized. At the 54-month wave interviews, 5,053 mothers were asked if language concerns had been raised and to rate their child's main language proficiency along with other measures. Logistic regression models (including influencing variables) indicated Chinese, Indian, and other Asian mothers were less likely to report language concern, whereas Māori, Pacific, other Asian, and Middle Eastern, Latin American, and African children were more likely to score low on the language measure. Higher maternal education was associated with higher child main language scores, but not with language concerns. Child multilingualism was not associated with low language scores, and these mothers were less likely to raise concern. This study demonstrated differences by ethnicity in mothers' language concern and child main language scores, which are likely to affect access to speech-language pathology services, as these typically rely on parent concern being expressed. Cultural bias in the language measure may also be present. Further research is needed to ask ethnic communities their views on culturally appropriate ways to identify children with communication needs and to develop culturally safe services.

Telehealth versus face-to-face delivery of speech language pathology services: A systematic review and meta-analysis.

There is an increasing demand for the provision of speech language pathology (SLP) services via telehealth. Therefore, we systematically reviewed randomized controlled trials comparing telehealth to face-to-face provision of SLP services. We searched Medline, Embase and Cochrane, clinical trial registries, and conducted a citation analysis to identify trials. We included randomized trials comparing similar care delivered live via telehealth (phone or video), to face-to-face. Primary outcomes included: % syllables stuttered (%SS) (for individuals who stutter); change in sound pressure levels monologue (for individuals with Parkinson's disease); and key function scores (for other areas). Where data were sufficient, mean differences were calculated. Nine randomized controlled trials were included; eight evaluated video and one evaluated phone telehealth. Risk of bias was generally low or unclear, excepting blinding. There were no significant differences at any time-point up to 18 months for %SS (mean difference, MD 0.1, 95% CI -0.4 to 0.6, p = 0.70). For people with Parkinson's disease, there was no difference between groups in change in sound pressure levels (monologue) (MD 0.6, 95% CI -1.2 to 2.5, p = 0.49). Four trials investigated interventions for speech sound disorder, voice disorder and post-stroke dysphagia and aphasia; they found no differences between telehealth service delivery and face-to-face delivery. Evidence suggests that the telehealth provision of SLP services may be a viable alternative to their provision face-to-face, particularly to people who stutter and people with Parkinson's disease. The key limitation is the small number of randomized controlled trials, as well as evidence on the quality of life, well-being and satisfaction and economic outcomes.

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.

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.

The telehealth surge: Speech-language pathology mode of service delivery and consumer characteristics during COVID-19

Purpose To examine the characteristics of speech-language pathology (SLP) consumers prior to and during the COVID-19 pandemic, with respect to the mode of service delivery within a local health district in New South Wales, Australia, to inform future health service planning. Method Observational study examining SLP occasions of service data pre-COVID-19 (2019–2019; n = 6413) and during the COVID-19 pandemic (2020–2021; n = 6908). Spatial mapping and multilevel models were used to examine associations between sociodemographic characteristics, telehealth utilisation, and videoconferencing. Result During COVID-19, SLP occasions of service increased by 7.7% compared to pre-COVID-19. Model 1 found odds of adopting telehealth (telephone or videoconference) during COVID-19 were significantly higher for those aged 0–4 and 5–17 years compared to older age groups. Consumers in inner regional areas were significantly less likely to adopt telehealth than in major city areas, whereas females were significantly more likely to adopt telehealth. Those living in areas experiencing higher relative disadvantage were less likely to use telehealth. Model 2 found odds of adopting videoconferencing only were also significantly higher for the younger age groups (0–4 and 5–17 years) and females. Conclusion A rapid transition to a virtual model of care was critical to the successful delivery of SLP services during COVID-19. Immediate prioritisation and integration of targeted models of care, where suitability is high and benefits most likely to be experienced, is feasible.

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

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

“I used to be a storyteller”: the perspectives of people with primary progressive aphasia on the communication needs for themselves and their family members

ABSTRACT Background Primary progressive aphasia (PPA) refers to a group of neurological disorders characterised by the progressive deterioration of language functions. The primary avenue of support for the wide-ranging impacts of PPA on the lives of people with PPA and their family members is the delivery of communication care from speech-language pathologists. To align the provision of communication care services and the development of communication interventions with the peoples’ and family members’ needs, it is important to understand those needs from the perspectives of key stakeholders, particularly individuals with PPA. Aims The aims of the current study were to explore (a) the communication needs of people with PPA in the early and middle stages, and (b) the communication needs of their family members, from the perspectives of people with PPA. Methods & Procedures Semi-structured qualitative interviews were conducted with seven people with PPA (all variants of PPA) from one to 96 months post diagnosis. The qualitative data was analysed using qualitative content analysis to identify codes and categories that related to the study’s research aims. Outcomes & Results Qualitative content analysis yielded six categories of communication need pertaining to people with PPA: Diagnosis and disclosure; Wanting information for self and the general public; General communication difficulties; Impact on communication in everyday life; Impact on psychosocial wellbeing; and Future planning. In contrast, only one category of need pertaining to family members was identified: Impact on family and others. Conclusion This study has yielded a breadth of findings on the communication needs of people with PPA and an initial contribution on those of their family members, implicating a range of health and social care professionals and other system level supports, as well as community members and family and friends, in addition to speech-language pathology services. Speech-language pathologists supporting this population might consider needs in areas such as impact on working life, impact on driving, coping with a changing self-perception of their identity (e.g. as a storyteller), and managing fluctuation in communication abilities. Future research can build on these findings to inform clinical practice and to develop interventions which address the needs of this population.

Awareness of audiology and speech-language pathology services among healthcare professionals in Saudi Arabia.

Healthcare professionals are required to work effectively together to deliver the best healthcare services. Without awareness of other healthcare professionals' roles and responsibilities, interprofessional practice (IPP) cannot be optimally achieved. This study aimed to investigate healthcare professionals' awareness of audiology and speech-language pathology (SLP) services in Saudi Arabia. This cross-sectional descriptive study consisted of two parts. The content of a 20-item paper questionnaire was firstly validated. The full-scale study addressed the aim through distributing questionnaire items among potential participants. Descriptive statistics and chi-square test were used. A total of 403 participants completed the questionnaires for the main study. Most of the participants were Saudi citizens (84.1%), aged 18 years - 40 years (84.8%) years, and lived in Riyadh region (76.2%). Allied health professionals (40.2%), physicians (22.6%), nursing (15.4%) and dentistry (11.2%) were the main group of participants working mainly at governmental hospitals (69.2%). Of the total participants, 92.6% and 95.3% reported being fully aware of the services provided by audiologists and SLPs, respectively. No statistically significant association between the specialty of participants and their familiarity with the scope of practice for SLPs and audiologists was determined. Our study examined healthcare professionals' awareness of audiology and SLP services and revealed a high level of awareness.Contribution:The existed level of awareness is expected to facilitate IPP and enhance the quality of care. Still, awareness campaigns about audiology and SLP services are needed to address the existing lack of knowledge among some healthcare professionals.

Epidemic preparedness and innovations in digital healthcare: enhancing post-pandemic speech-language pathology services for child and adolescent mental health in Qatar

BackgroundThis paper discusses the critical importance of epidemic preparedness and innovations in digital health care by examining the transformative impact on speech-language pathology (SLP) services in a specialist outpatient child and adolescent service (CAMHS).MethodThis retrospective review analyzes referral data from three periods: pre-pandemic (15 March 2019–14 March 2020), pandemic (15 March 2020–14 March 2021), and post-pandemic (15 March 2021–14 March 2022). Statistical analyses assess trends in referrals and diagnoses during these periods. Feedback was also obtained from Parents of children who received virtual consultations during the pandemic.ResultsThe results reveal an increase in the demand for SLP services during and after the pandemic, with a surge in referrals (increased from 9.7 to 12.9% when compared pre-pandemic to post-pandemic periods; Chi-Square value 3.33, P = 0.068) for children with social communication challenges and autism spectrum disorder. Phone and video consultations were effectively adopted. Feedback from families shows a positive response (69%–98% of participants responded as strongly agreed and agreed on various items listed in feedback form specifically designed in line with the service objectives) to telehealth interventions, with many parents finding virtual consultations effective and helpful.ConclusionsThe study emphasizes the importance of telehealth SLP services in meeting the increasing demand for mental health interventions among children and adolescents. It suggests integrating telehealth into clinical practice beyond the pandemic and highlights the need for long-term evaluation and addressing potential barriers to access.

Exploration of how youth justice staff perceive the speech-language pathology role and service provision in an Australian youth justice setting

Purpose The aims of this project were to explore how youth justice staff perceive the speech-language pathology role and provision in an Australian youth justice setting, including the speech-language pathologist’s role in supporting young people to participate in the activities of the youth justice service studied. Method A narrative inquiry approach was employed to guide semi-structured interviews with youth justice staff. Perceptions and experiences were analysed via reflexive thematic analysis, with member checking and inter-rater coding utilised for rigour. Result Seven semi-structured interviews were conducted. Interviewees worked in either the custodial setting (n = 3) or the community setting (n = 4) for the youth justice service studied, though most had worked in both settings. Six themes and six subthemes were identified from the interview data and related to factors that supported improved participation in the activities of the youth justice service studied. These factors were the speech-language pathology skillset and approach, and that there were systemic barriers within the service. All participants perceived speech-language pathology input as valuable for the young people in the service studied. There was also acknowledgement by the participants of how speech, language, and communication needs of the young people impacted their participation in the activities of the service studied. These findings were despite the perceived need for organisation-wide education on the speech-language pathologist role and offering. Conclusion Increased understanding of how youth justice staff perceive the role and benefits of speech-language pathology in supporting young people in contact with the youth justice system will assist with service planning, inform education strategies, and may support policy change.

The model of access to speech-language pathology services

Purpose Within Australia, some families face challenges in accessing paediatric speech-language pathology services. This research sought to investigate the factors that impact access to paediatric speech-language pathology services within Western Australia. Method Researchers used constructivist grounded theory to investigate the construct of access, as experienced and perceived by service decision-makers, namely caregivers of children with communication needs and speech-language pathologists who provide communication services. Eleven speech-language pathologists and 16 caregivers took part in 32 semi-structured in-depth interviews. Researchers used layers of coding of interviews transcripts and the constant comparative method to investigate data. Result Findings outline the factors that impact access to speech-language pathology services, as organised into the seven categories of the Model of Access to Speech-Language Pathology Services (MASPS). The categories and properties of this model are grounded within experiences and perspectives that participants contributed to the dataset. Conclusion MASPS provides a theoretical structure that has been constructed using inductive and abductive reasoning. This model can be used by service designers and decision-makers to reflect upon and improve experiences of service for a range of consumers. MASPS can also be used as a basis for further investigation into aspects of service access.

Therapy deserts: A call to action to address inequitable access to therapy services among pediatric orthopaedic patients

Background"Food deserts" are areas with limited access to affordable and healthy foods, disproportionately affecting low-income and ethnic minority communities in the United States. Analogous disparities exist in other disciplines. Our interprofessional team observed "therapy deserts” in orthopaedic and rehabilitation settings, wherein pediatric patients (particularly those with Medicaid-type insurance) appeared to lack equal access to physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services. Inadequate access to therapy services places patients at risk for worse outcomes. MethodsWe conducted a quality improvement project to assess pediatric patients’ access to therapy care in our region. We surveyed all local PT, OT, and SLP clinics identified from a comprehensive listserv maintained by pediatric therapy teams in our institution. Using a scripted questionnaire, we contacted 113 PT, 38 OT, and 82 SLP clinics external to our institution, collecting data on accepted conditions, appointment waitlist periods, and accepted insurance types. Our primary objective was to determine the percentage of clinics that accepted patients with Medicaid-type insurance. We supplemented our survey with an examination of the Area Deprivation Index (ADI) for each clinic location. Results59 PT clinics (52%), 15 OT clinics (39%), and 36 SLP clinics (44%) completed the survey. Clinics often had limited capacity to care for medically complex conditions. Waitlist times varied, with a median wait of 1 week for PT services, 1 month for OT services, and immediate availability for SLP services. Only 14% of responding PT clinics, 53% of OT clinics, and 22% of SLP clinics accepted patients with Medicaid-type insurance. Insufficient reimbursement rates were frequently cited as the reason for not accepting Medicaid-type insurance. Waitlist times were longer for PT and SLP clinics that accepted Medicaid-type insurance compared to those that did not. Moreover, clinics that accepted Medicaid-type insurance were, on average, in more disadvantaged locations. ConclusionsOur findings suggest the existence of “therapy deserts,” where limited access to therapy services is influenced by insurance type and patient complexity. These restrictions likely exacerbate existing health disparities and illustrate a systemic problem rooted in complex social drivers of health. Addressing "therapy deserts" requires collaborative efforts from multidisciplinary teams. Level of EvidenceLevel III

Speech-Language Pathology Services Associated with Improvement in Self-Care and Mobility for Post-Acute Skilled Nursing Facility Residents

Speech-Language Pathology Services Associated with Improvement in Self-Care and Mobility for Post-Acute Skilled Nursing Facility Residents

Acute Inpatient Rehabilitation Functional Outcomes and Disposition After Liver Transplant

ObjectiveTo describe the outcomes (change in functional independence and discharge disposition) of patients who after liver transplantation received acute inpatient rehabilitation in a freestanding rehabilitation hospital. DesignA retrospective chart review was conducted of patients admitted to an acute inpatient rehabilitation hospital within 6 months of undergoing liver transplantation between January 2014 and December 2018. Change in function from rehabilitation admission to discharge was measured using FIM Change and FIM Efficiency. SettingA freestanding rehabilitation hospital. Participants107 patients who underwent acute inpatient rehabilitation at a freestanding rehabilitation hospital within 6 months after liver transplantation who met inclusion criteria (N=107). Most were men (71.96%), and the mean age of the patient population was 62.15 years. InterventionsAcute inpatient rehabilitation consisting of at least 3 hours of therapy 5 days a week split between physical therapy, occupational therapy, and speech language pathology services. Main Outcome MeasureFIM Change, FIM Efficiency, Discharge Disposition. ResultsParticipants were found to have statistically significant positive FIM Change (P<.00001) and FIM Efficiency (P<.00001). The mean FIM Change and Efficiency were 35.7±11.8 and 2.4±1.0, respectively. 83.2% (n = 89) were ultimately discharged to the community. ConclusionAcute inpatient rehabilitation provides patients who have received a liver transplant with the opportunity to measurably improve their function and independence, with most patients being able to return home.

Aligned or misaligned: Are public funding models for speech-language pathology reflecting recommended evidence? An exploratory survey of Australian speech-language pathologists

Government subsidised funding arrangements serve as an essential medium for families to access private speech-language pathology (SLP) services in Australia. This study aimed to investigate whether, from a provider perspective, contemporary public funding models (PFMs) align with best-available scientific evidence for management of children and young persons with swallowing and communication disorders within Australian private-practice settings. This exploratory study was distributed to paediatric speech-language pathologists throughout Australia via an online survey. A total of 121 valid surveys were completed by Australian speech-language pathologists with divergent career experiences. In comparing three familiar PFMs using mixed effects logistic regression models to estimate odds ratios, results indicated that perceived congruence with recommended scientific evidence for SLP management varied across PFMs: the odds of failing to align with scientific evidence was 4.92 times higher for Medicare’s Chronic Disease Management Plan (MBS_CDMP) than for the National Disability Insurance Scheme; and 7.40 times higher in comparison to Medicare’s Helping Children with Autism initiative. This study is the first to report on (in)congruence between PFMs that provide access to independent Australian SLP services for children and young persons and best available scientific evidence to inform clinical practice. Participants identified that: (a) four out of seven contemporary PFMs were unfamiliar to speech-language pathologists; and (b) MBS_CDMP initiative failed to align with the evidence-base for best scientific SLP management.

Speech-Language Pathologist's Pattern of Practice in the Rehabilitation of Head and Neck Cancer patients across Hospitals in India.

India has a significant burden of Head and Neck cancer (HNC) patients. Patients afflicted with HNC often encounter difficulties in speech, voice, and swallowing, either due to the disease itself or the treatment they receive. The rehabilitation of HNC patients is crucial, and Speech and Language Pathologists (SLPs) have a significant role in it. The current study aimed to understand the practices followed by SLPs in India while rehabilitating HNC patients. A questionnaire was developed and validated by five Speech-language pathologists, before circulation as an E-survey. The target participants were SLPs working in hospitals across India. The final online version of the questionnaire remained open for eight weeks. A total of 75 Hospital-based SLPs working in India participated in the survey. The responses depict notable trends and differences in the assessment and management approaches. HNC patients who had undergone surgery were more likely to be referred for rehabilitation than those who received non-surgical treatments. Only 36% of the SLPs reported getting pre-operative referrals for HNC patients. The time point for initial assessment and intervention, as well as the protocols used, varied across different hospitals. About 50% of participants had instrumental swallow evaluation facilities in their hospitals, and the majority of hospitals only used instrumental swallow evaluation for 1-3 assessments per week. Variability exists in several aspects of SLP practice for HNC patients offered across Hospitals in India. All HNC patients do not get access to speech-language pathology services. Developing standardized protocols towards early evaluation, intervention and enhancing compliance could improve SLP-led rehabilitation of HNC patients in India.

Adapting educational speech-language pathology services during a pandemic

Background: Hanen Programs® have a research-based history of helping parents learn to support the oral language, social communication, and literacy development of their young children. Programs are delivered by Hanen-certified speech-language pathologists, usually in preschool speech and language centers. The global COVID-19 pandemic that began in March 2020 required school-based clinicians to adjust their professional practices to meet the needs of students during disruptive school years. Method: This clinical case study describes the two-year project launched to incorporate Hanen Programs® through telepractice, and discusses the feasibility of offering them as part of a continuum of services at the Toronto District School Board in Toronto, Ontario Canada. Results: Favorable responses from stakeholders led to the expansion of the project. Attrition rate and staff allocation were found to be problematic. Discussion/conclusion: Reasons for the high attrition rate were explored, and a response plan was developed. Additional training for interested staff members was scheduled. Ongoing monitoring is needed to determine the long-term feasibility of offering Hanen Programs® in a school board setting.

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

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

Dysphagia Management in the Emergency Department: Using Concept Mapping to Identify Actionable Change to Improve Services

BackgroundIntegrated speech-language pathology (SLP) services within the emergency department (ED) may facilitate timely dysphagia management. However, there are multiple patient and logistical factors specific to the ED that challenge the delivery of optimal dysphagia referral and management practices within this setting. The aim of the current study was to engage a stakeholder group to identify prioritised, actionable goals that could help enhance dysphagia management within the ED.Methods and ProceduresApplying concept mapping methodology, 16 ED stakeholders from SLP, medical, nursing, and leadership participated in semi-structured interviews to develop action statements which were sorted and ranked for importance and changeability. Multidimensional scaling and hierarchical cluster analysis were used to organise data in clusters with unifying themes before statements were ranked by importance and changeability.Outcomes and ResultsStakeholders identified 53 unique statements, grouped into 8 clusters. Review of the 8 clusters identified 3 overarching aspects for change: (a) Improving processes related to identification and referral of patients as well as communication; (b) Teamwork and collaboration amongst the ED multidisciplinary team and SLP; and (c) Improving staffing and access to training resources for SLP and nursing teams.Seventeen statements were within the Go-zone rated highest for importance and changeability) with the highest rated statement being: Clear documentation by SLP re: recommendations.ConclusionThe current data identified multiple aspects of service provision that require change to facilitate improved dysphagia referral and management services in the ED. Collaborative actions are required by both SLP and the ED multidisciplinary team to help optimise dysphagia services.