Speech-language Therapy Services Research Articles

Speech-language therapy services for children with cleft palate: A scoping review on continuity of care.

Children with a cleft palate (with or without a cleft of the lip) often require speech-language therapy (SLT) services to achieve age-appropriate speech. For many children, this involves attending SLT services delivered by both specialised cleft team speech-language therapists (SLTs) and a local, community or school-based SLT. Given that these two different SLTs are typically involved in the child's care, it is important to ensure that effective communication, coordination and collaboration occur between them. This is known as continuity of care. While continuity of care in speech therapy has not generally been evaluated, in medicine it has been shown to improve health outcomes. To identify what is known from the existing literature about processes for continuity of care in cleft speech therapy services. A scoping review was conducted using Arksey and O'Malley's methodological framework. Seven databases were searched including MEDLINE via OVID, EMBASE via OVID, CINAHL via EBSCO, PsychINFO, Scopus, Web of Science and SpeechBITE. Covidence was used to screen 733 initial articles and five studies met the inclusion criteria. Thematic analysis was conducted to identify global and subthemes. Five papers were included for analysis. These identified two salient characteristics of cleft speech therapy continuity of care: (1) it is a continuous cycle and (2) it is complex. Although parents are integral team members, cleft and community SLTs must be responsible for initiating communication and collaborating. Furthermore, cleft SLTs have a crucial role in disseminating information and resources, as well as offering guidance and support. Given that only five studies were included, there is a need to gather more information from parents, community SLTs, and cleft SLTs to understand their experiences and perspectives. From what is known, there are breakdowns in the processes needed for continuity of care, including confusion regarding roles and responsibilities, and community SLTs lacking confidence, knowledge and support. Recommendations are provided to facilitate improvements in continuity of care. What is already known on the subject Children with CP+L often require SLT from two different clinicians including a specialised cleft SLT and a community or school-based SLT. As such, it is important that effective communication and collaboration occur between them to ensure continuity of care. What this study adds to the existing knowledge This study identified a breakdown in the processes necessary for continuity of care. According to community SLTs, there is a discrepancy between their expectations and current practices. This scoping review has identified two critical characteristics of effective continuity of care: (1) it operates as an ongoing cycle; and (2) it is a complex, multifaceted endeavour. What are the practical and clinical implications of this work? This study highlights the importance of cleft and community SLTs taking the initiative in communication and collaboration, rather than solely relying on parents as intermediaries. By offering practical recommendations, this research aims to improve continuity of care, potentially fostering greater awareness and advancements in service delivery.

A study on the reliability and validity of the Japanese version of the Scenario Test for people with chronic stroke-induced aphasia: A cross-sectional study.

The Scenario Test is recognised for its effectiveness in assessing the interactive aspects of functional communication in people with post-stroke aphasia (PWA). To develop a Japanese version of the Scenario Test (Scenario Test-JP) and assess its reliability and validity. Among 66 participants, we selected 61 individuals: 34 PWA and 27 healthy controls (HCs). We modified the Scenario Test-JP based on the UK version and subsequently evaluated its reliability (internal consistency, test-retest and intra-rater and inter-rater reliabilities) and validity (convergent and discriminant) by comparing PWA and HCs. The Scenario Test-JP showed strong reliability with a Cronbach's α of 0.93, test-retest reliability with an intraclass correlation coefficient (ICC) of 0.97, intra-rater reliability with an ICC of 0.95-1.00, and inter-rater reliability with an ICC of 0.96. The validity of the test was confirmed with concurrent scores ranging from ρ = 0.37 to 0.76 (p < 0.05) and known-groups validity (p < 0.001, r = -0.56). The reliability and validity of the Scenario Test-JP align with those of the original Dutch version and the UK and Greek versions. Additionally, the assessment can now include extended alternative communication methods, such as digital devices, indicating the potential of the Scenario Test-JP for modern Japanese speech-language therapy. What is already known on the subject Interactive communication is a facet of functional communication and is crucial for evaluating engagement and participation of people with aphasia (PWA) in speech-language therapy. The Scenario Test provides valuable information for planning speech-language treatment strategies by assessing dialogic communication. What this study adds This study describes the development of the Scenario Test-JP for use with Japanese speakers and Japanese PWA, which is adapted from the Scenario Test UK version. This study evaluated the reliability and validity of this assessment tool and provided supporting evidence. What are the clinical implications of this work? The reliability and validity of the Scenario Test-JP were consistent with those of the Dutch, UK and Greek versions. The Scenario Test-JP contributes to speech-language therapy in Japan, where high-quality support for the activities and participation of PWA is required. Insights from the Scenario Test The Scenario Test plays a crucial role in evaluating the functional communication skills of people with post-stroke aphasia (PWA). Enhancing functional communication has been linked to improved social engagement among PWA, which in turn influences their overall quality of life (QOL). Issues addressed by the Scenario Test The Scenario Test aids in delineating rehabilitation objectives for activities and participation among PWA, particularly concerning functional communication. The test facilitates tailored support for PWAs' interactive communication and forms the foundation for appropriate speech-language therapy interventions. Transformation of speech-language therapy (SLT) in Japan through the introduction of the Scenario Test-JP The integration of the Scenario Test-JP could enhance the SLT services provided to PWA in Japan. With Japan experiencing an unprecedented ageing population, the prevalence of social isolation and diminished QOL resulting from communication disorders like stroke-induced aphasia is expected to rise. Consequently, the SLT rehabilitation sector in Japan is actively seeking effective interventions to support functional communication among PWA. Hence, the adoption of the Scenario Test-JP is anticipated to streamline the evaluation of functional communication, facilitating the judicious selection and timely provision of assistance to PWA in SLT, including guidance on communication partner support and communication skill training.

Core outcomes for speech-language services in Ontario schools: a group concept mapping study and guiding framework

BackgroundEstablishing the most important outcomes for school-based speech-language therapy is essential to guide future research and program evaluation for these services. Many health disciplines have developed core outcomes sets (COS) for this purpose. A COS encompasses the most important outcomes for particular health services as identified by appropriate interested parties. These interested parties usually represent health care providers and those with the health condition. In this paper, we report the development of a guiding framework for a COS for speech-language therapy services in schools in a Canadian context.MethodsUsing a group concept mapping method, we identified the outcomes for inclusion in the COS guiding framework through the elicited opinions of key interested parties: speech-language therapists, teachers, and family members of children with speech, language, and communication needs. We extracted 103 statements (potential outcomes) from a previous data set of interview transcripts. We then asked participants to sort the statements into conceptually similar groups, which were aggregated and transformed into a cluster map using multidimensional scaling followed by hierarchical cluster analysis. Participants also rated each statement on 5-point scales for importance and feasibility. We calculated mean ratings for individual statements and for all statements in a cluster, for all participants and for participant groups separately.ResultsWe identified seven core outcomes for school-based speech-language services in Ontario, Canada. These included: classroom-based services, a holistic approach, support for teachers, care coordination, accessible services, family supports, and student success. All outcomes were rated highly for importance. Feasibility ratings were consistently below importance ratings. All participant groups concurred that a holistic approach was the most important outcome and accessible services was the least feasible outcome to achieve.ConclusionsThe seven outcomes identified in this study are recommended to guide the development of a full COS to direct future research and program evaluation for school-based speech-language services. These outcomes have not been widely included in previous research and should be incorporated into future research alongside specific intervention outcomes. Data for some outcomes may be available from non-traditional sources such as administrative data sets. Consequently, their use for program evaluations should be accompanied by appropriate institutional support to allow speech-language therapists to make meaningful use of appropriate outcomes data.

The impact of PD Check-In on self-management skills for maintenance of speech after intensive treatment.

Maintenance of speech outcomes following speech-language therapy (SLT) in Parkinson's disease (PD) is an unmet expectation of people with PD (PWPD) and poorly defined in SLT practice. PD Check-In, a model for supported self-managed maintenance of speech following Lee Silverman Voice Treatment (LSVT) LOUD was investigated. To investigate the impact of the semi-structured component of PD Check-In on the adoption of self-management concepts and behaviours and the identification of facilitators, barriers and strategies for speech maintenance by PWPD over 24 months post-treatment. Following LSVT LOUD, 16 PWPD participated in individual PD Check-In semi-structured discussions with a SLT at 6 and 12 weeks, and 6, 12 and 24 months post treatment. A two-stage qualitative content analysis was applied: directed content analysis using categories from the theoretical framework of PD Check-In followed by inductive content analysis to identify subcategories. Statements from PWPD indicated adoption of seven concepts of self-management across participants and across time. Six concepts from the theoretical framework of PD Check-In (partnerships, self-reflection, maintenance barriers and facilitators, revision of LSVT LOUD skill, goal setting and maintenance strategies), and one new category, participation, emerged from the analysis. Self-reflection, maintenance facilitators and barriers and participation were most prevalent in discussions. PWPD identified facilitators, barriers and strategies for maintenance across time points. Statements from PWPD indicated a positive impact of SLT-supported self-management of speech using self-tailored strategies for sustainable maintenance according to their individual circumstances and needs. What is already known on this subject People with Parkinson's disease (PWPD) have expressed their need for speech-language therapy (SLT) services that are accessible for the duration of the condition and responsive to their expectation of maintaining speech following treatment. Outcomes for maintenance of the treatment effect following Lee Silverman Voice Treatment (LSVT) LOUD are variable. What this paper adds to existing knowledge This study presents the outcomes of five PD Check-In interventions delivered in semi-structured discussions between PWPD and a SLT over 24 months following LSVT LOUD for the development of self-management skills and behaviours. PWPD adopted self-management positively using self-tailored strategies for sustainable maintenance according to their individual circumstances and needs. What are the potential or actual clinical implications of this work? PWPD responded positively to the individual development of self-management skills and behaviours over time. Individuality and flexible responsivity are features of PD Check-In which resonate with PWPD and speak to SLT supported self-managed maintenance of speech as a long-term model for PD.

Exploring the valued outcomes of school-based speech-language therapy services: a sequential iterative design.

Achieving outcomes that community members value is essential to high-quality, family-centred care. These valued outcomes should inform the production and interpretation of research evidence. To date, outcomes included in studies of service delivery models for speech-language services in schools have been narrowly defined, and do not match the outcomes suggested as important by families, teachers, and children. The most important outcomes of school-based, speech-languages services have not been directly and systematically investigated. We aimed to address this gap by asking school community members what outcomes were most relevant to evaluating and improving the delivery of speech-language services in schools. A sequential, iterative mixed-method study was conducted using interviews with 14 family members, educators, and speech-language therapists that asked what outcomes or impacts of school-based services they considered most important or valuable. Summative content analysis was used to analyse the data. Structural topic modelling between rounds of qualitative analysis was used to describe both the quality and the quantity of the interview content. School community members' perspectives were compared through estimation of topic proportions within interviews from each member group and through qualitative comparison. Structural topic modelling diagnostics and qualitative interpretation of topic output suggested a six-topic solution. This solution was estimated successfully and yielded the following topics: (1) meeting all needs appropriately, (2) teamwork and collaboration, (3) building capacities, (4) supporting individual student needs in context, (5) coordinating care, and finally (6) supporting core educational goals. Families focused on school-based services meeting all needs appropriately and coordinating care, while educators highlighted supporting individual student needs in context. By contrast, speech-language therapists emphasized building capacities and supporting core educational goals. All school community members agreed that current assessment tools and outcome measures were inadequate to capture the most important impacts of school-based services. Outcomes identified by school community members as important or valuable were broad, and included individual student outcomes, interpersonal outcomes, and systems-level outcomes. Although these outcomes were discussed by all member groups, each group focused on different outcomes in the interviews, suggesting differences in the prioritization of outcomes. We recommend building consensus regarding the most important outcomes for school-based speech-language services, as well as the prioritization of outcomes for measure development.

Communicative participation outcomes in individuals with Parkinson's disease receiving standard care speech-language therapy services in community settings.

The Communicative Participation Item Bank (CPIB) is a patient-reported outcome measure (PROM) designed to measure the extent of interference, or difficulty, experienced by adults with communication disorders participating in their day-to-day communication activities. To date, there is limited evidence regarding sensitivity of the CPIB for capturing change with intervention in people with Parkinson's disease (PwPD). The purpose of this study was to examine the following measurement properties of the CPIB in PwPD who received community-based, standard care, speech-language therapy focusing on motor speech concerns: Change over time between treatment and observation groups, comparison to patient-defined ideal and satisfactory targets, comparison of static short form to computerised adaptive testing (CAT), comparison of self to proxy-rated scores, and comparison to other common PROMs. Forty-six PwPD (20 treatment/26 observation) completed data collection upon enrolment (pre-treatment) and 6 months later. In addition to the CPIB, PROMs included the Voice Handicap Index 10-item short form (VHI-10), PROMIS Global Health-Related Quality of Life, Levels of Speech Usage, self-rated speech severity, and Patient Health Questionnaire-9 (PHQ-9). Participants also engaged in qualitative interviews. Forty-four family members completed proxy CPIB ratings. There were no significant differences between treatment and observation groups on the CPIB pre-treatment, but there were significant differences post-treatment. The differences appeared to be largely due to significant gains in the treatment group. No participants reached their ideal CPIB target, and few reached their satisfactory target. Static CPIB short form and CAT scores were not significantly different, with an average of five CAT items administered per participant. Overall group similarities between patient and proxy scores may have obscured wide variability across individual patient-proxy pairs. Associations between CPIB and VHI-10, health-related quality of life, self-reported speech severity, and depression ranged from weak to moderate. The CPIB appears to be sensitive to capturing change with intervention, and similar results are obtained with the static short form and CAT formats. One clinical caution is that even with gains observed in the treatment group, no participants obtained their ideal communicative participation goals, and few obtained a satisfactory level of communicative participation. Thus, while current interventions are beneficial, they may not meet the full range of clients' communication needs. While responding to the CPIB through a proxy rater may be feasible, caution is warranted due to concerns about maintaining the autonomy of PwPD. What is already known on this subject The communication disorders associated with Parkinson's disease (PD) can have a negative impact on quality of life and life participation as measured by patient (or person)-reported outcome measures (PROMs). The Communicative Participation Item Bank (CPIB) is one PROM available to use with adults with communication disorders. However, little is known about whether the CPIB captures changes in communicative participation as a result of standard care treatment for people with Parkinson's disease (PwPD). Use of computerised adaptive testing (CAT), proxy report and comparison to targeted participation outcomes have not been explored. What this study adds to existing knowledge As a result of this study, we know that the CPIB captured differences between treatment and observation groups after community-based, standard care speech therapy intervention focusing on motor speech production in PwPD. Static short form and CAT scores did not differ significantly, so the CAT option provides better efficiency requiring, on average, five items to administer compared to the 10-item short form. Proxy and PwPD scores did not differ as a group, but wide variability was noted. What are the potential or actual clinical implications of this work? The CPIB may be a clinically sensitive instrument for capturing changes in communicative participation after treatment. No participants met their ideal CPIB target, and few reached their satisfactory target, suggesting that while current interventions contribute to gains in communicative participation, there are still unmet needs that may call for support and interventions addressing the more complex array of factors affecting communicative participation outcomes for PwPD.

Speech-Language Pathologists’ Perception of Telepractice at the Start of the COVID-19 Pandemic in Jordan

This study explored how speech-language pathologists (SLPs) in Jordan perceived and implemented telepractice at the beginning of the COVID-19 pandemic, from April to June 2020. Eighty-five SLPs who provided telepractice and 57 SLPs, who did not, completed an online survey sharing their perceptions related to the delivery and barriers of telepractice. The results showed a significant increase of telepractice use in response to the pandemic. However, the SLPs identified several barriers to telepractice, including environmental distractions at the client’s end, limited computer knowledge, technological issues, internet connectivity problems, and platform availability. There was general agreement among the SLPs regarding the need for professional training and governmental guidelines to regulate the use of telepractice. The study’s findings demonstrate how SLPs in Jordan adapted to the sudden shift toward telepractice, and identify potential implementation obstacles, which could assist in establishing telepractice as a reliable model for speech-language therapy services in the future.

Comparisons of Clients' and Caregivers' Satisfaction Across Conventional, Virtual, and Hybrid Speech-Language Therapy Services in Malaysia.

This study compared the satisfaction of recipients of conventional speech-language therapy (C-SLT), speech-language teletherapy (SLTT), and hybrid speech-language therapy (H-SLT), and determined sociodemographic factors that affect their satisfaction. Participants were clients and caregivers of a speech-language clinic at a public university. Services were primarily provided by student clinicians, who were undergoing supervised clinical training. An online survey was distributed, which consisted of three sections: Background Information, Overall Satisfaction in SLT, and Satisfaction in SLTT. All participants completed the first two sections, while the third section was completed only by those who experienced SLTT or H-SLT. Most of the respondents were caregivers (89.7%), female (79.4%), of Malay ethnicity (80.9%), have received tertiary education (77.9%), within the low-income category (66.2%), held a job (76.5%), and resided in central West Malaysia (83.8%). Many participants experienced C-SLT (51%), followed by H-SLT (34%), and SLTT (15%). There were no significant differences in the overall satisfaction of the participants across three modes of services delivery (F[2,67] = 0.02, p = 0.95), and in the satisfaction with teletherapy between the H-SLT and SLTT groups (t = 0.90, p = 0.38). Income was the only sociodemographic factor that was correlated with the satisfaction level in teletherapy (r = 0.37, p = 0.04).

Reflect, Reframe, and Re-Imagine Theory and Practice in Speech, Language, and Hearing Sciences: Introduction to the Forum.

Reflect, Reframe, and Re-Imagine Theory and Practice in Speech, Language, and Hearing Sciences: Introduction to the Forum.

Rehabilitation access for individuals with cognitive-communication challenges after traumatic brain injury: A co-design study with persons with lived experience.

Adults with traumatic brain injuries (TBI) frequently experience cognitive, emotional, physical and communication deficits that require long-term rehabilitation and community support. Although access to rehabilitation services is linked to positive outcomes, there can be barriers to accessing community rehabilitation related to system navigation, referral processes, funding, resource allocation and communications required to ensure access. This study aimed to identify barriers to accessing insurer funding for rehabilitation and healthcare services, for adults with TBI injured in motor vehicle collisions (MVCs). We used a co-design approach to collaborate with persons with lived experience to design a survey of adults who sustained a TBI in an MVC. The survey examined access to insurer funding for rehabilitation services and was disseminated through brain injury networks in Ontario, Canada. Respondents (n = 148) identified multiple barriers to accessing rehabilitation services through insurer funding, including delays of more than 2 years (49%), mandatory duplicative assessments (64%) and invasion of privacy (55%). Speech-language therapy and neuropsychological services were denied most frequently. Negative experiences included insurers' poor understanding of TBI symptoms, denials of services despite medical evidence demonstrating need and unsupportive insurer interactions. Although 70% of respondents reported cognitive-communication difficulties, accommodations were rarely provided. Respondents identified supports that would improve insurer and healthcare communications and rehabilitation access. The insurance claims process had many barriers for adults with TBI, limiting their access to rehabilitation services. Barriers were exacerbated by communication deficits. These findings indicate a role for Speech-language therapists in education, advocacy and communication supports during the insurance process specifically as well as rehabilitation access processes in general. What is already known on this subject There is extensive documentation of the long-term rehabilitation needs of individuals with traumatic brain injury (TBI) and their challenges in accessing rehabilitation services over the long term. It is also well known that many individuals with TBI have cognitive and communication deficits that affect their interactions in the community, including with healthcare providers, and that SLTs can train communication partners to provide communication supports to individuals with TBI in these communication contexts. What this study adds This study adds important information about barriers to accessing rehabilitation, including barriers to accessing SLT services in the community. We asked individuals with TBI about challenges to accessing auto insurance funding for private community services, and their responses illustrate the broader challenges individuals with TBI face in communicating their deficits, conveying service needs, educating and convincing service administrators and self-advocating. The results also highlight the critical role that communication plays in healthcare access interactions, from completing forms to reviewing reports and funding decisions, to managing telephone calls, writing emails and explaining to assessors. What are the clinical implications of this work? This study shows the lived experience of individuals with TBI in overcoming barriers to accessing community rehabilitation. The results show that best practices in intervention should include evaluating rehabilitation access, which is a critical step in patient-centred care. Evaluation of rehabilitation access includes evaluating referral and navigation, resource allocation and healthcare communications, and ensuring accountability at each step, regardless of model of service delivery or funding source. Finally, these findings show the critical role of speech-language therapists in educating, advocating and supporting communications with funding sources, administrators and other healthcare providers.

Māori aspirations following stroke: A pathway forward for the speech-language therapy field

ABSTRACT Background Attempts to improve Indigenous health outcomes are evident in the speech-language therapy (SLT) field, although they are restricted by a limited evidence base. Prior research has shown that SLT services do not always meet Indigenous stroke survivors’ needs, however, few studies have investigated this phenomenon and fewer have explored solutions. Consequently, the SLT field lacks knowledge of appropriate and optimal supports. Aims To identify and compare experiences and aspirations of Māori stroke survivors, whānau (family), and speech-language therapists (SLTs) in Aotearoa New Zealand regarding SLT service provision. Methods & Procedures Kaupapa Māori research and interpretive description methodologies underpinned this study. Four Māori stroke survivors, two whānau members, and five SLTs participated in semi-structured interviews. Data were analysed using constant comparative analysis and collaboratively interpreted during a hui (meeting) between researchers and participants. Outcomes & Results Analysis highlighted six themes spanning experiences and aspirations: (1) tautoko (support), (2) kaupapa Māori (Māori approach), (3) whanaungatanga (relationships), (4) tino rangatiratanga (autonomy), (5) taiao (environment), and (6) kōnekeneke (change). Positive aspects of SLT were described, however, Māori often did not receive optimal supports. Aspirations centred on changes to SLT services and the wider healthcare system. Conclusions Adaptations to SLT services are indicated to improve the quality of SLT received by Māori following stroke. To meet aspirations described in this study, the SLT profession may incorporate Māori approaches; prioritise strong, collaborative relationships; offer more autonomy to Māori stroke survivors; support the development of SLTs and SLT students; increase public awareness; and encourage change in the wider healthcare system. Many aspirations identified in the current study are consistent with those identified by Indigenous people in Australia, suggesting that some common solutions may exist to improving Indigenous SLT services.

Challenges Faced by Individuals with Hearing Impairment during COVID-19 Pandemic Lockdown in India - A Pilot Study.

COVID - 19 (Corona Virus Infectious Disease) situations reported in 2019, declared by World Health Organization (WHO) as a pandemic is still a prevailing global crisis. Common regulations were implemented such as lockdown, wearing face masks as mandatory, face shields, gloves and maintaining physical and social distance in public places to reduce the spread of the virus. These pandemic induced challenges affected social communication, technical and behavioral aspects in lifestyle of people with hearing impairment. Along with medical, paramedical services, the crisis had challenged hearing, speech language pathology and therapy services too. The study aimed to explore the challenges that adults with hearing impairment had experienced during the pandemic and to suggest some practical solutions that can be implemented by audiologists. It is a questionnaire-based study with purposive sampling method employed in data collection. The questionnaire was administered on adult hearing aid users (mean age: 18 years) recruited for participation from different parts/ clinical setups across India. The outcome of the questionnaire did support the assumption that availing audiological services was difficult or impossible for most of the hearing aid users. Accessing batteries was reported to be the most frequent issue. Adequate level of hearing though hearing aid was important to them and clinical services could not be availed for long period of time due to travel related issues and closure of audiological services. Also, social isolation impacted on their quality of life and effective communication. As a possible solution most of the users chose tele services as a better solution.

Participants' perspective on a COVID-19 online vocal group stimulation for people with Parkinson's disease.

The COVID-19 related confinement and social distancing had negative consequences on the health of individuals living with Parkinson's Disease (PD). In collaboration with a non-profit organization, we developed and implemented a daily online vocal stimulation group named “Musculation de la Voix” (MdlV) in April 2020. To better understand the potential of MdlV to diversify existing services available to people with PD experiencing vocal symptoms, this study aimed to explore participants' experience and perception of MdlV in terms of participation, motivations, feelings, perceived changes, and appreciation. The 45 individuals who registered to the Summer 2020 Semester of MdlV were invited to complete an online ten-question survey. Responses to the four close-ended questions were analyzed using descriptive statistics while statements provided in response to the six open-ended questions were subjected to an inductive qualitative content analysis. Thirty seven participants completed the survey. Results revealed that the sample of respondents was mostly constituted of individuals who were engaged in this activity since its very beginning (62,2%), participated daily (59,5%), intended to keep participating in the activity (97,3%), and had never received speech-language therapy (SLT) services before (72,97%). The qualitative analysis yielded one theme relating to prior services: “Previous SLT services are variable and perceived as beneficial but with limitations,” and three themes pertaining to MdlV: “Seeking improvement and support as initial motivations to engage in MdlV,” “Unanticipated benefits and desired gains catalyzing motivation to participate in MdlV,” and “Perceived limitations of MdlV and persisting needs.” Our study participants' engagement and motivation toward MdlV as well as the benefits they perceived in relation to this activity suggest that an online vocal stimulation group may be a promising complement to currently limited SLT services. As limitations and persisting needs were also identified, future studies are required to elucidate what aspect of MdlV works, for whom and how.

Communication disability in Bangladesh: issues and solutions

ABSTRACT Context The UN declaration of Human Rights (1948) included people's right to be able to communicate. This gave all countries the responsibility to provide services for those with communication disabilities. However Speech Language Therapy (SLT) is largely a Minority (developed) World construction, leaving a question about how SLT could or should be constructed in Majority World (developing) countries. Solutions embedded within their context and culture are needed, rather than reproducing Minority World systems. Bangladesh is a Majority World country with a very large population. It has both issues and potential solutions in common with other Majority World countries, but also unique features of its own. Issues SLT services in Bangladesh began only 15 years ago. Social, geographic, economic, historical and political barriers mean they are often unavailable or inaccessible to those in need. There is low public awareness of SLT, but if this were to increase it would be faced by inadequate numbers of qualified Speech Language Therapists. There is a rural-urban divide and high amounts of poverty presenting challenges about how to fund such a service equitably. Potential Solutions The fledgeling SLT profession in Bangladesh has adapted to address local needs, culture, and circumstances, however more solutions are needed. This paper considers ways of raising awareness, improving background information on which to base decisions about distribution and funding of SLT, and taking advantage of a growing number of local tertiary training institutions to provide a solid professional base for SLT services to grow from.

Delivery of Speech-Language Therapy and Audiology Services Across the World at the Start of the COVID-19 Pandemic: A Survey

Purpose:Speech-language pathologists (SLPs) and audiologists from around the world were forced to enter the world of telepractice at the start of the COVID-19 pandemic. This study investigated which types of applications SLPs and audiologists used most frequently at that time. It also examined what the main obstacles then were to provide speech, language, and hearing services through telepractice.Method:A short electronic survey with 13 questions was distributed around the world. In total, 1,466 surveys from SLPs and audiologists from 40 countries were used for the analysis. Most of them (77.4%) delivered care through online real-time communication. A minority (40.1%) also delivered care through videos or exercises that they sent to their clients, 37.8% delivered through face-to-face intervention in the same room, 30.0% delivered through telephone without video, and 21.5% provided distant computer-based treatment.Results:The most frequently used applications were those that establish synchronous video communication with the client (60.5%). SLPs and audiologists reported using applications to create exercises more frequently than applications that contain exercises or training (15.0% vs. 12.0%). The most reported obstacle (31.2%) referred to technical problems (poor Internet connection, poor quality, or poor access to resources). Other frequently reported obstacles included the difficulty to perform assessment or treatment procedures (13.8%), concentration issues during sessions (12.4%), and lack of interaction between professional and client or patient (10.9%).Conclusions:Many SLPs and audiologists reported using telepractice technology, mainly in the form of real-time videoconferencing. However, existing barriers included technical problems such as poor Internet connection.

Listening to Stakeholders Involved in Speech-Language Therapy for Children With Communication Disorders: Content Analysis of Apple App Store Reviews.

BackgroundWith the plethora of mobile apps available on the Apple App Store, more speech-language pathologists (SLPs) have adopted apps for speech-language therapy services, especially for pediatric clients. App Store reviews are publicly available data sources that can not only create avenues for communication between technology developers and consumers but also enable stakeholders such as parents and clinicians to share their opinions and view opinions about the app content and quality based on user experiences.ObjectiveThis study examines the Apple App Store reviews from multiple key stakeholders (eg, parents, educators, and SLPs) to identify and understand user needs and challenges of using speech-language therapy apps (including augmentative and alternative communication [AAC] apps) for pediatric clients who receive speech-language therapy services.MethodsWe selected 16 apps from a prior interview study with SLPs that covered multiple American Speech-Language-Hearing Association Big Nine competencies, including articulation, receptive and expressive language, fluency, voice, social communication, and communication modalities. Using an automatic Python (Python Software Foundation) crawler developed by our research team and a Really Simple Syndication feed generator provided by Apple, we extracted a total of 721 app reviews from 2009 to 2020. Using qualitative coding to identify emerging themes, we conducted a content analysis of 57.9% (418/721) reviews and synthesized user feedback related to app features and content, usability issues, recommendations for improvement, and multiple influential factors related to app design and use.ResultsOur analyses revealed that key stakeholders such as family members, educators, and individuals with communication disorders have used App Store reviews as a platform to share their experiences with AAC and speech-language apps. User reviews for AAC apps were primarily written by parents who indicated that AAC apps consistently exhibited more usability issues owing to violations of design guidelines in areas of aesthetics, user errors, controls, and customization. Reviews for speech-language apps were primarily written by SLPs and educators who requested and recommended specific app features (eg, customization of visuals, recorded feedback within the app, and culturally diverse character roles) based on their experiences working with a diverse group of pediatric clients with a variety of communication disorders.ConclusionsTo our knowledge, this is the first study to compile and analyze publicly available App Store reviews to identify areas for improvement within mobile apps for pediatric speech-language therapy apps from children with communication disorders and different stakeholders (eg, clinicians, parents, and educators). The findings contribute to the understanding of apps for children with communication disorders regarding content and features, app usability and accessibility issues, and influential factors that impact both AAC apps and speech-language apps for children with communication disorders who need speech therapy.

The process of telepractice implementation during the COVID-19 pandemic: a narrative inquiry of preschool speech-language pathologists and assistants from one center in Canada

BackgroundMany professional services were pressed to adopt telepractice in response to the global coronavirus SARS-CoV-2 (COVID-19) pandemic. The need to adopt a new service delivery approach quickly created different implementation challenges. This study explored the lived experiences of frontline clinicians who successfully transitioned their in-person speech-language therapy services to telepractice through an implementation science lens.MethodsThe study was conducted in partnership with one publicly funded program in Ontario, Canada that offers services to preschoolers with speech, language and communication disorders. Sixteen frontline speech-language pathologists and assistants at this organization shared their lived experience transitioning to telepractice during the pandemic during videoconference interviews. A narrative inquiry approach was used to analyze interview transcripts to identify the processes (or steps) this program took to implement telepractice and to understand the facilitators and barriers to telepractice implementation during the pandemic.ResultsThe following six stages were identified from clinicians’ narratives: abrupt lockdown; weeks of uncertainty; telepractice emerged as an option; preparation for telepractice; telepractice trials; and finally, full implementation of telepractice. The stages of events offered significant insights into how government public health measures influenced clinicians’ decisions and their processes of adopting telepractice. In terms of barriers, clinicians reported a lack of knowledge, skills and experience with telepractice and a lack of technological support. The organization’s learning climate and team approach to transitioning services were identified as the main facilitator of implementation.ConclusionsFindings suggest a need for better coordination of public health measures and professional services, which would have eased clinicians’ stress and facilitated an earlier transition to telepractice. Fostering an organization’s learning climate may improve organization’s resilience in response to emergency situations.

A script for the telepractice of speech-language therapy and audiology services - what was learnt from the COVID-19 pandemic

RESUMO Apresenta-se um roteiro de atuação em telessaúde para atendimento fonoaudiológico de pacientes adultos em domicílio que foi aplicado em um projeto comunitário durante a Pandemia da COVID-19. O roteiro foi desenvolvido em três etapas distintas. A partir de uma revisão de literatura para a identificação de facilitadores e barreiras para o atendimento de pacientes via telessaúde, foi feita a implementação de um serviço de telefonoaudiologia em uma Unidade Básica de Saúde, possibilitando a experiência para a discussão mediante a prática de facilitadores para a atuação clínica e maneiras de qualificar a teleconsulta fonoaudiológica. Por fim, deu-se a elaboração do roteiro, organizado em 20 itens, divididos em três seções. A sua elaboração incluiu, além da escrita, a discussão detalhada de cada item elencado, considerando a efetividade das ações propostas, qualificação das teleconsultas e integralidade do atendimento do paciente. O roteiro apresentado se propõe a ser suporte para a atuação em telefonoaudiologia. Entretanto, deve ser adaptado à realidade cultural e social dos profissionais e pacientes que a esta forma de atuação forem expostos. Visto que não se trata de um conjunto de práticas e procedimentos fechados em si, deverá ser atualizado conforme novos procedimentos e tecnologias estejam acessíveis para a atuação em telefonoaudiologia.

Outcomes of Telepractice Speech Therapy for an Adult Who Covertly Stutters: A Case Study

Purpose: The purpose of this study was to report on telepractice-based holistic speech-language therapy services to reduce avoidance of stuttering and increase positive self-image as a communicator for an adult who covertly stutters as compared with baseline. Method: A single case study design was employed with baseline, intervention, and maintenance phases completed via telepractice. The participant received biweekly speech-language pathology services, including both individual and group sessions. The Overall Assessment of the Speaker's Experience of Stuttering–Adult and Stuttering Severity Instrument–Fourth Edition assessed the participant's overt and covert stuttering behaviors at pretreatment and posttreatment time frames. Weekly data points of participant's self-report of avoidance of stuttering during therapy sessions and during the week between therapy sessions as well as researcher-calculated frequency of stuttering were measured. Visual inspection was utilized to analyze treatment outcomes. Results: The participant demonstrated a reduction in avoidance of stuttering within sessions as well as the week prior to a session, as compared with baseline. Additionally, the participant presented with an increased percent of words stuttered following into maintenance as compared with baseline. Visual inspection of weekly data points of frequency of stuttering and self-report of avoidance appeared to present promising results throughout the intervention phase with potential treatment effects continuing into the maintenance phase. Conclusion: Results of this study demonstrate preliminary evidence for potential positive outcomes of holistic speech therapy via telepractice for people who covertly stutter.

Preferences of speech and language therapists for telepractice in the COVID-19 pandemic and factors affecting their acceptance of the delivery model

Objectives: With the COVID-19 pandemic, telepractice became a great option in speech-language therapy services, as in many healthcare utilities. However, the transition to this service model did not occur at a similar rate for every clinician. Therefore, this study aimed to determine the experiences, preferences and factors affecting the acceptance of speech-language therapists (SLT) regarding telepractice in Turkey. Methods: Sixty-seven SLTs were presented with a questionnaire that addressed the professional tendencies, experiences and views on telepractice of them. Descriptive statistics regarding the preferences and experiences of SLTs were calculated. Moreover, factors that might be related to the number of sessions they held at the pandemic were examined with the Chi-squared test. Results: The speech-language disorders that SLTs find the most suitable for telepractice were fluency disorders, voice disorders and speech sound disorders. Groups that SLTs deemed most suitable for receiving telepractice in terms of age were 12-21, 22-64 and 7-11, respectively. A significant relationship was found between the frequency of online meetings and telepractice sessions before the pandemic and the number of sessions during the pandemic. Furthermore, a significant relationship also was found between satisfaction with using clinician skills in telepractice and the number of telepractice sessions during the pandemic. Conclusions: The importance of the first experiences of SLTs in the acceptance of the delivery method emerged. The necessity of in-service trainings and exemplary models to improve attitudes emerged. With these trainings, ensuring security, standardizing practices and increasing qualified services will be provided as well.