Speech-language Therapists Research Articles

Speech language therapists’ experiences with subjective well‐being in people with aphasia

Subjective well-being (SWB) and quality of life (QOL) are intricately related constructs. Recent research shows both constructs share some facets, but are distinct entities. It is unclear, both internationally and in the Netherlands, if and how SLTs address SWB in clinical practice. The current study was set up to explore Dutch SLTs' perceptions of SWB in relation to the management of people with aphasia. To describe how Dutch SLTs, working with people with aphasia in a private practice or a healthcare setting, address patient's SWB during diagnosis and treatment, and to identify barriers and facilitators they experience when addressing SWB. A qualitative research design with a phenomenological approach was used. SLTs from private practices and healthcare settings were invited to participate in individual interviews and a focus group. The data were analysed thematically using a combination of inductive and deductive methods. Eight SLTs participated in the study. The SLTs' experiences were captured in four themes that emerged from the data: (1) SWB is a multifaceted concept and depends on patient-specific factors: premorbid factors, life priorities and time post-stroke; (2) SLTs experience more responsibility for patients' SWB than their profession allows; (3) collaboration between SLTs and patients, patients' network and other healthcare professionals is required to address SWB during diagnosis and treatment; and (4) misinterpretations are inevitable when SLTs or the patients' network address patients' SWB. The results showed that SLTs feel responsible for addressing SWB in the management of people with aphasia. Their perception of the concept of SWB is similar to the definition used in the literature and is multifaceted. They feel responsible for the part of SWB that is related to communicative functioning, but less so for the more heuristic aspects of SWB. This is related to their experienced limitation of influence on SWB, which for some leaves them feeling out of depth and uncertain about boundaries between professionals. Addressing SWB in a multidisciplinary team is therefore considered important in order to adequately and fully capture someone's SWB and reduce to clinicians' experienced burden and responsibility. What this paper adds What is already known on this subject Recent studies suggest that quality of life measures may lack facets related to subjective well-being (SWB). Aphasia is likely to impact on SWB of a stroke survivor, but it is unclear if and how SWB is addressed by speech and language therapists in diagnosis, and treatment of Dutch PWA. What this study adds This study provides insight into the operationalization of SWB in Dutch clinical practice, including barriers SLTs experience when addressing SWB. Clinical implications of this study Monitoring and influencing SWB of people with aphasia is a complex process, that SLTs consider only possible in multi-disciplinary teams. Clear guidelines on roles and responsibilities between various disciplines involved are necessary to improve care for people with aphasia.

Changing attitudes towards teletherapy in Austrian therapists during the COVID-19 pandemic

Introduction Telehealth and its usage strongly depend on regulatory frameworks and user acceptance. During the COVID-19 pandemic, physiotherapists, occupational therapists, speech-language therapists and their patients experienced restrictions regarding the usual face-to-face therapy. Teletherapy has become a highly discussed medium for providing therapy services. This study aimed at assessing Austrian therapists’ attitudes towards teletherapy, including perceived barriers, during and before the COVID-19 lockdown. Further interest referred to therapists’ technical affinity and experiences with the application of teletherapy. Methods Therapists (n = 325) completed an online survey amid the COVID-19 lockdown in 2020. Retrospective indications referred to the time prior to the lockdown. Ratings were opposed across the three therapeutic professions. Subgroup analyses investigated the role of gender and age regarding technical affinity. Measures included custom-made attitudinal statements towards teletherapy and the standardized TA-EG survey. Results The COVID-19 lockdown caused attitude changes towards teletherapy – for example, in terms of interest (r = 0.57, p > 0.01), perceived skills for performance of teletherapy (r = 0.33, p > 0.01) and perceived need for physical contact with patients (r = 0.35, p > 0.01). Regarding technical affinity, women reported significantly higher values than men did (r = 0.32, p > 0.01). Nearly half of the participants already applied teletherapy, with mainly positive ratings regarding perceived skills and feasibility. Barriers identified were missing or unstable reimbursement policies by insurance companies and therapeutic software with guaranteed data security. Discussion Austrian therapists indicate a relatively high level of telehealth positivity, with an improvement in the course of the COVID-19 lockdown. However, therapists outline the need for stable reimbursement policies and secure software solutions.

Adaptation of the Brazilian Functional Auditory Performance Indicators - Short Version.

To adapt the Brazilian Functional Auditory Performance Indicators protocol to a short version including the production of material and an application manual. Methodological, descriptive, cross-sectional study with a quantitative and qualitative approach conducted with seven speech-language therapists who applied the protocol to 34 children with hearing loss and their guardians. The analysis of content validity and the instrument reliability evaluated the semantic equivalence, analysis of satisfaction of speech therapists, and statistical tests of Cronbach's Alpha and Kappa coefficient. The short version, called FAPI-r, was adapted considering coefficients that indicate internal consistency and almost perfect inter-evaluator agreement. Speech-language therapists reported satisfaction with the instrument and stated that the manual facilitates the understanding of the test application. However, there was no agreement between the assessment of speech-language therapists and the answers of families, indicating a need for a greater insertion of families in the therapeutic scenario. The adapted FAPI-r has validity and reliability, promising future developments for research and clinical performance in the population of hard of hearing children.

Profile of users receiving Speech-Language Therapy service at a Critical Patient Unit

ABSTRACT Objective: to describe the profile of patients treated by Speech-Language therapists in a Critical Patient Unit. Methods: an ex post facto, observational and descriptive study was carried out. Monthly statistical data of patients hospitalized in the period January-December 2018 were analyzed, in the Intensive Care Unit at a public hospital. Data were described from the analysis of frequency and measures of central tendency. The distribution of the variables was determined through the skewness-kurtosis test, considering a significance level of p<0.05. Results: 217 individuals got 868 speech-language therapy services. Men (57.26%), older than 65 years old, required a more frequent intervention. The main medical diagnosis of admission to the unit corresponded to non-specific pathologies (57.14%), respiratory disease (15.21%) and cerebrovascular disease (12.79%). The speech-language therapy functions were related to the evaluation of swallowing (54.31%) and voice (32.4%). In relation to the intervention, the treatment of dysphagia (25.82%) and oral motor functions (25.04%) was predominant in the duties. Functions associated with language, speech and cognition were secondary. Conclusion: the profile of the critical patient and the speech-language therapy work in this field represent a first step to characterize the role of the speech-language therapist in Intensive Medicine teams.

A study on the present status of freelancers in speech-language rehabilitation

Purpose Corona-19 Infectious Diseases temporarily closed the workplace of speech therapists or temporarily suspended the work. Therefore, we investigated the current status of speech therapists in order to enact freelancer support ordinances of each local government and to urge language rehabilitation workers to support them. Methods The study was conducted through an online Google questionnaire from May 20 to October 2, 2020 for language rehabilitation workers. The total number of participants was 2,055. The results were processed using SPSS 25.0 and descriptive statistics were performed. Results The results were processed using SPSS 25.0 and descriptive statistics were performed. First, private speech therapy centers 55.4%, social welfare facilities 22.2%, and hospitals 14.6% were in order of the type of workplace of Speech-language rehabilitation. Second, the types of work of Speech-language rehabilitation were professional freelance workers 43.0%, contract workers of fixed pay 9.3%, and contract workers of combination with fixed pay and rate system pay 6.9%. Third, the insurance coverage of Speech-language rehabilitation were in the order of four major insurance 67.2%, non-insured 20.3%, and two major insurance 12.5%. Forth, the number of workplaces of Speech-language rehabilitation were one workplaces 63.9%, 2 workplaces 17.5%, others 16%, 3 workplaces 2.6%. Conclusions Therefore, this study will be used as basic data for improving the treatment of speech therapists, and various efforts will be needed to expand the employment place that can guarantee the financial and employment stability from enactment of freelancer ordinances in each local government. Keywords: Speech-language rehabilitation; Speech-language therapist; freelancer; Crona-19; contract workers; Rate-based salary

Therapeutic relationships in aphasia rehabilitation: Using sociological theories to promote critical reflexivity.

BackgroundTherapeutic relationships are fundamental in aphasia rehabilitation, influencing patient experience and outcomes. While we have good understandings of the components of therapeutic relationships, there has been little exploration of how and why therapists construct and enact relationships as they do. Sociological theories may help develop nuanced understanding of the values, assumptions and structures that influence practice, and may facilitate critical reflexivity on practice.AimsTo explore the potential for theoretical approaches from outside speech–language therapy to enable a deeper understanding of the nature and enactment of therapeutic relationships in aphasia rehabilitation.Methods & ProceduresAn explanatory single case study of one speech–language therapist–patient dyad in an in‐patient stroke rehabilitation setting. Data included observations of five interactions, two interviews with the client and three interviews with the speech–language therapist. Analysis was guided by analytical pluralism that applied aspects of three sociological theories to guide data analysis and make visible the contextual factors that surround, shape and permeate the enactment of therapeutic relationships.Outcomes & ResultsThe analysis of this dyad made visible individual, interactional and broader structural features that illustrate the dynamic processes that practitioners and patients undertake to enact therapeutic relationships. Clinical practice could be viewed as a performance with each person continually negotiating how they convey different impressions to others, which shapes what work is valued and foregrounded. The patient and therapist took up or were placed in different positions within the interactions, each with associated expectations and rights, which influenced what types of relationships could, or were likely to, develop. Organizational, rehabilitation and individual practitioner structures assigned rules and boundaries that shaped how the therapist developed and enacted the therapeutic relationship. Whilst the therapist had some agency in her work and could resist the different influencing factors, such resistance was constrained because these structures had become highly internalized and routinized and was not always visible to the therapist.Conclusions & ImplicationsWhile therapists commonly value therapeutic relationships, social and structural factors consciously and unconsciously influence their ability to prioritize relational work. Sociological theories can provide new lenses on our practice that can assist therapists to be critically reflexive about practice, and to enact changes to how they work to enhance therapeutic relationships with clients. What this paper addsWhat is already known on the subject Therapeutic relationships are critical in aphasia rehabilitation. We have a good understanding of the different components of therapeutic relationships and how relationships are perceived by patients and practitioners. What this paper adds to existing knowledge This study is novel in its use of sociological lenses to explore contexts and complexities inherent in building and maintaining therapeutic relationships. These are often invisible to the practitioner but can have a significant impact on how relational work is enacted and what forms of relationship are possible. What are the potential or actual clinical implications of this work? This study will support clinicians to critically reflect on how they enact therapeutic relationships and may enhance awareness of the often‐hidden factors which influence the ways in which they work.

Perspectives of working-age adults with aphasia regarding social participation.

BackgroundWorking-age adults with aphasia experience difficulties in social participation, specifically fulfilling social roles and reintegrating into communities. Literature regarding social participation of people with aphasia (PWA) is predominantly based on studies conducted in high-income countries (HIC), limiting generalisability of findings. Perspectives of social participation are influenced by person, place and cultural background warranting investigation in heterogeneous low- and middle-income countries (LMICs), like South Africa.ObjectivesDescribe perspectives of working-age adults with aphasia regarding social participation within the first 2 years post-incident.MethodSemi-structured interviews gained perspectives of 10 working-age adults (with mild to moderate aphasia) using principles of supported conversation for adults with aphasia. Data were thematically analysed to describe participants’ perspectives of social participation.ResultsSeven themes were identified pertaining to participants’ perspectives of social participation. Participants considered rehabilitation services, faith-related activities and returning to work as valued areas of social participation. Previous interests, presence of support and characteristics of communication partners determined their preference and willingness to participate with others. Finally, personal attitudes and feelings continued to influence their perspectives of social participation, as well as their motivation to participate.ConclusionSuccessful social participation was dependent on the PWA’s perceived value of social activities and presence of support from significant others. Speech-language therapists are in the ideal position to facilitate PWA’s communication abilities and their experience of successful participation through the implementation of person-centered care and community-led intervention. This study provided a preliminary investigation of social participation in South Africa and further investigation is warranted.

Neurological Examination Techniques of Speech in Bahasa Malaysia for Adults: Simple Approach Practiced in Hospital Universiti Sains Malaysia.

There are four classification levels for speech disorders namely dysphonia, dysarthria, dysprosody and dysphasia. In general, speech examination mainly focuses on three main components that are spontaneous speech, auditory comprehension, and oral motor examination. Quick bedside assessment on speech in Bahasa Malaysia is essential to assist the speech language therapist (SLT) and other physicians to determine the disorders. Speech therapy is also essential in monitoring and continuous assessment for patients with speech and language disorders such as dysphasia and dysarthria. Speech clinicians in Hospital Universiti Sains Malaysia (HUSM) have been adapting two most widely used batteries of speech assessment tools namely Western aphasia battery-revised (WAB-R) by Andrew Kertesz and Boston diagnostic aphasia examination (BDAE). These tools have been modified into simple and validated speech assessments in Bahasa Malaysia. This video manuscript will demonstrate the use of both tools in performing bedside speech assessment for patients with speech disorders. The Bahasa Malaysia speech examination should not be difficult when WAB-R and BDAE speech assessment tools are applied. The aim of this simple approach using the adapted version of BDAE and WAB-R is to assist the clinician to achieve quick and accurate diagnosis with a validated scoring system.

The experiences of whānau and kaiako with Speech-Language Therapy in Kaupapa Māori education

In New Zealand, speech-language therapists work through both the health and the education systems. In common with many Indigenous peoples, Māori have faced inequities in both health and education for decades. Kaupapa Māori education systems have been developed to support educational success and the survival of kaupapa Māori knowledge and te reo Māori. However, disparities between Māori and non-Māori still exist in the delivery of speech-language therapy services. The study reported in this article explored Māori experiences of speech-language therapy in kaupapa Māori education using Kaupapa Māori methodology, an Indigenous research approach that privileges Māori culture and knowledge. Six whānau members and educators all connected to one kōhanga reo participated in a focus group, where they reported a mix of positive and negative experiences. Thematic analysis was used to identify four significant themes. The whānau emphasised the need for te ao Māori to permeate all aspects of the therapy process, including a focus on te reo Māori, suitable settings for therapy, use of relevant resources, and appropriate methods of communication.

A retrospective review of speech-language therapy services provided to adult inpatients at a central-level hospital in Gauteng, South Africa.

BackgroundThe quadruple burden of disease (BoD) and multimorbidity reflected in South Africa’s public health sector challenges speech-language therapists (SLTs) to optimise patient management in this context. For planning and delivery of appropriate services, it is important to understand the profile of speech-language therapy (SLT) patients and the public healthcare services provided by SLTs.ObjectivesThis study aimed to describe the prevalence of inpatient adult speech, language and swallowing disorders associated with various medical conditions and South Africa’s BoD, in addition to the target areas and duration of SLT interventions provided at a central public hospital.MethodA retrospective review was conducted on records of 2549 adult inpatients who received SLT services between January 2014 and December 2015 at Chris Hani Baragwanath Academic Hospital. Data, including demographics, medical and SLT diagnoses, and treatment recommendations, were analysed using descriptive and inferential statistics.ResultsNon-communicable diseases (NCDs) were most prevalent (77.48%), with multimorbidity of BoD categories in 29.27% of patients. Cerebrovascular disease (CeVD) comprised 52.45% patients, with CeVD, traumatic brain injury, other neurological conditions, cancer and burns comprising 88.74% patients. More than a third of the patients with CeVD were < 56 years (n = 486; 36.35%). Dysphagia (48.96%), aphasia (30.95%) and dysarthria (23.62%) were the most common, with 44.68% of patients having multiple SLT diagnoses. The number of SLT sessions significantly correlated with SLT comorbidity (rs = 0.4200; p = 0.0000), but not BoD comorbidity (rs = 0.0049; p = 0.8058).ConclusionSpeech-language therapy patients reflected a heavy NCD burden and multimorbidity. Provision of SLT services should take into consideration a profile of increased complexity of medical conditions and SLT diagnoses.

The promise of self-determination theory to study the therapist-client relationship in speech-language treatment

This study aims at examining the therapist-client relationship in speech-language treatment and its relationships with clients’ motivation from the perspective of Self-Determination Theory (SDT). It adds to the current literature by relying on observations as well as client perceptions of the therapists’ interaction style and by studying three different age groups of adults (>18 years old), adolescents (12−18 years old) as well as children (<12 years). Two convenience samples: 1) 42 Speech Language Therapists (SLPs; 95.2 % female) and 72 individuals with communication disorders (ICDs) (72.2 % female;>12 years old), and 2) 21 SLPs (100 % female) and 44 ICDs (50 % girls; <12 years) were recruited for this cross-sectional study. After engaging in a treatment session, ICDs responded to a set of validated questionnaires measuring the SLPs’ motivating style, their need-based experiences and motivation towards the treatment. Moreover, each treatment session was observed. Both client-reported as well as observational measures show that SLPs more strongly evince an autonomy-supportive (i.e. motivating) when compared to a controlling (i.e. demotivating) style to the benefit of their clients’ motivation. The display of empathy was the most frequently observed strategy. SLPs regularly provided rationales, choices, and opportunities for clients to experiment. However, these behaviors were more frequent in younger compared to older clients. With the younger clients, SLPs frequently used effort-contingent rewards, which is considered a controlling strategy in SDT. Results showed that motivational benefits may be expected if SLPs rely on an autonomy-supportive rather than a controlling style. This study provides a valuable starting point for an SDT-driven examination of the therapist-client relationship and ICD’s motivation in the context of speech-language pathology.

Uwarunkowania skuteczności terapii utrwalonego jąkania w opiniach logopedów i studentów logopedii

W artykule podjęto tematykę uwarunkowań skuteczności terapii jąkania utrwalonego w ocenie logopedów i studentów logopedii. W części teoretycznej zarysowano czynniki wpływające pośrednio i bezpośrednio na skuteczność terapii tego zaburzenia. Podczas badania analizie poddano czynniki mające wpływ na powodzenie terapii jąkania chronicznego. W tym celu wykorzystano metodę sondażu diagnostycznego i użyto autorskiego kwestionariusza ankiety. W badaniu wzięło udział 147 respondentów (81 logopedów oraz 66 studentów logopedii). Wyniki tego projektu badawczego wykazują, że zarówno logopedzi, jak i studenci logopedii dysponują adekwatną wiedzą na temat uwarunkowań terapii jąkania utrwalonego. Ustalono, że według ankietowanych skuteczna terapia wiąże się z zastosowaniem kompleksowej diagnozy, hybrydowych podejść terapeutycznych i różnych form terapii, dostosowanych do indywidualnych potrzeb klienta czy pacjenta. W rezultacie badań ujawniono pozytywny stosunek badanych do autoterapii klienta, jego udziału w spotkaniach grup samopomocowych oraz zaangażowania najbliższego otoczenia w proces wsparcia. Wyniki badania wskazują, że respondenci dostrzegają znaczenie jakości relacji logopeda – klient w procesie terapii. Większość badanych manifestowała jednak duże wątpliwości w związku z własnymi umiejętnościami w zakresie wdrażania terapii jąkania. W podsumowaniu zaakcentowano, że niezależnie od stosunkowo zadowalającego stanu wiedzy na temat terapii jąkania ważne jest rozwijanie umiejętności praktycznych i poczucia kompetencji logopedów i studentów logopedii w tym zakresie. Dodatkowo zwrócono uwagę na rosnące zainteresowanie tematyką zaburzeń płynności mowy.

Postępowanie logopedyczne w przypadku dzieci z niewielkim nasileniem niepłynności mówienia

Artykuł podejmuje zagadnienie postępowania logopedycznego w przypadku dzieci w wieku przedszkolnym i wczesnoszkolnym, u których występuje niewielkie nasilenie niepłynności mówienia. Jest to ważny problem w praktyce logopedycznej, ponieważ niepłynność mówienia występuje w okresie rozwoju mowy u 5% dzieci. Jąkanie dotyczy tylko 1% i tylko w przypadku dzieci jąkających się napotykamy jasno określone procedury terapii. Praca logopedy z dziećmi z mniej nasiloną niepłynnością, odróżnienie niepłynności rozwojowej od patologicznej oraz odpowiednie działania terapeutyczne i profilaktyczne stają się zasadniczą kwestią terapii. W artykule omówiono zagadnienia podłoża niepłynności u dzieci, jej diagnozy oraz dalszych działań terapeutyczno-profilaktycznych.

Intervention in Syntactic Skills in Pupils with Developmental Language Disorder.

The main objective of this research has been to verify the effectiveness of an intervention program on syntactic skills of pupils with typical development and with developmental language disorder. A total of 99 five-year-old pupils from schools of Tenerife (Spain) participated. The CELF-4 Recalling Sentences, Formulated Sentences, and Sentence Structure subtests were used. The intervention program consisted of 40 sessions implemented by teachers and speech language therapists. Three levels of practice were organized: in the ordinary classroom (large group and small group) and in the support classroom. Pupils diagnosed with developmental language disorder initially performed worse on syntax than those with typical development. In addition, the goodness of an intervention program was verified especially for Recalling sentences, and, to a lesser extent, for Sentences Structure, which improves in the experimental group with typical development as well as in the control and experimental groups with language development disorder. A collaborative and inclusive intervention program that uses implicit techniques favors the improvement of certain aspects of the syntactic processing of pupils with developmental language disorder.

Are Australian speech-language therapists working in the literacy domain with children and adolescents? If not, why not?

A cross-sectional online survey was completed by 219 speech-language therapists (SLTs) to explore their views and practices when working with children and adolescents who have literacy difficulties. They were recruited via 11 workshops hosted by Speech Pathology Australia, held across Australia and completed the survey prior to attending their respective workshop. Participants reported overwhelming support for SLTs to work with students struggling to learn literacy and supported not only a role for SLTs to work with children in the preschool years to promote readiness to learn to read at school, but also a role for services to students beyond the early years of school. While SLTs valued specific clinical and collaborative activities, a significant gap was found between their perceived feasibility of those activities and their perceived value. Results show SLTs are less confident providing written support to students than they are in providing phonological awareness and vocabulary interventions. While SLTs clearly value their role in the literacy domain, this study highlights evident gaps in preservice training in this area, as well as a need for improved SLT and teacher knowledge exchange, and collaboration in supporting children and adolescents with literacy difficulties.

Priorities and Needs Regarding Sexual Rehabilitation for Individuals in the Subacute Phase Post-stroke

It is recommended that sexuality be addressed at all transition points along the continuum in stroke rehabilitation. However, little is known about needs specific to the subacute phase. (1) Explore priorities and needs of individuals who have had a stroke regarding sexuality in the subacute phase of stroke rehabilitation, according to both clients and clinicians; (2) Explore clinicians’ perceptions of their professional roles with regard to sexuality rehabilitation after stroke. This qualitative study involved a convenience sample composed of five clients and 15 clinicians. Clinicians were asked to implement an interview guide to assess their clients’ need to address sexuality during rehabilitation. Following implementation, data was collected through individual interviews (n = 6) and focus groups (n = 3). Verbatim were partially co-coded (15%) and analyzed by two independent assessors through a thematic analyzis. The mean age of the five clients (3 female, 2 male) was 67.0 years-old (S.D. 4.6) and clinicians included a psychologist and occupational, physical and speech language therapists. Three themes emerged: (1) Sexuality: a secondary priority, (2) Clients’ needs: just talk about it!, and (3) professional roles. Clients and clinicians considered sexuality as important, but a secondary priority to be addressed after more basic activities of daily living. Needs varied among clients regarding sexuality and clinicians shared their respective contribution to the issue while emphasizing interdisciplinarity. This study is among the first to identify priorities and needs related to sexuality for clients in subacute phase of stroke rehabilitation and their clinicians.

Uptake of telepractice among speech-language therapists following COVID-19 pandemic in India

ABSTRACT Uptake of telepractice has drastically increased among speech-language therapists (SLTs) following the COVID-19 pandemic. This study aimed to explore the sudden uptake of telepractice in India among SLTs. An online survey consisting of 20 questions was carried out between 4 and 17 May 2020 using Google form. The participants comprised of SLTs who indicated that they had shifted their services to telepractice during the COVID-19 pandemic. Descriptive analysis was used to summarize the findings. Eighty-four SLTs participated in the study, working across different work settings and from 21 to 53 years of age. Forty-nine percent of SLTs had conducted more than 11 telepractice sessions, 89% conducted only individual sessions. Further, 85% had a mostly paediatric caseload with 75% working with child language disorders. They learnt about telepractice in a range of ways including from colleagues (19%), social media and the internet (18%), formal education (24%), reading (8%) and experience (8%). Overall, SLTs exhibited a positive attitude towards the use of telepractice. The most common platform used was WhatsApp video calling feature (82%), although more than one platform was being used. The greatest challenges faced were dealing with network issues (38%) and lack of cooperation from the child during sessions (27%). The findings highlight an acceptance and uptake towards telepractice. This might pave the path for serious consideration for telepractice in the field of speech-language therapy in India in the future.

What works for whom? Multidimensional individualized stuttering therapy (MIST)

PurposeThis study reports outcomes from a stuttering therapy approach that combines value and awareness-based elements from Acceptance and Commitment Therapy (ACT) with those of stuttering and speech modification interventions. The approach, entitled Multidimensional Individualized Stuttering Therapy (MIST), includes a combined clinician and client selection of factors across five areas: 1) general breathing patterns and body tension, 2) breathing patterns during speech production, 3) vocal features in speech production, 4) value and mindfulness-based strategies, and 5) general communication and/or presentation skills. The aims of this study were to evaluate whether the MIST a) reduces the impact of stuttering and stuttering severity, and b) has a positive impact on speaking ability, confidence in communication, avoidance-behavior, and quality of life. MethodEighteen adults, age 21–61 years took part in an A-B-A multiple case study design. Participants underwent a pre-clinic assessment phase, followed by 10 h of therapy over four sessions administered by an experienced speech-language therapist. Outcome measures examined both psychosocial and behavioral aspects of therapy three-, six- and twelve-months post-therapy. ResultsMost participants chose elements from at least four of the five areas of focus. There was a significant reduction in the impact of stuttering at both 6- and 12-months post-therapy, with moderate (d = .71) to very large (d = 1.06) effect sizes. A strong association was found between overall satisfaction with MIST and improved speaking abilities. Moderate to strong associations were also found between experienced speaking abilities, confidence in communication, reduction in avoidance behaviors and improved quality of life. DiscussionFindings indicate that MIST can be effective in managing adult stuttering. The findings highlight the importance of shared decision making and personal considerations using flexible therapy approaches that integrate stuttering and speech modification interventions with value and awareness-based skills. The nature of a multidimensional individualized approach, as shown in this study, highlights the importance of adjusting the relative weighting of different subcomponents according to each individual’s needs and goals. ConclusionMIST was shown to be efficacious in clinical settings and effective in real life settings. Findings were promising, despite a relatively small sample, and replication by other SLPs and with larger samples is warranted.

Competencias profesionales para el trabajo con población multilingüe y multicultural en España: creencias, prácticas y necesidades de los/las logopedas

Background and aimsThe increase in the number of people who require bilingual and multilingual speech-language intervention justifies reviewing the current practices of Speech-Language Therapists (SLTs), who are ethically responsible for providing the best possible evidence-based intervention to the families with whom they work. There is, therefore, a clear need to competently serve populations with linguistically and culturally diverse backgrounds. The goal of this work was to document the beliefs, needs and practices of SLTs in Spain, as well as to obtain a deeper understanding of linguistic, cultural and professional competencies from the perspective of SLTs. MethodBased on previous work in other countries, a questionnaire was designed to study multilingual and multicultural speech-language intervention in Spain. The sample consisted of 208 SLTs working with a diverse population across regions of Spain. ResultsEighty-four percent of the survey respondents reported that they speak more than one language, but only 56% considered themselves bilingual; 77% reported having faced the challenge of working with multilingual people; 86% reported that they had not received training focused on this diversity and 92% reported that they lacked resources for conducting bilingual speech and language evaluations. Nevertheless, there were significant differences in the beliefs and practices when bilingual and monolingual SLTs were compared. ConclusionsThis work, with results similar to those of previous studies, provides a first step for designing methods, policies and resources to improve professional competencies and multilingual practices. Several challenges for SLTs facing this new social reality are discussed.

Perceived barriers to compliance with speech-language therapist dysphagia recommendations of South African nurses.

BackgroundLiterature has shown that there is limited compliance amongst nurses with the dysphagia recommendations made by speech-language therapists (SLTs). Poor compliance could have a significant impact on the health outcomes of patients with dysphagia.ObjectivesThis study aimed to determine the specific barriers to compliance with dysphagia recommendations experienced by South African nurses, with the goal of identifying viable strategies to overcome these barriers.MethodThis cross-sectional study made use of a self-administered questionnaire to obtain quantitative data on nurses’ perceptions of barriers to the implementation of SLT dysphagia recommendations. Eighty-one nurses were recruited from two tertiary hospitals in two South African provinces. Descriptive statistics were used to analyse the reported barriers to compliance.ResultsThree main barriers to compliance were identified, namely a lack of knowledge regarding dysphagia, patient-related barriers and workplace concerns. Knowledge barriers included poor familiarity with the role of the SLT in dysphagia management, lack of knowledge regarding SLT terminology, disagreement with dysphagia recommendations and insufficient dysphagia training. Workplace concerns included staff shortages, heavy workloads and time constraints. Poor patient cooperation was emphasised as a patient-related barrier.ConclusionFor dysphagia recommendations to be followed by nurses, SLTs need to be aware of the barriers experienced by nurses within the relevant facility. Speech-language therapists need to consider the provision of appropriate in-service dysphagia training and include nurses in the decision-making process when recommendations are made. Speech-language therapists need to consider their role in both clear communication with the nurses and the development of supporting material, such as glossaries and visual aids.