Speech-language Pathology Training Research Articles

Is there a doctor in the house? Roles and practices in videofluoroscopic swallowing assessment of structural abnormalities

Purpose Increasingly, videofluoroscopic swallow studies are being conducted without a radiologist. This study explored current assessment of structural dysphagia in adults during videofluoroscopic swallow studies, both internationally and within the Australian context. Method A document analysis of available international videofluoroscopic swallow studies guidance regarding the use of videofluoroscopic swallow studies for structural dysphagia was performed, followed by an online survey of Australian speech-language pathologists seeking information regarding roles, practices, training, and self-perceived competence specific to interpreting structural abnormalities. Result Eleven international guidelines agreed that: a) identification of structural abnormalities is one purpose of videofluoroscopic swallow studies, b) radiologists are responsible for diagnostics, however, c) 55% conceded videofluoroscopic swallow studies takes place without a radiologist if unavailable. Of 139 Australian speech-language pathologists surveyed, only 11% reported constant radiologist presence with 84% requesting radiologists’ input to review images. Fifty eight percent had received training to identify structural abnormalities. Self-perceived competence in identifying structural dysphagia was positively correlated with videofluoroscopic swallow studies experience (r = 0.43, p < 0.05). Conclusion International guidance varies in its advocacy for speech-language pathologist led videofluoroscopic swallow studies. Speech-langauge pathologists in Australia are often conducting videofluoroscopic swallow studies without a radiologist present and may need to determine when to request radiologist review of potential structural abnormalities. Speech-language pathology training and multidisciplinary clinical pathways are needed to mitigate the risk of missed structural diagnoses.

Speech-Language Pathology Interventions in Pediatric Awake Brain Surgery: A Moroccan and Global Perspective.

Introduction Awake brain surgery (ABS) is a groundbreaking technique that not only enhances tumor resection but also preserves vital neurocognitive functions, particularly through advanced brain mapping. Despite its success in adults, ABS in pediatric patients remains significantly underexplored, especially concerning the role of speech-language pathology (SLP) in these procedures. This study addresses this gap by providing a thorough examination of SLP interventions in pediatric ABS across various university hospitals, including those in Morocco and internationally. Methods We utilized a web-based survey, translated into French, English, and Spanish, to capture the clinical practices of 10 pediatric ABS teams globally, including one team at Rabat University Hospital in Morocco. The survey included questionnaires tailored for neurosurgeons, speech therapists, and other professionals involved in ABS. Additionally, a detailed review of medical records for three pediatric patients who underwent ABS in Morocco between 2017 and 2022 was conducted. Data were analyzed using SPSS (IBM Corp., Armonk, NY, USA) for quantitative results and qualitative content analysis for case study evaluations. Results The study found a global consensus on the essential role of SLPin pediatric ABS, with 62.5% of neurosurgeons stressing the need for specialized SLP training. A significant correlation was observed between postoperative speech therapy and reduced neurolinguistic disorders (Pearson correlation=0.340, p=0.007). Challenges in assessing written language components were identified due to a lack of suitable tools, highlighting the need for improved resources. Additionally, most speech assessments during brain mapping were conducted in the patient's mother tongue (60.7%), and assessments were most commonly performed during all three stages of surgery (25%). Conclusion This study emphasizes the importance of speech therapy in pediatric ABS, highlighting the need for specialized tools and training. Findings suggest a positive impact of postoperative speech therapy on neurolinguistic outcomes, but further research with larger cohorts and long-term follow-up is needed to confirm these benefits.

Is There a Place for Pseudostuttering Assignments in Speech-Language Pathology Training Within the Neurodiverse Paradigm?

Purpose: The continued use of pseudostuttering assignments, a disability simulation for speech-language pathology students, needs to be reexamined to align with neurodiversity and students' reluctance to participate in these studies. Stuttering, from a neurodiverse perspective, is regarded as a normal speech variation, rather than a disorder. The purpose of this research was for people who stutter, speech-language therapy students, and faculty members to respond to a survey to determine the future of these assignments, in terms of developing empathy and clinical skills of pseudostuttering. Method: A descriptive design electronic survey using typical case sampling was disseminated globally. A total of 134 participants, divided into three participant groups, completed the survey. The survey consisted of 84 closed- and open-ended questions. Percentages and thematic analysis were used to determine the results. Results: Quantitative and qualitative analyses indicated that 83% of speech-language pathology faculty members supported these assignments. Forty-eight percent of people who stutter and 58% of speech-language pathology students felt negatively toward pseudostuttering assignments. Students reported being more comfortable performing augmentative and alternative communication simulations than pseudostuttering or aphasia simulations. Students were concerned that pseudostuttering assignments were offensive and stigmatizing for people who stutter. Conclusions: The results reflect the benefits of partnering with all the constituent groups. Adaptations to pseudostuttering assignments, such as speaking with people who stutter and adopting a neurodiverse, inclusive approach to student education, are recommended.

Rehabilitation of post-stroke aphasia in Ghana.

Aphasia, a common consequence of stroke, which affects both communication and social functioning, and in turn, quality of life, is on the rise due to increases in stroke prevalence and survival rate. The rehabilitation of post-stroke aphasia primarily falls within the purview of speech-language pathology and research supports the effectiveness of such services. However, provision of aphasia rehabilitation services in sub-Saharan Africa is associated with challenges. This study aimed to examine rehabilitation services for individuals with post-stroke aphasia in Ghana by exploring the roles of the stakeholder groups involved in the assessment and treatment of post-stroke aphasia in Ghana, as well as the challenges they encounter in providing or identifying services. The stakeholder groups included educational institutions, interdisciplinary healthcare professionals, and family caregivers of individuals with post-stroke aphasia. A qualitative case study approach was used to collect and integrate from multiple sources data such as demographic information, interview responses and program syllabi to develop a holistic image. Fifteen respondents from the stroke and speech therapy units at Komfo Anokye and Korle-Bu Teaching Hospitals, University of Ghana, and University of Health and Allied Sciences, Ghana were purposively sampled. Interview questions were developed and centred on aphasia education and training, knowledge of speech-language pathology services, speech-language pathology service delivery, access to speech-language pathology services, challenges in both delivery and access to speech-language pathology services and suggestions for improving speech-language pathology services. In-person and virtual interviews were conducted after demographic information was collected. Interviews were analysed thematically, and demographic information and program syllabi were triangulated with the interview data collected. All stakeholder groups identified concerns with current aphasia services in Ghana. Issues raised included the insufficient number of speech-language pathologists, lack of awareness of speech-language pathology services for post-stroke aphasia (among healthcare professionals and the public), absence of aphasia management information and clinical training in educational programming, lack of interest in speech-language pathology training programs, financial challenges, spiritual and traditional beliefs and geographic barriers (i.e., speech-language pathology services are currently available in only a few cities). These findings emphasised the need to improve post-stroke aphasia rehabilitation in Ghana. The process of data collection itself educated respondents on the importance of post-stroke aphasia rehabilitation, and by identifying barriers, strategies to improving services, such as designing standardised aphasia assessments for the Ghanaian context, can now be initiated. What is already known on the subject To address post-stroke aphasia, evidence-based speech-language pathology services are provided. However, there is a paucity of studies on post-stroke aphasia services in Ghana, preventing an accurate report of services and practices in the country. What this study adds This study provides an overview of the existing rehabilitation services for post-stroke aphasia in Ghana. It highlights challenges facing the existing services and suggested strategies to improve post-stroke aphasia services. What are the clinical implications of this work? The study created awareness among healthcare professionals and general public (study participants) about the importance of rehabilitation services for post-stroke aphasia. Based on the study findings, appropriate stakeholders such as policy makers, researchers, and healthcare professionals can further design assessments and interventions to improve rehabilitation, including speech-language pathology services, for post-stroke aphasia in Ghana.

The exploration of speech language pathology students’ perceptions and attitudes towards written clinical reflection

Purpose: Written clinical reflection is frequently used in speech-language pathology training programs to develop student clinical skills. The aim of this study was to explore speech-language pathology students’ perceptions towards written clinical reflection. Method: Seventy-two undergraduate speech-language pathology students completed an online survey. An observational research design was undertaken. Descriptive statistics were used to analyse quantitative data. Inductive content analysis was used for qualitative data analysis. Result: Speech-language pathology students reported that written clinical reflections are useful but also wanted to explore alternative ways to reflect. Most students used written clinical reflection to focus on self-improvement of clinical skills and a small number of students used reflection to consider stakeholders’ points of view. Students wanted more guidance and feedback on written clinical reflections. Conclusion: The results indicate that written clinical reflection is a useful learning tool. To facilitate the development of reflection skills in speech-language pathology students, it is important to explicitly teach clinical reflection in university curricula and to receive guidance from professional practice educators.

Elizabeth Usher memorial lecture: Speech-language pathology in the transformative age - valuing connectivity

Living in the transformative age is one of disruption, change, and infinite opportunity. However, living in a cloud-based world with self-driving cars, advanced robotics, artificial intelligence, e-health, 3-D printing, and COVID-19 can also be somewhat daunting, challenging, and even confronting. As speech-language pathologists, researchers, educators, and advocates, we need to be agile, more creative and connected to data, experiences, and people. Now more than ever, these connections will enable transformation and ensure the future of our profession. speech-language pathologists are now practising on a global scale, in multiple languages and unique contexts, and the education of our future workforce is critical. Over the past 10 years, there has been rapid growth in the number of speech-language pathology training programs delivered by universities in Australia, as well as a significant shift in the demand for services and changing employment opportunities. In Australia, the profession has been planning for the future; Making Futures Happen, Building a Future workforce, and re-developing our Professional Standards. But, are we really cognisant of the global challenges and opportunities for our profession? Do we really value global connectivity? In this discussion paper, authentic examples and plausible scenarios are being used to explore the global transformation of the speech-language pathology profession. Each will highlight some of the political, economic, societal, cultural, and technological influences on speech-language pathology research, teaching, and practices that are driving development, change, and innovation. Readers will be challenged to consider how thinking globally, with a focus on context, translation, and connection will enable them to rise to the challenges we face today and forge new paths for the future.

Interprofessional Collaboration: Training Preservice Adapted Physical Education Teachers to Facilitate Peer Engagement Among Children With Disabilities

PurposeSpeech-language pathologists (SLPs) and adapted physical education (APE) teachers working in schools have a distinct opportunity to collaborate and serve students with communication and movement needs.MethodTwenty-three preservice APE teachers were given a brief presentation led by SLPs and then rated using a fidelity checklist during the duration of a summer physical activity camp for children with disabilities. A cumulative link mixed model was used to determine APE preservice teachers' ability to facilitate peer engagement and social interaction among children with disabilities within tasks related to their discipline following speech-language pathology training and live coaching.ResultsFollowing intervention, preservice APE teachers demonstrated significant gains in increasing peer engagement between campers with disabilities. In addition, observers rated the preservice APE teachers as more skilled in demonstrating comprehension of and implementing the engagement techniques.DiscussionResults indicate even a brief in-service from SLPs to APE preservice teachers can help them better recognize and support opportunities for peer engagement for children with disabilities while targeting tasks related to their discipline. Future research is warranted with a larger sample size to elucidate collaboration opportunities that promote optimal outcomes for children with needs across disciplines.

Incorporating IPE and simulation experiences into graduate speech-language pathology training

Ineffective interprofessional collaboration between healthcare workers can negatively impact patient care. At a time when people are living longer with chronic health conditions, it is becoming inc...

A simulation-based learning experience in augmentative and alternative communication using telepractice: speech pathology students\u2019 confidence and perceptions

BackgroundSimulation, as an activity in speech-language pathology training, can increase opportunities for students to gain required skills and competencies. One area that has received little attention in the simulation literature, yet is a growing area of clinical practice, is alternative and augmentative communication (AAC). Also growing, is the use of telepractice to deliver services. This exploratory study investigated graduate entry speech-language pathology student perceptions of a simulation learning experience working with an adult with complex communication needs via telepractice.MethodsFirst year Master of Speech Pathology students completed a 1-day simulation using a videoconferencing delivery platform with an actor portraying an adult client with motor neurone disease requiring AAC. Quantitative and qualitative survey measures were completed pre- and post-simulation to explore students’ confidence, perceived impact on clinical performance, and perceived extent of learning, specifically, their interest, competence, and tension. Further, students’ perceptions about the telepractice system useability were explored. Fifty-two responses were received and analysed using descriptive statistics and content analysis.ResultsPost-simulation, students reported increased confidence and perceived positive impacts on their confidence and clinical skills across communication, assessment, and management domains. They felt better prepared to manage a client with a progressive neurological condition and to make AAC recommendations. For telepractice delivery, technology limitations were identified as impacting its use, including infrastructure (e.g., weak internet connection). In addition, some students reported feeling disconnected from the client.ConclusionThis study supports the use of simulation in AAC through telepractice as a means of supporting Masters-level speech pathology student learning in this area of practice.

Perceived Gaps in Genetics Training Among Audiologists and Speech-Language Pathologists: Lessons From a National Survey.

Purpose The aim of this study was to assess knowledge, self-rated confidence, and perceived relevance of genetics in the clinical practice of audiologists and speech-language pathologists (SLPs) toward a better understanding of the need for genetics education, given that genetics plays a growing role in the diagnosis of hearing impairment and communication disorders. Method A survey consisting of 8 demographic items and 16 content questions was returned by 233 audiologists and 283 SLPs. Knowledge of applied genetics was queried with clinical scenarios in a multiple-choice format. Self-assessment of clinical confidence and perceived relevance of genetics in one's field was queried with questions and statements rated on 5-point Likert scales. The benefit of additional training in genetics was rated with a yes/no question, and if answered with yes, suggested topics were entered. Results A large significant gap between confidence in one's own genetics skills and the perceived relevance of genetics was evident, regardless of professional group. Over one third of the audiologists and over two thirds of the SLPs indicated low or somewhat low confidence in their own ability to implement principles of genetics, whereas over two thirds of both groups agreed that genetics is relevant for their field. Regardless of group, confidence scores were significantly and positively associated with relevance scores. Over 80% of respondents in both groups indicated that they would benefit from additional training in genetics. Most commonly suggested topics included genetic causes, general information about genetics, and making referrals. Conclusion Both audiologists and SLPs felt that genetics is relevant for their fields and that additional training in genetics would be beneficial. Future studies should evaluate the effect of genetics training on patient outcomes and the need for incorporating genetics more extensively into audiology and speech-language pathology training programs.

Developing clinical skills in paediatric dysphagia management using human patient simulation (HPS)

Purpose: The use of simulated learning environments to develop clinical skills is gaining momentum in speech-language pathology training programs. The aim of the current study was to examine the benefits of adding Human Patient Simulation (HPS) into the university curriculum in the area of paediatric dysphagia.Method: University students enrolled in a mandatory dysphagia course (n = 29) completed two, 2-hour HPS scenarios: (a) performing a clinical feeding assessment with a medically complex infant; and (b) conducting a clinical swallow examination (CSE) with a child with a tracheostomy. Scenarios covered technical and non-technical skills in paediatric dysphagia management. Surveys relating to students’ perceived knowledge, skills, confidence and levels of anxiety were conducted: (a) pre-lectures; (b) post-lectures, but pre-HPS; and (c) post-HPS. A fourth survey was completed following clinical placements with real clients.Result: Results demonstrate significant additive value in knowledge, skills and confidence obtained through HPS. Anxiety about working clinically reduced following HPS. Students rated simulation as very useful in preparing for clinical practice. Post-clinic, students indicated that HPS was an important component in their preparation to work as a clinician.Conclusion: This trial supports the benefits of incorporating HPS as part of clinical preparation for paediatric dysphagia management.

Checklist for Assessing Graduate Student Competencies in Voice Disorders

Low-incidence clinical disorders such as voice, nasal resonance, and fluency present challenging areas for graduate-level speech-language pathology training programs to help students acquire necessary knowledge and skills. A checklist of competencies for fluency disorders exists in the literature. The authors are presently collecting pretest/posttest data on the fluency disorders checklist over several cohorts of graduate students to determine student level of proficiency and confidence regarding these competencies. Preliminary data analysis suggests significant student perception of growth as a result of completing course requirements. These data have been useful to the second author, who teaches a course in fluency disorders and utilizes the checklist for purposes of course design and case-based project development to help students gain competence. The authors observed that a similar checklist of competencies for voice disorders would be useful for training programs as well as for other reasons described throughout this paper. Consequently, the authors compiled a checklist for assessing graduate student competencies for voice disorders. This checklist provides academic and clinical faculty with a comprehensive tool to guide the education of graduate clinicians and assist in the assurance of educational quality for speech-language pathologists.

Abstracts for Canadian Stroke Conference

Specogna, AV; Patten, SB; Hill, MD; University of Calgary, Calgary, AB Background: Previous studies have examined predictors of treatment costs after Spontaneous Intracerebral Hemorrhage (ICH) in various countries and healthcare systems. Currently however, there is no clear understanding of which factors are associated with cost in any Canadian setting and thus no way of understanding how to plan ICH healthcare spending. Methods: We used a retrospective case series study design and adjusted linear regression to investigate if an association existed between the total cost of ICH hospital care in a Canadian health centre and age (years), gender (female vs. male), Charlson Comorbidity Index (0 vs. ≥1), in-hospital mortality (alive vs. dead), and having surgery (no vs. yes). Economic, treatment, and patient data were obtained from administrative sources. Total inflation-adjusted hospital cost per discharge was estimated in Canadian Dollars and log transformed for all analyses. Results: Analyses were performed using 987 consecutive ICH discharges from 1999 to 2008. The total cost of ICH hospital care was highly variable (mean cost per discharge=$25,613.96±$36,116.33; min $446.81 to max $326,275.10). Older age (β=–0.0057; 95% CI: –0.0103 to –0.0011) and death in hospital (β=–0.4859; 95% CI: –0.6357 to –0.3342) were significantly associated with lower total hospital cost per discharge. Whereas Charlson Comorbidity Index of ≥1 (β=0.6489; 95% CI: 0.5063 to 0.7916) and having surgery (β=1.3552; 95% CI: 1.1893 to 1.5210) were significantly associated with higher total hospital cost per discharge. Gender was not significantly associated with cost (β=0.0727; 95% CI: –0.0679 to 0.2134). Conclusions: To our knowledge this is the first study to examine predictors of ICH treatment costs in Canada. In a Canadian health centre, ICH treatment costs were significantly associated with patient age, level of comorbidity, in-hospital mortality, and surgical treatment. This study provides evidence that it may be reasonable to consider …

The World Report on Disability and communication disability: Some considerations from an Indian context

The aim of this paper is to reflect and comment on the lead article by with reference to people with communication disability in India and illustrated by the work of one Indian non-governmental organization. Key themes and questions from Wylie et al. are identified and discussed. Suggestions for how the recommendations of the World Report on Disability might be implemented in an Indian context are made, notwithstanding the magnitude and scale of the demand for services in the context of the vast population. Nine recommendations at the meso- and micro-level are included. These emphasize three major themes: methodologies to ensure access for all those who need speech-language pathology services; enhancement of speech-language pathology training capacities to deliver holistic professional services in urban and rural settings; promotion of the involvement of advocacy groups in policy-making and, hence, facilitating people with communication needs to be more assertive about rights and entitlement.

Dysphagia training for speech-language pathologists: Implications for clinical practice

There are competency standards available in countries with established speech-language pathology services to guide basic dysphagia training with ongoing workplace mentoring for advanced skills development. Such training processes, however, are not as well established in countries where speech-language pathology training and practice is relatively new, such as Malaysia. The current study examines the extent of dysphagia training and workplace support available to speech-language pathologists (SLPs) in Malaysia and Queensland, Australia, and explores clinicians’ perceptions of the training and support provided, and of their knowledge, skills, and confidence. Using a matched cohort cross-sectional design, a purpose-built survey was administered to 30 SLPs working in Malaysian government hospitals and 30 SLPs working in Queensland Health settings in Australia. Malaysian clinicians were found to have received significantly less university training, less mentoring in the workplace, and were lacking key infrastructure needed to support professional development in dysphagia management. Over 90% of Queensland clinicians were confident and felt they had adequate skills in dysphagia management; in contrast, significantly lower levels of knowledge, skills, and confidence were observed in the Malaysian cohort. The findings identify a need for improved university training and increased opportunities for workplace mentoring, training, and support for Malaysian SLPs.

Point/Counterpoint: Electrical Stimulation for Dysphagia: The Argument Against Electrical Stimulation for Dysphagia

Surface electrical stimulation for dysphagia is still a controversial subject. Some studies tout the benefits of using electrical stimulation (e-stim) for improving a disordered swallow. It is important to ensure that the discussion about e-stim is balanced. In this article, I discuss selected counterpoints, including e-stim's intended use, the objective findings of scientific findings, and whether speech-language pathology training in the area of swallowing anatomy and physiology adequately prepares clinicians to use e-stim for dysphagia. Overall, clinicians are urged to take into account all sides of this debate and make educated decisions about whether it should be a part of their clinical practice.

Policies and Practices Regarding Students With Accents in Speech-Language Pathology Training Programs

Speech-language pathology (SLP) training programs are the initial gateway for nonnative speakers of English to join the SLP profession. An anonymous web-based survey in New York State examined policies and practices implemented when SLP students have foreign accents in English or in other languages. Responses were elicited from 530 students and 28 clinic and program directors. Few policies delineated criteria for determining how native like or intelligible students’ speech needed to be for them to work effectively or for determining when accent modification was required. Students with foreign accents in English were asked more often to undergo accent modification than were students with foreign accents in Spanish or other languages. Strategies for practices regarding SLP students with accents are proposed.

Current Issues: RiteCare Family Autism Camp at Radford University: An Innovative Clinical Education Model for Speech-Language Pathology Students

The “unique learning style and social communication challenges” experienced by children with autism spectrum disorders (ASD) necessitate that speech-language pathologists (SLPs) receive education specific to this disability (American Speech-Language-Hearing Association [ASHA], 2006a, p.18). Graduate training programs often provide this education through classroom instruction and clinical education (also referred to as clinical teaching or supervision). Clinical education has a long-standing tradition in the field of speech-language pathology and is considered “an essential component in the education of students” (ASHA, 2008a, p. 1). This article presents a description of clinical education experience, specific to serving children with ASD, that is offered to graduate level speech-language pathology students at Radford University. The RiteCare Family Autism Camp, hosted by the Department of Communication Sciences and Disorders, provides graduate level clinical training in a model of service delivery amendable to many best practices when serving this population, such as intensive services, a partnership with parents, development of social communicative competence through the use of peer mediators, and a focus on literacy. This article describes the role of the SLP working with ASD and the RiteCare camp and seeks to inspire other graduate speech-language pathology training programs to consider an intensive, family-based day program for children with ASD as a clinical education model for its speech-language pathology students.

Preparation in Augmentative and Alternative Communication: An Update for Speech-Language Pathology Training

To report on data from the current survey about academic and clinical education in augmentative and alternative communication (AAC), as well as to compare these findings with earlier surveys in an attempt to identify any changes being made as programs in the United States implement the new certification standards of the American Speech-Language-Hearing Association in the area of speech-language pathology. A survey was sent to all speech-language pathology training programs in the United States via e-mail directed to program directors or faculty teaching in AAC. A total of 168 surveys were returned, for a return rate of 57.93%. Seventy-three percent of the respondents had a separate course in AAC, and 80% indicated AAC content was infused in other courses. Academic preparation in AAC, while varying across academic programs, has in general increased over the past decade. Data also suggested a continuing critical need for more academic and clinical preparation in this area.

A Counseling Training Module for Students in Speech-Language Pathology Training Programs

A Counseling Training Module for Students in Speech-Language Pathology Training Programs