RESUMO
PURPOSE: To evaluate the impact of a speech-language pathology (SLP) pathway on recovery following oesophagectomy. METHOD: An audit was conducted at a single metropolitan public hospital in Sydney, Australia. Patients between 2014-2021 undergoing a three-stage oesophagectomy (n = 41) were included in the study. The sample was divided into two groups, those who received usual care (2014-2019) and those who received perioperative SLP assessment and intervention (2020-2021), with data collected across swallowing and health outcomes. Patient demographics and outcomes between the two groups were compared. RESULT: Patients who received perioperative SLP intervention commenced oral intake faster postoperatively (SLP intervention group Mdn = 6.50 days, IQR = 6.00-7.00; usual care group Mdn = 9.00 days, IQR = 7.00-13.25; p = 0.001). There was no statistically significant difference between groups in rates of aspiration on the postoperative leak test (p = 0.32). No statistically significant differences were found between the two groups in length of hospital stay or number of swallowing-related medical images completed during their admission. CONCLUSION: Perioperative SLP intervention has a positive impact on commencing oral intake following a three-stage oesophagectomy, however, it does not have a significant impact on rates of aspiration postoperatively. This pathway may contribute to enhanced recovery after oesophagectomy.
RESUMO
Meaningful engagement with stakeholders in research demands intentional approaches. This paper describes the development of a framework to guide stakeholder engagement as research partners in a pragmatic trial proposed to evaluate behavioral interventions for dysphagia in head and neck cancer patients. We highlight the core principles of stakeholder engagement including representation of all perspectives, meaningful participation, respectful partnership with stakeholders, and accountability to stakeholders; and describe how these principles were operationalized to engage relevant stakeholders throughout the course of a large clinical trial.
Assuntos
Neoplasias de Cabeça e Pescoço , Participação dos Interessados , Humanos , Neoplasias de Cabeça e Pescoço/terapia , Transtornos de Deglutição/terapia , Transtornos de Deglutição/etiologia , Projetos de Pesquisa , Ensaios Clínicos Pragmáticos como Assunto/métodos , Participação do PacienteRESUMO
PURPOSE: To examine the characteristics of speech-language pathology (SLP) consumers prior to and during the COVID-19 pandemic, with respect to the mode of service delivery within a local health district in New South Wales, Australia, to inform future health service planning. METHOD: Observational study examining SLP occasions of service data pre-COVID-19 (2019-2019; n = 6413) and during the COVID-19 pandemic (2020-2021; n = 6908). Spatial mapping and multilevel models were used to examine associations between sociodemographic characteristics, telehealth utilisation, and videoconferencing. RESULT: During COVID-19, SLP occasions of service increased by 7.7% compared to pre-COVID-19. Model 1 found odds of adopting telehealth (telephone or videoconference) during COVID-19 were significantly higher for those aged 0-4 and 5-17 years compared to older age groups. Consumers in inner regional areas were significantly less likely to adopt telehealth than in major city areas, whereas females were significantly more likely to adopt telehealth. Those living in areas experiencing higher relative disadvantage were less likely to use telehealth. Model 2 found odds of adopting videoconferencing only were also significantly higher for the younger age groups (0-4 and 5-17 years) and females. CONCLUSION: A rapid transition to a virtual model of care was critical to the successful delivery of SLP services during COVID-19. Immediate prioritisation and integration of targeted models of care, where suitability is high and benefits most likely to be experienced, is feasible.
RESUMO
OBJECTIVE: To identify risk factors related to falls within the scope of speech-language pathology (SLP) using assessments from the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) over a 4-month period in four Inpatient Rehabilitation Facilities (IRFs). DESIGN: Observational Retrospective Cohort Study SETTING: : Four inpatient rehabilitation facilities (IRFs) as part of a larger learning health system PARTICIPANTS: : Adults 18 years or older admitted to the IRFs from 10/01/2022 and 02/28/2023 were included. INTERVENTION: N/A MAIN OUTCOME MEASURES: : Occurrence of falls RESULTS: : Analyses of 631 patient records revealed that the odds of falling were almost 3 times greater in people with limited English proficiency compared to English speakers (ORâ¯=â¯2.92, 95% CI [1.09, 6.85]). People with limited English proficiency who reported poorer health literacy had a 4 times higher odds of falling, (ORâ¯=â¯3.90, 95% CI [1.13, 13.44]) when compared to English speakers who reported adequate health literacy. People with limited English proficiency who reported adequate health literacy had the same risk of falling as English speakers, (ORâ¯=â¯.98, 95% CI [.16, 6.12]) suggesting the protective role of health literacy for people with limited English proficiency. CONCLUSIONS: Language barriers have a significant impact on falls among patients in IRFs. SLPs improving health literacy and providing language support may play a crucial role in mitigating fall risk, thereby enhancing patient safety and outcomes.
RESUMO
PURPOSE: The current research aimed to determine the prevalence and the relationships between perceived stress, burnout, and job satisfaction among practicing speech-language pathologists (SLPs) in Spain. In addition, their perspectives and experiences related to their job were explored. METHOD: A mixed methods research design was used with cross-sectional quantitative and qualitative methodology. Four hundred and thirty-eight SLPs completed the Perceived Stress Scale, the Maslach Burnout Inventory, and the Font Roja Job Satisfaction Questionnaire in order to report perceived stress, burnout, and job satisfaction, respectively. Ten SLPs participated in semi-structured interviews. RESULT: With respect to stress, 61.6% of SLPs reported a moderate level of stress and 18.7% reported a high level of stress. With respect to burnout, only 7.56% of the participants met the criteria commonly used for its diagnosis. However, 45.2% of SLPs reported a high level of emotional exhaustion, and 52.7% expressed a low degree of personal accomplishment. Job satisfaction was average for 94% of SLPs and high for just 1% of participants. The level of job satisfaction was significantly related to job stress, emotional exhaustion, and depersonalisation. Qualitative content analyses produced themes and subthemes regarding work recognition, relationships with people in the workplace, work conditions, and job control. CONCLUSION: A noteworthy percentage of SLPs reported emotional exhaustion and reduced personal achievement. Findings suggest that strengthening job control and social support might become protective factors to avoid the full development of burnout, which should impact positively on an individual's wellbeing and, in turn, the quality of the services provided.
RESUMO
PURPOSE: Ethiopia is the second most populous country in sub-Saharan Africa. While Ethiopia's health care system includes primary health centres, general, and specialised hospitals, allied health care like speech-language pathology was not available until 2003. This article was written with the aim of sharing the experience of establishing speech-language pathology as a profession and the first speech-language pathology training program in Ethiopia. METHOD: In this paper, we retrospectively examine how the leadership of local stakeholders, a multidisciplinary team, and the development of a professional infrastructure led to the success of the program. The authorship group, who were involved in the program from inception to implementation, share their experiences. RESULT: The speech-language pathology undergraduate program at Addis Ababa University graduated its first class in 2019. Plans to grow the training program at the graduate level are ongoing. CONCLUSION: This novel program, grown from several international partnerships, is an example of how low- and middle-income countries can improve access to the service providers necessary to treat their populations.
RESUMO
PURPOSE: Speech-language pathologists (SLPs) are often the first point of contact for families of children with autism. Despite this, little is known about SLPs' understanding of autism and its early indicators. This study sought to investigate what Australian SLPs know about autism, the early indicators, and the actions they take when they identify these characteristics. METHOD: A 34 question cross-sectional online survey was distributed through professional networks, social media channels, and industry contacts to Australian SLPs. Quantitative and qualitative data were analysed. RESULT: The 70 participants worked in various contexts around the country. The majority of participants demonstrated sound knowledge of the main characteristics of autism, and some early indicators. Quantitative analysis identified a significant correlation between participant age and confidence talking to parents about possible autism. Overarching themes were identified: (a) caution may delay or prevent SLPs from taking action, (b) some factors may influence SLPs' action, and (c) SLPs take action. CONCLUSION: Australian SLPs working with children have the knowledge and understanding of the main characteristics of autism and some early indicators. However, they demonstrate a cautious approach around the subject of autism, and this caution may cause delays for children requiring diagnostic services.
RESUMO
BACKGROUND: A growing body of research indicates that music-based interventions show promising results for adults with a wide range of speech, language and communication disorders. AIMS: The purpose of this scoping review is to summarize the evidence on how speech-language therapists (SLTs) use music and music-related elements in therapeutic interventions for adults with acquired neurogenic communication impairments. METHODS: This scoping review was completed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. A systematic search of three databases (Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature and OVID Medline) was conducted and articles were included if they (1) incorporated adult human participants; (2) received an assessment or intervention facilitated by an SLT; (3) incorporated techniques and interventions which included music-related elements (e.g., rhythm, melody, harmony and dynamics); (4) were written in the English language; and (5) were peer-reviewed full-text articles. Data were extracted using the Rehabilitation Treatment Specification System framework. MAIN CONTRIBUTION: A total of 25 studies met the inclusion criteria. The studies included participants with neurogenic communication impairments secondary to stroke, Parkinson's disease, dementia and traumatic brain injury. Musical interventions identified in the studies were Melodic Intonation Therapy, Modified Melodic Intonation Therapy, choral singing, singing therapy and songwriting. The majority of the studies reported interprofessional collaboration between SLTs and at least one other healthcare clinician and/or musician. Many studies also included music-based interventions lead and facilitated by musically trained SLTs. CONCLUSION: The results of the studies included in this review indicate that SLTs are using music-based interventions to target therapeutic goals to improve speech, language, voice and quality of life in collaboration with other clinicians and professional musicians. WHAT THIS PAPER ADDS: What is already known on this subject A growing body of research indicates that interventions using music (i.e., choirs and songwriting) and musical elements (i.e., rhythm and dynamics) show promising results for adults with neurogenic communication impairments. Currently, however, there is no clear indication of how speech-language therapists (SLTs) are using music in their clinical practice. What this study adds This scoping review collates the current evidence on how SLTs use music and musical elements in their clinical practice. SLTs are using music and musical elements for individuals with neurogenic communication impairments in populations such as Parkinson's disease, dementia and traumatic brain injury. Common interventions described in the literature include Melodic Intonation Therapy, choral singing, singing therapy and songwriting. What are the clinical implications of this work? Many SLTs collaborate when delivering music-based interventions, particularly with music therapists (MTs). This scoping review suggests that SLTs should continue to explore music-based interventions in collaboration with MTs and professional musicians to target therapeutic goals to improve speech, language, voice and quality of life.
RESUMO
Simulation is an education modality known to support clinical skill development. Unfortunately, access to simulation has been challenging, both prior to and during the pandemic. Simulation via telepractice, i.e., "telesimulation", has emerged, but little is known about whether outcomes are comparable to in-person simulation. This study compared in-person versus telesimulation learner outcomes in an infant feeding scenario. The secondary aim was to compare outcomes between novice and experienced participants.This pragmatic randomized controlled trial included speech pathologists who could attend if randomized to the in-person modality. Block randomization matched participants with < 6 months' infant feeding experience to those with > 6 months experience (2:1 ratio) into telesimulation or in-person simulation. Measures of clinical reasoning, confidence/anxiety, and satisfaction were collected, pre-, post-, and 4-weeks post-simulation.Overall, 39 clinicians completed either in-person simulation (n = 17) or telesimulation training (n = 22), including 16 experienced and 23 novice learners. Both in-person and telesimulation groups achieved significant improvements across time in clinical reasoning, self-reported confidence, and anxiety. The extent of change in clinical reasoning, confidence and anxiety was comparable between the telesimulation and in-person simulation groups. Comparing by experience, novice-level participants reported significantly greater changes in confidence and anxiety than experienced participants. Satisfaction levels were high regardless of simulation modality or experience.Participants in telesimulation and in-person simulation achieved similar improvements in the primary outcome measure of clinical reasoning, had comparable improvements in self-perceived confidence and anxiety, and demonstrated high satisfaction levels. Telesimulation is a promising means to improve clinician access to simulation training in infant feeding.
RESUMO
PURPOSE: This survey-based study explored public awareness of the speech-language pathology profession in Aotearoa New Zealand. The study also aimed to understand participants' knowledge and experiences of individuals with speech, language, and communication impairments. METHOD: An online survey was designed and distributed via the Qualtrics survey platform. The survey included three sections, which focused on participant demographics, awareness about speech-language pathology, and knowledge and experiences of communication impairments. RESULT: The responses from 800 fully completed surveys were analysed. A majority of participants indicated that they had never heard or read anything about speech-language pathology and had never met a speech-language pathologist. The participants' responses reflected low or moderate levels of understanding about the roles of speech-language pathologists and their scope of practice. CONCLUSION: Findings indicated low levels of awareness among the general public about speech-language pathology and individuals with communication impairments. These findings were consistent with similar international research conducted over the past 4 decades. Further research is needed to support the development of initiatives designed to increase awareness of the speech-language pathology profession and the needs of individuals with communication impairments.
RESUMO
OBJECTIVE: To investigate the current assessment practices of speech-language pathologists (SLPs) in the United States working with adult clients with voice disorders with regard to the frequency, utility, and confidence in the use of five elements of a comprehensive voice evaluation, as well as training, access to instrumentation, and the use of published scales. METHODS: An online survey was distributed to SLPs who currently see adults with dysphonia as part of their caseload. Clinicians in a voice-focused setting were compared to those who worked in a general medical setting. RESULTS: Nearly all of the 86 participants reported using published validated scales for patient self-assessment and auditory-perceptual ratings. Most respondents had received training in auditory-perceptual voice assessment, acoustic assessment, and videostroboscopy, but a minority reported training in aerodynamic assessment. The majority of SLPs had access to acoustic equipment but a minority had access to the instrumentation for videostroboscopic or aerodynamic assessment. Auditory-perceptual voice evaluation was the procedure most commonly performed and most highly rated for diagnostic utility. Postgraduate training and access to instrumentation were associated with significantly higher frequency of use and confidence with all three instrumental assessment methods. SLPs in voice-focused settings were significantly more likely to have received training in videostroboscopy and perform or interpret it. SLPs in voice-focused settings were also significantly more likely to have access to equipment for all three instrumental techniques and reported significantly higher confidence in their use. Both groups rated the utility of the different components of a voice evaluation similarly and there were no significant differences between the groups in the use of validated patient questionnaires or auditory-perceptual scales. CONCLUSIONS: Most clinicians in our survey reported following practice guidelines when performing comprehensive voice evaluations across settings, despite barriers of training and access to instrumentation.
RESUMO
The past decade has witnessed unprecedented progress in tracheostomy care, through communication, dissemination, and implementation of key drivers including interprofessional education, team-based care, standardized protocols, patient and family engagement, and data-driven practice. Improved safety, efficiency, and quality of tracheostomy care reflects contributions from fields of competency-based education, evidence-based practice, and quality improvement. These elements are interconnected, reinforcing one another to enhance patient care. Competency-based interactive education emphasizes active and practical learning through simulations and case studies, which enhance the clinical skills essential for high-quality care. These educational strategies are grounded in clinical research, ensuring that care practices are continually updated and aligned with the latest evidence, thereby bridging the gap between research findings and clinical application. Quality improvement processes such as Plan-Do-Study-Act (PDSA) cycles refine care delivery in real-world settings. Implementation science promotes the uptake of evidence-based practices, ensuring that discoveries translate to improved health outcomes, quality of care, and overall system performance. In each of these domains, patient and family engagement ensures alignment with patient needs and values. The Global Tracheostomy Collaborative leverages this integrated approach through international educational symposia and webinars, comprehensive data analyses, and a learning community that promotes innovative technologies like in situ simulation and augmented and virtual reality. Together, these approaches enhance the learning and application of best practices in tracheostomy care. The continuous, dynamic interaction of education, research, and quality improvement, grounded in patient-centered care, fosters excellence and innovation in care of patients with tracheostomy.
RESUMO
In Sweden, treatment for children with (developmental) language disorder ((D)LD) is traditionally carried out at a speech-language pathology (SLP) clinic, and based on formal language tests, which may not entirely represent the child's everyday language and communication skills. SLP services that include video recordings have shown positive outcomes in terms of providing information about children's linguistic and communicative abilities in everyday life, but little is known about the use of video in clinical practice. The aim of this study is therefore to investigate how Swedish SLPs link their clinical practices (assessment, treatment, and evaluation of treatment outcome) to the everyday language and communication abilities of children with (D)LD. A further aim is to explore SLPs' utilisation of video recordings as a part of their clinical practices with the target group. A web-based questionnaire was distributed to SLPs in Sweden, who work with children with (D)LD. Results demonstrate that Swedish SLPs perceive that their intervention is in alignment with children's everyday language and communication needs to a fairly high degree. However, an exception is assessment, which is considered to have a weaker alignment with children's everyday communication abilities. The use of video recordings for clinical purposes is very limited. It is suggested here that incorporating video recordings from children's everyday life would be an easy and time-efficient way to strengthen the ecological validity of SLP practices for children with (D)LD.
RESUMO
BACKGROUND: Many challenges exist in promoting inclusion in childcare settings. Adequate support from specialized professionals is necessary to create inclusive childcare settings. Understanding which services are being delivered by specialized professionals in childcare contexts is an important first step. The aim of this study was to (1) describe the services currently being delivered by specialized professionals in childcare settings in Quebec (Canada) and (2) seek childcare administrators' perspectives on their preferred services. METHODS: An online province-wide descriptive survey was conducted with childcare administrators (n = 344). Questions focused on 11 service delivery dimensions (e.g. professionals involved, children served). Descriptive statistics were calculated. RESULTS: Childcare settings received services from a median of two specialized professionals (IQR [1-4]). Most services were delivered by early childhood special educators (61.3%), speech-language pathologists (57.6%), psycho-educators (43.6%) and occupational therapists (43.3%). Childcare administrators identified these four services as being particularly supportive. Professionals delivered a median of 0.4 h of service per week in each childcare setting (IQR [0.1-3.0]). A high percentage (91.2%) of administrators reported unmet needs for professional support in at least one developmental domain, with a high percentage (57.3%) of administrators identifying needs in the socio-emotional domain. Most (63.3%) expressed a desire to prioritize services for children without an established diagnosis but identified by early childhood educators as having needs for professional support. Most administrators (71.4%) also preferred in-context services. CONCLUSIONS: Childcare administrators perceive an important role for specialized professionals in supporting inclusion in their settings. Recommendations emerging are based on the four main professional service needs identified: (1) increasing the intensity and stability of services; (2) providing services for undiagnosed children identified by early childhood educators as having unmet needs; (3) ensuring that services encompassing all developmental domains with a focus on the socio-emotional domain; and (4) prioritizing of in-context services.
Assuntos
Creches , Humanos , Quebeque , Creches/organização & administração , Pré-Escolar , Feminino , Masculino , Cuidado da Criança/organização & administração , Criança , Inquéritos e Questionários , Adulto , Serviços de Saúde da Criança/organização & administração , Patologia da Fala e Linguagem/organização & administração , Atitude do Pessoal de Saúde , Terapeutas Ocupacionais/psicologia , Educação Inclusiva/organização & administraçãoRESUMO
BACKGROUND: Healthcare professionals are required to work effectively together to deliver the best healthcare services. Without awareness of other healthcare professionals' roles and responsibilities, interprofessional practice (IPP) cannot be optimally achieved. OBJECTIVES: This study aimed to investigate healthcare professionals' awareness of audiology and speech-language pathology (SLP) services in Saudi Arabia. METHOD: This cross-sectional descriptive study consisted of two parts. The content of a 20-item paper questionnaire was firstly validated. The full-scale study addressed the aim through distributing questionnaire items among potential participants. Descriptive statistics and chi-square test were used. RESULTS: A total of 403 participants completed the questionnaires for the main study. Most of the participants were Saudi citizens (84.1%), aged 18 years - 40 years (84.8%) years, and lived in Riyadh region (76.2%). Allied health professionals (40.2%), physicians (22.6%), nursing (15.4%) and dentistry (11.2%) were the main group of participants working mainly at governmental hospitals (69.2%). Of the total participants, 92.6% and 95.3% reported being fully aware of the services provided by audiologists and SLPs, respectively. No statistically significant association between the specialty of participants and their familiarity with the scope of practice for SLPs and audiologists was determined. CONCLUSION: Our study examined healthcare professionals' awareness of audiology and SLP services and revealed a high level of awareness.Contribution: The existed level of awareness is expected to facilitate IPP and enhance the quality of care. Still, awareness campaigns about audiology and SLP services are needed to address the existing lack of knowledge among some healthcare professionals.
Assuntos
Audiologia , Patologia da Fala e Linguagem , Humanos , Arábia Saudita , Audiologia/educação , Estudos Transversais , Adulto , Masculino , Feminino , Adulto Jovem , Inquéritos e Questionários , Adolescente , Pessoal de Saúde , Pessoa de Meia-Idade , Conhecimentos, Atitudes e Prática em Saúde , Atitude do Pessoal de Saúde , Pessoal Técnico de Saúde/educaçãoRESUMO
OBJECTIVES: Speech-language pathologists (SLPs) and laryngologists often work closely in interdisciplinary settings evaluating and treating patients with voice, swallowing, and airway disorders. This collaboration is integral to providing optimum patient care. We theorize that trust is an essential component of this relationship and contributes to effective patient care and professional satisfaction. There is currently no literature that explores the development and role of trust in this unique interprofessional relationship. We aim to explore the SLP and laryngologist interprofessional relationship and the development and role of trust in that relationship. STUDY DESIGN: Qualitative Realist Thematic Analysis. METHODS: Thematic analysis of semistructured qualitative interviews was performed to explore the relationship between SLPs and laryngologists. Through purposive sampling from November 2022-January 2023, we recruited SLPs (n = 10) and laryngologists (n = 10) from 12 centers with varying years of practice, practice setting (academic or private), geographic location, and team structures. RESULTS: Trust between SLPs and laryngologists is comprised of confidence in (1) ability (clinical judgment, technical skill), (2) benevolence, and (3) integrity. Trust formation is enhanced by frequency and quality of communication, physical proximity, and reduction of practical barriers (scheduling, billing, departmental structure). Role negotiation was not identified as a factor. The presence of all three components of trust contributes to job satisfaction, perceptions of patient experience and care outcomes, and the willingness to collaborate in academic areas beyond clinical care. CONCLUSIONS: All three elements (ability, benevolence, integrity) must be present for trust in an interprofessional relationship between SLPs and laryngologists, and formation of trust is facilitated by robust communication, physical proximity, and reduction of practical barriers to collaboration. The lack of these elements and lack of trust between the two professions can negatively impact collaboration, job satisfaction, and patient care outcomes, contributing to inefficiencies in patient care.
RESUMO
PURPOSE: To investigate the use of two versions of a simulation-based learning experience (SBLE) to decrease speech-language pathology (SLP) students' anxiety and increase their confidence and sense of preparedness for clinical placements. METHOD: Two cohorts of third-year SLP students (n = 33) participated in a mixed-methods study with each cohort completing one version of the SBLE. Participants completed pre- and post-program quantitative ratings of anxiety, confidence, and preparedness for clinical placements and participated in focus groups. Three clinical educators also provided qualitative data in debriefs and interviews. RESULT: Significant decreases in student ratings of anxiety, and increases in confidence and sense of preparedness, were found for participants from both versions of the SBLE. No significant differences were found between changes in each measure between the two groups. Qualitative data from the student focus groups and clinical educator interviews described affective changes in the students, which concurred with the quantitative results. CONCLUSION: Results suggest this SBLE can be used to improve SLP students' self-perceptions of readiness for clinical placements. Comparable outcomes can be achieved for students using the shorter, less resource intensive version of the SBLE program, with reduced costs, to overcome barriers to its implementation.
Assuntos
Ansiedade , Patologia da Fala e Linguagem , Humanos , Patologia da Fala e Linguagem/educação , Patologia da Fala e Linguagem/métodos , Feminino , Masculino , Treinamento por Simulação/métodos , Adulto Jovem , Grupos Focais , Adulto , Estudantes de Ciências da Saúde/psicologia , Competência Clínica , AutoimagemRESUMO
INTRODUCTION/AIMS: Many people living with amyotrophic lateral sclerosis (PALS) report restrictions in their day-to-day communication (communicative participation). However, little is known about which speech features contribute to these restrictions. This study evaluated the effects of common speech symptoms in PALS (reduced overall speaking rate, slowed articulation rate, and increased pausing) on communicative participation restrictions. METHODS: Participants completed surveys (the Communicative Participation Item Bank-short form; the self-entry version of the ALS Functional Rating Scale-Revised) and recorded themselves reading the Bamboo Passage aloud using a smartphone app. Rate and pause measures were extracted from the recordings. The association of various demographic, clinical, self-reported, and acoustic speech features with communicative participation was evaluated with bivariate correlations. The contribution of salient rate and pause measures to communicative participation was assessed using multiple linear regression. RESULTS: Fifty seven people living with ALS participated in the study (mean age = 61.1 years). Acoustic and self-report measures of speech and bulbar function were moderately to highly associated with communicative participation (Spearman rho coefficients ranged from rs = 0.48 to rs = 0.77). A regression model including participant age, sex, articulation rate, and percent pause time accounted for 57% of the variance of communicative participation ratings. DISCUSSION: Even though PALS with slowed articulation rate and increased pausing may convey their message clearly, these speech features predict communicative participation restrictions. The identification of quantitative speech features, such as articulation rate and percent pause time, is critical to facilitating early and targeted intervention and for monitoring bulbar decline in ALS.
Assuntos
Esclerose Lateral Amiotrófica , Humanos , Esclerose Lateral Amiotrófica/fisiopatologia , Esclerose Lateral Amiotrófica/psicologia , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Fala/fisiologia , Adulto , Comunicação , AutorrelatoRESUMO
BACKGROUND: High-intensity therapy is recommended in current treatment guidelines for chronic poststroke aphasia. Yet, little is known about fatigue levels induced by treatment, which could interfere with rehabilitation outcomes. We analyzed fatigue experienced by people with chronic aphasia (>6 months) during high-dose interventions at 2 intensities. METHODS: A retrospective observational analysis was conducted on self-rated fatigue levels of people with chronic aphasia (N=173) collected during a previously published large randomized controlled trial of 2 treatments: constraint-induced aphasia therapy plus and multi-modality aphasia therapy. Interventions were administered at a higher intensity (30 hours over 2 weeks) or lower intensity (30 hours over 5 weeks). Participants rated their fatigue on an 11-point scale before and after each day of therapy. Data were analyzed using Bayesian ordinal multilevel models. Specifically, we considered changes in self-rated participant fatigue across a therapy day and over the intervention period. RESULTS: Data from 144 participants was analyzed. Participants were English speakers from Australia or New Zealand (mean age, 62 [range, 18-88] years) with 102 men and 42 women. Most had mild (n=115) or moderate (n=52) poststroke aphasia. Median ratings of the level of fatigue by people with aphasia were low (1 on a 0-10-point scale) at the beginning of the day. Ratings increased slightly (+1.0) each day after intervention, with marginally lower increases in the lower intensity schedule. There was no evidence of accumulating fatigue over the 2- or 5-week interventions. CONCLUSIONS: Findings suggest that intensive intervention was not associated with large increases in fatigue for people with chronic aphasia enrolled in the COMPARE trial (Constraint-Induced or Multimodality Personalised Aphasia Rehabilitation). Fatigue did not change across the course of the intervention. This study provides evidence that intensive treatment was minimally fatiguing for stroke survivors with chronic aphasia, suggesting that fatigue is not a barrier to high-intensity treatment.
Assuntos
Afasia , Fadiga , Humanos , Afasia/etiologia , Afasia/reabilitação , Afasia/terapia , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Fadiga/etiologia , Fadiga/terapia , Adulto , Idoso de 80 Anos ou mais , Estudos Retrospectivos , Doença Crônica , Acidente Vascular Cerebral/complicações , Adolescente , Adulto Jovem , Reabilitação do Acidente Vascular Cerebral/métodos , AutorrelatoRESUMO
Dysphagia is a leading cause of morbidity and mortality among individuals with Parkinson's disease (PD). The primary objectives of the present study were to explore patients' narrative reports focused on what information and evaluation and treatment experiences they identified as they manage dysphagia, and to identify practice patterns relevant to dysphagia management. A secondary objective was to produce an educational resource for this population that addressed their questions about dysphagia. A sample of individuals with oropharyngeal dysphagia secondary to PD (n = 25) across all regions of the United States were interviewed using open- and closed questions and a written questionnaire. Verbatim interview transcripts were interrogated using qualitative content analysis (QCA) with an inductive approach to identify themes from the participants' reported knowledge of dysphagia and experiences with swallowing evaluation and treatment. Authors developed a pamphlet addressing common questions that participants posed in the interviews and conducted a member check to revise it with their feedback. Most participants reported having been asked about their swallowing function by a healthcare professional. 60% of the sample reported having had a swallowing evaluation. Only 20% (5/25) of participants reported having completed swallowing therapy. Some participants did not know that swallowing therapy exists. Nearly all participants reported having a strong desire to know more about dysphagia and preferred a pamphlet as a resource format. Few of the study participants had received swallowing therapy, and nearly all participants were eager to learn about the nature of dysphagia, its progression, and treatment options. Given the physical, emotional, and social ramifications of living with dysphagia, access to swallowing education and treatment needs to be a stronger focus of PD management.