Speech Therapy Research Articles

Current oral care practices in an acute aged care setting: An Australian metropolitan hospital perspective

Purpose To evaluate current oral care practices in an acute aged care hospital setting, and staff perceptions of the barriers and enablers to delivery of evidence-based oral care practices. Method A mixed method study comprised of retrospective file audit and cross-sectional survey was conducted within a single acute aged care unit. Medical records of patients aged ≥ 65 years admitted over a 6 month period were retrospectively audited. A clinician survey was used to explore barriers to and enablers of the delivery of oral care practices using the Capability, Opportunity, Motivation, Behaviour (COM-B) questionnaire. Result were analysed using descriptive statistics. Result Patient file audits (n = 206) found 13.6% (n = 28) of patients had oral care completed, despite 23% (n = 47) of patients being recommended by a speech language pathologist to receive oral care. Staff survey respondents (n = 31) reported they do not have the physical or social opportunities to provide oral care (i.e. adequate resources, time, and social support), however, they were motivated and reported they have the required knowledge and skills to provide oral care. Conclusion There is a need for implementation strategies to enable an interprofessional response to improve the delivery of evidence-based oral care practices and optimise patient outcomes.

Incorporating client perspectives: moving towards digital outcome measurement in pediatric speech-language pathology

ABSTRACT Caregivers’ needs and preferences regarding outcome measurement in pediatric speech-language pathology are not well-understood, but are critical to the development and implementation of meaningful clinical tools. This project engaged caregivers of preschoolers with speech, language and communication needs to understand their views on the potential for, and their preferences surrounding a digital version of one participation-focused outcome measure called the Focus on the Outcomes of Communication Under Six (FOCUS-34). Fifteen caregivers of preschoolers who were receiving services in a large health system participated in one of four 30–60-minute virtual focus groups or one of three individual interviews. Caregivers shared their perceptions of whether and how a digital FOCUS-34 may improve their service experience, and their preferred features and formats to make it useful. An inductive content analysis was used to identify relevant categories that described caregivers’ perspectives. Data were sorted into two categories: (1) caregivers believe a digital solution would improve their service experience, and (2) caregivers want a user-friendly digital FOCUS-34 to measure and give feedback on intervention outcomes. Multiple sub-categories were also identified, which further described caregivers’ views on how a digital measure would improve the feasibility of outcome measurement, family engagement in services, and transparent communication with providers. Sub-categories also outlined caregivers’ preferences for the features and functions of a digital measure and their suggested considerations for developers of the digital tool. Results provide new insight into caregivers’ perspectives on digital outcome measurement and will inform efforts to improve the utility of the FOCUS-34 for families.

Prevalence and Management of Oral Intake Restrictions in Critically Ill Patients: Insights from a Multicenter Point Prevalence Study.

Oral intake restrictions due to dysphagia in the intensive care unit (ICU) can increase morbidity, mortality, and negatively impact quality of life. The current oral intake practice and clinical management strategies for addressing dysphagia in the ICU are not well-defined. This study aimed to elucidate the clinical practices surrounding oral intake restrictions due to dysphagia and its management strategies in the ICU. A multicenter, prospective, cross-sectional, 2-day point prevalence study was conducted in Japan. Relevant data on the clinical circumstances surrounding oral intake practice and the implementation of strategies to prevent dysphagia for patients admitted to the ICU on November 1, 2023, and December 1, 2023, were collected. The primary outcome was the prevalence of oral intake restrictions in patients, defined by a Functional Oral Intake Scale score of less than 7 among eligible patients for oral intake. Out of 326 participants, 187 were eligible for the final analysis after excluding 139 patients who were not eligible for oral intake, primarily due to tracheal intubation. Among those eligible, 69.0% (129/187) encountered oral intake restrictions. About 52.4% (98/187) of patients underwent swallowing screenings; 36.7% (36/98) of these were suspected of having dysphagia. Compensatory and behavioral swallowing rehabilitation were provided to 21.9% (41/187) and 10.6% (20/187) of patients, respectively, from ICU admission to the survey date. Only 27.4% (14/51) of post-extubation and 9.3% (3/32) of post-stroke patients received swallowing rehabilitation. Notably, no ICUs had dedicated speech and language therapists, and most (85.7%, 18/21) lacked established swallowing rehabilitation protocols. This 2-point prevalence survey study revealed that oral intake restrictions due to dysphagia are common in ICUs, but few patients are screened for swallowing issues or receive rehabilitation. More clinical studies are needed to develop effective protocols for identifying and managing dysphagia, including screenings and rehabilitation in the ICU.

Health care providers' perceptions of family participation in essential care in the intensive care unit: A qualitative study.

Family participation in essential care may benefit patients and relatives. To examine the needs, perceptions and preferences of health care providers about family participation in essential care in the adult intensive care unit. A qualitative descriptive study using inductive thematic analysis. Three focus group interviews with a total of 30 intensive care unit health care providers, consisting of 20 critical care nurses, one nursing assistant, five physicians, three physical therapists and one speech therapist working in three Dutch intensive care units. One overarching theme, balancing interests, and four main themes emerged: looking after the patient's interests, taking the relatives' perspective into account, looking after interests of intensive care unit health care providers and conditions for family participation. The first theme, looking after the patient's interests, included three sub-themes: insecurity about patient's wishes and needs, patient safety concerns and potential benefits for the patient. The second theme, taking the relatives' perspective into account, was also characterized by three sub-themes: concerns about the relatives' possible burden, potential benefits for the relative and the relationship between patient and relative. The third theme, looking after interests of intensive care unit health care providers, included three sub-themes: attitude towards family participation in essential care, differing perceptions of essential care and concerns about intensive care unit health care provider's burden. The last theme, conditions for family participation, included two sub-themes: establishing a relationship and considering family participation in essential care as a process. Health care providers' perceptions and preferences regarding family participation in essential care in the intensive care unit are summarized in the overarching theme balancing interests. This overarching theme also reflects the needs and perceptions of patients and relatives. These findings may support critical care nurses and other health care providers when encouraging family participation in essential care.

Hearing, speech, and language outcomes in school-aged children after cleft palate repair.

Following primary cleft palate repair, individuals face a heightened risk of hearing problems, particularly conductive hearing loss, compensatory articulation disorders (CADs), resonance disorders, delayed speech and language development, and voice disorders. This study aimed to investigate the prevalence and impact of these challenges in children with cleft palate with or without cleft lip (CP± L). This cross-sectional study included 38 children with CP± L aged 5 to 13 years. A comprehensive evaluation involved audiological assessments (audiograms, tympanograms) by an audiologist and speech-language pathology assessments (Thai Speech Parameters for Patients with Cleft Palate, Articulation Screening Test) by speech-language pathologists. The prevalence of hearing loss affected 27.63% of participants (21 out of 76 ears) and majority of cases involved conductive hearing loss. Velar substitution was the most common CAD, followed by nasalized voiced pressure consonants, phoneme-specific nasal air emission, and pharyngeal substitution. A moderate correlation was found between these CAD patterns and hypernasality at the word, sentence, and screening levels (r= 0.44, p< 0.01; r= 0.43, p< 0.01; and r= 0.40, p= 0.01). For summary, the most common type of hearing loss was conductive hearing loss. The predominant CAD pattern was velar substitution. The protocol could be designed to enhance early improvement in hearing and articulation, thereby supporting academic achievement and long-term quality of life.

Meta-analysis reveals low language capacity in childhood is associated with mental health problems in adulthood.

Children and adolescents with language problems have poorer mental health compared with their non-language impaired peers. Less is known about mental health in adults with a history of language problems. This paper presents a systematic review and meta-analysis that addresses this gap in the literature. Specifically, it summarisesthe results from studies examining anxiety and depression in adults (aged 18 years and over) who were identified with language impairments or problems earlier in development. Five electronic databases (PsycINFO, ERIC, CINAHL, EMBASE and PubMed) were searched for studies comparing anxiety and/or depression in a sample of adults with and without a history of language problems. Nine studies were found that met the inclusion criteria. From each, an odds ratio (OR) was computed measuring the relationship between childhood language problems and anxiety or depression in adulthood. The OR was computed so values > 1 which indicated anxiety/depression were associated with a history of language problems. ORs were averaged using multilevel random effects meta-analysis. Averaging the study's findings across both anxiety and depression outcomes, we found that a history of childhood language problems was associated with poorer mental health in adulthood (OR = 1.79, p = 0.004). The association for anxiety was also significant (OR = 1.80, p = 0.012) and close to statistical significance for depression (OR = 1.60, p = 0.054). This review reveals that adults with a history of language problems are more likely to experience poorer mental health outcomes compared with controls. These findings demonstrate childhood language problems affect not only communication but also mental health and well-being in the long term. What is already known on the subject Prior research examining mental health in children and adolescents with language problems reveals a twofold increased risk of internalisingproblems, including anxiety and depression. However, little is known about mental health outcomes in adults with a history of language problems. What this paper adds to the existing knowledge The main finding was that childhood language problems are associated with increased risk of anxiety and depression in adulthood. What are the practical and clinical implications of this work? First, the study demonstrates childhood language problems increase the risk of poor mental health in adulthood. Second, in adult mental health settings there is a need to screen for language problems and, where applicable, adjust interventions to accommodate communicative needs for patients/clients. Solving these issues requires integration and recognition of the importance of speech-language therapy in the adult mental health system.

Autism Spectrum Disorder and Associated Factors in Children in Spain, 2017: Population-Based Cross-Sectional Study.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with biological, multicausal and polygenic origins. The true prevalence of ASD has not been clearly established. The aim of this study was to estimate the prevalence of ASD in children aged 3 to 14 years in Spain and to analyze the factors associated with it. A cross-sectional observational study using data from the 2017 National Survey of Health in Minors in Spain. Primary outcome was the diagnosis of ASD, and sociodemographic, behavioral, health-related, the use of health services, household and medication use variables was analyzed. Multivariable logistic regression model with a correction for modelling rare events was fitted. Complex sampling was undertaken, using the survey elevation factor in the analysis. A total of 4409 children were included, and there were 26 children with ASD, for a prevalence of 0.59%, representing 29,143 children with ASD. Factors significantly associated were male sex, having visited a psychologist, and/or a speech therapist in the past year, presenting probable problems with peers, antisocial behavior, taking antibiotics and taking other medications. The findings of this study may be useful to inform health policies and develop strategic plans to identify and address the needs of children with ASD.

Write here write now. What can we learn from the writing goals of people with aphasia?

ABSTRACT Background People with aphasia commonly have difficulties with producing written language (dysgraphia). Greater understanding of people with aphasia’s rehabilitation goals for writing can inform development of evidence-based assessment and management tools. Aims This qualitative study aimed to explore the nature of writing goals of people with aphasia who attended an intensive speech and language therapy (SLT) centre. Methods and Procedures Qualitative data was obtained from five years-worth of client SLT reports from an intensive aphasia centre. Using qualitative content analysis, a deductive coding framework was used to identify any description of writing goals; coding incorporated iterative refinement and agreement among authors. Themes were then constructed to reflect clients’ goals to inform writing assessment and therapies. Outcomes and Results Qualitative analysis focused on content describing 66 goals on writing from 87 reports. There were two dominant interrelated themes: Supporting Communication (33 goals) and Technology (25 goals). Technology included subthemes on Emailing, Texting, Social Media, and Assistive Technology. Two smaller themes were Impairment Focused (4 goals), where goals did not have a clear functional direction, and Other (4 goals), where goals targeted specific writing activities, e.g. crosswords. Conclusions These thematic findings demonstrate the varied real-life goals for writing among attendees at an aphasia centre. They highlight the nature of relatively early-stage rehabilitation goals for individuals with aphasia, focusing on supporting communication and returning to valued activities. The results provide a context within which we can scrutinise the adequacy of current clinical tools to support goal setting, assess functional writing and design interventions for acquired writing difficulties. Further guidance is needed on assessment of writing as a supportive communication strategy and therapy towards improving this skill. There are also gaps in supporting the personal goals of people with aphasia who wish to produce written language via technology or in online environments. Future research should recognise these priorities and work together with people with aphasia, clinicians, and technology specialists to address an area of clinical need.

Understanding hospital rehabilitation using electronic health records in patients with and without COVID-19

BackgroundMany hospitalised patients require rehabilitation during recovery from acute illness. We use routine data from Electronic Health Records (EHR) to report the quantity and intensity of rehabilitation required to achieve hospital discharge, comparing patients with and without COVID-19.MethodsWe performed a retrospective cohort study of consecutive adults in whom COVID-19 testing was undertaken between March 2020 and August 2021 across three acute hospitals in Scotland. We defined rehabilitation contacts (physiotherapy, occupational therapy, dietetics and speech and language therapy) from timestamped EHR data and determined contact time from a linked workforce planning dataset. Our aim was to clarify rehabilitation required to achieve hospital discharge and so we excluded patients who died during their admission, and those who did not require rehabilitation (fewer than two specialist contacts). The primary outcome was total rehabilitation time. Secondary outcomes included the number of contacts, admission to first contact, and rehabilitation minutes per day. A multivariate regression analysis for identifying patient characteristics associated with rehabilitation time included age, sex, comorbidities, and socioeconomic status.ResultsWe included 11,591 consecutive unique patient admissions (76 [63,85] years old, 56% female), of which 651 (6%) were with COVID-19, and 10,940 (94%) were admissions with negative testing. There were 128,646 rehabilitation contacts. Patients with COVID-19 received more than double the rehabilitation time compared to those without (365 [165, 772] vs 170 [95, 350] mins, p<0.001), and this was delivered over more specialist contacts (12 [6, 25] vs 6 [3, 11], p<0.001). Admission to first rehabilitation contact was later in patients with COVID-19 (3 [1, 5] vs 2 [1, 4] days from admission). Overall, patients with COVID-19 received fewer minutes of rehabilitation per day of admission (14.1 [9.8, 18.7] vs 15.6 [10.6, 21.3], p<0.001). In our regression analyses, older age and COVID-19 were associated with increased rehabilitation time.ConclusionsPatients with COVID received more rehabilitation contact time than those without COVID, but this was delivered less intensively and was commenced later in an admission. Rehabilitation data derived from the EHR represents a novel measure of delivered hospital care.

Child, family and professional views on valued communication outcomes for non-verbal children with neurodisability: A qualitative meta-synthesis.

There are many children with neurodisability who are unable to rely on speech to communicate and so use a range of augmentative and alternative communication (AAC) methods and strategies to get their message across. Current instruments designed to measure the outcomes of speech and language therapy interventions lack specific attention to communication outcomes that are valued by non-verbal children with neurodisability, their families and support networks. This qualitative meta-synthesis was conducted to identify valued communication outcomes to inform the next stage of developing a novel outcome measure. To systematically identify and synthesise the qualitative evidence about which communication outcomes non-verbal children with neurodisability, their family members, healthcare professionals and educators think are important to achieve, specifically which communication outcomes are most valued by: (1) non-verbal children with neurodisability; (2) parents or other family members of non-verbal children with neurodisability; and (3) professionals who work with non-verbal children with neurodisability. A systematic search of bibliographic databases and the grey literature was undertaken to identify qualitative studies that included evidence of views expressed by children, family members, healthcare professionals and educators on outcomes in relation to the communication of non-verbal children with neurodisability. All papers meeting the inclusion criteria were quality appraised using the Critical Appraisal Skills Programme Qualitative checklist, although none were excluded on this basis. The data synthesis involved organising coded data into descriptive themes which were then synthesised into analytical themes. We found 47 papers containing qualitative data meeting the inclusion criteria from research situated in 14 countries. The views of 35 children, 183 parents, six other family members, 42 healthcare professionals and 18 educators are represented in the review. The included studies contained very few data reported by children themselves; most data were provided by adults, especially parents. Three main analytical themes were identified: Experiences of communication and expectations; adapting to and acceptance of AAC; and becoming an autonomous communicator. This meta-synthesis brings together the limited qualitative research findings about what parents, professionals and children consider are important communication outcomes for non-verbal children with neurodisability. The synthesis identifies key gaps in our knowledge about the perspectives of children and their siblings. This synthesis will inform primary research to understand valued communication outcomes in this group, and ultimately the development of a patient-reported outcome measure (PROM) that can be used to demonstrate the effect of interventions, at both clinical and service levels. What is already known on the subject Studies of children with cerebral palsy and autism spectrum disorder indicate that at least 25% of children with these conditions are non-verbal. Studies on the health outcomes of children with neurodisability have identified that communication is rated as important by parents and health professionals. There is an evidence gap about which communication outcomes are important to non-verbal children, their families and the people who work with them. What this paper adds to the existing knowledge This is the first synthesis of data that relates to communication outcomes for non-verbal children with neurodisability. This qualitative meta-synthesis identifies from previous research studies the communication outcomes valued by children who are non-verbal, their parents or other family members, and the professionals who work with them. The findings will be used to shape further primary research and the development of a novel patient-reported communication outcome measure for non-verbal children with neurodisability. It is anticipated that this will be used by clinicians to measure the effect of their interventions. What are the practical and clinical implications of this work? Clinicians should reflect on parents' experiences of communication with their child before discussing potential outcomes with them. Gaining insight into the lived experience of communication for non-verbal children and their families will help healthcare professionals to understand which goals are important to them and why. Few studies have specifically asked which communication outcomes are important for non-verbal children with neurodisability. Further exploration is needed to determine which communication outcomes non-verbal children and their families would like to see included in outcome measures used by clinicians.

Artificial Intelligence and the Future of Communication Sciences and Disorders: A Bibliometric and Visualization Analysis.

As artificial intelligence (AI) takes an increasingly prominent role in health care, a growing body of research is being dedicated to its application in the investigation of communication sciences and disorders (CSD). This study aims to provide a comprehensive overview, serving as a valuable resource for researchers, developers, and professionals seeking to comprehend the evolving landscape of AI in CSD research. We conducted a bibliometric analysis of AI-based research in the discipline of CSD published up to December 2023. Utilizing the Web of Science and Scopus databases, we identified 15,035 publications, with 4,375 meeting our inclusion criteria. Based on the bibliometric data, we examined publication trends and patterns, characteristics of research activities, and research hotspot tendencies. From 1985 onwards, there has been a consistent annual increase in publications, averaging 16.51%, notably surging from 2012 to 2023. The primary communication disorders studied include autism, aphasia, dysarthria, Parkinson's disease, and Alzheimer's disease. Noteworthy AI models instantiated in CSD research encompass support vector machine, convolutional neural network, and hidden Markov model, among others. Compared to AI applications in other fields, the adoption of AI in CSD has lagged slightly behind. While CSD studies primarily use classical machine learning techniques, there is a growing trend toward the integration of deep learning methods. AI technology offers significant benefits for both research and clinical practice in CSD, but it also presents certain challenges. Moving forward, collaboration among technological, research, and clinical domains is essential to empower researchers and speech-language pathologists to effectively leverage AI technology for the study, diagnosis, assessment, and rehabilitation of CSD. https://doi.org/10.23641/asha.27162564.

Evaluating Speech-Language Pathologists' Knowledge of Functional Speech Disorders

Purpose: The purpose of this article is to offer an evaluation of speech-language pathologists' (SLPs') experiences with and knowledge of functional speech disorders. Functional speech disorders occur as a part of functional neurological disorders, a complex disorder that is often overlooked and misdiagnosed. Through an assessment of experience with and common myths about functional speech disorders among SLPs, the importance of providing education to SLPs about this patient population is discussed. Method: As a part of the presentation about functional speech disorders during the 2023 American Speech-Language-Hearing Association Health Care Summit, 122 participants were asked to anonymously respond to a series of questions that outlined their demographics, training in functional speech disorders, and experiences with this patient population. Descriptive data are presented. Results and Conclusions: Among attendees, 58% were exposed to functional speech disorders in graduate school while 75% had seen a patient with a functional speech disorder, most of whom had also diagnosed the patients' communication disorder. This study highlights the role of the SLP in identifying and managing functional speech disorders and the increased attention this patient population has received over time, as well as the work yet to be done. Functional speech disorders are a legitimate clinical entity, for which a diagnosis can be made based on positive clinical features (i.e., is not a diagnosis of exclusion). The call to action includes guidance for clinicians, educators, and academic training programs to support this patient population. See the Appendix for a plain language summary.

Filipino Rehabilitation Practitioners’ COVID-19 knowledge, practice and attitude: A cross-sectional study

Background: The rehabilitation team, consisting of physiatrists, physical and occupational therapists, and speech pathologists, faces heightened risk of COVID-19 exposure because of treatment practices in rehabilitation settings.Aim: The study aimed to assess the knowledge, practices and attitudes of rehabilitation professionals in treating COVID-19 patients and to determine potential associations with respondents’ demographic factors (e.g., age, gender, type of profession).Setting: The study was conducted in the Philippines.Methods: This cross-sectional study was conducted from June 2021 to July 2021. Researchers employed snowballing and purposive homogenous convenient sampling methods. Participants completed a 31-item online questionnaire via Google Forms.Results: A total of 410 rehabilitation professionals participated in the study. The total mean scores for knowledge, practices and attitudes are 41.14 ± 3.16, 104.54 ± 33.65 and 37.13 ± 3.55, respectively which were considered adequate. However, only 9.8% (n = 40) professional was actively treating COVID-19 patients with analysis of variance indicated that age, type of profession and gender did not significantly impact COVID-19 knowledge. However, age (p = 0.005) and type of profession (p = 0.004) were found to influence COVID-19 practices, with physiatrists exhibiting higher adherence. There was a strong positive correlation between age and positive COVID-19 attitudes (p 0.000).Conclusion: Filipino rehabilitation professionals have positive attitude, adequate knowledge and skills about COVID-19.Contribution: The study provides information to modify training courses and curricula to further improve the knowledge and practices related to COVID-19.

Unlocking Insights: Exploring the Profiles of School-Based Telefacilitators.

School-based telefacilitators are critical yet underresearched members of telepractice programs. They are the face of the telepractice program and are often telepractice champions in their communities. However, we have little research explaining the typical profile of telefacilitators, making it more difficult to identify personnel characteristics that contribute to the implementation of sustainable telepractice programs. The purpose of this study was to describe the typical profile and preparation of school-based telefacilitators for physical, occupational, and speech therapy in the United States. A cross-sectional survey gathered 21 telefacilitator responses about their primary job title, preparation, confidence, and basic demographics. Survey recruitment followed an adaptive sampling method with three phases: stratified random sampling, purposive sampling, and targeted convenience sampling. Results were analyzed using frequency counts and descriptive statistics where appropriate. Most respondents held the primary job title of paraprofessional, but a diverse range of titles were reported, including superintendents and directors of special education. Half of the respondents received various methods of formal training for the role, whereas the other half were self-taught. Overall levels of confidence in job performance were high, yet self-taught telefacilitators felt that lack of training negatively impacted their performance. Most respondents had a bachelor's degree or higher. There is a high degree of variability in the profile and preparation of telefacilitators. Inconsistency in terminology and lack of agreed-upon job responsibilities are significant barriers to studying the role of telefacilitators and the ability to plan telepractice staffing needs adequately. Clinical implications and opportunities for future investigation are highlighted. https://doi.org/10.23641/asha.27115216.

Exploring the effectiveness of the Pragmatic Intervention Programme (PICP) with children with autism spectrum disorder and developmental language disorder: A non-randomised controlled trial.

Children diagnosed with autism spectrum disorder (ASD) and developmental language disorder (DLD) often have difficulties using language in social contexts. An intervention programme for preschool-age children with pragmatic difficulties, called Pragmatic Intervention Programme (PICP), showed positive effects for these children. However, it was important to confirm these effects with a larger group and analyse them separately for each condition. In this study, the effectiveness of the PICP was analysed in preschool-age children with ASD or DLD with difficulties in using language in social contexts. The study was carried out with 36 children. Twenty-two were allocated to an experimental group to receive the PICP-based intervention first, and 14 children were assigned to a control group (waiting list). Each child attended 24 PICP-based intervention sessions provided by a speech and language therapist. Progress was measured using a Goal Attainment Scale (GAS) and other language assessment instruments. The results showed that all children in the experimental group made significant progress in their language competencies, compared to the control group after the intervention. This study confirms that the PICP is effective in improving language competencies in preschool-age children with ASD and DLD with difficulties in using language for social purposes, regardless of their condition. These results emphasise the importance of tailored interventions for these children and point to areas for further research.

Clinical diagnosis and management of spinocerebellar Ataxia in a resource-constrained setting: a case report from Eastern Nepal

Introduction: Spinocerebellar ataxias (SCA) are a diverse group of neurodegenerative disorders with autosomal dominant inheritance, primarily affecting the cerebellum and its connections. Diagnosis typically involves genetic testing, but in resource-limited settings, clinical and neuroimaging assessments become critical. This case report highlights the role of non-genetic methods in diagnosing SCA and outlines management strategies in such settings. Case Presentation: A 41-year-old male presented with a two-year history of progressive gait imbalance, headache, and abnormal speech. He had a family history of similar symptoms in two siblings, but no significant past medical history. Clinical examination revealed scanning speech, dysmetria, and a broad-based gait. Clinical and neuroimaging findings, including cerebellar atrophy, led to a diagnosis of SCA in the absence of genetic testing. Patient management with speech, occupational, and physical therapies, showed gradual improvement. Discussion: SCA, characterized by cerebellar atrophy and a range of clinical symptoms, is typically diagnosed through genetic testing, but clinical and imaging assessments are crucial when genetic resources are limited. This case illustrates that a comprehensive clinical evaluation, including neuroimaging, can support the diagnosis of SCA even without genetic testing. Strategic management emphasizing symptomatic relief and functional improvement through a multidisciplinary approach, including regular follow-up and personalized therapy, are crucial, as evidenced by the timely improvement observed in our case. Conclusion: In resource-limited settings, a comprehensive clinical and neuroimaging assessment is essential for diagnosing Spinocerebellar Ataxia when genetic testing is not feasible. Effective management through multidisciplinary therapies can improve patient outcomes, underscoring the need for innovative strategies to enhance diagnostic and treatment capabilities in such environments.

Executive functioning and nonverbal cognitive factors associated with response to technology-assisted language intervention

ObjectiveTo explore potential differences in the relationship between executive function (EF) skills and language development when integrating augmentative and alternative communication technology into speech-language therapy for deaf/hard of hearing (DHH) children. MethodRandomized trial data were analysed to investigate this relationship among children who participated in a Technology-Assisted Language Intervention (TALI) compared to treatment as usual (TAU). Language samples were assessed for pre-post-intervention changes, including mean length of utterance in morphemes (MLU), mean turn length (MTL), and number of different words spoken (NDW). EF skills were measured with standardized parent-report assessment. ResultsThirty-seven DHH children were included (TALI n = 19 and TAU n = 18). Results of regression models indicated that higher EF skills were significantly (p < 0.05) associated with improvements in MLU, MTL, and NDW among children who received TAU. No significant associations between EF skills and any of the measures (MLU, MTL, NDW) were seen in children who received TALI. ConclusionThese results suggest that TALI may offer language learning support, particularly for DHH children with EF difficulties. Future research should investigate the direct relationship between EF measurements and language outcomes in TALI recipients. Establishing baseline EF measurements in DHH children could inform personalized strategies within language interventions and therapy.

Charting the Course of Aphasia Recovery: Factors, Trajectories, and Outcomes

Aphasia, a neurological condition primarily resulting from stroke, significantly impairs communication and quality of life. This review focuses on aphasia recovery and emphasizes the interplay of clinical impairment, neural adaptation, and therapeutic intervention. Natural recovery varies with factors such as lesion characteristics, white matter integrity, and demographics, and neuroplasticity and cognitive compensation play crucial roles. Treatment-induced recovery encompasses traditional language therapies and innovative strategies, including the integration of advanced neurological techniques like neuromodulation and neurofeedback. Emerging trends, such as self-managed digital therapeutics and precision medicine approaches, offer promising avenues for enhancing language recovery. By bridging the gap between neurological understanding and clinical application, this review highlights the multifaceted nature of aphasia recovery and the latest advancements in treatment strategies, paving the way for more targeted and effective rehabilitation approaches.

Standardizing Identification of Cognitive Impairment in the Acute Hospital Setting: Toward a Common Language.

Although many hospitals universally screen their patients for functional mobility and activity impairment, there is no common method to do this for cognitive impairment. Establishing an interdisciplinary and standardized process to screen for cognitive impairment is essential for early identification of impairments, optimization of patients' function, and safe discharge planning. Previously, the reliability and validity of the Activity Measure for Post-Acute Care Applied Cognitive Inpatient Short Form "6-Clicks" (AM-PAC ACISF) were measured among occupational therapy practitioners and speech-language pathologists; however, its reliability among other team members, specifically nurses, is unknown. This study reports the interprofessional interrater reliability of the AM-PAC ACISF in the acute care hospital setting. To examine the nursing-therapist interrater reliability of the AM-PAC ACISF in the acute care hospital setting. A prospective study using a convenience sample. Acute care hospital. Fifty adult patients, six nurses, five occupational therapy practitioners, and one speech-language pathologist. Interrater reliability for the AM-PAC ACISF among therapists and nurses. Interrater reliability was good among nurses and therapists, with an intraclass correlation coefficient of .88 (95% confidence interval [.79, .93]) for the AM-PAC ACISF. Findings suggest that the AM-PAC ACISF is reliable for use among interdisciplinary teams, helps to establish a common language for early identification of cognitive impairment, and can be used for guiding clinical discussions around patient cognition in the acute care setting. Plain-Language Summary: Having an interdisciplinary and standardized process to screen patients early for cognitive impairment is essential for identifying impairments, optimizing patients' function, and facilitating safe discharge planning in the acute care setting. Early identification of cognitive impairment by the interdisciplinary team can also allow for timely occupational therapy and other rehabilitation service interventions. The findings of this study suggest that the Activity Measure for Post-Acute Care Applied Cognitive Inpatient Short Form "6-Clicks" (AM-PAC ACISF) can reliably be used by interdisciplinary teams, establishes a common language for early identification of cognitive impairment, and can be used for guiding clinical discussions around patient cognition in the acute care setting.

Implications of Constraints on the Language of Emerging Aided Communicators and Intervention Decisions: A Tutorial

This tutorial offers speech-language pathologists (SLPs) an opportunity to consider the theoretical constructs of language acquisition theory and the multifactorial determinants that can impinge on the language acquisition process for children with complex communication needs. The system of constraints observed through the lens of optimality theory is discussed alongside intrinsic and extrinsic barriers associated with children who acquire their first language simultaneous to their introduction to aided augmentative and alternative communication (AAC) systems. This examination calls into question whether the language competence of emerging aided communicators may be masked by their ability to produce language that accurately represents their understanding of their native language. Specific to this question is whether vocabularies available to emerging aided communicators, opportunities to access aided language models, and intervention decisions made by SLPs may be implicated in the language acquisition and development process. Suggestions for clinical practice are offered as a means of mitigating adverse outcomes related to extrinsic constraints.