Expiratory Muscle Strength Training for Drooling in Adults with Parkinson's Disease.

One of the most debilitating symptoms of advanced Parkinson's disease is drooling. Currently, the main treatment that is offered for drooling is botulinum toxin injections to the saliva glands which have a number of side effects and do not treat the causes of drooling, such as impaired swallowing and lip closure. This study explored the effect of an alternative therapy approach for drooling that aimed at improving the swallow, expiratory muscle strength training (EMST). Sixteen participants received EMST over a 6- to 8-week period. Measurements were taken pre- and post-training for drooling (Sialorrhea Clinical Scale for Parkinson's Disease; SCS-PD), swallowing, lip strength and peak cough flow. Measures of drooling, swallowing and peak cough flow were stable over pre-training assessments and improved following training (p < 0.01). The most conservative estimate of the within-group change for SCS-PD was - 2.50 (95% confidence interval -  3.22 to -  1.22). No adverse effects were reported and participants gave high satisfaction ratings for the training. A programme of EMST offers promise as a therapy to reduce drooling for people with Parkinson's disease. Adequately powered randomised controlled trials of EMST are now needed.

Communication strategies used by Parkinson's nurse specialists during healthcare interactions: A qualitative descriptive study.

AIM: To explore the range and use of communication strategies by Parkinson's nurse specialists, and describe key communication strategies, to support health professionals in their healthcare interactions with people with Parkinson's. DESIGN: A qualitative descriptive study. METHODS: Due to the COVID-19 pandemic, the study took place in an online setting. Online semi-structured interviews were conducted with eight Australian Parkinson's nurse specialists and one UK Parkinson's nurse between August and October of 2020. Interviews explored healthcare communication, specifically (1) ways Parkinson's nurse specialists support communication during healthcare interactions, (2) factors influencing the use of communication strategies, and (3) how the nurses learned to communicate effectively with people with Parkinson's disease. Reflexive thematic analysis was used to analyse the data. RESULTS: Parkinson's nurse specialists described the importance of establishing strong therapeutic relationships, the key role of the communication partner, adapting communication to reduce cognitive load, ensuring two-way understanding, and enabling expressive communication for people with Parkinson's. Knowing the person and family, knowing the disease and understanding the symptoms appeared to influence the choice of communication strategies in healthcare interactions. Learning through others, learning through experience and learning through education and research were considered important parts of becoming a skilled healthcare communicator when working with people with Parkinson's. CONCLUSION: Knowledge and use of effective communication strategies to support people with Parkinson's is crucial for all health professionals working with this population, in order to reduce the occurrence of poor healthcare outcomes. A deep understanding of how Parkinson's disease affects communication and experience in implementing communication strategies were reported as contributing to the success of Parkinson's nurses in communicating with their patients. IMPACT: This study provides a description of the key, translational communication strategies that can be used by all health professionals to support healthcare interactions with people with Parkinson's.

Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: a systematic review and meta-analyses.

AIM: To determine the prevalence of drooling, swallowing, and feeding problems in persons with cerebral palsy (CP) across the lifespan. METHOD: A systematic review was conducted using five different databases (AMED, CINAHL, Embase, MEDLINE, and PubMed). The selection process was completed by two independent researchers and the methodological quality of included studies was assessed using the STROBE and AXIS guidelines. Meta-analyses were conducted to determine pooled prevalence estimates of drooling, swallowing, and feeding problems with stratified group analyses by type of assessment and Gross Motor Function Classification System level. RESULTS: A total of 42 studies were included. Substantial variations in selected outcome measures and variables were observed, and data on adults were limited. Pooled prevalence estimates determined by meta-analyses were as high as 44.0% (95% confidence interval [CI] 35.6-52.7) for drooling, 50.4% (95% CI 36.0-64.8) for swallowing problems, and 53.5% (95% CI 40.7-65.9) for feeding problems. Group analyses for type of assessments were non-significant; however, more severely impaired functioning in CP was associated with concomitant problems of increased drooling, swallowing, and feeding. INTERPRETATION: Drooling, swallowing, and feeding problems are very common in people with CP. Consequently, they experience increased risks of malnutrition and dehydration, aspiration pneumonia, and poor quality of life. WHAT THIS PAPER ADDS: Drooling, swallowing, and feeding problems are very common in persons with cerebral palsy (CP). The prevalence of drooling, swallowing, and feeding problems is 44.0%, 50.4%, and 53.5% respectively. There are limited data on the prevalence of drooling, swallowing, and feeding problems in adults. Higher Gross Motor Function Classification System levels are associated with higher prevalence of drooling, swallowing, and feeding problems. There is increased risk for malnutrition, dehydration, aspiration pneumonia, and poor quality of life in CP.

PREVALENCIA DE PROBLEMAS DE SIALORREA, DEGLUCIÓN Y ALIMENTACIÓN EN PARÁLISIS CEREBRAL A LO LARGO DE LA VIDA: UNA REVISIÓN SISTEMÁTICA Y METAANÁLISIS: OBJETIVO: Determinar la prevalencia de problemas de sialorrea/babeo, deglución y alimentación en personas con parálisis cerebral (PC) a lo largo de la vida MÉTODO: Se llevó a cabo una revisión sistemática utilizando cinco bases de datos diferentes (AMED, CINAHL, Embase, MEDLINE y PubMed). El proceso de selección fue completado por dos investigadores independientes y la calidad metodológica de los estudios incluidos se evaluó utilizando las directrices STROBE y AXIS. Se realizó un metaanálisis para determinar las estimaciones de prevalencia agrupadas en problemas de babeo, deglución y alimentación con análisis de grupos estratificados por tipo de evaluación y nivel del Sistema de Clasificación de la Función Motora Gruesa. RESULTADOS: Se incluyeron un total de 42 estudios. Se observaron variaciones sustanciales en las medidas y variables de resultados seleccionadas, y los datos sobre adultos fueron limitados. Las estimaciones de prevalencia agrupadas determinadas por metaanálisis fueron tan altas como 44,0% (intervalo de confianza [IC] del 95% 35,6-52,7) para babeo, 50,4% (IC 95% 36,0-64,8) para problemas de deglución y 53,5 % (IC 95% 40,7-65,9) para problemas de alimentación. Los análisis de grupo para el tipo de evaluaciones no fueron significativos; sin embargo, el funcionamiento más severo en PC se asoció con problemas concomitantes de aumento de sialorrea, deglución y de la alimentación. INTERPRETACIÓN: Problemas relacionados con sialorrea, tragar, y de alimentación son muy comunes en personas con PC. En consecuencia, ellos experimentan mayores riesgos de desnutrición y deshidratación, neumonía por aspiración y mala calidad de vida.

PREVALÊNCIA DE PROBLEMAS COM SIALORRÉIA, DEGLUTIÇÃO E ALIMENTAÇÃO EM PARALISIA CEREBRAL AO LONGO DA VIDA: UMA REVISÃO SISTEMÁTICA E METANÁLISE: OBJETIVO: Determinar a prevalência de problemas com sialorréia, deglutição e alimentação em pessoas com paralisia cerebral (PC) ao longo da vida. MÉTODO: Uma revisão sistemática foi realizada utilizando cinco bases de dados diferentes (AMED, CINAHL, Embase, MEDLINE, e PubMed). O processo de seleção foi realizado por dois pesquisadores independentes e a qualidade metodológica dos estudos incluídos foi avaliada usando as diretrizes STROBE e AXIS. Metanálises foram realizadas para determinar as estimativas de prevalência agrupada de problemas de sialorréia, deglutição e alimentação, com análises estratificadas por tipo de avaliação e nível do Sistema de Classificação da Função Motora Grossa. RESULTADOS: Um total de 42 estudos foram incluídos. Variações substanciais nas medidas de resultado e variáveis selecionadas foram observadas, e dados em adultos são limitados. As estimativas de prevalência agrupada determiadas pela metanálise chegaram a 44,0% (intervalo de confiança [IC] 95% 35,6-52,7) para sialorréia, 50,4% (IC 95% 36,0-64,8) para problemas com deglutição, e 53,5% (IC 95% 40,7-65,9) para problemas de alimentação. Análises agrupadas por tipo de avaliação não foram significativas; no entanto, comprometimento funcional mais severo em PC foi associado com mais problemas concomitantes de salivação deglutição e alimentação. INTERPRETAÇÃO: Problemas de sialorréia, deglutição e alimentação são muito comuns em pessoas com PC. Consequentemente, elas apresentam risco aumentado de malnutrição e desidratação, pneumonia por aspiração e pior qualidade de vida.

What is needed to prepare speech pathologists to work in adult palliative care?

BACKGROUND: Speech pathologists have a pivotal role in palliative care, assisting patients with swallowing and communication disorders, yet very little is known about the preparedness of speech pathologists to work in this field. AIMS: To investigate the preparedness of speech pathologists for working in palliative care. The term 'palliative care' was viewed as an encompassing umbrella term incorporating the management/reduction of symptoms and improvement in a person's quality of life at any point of the disease progression. METHODS & PROCEDURES: Participants were Australian-trained speech pathologists who provided adult palliative care services. An online questionnaire was used to gather both quantitative and qualitative data from practising speech pathologists. Qualitative data were analysed and interpreted using conventional content analysis. Descriptive statistics were analysed via the Statistical Package for the Social Sciences (SPSS) for Windows Version 22. Non-parametric tests (chi-square and Mann-Whitney U-test) were used for further analysis. OUTCOMES & RESULTS: The majority (70%) of participants indicated that their university training did not prepare them to practice in palliative care. Participants who received palliative care education at the tertiary level were significantly more prepared to work with palliative patients than those who had not; however, only a minority (27%) had received such training. Just over half (57%) reported having completed post-university professional development in palliative care. The speech pathologist's role in palliative care was also highlighted, with speech pathologists outlining their contribution to the assessment of patients' communication and swallowing abilities. In addition, recommendations for palliative care content to be incorporated into university curriculum were suggested. CONCLUSIONS & IMPLICATIONS: Speech pathologists can make important contributions to end-of-life care, but there is much scope for improving the availability and quality of university and post-university palliative care training opportunities so that people receiving palliative care are best supported.

Psychometric properties of discourse measures in aphasia: acceptability, reliability, and validity.

BACKGROUND: Discourse in adults with aphasia is increasingly the focus of assessment and therapy research. A broad range of measures is available to describe discourse, but very limited information is available on their psychometric properties. As a result, the quality of these measures is unknown, and there is very little evidence to motivate the choice of one measure over another. AIMS: To explore the quality of a range of discourse measures, targeting sentence structure, coherence, story structure and cohesion. Quality was evaluated in terms of the psychometric properties of acceptability (data completeness and skewness), reliability (inter- and intra-rater), and validity (content, convergent, discriminant and known groups). METHODS & PROCEDURES: Participants with chronic mild-to-moderate aphasia were recruited from community groups. They produced a range of discourses which were grouped into Cinderella and everyday discourses. Discourses were then transcribed orthographically and analyzed using macro- and microlinguistic measures (Story Grammar, Topic Coherence, Local Coherence, Reference Chains and Predicate Argument Structure-PAS). Data were evaluated against standard predetermined criteria to ascertain the psychometric quality of the measures. OUTCOMES & RESULTS: A total of 17 participants took part in the study. All measures had high levels of acceptability, inter- and intra-rater reliability, and had good content validity, as they could be related to a level of the theoretical model of discourse production. For convergent validity, as expected, 8/10 measures correlated with the Western Aphasia Battery-Revised (WAB-R) spontaneous speech scores, and 7/10 measures correlated with the Kissing and Dancing Test (KDT) scores (r ≥ 0.3), giving an overall positive rating for construct validity. For discriminant validity, as predicted, all measures had low correlations with Raven's Coloured Progressive Matrices (RCPM) and WAB-R Auditory Verbal Comprehension scores (r < 0.3), giving an overall positive rating for construct validity. Finally, for known groups validity, all measures indicated a difference between speakers with mild and moderate aphasia except for the Local Coherence measures. Overall, Story Grammar, Topic Coherence, Reference Chains and PAS emerged as the strongest measures in the current study because they achieved the predetermined thresholds for quality in terms of each of the psychometric parameters profiled. CONCLUSIONS & IMPLICATIONS: The current study is the first to psychometrically profile measures of discourse in aphasia. It contributes to the field by identifying Story Grammar, Topic Coherence, Reference Chains and PAS as the most psychometrically robust discourse measures yet profiled with speakers with aphasia. Until further data are available indicating the strength of other discourse measures, caution should be applied when using them.

Integration of speech and gesture in aphasia.

BACKGROUND: Information from speech and gesture is often integrated to comprehend a message. This integration process requires the appropriate allocation of cognitive resources to both the gesture and speech modalities. People with aphasia are likely to find integration of gesture and speech difficult. This is due to a reduction in cognitive resources, a difficulty with resource allocation or a combination of the two. Despite it being likely that people who have aphasia will have difficulty with integration, empirical evidence describing this difficulty is limited. Such a difficulty was found in a single case study by Cocks et al. in 2009, and is replicated here with a greater number of participants. AIMS: To determine whether individuals with aphasia have difficulties understanding messages in which they have to integrate speech and gesture. METHODS & PROCEDURES: Thirty-one participants with aphasia (PWA) and 30 control participants watched videos of an actor communicating a message in three different conditions: verbal only, gesture only, and verbal and gesture message combined. The message related to an action in which the name of the action (e.g., 'eat') was provided verbally and the manner of the action (e.g., hands in a position as though eating a burger) was provided gesturally. Participants then selected a picture that 'best matched' the message conveyed from a choice of four pictures which represented a gesture match only (G match), a verbal match only (V match), an integrated verbal-gesture match (Target) and an unrelated foil (UR). To determine the gain that participants obtained from integrating gesture and speech, a measure of multimodal gain (MMG) was calculated. OUTCOMES & RESULTS: The PWA were less able to integrate gesture and speech than the control participants and had significantly lower MMG scores. When the PWA had difficulty integrating, they more frequently selected the verbal match. CONCLUSIONS & IMPLICATIONS: The findings suggest that people with aphasia can have difficulty integrating speech and gesture in order to obtain meaning. Therefore, when encouraging communication partners to use gesture alongside language when communicating with people with aphasia, education regarding the types of gestures that would facilitate understanding is recommended.

Reviewing the quality of discourse information measures in aphasia.

BACKGROUND: Discourse is fundamental to everyday communication, and is an increasing focus of clinical assessment, intervention and research. Aphasia can affect the information a speaker communicates in discourse. Little is known about the psychometrics of the tools for measuring information in discourse, which means it is unclear whether these measures are of sufficient quality to be used as clinical outcome measures or diagnostic tools. AIMS: To profile the measures used to describe information in aphasic discourse, and to assess the quality of these measures against standard psychometric criteria. METHODS & PROCEDURES: A scoping review method was employed. Studies were identified using a systematic search of Scopus, Medline and Embase databases. Standard psychometric criteria were used to evaluate the measures' psychometric properties. MAIN CONTRIBUTION: The current review summarizes and collates the information measures used to describe aphasic discourse, and evaluates their quality in terms of the psychometric properties of acceptability, reliability and validity. Seventy-six studies described 58 discourse information measures, with a mean of 2.28 measures used per study (SD = 1.29, range = 1-7). Measures were classified as 'functional' measures (n = 33), which focused on discourse macrostructure, and 'functional and structural' measures (n = 25), which focused on micro-linguistic and macro-structural approaches to discourse. There were no reports of the acceptability of data generated by the measures (distribution of scores, missing data). Test-retest reliability was reported for just 8/58 measures with 3/8 > 0.80. Intra-rater reliability was reported for 9/58 measures and in all cases percentage agreement was reported rather than reliability. Per cent agreement was also frequently reported for inter-rater reliability, with only 4/76 studies reporting reliability statistics for 12/58 measures; this was generally high (>.80 for 11/12 measures). The majority of measures related clearly to the discourse production model indicating content validity. A total of 36/58 measures were used to make 41 comparisons between participants with aphasia (PWA) and neurologically healthy participants (NHP), with 31/41 comparisons showing a difference between the groups. Four comparisons were made between discourse genres, with two measures showing a difference between genres, and two measures showing no difference. CONCLUSIONS: There is currently insufficient information available to justify the use of discourse information measures as sole diagnostic or outcome measurement tools. Yet the majority of measures are rooted in relevant theory, and there is emerging evidence regarding their psychometric properties. There is significant scope for further psychometric strengthening of discourse information measurement tools.

Inhibitory control and traumatic brain injury: The association between executive control processes and social communication deficits.

PRIMARY OBJECTIVE: To further examine the proposed relationship between executive impairments in inhibitory control and social communication difficulties reflecting poor inhibition following TBI. METHOD: Inhibitory control was assessed in 14 adults with TBI on the Hayling Sentence Completion Test (HSCT). Errors on Part B (failed inhibition) and Part B-Part A response latencies (delayed inhibition) were examined. A relative, friend or frequent communication partner of each participant with TBI completed the La Trobe Communication Questionnaire (LCQ) on the communication difficulties of the person with TBI. The Inhibitory Control Factor (ICF) score of the LCQ based on seven items relating to poor inhibition was specifically analysed against performance on the HSCT. RESULTS: Multiple regression analysis indicated that 58% (51% adjusted) of the variance in LCQ ICF scores was accounted for by measures on the HSCT. Only B-A response latencies on the HSCT explained a significant proportion of the variability in LCQ ICF scores. CONCLUSIONS: Reduced inhibition speed may more strongly contribute to disinhibited communication behaviours than failures in inhibition. These findings contribute to understanding of the cognitive processes underlying social communication and have the potential to support and inform the use and development of management practices for individuals following TBI.

Exploration of older and younger British adults' performance on The Awareness of Social Inference Test (TASIT).

BACKGROUND: Social perception is an important skill. One assessment that is commonly used to assess social perception abilities is The Awareness of Social Inference Test (TASIT). The only normative data available for this test are for Australian younger adults. Despite no normative data being available for British adults, the test is widely used in the UK with older and younger adults. There is a growing body of research that suggests that older adults have difficulty with skills associated with social perception. There is therefore a need to determine whether British adults, and more specifically British older adults, perform similarly to the Australian normative TASIT scores available in the manual. AIMS: To explore the differences between older and younger British adults' performance on TASIT, and to determine whether younger and older British adults perform similarly to the data from Australian adults in TASIT manual. METHODS & PROCEDURES: TASIT was administered to a total of 42 native British English speaking participants. The participants were split into two age groups 18-45 and 60-90 years. Comparisons were made between the two groups and the Australian data in TASIT manual. OUTCOMES & RESULTS: The younger British and Australian adults obtained similar scores on all parts of TASIT. The older British adults though, obtained significantly lower scores than the Australian younger adults on all parts of TASIT and when education was controlled for they obtained significantly lower scores than the British younger adults. CONCLUSIONS & IMPLICATIONS: The findings are discussed in the light of previous research that has found that older adults are worse than younger adults at social inferences. The findings of the current study suggest that caution should be used when using TASIT with older British adults to assess social perception abilities.

The language-gesture connection: Evidence from aphasia.

A significant body of evidence from cross-linguistic and developmental studies converges to suggest that co-speech iconic gesture mirrors language. This paper aims to identify whether gesture reflects impaired spoken language in a similar way. Twenty-nine people with aphasia (PWA) and 29 neurologically healthy control participants (NHPs) produced a narrative discourse, retelling the story of a cartoon video. Gesture and language were analysed in terms of semantic content and structure for two key motion events. The aphasic data showed an influence on gesture from lexical choices but no corresponding clausal influence. Both the groups produced gesture that matched the semantics of the spoken language and gesture that did not, although there was one particular gesture-language mismatch (semantically "light" verbs paired with semantically richer gesture) that typified the PWA narratives. These results indicate that gesture is both closely related to spoken language impairment and compensatory.

What information do UK speech and language therapists use when making oral versus nonoral feeding recommendations for adults with oropharyngeal dysphagia?

The current study explored what information UK speech and language therapists (SLTs) use when recommending oral versus nonoral feeding in adults with oropharyngeal dysphagia. This study differed from previous research on this topic by including a greater number of participants; focusing on UK-based clinicians; exploring whether different information was considered dependent on whether the person with oropharyngeal dysphagia had had a stroke, had motor neurone disease, or had dementia; and investigating how often videofluoroscopy was used when making these decisions. The current study surveyed UK-based SLTs via an online questionnaire. When asked to rate the ten most important factors involved when making oral versus nonoral decisions, UK SLTs chose 9 of the 13 factors chosen by US-based SLTs in an earlier study. Furthermore, the information considered important in oral versus nonoral decision-making varied depending on the diagnosis of the person with oropharyngeal dysphagia. Finally, the SLTs in the current study reported that they did not frequently use videofluoroscopy to make oral versus nonoral recommendations.

Use of spatial communication in aphasia.

BACKGROUND: Spatial communication consists of both verbal spatial language and gesture. There has been minimal research investigating the use of spatial communication, and even less focussing on people with aphasia. AIMS: The aims of this exploratory study were to describe the frequency and variability of spatial language and gesture use by three participants with aphasia in comparison to nine control participants. This included: 1) frequency of gestures; 2) types of gesture; 3) number of spatial descriptions described by gestures but no language; and 4) frequency and variety of locative prepositional, verb, and noun phrases. METHODS & PROCEDURES: Each participant was videoed undertaking 11 spatial communication tasks: four description tasks, and seven tasks involving directing the researcher in the placement of objects or pictures. Gestures and language produced were transcribed and analysed. OUTCOMES & RESULTS: Participants with aphasia used significantly more gesture. Participants with aphasia also used more gesture without spoken phrases when spatial vocabulary was unavailable. Finally, there were differences between the participants with regards to the types of gesture that they used when they were unable to access language. CONCLUSION & IMPLICATIONS: The results suggest that the analysis of gesture produced by people with aphasia may provide insight into their underlying language impairment. As this was an exploratory study, with just three participants with aphasia, further research is needed.

Being practically, professionally and personally prepared: Supporting people with intellectual disability and dysphagia to eat and drink outside the home.

PURPOSE: Eating and drinking outside the home is important for participation and social inclusion for people with intellectual disability and dysphagia (swallowing difficulties) but is likely to come with additional challenges. This qualitative research aimed to identify the challenges and strategies used by people with intellectual disability and dysphagia and their carers when eating outside the home. METHOD: This study used a qualitative research design and reflexive researcher stance following an interpretive phenomenological methodology to understand the nature of the phenomenon "supporting people to eat and drink outside the home". Participants (n = 20) including those with intellectual disability and dysphagia (ages 20-30 years), their support staff and families were interviewed about eating and drinking outside the home. Semi-structured interviews were used. Interviews were analysed thematically. RESULT: Three overarching themes were extracted using thematic analysis. These were being fully prepared; being a confident and respectful advocate; and being open to the varied responses of other people. CONCLUSION: The findings of this study suggest that there are unique challenges for people with intellectual disability and dysphagia and their carers when eating outside the home. There was a need to be practically, professionally, and personally prepared for eating outside the home. There is a need, therefore, to specifically address the challenges of eating outside the home and sharing the strategies used by others to overcome these challenges.

Chewing skills in two and three year old children: Gender and age comparisons on an adapted version of the test of mastication and swallowing (TOMASS-C).

PURPOSE: Few assessment tools objectively measure chewing skills in the paediatric population. There is a need for assessment tools that use consistent foods so comparisons can be made between typically developing children and children with paediatric feeding disorders, and to measure the efficacy of treatment. The Test of Masticating and Swallowing Solids for adults (TOMASS) and children (TOMASS-C) are assessments that use a cracker as a consistent measure to assess chewing skills. Normative data exist for children over 4 years, however, no data are available for younger children. This study investigated age and gender-related differences in mastication skills in typically developing children aged 2-3 years when eating a cracker. METHOD: Thirty participants aged 2;0-3;10 were assessed using an adapted version of the TOMASS-C. Participants were required to eat a single Arnott's Salada cracker, and the number of bites, masticatory cycles, swallows, and duration of time to finish the cracker were measured. RESULT: Two-year-old children used more masticatory cycles and took longer to finish the cracker than 3-year-old children. There were no significant effects of age on the number of swallows and number of bites, and no significant differences between boys and girls. CONCLUSION: This study provides preliminary normative data for chewing skills in children aged 2 and 3 years and confirms that the TOMASS-C is sensitive to developmental changes in mastication within this younger age range. These results expand our understanding of oral motor and chewing development in children.

Assessing and treating conversations with partners in Parkinson's disease: A scoping review of the evidence.

Purpose: This is a scoping review of the methods used in published research to assess conversations and the interventions used to treat conversations between people with Parkinson's disease and their partners. Communication partners were defined as significant others or next-of-kin. The aims were to describe the assessment methods and interventions used, and to identify gaps in the literature.Method: Four online databases were used to identify peer reviewed journal articles in English, which assess and/or treat conversations in this population. The titles and abstracts of the obtained articles were screened and irrelevant articles were excluded. The full texts of the remaining articles were read to determine which studies met the inclusion/exclusion criteria of this review. The methods used, conversational aspects assessed, the treatments conducted and outcome measures used, and the speech and language domains targeted were charted in order to examine the extent of the evidence to inform future research directions.Result: Eight studies met inclusion criteria. "Conversation analysis" was the most widely used method to assess conversations. These studies assessed conversational aspects relating to the domains of pragmatics, fluency, prosody and semantics. They highlighted the role of communication partners to support conversational interactions by using repair strategies during a communication breakdown. Only one study treated conversations by implementing communication partner training.Conclusion: The findings of this review emphasise gaps in the literature. It highlights the need for future research implementing communication partner training. There is also a need to assess conversation skills of partners in order to determine which strategies would be most effective to support their interaction. It highlights the importance of incorporating a participation-based approach to assessment and intervention involving all communication partners. This may lead to enhanced support for people with Parkinson's disease and their families, thus improving their quality of life.

Barriers and Facilitators to Conversation: A Qualitative Exploration of the Experiences of People with Parkinson's and Their Close Communication Partners.

Conversations are an important part of our daily lives, enabling us to interact with others and participate in a range of activities. For people with Parkinson's, conversation can be challenging when communication is impacted. This qualitative exploratory study investigated the experiences of people with Parkinson's and their close communication partners in conversations. The study explored influences on conversational participation, considering perceived barriers and facilitators to participation in conversation for people with Parkinson's. Interviews were conducted with eight dyads, with participants interviewed both jointly and separately (24 interviews). Five themes revealed that conversation appears to be influenced not only by the communication skills of the person with Parkinson's, but also by factors associated with the communication partner, the complex nature of conversations, the communication environment, and the impact of experience in shaping participation in conversation. Specific barriers and facilitators to conversational participation were identified. This study offers important insight into the lived experience of people with Parkinson's affected by communication difficulties. The findings support the notion that it is more than simply the communication skills of the person with Parkinson's that influence conversations. It is important that other factors influencing conversational success should be included in interventions supporting communication for people with Parkinson's.

What can iconic gestures tell us about the language system? A case of conduction aphasia.

BACKGROUND: Speech and language therapists rarely analyse iconic gesture when assessing a client with aphasia, despite a growing body of research suggesting that language and gesture are part of either the same system or two highly integrated systems. This may be because there has been limited research that has systematically analysed iconic gesture production by people with aphasia. AIMS: The aim was to determine whether the gesture production of a participant with conduction aphasia was able to provide information about her language system. METHODS & PROCEDURES: The iconic gestures produced by a participant with conduction aphasia (LT) and five control participants produced during the retelling of a cartoon were analysed. In particular, the iconic gestures produced during lexical retrieval difficulties (co-tip-of-the-tongue (co-TOT) gestures) were compared with the iconic gestures produced during fluent speech (co-speech gestures). OUTCOMES & RESULTS: It was found that LT produced 57 co-speech gestures that were similar in form to the co-speech gestures produced by the control participants (mean = 34.2, standard deviation (SD) = 22.2). LT also produced an additional eleven co-TOT gestures that were unlike her co-speech gestures and unlike the co-speech gestures produced by the control participants. While the co-speech gestures depicted events, the co-TOT gestures depicted 'things' (for example, objects and animals). Furthermore, all but one of the co-TOT gestures produced by LT was classified as a shape-outline gesture, whereas co-speech gestures were rarely classified as shape-outline gestures. LT also produced a new type of gesture that has not previously been described in the literature: a homophone gesture. This co-TOT homophone gesture depicted the homophone of the target word. The iconic gestures produced by LT suggest that she had an intact semantic system but had difficulties with phonological encoding, consistent with a diagnosis of conduction aphasia. This raises the possibility that iconic gesture production can provide evidence about the level of breakdown in the language system. CONCLUSIONS & IMPLICATIONS: A larger study exploring the gestures produced by participants with aphasia is required. The research also highlights the importance of including gesture assessments in SLT's work with adults with acquired language disorder.

Nurses' knowledge of the provision of oral care for patients with dysphagia.

There has been little research on the provision and adaptation of oral care for patients with dysphagia in nursing homes. This study collected data via a questionnaire specifically on the knowledge of oral hygiene and the current oral care practices for patients with dysphagia. Fifty-three registered nurses (RNs) completed the questionnaires. The results of the questionnaire indicated that although RNs gave more oral care daily to their patients with dysphagia than to their patients without dysphagia, they had limited knowledge of drugs that affect oral care and of medical conditions associated with poor oral hygiene. Of particular concern was the limited knowledge of the link between dysphagia, oral hygiene and pneumonia and that some of the current oral care practices may be putting patients who have dysphagia at increased risk of developing pneumonia. These results are discussed in light of previous research on the topic and recommendations are made with regards to oral care training.

Cognitive Reserve, Executive Function, and Memory in Parkinson's Disease.

Cognitive impairment is acknowledged as a feature of Parkinson's disease (PD), and the most common cognitive declines are in executive function (EF) and memory. Cognitive reserve (CR) may offer some protection against cognitive dysfunction in PD. The present study used two proxies of CR (years of education, premorbid IQ) to examine the relationship between CR and (i) EF (ii) memory in a large PD sample (n = 334). Two aspects of EF were examined, including verbal fluency and planning skills. Two aspects of verbal memory were examined, including immediate recall and delayed recall. For EF, both CR proxies significantly predicted verbal fluency, but only years of education predicted planning skills. Years of education significantly predicted immediate recall, but premorbid IQ did not. Neither CR proxy predicted delayed recall. These findings suggest that CR, in particular years of education, may contribute to EF and memory function in those with PD. A key finding of this study is the varying contribution of CR proxies to different aspects of the same cognitive domain. The findings indicate that using only one proxy has the potential to be misleading and suggest that when testing the relationship between CR and cognition, studies should include tasks that measure different aspects of the cognitive domain(s) of interest.

Gesture and speech integration: an exploratory study of a man with aphasia.

BACKGROUND: In order to comprehend fully a speaker's intention in everyday communication, information is integrated from multiple sources, including gesture and speech. There are no published studies that have explored the impact of aphasia on iconic co-speech gesture and speech integration. AIMS: To explore the impact of aphasia on co-speech gesture and speech integration in one participant with aphasia and 20 age-matched control participants. METHODS & PROCEDURES: The participant with aphasia and 20 control participants watched video vignettes of people producing 21 verb phrases in three different conditions, verbal only (V), gesture only (G), and verbal gesture combined (VG). Participants were required to select a corresponding picture from one of four alternatives: integration target, a verbal-only match, a gesture-only match, and an unrelated foil. The probability of choosing the integration target in the VG that goes beyond what is expected from the probabilities of choosing the integration target in V and G was referred to as multi-modal gain (MMG). OUTCOMES & RESULTS: The participant with aphasia obtained a significantly lower multi-modal gain score than the control participants (p<0.05). Error analysis indicated that in speech and gesture integration tasks, the participant with aphasia relied on gesture in order to decode the message, whereas the control participants relied on speech in order to decode the message. Further analysis of the speech-only and gesture-only tasks indicated that the participant with aphasia had intact gesture comprehension but impaired spoken word comprehension. CONCLUSIONS & IMPLICATIONS: The results confirm findings by Records ( 1994 ) that reported that impaired verbal comprehension leads to a greater reliance on gesture to decode messages. Moreover, multi-modal integration of information from speech and iconic gesture can be impaired in aphasia. The findings highlight the need for further exploration of the impact of aphasia on gesture and speech integration.