Speech-language pathologists' perspectives of interprofessional collaboration.

This study aims to provide insight into speech-language pathologists' experiences of and preparation for interprofessional collaborative practice across various settings and geographical locations in the United States. We disseminated an online survey via Qualtrics© to reach a representative sample of speech-language pathologists. We questioned respondents about the extend to which they engage in interprofessional collaborative practice, professionals with whom they engage in interprofessional collaborative practice, preparation for interprofessional collaborative practice, and barriers to engaging in interprofessional collaborative practice. Responses from 296 participants were analyzed to describe details regarding speech-language pathologists' experiences in interprofessional collaboration. Quantitative data included means, ranges, standard deviations, and frequency counts. Open-ended responses underwent analysis through a consensual qualitative approach. Most speech-language pathologists in this study (59%) reported feeling prepared for interprofessional collaboration. Participants reported that they engage in interprofessional collaborative practice with other professionals from disciplines such as nursing, occupational therapy, teaching, physical therapy, and school psychology. To best prepare students for future speech-language pathology practice, participants recommended that students engage in interprofessional education to learn about collaborating with these disciplines. These results could have implications for future design and implementation of interprofessional education activities for students and practicing clinicians.

A Comparison of Electronic and Paper Versions of the Montreal Cognitive Assessment.

OBJECTIVE: The objective of this study was to investigate older adults' performance on the paper and electronic Montreal Cognitive Assessment (eMoCA). DESIGN: Repeated measures and correlational design. PARTICIPANTS: A convenience sample of 40 adults over 65 years of age living in the community. INTERVENTIONS: Participants completed the eMoCA and paper Montreal Cognitive Assessment (MoCA) in a randomized order during 1 session. Participants reported their touchscreen experience and comfort and indicated their modality preferences. MAIN OUTCOME MEASURES: The primary outcome measures were paper MoCA and eMoCA total and subscale scores. Secondary outcome measures included participants' reported touchscreen experience and comfort, as well as post-administration preferences. RESULTS: A moderate statistically significant correlation was found between eMoCA and paper MoCA performance across all participants. Analysis comparing first administration modality only (eMoCA vs. paper MoCA) found no statistically significant difference in total scores; however, there was a statistically significant difference for the visuospatial/executive subscale, which required physical interaction with paper or the tablet. For this subscale, participants scored lower on the eMoCA versus paper MoCA. There was a statistically significant correlation between experience with touchscreen devices and performance on the eMoCA, but not between modality preference and performance. CONCLUSION: Modality of administration can affect performance on cognitive assessments. Clinicians should consider individuals' level of touchscreen experience before selecting administration modality.

Fostering interprofessional teamwork through an immersive study abroad experience.

In 2017, American university students representing seven healthcare professions traveled to Australia (AU) for a 17-day study abroad course focused on expanding students' knowledge of interprofessional education (IPE) and global communities. This innovative course allowed for an immersive IPE learning experience through an examination of healthcare and culture. Based upon pilot study survey data from the 12 participating students (i.e., students from athletic training, nursing, occupational therapy, physical therapy, physician assistant studies, pre-medical, and speech-language pathology), positive perceptions of the experience related to teamwork, learning, and healthcare differences were achieved. However, survey data from the Readiness for Interprofessional Learning Scale (RIPLS) showed no significant change in attitudes or perceptions of collaboration, professional identity, or roles and responsibilities. These results suggest the potential that students who elect to participate in optional IPE study abroad programs already have positive attitudes toward IPE. Study abroad may be an appropriate setting to expand healthcare students' appreciation of IPE, teamwork, and global awareness. The results of this study may assist other professionals in developing future IPE activities in the international setting.

The effect of augmented input on the auditory comprehension of narratives for people with aphasia: a pilot investigation.

Augmented input is the strategy of supplementing expressive language with visuographic images, print, gestures, or objects in the environment. The goal of augmented input is to facilitate comprehension of spoken language. The purpose of this study was to evaluate the relative effectiveness of two different augmented input conditions in facilitating auditory comprehension of narrative passages in adults with aphasia. One condition involved the communication partner (clinician) of the adult with aphasia actively pointing (AI-PP) out key content words using visuographic supports. The second condition involved no active pointing (AI-NPP) by the communication partner (i.e., attention was not drawn to the visuographic supports). All 12 participants with aphasia listened to two narratives; one in each condition. Auditory comprehension was measured by assessing participants' accuracy in responding to 15 multiple-choice cloze-type statements related to the narratives. Of the 12 participants, seven gave more accurate responses to comprehension items in the AI-PP condition, four gave more accurate responses in the AI-NPP condition, and one scored the same in both conditions. These differences were not statistically significant (p > 0.05). Communication-partner-referenced augmented input using combined high-context and PCS symbol visuographic supports improved response accuracy for some participants. Continued research is necessary to determine partner involvement with and frequency of augmented input that improve auditory comprehension.

External Memory Aid Preferences of Individuals with Mild Memory Impairments.

Individuals with mild memory impairments often rely on external memory aids (EMAs) to compensate for impaired cognitive abilities and to support independent completion of activities of daily living. These strategies are evidence based; however, professionals have limited knowledge regarding individual preferences and guidance on how to incorporate a person-centered approach into the EMA development phase. The purpose of the current study was to qualitatively investigate individuals' preferences and experiences as they relate to EMAs. Data analysis included (1) evaluation of a posttreatment questionnaire to explore individual strategy preferences following intervention and (2) evaluation of group intervention videos using thematic coding to investigate individuals' experiences with strategies during intervention. Results suggest that older adults with mild memory impairments have unique preferences and experiences, despite limited variability in demographic characteristics. Some themes that emerged included memory ability awareness and attitudes toward technology. Within a person-centered approach, skilled professionals must consider individuals' unique needs, preferences, and experiences when developing strategies throughout the continuum of care to promote sustained EMA use within everyday settings.

A modified multimodal communication treatment for individuals with traumatic brain injury.

People living with the effects of traumatic brain injury (TBI) might use augmentative and alternative communication (AAC) due to cognitive-communication disabilities and/or co-occurring motor speech disorders. However, the most effective method for teaching people with TBI to use AAC strategies and resolve communication breakdowns is unknown. Prior research conducted with people with aphasia suggests an integrated multimodal treatment improved the use of AAC to resolve communication breakdowns. In this study, the researchers measured the effectiveness of a modified Multimodal Communication Treatment designed to increase communication breakdown resolution and use of AAC strategies by two individuals with TBI. A multiple baseline, single-case design was used to measure outcomes for the two participants who had motor speech disorders and cognitive-communication impairments. They completed four pre-treatment sessions, 20 treatment sessions, and three post-treatment sessions. Dependent variables included the number of AAC strategies produced during a modality probe task and two measures of communication breakdown resolution during a structured, functional task. Both participants increased use of AAC strategies during modality probes, but demonstrated minimal changes in communication breakdown resolution variables, potentially due to their impairments in executive function and memory. Results indicate that modifications to MCT may improve the use of AAC strategies for communication breakdown resolution for some people with TBI.

Bringing Interprofessional Case-Based Learning into the Classroom for Occupational Therapy and Speech-Language Pathology Students.

Instructors are increasingly integrating interprofessional education (IPE) activities into academic programs to address curricular demands. IPE aims to increase the quality of collaborative services provided to patients. This article describes a case-based IPE activity designed for occupational therapy and speech-language pathology graduate students. This activity was designed as a small-scale integration of IPE to compliment large scale, multi-discipline learning activities. Students from two courses participated in an IPE activity that included one online and one in-class activity. The purpose of the activity was for students to gain knowledge of their respective roles in augmentative and alternative communication services. Students perceived increased knowledge and skills following this activity. Despite the somewhat small scale of this educational intervention, the instructors viewed the activity a valuable addition to their courses.

Examining the perceived impact of an ethics workshop on interprofessional values and teamwork.

Interprofessional education (IPE) is a vital component of healthcare education yet challenges to implementation persist. This study aimed to evaluate the perceived impact of an ethics-based IPE workshop designed for professional phase healthcare students enrolled in athletic training, health management systems, occupational therapy, physical therapy, physician assistant studies, and speech-language pathology programmes at one university. A pre/post-test cohort study was conducted to evaluate the impact of the workshop on interprofessional values and teamwork. Findings from the 61 students who completed both pre- and post-programme evaluation surveys suggest that the ethics-based workshop was successful in improving perceived confidence as related to the workshop objectives and strengthened positive perceptions of IPE as evaluated by the Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R). Analysis of responses to open-ended reflection questions after the workshop suggest that student participants perceived changes in understanding related to multiple areas of IPE. These results suggest that an ethics-based workshop using case-based collaborative pedagogy may be an effective mechanism for delivery of IPE-oriented information resulting in greater student confidence and understanding of IPE competencies.

Use of Visual Cues by Adults With Traumatic Brain Injuries to Interpret Explicit and Inferential Information.

OBJECTIVE: Concomitant visual and cognitive impairments following traumatic brain injuries (TBIs) may be problematic when the visual modality serves as a primary source for receiving information. Further difficulties comprehending visual information may occur when interpretation requires processing inferential rather than explicit content. The purpose of this study was to compare the accuracy with which people with and without severe TBI interpreted information in contextually rich drawings. PARTICIPANTS: Fifteen adults with and 15 adults without severe TBI. DESIGN: Repeated-measures between-groups design. MAIN MEASURES: Participants were asked to match images to sentences that either conveyed explicit (ie, main action or background) or inferential (ie, physical or mental inference) information. The researchers compared accuracy between participant groups and among stimulus conditions. RESULTS: Participants with TBI demonstrated significantly poorer accuracy than participants without TBI extracting information from images. In addition, participants with TBI demonstrated significantly higher response accuracy when interpreting explicit rather than inferential information; however, no significant difference emerged between sentences referencing main action versus background information or sentences providing physical versus mental inference information for this participant group. CONCLUSIONS: Difficulties gaining information from visual environmental cues may arise for people with TBI given their difficulties interpreting inferential content presented through the visual modality.

Speech language pathologists' opinions of constraint-induced language therapy.

BACKGROUND: Constraint-induced language therapy (CILT) has received recent attention as a possible intervention to improve expressive language in people with nonfluent aphasia. Difficulties have been reported with the practical implementation of constraint-induced movement therapy due to its intensive treatment parameters. It remains unknown whether similar challenges may exist with CILT. OBJECTIVE: To determine the opinions of speech-language pathologists (SLPs) about CILT for people with nonfluent aphasia. METHOD AND PROCEDURES: One hundred sixty-seven SLPs completed an electronic survey assessing their opinions of various aspects of CILT. OUTCOMES AND RESULTS: Over 60% of participants felt that people with aphasia would be very unlikely or somewhat unlikely to adhere to CILT. The majority felt that people with aphasia would hold high or moderate concerns with the number of hours spent in therapy (high, 41.8%; moderate, 31.4%), the number of days spent in therapy (high, 44.4%; moderate, 24.8%), likelihood for managed care reimbursement (high, 74.8%; moderate, 15.2%), and other logistical issues (high, 39.2%; moderate, 30.7%). With respect to providing CILT, participants cited the number of hours of therapy (high, 37.3%; moderate, 21.6%) and the number of consecutive days of therapy (high, 29.4%; moderate, 20.3%) as concerns. There were 70.6% who indicated that their facilities lacked resources to provide CILT, and 90.9% felt that most facilitates do not have the resources to provide CILT. CONCLUSIONS: Some SLPs hold significant concerns with the administration of CILT, particularly related to its dosing and reimbursement parameters. Additional work is needed to investigate the issues that were identified in this survey using qualitative methods with SLPs and people with aphasia and to examine modified CILT protocols.

Variations in Eye-Gaze Behaviors Evident When Five Adults With Aphasia-Based Alexia Read Multisentence Passages.

PURPOSE: The problems that people with aphasia encounter when reading passages are poorly understood. This study's purpose was in-depth examination of eye-gaze behaviors exhibited by five people with aphasia-based alexia. METHOD: Five adults with aphasia-based alexia and five neurotypical adults (NAs) read paragraphs while having their eye movements recorded. Acquired data included descriptive characterization of overall eye-gaze behaviors and determination of the (a) percent of fixated words, (b) average fixation duration, (c) average initial and total summed fixation durations of processing attempts on individual words, and (d) effects of word length and frequency on fixation durations. Careful examination of these data allowed examination of consistencies and discrepancies among people with aphasia and supported speculation about underlying deficits. RESULTS: Case participants exhibited unique fixation behaviors in comparison to one another and to neurotypical adults. Case participants' total reading time, percent of fixated words, average fixation duration, and average initial and total summed fixation durations on passage words exceeded those of neurotypical adults. Four of five exhibited positive word length and negative word frequency correlations with fixation durations. CONCLUSIONS: People with aphasia display eye-gaze behaviors unique to them and differing from those of NAs when reading texts. Better understanding of the connection between specific eye-gaze behaviors and problems decoding words, linking them with lexical-semantic information, and constructing meaning from written content is necessary to further progress in developing effective assessment tools and treatments.

Modality Synchronization When People With Aphasia Read With Text-to-Speech Support.

PURPOSE: Text-to-speech (TTS) technology potentially benefits people with aphasia by presenting content through two modalities simultaneously; however, for this to help, eye fixations must synchronize with the auditory rendition of words. Researchers have yet to explore how often and to what extent people with aphasia achieve modality synchronization. This retrospective analysis examined the percent of words people with aphasia see and hear concurrently when reading passages presented via TTS technology. Text-to-speech (TTS) technology potentially benefits people with aphasia by presenting content through two modalities simultaneously; however, for this to help, eye fixations must synchronize with the auditory rendition of words. Researchers have yet to explore how often and to what extent people with aphasia achieve modality synchronization. This retrospective analysis examined the percent of words people with aphasia see and hear concurrently when reading passages presented via TTS technology. METHOD: Nine adults with aphasia had their eye movements tracked while processing TTS passages at a preselected default rate of 150 words per minute. Modality synchronization occurred whenever fixation on a written word occurred during the time span beginning 300 ms before auditory presentation and ending at the next word's initiation. Correlations between standardized test scores, unsupported reading rate, and modality synchronization percentages were informative about the association of aphasia and reading impairment severity with achievement of synchronicity. RESULTS: Three participants demonstrated consistent modality synchronization; average synchronicity ranged from 67% to 76% of passage words. One participant displayed inconsistent synchronization within passages and achieved an average of 58%. The remaining five participants rarely achieved synchronization, with fixations typically lagging substantially behind the auditory presentation. A significant positive correlation occurred between paragraph reading comprehension test scores and modality synchronization percentages. CONCLUSIONS: A default TTS presentation rate does not result in dual modality synchronization for most people with aphasia. This lack of synchronization may contribute to inconsistencies in the benefit people with aphasia experience when provided with TTS support.

Understanding Health Professionals' Experiences of Interprofessional Mentored Research During Clinical Training: A Qualitative Descriptive Study.

BACKGROUND: Interprofessional education is recognized as an important part of the training of future health professionals. Limited investigation has been done on the experiences of students who have completed interprofessional mentored research during their clinical training. PURPOSE: To explore if this experience provided meaningful training in key areas of interprofessional education. METHOD: Using a qualitative descriptive framework, one-on-one interviews were conducted with eight healthcare providers (three occupational therapists and five speech language pathologists) who engaged in interprofessional research during their clinical training. Qualitative content analysis was completed with triangulation by analyst and member checking. CONCLUSION: Three main themes were identified: 1) interprofessional research project collaboration, 2) professional development, and 3) recommendations for student-oriented interprofessional research collaborations. The results illustrated that the health practitioners found their student experiences valuable to their current interprofessional practice and provided salient training on roles and responsibilities, teamwork, and communication.

Self-Reported Home Program Adherence by People With Aphasia: Exploring Construct Validity.

PURPOSE: The study purpose was to compare the practice patterns captured by self-reported logbook data and those recorded by a computerized home program application. The current study is part of a larger single-case research design study aimed at investigating the effect of logbook use on home program adherence in people with aphasia poststroke. METHOD: Data from six adults with chronic aphasia with interest in improving their reading were used in this secondary analysis. Participants completed reading comprehension therapy tasks using a mobile application and tablet. The activities were self-directed and designed for people with aphasia to complete independently. We created an aphasia-friendly logbook based on best practices to allow participants to record their estimated total minutes practiced. Participants received instructions to practice the reading therapy application 80 min a day 7 days a week for the duration of the study. We calculated the difference in the total time per day recorded by each participant to the application data collected. RESULTS: All participants used the logbook to record their practice. There was a strong relationship between self-reported logbook practice and application-recorded practice for four of the six participants. Individual differences were noted and explored. CONCLUSION: These results suggest that some people with aphasia can use logbooks with aphasia-friendly modifications to accurately estimate the amount of practice completed outside of therapy sessions.

Generalization in Aphasia Treatment: A Tutorial for Speech-Language Pathologists.

PURPOSE: Generalization has been defined and instantiated in a variety of ways over the last half-century, and this lack of consistency has created challenges for speech-language pathologists to plan for, implement, and measure generalization in aphasia treatment protocols. This tutorial provides an overview of generalization with a focus on how it relates to aphasia intervention, including a synthesis of existing principles of generalization and examples of how these can be embedded in approaches to aphasia treatment in clinical and research settings. METHOD: Three articles collectively listing 20 principles of generalization formed the foundation for this tutorial. The seminal work of Stokes and Baer (1977) focused attention on generalization in behavioral change following treatment. Two aphasia-specific resources identified principles of generalization in relation to aphasia treatment (Coppens & Patterson, 2018; Thompson, 1989). A selective literature review was conducted to identify evidence-based examples of each of these 20 principles from the extant literature. RESULTS: Five principles of generalization were synthesized from the original list of 20. Each principle was supported by studies drawn from the aphasia treatment literature to exemplify its application. CONCLUSIONS: Generalization is an essential aspect of meaningful aphasia intervention. Successful generalization requires the same dedication to strategic planning and outcome measurement as the direct training aspect of intervention. Although not all people with aphasia are likely to benefit equally from each of the principles reviewed herein, our synthesis provides information to consider for maximizing generalization of aphasia treatment outcomes. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24714399.

The role of commonality, distinctiveness and importance of semantic features in persons with aphasia.

OBJECTIVE: Semantic feature approaches are frequently included in treatment for people with aphasia. The present study investigated the role of distinctiveness and importance in the semantic feature knowledge of people with aphasia. The relationships between feature knowledge and the ability to choose among semantically-related foils, comprehension and naming abilities were examined. METHODS: Participants distinguished target nouns from related foils and completed a sorting task involving mid-importance common (MIC), mid-importance distinctive (MID), low-importance common (LIC) and low-importance distinctive (LID) features. Participants also completed sub-tests from the short version of the Boston Diagnostic Aphasia Examination-Third Edition (BDAE-3) and Boston Naming Test-Second Edition (BNT-2). Participants were divided into two groups based on ability to accurately select target nouns from semantically-related foils. RESULTS: Group 1, participants with intact ability to choose among related foils, was significantly less impaired with the identification of distinctive features than Group 2, those with difficulty choosing among related foils. Importance was not a significant factor when comparing mid-importance to low-importance features. CONCLUSIONS: These results suggest that distinctive feature knowledge contributes in a significant way to the integrity of semantic representations in people with aphasia which can influence their performance of language tasks.

Eye Fixation Behaviors and Processing Time of People With Aphasia and Neurotypical Adults When Reading Narratives With and Without Text-to-Speech Support.

BACKGROUND: Researchers have used eye-tracking technology to investigate eye movements in neurotypical adults (NAs) when reading. The technology can provide comparable information about people with aphasia (PWA). Eye fixations occurring when PWA do and do not have access to text-to-speech (TTS) technology are of interest because the support improves reading comprehension and decreases processing time for at least some PWA. AIMS: This study's purpose was to examine forward, regressive, and off-track eye fixations when PWA and NAs read narratives in read-only (RO) and TTS conditions. A secondary aim was to examine the influence of eye fixations on processing time. METHOD AND PROCEDURE: A Tobii Dynavox Pro Spectrum eye tracker recorded eye movements of nine PWA and nine NAs while reading narratives in two conditions. Movements of interest were forward fixations; within-word, within-sentence, and previous-sentence regressive fixations; and off-track fixations. OUTCOMES AND RESULTS: PWA exhibited significantly more forward and regressive fixations in the RO than TTS condition, whereas NAs showed opposite behaviors. NAs had significantly more off-track fixations in the TTS than RO condition, whereas PWA exhibited no difference across conditions. PWA took significantly longer to process content in the RO condition, whereas NAs took longer in the TTS condition. CONCLUSIONS: PWA and NAs differ in important ways when processing texts with and without TTS support. Examining eye-tracking data provides a means of gaining insight into the decoding and reading comprehension challenges of PWA and helps elucidate how assistive technology can mediate these challenges.

A Mixed-Methods Exploration of the Experience of People With Aphasia Using Text-to-Speech Technology to Support Virtual Book Club Participation.

PURPOSE: This mixed-methods research sought to examine the experience of people with aphasia who used text-to-speech (TTS) support to read a novel for virtual book club participation. METHOD: Six people with chronic aphasia used a TTS system to review portions of a novel about which they conversed during eight virtual book club meetings occurring over 5 weeks. During one-on-one interactions prior to each meeting, participants answered comprehension questions and provided feedback about reading experiences. Then, during group meetings, they reviewed and discussed relevant book content and predicted upcoming content. During a structured individual interview, participants reflected on their supported reading and book club experience. RESULTS: Participants reported a range of reading confidence prior to study participation, mostly influenced by decreased comprehension or reading speed. After book club participation, four participants expressed increased confidence. Some reported searching for key words and skipping difficult words as strategies additional to TTS support. All reviewed at least some book sections more than once either with or without TTS support. Highly motivated participants expressed low frustration and high reading ease and enjoyment. Perceived comprehension was roughly consistent with actual comprehension across participants. Most believed TTS support promoted faster reading than otherwise possible. Participants liked adjustable features affecting speech output rate, word or sentence highlighting, and font size. Psychosocial benefits included decreased isolation and increased friendship. CONCLUSIONS: The findings extend previous evidence about perceived and actual benefits associated with TTS support. People with aphasia express positive experiences when given TTS support during book club participation.