[Study on brain mechanism of rehabilitation training of articulation disorder in cleft lip and palate patients based on functional magnetic resonance imaging].

The cleft lip and palate (CLP) is one of the most common craniofacial malformations in humans. We collected functional magnetic resonance data of 23 CLP patients before rehabilitation training (Bclp) and 23 CLP patients after rehabilitation training (Aclp), who were performing Chinese character pronunciation tasks, and performed brain activation analysis to explore the changes of brain mechanism in CLP patients after articulation disorder rehabilitation training. The study found that Aclp group had significant activation in the motor cortex, Broca area, Wernicke area and cerebellum. While the Bclp group had weak activation in the motor cortex with a small activation range. By comparing the differences and co-activated brain regions between the two groups, we found that rehabilitation training increased the activity level of negatively activated brain areas (cerebellum, left motor area, Wernicke area, etc.) to a positive level. At the same time, the activity level of weakly activated brain areas (right motor area, Broca area, etc.) was also increased. Rehabilitation training promoted the activity level of articulation-related brain regions. So that the activation intensity of articulation-related brain regions can be used as a quantifiable objective evaluation index to evaluate the effect of rehabilitation training, which is of great significance for the formulation of rehabilitation training programs.

Amplifying patient voices amid pandemic: Perspectives on tracheostomy care, communication, and connection.

OBJECTIVE: To investigate perspectives of patients, family members, caregivers (PFC), and healthcare professionals (HCP) on tracheostomy care during the COVID-19 pandemic. METHODS: The cross-sectional survey investigating barriers and facilitators to tracheostomy care was collaboratively developed by patients, family members, nurses, speech-language pathologists, respiratory care practitioners, physicians, and surgeons. The survey was distributed to the Global Tracheostomy Collaborative's learning community, and responses were analyzed. RESULTS: Survey respondents (n = 191) from 17 countries included individuals with a tracheostomy (85 [45 %]), families/caregivers (43 [22 %]), and diverse HCP (63 [33.0 %]). Overall, 94 % of respondents reported concern that patients with tracheostomy were at increased risk of critical illness from SARS-CoV-2 infection and COVID-19; 93 % reported fear or anxiety. With respect to prioritization of care, 38 % of PFC versus 16 % of HCP reported concern that patients with tracheostomies might not be valued or prioritized (p = 0.002). Respondents also differed in fear of contracting COVID-19 (69 % PFC vs. 49 % HCP group, p = 0.009); concern for hospitalization (55.5 % PFC vs. 27 % HCP, p < 0.001); access to medical personnel (34 % PFC vs. 14 % HCP, p = 0.005); and concern about canceled appointments (62 % PFC vs. 41 % HCP, p = 0.01). Respondents from both groups reported severe stress and fatigue, sleep deprivation, lack of breaks, and lack of support (70 % PFC vs. 65 % HCP, p = 0.54). Virtual telecare seldom met perceived needs. CONCLUSION: PFC with a tracheostomy perceived most risks more acutely than HCP in this global sample. Broad stakeholder engagement is necessary to achieve creative, patient-driven solutions to maintain connection, communication, and access for patients with a tracheostomy.

The Implementation of Telepractice in Speech Language Pathology in Hong Kong During the COVID-19 Pandemic.

Introduction: The aim of this study was to investigate the accelerated emergence of telepractice in speech language pathology during the coronavirus disease 2019 (COVID-19) pandemic in Hong Kong-a small city with limited accessibility concern that telepractice has not been widely implemented. Method: An online survey of speech therapists in Hong Kong was conducted between February and March in 2020. The survey comprised up to 15 questions to assess participants' demographics, existing service delivery in telepractice, perception, and their training and knowledge on telepractice. Results: One hundred thirty-five speech (n = 135) speech language pathologists responded to the survey. About one-third (34.8%; n = 47) of participants reported having provided services through telepractice, whereas 72.3% of them started in <3 months and half of them considered it was less effective than face-to-face service. Among the other participants (n = 88), 83% of them indicated that unsuitable patient type and age as the main reason for not providing telepractice. The majority of participants had no prior training for delivering telepractice, and focused on technology when asked about their desired training. Knowledge of participants on telepractice was found only to align fairly with international guidelines. Discussions: The survey findings suggested that telepractice provision in Hong Kong was different from that of other countries where telepractice has been well established, due to the accelerated emergence by the COVID-19 pandemic. Conclusions: The study showed how the development of telepractice would be like in a short time frame, and findings on perception and desired training could be a reference for a better establishment of this model of service.

Autistic adults' views of their communication skills and needs.

BACKGROUND: Autistic people require varying levels of support at different stages of their lives. Yet, the healthcare needs of autistic adults are largely unmet. Speech and language therapy (SLT) is one healthcare service that has an important role in supporting autistic people: both with initial diagnosis, and with the ongoing support needed to navigate different communicative challenges across the lifespan. Despite recommendations for such support, currently there is no clear SLT pathway for autistic adults, and a lack of established approaches to support autistic adults' speech, language and communication needs. AIMS: To seek autistic adults' views on (1) their communication skills and support needs; (2) the type of support SLT could offer; and (3) how such support could be provided. METHODS & PROCEDURES: A total of 18 autistic adults were interviewed in their preferred mode of communication (e.g., face to face, phone call, text messaging, e-mail), expressing their views on their communication skills and needs. Interview data were analysed using thematic analysis. OUTCOMES & RESULTS: Autistic adults presented complex views on communication, identifying the benefits of communication, while also emphasizing the significant negative impact that communication difficulties can have on their everyday lives. Identifying a range of internal (e.g., personal feelings) and external (e.g., the communication partner) factors, they highlighted the need for support at both individual levels (for specific life situations) and broader societal levels (to increase awareness and acceptance of communication difficulties). CONCLUSIONS & IMPLICATIONS: Considering the negative impact that communication difficulties can have for autistic adults, a need for support was emphasized. Despite recognition of this need within current legislation (in the UK) and positive steps toward providing support, more needs to be done. As experts in supporting individuals with communication difficulties, speech and language therapists could play a pivotal role in providing support at an individual level, as well as increasing awareness of communication differences more widely. What this paper adds What is already known on this subject There is a growing population of autistic adults with unmet support needs. A core characteristic of autism is difficulty with neurotypical social communication and interaction, which persists into adulthood and impacts across various life domains. What this paper adds to existing knowledge Autistic adults outlined the types of communication difficulties they experience, and how these can negatively impact on physical and mental health. Results highlight how these difficulties are not just rooted within the person themselves but can be influenced by external factors (e.g., the environment and the communication partner). What are the potential or actual clinical implications of this work? Some autistic adults may benefit from direct support from SLT services. However, increased awareness and respect for communication differences at a broader societal level is also needed. Speech and language therapists can play an important role in increasing this level of awareness, positively highlighting differences in communication and ways to support people with communication difficulties/differences.

Supporting language development in Lebanese preschools: SLT and pre-KT practice and perception of roles.

BACKGROUND: Speech and language therapists (SLTs) are increasingly engaging in school-based interventions targeting children with language difficulties. Collaborative work between teachers and SLTs has shown to be beneficial in fostering language development in all children. Both groups of professionals have different but complementary roles in offering language support, according to children's needs. Effective collaboration between SLTs and teachers requires both parties to understand their roles and practices in schools. However, little is known about language support practices in Lebanese preschools and the roles of SLTs in these contexts. AIMS: (1) To explore the perceptions and reported practices among preschool teachers (pre-KTs) to support language development; (2) to investigate the current practices of SLTs in preschools; and (3) to understand pre-KTs' and SLTs' perceptions of the SLTs' role in Lebanese preschools. METHOD & PROCEDURES: Using a quantitative method, the study reports the results of two questionnaires (one for pre-KTs and one for SLTs) that were developed based on a review of the academic literature and adapted to the contextual realities. Questionnaires were completed in hard or soft copy by pre-KTs and through an online survey by SLTs. OUTCOMES & RESULTS: The questionnaires were completed by 1259 out of 1442 pre-KTs from 175 Lebanese preschools, and by 200 out of 391 SLTs from across Lebanon. First, the findings show that both professional groups recognize they have a role in supporting language development. Second, differences in reported practices were identified regarding language strategies for children with communication needs. In particular, pre-KTs reported less use of specific language strategies targeting children with language difficulties, while SLTs reported that their practices in schools remain primarily focused on children with communication needs. Finally, the analysis of perceptions showed a lack of acknowledgement of the SLTs' role in the prevention of communication and language disorders among all children. CONCLUSIONS & IMPLICATIONS: This study provides an overview of the perceptions and reported practices of language development support in Lebanese preschools. The majority of SLTs and pre-KTs acknowledge their role in supporting language development. However, the slight differences in perceptions of SLT roles in prevention interventions highlight the necessity for SLTs to promote their active involvement in services targeting all children. Future research will investigate how SLTs are beginning to reconceptualize their role in intervention for preschool children. This will help to better define SLTs' roles and responsibilities in educational settings and foster effective professional collaboration. What this paper adds What is already known on the subject Collaboration between teachers and SLTs has been shown to be beneficial in supporting language among all children. The way SLTs and pre-KTs view each other's roles could result in more effective professional collaboration. The SLT profession in Lebanon emerged about 20 years ago, yet SLTs are still struggling to define a framework for the scope of their practice in Lebanese preschools and to increase awareness of the relevance of their intervention in language. What this paper adds to existing knowledge The results revealed that there are major agreements between pre-KTs and SLTs concerning the support of language development in preschools. However, the findings highlight slight differences in the perception of the SLTs' role in the prevention of communication, language and literacy disorders in educational settings. It seems that their role is more commonly acknowledged for children with identified language and communication needs. Moreover, despite the strong agreement between both professionals on the role of the SLT to target all children, SLTs' practices in preschools are still mostly limited to meeting only referred and diagnosed needs in children. What are the potential or actual clinical implications of this work? This study's findings contribute to a better understanding of the perceptions regarding the roles and practices of both groups of professionals in language development. The differences in how the SLTs' roles are perceived could lead to a more difficult implementation of collaborative language practices in preschools. It is therefore necessary to ensure a better understanding of the roles played by professionals, who could receive the relevant training in undergraduate education programmes. There is also a pressing need to provide a clearer definition of SLTs' roles in educational settings by reconceptualizing them into a preventive approach in collaboration with teachers.

Dysphagia and mealtime difficulties in dementia: Speech and language therapists' practices and perspectives.

BACKGROUND: There is increasing recognition of the impact that dementia has upon swallowing and at mealtimes, and the significant effect this can have on people with dementia's health and well-being. However, there remains a paucity of evidence for assessment and intervention practices for dysphagia and mealtime difficulties. Furthermore, there is a limited understanding of how speech and language therapists (SLTs) support people with these dementia-related issues and what are the barriers and facilitators to practice. Further research is therefore needed to guide policy as well as service guideline and delivery development. AIMS: To establish the current practices of SLTs managing dementia-related dysphagia and mealtime difficulties in the UK and Republic of Ireland (ROI), and to establish their opinions and experiences of what challenges or supports to practice they have encountered. METHODS & PROCEDURES: An anonymous, cross-sectional web-based survey was developed and distributed to SLTs working in the UK and ROI. Respondents completed a questionnaire that consisted of open and closed questions across nine topic areas. Closed responses were evaluated using descriptive statistics; open-ended questions were analysed using conventional content analysis. OUTCOMES & RESULTS: A total of 310 people accessed the survey, and 125 respondents completed it fully. While respondents agreed on their role in dysphagia management, they varied in their views on the extent of their role in managing mealtime difficulties. Additionally, their self-rated knowledge of mealtime difficulties in dementia was lower than their dysphagia knowledge. The respondents predominantly based their management decisions on their clinical experience of working with people with dementia. They primarily used compensatory strategies and frequently cited the need for family and care staff training. Respondents also highlighted barriers to effective management and training provision such as inefficient referral systems, a lack of carer knowledge and lack of SLT resources. CONCLUSIONS & IMPLICATIONS: The results provide valuable insight into the issues facing SLTs practising in this area. The SLTs surveyed considered dysphagia a core part of their role when supporting people with dementia; however, respondents' views on mealtime difficulties varied. This highlights the need to establish consensus guidelines on the SLT's role in order to avoid variations in service delivery that could negatively impact the health and well-being of people with dementia. Moreover, further research to develop efficient and effective training for care staff supporting mealtime difficulties and dysphagia is essential. What this paper adds What is already known on the subject Research indicates that people with dementia develop dysphagia and mealtime difficulties as dementia progresses. SLTs often manage these, but there is no research on the effective assessment and management procedures, or guidance on best practice. What this paper adds to existing knowledge This paper provides an understanding of the variation in practice across the UK and ROI. Respondents described barriers to delivering an effective service and frequently linked these to the SLTs' resources as well as service constraints. What are the potential or actual clinical implications of this work? These findings support the need for future research to develop guidelines for SLT practice in this area. They also support the need to examine resource allocation and workforce management to enable SLTs to manage dementia-related dysphagia and mealtime difficulties effectively.

Factors contributing to clinician training and development in the clinical area of laryngectomy and tracheoesophageal voice.

BACKGROUND: It has long been recognized that tracheoesophageal speech (TES) rehabilitation after laryngectomy is a specialized area of practice for speech and language therapist (SLTs) due to the complex nature of patient presentation and the invasive components of the SLT's role in this area. Therefore, postgraduate experience and training is required to work competently and safely in this clinical area. However, it is generally acknowledged that the steps and processes followed by individual clinicians to achieve this training and clinical skill development are inconsistent and vary widely across services. There is a need to identify critical elements deemed most beneficial to clinical skill development in order to inform future training models. AIMS: To explore clinicians' perceptions of factors that contribute to training and clinical skills development in the area of TES rehabilitation post-laryngectomy. METHODS & PROCEDURES: All participants were SLTs working in an Australian clinical service, with a current or recent clinical caseload that included patients using TES. A total of 36 SLTs were recruited and then grouped by level of experience (novice n = 15, intermediate n = 7, experienced n = 14). Each participant took part in one small focus group with other participants of similar experience level. Ten focus groups were conducted, each of approximately 60 min in duration. A semi-structured interview guide was used to facilitate the discussion of issues relating to training in this area. Thematic analysis was used to analyse transcripts and identify themes. OUTCOMES & RESULTS: Interviews identified six key themes, including: Learning with and from others; Formal programmes; Hands-on learning; Processes that influence training; and Individual influences. SLTs reported both positive issues and elements that were challenging across all five themes. The final (sixth) theme was identified regarding clinician perceptions of how this area differed to specialized training in other areas of the profession. The majority of themes were discussed equally by clinicians across all three experience levels. CONCLUSIONS & IMPLICATIONS: Participants across all experience levels identified that multiple factors contributed to clinicians successfully gaining skills, understanding and competency when working in TES rehabilitation post-laryngectomy. These factors, when fully considered and incorporated into future SLTs training pathways and opportunities, have the potential to optimize competency, skill acquisition and maintenance in this area. What this paper adds What is already known on this subject While studies have considered the training, preparation and knowledge base of SLTs working in the clinical area of TES, the focus has predominantly been at the immediate postgraduate level or assessment of university course work. No studies have used a qualitative methodology to consider the reflections and perceptions of clinicians' training pathways and training needs across all levels of experience for this clinical area. What this paper adds to existing knowledge The results of this study build upon the existing body of literature regarding education and training in this area, determining factors SLTs feel are required to successfully gain skills, understanding and competency when working in TES rehabilitation. The findings highlight that training pathways and methods in this clinical area are an ongoing consideration for SLTs regardless of experience level and have the ability to impact on future competency programmes, training opportunities and delivery methods in this area. What are the potential or actual clinical implications of this work? Effective and ongoing postgraduate training programmes and professional development opportunities have the potential to positively impact on professional competence and confidence, patient safety and overall service delivery. Hence, the themes generated from this research highlight essential factors to include within training and professional development programmes for SLTs in TES rehabilitation. This information can be used to help optimize current training pathways for all experience levels.

A survey of cognitive-communication difficulties following TBI: are families receiving the training and support they need?

BACKGROUND: Whilst research into the wide-ranging needs of family members following traumatic brain injury (TBI) is well established, investigation into the specific needs of families in relation to supporting cognitive-communication difficulties, relationships and social participation is limited. AIMS: To identify the family needs for cognitive-communication difficulties following TBI and to explore whether current services are meeting these needs. METHODS & PROCEDURES: Following a successful pilot, family members from the UK and Australia were invited via posters, social media and e-mail to take part in an anonymous, communication needs survey. Data arising from the thirty two closed questions (six eligibility, nine demographic and seventeen needs questions) were analysed using SPSS descriptive statistics. Data arising from one open question were analysed using qualitative content analysis. OUTCOMES & RESULTS: A total of 102 family members from the UK (n = 89, 87%) and Australia (n = 13, 13%) completed the survey. The majority of respondents were female (n = 76; 75%), between the ages of 30 and 69 (n = 88; 87%), and either a parent or a partner of the person following TBI (n = 78;76%). Respondents rated information about expected recovery from cognitive-communication difficulties and training in helpful strategies as their most important needs. The majority of respondents (more than 60%) were not satisfied that any of their cognitive-communication needs had been fully met and high levels of unmet need remained evident at three years or more post-injury. Written information, communication partner training and counselling were identified as key supports. CONCLUSIONS & IMPLICATIONS: Families report high levels of unmet need for managing cognitive-communication difficulties following TBI. Access to written information and communication partner training should be available to families at various time points following TBI and not just in the early stages. What this paper adds What is already known on this subject Attempting to support a person who has cognitive-communication difficulties following TBI has been found to be highly burdensome for family members. However, few studies have asked how families perceive their needs in relation to cognitive-communication difficulties or measured how well current services are meeting their needs. What this paper adds to existing knowledge This study demonstrates that current speech and language therapy services are not yet meeting the needs of the relatives of individuals with cognitive-communication difficulties following TBI. Important insights into the information, training and support families' rate as important are identified in addition to how these needs develop over time. What are the potential or actual clinical implications of this work? Speech and language therapy service design requires to reflect the ongoing nature of familial needs for cognitive-communication difficulties following TBI. Families require access to appropriate literature, speech and language therapy support, and communication partner training in the longer term, not just in the acute phase.

Do caregivers' personality and emotional intelligence modify their perception of relationship and communication with people with aphasia?

BACKGROUND: There is a wide agreement that family and friends of people with aphasia (PWA) can play a crucial role in the rehabilitation of interpersonal communication. Therefore, speech and language therapists (SLTs) should include family and friends in the process of therapy. However, little has been said about the role of caregivers of severely disabled PWA in the rehabilitation of communication functions. AIMS: To examine how caregivers of severely disabled PWA perceive their relationship and communication with PWA, how they facilitate communication with PWA, and whether the caregiver's personality and emotional intelligence modify the abovementioned processes. METHODS & PROCEDURES: The study involved 123 caregivers of severely disabled stroke survivors with aphasia. Participants took part in a structured interview based on a structured interview guide created for the purpose of this study. The standardized psychological questionnaires NEO Five-Factor Inventory (NEO-FFI) and Schutte Emotional Intelligence Scale (SEIS) were used. OUTCOMES & RESULTS: The caregiver's positive attitude towards the PWA correlated with the active facilitation of communication. The personality traits of caregivers and their level of emotional intelligence were associated with the tendency to use certain techniques to facilitate communication with PWA. CONCLUSIONS & IMPLICATIONS: Caregivers' positive attitude towards PWA is beneficial for the rehabilitation of communicative functions. Personality traits and emotional intelligence could modify the caregiver's strategy of coping with aphasia-related challenges and should be taken into consideration when providing support. What this paper adds What is already known on the subject Interpersonal communication must by definition involve at least two people. Therefore, there are a lot of approaches in SLT where support is given not only to the PWA but also to the communication partners. The most important group is significant others, which is usually understood as family members and friends. There is an increasing recognition that SLTs should include them in therapy. What this paper adds to existing knowledge For those PWA who need constant care, caregivers may have a significant influence on the quality of communication. Their positive attitude towards PWA corresponds with more active facilitation of communication and can make rehabilitation more efficacious. Caregivers should be educated on the cognitive and behavioural aspects of aphasia and encouraged to look actively for a PWA's positive characteristics. Caregivers' personality traits play a role in facilitating communication. For example, caregivers with high agreeableness are more likely to enjoy providing care, while those with higher conscientiousness declare using more techniques to facilitate communication with the PWA. What are the potential or actual clinical implications of this work? Caregivers' personality traits play a role in caring. Their positive attitude towards PWA corresponds to more active facilitation of communication, which can lead to more effective rehabilitation. This should be taken into account when training caregivers. Training programmes should include cognitive and behavioural aspects of aphasia as well as emphasize the need to maximize the PWA's abilities.

What really matters to people with aphasia when it comes to group work? A qualitative investigation of factors impacting participation and integration.

BACKGROUND: Participation in a group environment is an inherently complex undertaking for people with aphasia. It involves engaging in multi-person interactions with other people who may have a range of communication strengths and strategies at their disposal. The potential challenges of community aphasia-group participation and practice has had limited attention in the research literature. Evidence from group users have primarily been drawn from the perspective of long-term members or those participating in highly specific and time-bound groups. There is a need to explore the experiences of a broader sample, including people who have left groups, to improve our understanding of structures, processes as well as leadership behaviours that may facilitate positive group participation experiences. AIM: To examine the potential factors operating within the group environment that contribute to positive and negative participation experiences. METHODS & PROCEDURES: Twenty-two people with aphasia participated in semi-structured interviews about their experiences of community aphasia groups. People who maintained long-term membership as well as those who had left groups were sampled. An interpretative phenomenological framework was employed to examine the data collected. OUTCOMES & RESULTS: Seven factors emerged as central to participation experiences and contributed to the ability of people with aphasia to integrate and engage in the group space. These factors included: (1) balanced interactional patterns; (2) an open and non-hierarchical group environment; (3) communication awareness and education amongst members; (4) meaningful activity; (5) ritual and structure; (6) composition and group size; and (7) group leadership. CONCLUSIONS & IMPLICATIONS: People with aphasia perceive community aphasia-group participation to be beneficial to their ability to live well with aphasia. However, a range of challenges to successful participation are also evident. Inputs such as peer-to-peer communication strategies, shared roles and responsibilities, and consultation with regard to group objectives and processes provide group members with the opportunity to become active contributors, demonstrate competence and have influence over the group. When inputs are poorly implemented or absent, people with aphasia are at risk of feeling disabled and marginalized by the group experience.

Clinicians' views of the training, use and maintenance of phonetic transcription in speech and language therapy.

BACKGROUND: The critical role of phonetic transcription in the assessment, diagnosis and management of speech disorders is well established and thus pre-registration degrees dedicate numerous hours to phonetic training. However, this training is not always fully used in clinical work and clinicians may find it difficult to maintain their skills, suggesting a 'theory/practice gap'. AIMS: This paper surveys speech and language therapists' (SLTs) views of their training, practice and maintenance of transcription in order to investigate the posited theory/practice gap and to explore how education in phonetics is translated into practice. METHODS & PROCEDURES: A total of 759 SLTs from the UK were surveyed via an online questionnaire. Multiple-choice questions were analysed using descriptive statistics, and free-text comments were analysed thematically. OUTCOMES & RESULTS: Thirty-five per cent of SLTs found learning phonetics quite easy, and 30% quite difficult. Respondents suggested that more time was needed to practise transcription in and out of the classroom; nevertheless, the majority felt at least equipped to undertake transcription after their training. A total of 75% of SLTs require transcription for their role, with 61% using it often or all the time. Some 45% use a mix of broad and narrow transcription, with 41% using only broad transcription. Those not using narrow transcription attributed this to lack of confidence. A total of 57% of SLTs did not feel supported to maintain transcription skills in the workplace, and 80% had never attended a refresher course in transcription, with 75% wishing to do so. CONCLUSIONS & IMPLICATIONS: As many clinicians found it difficult to learn transcription, there is an opportunity to provide more transcription practice both in and beyond the classroom. Despite most clinicians feeling equipped to undertake transcription upon completion of their training, and a large majority requiring transcription for their role, a theory/practice gap is apparent in the relatively small number of clinicians using narrow transcription exclusively, and those not using it expressing lack of confidence in their skills. Additionally, as many clinicians have never attended refresher training in transcription, and rely on their course notes to maintain their skills, more provision of opportunities for revision should be made available. With clinicians remembering a need for more practice during their training, and expressing a desire for more training opportunities in practice, there is an opportunity for clinicians, educators and regulatory bodies to work together to provide packages of transcription training material that can be used by students and practitioners to maintain and extend their skills.

Exploring accounts of collaborative working between speech and language therapists and stroke association communication support coordinators following stroke.

In the United Kingdom, speech and language therapists (SLTs) and Stroke Association communication support coordinators (CSCs) are both employed to provide services for people with communication difficulties following stroke. There is very little literature of this type of collaborative working. This research is unique because it explores collaborative working between SLTs who are employed by the National Health Service and CSCs who are employed by the Stroke Association. Five CSCs and seven SLTs from the East of England participated in a series of in-depth interviews. Data were analysed using thematic analysis informed by an interpretative phenomenological approach. The analysis suggested complex negotiation processes occur at a number of different levels. These levels include negotiation of individual relationships between SLTs and CSCs, negotiating the particular challenges involved in working across organisations and professions, and the need for both roles to negotiate and promote the value of their services at a societal level. The findings of this research are discussed in relation to existing theories and research within the field of collaborative working. Clinical applications are suggested for collaborative working within communication services. We propose that our findings may have relevance to other individuals and organisations delivering services collaboratively.

[IMPACT OF URANOSTAPHILOPLASTY ON QUALITY OF LIFE OF THE PATIENTS].

Abstract Retrospective analysis was conducted in 78 patients of various age, who suffered the inborn lip and palate fissura, for estimation of the patients quality of life after uranostaphiloplasty. The operations were performed on clinical base of The Oral Cavity Surgery and The Jaw-Facial Surgery Cathedra in Department of The Jaw-Facial Surgery of Clinical Medical Center (Baku). There was established, that application of uranostaphiloplasty procedure, as well as timely initiated rehabilitation, influences a further establishment of the patient personality. A timely refer to a speech therapeutist and the treatment began also have great significance for further establishment of the patient personality. Disorders of speech, incorrect bite hampers obtaining of education, working, interferes with a family creation, hampers the employment and worsens a quality of life.

Speech-related fatigue and fatigability in Parkinson's disease.

This study tested the assumption that speech is more susceptible to fatigue than normal in persons with dysarthria. After 1 h of speech-like exercises, participants with Parkinson's disease (PD) were expected to report increased perceptions of fatigue and demonstrate fatigability by producing less precise speech with corresponding acoustic changes compared to neurologically normal participants. Twelve adults with idiopathic PD and 13 neurologically normal adults produced sentences with multiple lingual targets before and after six 10-min blocks of fast syllable or word productions. Both groups reported increasing self-perceived fatigue over time, but trained listeners failed to detect systematic differences in articulatory precision or speech naturalness between sentences produced before and after speech-related exercises. Similarly, few systematic acoustic differences occurred. These findings do not support the hypothesis that dysarthric speakers are particularly susceptible to speech-related fatigue; instead, speech articulation generally appears to be resistant to fatigue induced by an hour of moderate functional exercises.

Speech-language therapists' process of including significant others in aphasia rehabilitation.

BACKGROUND: Although aphasia rehabilitation should include significant others, it is currently unknown how this recommendation is adopted in speech-language therapy practice. Speech-language therapists' (SLTs) experience of including significant others in aphasia rehabilitation is also understudied, yet a better understanding of clinical reality would be necessary to facilitate implementation of best evidence pertaining to family interventions. AIMS: To explore the process through which SLTs work with significant others of people with aphasia in rehabilitation settings. METHODS & PROCEDURES: Individual semi-structured interviews were conducted with eight SLTs who had been working with persons with aphasia in rehabilitation centres for at least 1 year. Grounded theory principles were applied in analysing interview transcripts. OUTCOMES & RESULTS: A theoretical model was developed representing SLTs' process of working with significant others of persons with aphasia in rehabilitation. Including significant others was perceived as challenging, yet a bonus to their fundamental patient-centred approach. Basic interventions with significant others when they were available included information sharing. If necessary, significant others were referred to social workers or psychologists or the participants collaborated with those professionals. Participants rarely and only under specific conditions provided significant others with language exercises or trained them to communicate better with the aphasic person. As a result, even if participants felt satisfied with their efforts to offer family and friends interventions, they also had unachieved ideals, such as having more frequent contacts with significant others. CONCLUSIONS & IMPLICATIONS: If SLTs perceived work with significant others as a feasible necessity, rather than as a challenging bonus, they could be more inclined to include family and friends within therapy with the aim to improve their communication with the person with aphasia. SLTs could also be more satisfied with their practice. In order to operate these changes in perceptions, we suggest that SLT curriculums include in-depth training about family intervention, a redefinition of the concept of patient, and exploration of SLTs' beliefs and emotions related to significant others.

Dysphagia therapy in stroke: a survey of speech and language therapists.

BACKGROUND: Dysphagia is common after stroke, leading to adverse outcome. There is a paucity of high-quality evidence for dysphagia therapy, thus making it difficult to determine the best approaches to treatment. Clinical decisions are often based on usual practice, however no formal method of monitoring practice patterns exists. AIMS: To determine speech and language therapists' (SLTs) approaches to direct dysphagia therapy with stroke patients in the UK and Ireland. METHODS & PROCEDURES: A 24-item questionnaire was developed, piloted and delivered in a web-based cross-sectional survey targeting all SLTs working with stroke patients in the UK and Ireland. OUTCOMES & RESULTS: A total of 138 SLTs responded from a range of clinical settings and levels of experience. There was variation in the responses to all questions. Respondents reported treating patients a median of once a day, 3 days a week for 15 min. The most commonly recommended direct exercises were supervised swallow trials (recommended 'frequently or always' by 73%). Despite most respondents having access to an instrumental swallowing assessment, over half reported rarely or never conducting one before recommending exercises. Most (93%) did not use a protocol for systematically progressing patients' exercises and only 37% reported using standardized outcome measures. CONCLUSIONS & IMPLICATIONS: This survey gives valuable insight into the direct dysphagia therapy practices of SLTs based in the UK and Ireland working in stroke. It highlights discrepancies between reported approaches and recommendations from existing evidence and clinical guidelines. The variation in responses indicates a need to develop a consensus statement and further research to guide practice.

Clinician perspectives of an intensive comprehensive aphasia program.

BACKGROUND: Intensive comprehensive aphasia programs (ICAPs) have increased in number in recent years in the United States and abroad. OBJECTIVE: To describe the experiences of clinicians working in an ICAP. METHODS: A phenomenological approach was taken. Seven clinicians from 3 ICAPs were interviewed in person or on the phone. Their interviews were transcribed and coded for themes relating to their experiences. RESULTS: Clinicians described 3 major themes. The first theme related to the intensity component of the ICAP that allowed clinicians to provide in-depth treatment and gave them a different perspective with regard to providing treatment and the potential impact on the person with aphasia. The second theme of rewards for the clinicians included learning and support, seeing progress, and developing relationships with their clients and family members. Third, challenges were noted, including the time involved in learning new therapy techniques, patient characteristics such as chronicity of the aphasia, and the difficulty of returning to work in typical clinical settings after having experienced an ICAP. CONCLUSIONS: Although there is a potential for bias with the small sample size, this pilot study gives insight into the clinician perspective of what makes working in an ICAP both worthwhile and challenging.

The therapeutic link in the speech therapy clinic: a necessary reflection. / O vínculo terapêutico na clínica fonoaudiológica: uma reflexão necessária.

PURPOSE: To understand the meanings that the therapeutic bond assumes for clinical speech therapists. METHODS: The research was approved by the Ethics Committee, being of a transversal character, with a quantitative-qualitative approach in the Content Analysis. The research with the participation of 96 clinical speech therapists, registered in the Speech Therapy Council of the 3rd region (CRFa 3), which covers the States of Paraná and Santa Catarina. RESULTS: Of the 96 speech therapists included, a significant part of the participants defined the therapeutic bond as a relationship/interaction. Regarding the role of the bond for the speech therapy clinical work, most professionals declared theirs as a fundamental basis and another part of the bond is necessary for the evolution/development of the patient. CONCLUSION: It is possible to understand that, according to the therapeutic patients, it is essential to sustain, maintain the clinical work for users, impacting the resignification of the complaint and the minimization of the users' suffering.

OBJETIVO: Compreender os sentidos que o vínculo terapêutico assume para fonoaudiólogos clínicos. MÉTODO: A pesquisa foi aprovada por Comitê de ética, sendo de caráter transversal, de abordagem quanti-qualitativa, pautada na Análise do Conteúdo. A pesquisa contou com a participação de 96 profissionais fonoaudiólogos clínicos, inscritos no Conselho de Fonoaudiologia da 3ª região (CRFa 3), o qual abrange os Estados do Paraná e de Santa Catarina. RESULTADOS: Dos 96 fonoaudiólogos incluídos, parte significativa dos participantes definiram o vínculo terapêutico como sendo relação/interação. Referente ao papel do vínculo para o trabalho clínico fonoaudiológico, a maioria dos profissionais o descreveu como base fundamental e outra parte deles afirmou que tal vínculo é necessário para a evolução/desenvolvimento do paciente. CONCLUSÃO: É possível compreender que, de acordo com os participantes, a relação terapêutica é essencial para a sustentação e manutenção do trabalho clínico fonoaudiológico, impactando na ressignificação da queixa e na minimização do sofrimento dos usuários.

"Language construction in an autistic child: thoughts regarding language acquisition and language therapy": translation, update, and commentary on a 1977 case report.

A 1977 Swiss case study is presented in English translation: a mute child with infantile autism is taught to speak starting at the relatively late age of 6. The author, who is the primary therapist and the child's father, details the conditioning procedure, discusses theoretical considerations in speech acquisition, and outlines the limits of the training. The author and translator update the child's status and add commentary.

Importance of correct therapeutic procedure selection in voice recovery.

Psychological and physical patient state as well as the influence of other social factor is of great influence voice rehabilitation. A team of experts in the field of voice and its function are involved in voice therapy. Our research was focused on the successfulness of voice recovery depending on the patient vocal disorder approach. We made a comparison of two methods: RVT and Accent method. We attempted to evaluate clinically relevant voice disorders in relation to certain vocal methods, we propose that a lot can be learned about voice trough therapeutic procedures, which can also be used to enhance the practical application of vocal methods and raise the level of success in dealing with people that suffer from voice pathology.