Speech-language Pathology Treatment Research Articles

Prevalence and recovery of dysphonia in COVID-19 patients requiring intensive care treatment

BackgroundDysphonia and laryngeal pathology are considerable issues in patients hospitalised with COVID-19 with prevalence rates cited between 29% and 79%. Most studies currently are limited to reporting single-institution data with many retrospective. ObjectivesThe aims of this study were to prospectively explore the following: (i) prevalence; (ii) treatment; and (iii) recovery pattern and outcomes for dysphonia, in patients with COVID-19 requiring intensive care unit (ICU) treatment. MethodsPatients admitted to 26 ICUs over 12 months, diagnosed with COVID-19, treated for survival, and seen by speech–language pathology for clinical voice assessment were considered. Demographic, medical, speech–language pathology treatment, and voice outcome data (grade, roughness, breathiness, asthenia, strain [GRBAS]) were collected on initial consultation and continuously monitored throughout the hospital admission. FindingsTwo-hundred and thirty five participants (63% male, median age = 58 yrs) were recruited. Median mechanical ventilation duration and ICU and hospital lengths of stay (LOSs) were 16, 20, and 42 days, respectively. Dysphonia prevalence was 72% (170/235), with 22% (38/170) exhibiting profound impairment (GRBAS score = 3). Of those with dysphonia, rehabilitation was provided in 32% (54/170) cases, with dysphonia recovery by hospital discharge observed in 66% (112/170, median duration = 35 days [interquartile range = 21–61 days]). Twenty-five percent (n = 42) of patients underwent nasendoscopy: oedema (40%, 17/42), granuloma (31%, 13/42), and vocal fold palsy/paresis (26%, 11/42). Presence of dysphonia was inversely associated with the number of intubations (p = 0.002), intubation duration (p = 0.037), ICU LOS (p = 0.003), and hospital LOS (p = 0.009). Conversely, duration of dysphonia was positively associated with the number of intubations (p = 0.012), durations of intubation (p = 0.000), tracheostomy (p = 0.004), mechanical ventilation (p = 0.000), ICU LOS (p = 0.000), and hospital LOS (p = 0.000). More severe dysphonia was associated with younger age (p = 0.045). Proning was not associated with presence (p = 0.075), severity (p = 0.164), or duration (p = 0.738) of dysphonia. ConclusionsDysphonia and laryngeal pathology are common in critically ill patients with COVID-19 and are associated with younger age and protracted recovery in those with longer critical care interventions.

Dysphagia Prevalence and Outcomes Associated with the Evolution of COVID-19 and Its Variants in Critically Ill Patients

Data collected during the 2020–21 COVID-19 alpha wave indicated dysphagia prevalence rates up to 93%. Whilst many patients recovered during hospital admission, some experienced persistent dysphagia with protracted recovery. To explore (1) prevalence, (2) treatment, and (3) recovery patterns and outcomes for swallowing, in the ICU patient with Delta and subsequent variants of COVID-19. Prospective observational study. Patients admitted to 26 Intensive Care Units (ICUs) over 12 months, diagnosed with COVID-19, treated for survival and seen by Speech–Language Pathology (SLP) for clinical swallowing assessment were included. Demographic, medical, SLP treatment, and swallowing outcome data were collected. 235 participants (63% male, median age = 58 years) were recruited. Median mechanical ventilation was 16 days, and ICU and hospital length of stay (LOS) were 20 and 42 days, respectively. ICU-Acquired Weakness (54%) and delirium (49%) were frequently observed. Prevalence of dysphagia was 94% with the majority (45%) exhibiting profound dysphagia (Functional Oral Intake Scale = 1) at initial assessment. Median duration to initiate oral feeding was 19 days (IQR = 11-44 days) from ICU admission, and 24% received dysphagia rehabilitation. Dysphagia recovery by hospital discharge was observed in 71% (median duration = 30 days [IQR = 17-56 days]). Positive linear associations were identified between duration of intubation, mechanical ventilation, hospital and ICU LOS, and duration to SLP assessment (p = 0.000), dysphagia severity (p = 0.000), commencing oral intake (p = 0.000), dysphagia recovery (p < 0.01), and enteral feeding (p = 0.000). Whilst older participants had more severe dysphagia (p = 0.028), younger participants took longer to commence oral feeding (p = 0.047). Dysphagia remains highly prevalent in ICU COVID-19 patients. Whilst invasive ventilation duration is associated with swallowing outcomes, more evidence on dysphagia pathophysiology is required to guide rehabilitation.

Speech-Language Pathology Treatment of Cognitive-Communication Deficits in School-Aged Children With Traumatic Brain Injury: A Scoping Review.

The purpose of this scoping review was to synthesize the current evidence-based treatment practices used with school-aged children with any severity of traumatic brain injury (TBI) that could benefit the practice of speech-language pathologists (SLPs). A scoping review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Included studies were assigned thematic labels based on a modified version of the Rehabilitation Treatment Specification System. A total of 27 articles that covered 16 different treatment approaches met inclusion criteria for this study. Most studies included adolescent or teenage participants with moderate-severe TBIs. Treatment targets included executive functioning (n = 15), social competence (n = 6), postconcussive symptoms (n = 5), behavior (n = 3), family functioning (n = 1), and health-related quality of life (n = 1). The majority of current interventions for school-aged children with TBI include a multidisciplinary approach and components of family involvement education. Further research is needed on interventions that are specifically implemented by SLPs as well as protocols that include more heterogeneous samples (e.g., varied sociodemographic factors and injury severity) to allow for the development and testing of ecologically valid intervention practice. SLPs can use the results of this scoping review to individualize treatment based on the child's areas of need while considering individual characteristics and to provide person-centered intervention for children with school-aged TBI.

Speech-Language Pathologists' Use of Myofunctional Devices in Therapy Programs

Purpose: This study aimed to explore the use of myofunctional devices (MDs) by speech-language pathologists (SLPs) to gain a better understanding of how SLPs are utilizing these in the treatment of their patients. Method: Eleven SLPs from four countries participated in semistructured interviews. The interview transcripts were analyzed using qualitative content analysis. Participants' responses were coded and categorized to identify key themes related to the use of MDs in therapy. Results: Five key themes, composed of 11 main categories and 54 subcategories, were identified. Themes highlighted variability in the use of MDs, including the type of device, application of the device, and dosage. Successful outcomes with the use of MDs were influenced by clinical experience and training, a multidisciplinary approach, along with client/family adherence to therapy. Participants frequently described the use of MDs as one component of an overall therapy program and reported on the need for further research to guide the use of MDs in speech-language pathology treatment. Conclusions: The use of MDs in speech-language pathology practice is often related to the expertise and experience of the SLP. Although SLPs report positive clinical outcomes, there remains a need for further research to support the use of MDs in therapy.

Assessing the Impact of Nasotracheal Intubation on Postoperative Neonates With Congenital Heart Disease: A Quality Improvement Project at a Single Heart Center.

Nasotracheal intubation (NTI) is associated with fewer unplanned extubations and improved oral motor skills compared with orotracheal intubation (OTI). Our study aimed to implement a practice change from OTI to NTI for neonatal cardiac surgery and assess impact on postoperative outcomes. Single-center, prospective, quality improvement study. Academic children's hospital. One hundred thirty neonates undergoing cardiac surgery with cardiopulmonary bypass. NTI during index cardiac surgery. Data were collected between January 2019 and April 2021. The study was implemented in three phases: retrospective: OTI neonates ( n = 43), I: safety and feasibility of NTI ( n = 17), and II: speech language pathology (SLP) evaluation on postoperative day 1 facilitated by NTI ( n = 70). Retrospective and phase I patients were combined for analysis. Groups were compared using Kruskal-Wallis test or Wilcoxon rank-sum test.Ninety-one percent of eligible neonates were nasotracheally intubated. There were no clinically significant complications. Days to first SLP encounter decreased from a median 4.5 days (interquartile range [IQR], 3.8-6.2) to 1.1 days (IQR, 1.0-1.9; p < 0.001). Oral readiness time decreased from a median of 6.6 days (IQR, 5.4-8.9) to 4.3 days (IQR, 3.4-8.6; p < 0.001). . NTI is feasible and safe in neonatal cardiac surgery. System-level engagement with stakeholders is necessary to change clinical practice. NTI facilitates early SLP evaluation and treatment and significantly affects oral readiness after neonatal cardiac surgery.

A Systematic Review of Adherence Strategies for Adult Populations in Speech-Language Pathology Treatment.

Speech-language pathologists (SLPs) often advise adult patients to complete at-home programs in order to improve outcomes. Despite this widespread practice, relatively little is known about treatment adherence. The purposes of this systematic review were to identify adherence strategies and adherence tracking methods used by adult populations that are commonly treated by SLPs (i.e., dysphagia, aphasia, traumatic brain injury, dysphonia, dysarthria), and to identify the efficacy of these strategies. The systematic review was conducted in accordance with A Measurement Tool to Assess Systematic Reviews guidelines. A comprehensive literature search was performed in three databases (CINAHL, PubMed, and Web of Science). Of the 679 articles found, 18 were selected for analysis. Two thirds of the included articles received the second highest rating on the 5-point JAMA Quality Rating Scheme. Interventions designed to alter treatment adherence included (most to least frequent) computer programs, portable devices/phone apps, alarm reminders, instructional DVDs, check-ins from a clinician/volunteer, and wearable device. Adherence reporting methods included (most to least frequent) self-report diaries, computer program/app-aided collection, wearable device, and clinician/volunteer observation. Of the articles that reported practice frequency, 58% found that adherence strategies improved practice frequency as compared to control. Of the articles that reported treatment outcomes, 66% found that adherence strategies were associated with improved treatment outcomes as compared to control. The paucity of publications reviewed suggests that treatment adherence is considerably understudied in speech-language pathology. A clearer understanding of how to improve the design of adherence strategies could yield highly valuable clinical outcomes. https://doi.org/10.23641/asha.19393793.

Counseling and Care Partner Training in Primary Progressive Aphasia.

Individuals with primary progressive aphasia (PPA) experience loss of communication abilities in the context of neurodegenerative disease. Consequently, many individuals with PPA endorse negative psychosocial effects, including social isolation, reduced communication confidence, and depression. Incorporating communication-centered counseling early and often within the speech-language pathology treatment framework is a vital component in holistically addressing the multifaceted ramifications of living with this devastating disorder. Additionally, care partners are key stakeholders in the treatment dynamic. Involving these individuals in the treatment paradigm through care partner training is crucial for facilitating optimal communication in daily life. The purpose of this narrative literature review is to discuss existing research regarding counseling and care partner training in PPA and to outline additional treatment considerations and future research needs in this understudied area. Relative to studies that delineate restitutive speech-language interventions for PPA, the literature pertaining to counseling and care partner training is limited. Available evidence supports the utility of these approaches, which serve as complementary components to restitutive and compensatory speech-language intervention. Additional research is warranted to support generalizability and long-term benefit of these interventions, and to address facets of counseling and care partner training that have not been explored in PPA (e.g., counseling interventions drawing from specific psychotherapeutic traditions; multicultural counseling) or have only been explored to a limited degree (e.g., interventions that jointly provide counseling and partner training).

Measuring Stakeholder Perceptions: A Review of Social Validity Reporting in ASHA Journals

Purpose Intervention research in speech-language pathology is growing; however, there remains a gap between research and clinical practice. To promote evidence-based practice, stakeholder input may be solicited during the development and evaluation of treatments. One method of evaluating stakeholder input is by subjectively measuring social validity. Social validity probes end users' satisfaction and acceptability of a treatment. Method This review article explores the type and frequency of subjective social validity measures reported in speech-language pathology treatment literature published in American Journal of Speech-Language Pathology; Journal of Speech, Language, and Hearing Research; and Language, Speech, and Hearing Services in Schools from January 2017 through April 2019. In total, 93 treatment studies were included and coded descriptively. Results Of the 93 treatment studies included in this review, 20 reported subjective measures of social validity. The most common method of measurement was questionnaires (n = 19), followed by interviews (n = 5), and direct observation (n = 1). Conclusions Only 21.5% of reviewed speech-language pathology treatment articles from American Speech-Language-Hearing Association journals reported measures of social validity, although it is a crucial component of implementation of evidence-based practice. We urge researchers and journal editors to include social validity measures in treatment literature as we promote the uptake of evidence-based practices and the involvement of stakeholders during the development of evidence-based practices. We also encourage the development of social validity measures that can be validated on individuals with communication disorders.

Orofacial Myofunctional Therapy and Myofunctional Devices Used in Speech Pathology Treatment: A Systematic Quantitative Review of the Literature.

Purpose A growing number of speech-language pathologists (SLPs) are using orofacial myofunctional therapy (OMT) and/or myofunctional devices (MDs) in the treatment of their clients. However, governing bodies suggest SLPs carefully consider the availability and quality of evidence in the utilization of these therapies in speech-language pathology treatment. The purpose of this study was to review the existing evidence for OMT and MDs used by SLPs. Method A systematic quantitative review was conducted using key search terms in three electronic platforms housing multiple databases, along with a hand search, to identify additional literature. All studies published in English in full text were included if they reported pre- and posttreatment data of OMT and/or MDs provided by an SLP. Data were extracted and analyzed by the first author and confirmed by the co-authors. Results Twenty-eight studies met the criteria for inclusion in the review. Two thirds were published in the last decade and involved the use of OMT/MDs targeting multiple areas of speech pathology intervention within the same study, that is, swallowing, breathing, oral hygiene, and speech production. Majority of studies were rated as low level of evidence. All studies used OMT, with very few using MDs. While the assessment, treatment protocols, and outcome measures were highly variable, all of the studies reported an improvement in the function of the orofacial systems posttreatment. Few studies reported long-term follow-up data. Almost half of the studies recommended the use of OMT/MDs in a multidisciplinary/interdisciplinary team or in conjunction with other therapy. Conclusions There has been an increase in literature over the last decade in SLPs' use of OMT; however, there are only a small number of studies to date that explore the use of MDs. There is a growing body of evidence to support the use of OMT and MDs within a multidisciplinary team for people with communication and swallow difficulties. However, development of future research should consider investigating assessment and outcome measures, optimal dosage, and service delivery.

Navigating the “Passaggio” Between Voice Therapy and a Singing Lesson: Ethical Considerations for the Speech-Language Pathologist

Purpose The purpose of this article is to discuss factors that guide ethical decision making in determining what constitutes medically necessary voice therapy that involves or targets singing, which is distinct from a singing lesson. Method Different treatment tasks and scenarios are identified, and their rationales are compared with deference to precedent literature and relevant portions of the American Speech-Language-Hearing Association Code of Ethics. These materials are referenced in an effort to define the boundaries between voice therapy involving singing technique and a singing lesson. Results Suggestions regarding goal writing and documentation to highlight apparent boundaries are made. Conclusions In the care of injured voices, both precedent and ethical principles support speech-language pathology treatment that targets singing. However, it is incumbent upon the treating speech-language pathologist to determine when they are venturing into tasks that no longer serve a therapeutic purpose and to refer the patient for voice lessons as appropriate.

A survey of speech-language pathology treatment for non-progressive dysarthria in Australia

AbstractAim:To identify management practices of Australian speech-language pathologists (SLPs) in the treatment of non-progressive dysarthria using a subsystem approach, and to explore SLPs’ consideration and implementation of the theoretical underpinnings of non-progressive dysarthria management.Method:A 39-item online survey was distributed to Australian SLPs, with 80 responses suitable for data analysis.Results:Practices of SLPs were variable for the management of the speech subsystems. The Lee Silverman Voice Treatment (LSVT®) was the most commonly used manualised treatment program, and was employed by 63.77% of respondents. Almost all SLPs (&gt;88%) provided strategies to improve functional communication. There was no clear preference for low tech alternative and augmentative communication (AAC) devices. Speech generating devices were the most commonly employed high tech device. Almost two-thirds of respondents used non-speech oral motor exercises (NSOMEs) in treatment. SLPs had varied frequencies and models of service delivery for intervention. SLPs valued interventions targeting the activity and participation domains of the ICF, however this was restricted by the treatment context and resources available. The majority of SLPs (92.06%) were aware of the principles of motor learning, however many were unsure regarding the specifics of implementation.Conclusion:There is a clear need for further research into the efficacy of treatment techniques to guide decision-making.

Supplementing stuttering treatment with online cognitive behavior therapy: An experimental trial

PurposeIt is now well established that adults who present to speech clinics for help with stuttering will have an increased risk of having an anxiety disorder, particularly social anxiety disorder. Concomitant psychological problems are known to interfere with the maintenance of the benefits of behavioral speech treatments for stuttering. The current team has developed and trialed a cognitive behavior therapy (CBT) program designed specifically to reduce anxiety in adults who stutter, and trials have shown promise for both an in-clinic version and a standalone internet-based version. The aim of the present study is to determine whether iGlebe, the internet-based version of the team’s internet CBT treatment (previously known as CBTPsych), enhances the benefits of behavioral stuttering treatment. MethodParticipants were 32 adults seeking treatment for stuttering. The design was a two-arm randomized experimental trial with blinded outcome assessments at 6 and 12 months post-randomization. Both arms received basic speech-restructuring training to reduce stuttering, without any anxiolytic (anxiety reducing) components. The experimental arm also received 5 months access to iGlebe. ResultsThere was evidence that, at 12 months post-randomization, iGlebe added clinically significant improvements to self-reported stuttering severity and quality of life. The present experimental trial provides the first evidence that the addition of CBT to speech restructuring improves speech outcomes. ConclusionsThe present results will be the basis for the development of a comprehensive, internet-based treatment program for anxiety associated with stuttering. Ultimately, it may be possible for such an economical, scalable, and translatable comprehensive treatment model to supplement standard speech-language pathology treatment practices for those who stutter.

Impactos da gagueira nas atividades e participação de adolescentes e adultos

Introdução: A gagueira pode causar repercussões nas atividades e participação, nos aspectos sociais e pessoais de indivíduos com gagueira. Objetivo: Investigar a repercussão da gagueira e suas implicações nas atividades e participação de pré-adolescentes/adolescentes e adultos gagos, tomando a Classificação Internacional de Funcionalidade, Incapacidade e Saúde como base conceitual. Método: Estudo transversal qualitativo e quantitativo, com 40 participantes, 10 adultos e 10 pré-adolescentes/adolescentes gagos em acompanhamento fonoaudiológico (G1) e 10 adultos e 10 pré-adolescentes/adolescentes sem queixas de gagueira (G2). A coleta de dados englobou: i) questionário com o perfil dos participantes; ii) produção de uma narrativa oral para classificação do Perfil de Fluência da Fala e iii) entrevistas semiestruturadas. Resultados: Em relação ao Perfil de Fluência da Fala, todos participantes do G1 apresentaram alterações nos parâmetros estudados, diferente do observado no G2. Quanto aos domínios da Classificação Internacional de Funcionalidade, Incapacidade e Saúde, os participantes do G1, especialmente adultos, relataram mais problemas em fatores ambientais, funções do corpo e atividades e participação do que o G2. Conclusão: Os resultados reiteram o impacto da gagueira na vida das pessoas com gagueira, baseados na Classificação Internacional de Funcionalidade, Incapacidade e Saúde, o qual fornece subsídios para uma atenção integrada à saúde. A comparação entre grupos mostra percepções diferenciadas dos participantes quanto às suas falas, sendo que o G1 apresentou piores resultados, especialmente para o grupo de adultos.

Otolaryngology utilization of speech-language pathology services for voice disorders.

To examine the utilization of speech-language pathology (SLP) services by otolaryngology for outpatients with laryngeal/voice disorders. Retrospective analysis of a large, national, administrative US claims database. The study population included patients with a laryngeal/voice disorder based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004 to December 31, 2008, seen by an otolaryngologist as an outpatient, and 12 months of follow-up. Data were collected on SLP evaluation and treatment and patient factors including age, gender, geographic region, employment status, initial laryngeal diagnosis, and laryngeal diagnosis change over 12 months. Multivariable logistic regression analysis was used to investigate factors associated with receipt of SLP evaluation and treatment. There were 91,898 unique patients who met study criteria. A total of 4,485 (4.9%) patients had an SLP evaluation, of whom 2,216 (49.4%) had at least one voice therapy session. Patient age, gender, geographic region, and laryngeal diagnosis were associated with increased likelihood of receiving SLP services. Patients whose final laryngeal diagnosis changed from their initial diagnosis had greater odds of having an SLP evaluation (odds ratio = 1.18, 95% confidence interval = 1.06-1.31) compared to patients without laryngeal diagnosis change. SLP evaluation and treatment occurred in a minority of laryngeal/voice-disordered patients. Further study is needed to assess the impact of SLP services on the healthcare utilization of patients with laryngeal/voice disorders. 2C.

Evidence-Based Systematic Review: Effects of Speech-Language Pathology Treatment for Individuals With Paradoxical Vocal Fold Motion.

In this article, our goal was to determine the state of the evidence and the effect of speech-language pathology (SLP) treatment for individuals with paradoxical vocal fold motion (PVFM). The American Speech-Language-Hearing Association's National Center for Evidence-Based Practice in Communication Disorders searched 22 electronic databases using key words related to PVFM, speech or voice treatment, and behavioral intervention for articles published through July 2013. Identified articles were systematically evaluated to assess the quality of the evidence using a modification of the American Speech-Language-Hearing Association's critical appraisal scheme. Sixty-five articles met the search criteria. Only 2 out of the 65 articles were judged to contain adequate evidence to evaluate the effect of SLP treatment for PVFM. All 65 articles exemplify the state of the evidence for SLP treatment for PVFM. The state of the evidence for the use of SLP treatment is in its infancy, with a majority of articles in the exploratory stage of research. Consequently, few clinical implications can be drawn at this time. SLP treatment for PVFM is promising; however, there is clearly a pressing need for systematic experimental studies that involve a control group to further the evidence base.

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Adesão das professoras disfônicas ao tratamento fonoterápico

To study the possible factors associated with adherence to the speech-language pathology treatment of dysphonia in female teachers of municipal schools of Belo Horizonte. This was a retrospective study that analyzed the medical records of 251 teachers treated at the Voice Ambulatory Speech Language Pathology Service, Hospital das Clínicas da Universidade Federal de Minas Gerais (AV-UFMG) from August 2007 to December 2009. The collected data included age, number of scheduled sessions, number of absences, number of children, type of dysphonia, degree of dysphonia, monthly family income, and education. We calculated the distance, in kilometers, of the residence to the place of treatment and the workplace to place of treatment. We also analyzed the social vulnerability index of the workplace. The results of this research indicated that of the 135 records that were included in the study, 89 (65.93%) corresponded to the discharged group and 46 (34.07%) corresponded to the abandonment group. In comparison with all the variables studied, only the number of faults and the type of dysphonia were associated with poor adherence to voice therapy. Results showed that the number of absences in sessions, treatment-related factor, organofuncional dysphonia type, and clinical-related factor were all associated with the abandonment of voice therapy.

Multidisciplinary head and neck cancer clinic and adherence with speech pathology

To determine the effect of referral patterns on compliance with speech-language pathology (SLP) treatment of voice and swallowing difficulties in patients with head and neck cancer (HNCA). Retrospective cohort study. Patients with newly diagnosed oropharyngeal HNCA referred for pretreatment SLP evaluation comprised the study population. Compliance was measured by participation in SLP therapy during and after head and neck treatment, as well as by the number of missed and completed visits. Outcomes were compared between patients who were initially evaluated through the multidisciplinary clinic and those evaluated outside of the multidisciplinary clinic format. The final study sample included 118 individuals with oropharyngeal tumors. All patients were treated with primary radiotherapy with or without chemotherapy. Patients evaluated initially through the multidisciplinary clinic had more SLP visits than those who did not participate in the multidisciplinary clinic (mean = 1.8 vs. 0.2, P <.0001). Participation in SLP treatment was significantly greater for patients ≥ 60 years of age (odds ratio [OR] = 2.4, P =.032) and for patients who participated in the multidisciplinary clinic (OR = 19.3, P <.0001). Tumor stage, sex, race, marital status, and insurance status were not associated with patient compliance. Multivariate analysis revealed that participation in a multidisciplinary clinic was the only significant variable associated with SLP treatment compliance (OR = 12.9, P <.0001), after controlling for all other variables. Patients evaluated in a multidisciplinary clinic are more likely to comply with SLP treatment recommendations.

Cough Reflex Sensitivity Improves with Speech Language Pathology Management of Refractory Chronic Cough

Speech language pathology is an effective management intervention for chronic cough that persists despite medical treatment. The mechanism behind the improvement has not been determined but may include active cough suppression, reduced cough sensitivity or increased cough threshold from reduced laryngeal irritation. Objective measures such as cough reflex sensitivity and cough frequency could be used to determine whether the treatment response was due to reduced underlying cough sensitivity or to more deliberate control exerted by individual patients. The number of treatments required to effect a response was also assessed. The aim of this study was to investigate subjective and objective measures of cough before, during and after speech language pathology treatment for refractory chronic cough and the mechanism underlying the improvement. Adults with chronic cough (n = 17) were assessed before, during and after speech language pathology intervention for refractory chronic cough. The primary outcome measures were capsaicin cough reflex sensitivity, automated cough frequency detection and cough-related quality of life. Following treatment there was a significant improvement in cough related quality of life (Median (IQR) at baseline: 13.5 (6.3) vs. post treatment: 16.9 (4.9), p = 0.002), objective cough frequency (Mean ± SD at baseline: 72.5 ± 55.8 vs. post treatment: 25 ± 27.9 coughs/hr, p = 0.009), and cough reflex sensitivity (Mean ± SD log C5 at baseline: 0.88 ± 0.48 vs. post treatment: 1.65 ± 0.88, p < 0.0001). This is the first study to show that speech language pathology management is an effective intervention for refractory chronic cough and that the mechanism behind the improvement is due to reduced laryngeal irritation which results in decreased cough sensitivity, decreased urge to cough and an increased cough threshold. Speech language pathology may be a useful and sustained treatment for refractory chronic cough. Australian New Zealand Clinical Trials Register, ACTRN12608000284369.

Speech-language pathology treatment time during inpatient spinal cord injury rehabilitation: the SCIRehab project

Background/objectiveFollowing spinal cord injury (SCI), speech-language pathologists (SLPs) perform assessments and provide treatment for swallowing, motor speech, voice, and cognitive–communication disorders that result from the SCI and/or co-occurring brain injuries. This paper describes the nature and distribution of speech-language pathology (SLP) activities delivered during inpatient SCI rehabilitation and discusses predictors (patient and injury characteristics) of the amount of time spent in specific SLP treatment activities.MethodsSix rehabilitation centers enrolled 600 patients with traumatic SCI for an observational study of acute inpatient rehabilitation treatment (SCIRehab). SLPs documented the details of assessment and treatment and time spent on each of a set of specific SLP activities during each patient encounter. Patterns of time use are described for all patients by neurological injury category. Ordinary least squares stepwise regression models are used to identify patient and injury characteristics predictive of treatment time in the specific SLP activities identified.ResultsSLP consults were requested for 40% of SCIRehab patients. Fifty-seven percent of these patients received intense therapy (defined as more than five sessions during the rehabilitation stay); the remainder received primarily evaluation or less intense services (one to five sessions). The patients who participated in intense treatment received a mean total of 16.1 hours (range 2.5–105.2 hours, standard deviation (SD) 16.5, median 9.7 hours) of SLP; significant differences were seen in the amount of time spent in each activity among neurological injury groups. Cognitive–communication and swallowing therapy were the most common SLP activities. Patients with motor levels of injury at C1–C4 spent the highest percentage of their therapy time working on swallowing therapy while patients with low tetraplegia and paraplegia, and those classified as AIS D (regardless of motor level of injury) focused the greatest percentage of time on cognitive–communication work. Patient and injury characteristics explained a portion of the variation in time spent on cognitive–communication therapy but did not explain the variation in time spent on swallowing and other SLP treatment activities.ConclusionThe need for swallowing and cognitive treatment by SLP is common during inpatient rehabilitation due to dysfunction resulting from use of artificial airways and feeding approaches, as well as secondary brain injuries. The large amount of variability seen in SLP treatment time, which is not explained well by patient and injury characteristics, sets the stage for future analyses to associate treatments with outcomes.