A Role for Health Literacy in Protecting People With Limited English Proficiency Against Falling: A Retrospective, Cohort Study.

OBJECTIVE: To identify risk factors related to falls within the scope of speech-language pathology (SLP) using assessments from the Inpatient Rehabilitation Facility-Patient Assessment Instrument over a 4-month period in 4 inpatient rehabilitation facilities (IRFs). DESIGN: Observational retrospective cohort study. SETTING: Four IRFs as part of a larger learning health system. PARTICIPANTS: Adults aged ≥18 years admitted to the IRFs from October 1, 2022 to February 28, 2023 were included. INTERVENTION: N/A. MAIN OUTCOME MEASURES: Occurrence of falls. RESULTS: Analyses of 631 patient records revealed that the odds of falling were almost 3 times greater in people with limited English proficiency than in English speakers (odds ratio [OR], 2.92; 95% confidence interval [CI], 1.09-6.85). People with limited English proficiency who reported poorer health literacy had 4 times higher odds of falling (OR, 3.90; 95% CI, 1.13-13.44) than English speakers who reported adequate health literacy. People with limited English proficiency who reported adequate health literacy had the same risk of falling as English speakers (OR, 0.98; 95% CI, 0.16-6.12), suggesting the protective role of health literacy for people with limited English proficiency. CONCLUSIONS: Language barriers have a significant effect on falls among patients in IRFs. SLPs improving health literacy and providing language support may play a crucial role in mitigating fall risk, thereby enhancing patient safety and outcomes.

Developing pre-licensure interprofessional and stroke care competencies through skills-based simulations.

Interprofessional collaboration (IPC) in stroke care is accepted as best practice and necessary given the multi-system challenges and array of professionals involved. Our two-part stroke team simulations offer an intentional interprofessional educational experience (IPE) embedded in pre-licensure occupational therapy, physical therapy, pharmacy, medicine, nursing and speech-language pathology curricula. This six-year mixed method program evaluation aimed to determine if simulation delivery differences necessitated by COVID-19 impacted students' IPC perception, ratings, and reported learning. Following both simulations, the Interprofessional Collaborative Competency Assessment Scale (ICCAS) and free-text self-reported learning was voluntarily and anonymously collected. A factorial ANOVA using the ICCAS interprofessional competency factors compared scores across delivery methods. Content and category analysis was done for free-text responses. Overall, delivery formats did not affect positive changes in pre-post ICCAS scores. However, pre and post ICCAS scores were significantly different for interprofessional competencies of roles/responsibilities and collaborative patient/family centered approach. Analysis of over 10,000 written response to four open-ended questions revealed the simulation designs evoked better understanding of others' and own scope of practice, how roles and shared leadership change based on context and client need, and the value of each team member's expertise. Virtual-experience-only students noted preference for an in-person stroke clinic simulation opportunity.

Leading the Way in Dementia Care: Embracing the Whole Person.

Audrey Holland was a leading innovator and speech-language pathologist (SLP) in adult neurological communication disabilities for over five decades. She was a pioneer in the involvement of SLPs with people with dementia, inspiring both knowledge development and clinical practice regarding language, functional communication, and quality of life in persons living with dementia. Dr. Holland was also an extraordinary mentor who has impacted many generations of researchers and clinicians. Here, four researchers in the area of dementia and communication discuss the lessons they learned from Dr. Holland that fundamentally shaped their careers and the field of dementia and speech-language pathology. Lessons learned include the following: (1) do not be afraid to stand out when you have a novel idea that will help people; (2) look for strengths to support functional communication; (3) use communication strategies to support identity, quality of life, and self-determination in adults with acquired communication disabilities, including those with dementia; (4) shift from pathologizing to coaching; and (5) challenge the status quo. This article concludes by discussing Dr. Holland's lasting legacy.

Creating Positive Environments in Skilled Nursing Facilities to Support Best Practice Implementation: An Overview and Practical Suggestions.

The purpose of this article is to discuss various types of organizational cultures and climates in relationship to best practice implementation. Although not specific to speech-language pathology, positive organizational cultures and climates are associated with better clinician and patient outcomes in health care services than dysfunctional and/or hierarchical organizational cultures and climates. A goal of this article is to help the practicing speech-language pathologist (SLP) promote positive culture change in the skilled nursing facility (SNF) setting. Recommendations to improve the organizational culture and climate of SNFs will be presented through practical examples of collaborative practice. Further suggestions will be surmised from the organizational psychology and interprofessional education literature. The connection between organizational culture and climate, interprofessional education, collaborative practice, and SLPs' best practice implementation in the SNF setting will be discussed. Avenues for future work are suggested.

Stitching a new garment: Considering the future of the speech-language therapy profession globally.

Providing equitable support for people experiencing communication disability (CD) globally is a historical and contemporary challenge for the speech-language therapy profession. A group of speech-language therapists (SLTs) with ongoing and sustained experiences in Majority and Minority World contexts participated in five virtual meetings in 2021. The aim of these meetings was to develop provocative statements that might spur a global discussion among individuals and organisations that support people experiencing CD. The following questions were discussed: What is our vision for the future of the profession globally? What are the global challenges around access to speech-language therapy services?Four main themes emerged: (1) the need to centre people experiencing CD as the focal point of services, (2) participation, (3) equity and (4) community. The themes relate to the need for a process of de-imperialism in the profession. Suggestions were made to develop more suitable terminology and to establish a global framework that promotes more equitable access to communication services. We seek the adoption of approaches that focus on reciprocal global engagement for capacity strengthening. Alternative models of culturally sustaining and equitable service delivery are needed to create impact for people experiencing CD, and their families worldwide.Contribution: Provocative statements were developed to prompt global conversations among speech-language therapy professionals and associations. We encourage readers to consider the questions posed, share their viewpoints and initiate positive change towards a global strategy.

Successes and challenges of speech language therapy service provision in Western Kenya: Three case studies.

BACKGROUND: The need for communication-related services in sub-Saharan Africa to support individuals experiencing communication disability is a longstanding and well-documented situation. We posit the inequities highlighted by coronavirus disease 2019 (COVID-19) make this a relevant time for speech language therapists and the professional bodies that govern us to broadly consider our roles and practices in education, health and disability in local, national and global contexts. OBJECTIVE: To illustrate what services developed with local knowledge can look like in Kenya in order to promote dialogue around alternative speech language therapy models, particularly in contexts where there are insufficient services, few trained speech language therapists and limited structures to support the emerging profession. METHOD: This article examines three clinical case studies from Western Kenya, using a conceptual framework for responsive global engagement. RESULTS: Service needs in Western Kenya well exceed a direct one-on-one model of care that is common in the minority world. The service delivery models described here emphasise training, skills sharing and engaging the myriad of communication partners available to individuals with communication disabilities. CONCLUSION: We offer up these case studies of collaborative practice as contextual realities that may be present in any speech language therapy programming in under-resourced communities. We dispel the idea that success in this work has been linear, progressed on planned time frames or come to fruition with targeted goal attainment. The fact that our relationships have endured in these communities since 2007 is our primary success.

Speech-language pathology and ethical practice in global contexts.

Given the growing professional interest of speech-language pathologists (SLP) in global development work and the opportunities for minority world health providers to use their skills internationally, conversations about what SLPs do when working in majority world settings, and how they do it are imperative. This paper presents case studies of speech-language pathology work in global settings examined within the context of ethical frameworks developed by: The American Speech-Language-Hearing Association, Speech-Language and Audiology Canada, and Speech Pathology Australia. These case studies drawn from personal experiences working as SLPs in majority world contexts are used to discuss the following issues: (1) the need for honest and reflective conversations about SLPs' motivations for engagement in global work; (2) the need to consider how funds are used to have the biggest and most sustainable impact on emerging professional contexts; (3) the necessity of long-term mutually beneficial global partnerships; (4) critical examination of culturally appropriate speech-language pathology services and recommendations; (5) learning to listen to majority world colleagues; (6) creating opportunities for majority world colleagues to represent themselves at conferences, meetings and in the literature, and; (7) the crucial role university staff play in fostering ethical and sustainable speech-language pathology practices.

An evidence-based systematic review on cognitive interventions for individuals with dementia.

PURPOSE: To evaluate the current state of research evidence related to cognitive interventions for individuals with Alzheimer's disease or related dementias. METHOD: A systematic search of the literature was conducted across 27 electronic databases based on a set of a priori questions, inclusion/exclusion criteria, and search parameters. Studies were appraised for methodological quality and categorized according to intervention technique and outcome (e.g., cognitive-communication impairment or activity limitation/participation restriction). Results were summarized and, when possible, analyzed quantitatively using indicators of treatment effect size. RESULTS: Forty-three studies met criteria for inclusion in the review. The most commonly used cognitive intervention techniques used were errorless learning, spaced-retrieval training, vanishing cues, or verbal instruction/cueing. Most treatment outcomes were measured at the cognitive-communication impairment level of functioning and were generally positive. However, results should be interpreted cautiously because of methodological limitations across studies. CONCLUSIONS: Research evidence to support the use of cognitive interventions for individuals with dementia is accumulating. Researchers are beginning to evaluate treatment efficacy, yet the focus tends to be on discovery, specifically, refining intervention variables that will facilitate optimal outcomes. Implications for clinical practice and avenues for future research are discussed.