Speech Pathology Services Research Articles

Study Protocol:Missing Voices– Communication Difficulties after Stroke and Traumatic Brain Injury in Aboriginal Australians

Background:Aboriginal and Torres Strait Islander Australians experience stroke and traumatic brain injury (TBI) with much greater frequency than non-Aboriginal Australians. Acquired communication disorders (ACD) can result from these conditions and can significantly impact everyday life. Yet few Aboriginal people access rehabilitation services and little is known about Aboriginal peoples’ experiences of ACD. This paper describes the protocol surrounding a study that aims to explore the extent and impact of ACD in Western Australian Aboriginal populations following stroke or TBI and develop a culturally appropriate screening tool for ACD and accessible and culturally appropriate service delivery models.Method/Design:The 3-year, mixed methods study is being conducted in metropolitan Perth and five regional centres in Western Australia. Situated within an Aboriginal research framework, methods include an analysis of linked routine hospital admission data and retrospective file audits, development of a screening tool for ACD, interviews with people with ACD, their families, and health professionals, and drafting of alternative service delivery models.Discussion:This study will address the extent of ACD in Aboriginal populations and document challenges for Aboriginal people in accessing speech pathology services. Documenting the burden and impact of ACD within a culturally secure framework is a forerunner to developing better ways to address the problems faced by Aboriginal people with ACD and their families. This will in turn increase the likelihood that Aboriginal people with ACD will be diagnosed and referred to professional support to improve their communication, quality of life and functioning within the family and community context.

Mapping speech pathology services to developmentally vulnerable and at-risk communities using the Australian Early Development Census

Purpose: The Australian Early Development Census (AEDC) is a population-based measure of children's development across five domains in the first year of formal schooling. In this study, the AEDC data from two domains (Language and Cognitive Skills and Communication Skills and General Knowledge) were used to explore the extent and distribution of vulnerability in communication skills among children in Australian communities. Speech Pathology Australia (SPA) membership data were then used to explore the accessibility of services within those communities.Method: The 2012 AEDC data were accessed for 289,973 children, living in 577 communities across Australia. The number of children identified as “at risk” (10–25th percentile) or developmentally “vulnerable” (< 10th percentile) in each of the domains was calculated, then the location of communities with high proportions (> 20%) of these children was determined. These data were mapped against the location of paediatric speech-language pathologists (SLPs) to identify the number of communities with little to no access to speech-language pathology services.Result: Across Australia, there were 47,636 children (17.4%) identified as developmentally vulnerable/at risk in Language and Cognitive Skills and 69,153 children (25.3%) in Communication Skills and General Knowledge. There were 27 communities with > 20% of children identified as developmentally vulnerable/at risk in Language and Cognition in their first year of formal schooling. Of those, none had access to speech-language pathology services, according to current SPA membership data. There were also 27 local government areas with > 20% of children identified as developmentally vulnerable/at risk in the Communication Skills and General Knowledge domain. Of these, three had access to SLP(s) and these were in regional/metropolitan areas.Conclusion: The AEDC provides a means of identifying communities where children are performing well and communities which may benefit from population-based prevention or intervention. Given the number of communities within Australia without access to SLPs, there is a need to reconsider how such population-based services could be delivered, particularly in the communities with higher levels of vulnerability in communication development.

Multiple Stakeholder Perspectives on Teletherapy Delivery of Speech Pathology Services in Rural Schools: A Preliminary, Qualitative Investigation

The objective of this study was to investigate stakeholders’ views on the feasibility and acceptability of a pilot speech pathology teletherapy program for children attending schools in rural New South Wales, Australia. Nine children received speech pathology sessions delivered via Adobe Connect® web-conferencing software. During semi-structured interviews, school principals (n = 3), therapy facilitators (n = 7), and parents (n = 6) described factors that promoted or threatened the program’s feasibility and acceptability. Themes were categorized according to whether they related to (a) the use of technology; (b) the school-based nature of the program; or (c) the combination of using technology with a school-based program. Despite frequent reports of difficulties with technology, teletherapy delivery of speech pathology services in schools was highly acceptable to stakeholders. However, the use of technology within a school environment increased the complexities of service delivery. Service providers should pay careful attention to planning processes and lines of communication in order to promote efficiency and acceptability of teletherapy programs.

Reliability of the Filipino version of the Parent Satisfaction Scale: A preliminary study

Abstract Parent satisfaction is vital in improving the delivery of paediatric health care. However, there are no linguistically appropriate instruments that measure parent satisfaction among Filipino parents of children receiving occupational therapy, physical therapy, and speech pathology services. This study aimed to provide preliminary information about the reliability of the Filipino version of the Parent Satisfaction Scale (F-PSS). Research procedures included forward- and backward-translation of the PSS, cognitive interview, and data collection for reliability. These were conducted on primary caregivers of children who were receiving therapy services in a local clinic. Internal consistency and reproducibility of the translated tool were determined. Internal consistency was measured using an ordinal α value based on a polychoric correlation matrix, reproducibility using Randolph's κ, and standard error of measurement (SEM). Data analysis showed an ordinal α value of 0.96, κ values ranging from 0.56 to 0.72, and a standard error of measurement of 0.11. In summary, the F-PSS has excellent internal consistency, moderate to substantial agreement after repeated measures, and excellent absolute reliability for determining parent satisfaction in paediatric health care. Supplementary studies on its validity are needed to further ascertain its clinical utility.

Specific language impairment: a convenient label for whom?

The term 'specific language impairment' (SLI), in use since the 1980s, describes children with language impairment whose cognitive skills are within normal limits where there is no identifiable reason for the language impairment. SLI is determined by applying exclusionary criteria, so that it is defined by what it is not rather than by what it is. The recent decision to not include SLI in DSM-5 provoked much debate and concern from researchers and clinicians. To explore how the term 'specific language impairment' emerged, to consider how disorders, including SLI, are generally defined and to explore how societal changes might impact on use the term. We reviewed the literature to explore the origins of the term 'specific language impairment' and present published evidence, as well as new analyses of population data, to explore the validity of continuing to use the term. We support the decision to exclude the term 'specific language impairment' from DSM-5 and conclude that the term has been a convenient label for researchers, but that the current classification is unacceptably arbitrary. Furthermore, we argue there is no empirical evidence to support the continued use of the term SLI and limited evidence that it has provided any real benefits for children and their families. In fact, the term may be disadvantageous to some due to the use of exclusionary criteria to determine eligibility for and access to speech pathology services. We propose the following recommendations. First, that the word 'specific' be removed and the label 'language impairment' be used. Second, that the exclusionary criteria be relaxed and in their place inclusionary criteria be adopted that take into account the fluid nature of language development particularly in the preschool period. Building on the goodwill and collaborations between the clinical and research communities we propose the establishment of an international consensus panel to develop an agreed definition and set of criteria for language impairment. Given the rich data now available in population studies it is possible to test the validity of these definitions and criteria. Consultation with service users and policy-makers should be incorporated into the decision-making process.

Speech and Language Services in South Korea for Individuals with Neurogenic Communication Disorders

There is a growing need for speech and language pathology services in South Korea, especially for persons with neurogenic communication disorders, given that the population of elderly adults increases rapidly. This article provides information on (a) prevalence and incidence of neurogenic communication disorders, (b) speech and language service delivery system, and (c) demographics of speech-language pathologists (SLPs) and obtaining competency in neurogenic communication disorders in South Korea. The importance of international collaborations is discussed to better understand culturally and linguistically diverse populations with neurogenic communication disorders.

Associations between speech features and phenotypic severity in Treacher Collins syndrome.

BackgroundTreacher Collins syndrome (TCS, OMIM 154500) is a rare congenital disorder of craniofacial development. Characteristic hypoplastic malformations of the ears, zygomatic arch, mandible and pharynx have been described in detail. However, reports on the impact of these malformations on speech are few. Exploring speech features and investigating if speech function is related to phenotypic severity are essential for optimizing follow-up and treatment.MethodsArticulation, nasal resonance, voice and intelligibility were examined in 19 individuals (5–74 years, median 34 years) divided into three groups comprising children 5–10 years (n = 4), adolescents 11–18 years (n = 4) and adults 29 years and older (n = 11). A speech composite score (0–6) was calculated to reflect the variability of speech deviations. TCS severity scores of phenotypic expression and total scores of Nordic Orofacial Test-Screening (NOT-S) measuring orofacial dysfunction were used in analyses of correlation with speech characteristics (speech composite scores).ResultsChildren and adolescents presented with significantly higher speech composite scores (median 4, range 1–6) than adults (median 1, range 0–5). Nearly all children and adolescents (6/8) displayed speech deviations of articulation, nasal resonance and voice, while only three adults were identified with multiple speech aberrations. The variability of speech dysfunction in TCS was exhibited by individual combinations of speech deviations in 13/19 participants. The speech composite scores correlated with TCS severity scores and NOT-S total scores. Speech composite scores higher than 4 were associated with cleft palate. The percent of intelligible words in connected speech was significantly lower in children and adolescents (median 77%, range 31–99) than in adults (98%, range 93–100). Intelligibility of speech among the children was markedly inconsistent and clearly affecting the understandability.ConclusionsMultiple speech deviations were identified in children, adolescents and a subgroup of adults with TCS. Only children displayed markedly reduced intelligibility. Speech was significantly correlated with phenotypic severity of TCS and orofacial dysfunction. Follow-up and treatment of speech should still be focused on young patients, but some adults with TCS seem to require continuing speech and language pathology services.

Client Safety and Telepractice in a Clinic or Home Setting

Telepractice is an exciting addition to the arsenal of speech-language pathologists for delivering services. Efficacy data continues to emerge proving the benefit of using available technology to provide assessment and treatment for persons with a variety of communication disorders, ages, and gender. In addition to providing assessment and treatment using telepractice technology, several professional issues have arisen which must be addressed before implementation of this service delivery system. Licensure and reimbursement have been at the forefront, as well they should. However, client safety is another issue that should also be addressed. Providing speech pathology services in a safe environment is a concept which may not have been considered before technological advances made it possible to provide services to someone while not being physically present.

Speech pathology services for people with aphasia: what is the current practice in Singapore?

Purpose: This study reports on current provision of aphasia services by speech pathologists in Singapore. Method: A 44-item web-based survey was conducted looking into areas of service delivery, assessment, cultural and linguistic adaptations, clinical approaches, education of clients, recovery, goal setting and discharge as well as scope and challenges to practice. Results: A total of 36 surveys were completed representing approximately 86% of the potential target population. The intensity of aphasia services provided was well below that recommended by the literature. Participants reported embracing approaches to aphasia rehabilitation that spanned across the ICF domains. Numerous challenges were reported in providing aphasia services. These included the lack of locally relevant resources for aphasia, lack of family support and patient motivation, manpower shortages as well as barriers such as transport and cost restricting access to services. Conclusions: This research reveals several findings with considerable implications for practice planning and future direction in aphasia rehabilitation. There is a need for the development of locally relevant aphasia resources to enable comprehensive provision of aphasia services. In addition, further investigation is required to tackle the resource challenges faced by the profession and improve community support for people with aphasia.Implications for RehabilitationSpeech pathology services for aphasia in SingaporeThis article has identified the challenges of providing aphasia services in the Singapore context.Further investigation is required to address the key issues to improve aphasia services in Singapore.This includes developing locally relevant resources, looking at means like telerehabilition to tackle resource challenges, and improving community support for people with aphasia.

Filipino version of the parent satisfaction scale to measure satisfaction with pediatric occupational therapy, physical therapy and speech pathology services: Preliminary validation

Filipino version of the parent satisfaction scale to measure satisfaction with pediatric occupational therapy, physical therapy and speech pathology services: Preliminary validation

A pilot trial of a speech pathology telehealth service for head and neck cancer patients

We explored the feasibility of providing access to specialist speech pathology services via telehealth for patients with head and neck cancer. A weekly telehealth clinic was conducted between the speech pathology departments of a tertiary hospital and a regional hospital in Queensland. Over a 5-month period, 50 telehealth sessions were conducted for 18 patients. There were 38 patient consultations, nine case discussions between clinicians and three clinical training sessions relating to the skills needed for specific client management (e.g. voice prosthesis selection). Eight sessions had multidisciplinary involvement. All cases were successfully managed via telehealth. All patients agreed that they were comfortable using telehealth and would be happy to use it again in future. Both clinicians agreed that they could competently assess patients using the telehealth system. There appeared to be financial benefits for the patient, because by receiving specialist intervention at a local facility their travel expenses were lower. There was also the opportunity for workforce training and development through online case discussion and clinical consultation.

Speech Pathology Services to Children With Cancer and Nonmalignant Hematological Disorders

Children with cancer and nonmalignant hematological disorders may require speech pathology (SP) support; however, limited evidence is available describing prevalence and severity of swallowing/feeding and communication impairments in this population. A retrospective chart review of 70 children referred to SP at the newly formed Queensland Children's Cancer Centre was conducted to describe the prevalence and severity of swallowing/feeding and communication dysfunction, and the association between impairment, oncology and hematology diagnosis, and service utilization (time and occasions of service). Swallowing/feeding disorders were the most commonly observed impairments at initial assessment (58.6%). Children with central nervous system tumors (P = .03) and nonmalignant hematological disorder (P = .03) had significantly higher rates of feeding impairment than other oncology and hematology diagnostic groups. Children with central nervous system tumors had the highest rates of oral phase (P = .01) and pharyngeal phase (P = .01) dysphagia (swallowing disorder). No significant difference was found between diagnostic groups for intensity of SP service delivery. Prospective research is required to examine prevalence and severity of disorders, and service utilization in a more established clinic, and to investigate interactions between cancer treatment and swallowing/feeding and communication dysfunction.

Incidence and Predictive Factors for Dysphagia After Thermal Burn Injury: A Prospective Cohort Study

The objective of this study is to determine dysphagia incidence for a consecutively admitted population of thermal burn injury patients and to determine admitting characteristics that can be used to reliably predict patients at risk of developing dysphagia after thermal burn. Four hundred thirty-eight patients with thermal burns, with or without inhalation injury, who were consecutively admitted to and received management at a state-wide burn center over a 2-year period (2007-2009) were included. All patients meeting the project's inclusion criteria underwent clinical swallowing assessment to determine the presence or absence of dysphagia. Dysphagia incidence was found to be 11.18% (n = 49) in the admitted population. Dysphagia severity at initial assessment was classified as severe for 40.82%, moderate for 30.61%, and mild for 28.57%. Statistical analysis revealed a core set of statistically significant parameters known within the first 24 hours postinjury that showed strong sensitivity and specificity for detection of dysphagia risk. These include, in isolation or in combination, with the consideration of increasing age, TBSA burnt ≥18%, head and neck burns, need for escharotomy, inhalation injury, need for intensive care admission, and need for mechanical ventilation. This is the first large, prospective cohort study to document dysphagia incidence within the thermal burn population and to validate key predictors for dysphagia risk in this population. These data will assist the allocation and planning of speech pathology services and provide an evidence-based pathway for ensuring early identification and management of patients at high risk of dysphagia after thermal burn injury.

Assessing Swallowing Disorders Online: A Pilot Telerehabilitation Study

Dysphagia (a swallowing disorder) is known to occur in numerous clinical populations, but unfortunately because of issues accessing speech pathology services, not all patients are able to receive dysphagia intervention and rehabilitation services in a timely manner. Existing research supports the use of telehealth technology for providing various aspects of speech pathology service; however, to date there is limited evidence to support the utilization of telerehabilitation in the assessment and management of dysphagia. The aim of this research was to provide pilot information on the basic feasibility and validity of conducting dysphagia assessments via telerehabilitation. Ten simulated patients, actors portraying patients with a range of swallowing difficulties, were used rather than actual patients to minimize any potential patient risk from unidentified aspiration. Dysphagia was assessed simultaneously by a face-to-face (FTF) and telerehabilitation speech pathologist (T-SP). Each simulated patient was assessed using a Clinical Swallowing Examination (CSE) protocol that was modified to suit a telerehabilitation environment. The CSE was administered with the support of an assistant via an Internet-based videoconferencing telerehabilitation system using a bandwidth of 128 kilobits per second. Results revealed high to excellent levels of agreement between the T-SP and the FTF-SP across all parameters of the CSE. Agreement for aspiration risk was excellent. The pilot data indicate that the current model of administering a CSE via telerehabilitation has potential to be a feasible and valid method for the remote assessment of swallowing disorders.

Supporting parents of children with autism spectrum disorders to become informed consumers of evidence on speech pathology practice

The aim of this pilot study was to evaluate the effectiveness of an intervention program designed to help parents of children with autism spectrum disorders (ASD) to become informed consumers of evidence for speech pathology services. The program comprised an interactive workshop and the provision of written materials aimed at increasing the participants’ knowledge of evidence-based practice (EBP) principles and confidence discussing EBP with their children's speech pathologists. Using a repeated measures within-group design (pre/post) and mixed methods of analysis, the results indicate that the participants’ knowledge and confidence increased following their participation in the program. Qualitative analysis revealed that parents differed with regard to which component (workshop or written information) was most helpful. The results provide preliminary evidence to support the further development and testing of intervention programs aimed at supporting parents of children with ASD to become informed consumers of evidence-based speech pathology services. Source of funding: No source of funding reported.

Productivity in Audiology and Speech-Language Pathology

Productivity in Audiology and Speech-Language Pathology

Treating disordered speech and voice in Parkinson's disease online: a randomized controlled non‐inferiority trial

Telerehabilitation may be a feasible solution to the current problems faced by people with Parkinson's disease in accessing speech pathology services. To investigate the validity and reliability of online delivery of the Lee Silverman Voice Treatment (LSVT®) for the speech and voice disorder associated with Parkinson's disease. Thirty-four participants with Parkinson's disease and mild-to-moderate hypokinetic dysarthria took part in the randomized controlled non-inferiority laboratory trial and received the LSVT® in either the online or the face-to-face environment. Online sessions were conducted via two personal computer-based videoconferencing systems with real-time and store-and-forward capabilities operating on a 128 kbit/s Internet connection. Participants were assessed pre- and post-treatment on acoustic measures of mean vocal sound pressure level, phonation time, maximum fundamental frequency range, and perceptual measures of voice, articulatory precision and speech intelligibility. Non-inferiority of the online LSVT® modality was confirmed for the primary outcome measure of mean change in sound pressure level on a monologue task. Additionally, non-significant main effects for the LSVT® environment, dysarthria severity, and interaction effects were obtained for all outcomes measures. Significant improvements following the LSVT® were also noted on the majority of measures. The LSVT® was successfully delivered online, although some networking difficulties were encountered on a few occasions. High participant satisfaction was reported overall. Online treatment for hypokinetic dysarthria associated with Parkinson's disease appears to be clinically valid and reliable. Suggestions for future research are outlined.

Assessing disordered speech and voice in Parkinson's disease: a telerehabilitation application

Patients with Parkinson's disease face numerous access barriers to speech pathology services for appropriate assessment and treatment. Telerehabilitation is a possible solution to this problem, whereby rehabilitation services may be delivered to the patient at a distance, via telecommunication and information technologies. A number of studies have demonstrated the capacity of telerehabilitation to provide reliable and valid assessments of speech, voice and language. However, no studies have specifically focused on assessing patients with Parkinson's disease. To investigate the validity and reliability of a telerehabilitation application for assessing the speech and voice disorder associated with Parkinson's disease. Sixty-one participants with Parkinson's disease and hypokinetic dysarthria were simultaneously assessed in an online and face-to-face environment by two speech-language pathologists. The assessment protocol included perceptual measures of voice and oromotor function, articulatory precision, speech intelligibility, and acoustic measures of vocal sound pressure level, phonation time and pitch range. Online assessments were conducted via a personal computer-based videoconferencing system with store-and-forward capabilities, operating on a 128 kbit/s Internet connection. The level of agreement between the online and face-to-face ratings was determined using several different analyses, depending on the parameter. These included per cent close agreement, quadratic weighted Kappa, and the Bland and Altman limits of agreement. Per cent close agreement between the two environments was within a predetermined clinical criterion of 80% agreement for all voice and oromotor parameters, articulatory precision and speech intelligibility in conversation. Levels of agreement between the environments, based on quadratic weighted Kappa, ranged from poor to good for vocal parameters and from fair to very good for oromotor parameters. Bland and Altman limits of agreement analyses revealed comparability between online and face-to-face environments for vocal sound pressure level, phonation time, pitch range, sentence intelligibility and communication efficiency in reading. Intra- and inter-rater reliability scores for all tasks were comparable between the online and face-to-face environments. For the majority of parameters, comparable levels of agreement were achieved between the two environments. Online assessment of disordered speech and voice in Parkinson's disease appears to be valid and reliable. The telerehabilitation application described in this study provides evidence for the delivery of online assessment for the dysarthric speech disorder associated with Parkinson's disease.

A Survey of Corporate Speech Pathologists' Demographic Characteristics, Professional Activities, and Career Satisfaction

Purpose: Survey methodology was used to examine a sample of corporate speech pathologists' demographic characteristics, professional activities, and career satisfaction. Method: Forty-one members of the Corporate Speech Pathology Network (CORSPAN) responded to an online survey. Participants described their corporate practices in terms of their professional training, experience, client characteristics, services provided, marketing practices, and job satisfaction. Descriptive statistics were calculated for individual survey items and correlations between pairs of items. Results: In general, respondents reported (a) spending approximately one third of their work-related time in direct client training; (b)employing a variety of marketing tools to promote their corporate speech pathology (CSP) services; and (c) being experienced with accent/dialect modification, articulation/pronunciation, and speech rate modification. Results of paired t tests revealed that par- ticipants were significantly more satisfied with their cur- rent corporate practice than with their prior work setting. Results provide preliminary quantitative data pertaining to the attributes and activities of the corporate speech pathologist.

Doing Therapy Out of My Purse

The practice of speech—language pathology in the home health care setting is challenging, requiring complex organization of information, deductive and diagnostic skill, and grasp of functional outcomes targeting the patient’s goals. Strong interpersonal communication ability is needed to communicate with the patient, family, and team members in the home care environment. This article discusses the need for on the spot training and adapting care to the home care setting. This author discusses how their orientation, education, and training formed the foundation for practice, but the reality provided the true experience for delivery of speech pathology services within the patient’s home.