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

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

Considerations for paediatric student-led telepractice in speech-language therapy: A pilot observational study from South Africa.

BACKGROUND: COVID-19 necessitated emergency telepractice for student-led speech-language therapy clinical practicals in training institutions, with limited preparation and evidence-based guidelines. Beyond the pandemic, practitioners and university training sites are likely to continue to offer telepractice necessitating thorough preparation for telepractice services underpinned by a comprehensive understanding of the complexities involved in online therapy. AIMS: Adopting realist evaluation principles, our aim in this paper was to explore broadly what works and does not work in a set of student-led telepractice sessions in a diverse, resource-limited context. The broader goal of this project was to provide evidence-based support to enhance the efficiency and success of telepractice sessions in student clinical training contexts. METHODS & PROCEDURES: We used qualitative observational methods with reflexive thematic analysis to analyse 28 video recordings and 61 observation notes of student-led paediatric telepractice sessions from a South African university clinic as part of a pilot study. OUTCOMES & RESULTS: We identified four overarching considerations for student-led telepractice: (1) additional, specific preparation is required, (2) with greater management of technology and adaptation of tasks, especially during times of poor connectivity; (3) telepractice relies heavily on caregiver input and collaboration; and (4) promoting engagement online, holding a client's attention, building rapport and offering reinforcement are critical skills that are complicated by the lack of face-to-face contact. CONCLUSIONS & IMPLICATIONS: Our findings indicate that telepractice pedagogy needs to be explicitly taught and students require practical assistance as they learn how to use this service delivery approach effectively. There are some aspects peculiar to telepractice that require unique consideration and planning, especially in contexts where service providers and users may be unfamiliar with this form of service provision. The findings of this pilot study can be used by clinical educators and student clinicians to enhance clinical training opportunities involving telepractice. WHAT THIS PAPER ADDS: What is already known on this subject Many speech-language therapy (SLT) student clinicians had to transition quickly to telepractice service provision during COVID-19 with limited existing guidelines and support, especially in contexts where teletherapy is typically non-existent or difficult to access. Although there is some literature available on experiences of telepractice, there is very little evidence-based research which explores the mechanics of such sessions in real-time and which offers practical support to student clinicians and clinical educators engaging in this mode of service delivery. What this study adds This pilot study examined video-recorded, student-led, paediatric, speech-language teletherapy sessions to understand challenges and considerations involved in using telepractice as a clinical training tool. Findings show that additional preparation for telepractice sessions is required, particularly in contexts of poor digital literacy; students must learn to manage technology, especially when connectivity poses a challenge, and adapt therapy tasks for online work with clients; telepractice relies heavily on caregiver input and collaboration, more so than in in-person consultations, and this relationship requires careful management; and promoting engagement online, holding a client's attention, building rapport and offering reinforcement are critical yet challenging skills in telepractice. What are the potential or actual clinical implications of this work? Our findings highlight a need to teach telepractice pedagogy explicitly and support students practically in learning how to provide therapy effectively via this mode of service delivery. Observational methods for studying practices in recorded telepractice sessions can be used as part of a reflective approach to clinical training. Using already available data allowed us to unpack the 'messy reality' of clinical training using telepractice.

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

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

The use of music and music-related elements in speech-language therapy interventions for adults with neurogenic communication impairments: A scoping review.

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.

Community responses to persons with aphasia participating in CoActive therapeutic theatre: A pilot study.

BACKGROUND: Persons with aphasia (PWA) experience a number of communicative and social-emotional challenges. Reported experiences of PWA include but are not limited to, being misunderstood, isolated, frustrated, and infantilised. AIMS: The aim of this pilot study, involving a Life Participation Approach to Aphasia (LPAA), conducted over the course of 2 years, was to understand community perceptions of aphasia while PWA engaged in an interprofessional treatment program involving speech and drama therapy. METHODS & PROCEDURES: The interprofessional treatment program involved PWA participating in a therapeutic theatre program using the CoActive Therapeutic Theater (CoATT) while also receiving speech-language therapy. Each year, the PWA performed a different, original therapeutic theatre production for a public audience, at the culmination of their interprofessional treatment program. In this paper, we share data obtained from perspectives of audience members who witnessed the theatre production and aphasia education during the first year of the study and friends and family of PWA who participated in the therapeutic theatre process during the second year of the study. OUTCOMES & RESULTS: Responses from audience members who participated in aphasia education and witnessed the therapeutic theatre performance by the PWA during the first year, indicated an increased knowledge of aphasia. Friends and family members of PWA who witnessed their loved ones engaging in the CoATT process through interprofessional treatment, in the second year, reported that their loved ones benefited from the CoATT process, which was distinct from other therapeutic processes to their knowledge and that they were impacted by watching their loved one perform. CONCLUSIONS & IMPLICATIONS: These initial findings create footing towards understanding impact of therapeutic theatre in combination with speech-language therapy in the lives of PWA. They help us to obtain an initial appreciation of how therapeutic theatre and aphasia education help connect PWA and their community. WHAT THIS PAPER ADDS: What is already known on this subject Caregivers and communities at large play a significant role in and substantially impact the recovery of their loved ones (Dalemans et al., 2010; Grawburget et al., 2013; Kniepmann & Cupler, 2014) with aphasia. However, existing research suggests that persons with aphasia (PWA) are often misunderstood, isolated and infantilised by their communities. What this paper adds to existing knowledge The findings of our study reveal that friends, families and extended communities of PWA gain a positive and deep understanding of challenges experienced by PWA through therapeutic theatre supported by speech language therapy, based in a new CoActive Therapeutic Theatre (CoATT) model. This PWA community also agrees that therapeutic theatre in combination with speech-language therapy provides confidence and camaraderie between PWAs and strengthen connection between all constituencies. These results support the need for interprofessional intervention within the framework of a Life Participation Approach to Aphasia (LPAA). What are the potential or actual clinical implications of this work? Treatment paradigms that bring PWAs in contact with their communities using an LPAA approach can increase confidence and social engagement for PWAs potentially leading to better outcomes for their individual speech-language therapy as well as create means of educating communities about PWA, and their stories.

Phonological assessment and analysis tools for Polish: Construction and use.

This contribution presents tools for the assessment of phonological development of Polish-learning children and an initial qualitative evaluation thereof. The tools are consistent with those developed for 16 other languages in a cross-linguistic study of phonological development that is embedded in the framework of constraint-based nonlinear phonology. This theoretical foundation underlies the composition of a Polish word list for elicitation plus a supplementary analysis and intervention planning form (where intervention is warranted). A qualitative pilot study evaluated the tools in terms of adherence to underlying theoretical constructs, coverage of Polish phonology in the developmental context and utility for testing two children, one of whom was characterised by protracted phonological development. Further steps are required to develop the test into a norm-referenced instrument for clinical and research purposes, including quantitative evaluations of the tools' psychometric properties.

Understanding Dysphagia Care in Pakistan: A Survey of Current Speech Language Therapy Practice.

Dysphagia affects individuals across all ages and has pervasive and potentially life-threatening consequences. Individuals with dysphagia are assessed and treated by speech and language therapists (SLTs), however, little attention has been paid to their practices in Pakistan. This study aimed to explore SLTs practices for dysphagia assessment, signs and symptoms observed during evaluation, and management strategies, alongside barriers and facilitators to service delivery in Pakistan. A 45-item survey was distributed to SLTs online. Responses were received from 101 participants and analyzed descriptively, and open-text responses were analyzed using content analysis. Results revealed that 65.3% SLTs worked across the lifespan, and most (79.4%) had dysphagia-related experience of five years or less. SLTs were an active workforce engaged with varying ages, disorders, and settings, yet dysphagia contributed to a small caseload percentage for most. Analyses found informal clinical exams were more frequently used than instrumental assessments. A variety of service provision facilitators were described, such as supportive teams and accessible resources, and responses about barriers revealed gaps in awareness, education, and guidance. This exploratory study presents novel and unexplored data which provides a deeper understanding of dysphagia-related care in Pakistan.

Written reflective practice abilities of SLT students across the degree programme.

BACKGROUND: Written reflective practice (WRP) is a teaching tool used across speech-language therapy (SLT) clinical education programmes. The process aims to support the development of reflective skills required for the workplace (e.g., problem-solving and self-evaluation). AIMS: This cross-sectional and repeated-measures study design investigated students' demonstration of breadth of WRP across the clinical education programme. METHODS & PROCEDURES: The participants were 77 undergraduate SLT students in their first, second or final professional year of the clinical programme. Participants wrote critical reflections following an interaction with a client/s as part of their clinical education experiences. Formative feedback was provided after each written reflection (WR). In total four WRs per participant were coded for breadth of WRP using a modification of Plack et al.'s coding schema from 2005. This was completed for each of the four time points across the academic year for each professional year. OUTCOMES & RESULTS: There was a statistically significant association between time (i.e., professional year of the programme) and likelihood of demonstration of breadth of reflection for the lower level reflective element of 'attend' and higher level reflective element of 're-evaluate'. A positive trend between time and likelihood of demonstration of breadth of reflection was seen for the lower level element of 'reflection-for-action'. Final-professional-year students exhibited significant enhancements in the higher level elements (e.g., 'premise') compared with first- and second-professional-year students. CONCLUSIONS & IMPLICATIONS: This group of SLT students exhibited significant change in breadth of WRP across the degree programme. This finding has positive implications for facilitating WRP with students and using the current coding framework in clinical programmes. WHAT THIS PAPER ADDS: What is already known on this subject WRP is one form of reflective practice (RP) used in SLT, allied health, medical and nursing clinical education programmes. Researchers have suggested that RP skills develop over time for students. Previously, studies examining WRP have focused on one off assessment of skill or over a timeframe of 6-10 weeks. Here, we examine SLT students' WRP skills across the degree programme. What this paper adds to existing knowledge SLT students exhibited significant positive change in breadth of WRP across the degree programme as their clinical experience increased. Our results provide quantitative information in support of using RP as a learning tool throughout clinical education programmes for SLT. What are the potential or actual clinical implications of this work? This study offers support for educators of SLT students; for example, how educators can assess WRP, and how educators can foster SLT student skill development with formative feedback and reflective questioning. This study also offers support for student SLT, for example, describing how WRP can be part of their individualized learning approach and provide a purposeful examination of self and clinical skill development.

'Talking Very Properly Creates Such a Distance': Exploring Style-Shifting in Speech-Language Therapists.

BACKGROUND: In the governmental delineation of the speech-language therapist (SLT) profession and in preservice SLT education, Flemish SLTs are considered as gatekeepers of the standard language in Flanders. Yet, most Flemish clients typically use a colloquial language style. Following earlier research on how teachers' language style affects teacher-student interactions, an SLT's strict adherence to standard Dutch may potentially evoke perceptions of inequality in their clients. As a result, Flemish SLTs may find themselves torn between on the one hand adhering to the standard language and on the other hand adapting to the sociolinguistic style of their client and establishing trust. In the present study, we explored SLTs' views on using standard/colloquial language varieties in their practice. METHODS & PROCEDURES: Individual semistructured interviews were conducted with 13 Flemish SLTs who worked with children, adolescents and adults in special schools, private practices and hospitals. Interview transcripts were analysed with reflexive thematic analysis. OUTCOMES & RESULTS: Analyses yielded three themes. Switching between styles was (1) triggered by client characteristics (age, style, therapeutic needs), and it was shaped by (2) the need for establishing trust and (3) a balance between the SLT's professional and personal identity. Notably, most SLTs described partially converging with their clients' colloquial style, effectively reconciling their professional identity as expert speakers with their personal identity as a colloquial language user. CONCLUSIONS & IMPLICATIONS: Despite consensus on the role of the SLT as gatekeeper of standard language, many SLTs felt that colloquial language also plays an important role as it bolsters therapeutic alliance and rehabilitation of functional communication. By implementing reflective mixed methods and integrating the client perspective, future studies should further examine how authentic style-switching occurs and how various styles used by the SLT are evaluated by clients in different contexts. These findings may guide the development of style-switching as a communicative strategy that can be addressed in preservice education. WHAT THIS PAPER ADDS: What is already known on the subject In Flanders, the existence of various (non-)standard varieties of Dutch may evoke some tension regarding the preferred variety in a given context. Flemish teachers switch between standard language and colloquial language (style-shifting), depending on the foregrounding of the transactional or relational nature of the context. Moving towards students' colloquial speech builds trust and perceptions of equality. Despite the importance of alliance in speech-language therapy, little is known about how speech-language therapists (SLTs) feel about using colloquial speech given that they are considered expert speakers. What this paper adds to existing knowledge While 'talking properly' is part of the SLT's professional identity, many Flemish SLTs felt that strict adherence to the standard language variety hinders therapeutic alliance. While standard language was strongly associated with professionalism, strict adherence to standard language was used only when SLTs felt they had to prove their clinical competency or when language scaffolding was in the foreground. Partially converging with the clients' language use allowed SLTs to reconcile their professional identity as expert speaker with personal identity and authenticity. What are the potential or actual clinical implications of this work? Both colloquial speech and standard speech serve a function in SLT practice. Therefore, switching between standard and colloquial speech needs further consideration as a communicative strategy rather than instilling in therapists an ideological, normative stance towards language.

Outcomes management practices in tiered school-based speech-language therapy: A Canadian example.

BACKGROUND: Measuring, assessing and managing outcomes in school practice environments is difficult due to the complex nature of school communities as well as the recent shift in service-delivery models towards tiered approaches. In tiered approaches, multiple levels of service are offered to better match students' needs. Each level of service may require different outcomes and management techniques. Research to date on outcomes has focused on measuring outcomes in medical settings, leaving a substantive gap in the literature regarding practice in schools. AIMS: The first aim was to explore how school-based speech-language therapists approached outcomes management as their clinical programmes transitioned to tiered service-delivery models The second aim was to describe the successes and challenges in outcomes management reported by clinicians in this context. METHODS & PROCEDURES: A secondary deductive-inductive content analysis was performed using qualitative interviews with 24 clinical managers and senior therapists from schools across Ontario, Canada. Using a framework of outcomes measurement, assessment and management in schools based on previous research studies, data were grouped into broad categories deductively, and then the content of each category was further explored using inductive coding. Iterative peer debriefing and reflexive journaling were key strategies to increase the trustworthiness of the results. FINDINGS & RESULTS: Participants reported measuring and qualitatively assessing seven key outcomes for school-based practice. These included: (1) student progress and achievement, (2) student participation and inclusion in the school community, (3) stakeholder perspectives, (4) 'buy-in', (5) expanded capacities, (6) responsiveness to needs and (7) accountability to systems. Participants reported more challenges than successes in outcomes management during this transition to tiered services. Challenges were attributed to idiosyncratic organizational barriers, the transition to tiered models and the philosophy of working within the educational system. CONCLUSIONS & IMPLICATIONS: School-based speech-language therapists measure, assess and manage multiple outcomes relevant to school-based practice in tiered service-delivery models. Many challenges remain. Solutions to support meaningful, systematic and proactive outcomes management in schools should address the broader set of outcomes relevant to tiered service-delivery models and the unique practice context of the educational system, while remaining responsive to idiosyncratic organizational factors. Sustained clinical-research collaboration and knowledge exchange is recommended. WHAT THIS PAPER ADDS: What is already known on the subject Systematic, proactive collection and interpretation of outcomes has long been encouraged within speech-language therapy. However, implementing outcomes management in clinical practice remains a substantial challenge. Additionally, research on outcomes to date has focused on medical practice environments, to the exclusion of school-based practice. What are the potential or actual clinical implications of this work? Outcomes management is valued in school practice environments; however, the current repertoire of techniques for outcomes management are a poor match for school-based practice. Clinicians in schools would benefit from the development of contextually relevant, meaningful and feasible outcomes management tools.

Outcomes of a first point of contact speech language therapy clinic for patients requiring vocal cord check pre and post thyroid/parathyroid surgery.

INTRODUCTION: Speech Language Therapy First Point of Contact Clinic (SLT-FPOCC) models can assist assessment of low-risk patient populations referred to ear, nose and throat (ENT) services. To further improve ENT waitlist management and compliance with best-practice care, consideration of other low-risk populations that could be safely managed through this service model is needed. The aims of this paper are to evaluate the clinical and service outcomes of completing vocal cord check (VCC) assessments for patients' pre and post thyroid/parathyroid surgery within an SLT-FPOCC model and examine consumer perceptions. METHODS & PROCEDURES: The service followed existing SLT-FPOCC procedures, with ENT triaging referrals, then SLT completing pre- and postoperative VCC assessment (interview, perceptual assessment, flexible nasendoscopy), with assessment data later reviewed by ENT to diagnose laryngeal pathology. Clinical and service outcomes were collected prospectively. Patients completed an anonymous post-service satisfaction survey. RESULTS: Of the first 100 patients referred for preoperative VCCs, SLT assessment identified 42 with dysphonia and 30 reporting dysphagia, while ENT confirmed 9 with significant preoperative anatomical findings. Eighty-three underwent surgery, with 63 (95 nerves at surgical risk) returning for a postoperative VCC. Postoperative VCC identified three temporary neuropraxias (3.2%) and three unilateral vocal fold paresis (3.2%). Patients were highly satisfied with the service. All 163 pre-/postoperative VCCs were completed with no adverse events. CONCLUSION & IMPLICATIONS: The current data support SLT-FPOCC service expansion to include pre and post thyroid/parathyroid surgery VCC checks, with positive consumer perception. The model supports delivery of best practice management (i.e., pre- and postoperative VCC) for patients receiving surgery for thyroid/parathyroid dysfunction, and associated efficiencies for ENT services. WHAT THIS PAPER ADDS: What is already known Assessment of laryngeal function via flexible nasoendoscopy is recommended best practice for patients pre and postthyroid/parathyroid surgery, as recurrent laryngeal nerve injury is a low incidence (<10%), yet well-recognised risk of these surgeries. Traditionally, general surgeons refer presurgical patients to ear, nose and throat (ENT) for vocal cord check (VCC) assessment. However, with access to specialist outpatient services under increasing pressure, there is growing support for utilisation of other health professionals, such as speech-language therapists working in first point of contact (FPOCC) models, to assist with the administration of pre- and postsurgical assessments of such low-risk populations. What this study adds This work expands on the emerging body of evidence for speech language therapy (SLT) led FPOCC models within ENT outpatient services, providing clinical and service outcomes to support the safety of a new model designed to administer VCCs for patients pre and post thyroid/parathyroid surgery. Adopting a similar model to a prior published SLT-led FPOCC model, the trained SLT completes the pre- and postsurgical VCC including flexible nasoendoscopy and videostroboscopy, with images and clinical information then presented to ENT for diagnosis and management planning. This study also provides the first data on consumer perceptions of this type of service model. Clinical implications of this study Data on 100 consecutive presurgical patients revealed positive service findings, supporting the safety of this model. Nature and incidence of clinical findings pre and post surgery were consistent with previously published studies using traditional models of care (i.e., ENT completing the flexible nasendoscopy). Consumer perception was positive. This model enables delivery of pre-and postsurgical assessments for patients receiving thyroid/parathyroid surgery, consistent with best practice care, and reduces burden on ENT services. In total 163 ENT appointments were avoided with this model, with positive implications for ENT waitlist management.

Implementing an interprofessional palliative care education program to speech-language therapy and dietetic students.

Palliative care education for allied health professionals has received minimal research attention. This longitudinal study followed the development of an education program for speech-language therapy (SLT) and dietetic (DT) students. The project comprised three stages. In Stage I, consenting SLT and DT graduates (n = 9) were interviewed 6 months after graduation exploring preparedness for working in palliative care. Interviews were transcribed, and topics were extracted through content analysis. In Stage II, a new palliative care curriculum was developed using the extant literature and gaps reported in Stage I. In Stage III, we implemented and evaluated the new curriculum. Students were surveyed before (n = 68) and after (n = 42) the new program and at 6-month post-graduation (n = 15) to capture student-reported changes in knowledge and confidence in palliative care. In Stage I, 10 topics were developed covering knowledge, roles, team, family-focused care, and feelings. In Stage II, a hybrid program was developed including e-learning modules, didactic lectures, and a simulated learning experience. In Stage III, student feedback demonstrated positive shifts in knowledge and confidence ratings from medians 3-6 to 5-8 (1 = none; 10 = excellent) across all domains. Gains in knowledge and confidence were consistently higher at 6-month post-graduation for final survey respondents. Mixed modality interprofessional palliative care education for allied health professionals has merit in improving knowledge, confidence, and perceived preparedness for practice.

Supporting Children Who Are English Language Learners Succeed in Their Early Literacy Development.

INTRODUCTION: The Better Start Literacy Approach is an example of a multi-tiered system of support (MTSS) to facilitate children's early literacy success. It is set within a strengths-based and culturally responsive framework for literacy teaching and is being implemented in over 800 English medium schools across New Zealand. This report focuses on how children identified at school entry as English Language Learners (ELL) responded to the Better Start Literacy Approach during their first year at school. METHOD: Using a matched control design, the growth in phoneme awareness, phoneme-grapheme knowledge, and oral narrative skills for 1,853 ELL was compared to a cohort of 1,853 non-ELL. The cohorts were matched for ethnicity (mostly Asian, 46% and Pacific, 26%), age (M = 65 months), gender (53% male), and socioeconomic deprivation index (82% in areas of mid to high deprivation). RESULTS: Data analyses indicated similar positive growth rates for ELL and non-ELL from baseline to the first monitoring assessment following 10 weeks of Tier 1 (universal/class level) teaching. Despite demonstrating lower phoneme awareness skills at baseline, following 10 weeks of teaching, the ELL cohort performed similarly to non-ELL in non-word reading and spelling tasks. Predictors of growth analyses indicated that ELL from areas of low socioeconomic deprivation, who used a greater number of different words in their English story retells at the baseline assessment, and females made the most growth in their phonic and phoneme awareness development. Following the 10-week monitoring assessment, 11% of the ELL and 13% of the non-ELL cohorts received supplementary Tier 2 (targeted small group) teaching. At the next monitoring assessment (20 weeks post baseline assessment) the ELL cohort showed accelerated growth in listening comprehension, phoneme-grapheme matching and phoneme blending skills, catching up to their non-ELL peers. DISCUSSION: Despite limitations of the dataset available, it provides one of the few insights into the response of ELL to Tier 1 and Tier 2 teaching in their first year at school. The data suggest that the Better Start Literacy Approach, which includes high-quality professional learning and development for teachers, literacy specialists, and speech-language therapists, is an effective approach toward developing foundational literacy skills for ELL. The important role speech-language therapists have in collaborating with class teachers to support children's early literacy success within a MTSS framework is discussed.

Person-centred care in speech-language therapy research and practice for adults: A scoping review.

BACKGROUND: Person-centred care (PCC) has shown positive effects in various health-care settings and therefore is desirable in clinical work. However, as PCC is still being developed, the literature reflects a heterogeneous use of both terminology and conceptualisation. This lack of consistency hinders the implementation or adaptation of PCC in general and in select fields of practice such as speech-language therapy (SLT). AIMS: To describe how the concept of PCC manifests in current speech and language therapy research and practice for adult patients. METHODS & PROCEDURES: Searches for published literature were conducted in five databases (PubMed, Scopus, CINAHL, Psych INFO, and Linguistics and Language Behaviour Abstracts) using search terms related to PCC and SLT. Records were included if they involved an adult population, were written in English, and focused on PCC and SLT irrespective of year of publication. MAIN CONTRIBUTION: A total of 134 records published 1996-2020 were included in this review. Many of these records were discussion papers that described how speech-language therapists (SLTs) can or should work in a person-centred way. The search did not find any records that explore the implementation, effects, or patients' views of person-centred SLT. This literature review revealed that person-centred SLT practice mainly relates to the International Classification of Functioning, Disability, and Health framework, and the Life Participation Approach to Aphasia. Studies incorporating exploration of proposed clinical routines of PCC demonstrate specific context-dependant aspects including barriers to eliciting a patient narrative, involving patient and family members, and documenting SLT. CONCLUSIONS & IMPLICATIONS: This study provides information that can be used to implement person-centred care in SLT education, clinical practice, and research by providing an inventory of the current knowledge and the existing gaps. WHAT IS ALREADY KNOWN ON THE SUBJECT: PCC has shown positive effects and is currently being implemented in various health-care settings worldwide. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: This study provides an account of the current state in research and practice on how PCC for adults is described, discussed, and evaluated. While related concepts such as family-centred care have mainly been explored within paediatrics, little is known about how PCC manifests in SLT for adults. Our results show that PCC is presently being discussed and valued in SLT although obstacles exist, and few studies explore whether current practice is person centred and the potential effects of such practice. WHAT ARE THE POTENTIAL OR ACTUAL CLINICAL IMPLICATIONS OF THIS WORK?: This study provides clinicians, researchers, and policymakers' guidance on what aspects to consider when working to implement person-centred SLT for adults.

A pilot study of AID-COMp: An innovative speech-language intervention for patients with early-stage major neurocognitive disorder.

BACKGROUND: Major neurocognitive disorder (MND) alters cognition, memory and language, and consequently affects communication. Speech-language therapy (SLT) may alleviate communication difficulties. AIMS: This pilot study explored the effects of intensive SLT emphasizing memory, language, and discourse impairment and complementary communication strategies, called Aid for Communication-For Persons Who Live with MND (AID-COMp). METHODS & PROCEDURES: We employed a mixed design using quantitative and qualitative methods with four dyads, including a person living with MND (PwMND) and a family carer. The design included a control period, and we tested participants before (T1) and after 2 months without therapy (T2). AID-COMp was then provided intensively three times per week for 10 sessions and participants were tested again (T3). Participants were also involved in an individual qualitative interview after therapy ended, probing their experience and possible effects on their lives. AID-COMp included: (1) spaced retrieval to teach the use of a memory book; (2) semantic and phonological therapy for lexical access; (3) discourse treatment based on the analysis of the macrostructure and microstructure of stories in pictures and texts; and (4) PACE therapy for generalization. Carers were not included in treatment, did not attend sessions and were only involved in the evaluations. Measures included language, communication, cognitive and well-being tests. Paired t-tests (one-tailed) compared scores for the control period, that is, T1 versus T2. We compared scores after therapy (T3) with those at T2. Interviews were transcribed verbatim and analysed qualitatively. OUTCOMES & RESULTS: For the control period, only text comprehension scores significantly decreased in PwMND. After therapy, improvements occurred on the Boston Naming Test (BNT), the Mini-Mental State Exam (MMSE) and the well-being measure for the PwMND. Carer scores were unchanged after therapy except for their perception of the PwMND's communication which improved. Qualitative findings comprised three themes: (1) understanding therapy; (2) recovering abilities and relationships; and (3) naming further needs. CONCLUSIONS & IMPLICATIONS: We hypothesize that AID-COMp addressed the underlying impairments associated with MND and provided various tools to PwMND for composing effectively with them. Indeed, AID-COMp appears to provoke some degree of improvement of language skills, cognition and emotional well-being. These improvements may lead to more confidence in conversation and the recovery of relationships between the PwMND and their entourage. It is also possible that improvements acted positively on one another. These preliminary findings warrant further controlled studies with more participants, including a qualitative exploration of participant experiences. WHAT THIS PAPER ADDS: What is already known on the subject MND affects cognition and communication, which are crucial to a good relationship between a carer and a person with MND. Interventions involving only PwMND have been shown to be effective, but do not address all the communication impairments in the mild stage of MND. These interventions may require many therapy sessions. Generally, SLT interventions do not examine the potential effects of an intervention on carers. What this paper adds to existing knowledge AID-COMp, an intensive intervention of 10 sessions over 1 month, was provided to people living with MND in the community. It included training the person with MND in using a memory notebook combined with semantic and phonological therapy, a new discourse therapy and PACE therapy, addressing several communication deficits. After a control period of 2 months without intervention and a 1-month intensive intervention, the results showed significant improvement in naming, cognition and communication, and PwMND well-being. Moreover, the carers witnessed the impacts of therapy in their everyday life interactions with the PwMND. What are the potential or actual clinical implications of this work AID-COMp can provide communication support for PwMND that has further benefits reported by both PwMND and carers. We described AID-COMp in detail to inspire clinicians in providing SLT for unserved PwMND. Future research studies should use controlled designs, more participants and a qualitative component.

Virtual INSIGHT: Improving natural social interaction: Group reHabilitation after traumatic brain injury.

BACKGROUND: There is a growing body of literature that indicates positive outcomes of group treatment approaches to intervention for communication difficulties in chronic traumatic brain injury (TBI). The published research to date examines face-to-face group intervention. AIM: This study draws on one of these approaches, 'Improving Natural Social Interaction: Group reHabilitation after Traumatic brain injury' (INSIGHT), and examines the adaptation of this program to a virtual setting. The principles underlying the program, which involved providing an authentic contextualised and natural environment for group interactions and enhancing opportunities for identity expression, were maintained. METHODS & PROCEDURES: Six participants with mild to severe TBI and cognitive communication difficulties participated in an 8-week pilot program of the virtual INSIGHT program. Goal Attainment Scaling (GAS) scores completed over the course of the intervention served as the primary outcome measure. Secondary outcomes measures included The Repeatable Battery for the Assessment of Neuropsychological Status Update, The Awareness of Social Inference Test-Revised, the La Trobe Communication Questionnaire and the Satisfaction with Life Scale. OUTCOMES & RESULTS: A mixed multilevel analysis revealed significant improvement in GAS scores. A Wilcoxon signed rank test revealed no significant changes in secondary measures. CONCLUSIONS & IMPLICATIONS: There is a growing potential for this group treatment approach, in an online medium, and progress towards individualised goals was clear. The data have implications for examining the assessment measures typically used to document functional outcomes in clinical intervention. Future directions indicate a need to pursue more ecologically valid assessment methods. WHAT THIS PAPER ADDS: What is already known on the subject Recent literature has focused on the benefits of group intervention for cognitive communication diffuclties after traumatic brain injury (TBI). However, research to date examines only face-to-face group rehabilitation. As there has been a demand for a shift in the way we communicate worldwide, we must make adaptations to current intervention procedures to continue to serve individuals with diverse communication needs. What this paper adds to existing knowledge This study contributes new information about the feasibility of a virtual communication skills group for individuals with TBI. This virtual INSIGHT (Improving Natural Social Interaction: Group ehabilitation after Traumatic brain injury) group intervention facilitates progress towards collaboratively set communication goals and the online setting has the potential to increase the accessibility of these services. What are the potential or actual clinical implications of this work? Progress towards cognitive and social communication goals can be facilitated by an online group intervention. However, this progress was not correlated with scores on standard assessments of cognitive communication, social communication and quality of life. This has implications for the evaluation of the assessments typically used and their ecological validity and applicability to the communication context.

Speech and language therapy treatment on hypokinetic dysarthria in Parkinson disease: Systematic review and meta-analysis.

OBJECTIVE: To assess the effect of speech and language therapy (SLT) on Hypokinetic dysarthria (HD) in Parkinson's disease. DESIGN: Systematic review and meta-analysis of randomized controlled trials. METHODS: We performed a literature search of randomized controlled trials using PubMed, Web of Science, Science Direct and Cochrane database (last search October 2020). Quality assessment and risk of bias were assessed using the Downs and Black scale and the Cochrane tool. The data were pooled and a meta-analysis was completed for sound pressure levels, perceptual intelligibility and inflection of voice fundamental frequency. RESULTS: We selected 15 high to moderate quality studies, which included 619 patients with Parkinson's disease. After pooling the data, 7 studies, which compared different speech language therapies to no treatment, control groups and 3 of their variables, (sound pressure level, semitone standard deviation and perceptual intelligibility) were included in the analysis.Results showed significant differences in favor of SLT for sound pressure level sustained phonation tasks (standard mean difference = 1.79; 95% confidence interval = 0.86, 2.72; p ⩽ 0.0001). Significant results were also observed for sound pressure level and semitone standard deviation in reading tasks (standard mean difference = 1.32; 95% confidence interval = 1.03, 1.61; p ⩽ 0.0001). Additionally, sound pressure levels in monologue tasks showed similar results when SLT was compared to other treatments (standard mean difference = 0.87; 95% confidence interval = 0.46, 1.28; p ⩽ 0.0001). CONCLUSION: This meta-analysis suggests a beneficial effect of SLT for reducing Hypokinetic Dysarthria in Parkinson's disease, improving perceptual intelligibility, sound pressure level and semitone standard deviation.

Effect of Anodic Transcranial Direct Current Stimulation Combined With Speech Language Therapy on Nonfluent Poststroke Aphasia.

OBJECTIVES: Transcranial direct current stimulation (tDCS) facilitates or inhibits spontaneous neuronal activity by low-intensity current. In this study, we evaluated the effects of tDCS and sham stimulation combined with speech language therapy (SLT) on nonfluent poststroke aphasia (PSA) patients. MATERIALS AND METHODS: Patients with PSA were randomly divided into the anode tDCS (A-tDCS) group (n = 8) and sham tDCS (S-tDCS) group (n = 10). The anodes and cathodes were fixed over left inferior gyrus frontalis (L-IFG) and the deltoid muscle of the right shoulder. A-tDCS consisted of 2 mA for 20 min, while S-tDCS current started at 2 mA but automatically decreased to 0 mA after 30 sec. Stimulation was concurrent with 30 min of SLT. Stimulation + SLT sessions occurred five times a week for four weeks. The Western Aphasia Battery (WAB) was given before treatment to obtain the baseline score and once more after all sessions were completed, and the Aphasia Quotient (AQ) was calculated. RESULTS: After tDCS treatment, the AQ mean(SD) in both groups was significantly higher than before treatment (p < 0.001) and the AQ of the A-tDCS group 72.99 (21.91) was significantly higher than that of the S-tDCS group 46.18 (19.29) (t = 2.760, p < 0.05). Upon further analysis of the WAB subscores, except for comprehension, all other items were significantly higher in the A-tDCS group than in the S-tDCS group (p < 0.05). CONCLUSION: Our results suggest that left inferior gyrus frontalis anodic transcranial direct current stimulation is an effective adjuvant to conventional speech language therapy for patients with nonfluent PSA.

English foreign language teachers' awareness of childhood language impairment.

The increasing number of children with Language Impairment (LI) globally, and practitioners' limited knowledge and specialized training can have a serious effect on foreign language learning and development. The present study proposes useful and meaningful practices in the area of raising awareness and alerting a wide range of stakeholders in the field of language education. More specifically, the study concentrates on foreign language secondary school pre-service teacher trainees and their knowledge regarding a) students' problems in language understanding, b) why LI occurs and, c) LI intervention. This work aims to encourage collaboration among speech therapists and teachers, to foster a better understanding of each other's expertise, and create communication-friendly classrooms that will enhance foreign language development in a supportive and inclusive learning environment.

Evaluation of a tracheostomy education programme for speech-language therapists.

BACKGROUND: Tracheostomy management is considered an area of advanced practice for speech-language therapists (SLTs) internationally. Infrequent exposure and limited access to specialist SLTs are barriers to competency development. AIMS: To evaluate the benefits of postgraduate tracheostomy education programme for SLTs working with children and adults. METHODS & PROCEDURES: A total of 35 SLTs participated in the programme, which included a 1-day tracheostomy simulation-based workshop. Before the workshop, SLTs took an online knowledge quiz and then completed a theory package. The workshop consisted of part-task skill learning and simulated scenarios. Scenarios were video recorded for delayed independent appraisal of participant performance. Manual skills were judged as (1) completed successfully, (2) completed inadequately/needed assistance or (3) lost opportunity. Core non-medical skills required when managing a crisis situation and overall performance were scored using an adapted Ottawa Global Rating Scale (GRS). Feedback from participants was collected and self-perceived confidence rated prior, immediately post and 4 months post-workshop. OUTCOMES & RESULTS: SLTs successfully performed 94% of manual tasks. Most SLTs (29 of 35) scored > 5 of 7 on all elements of the adapted Ottawa GRS. Workshop feedback was positive with significant increases in confidence ratings post-workshop and maintained at 4 months. CONCLUSIONS & IMPLICATIONS: Postgraduate tracheostomy education, using a flipped-classroom approach and low- and high-fidelity simulation, is an effective way to increase knowledge, confidence and manual skill performance in SLTs across patient populations. Simulation is a well-received method of learning.