An Applied Model of Interprofessional Collaboration-Assessment (AMIC-A): A Process-Based Approach to Augmentative and Alternative Communication.

Speech-language pathologists and board-certified behavior analysts both provide important support services to children who are candidates for augmentative and alternative communication. Current assessment practices neglect critical socioecological factors that are necessary to inform communication-based interventions. By leveraging the unique knowledge, research, and expertise of both disciplines, an interprofessional approach to assessment may help realize individualized or precision interventions and personalized supports that address the unique communication needs of each person. The purpose of this article is to introduce a process-based approach to assessment called the "Applied Model of Interprofessional Collaboration-Assessment (AMIC-A)." The AMIC-A will be defined and detailed including the rationale for development, a description of the approach, and recommendations for implementation. A case study example is provided to illustrate implementation of the AMIC-A.

Montreal Cognitive Assessment Scores Do Not Associate With Communication Challenges Reported by Adults With Alzheimer's Disease or Parkinson's Disease.

PURPOSES: Screening for cognitive-communication challenges in people with Alzheimer's disease (AD) or Parkinson's disease (PD) may benefit from multiple kinds of information about the client (e.g., patient-reported, performance-based). The purposes of this report are (a) to describe, using recently published score range descriptors (e.g., "mild," "moderate"), the patient-reported communication challenges of people with AD or PD using the Communicative Participation Item Bank (CPIB) and the Aphasia Communication Outcome Measure (ACOM); and (b) to examine the relationships between the performance-based Montreal Cognitive Assessment (MoCA), a cognitive screener, and patient-reported CPIB and ACOM scores. METHOD: Participants were a convenience sample of 49 community-dwelling adults with AD or PD. Participants completed the measures in person as part of a larger assessment battery. RESULTS: MoCA total scores ranged from 7 to 28. CPIB T-scores fell in the following ranges: 31% were "within normal limits," 57% reflected "mildly" restricted participation, and 12% reflected "moderately" restricted participation. ACOM T-scores fell in the following ranges: 50% were either "within normal limits" or reflected "mild" impairment, 29% reflected "mild-moderately" impaired functional communication, and 21% reflected "moderately" impaired functional communication. There were only weak and nonsignificant correlations between T-scores on the ACOM or CPIB and scores on the MoCA, and there were no group differences on the ACOM or CPIB between individuals who screened positive versus negative on the MoCA. CONCLUSION: When screening individuals with AD or PD, patient-reported communication challenges seem to be complementary to information provided by the MoCA and perhaps most useful in screening for mild communication challenges.

Pain assessment tools in adults with communication disorders: systematic review and meta-analysis.

BACKGROUND: Verbal communication is the "gold standard" for assessing pain. Consequently, individuals with communication disorders are particularly vulnerable to incomplete pain management. This review aims at identifying the current pain assessment instruments for adult patients with communication disorders. METHODS: A systematic review with meta-analysis was conducted on PubMed, PEDRO, EBSCOhost, VHL and Cochrane databases from 2011 to 2023 using MeSH terms "pain assessment, "nonverbal communication" and "communication disorders" in conjunction with additional inclusion criteria: studies limited to humans, interventions involving adult patients, and empirical investigations. RESULTS: Fifty articles were included in the review. Seven studies report sufficient data to perform the meta-analysis. Observational scales are the most common instruments to evaluate pain in individuals with communication disorders followed by physiological measures and facial recognition systems. While most pain assessments rely on observational scales, current evidence does not strongly endorse one scale over others for clinical practice. However, specific observational scales appear to be particularly suitable for identifying pain during certain potentially painful procedures, such as suctioning and mobilization, in these populations. Additionally, specific observational scales appear to be well-suited for certain conditions, such as mechanically ventilated patients. CONCLUSIONS: While observational scales dominate pain assessment, no universal tool exists for adults with communication disorders. Specific scales exhibit promise for distinct populations, yet the diverse landscape of tools hampers a one-size-fits-all solution. Crucially, further high-quality research, offering quantitative data like reliability findings, is needed to identify optimal tools for various contexts. Clinicians should be informed to select tools judiciously, recognizing the nuanced appropriateness of each in diverse clinical situations. TRIAL REGISTRATION: This systematic review is registered in PROSPERO (International prospective register of systematic reviews) with the ID: CRD42022323655 .

Stakeholder views on cognitive communication assessment and intervention for a person living independently in the community with severe traumatic brain injury.

BACKGROUND: Cognitive communication disorder (CCD) following traumatic brain injury (TBI) is well documented and these communication problems impede successful re-integration into community living. While there is growing evidence for intervention to both detect and treat the impact of these deficits across the rehabilitation continuum, there are barriers to accessing services. Cognitive communication impairments may be missed because the person can talk, and this may mask the subtle but debilitating impact of a CCD. Referral to a speech and language therapist (SLT) may be overlooked or not timely, which prevents the individual accessing evidence-based interventions. Inadequate treatment provision and an under- or overestimation of communication capability can potentially undermine the effectiveness of wider team assessment and intervention. AIMS: To report stakeholder views on specialist SLT input for CCD within a multidisciplinary team intervention for a community-dwelling individual with severe TBI. The investigation explored perspectives on understanding of CCD, on practice and on outcomes, in order to inform professional groups on perceived impacts of the evidence-to-practice gap. METHODS AND PROCEDURES: A semi-structured interview methodology was employed with 11 stakeholder participants involved in a single case. Data were evaluated using a thematic framework method. Themes were inductively derived from the stakeholder narratives. OUTCOMES: Stakeholders reported the following outcomes from specialist SLT input for CCD within a collaborative team approach: improved engagement with rehabilitation and support teams, improved health-related quality of life and well-being, and increased client participation in community activities of personal relevance. Stakeholders also reported inequities in wider service provision where limitations in professional understanding of CCD and knowledge of best practice recommendations preclude access to specialist SLT services. CONCLUSIONS: CCDs are under-recognised and this can have a devastating effect on people with CCD and on those around them. Stakeholder reports provide evidence for the effectiveness of SLT practice recommendations for the treatment of CCD following TBI. They also provide additional evidence of persisting barriers to accessing treatment. Future research to explore ways to close this evidence-to-practice gap is required. WHAT THIS PAPER ADDS: What is already known on this subject Cognitive communication difficulties are a well-documented consequence of TBI. There is evidence for the effectiveness of person-centred interventions for CCD across the recovery continuum. International evidence-based practice recommendations are in place for CCD assessment and management. Barriers to accessing SLT expertise for CCD have previously been reported. What this paper adds to existing knowledge This investigation explores the views of a diverse group of stakeholders involved in a single case of a community-dwelling individual with severe TBI. Stakeholders report positive real-world outcomes from SLT interventions for CCD within a coordinated multidisciplinary rehabilitation team. Stakeholder reports also indicate inequities in wider service provision and CCD knowledge gaps amongst professional groups providing rehabilitation services for people with TBI. What are the potential or actual clinical implications of this work? CCDs are under-recognised, with devastating effect for people with CCD and those around them. These findings underscore the importance of raising professional awareness of CCD and best practice recommendations, in order to improve access to SLT expertise for people with CCD following TBI.

Memory and Traumatic Brain Injury: Assessment and Management Practices of Speech-Language Pathologists.

PURPOSE: Memory impairments are among the most commonly reported deficits and among the most frequent rehabilitation targets for individuals with traumatic brain injury (TBI). Memory and learning are also critical for rehabilitation success and broader long-term outcomes. Speech-language pathologists (SLPs) play a central role in memory management for individuals with TBI across the continuum of care. Yet, little is known about the current practice patterns of SLPs for post-TBI memory disorders. This study aims to examine the clinical management of memory disorders in adults with TBI by SLPs and identify opportunities to improve post-TBI memory outcomes. METHOD: SLPs from across the continuum of care were recruited to complete an online survey. The survey assessed key practice areas specific to memory and memory disorders post-TBI, including education and training, knowledge and confidence, and assessment and treatment patterns. RESULTS: Surveys from 155 SLPs were analyzed. Results revealed that TBI-specific training remains low in the field. Respondents varied in their practice patterns in assessing and treating memory disorders. Most SLPs do not appear to have access to appropriate standardized assessments to measure unique forms of memory. Respondents also reported a range of barriers and opportunities to advance memory outcomes following TBI and provided suggestions of areas in which they would like to see more basic and clinical research. CONCLUSIONS: These findings establish a baseline of the current practices for clinical management of memory impairment in adults with TBI by SLPs. Improved opportunities for clinician training, the development of a single tool to assess multiple forms of memory, better access to existing memory assessments, and implementation of evidence-based interventions promise to lead to improved memory outcomes for individuals with TBI.

"The barriers are plentiful." Speech-language pathologists' perspectives of enablers and barriers to hearing assessment for children in metropolitan, regional, and rural Australia: A mixed methods study.

PURPOSE: Access to hearing assessment is important for children, as poor auditory information can lead to poor speech and oral language development. This study aims to identify enablers and barriers to accessing hearing assessments for Australian children from the perspective of speech-language pathologists (SLPs), comparing access in metropolitan, regional, and rural areas. METHOD: This is a sequential, explanatory mixed-methods study. Forty-nine participants completed the quantitative survey and 14 participated in semi-structured interviews. The study was undertaken online and included participants from metropolitan, regional, and rural parts of Australian states and territories. RESULT: Similar accessibility issues were experienced across geographic locations and access to hearing assessment was related to the complexity of individual contexts. Speech-language pathologists felt that awareness and knowledge of hearing loss was low in parents and health professionals. Participants discussed barriers such as long wait times, complex criteria, and inefficient services that lead to compromised outcomes for clients. CONCLUSION: Barriers to hearing assessment are extensive and multifaceted. Future research might examine the accessibility of the health system in light of the barriers discussed in this research, and whether policies and procedures could be adapted to allow more easily accessible services.

Assessment of Developmental Language Disorder in Multilingual Children: Results from an International Survey.

INTRODUCTION: The Multilingual-Multicultural Affairs Committee of the International Association of Communication Disorders (IALP) conducted a survey of diagnostic criteria for developmental language disorder (DLD) in multilingual children to discover how clinicians apply terminology and diagnostic criteria to multilingual children in different parts of the world. METHODS: An international web survey was used to survey 354 participants from 44 countries about their assessment practices, and clinical opinions about assessing multilingual children for DLD. RESULTS: The findings show that most clinicians felt confident in assessing multilingual children, and they applied the DLD terminology and inclusionary criteria to multilingual children with difficulty learning language. Clinicians used different procedures to assess heritage and societal languages. Barriers to access to services included a lack of knowledge by parents and referral sources about services available and typical multilingual development, with additional reasons differing by geographical region. DISCUSSION: Speech pathologists across the globe have many similarities in the way that they assess multilingual children. Differences may be attributed to clinical experience, professional education, the clinician's role, the system they work in, and the clinician's own language skills. This paper advances knowledge of current clinical practices, which can be used to evaluate frameworks in international and national contexts, with implications for policy and practice to improve access to clinical services.

Identification of a know-do gap: An observational study of the assessment and treatment of dysphagia during inpatient stroke rehabilitation in primary healthcare in Norway.

PURPOSE: Oropharyngeal dysphagia is a common swallowing impairment post-stroke managed by speech language pathologists (SLP). This article aims to demonstrate a local know-do gap assessment for usual dysphagia care for patients undergoing inpatient stroke rehabilitation in primary healthcare in Norway, which included an assessment of the functional level of the patients and characteristics and outcomes of treatment. MATERIALS AND METHODS: In this observational study, we assessed the outcomes and interventions of patients admitted to inpatient rehabilitation following stroke. The patients received usual care from SLPs while the research team administered a dysphagia assessment protocol that included assessment of several swallowing domains including oral intake, swallowing, patient self-reported functional health status and health-related quality of life, and oral health. The treating SLPs documented the treatments provided in a treatment diary. RESULTS: Of 91 patients who consented, 27 were referred for SLP and 14 received treatment. During the median treatment period of 31.5 days (IQR = 8.8-57.0), patients received 7.0 treatment sessions (IQR = 3.8-13.5) of 60 minutes (IQR = 55-60). The patients who received SLP treatment demonstrated no/minor disorders (n = 7) and moderate/severe disorders (n = 7). Dysphagia treatments primarily included oromotor training and advice on bolus modification and were provided without association to dysphagia severity. Patients with moderate/severe swallowing impairments received slightly more SLP sessions over a longer time. CONCLUSIONS: This study identified gaps between current and best practices and opportunities to improve assessment, decision-making, and implement evidence-based practices.

A Delphi survey-based development and validation of cognitive-communication assessment tool for Indian preschoolers.

PURPOSE: To address the need for a standardized assessment tool for assessing cognitive-communication abilities among Indian preschoolers, the current study aimed at describing a Delphi based development and validation process for developing one such tool. The objectives of the research were to conceptualize and construct the tool, validate its content, and assess its feasibility through pilot testing. METHODS: The study followed a Delphi approach to develop and validate the tool across four phases i.e. conceptualization; construction; content validation; and pilot testing. The first three phases were performed with a panel of six experts including speech-language pathologists and preschool teachers while the pilot testing was done with 20 typically developing preschoolers. A literature review was also conducted with the Delphi rounds to support the developmental process. RESULTS: The first two rounds of the Delphi aided in the construction of a culturally and linguistically suitable story-based cognitive-communication assessment tool with the memory (free recall, recognition, and literary recall) and executive function (reasoning, inhibition, and switching) related tasks relevant for preschoolers. The content validation of the tool was continued with the experts till the revisions were satisfactory and yielded an optimum Content Validity Index. The pilot test of the finalized version confirmed its feasibility and appropriateness to assess developmental changes in the cognitive-communication abilities of preschoolers. CONCLUSION: The study describes the Delphi-based conceptualization, construction, content validation, and feasibility check of a tool to assess cognitive-communication skills in preschool children.

Supporting Culturally Responsive Assessment Practices With Preschoolers: Guidance From Methods in the Jamaican Context.

PURPOSE: There is a shortage of available methods to accurately inform the developmental status of children whose cultural and linguistic backgrounds vary from the mainstream. The purpose of this review article was to describe different approaches used to support the accurate characterization of speech, language, and functional communication in children speaking Jamaican Creole and English, an understudied paradigm in the speech pathology research. METHOD: Approaches used across four previously published studies in the Jamaican Creole Language Project are described. Participants included 3- to 6-year-old Jamaican children (n = 98-262) and adults (n = 15-33). Studies I and II described validation efforts about children's functional communication using the Intelligibility in Context Scale (ICS; speech) and the Focus on the Outcomes of Communication Under Six (FOCUS; speech and language). Study III described efforts to accurately characterize difference and disorder in children's expressive grammar using adapted scoring, along with adult models to contextualize child responses. Last, Study IV applied acoustic duration (e.g., whole word) and an adapted scoring protocol to inform variation in speech sound productions in the Jamaican context where a post-Creole continuum exists. RESULTS: Studies I and II offered promising psychometric evidence about the utility of the ICS and the FOCUS. Study III revealed strong sensitivity and specificity in classifying difference and disorder using adult models. Last, in Study IV, linguistically informed acoustic analyses and an adapted protocol captured variation in speech productions better than a standard approach. CONCLUSIONS: Applying culturally responsive methods can enhance the accurate characterization of speech, language, and functional communication in Jamaican children. The innovative methods used offer a model approach that could be applied to other linguistic contexts where a mismatch exists between speech-language pathologists and their clientele. PRESENTATION VIDEO: https://doi.org/10.23641/asha.23929461.

Assessment of mouth breathing by Speech-Language Pathologists: an international Delphi consensus.

PURPOSE: mouth breathing (MB) has detrimental effects on children's growth. Diagnosis of MB is possible through a multidisciplinary approach including Speech-Language Pathologist's (SLP) assessment; however, SLPs currently have little to no defined selection criteria to determine the awake and habitual breathing pattern. This study aims at identifying relevant criteria for the assessment of the habitual and awake breathing pattern of preschool children, and developing a grid that would help SLPs diagnose MB in their clinical practice. METHODS: A three-rounded online international Delphi process was conducted to achieve a consensus on the relevant items and their interpretation. Agreement was established through a Content Validity Ratio calculation. Based on the agreed items, we developed a grid through a scoring function. RESULTS: Observing the child at rest (i.e., time spent with an open/closed mouth and position of the tongue/lips) was considered the most important criterion. The experts also considered that observing the breathing pattern while chewing (open/closed mouth) and after swallowing (i.e., air intake and open/ closed mouth just after swallowing) should provide relevant but secondary information in decision-making. We were able to establish a clinical grid based on those criteria. CONCLUSION: The Delphi procedure provided content-valid criteria and conditions of observation for the myofunctional SLP assessment of the awake and habitual breathing pattern in preschoolers. A clinical validation of the developed prototype grid should be conducted in preschool children to explore its effectiveness in the diagnosis of MB.

Prevalence and sociodemographic characteristics of US community-dwelling older adults with communication disabilities, using the national health and aging trends survey.

INTRODUCTION: Identifying the population-level prevalence of a disability group is a prerequisite to monitoring their inclusion in society. The prevalence and sociodemographic characteristics of older adults with communication disabilities (CDs) are not well established in the literature. In this study we sought to describe the prevalence and sociodemographic characteristics of community-dwelling older adults experiencing difficulties with understanding others or being understand when communicating in their usual language. METHODS: We conducted a cross-sectional analysis of the National Health and Aging Trends Survey (2015), a nationally representative survey of Medicare beneficiaries ages ≥ 65 years old (N = 7,029). We calculated survey weight-adjusted prevalence estimates by mutually exclusive subgroups of no, hearing only, expressive-only, cognitive only, multiple CDs, and an aggregate any-CD prevalence. We described race/ethnicity, age, gender, education, marital status, social network size, federal poverty status, and supplemental insurance for all groups. Pearson's chi-squared statistic was used to compare sociodemographic characteristics between the any-CD and no-CD groups. RESULTS: An estimated 25.3% (10.7 million) of community-dwelling older adults in the US experienced any-CDs in 2015; approximately 19.9% (8.4 million) experienced only one CD while 5.6% (2.4 million) had multiple. Older adults with CDs were more likely to be of Black race or Hispanic ethnicity as compared to older adults without CDs (Black 10.1 vs. 7.6%; Hispanic: 12.5 vs. 5.4%; P < 0.001). They also had lower educational attainment (Less than high school: 31.0 vs 12.4%; P < 0.001), lower poverty levels (<100% Federal poverty level: 23.5% vs. 11.1%; P < 0.001) and less social supports (Married: 51.3 vs. 61.0%; P < 0.001; Social network ≤ 1 person: 45.3 vs 36.0%; P < 0.001). CONCLUSIONS: The proportion of the older adult population experiencing any-CDs is large and disproportionately represented by underserved sociodemographic groups. These findings support greater inclusion of any-CDs into population-level efforts like national surveys, public health goals, health services, and community research aimed at understanding and addressing the access needs of older adults who have disabilities in communication.

Is Articulation Assessment via Synchronous Telepractice as Reliable as In-Person Assessment?

PURPOSE: This study aimed to determine whether articulation assessment via telepractice is as reliable as in-person assessment. METHOD: Thirty-four children aged 4-11 years with speech sound disorder (SSD) participated in the study. The Articulation Subtest (SET) of the Turkish Articulation and Phonology Test (SST) was used to assess the children's articulation skills. The study's procedures comprised two stages. First, in the Baseline Pilot Stage, five speech-language pathologists (SLPs; four graduate SLPs and one SLP with a PhD degree) conducted in-person assessments on seven children, and their agreement was examined (α for five SLPs = .950; p < .0001). In the Main Assessment Stage, four SLPs assessed 27 children synchronously on four separate days through either online (two SLPs) or in-person (the other two SLPs) clinician roles, which changed daily. Online evaluators did not use microphones and headphones to avoid any advantage. The agreement among the four raters was examined by calculating the intraclass correlation coefficient. RESULTS: The results revealed an excellent level of agreement regarding overall assessment between online and in-person clinicians (p < .0001). All articulation manners were acceptable, good, or excellent. However, some sounds' (α < .7 for /d/, /É£/, /b/; α < .8 for /p/, /ʃ/, /t/, /l/, /v/) reliability levels were relatively low compared with others. CONCLUSIONS: There may be certain restrictiveness regarding discriminating visual or auditory clues related to certain phonemes in a telepractice environment. This restrictiveness may be related with sonority and with differentiation between minimal pairs where visual clues are limited.

The impact of climate-related disasters on children's communication and wellbeing: Addressing Sustainable Development Goals.

PURPOSE: Natural disasters can significantly impact children's health, development, and wellbeing, as well as their access to education and support services (including speech-language pathology). Children's needs are often overlooked in the urgent aftermath of natural disasters. This is especially true for children with communication difficulties. This commentary explores the impacts of bushfire on Australian children, to propose a sustainable, community-based approach to supporting children's health, wellbeing, and communication. RESULT: The Royal Far West Bushfire Recovery Program, a multidisciplinary allied health program, supported children's recovery, resilience, and development in the aftermath of Australia's Black Summer bushfires in 2019-2020. Children learnt coping strategies and were more able to communicate with adults and peers about their feelings and experiences, but residual impacts of bushfires remained for some children. Allied health telepractice services, including speech-language pathology, enhanced access for vulnerable children, highlighting the potential for technology to provide high-quality services to support recovery, particularly in remote areas. CONCLUSION: Climate change increases the frequency and severity of bushfires and other natural disasters with significant consequences for vulnerable and at-risk communities. Children with communication needs are particularly vulnerable during and following these disasters. High quality, evidence-based interventions are needed to support the health, wellbeing, and communication needs of children, with opportunities for involvement of speech-language pathologists. This commentary paper focusses on SDG 1, SDG 3, SDG 4, SDG 9, SDG 10, SDG 11, SDG 13, and SDG 15.

Questions of suitability: The Sustainable Development Goals.

PURPOSE: To stimulate critical thought, to challenge how speech-language pathologists (SLPs) achieve Sustainable Development Goals (SDGs) in supporting people with swallowing/communication disabilities, using a critical, political conscientisation approach. RESULT: We generate data from our professional and personal experiences interpreted through a decolonial lens to demonstrate how Eurocentric attitudes and practices are at the core of SLPs' knowledge base. We highlight risks associated with SLPs' uncritical use of human rights, the bases of the SDGs. CONCLUSION: While SDGs are useful, SLPs should take the first steps of becoming politically conscientised to consider whiteness, to ensure that deimperialisation and decolonisation are tightly woven into our sustainable development work. This commentary paper focusses on the SDGs a whole.

Diversity in the Australian speech-language pathology workforce: Addressing Sustainable Development Goals 3, 4, 8, and 10.

PURPOSE: Individuals have multiple intersecting identities, unique perspectives, and experiences which provide opportunities for new ways to interact, support inclusion and equity, and address the Sustainable Development Goals (SDGs). This commentary explores the diversity of the speech-language pathology workforce in Australia. RESULT: A survey of Australian speech-language pathologists (SLPs; n = 1,638) distributed in November and December 2021 explored personal characteristics and experiences of the workforce. Almost 30% of SLPs who responded reported having experiences or perspectives that were relevant to service users and a quarter described other lived experiences, which included disability, cultural and linguistic background, mental health, caring responsibilities, neurodiversity, and being LGBTQI+. CONCLUSION: This commentary affirms the value of diversity among allied health professions to enrich practice with individuals and communities. By understanding the diversity of the speech-language pathology workforce and perspectives of historically marginalised or invisible groups, the profession can introduce strategies to more meaningfully engage and support people with diverse backgrounds and perspectives in the workforce and enhance service equity and accessibility for people with communication and swallowing disabilities. This commentary focusses on SDG 3, SDG 4, SDG 8, SDG 10.

The role of service providers' linguistic backgrounds on assessment of multilingual children.

INTRODUCTION: Cultural and linguistic competencies play a critical role in speech-language pathology services when working with people from diverse linguistic backgrounds with communication disorders (CD; Hopf et al., 2021). The personal experiences of speech-language pathologists (SLPs) influence their cultural and linguistic competence skills. Training programs that consider these personal factors might address the unique needs of the SLPs based on their experiences. The current research explores the connection between the linguistic backgrounds of the SLPs and the challenges and needs they reported while assessing multilingual children with CD. METHOD: This study uses a survey method for documenting and comparing 105 SLPs with varying linguistic backgrounds - monolingual, bilingual, and multilingual - on their reported challenges and needs associated with evaluating communication abilities in children from multilingual families with CD. RESULTS: Although all the SLPs worked with children from multilingual families, their linguistic backgrounds introduced differences in their clinical assessment opinions. Across all SLPs in the study, common challenges were the limited availability of interpreters, dedicated assessment materials, multilingual clinical supervisors, and pre-professional training opportunities. CONCLUSION: This study provides valuable information on the effects of linguistic backgrounds on the clinical opinions of SLPs and alludes to the importance of personal experiences on clinical practices. Future research that examines other personal factors and their effects on the SLPs' clinical opinions and practices will help the development of evidence-based cultural and linguistic competence training programs.

The Excess Costs of Hospitalization for Acute Stroke in People With Communication Impairment: A Stroke123 Data Linkage Substudy.

OBJECTIVE: To describe the costs of hospital care for acute stroke for patients with aphasia or dysarthria. DESIGN: Observational study from the Stroke123 project. SETTING: Data from patients admitted with stroke (2009-2013) from 22 hospitals in Queensland participating in the Australian Stroke Clinical Registry (AuSCR) were linked to administrative datasets. PARTICIPANTS: Communication impairments were identified using International Classification of Diseases, 10th Revision, Australian Modification codes. Overall, 1043 of 4195 (25%) patients were identified with aphasia (49% were women; median age 78 years; 83% with ischemic stroke), and 1005 (24%) with dysarthria (42% were women; median age 76 years; 85% with ischemic stroke). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Linked patient-level, hospital clinical costing related to the stroke, were adjusted to 2013/2014 Australian dollars (AU$, US$ conversion x 0.691) using recommended national price indices and multivariable regression analysis with clustering by hospital performed. RESULTS: Compared with patients without aphasia, the median hospital costs/patient were greater for those with aphasia for medical (aphasia AU$2273 vs AU$1727, P<.001), nursing (aphasia AU$3829 vs AU$2748, P<.001) and allied health services (aphasia AU$1138 vs AU$720, P<.001). Similarly, costs were greater for patients with dysarthria compared with those without dysarthria. Adjusted median total costs were AU$2882 greater for patients with aphasia compared with patients without aphasia (95% confidence interval, AU$1880-3884), and AU$843 greater for patients with dysarthria compared with those without dysarthria (95% confidence interval, AU$-301 to 1987). CONCLUSIONS: People with communication impairment after stroke incur greater hospital costs, in particular for medical, allied health, and nursing resources.

Interpersonal violence experienced by people with communication disabilities in Iraq: Sustainable Development Goals 16 and 5.

PURPOSE: This paper presents an analysis of interpersonal identity-based violence experienced by persons with communication disabilities in Iraq and the barriers reported to accessing supports. The use of communication accessible data collection tools is discussed as a means of enabling an inclusive response for multiple marginalised groups in relation to Sustainable Development Goals (SDGs) 16 and 5. RESULT: People with communication disabilities reported similar levels of interpersonal violence to those with disabilities of other types, characterised by high rates of deprivation and physical violence. Many participants did not seek support, but those that did were most likely to speak to a family member or friend, followed by consulting legal services. Barriers to accessing support were varied, with lack of transport being the most commonly reported. Satisfaction with research communication supports was high for all participants, including those with no communication difficulties, suggesting that the resources invested in communication access have benefits beyond those with communication disabilities. CONCLUSION: Iraqi persons with communication disabilities, like those with other disabilities, face high levels of interpersonal violence. The use of communication supports in research addressing disability is likely to increase the representation of persons with communication disability in study samples and can benefit participants with other disabilities. This commentary paper, available in Arabic as a supplemental file, focusses on SDG 16 and also addresses SDG 5.