Speech-language Pathology Therapy Research Articles

Telepractice for bilingual and multilingual people with aphasia: a scoping review

ABSTRACT Background/aims The field of speech-language pathology/therapy (SLP/T) has evolved in the last decade, especially when it comes to technological advances for online and remote clinical services. However, the transition to a telepractice service model did not occur at a similar pace for every clinician. Considering the range of clients served and the disparities in clinician experience and training with remote service delivery, it is necessary to implement a telepractice model that is sensitive to the cultural and linguistic needs of individuals with bilingual or multilingual aphasia. This scoping review of the literature (a) identifies the intervention protocols utilized via telepractice and (b) describes their components using the Rehabilitation Treatment Specification system (RTSS) framework in order to make literature-based recommendations regarding best practice in speech-language pathology telepractice services. Methods/procedures A systematic scoping review was conducted in January 2023 following frameworks described by Arksey and O’Malley (2007) and Tricco et al. (2018). A literature search was conducted for articles published in English that addressed telepractice services for multilingual people with aphasia (MPWA) in the field of speech-language pathology/therapy. Results/outcomes A total of 11 full-text studies were assessed for eligibility. Based on the inclusion and exclusion criteria, five articles were included in this scoping review. The key factors that enabled successful telepractice sessions were described including, the technological platform used and the specific modalities of the interventions delivered. The Rehabilitation Treatment Specification System (RTSS) was used to describe the targets and ingredients of the interventions in the selected studies. In addition, the limitations and challenges of each study were summarized. This scoping review has demonstrated a need for expanding telepractice services for MPWA. There is a scarcity of studies addressing remote intervention, and those that do exist use mostly non-randomized designs such as single case or survey, which limits the generalizability of the results as well as their comparability and replication. Conclusions This scoping review examines the current existing literature on telepractice in MPWA. The paucity of studies included in this scoping review, indicates a need for future research in this area of telepractice for MPWA. This indicates a need for professional development and training to emphasize the cultural, linguistic, and digital skills of both clinicians and MPWA. Technological advances should be made available and accessible to diverse MPWA worldwide through improvements in digital equity.

Health Literacy and Adherence to Clinical Recommendations in Head and Neck Cancer

After definitive cancer treatment, survivors of head and neck cancer (HNC) are commonly recommended to participate in therapies aimed at reducing the burden of treatment-related side effects. In this study, we evaluated whether adherence to referral to physical therapy (PT) and speech-language pathology therapy (SLPT) is related to patient health literacy (HL). This is a retrospective cohort analysis of patients attending a multidisciplinary HNC survivorship clinic between 2017 and 2019. HL was measured using the Brief Health Literacy Screen, with scores below 10 indicating inadequate HL. Chi-square and logistic regression were used to evaluate the association between HL and adherence to PT or SLPT referral. From the overall cohort (N = 454), 80 patients (18%) had inadequate HL. Compared to those with adequate HL, patients with inadequate HL were significantly less likely to complete initial PT evaluation (74% vs. 58%, p = .034) but were not significantly less likely to complete initial SLPT evaluation (70% vs. 61%, p = .37). After adjusting for age, primary tumor site, and treatment stage, we found that patients with inadequate HL were half as likely to follow up for initial PT evaluation (odds ratio 0.45, p = .032). Overall, inadequate HL is associated with reduced adherence to PT but is not associated with adherence to SLPT among HNC survivors. These results highlight the clinical importance of HL and underscore the need for interventions to facilitate adherence to treatment for patients with inadequate HL. [HLRP: Health Literacy Research and Practice. 2023;7(1):e52-e60.].

Intensive speech-language pathology therapy with adults who stutter: preliminary study.

To compare the results of fluency and self-perception of the impact of stuttering on the lives of adults who stutter, before and after undergoing intensive speech-language pathology therapy. This is a descriptive and longitudinal study with data collection before and after intensive therapy in four patients who stutter. The intensive care program consisted of thirty one-hour sessions held in five individual sessions a week. Speech samples collected before and after therapy were analyzed by two fluency experts. Descriptive data analysis was performed through the frequency distribution of categorical variables and analysis of measures of central tendency and dispersion of continuous variables. The verification of agreement between the evaluations carried out by the two judges was performed using the intraclass correlation coefficient (ICC). Correlation analysis was also performed using Spearman's rank correlation coefficient between the variables in the speech sample and the OASES-A scores. There was a reduction of the percentage of stuttering disfluencies, increasing the flow of words per minute of the participants. The descriptive analysis of the OASES-A showed a decrease in the degree of impact of stuttering on the participants' lives in all parts of the questionnaire. There was an improvement in all variables analyzed after intensive care, including an improvement in speech fluency and a reduction in the impact of stuttering on the participants' lives, which suggests the relevance of the intensive speech therapy proposal for stuttering.

Terapia fonoaudiológica intensiva com adultos que gaguejam: estudo preliminar

ABSTRACT Purpose To compare the results of fluency and self-perception of the impact of stuttering on the lives of adults who stutter, before and after undergoing intensive speech-language pathology therapy. Methods This is a descriptive and longitudinal study with data collection before and after intensive therapy in four patients who stutter. The intensive care program consisted of thirty one-hour sessions held in five individual sessions a week. Speech samples collected before and after therapy were analyzed by two fluency experts. Descriptive data analysis was performed through the frequency distribution of categorical variables and analysis of measures of central tendency and dispersion of continuous variables. The verification of agreement between the evaluations carried out by the two judges was performed using the intraclass correlation coefficient (ICC). Correlation analysis was also performed using Spearman's rank correlation coefficient between the variables in the speech sample and the OASES-A scores. Results There was a reduction of the percentage of stuttering disfluencies, increasing the flow of words per minute of the participants. The descriptive analysis of the OASES-A showed a decrease in the degree of impact of stuttering on the participants' lives in all parts of the questionnaire. Conclusion There was an improvement in all variables analyzed after intensive care, including an improvement in speech fluency and a reduction in the impact of stuttering on the participants' lives, which suggests the relevance of the intensive speech therapy proposal for stuttering.

The Knowledge of Allied Health Professionals (AHPs) about Speech Language Pathology/Therapy (SLP/T) in Pakistan

SLP is a client-based health profession set up as part of a multidisciplinary team. AHP's acknowledgment of the role of another professional in the team results in quintessential referral among the professionals that can thoroughly benefit clients to receive finer quality services/care. This research focuses on surveying the insight and misconceptions of AHPs regarding SLP responsibilities. One central discussion was conducted among 20 AHP on the basis of a descriptive survey. Semi-structured face-to-face interviews were conducted to explore the perception of AHP’s role in SLP. We examined the extent of AHP’s knowledge of the speech-language pathology field. In research 20 AHP (P.T, O.T) were selected through convenient sampling techniques because of suitability for both. The study found mixed results, AHPs (0%) were in the category “No to Little Knowledge”, and AHPs 25% required further updated knowledge and education on best speech therapy requirements/treatment practices. AHPs are merely aware of the existence of this field, they do not know what sort of cases are dealt with by the professionals. AHPs30% are classified under “reasonable knowledge” for being aware of the patient’s basic speech therapy requirements, but will not refer to SLP, or AHPs, and 45% have expert-level knowledge, a clear concept regarding SLP requirements and practices. The study results showed that in Pakistan, AHPs' apprehension regarding clients’ speech needs and SLPs’ role still remain deficient. SLP needs to be promoted constantly for the client’s peak benefit and for the overall field’s progression as it is still a very new profession in Pakistan.

Multiplex array analysis of serum cytokines offers minimal predictive value for cognitive function in the subacute phase after stroke.

The effects of inflammation on post-stroke cognitive function are still unclear. This study investigated the correlation between the Th17-related cytokines in peripheral blood and post-stroke cognitive function after ischemic stroke in the subacute phase. A retrospective cohort study. Academic acute inpatient rehabilitation facility. One hundred and fourteen patients with first ischemic stroke were categorized as the poor cognitive recovery group (n = 58) or good cognitive recovery group (n = 56) based on their cognitive MRFS efficiency. All subjects received routine physical, occupational, and speech-language pathology therapy. Serum cytokines/chemokine (IL-1 β, IL-2, IL-4, IL-5, IL-6, IL-9, IL-10, IL-12p70, IL-13, IL-15, IL-17A, IL-17E, IL-17F, IL-21, IL-22, IL-23, IL-27, IL-28A, IL-31, IL-33, GM-CSF, IFN-γ, MIP-3 α, TNF-α, and TNF-β) levels were measured in duplicate using Human Th17 magnetic bead panel and multiplex array analysis (Luminex-200 system). The primary functional outcome was a gain in functional independence measure (FIM) cognitive subscore at discharge. The secondary outcome measures were FIM total score at discharge, length of stay in the hospital, and discharge destination. Cognitive Montebello Rehabilitation Factor Score (MRFS) and cognitive MRFS efficiency were calculated. Demographic and clinical characteristics were obtained from the medical record. The good cognitive recovery group had an interesting trend of higher IL-13 than the poor cognitive recovery group (good cognitive recovery group 257.82 ± 268.76 vs. poor cognitive recovery group 191.67 ± 201.82, p = 0.049, unit: pg/ml). However, Pearson's correlation analysis showed no significant correlation between cytokine levels and gain of cognition, cognitive MRFS, or cognitive MRFS efficiency. Receiver operating characteristic (ROC) analysis of cytokines also suggested a low accuracy of prediction as a predictor for post-stroke cognitive recovery improvement. Our preliminary findings suggested that the level of serum cytokines had minimal predictive value for the recovery of cognitive function during the subacute inpatient rehabilitation after stroke.

Presentation of the Therapy Program for Management of Chronic Cough.

To present a proposal for speech-language pathology rehabilitation called the Therapy Program for Management of Chronic Cough (TMCC) for the treatment of refractory chronic cough. TMCC was developed based on two stages: literature and clinical analysis. The literature analysis stage was carried out through the following procedures: electronic and manual search for articles and books published until June 2019 that included adult participants with chronic cough and intervention with speech-language pathology therapy; selection of sources; analysis of articles and books included; and, preparation of the initial version of the therapy program. The initial version of the therapy program resulting from literature analysis stage was submitted to clinical analysis stage through the following procedures: analysis by three judges; revision of the proposal by the authors; judges' re-analysis; elaboration of the final version called the Therapy Program for Management of Chronic Cough (TMCC). TMCC synthesizes scientific knowledge and current clinical experience on the behavioral management of refractory chronic cough into a program with three main components, each one with specific objectives and strategies. TMCC consists of four sessions, with weekly frequency and duration between 30-45 minutes per session, executed in hierarchical phases, with specific objectives and strategies per session. TMCC is a program structured to offer global cough rehabilitation. To obtain scientific evidence about its effectiveness is necessary, so that it can be used in clinical practice.

Access to speech-language pathology therapy and continuity of assistance in Primary Health Care for victims of motorcycle accidents.

To verify the access to speech-language pathology (SLP) therapy and continuity of assistance in Primary Health Care (PHC) for victims of motorcycle accidents. A quantitative and qualitative study was conducted at a large hospital in the city of Recife, Pernanbuco state, Brazil. Among the 99 victims recruited between June and July 2014, 30 had SLP complaints as a result of the accidents. After hospital discharge, all victims were contacted for investigation of the SLP rehabilitation process. Absolute and relative frequencies were used for the analysis in PHC, and data were displayed in tables for the therapy cases. Among the 30 individuals who reported having alterations of the stomatognathic system, eight were undergoing rehabilitation and 18 reported residing in an area covered by the Family Health Strategy (primary care modality). Seeking and obtaining continuity of treatment (medication and bandaging) in primary care were frequent; in contrast, home visits were less frequent. The main obstacles to access SLP therapy were distance to the service and waiting time to begin treatment. This study identified obstacles that hamper access to SLP therapy in PHC, such as the low frequency of home visits, contributing to the fragmentation of continuous and complete care for victims.

Augmentative and Alternative Communication on Autism Spectrum Disorder: Impacts on Communication.

To verify the effects of the Speech-Language Intervention with Augmentative and Alternative Communication (AAC) in communicative acts in children with Autism Spectrum Disorder (ASD). This is a longitudinal case-study design involving three subjects attended in a Speech-Language Pathology (SLP) Clinic School. Primary data were obtained from the observation of recorded videos of pre and post-intervention therapist assessment sessions with each child in play activities, while secondary data come from interviews with parents. The analysis was performed based on the Pragmatic Test of the Infant Language Test - ABFW, through observational recordings, aiming to identify and quantify the communicative acts. It was possible to observe a 51.47% increase in the production of communicative acts in the three research subjects. In addition, it was found that there was higher quality in the acts produced, using more present verbal components and decreased acts that had non-interpersonal functions, such as gestures and vocal acts. Thus, there was an evolution in the functional language of the subjects. The use of Augmentative and Alternative Communication in the SLP therapy clinic is promising and effective in promoting the development of communication skills of individuals with ASD.

The role of speech-language pathologists in adult palliative care

Purpose: Given minimal studies describing the role and practice of speech-language pathologists (SLPs) in adult palliative care, the aim of this review was to compile a database of research literature, examine the potential research gaps and to consider material that specifically discussed the need for and/or use of procedures and protocols for SLPs working in palliative care that would support the development of SLP palliative care guidelines.Method: A scoping review was conducted utilising Arksey and O’Malley’s framework with the goal of exploring any key concepts and approaches utilised by SLPs in adult palliative care, plus any literature and/or recommendations regarding SLP practice in adult palliative care settings.Result: Over 1200 articles were initially identified. Of the 1200 articles, 13 academic papers were considered relevant as they recommended, or at least suggested, the need for speech-language pathology therapy guidelines to be implemented within adult palliative care settings.Conclusion: The main focus of these articles was on ethical considerations and clinical recommendations for SLPs. Recommendations arising from this scoping review include providing goals to support current practising SLP clinicians and developing clinical guidelines to manage swallowing and/or communication needs of people receiving palliative care.

Caracterização e follow-up de crianças com desvio fonológico

Este estudo buscou investigar os dados de evolução terapêutica de um grupo de crianças com desvio fonológico. Objetivou-se caracterizar a demanda dos sujeitos atendidos em uma clínica-escola de Fonoaudiologia, no período de março a setembro de 2009. Essa caracterização priorizou: gênero, idade, número de sessões realizadas, quantidade e tipo de processos fonológicos apresentados ao início e ao final da coleta, e conduta. Participaram da pesquisa 12 crianças, de ambos os gêneros, com idades entre cinco e oito anos, que passaram por acompanhamento individual, subsidiados pelas abordagens PROMPT e Constrastiva. Foram aplicadas quatro avaliações fonológicas com intervalo de dois meses entre elas, sendo uma inicial, duas intermediárias e uma final. Nas avaliações, as crianças deveriam nomear 34 figuras que representavam vocábulos contendo todas as possibilidades fonêmicas do português. Foram realizadas a análise fonológica tradicional e a verificação dos processos fonológicos correspondentes. Os resultados indicaram o predomínio do gênero masculino e a média de idade foi de seis anos. Os processos fonológicos mais comuns na primeira avaliação foram redução de encontro consonantal, simplificação de líquida e simplificação de consoante final. Observou-se diminuição da quantidade média de processos fonológicos quando comparadas à primeira e à última avaliação. Quanto à conduta, cinco crianças receberam alta, quatro permaneceram em tratamento, após a quarta avaliação e três foram desligadas. Foi possível concluir que a atuação fonoaudiológica individual junto às crianças, tendo como base as abordagens PROMPT e Contrastiva, proporcionou evolução significativa no que se refere ao desvio fonológico.

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.

Perfil pragmático longitudinal de uma criança no espectro da neuropatia auditiva

A maior parte da comunicação humana depende da conversão de ideias em linguagem, envolvendo a interação de todos os seus componentes - fonológico, semântico, sintático e pragmático. A pragmática estuda a relação entre o significado social da linguagem e seu conteúdo semântico, manifestado pelo ato comunicativo em si. O espectro da neuropatia auditiva gera uma dessincronia na condução nervosa, contribuindo para o prejuízo na percepção da fala. Na criança deficiente auditiva, o processo de aquisição e desenvolvimento da linguagem pode ser estimulado com a intervenção. O objetivo dessa pesquisa foi realizar acompanhamento longitudinal do uso das habilidades pragmáticas de comunicação por uma criança com espectro da neuropatia auditiva. A criança realizou intervenção fonoaudiológica por três anos na área de Audiologia Educacional. Foram gravadas conversações espontâneas, ao início de cada ano, transcritas e analisadas segundo protocolo de habilidades comunicativas verbais. Na gravação inicial, a criança apresentou maior número de habilidade de respostas diretas; porém, estas foram ampliadas com o fornecimento de respostas mais complexas ao longo da intervenção. Na última gravação, já propõe novos tópicos de discurso, realiza narrativas e argumentações. O surgimento de habilidades comunicativas refinadas é explicado pelo desenvolvimento da linguagem, que é potencializado pela terapia com deficientes auditivos. Pode-se concluir que para o caso apresentado a intervenção fonoaudiológica proporcionou melhora nas habilidades pragmáticas de comunicação.

Comparação do processo evolutivo de crianças do espectro autístico em diferentes intervenções terapêuticas fonoaudiológicas

To analyze and compare the extension and the speed of the evolutional process of children with Autism Spectrum Disorders in direct and indirect interventions as opposed to only indirect intervention. The design of this study is a clinical trial. The sample was composed of 11 children diagnosed with Autism (n=6) and Asperger syndrome (n=5) by a multidisciplinary team, that attended specialized speech-language pathology therapy at the institution were the study was carried out. These children were randomly divided into two groups: Therapy Group (TG) - composed by six subjects receiving both direct and indirect intervention; and Orientation Group (OG) - constituted by five subjects receiving exclusively indirect intervention. It was used the Autism Behavior Checklist (ABC) to interview the mothers, and the Sample of Vocal Behavior (SVB), in three occasions: at the beginning of the intervention process (time 0), six months later (time 1) and 12 months later (time 2). It was observed greater speed and extension in the evolutional process of the TG Group, both in the analysis of the Autism Behavior Checklist (total and partial scores) and the Sample of Vocal Behavior, especially in the item Full Language. The performance of children with Asperger syndrome was considered more positive when compared to that of children with autism. There was greater evolution in younger children and with normal, mild, and moderate adaptive functioning. The tendency towards better performance of the children attending direct and indirect intervention showed that this association is fundamental in the therapeutic process of children with Autism Spectrum Disorders.

Características iniciais da comunicação verbal de pré-escolares com Alterações Específicas do Desenvolvimento da Linguagem em fala espontânea

OBJETIVO: Verificar desempenho fonológico de pré-escolares com Alterações Específicas do Desenvolvimento da Linguagem (AEDL) em fala espontânea. MÉTODOS: Foram sujeitos 27 crianças com AEDL, entre três anos e cinco anos e 11 meses, em tratamento fonoaudiológico. Foram selecionados aqueles que realizaram ao menos 50% da avaliação da fonologia a partir de provas de nomeação e imitação de palavras, ou que apresentaram inteligibilidade de fala passível de análise. Foram coletadas amostras de fala na prova de pragmática e no discurso eliciado por figuras. Foram realizadas análises a partir da utilização de processos fonológicos do desenvolvimento de linguagem (PD) e idiossincráticos (PI). RESULTADOS: A estatística descritiva (médias de PD e PI) indicou grande variabilidade intra-grupos. Não houve variação em número de processos conforme a idade (PD: p=0,38; PI: p=0,72), porém houve predominância de PD em todas as idades, nas duas provas aplicadas (Z=-6,327; p&lt;0,001). A ocorrência de PD e PI foi maior na prova de pragmática (p&lt;0,001), situação em que o número de palavras produzidas também foi maior (T-valor=8,93; p=0,000). CONCLUSÃO: A grande variabilidade intra-grupo confirma a heterogeneidade dos quadros de AEDL. Pode-se atribuir a ininteligibilidade, que dificulta a avaliação da linguagem expressiva desses sujeitos, à ocorrência de PD e PI concomitantemente. Ademais, a interação desenvolvida durante a prova de pragmática mostrou-se mais efetiva para a obtenção de amostra de fala espontânea para a análise da fonologia, além de confirmar a existência de grandes dificuldades relacionadas à elaboração de idéias e sua expressão em sujeitos com AEDL.