Rehabilitation Supported by Immersive Virtual Reality for Adults With Communication Disorders: Semistructured Interviews and Usability Survey Study.

BACKGROUND: Individuals who have acquired communication disorders often struggle to transfer the skills they learn during therapy sessions to real-life situations. Immersive virtual reality (VR) technology has the potential to create realistic communication environments that can be used both in clinical settings and for practice at home by individuals with communication disorders. OBJECTIVE: This research aims to enhance our understanding of the acceptance, usefulness, and usability of a VR application (SIM:Kitchen), designed for communication rehabilitation. Additionally, this research aims to identify the perceived barriers and benefits of using VR technology from the perspective of individuals with acquired communication disorders. METHODS: Semistructured interviews and usability surveys were conducted with 10 individuals with acquired neurogenic communication disorders aged 46-81 (mean 58, SD 9.57) years after trialing an immersive VR application. The audio-recorded interviews were transcribed and analyzed to identify themes. RESULTS: The quantitative data regarding the usability of the system associated with participants' immersion experience in the VR application were promising. Findings from semistructured interviews are discussed across five key thematic areas including (1) participant's attitude toward VR, (2) perceived usefulness of the VR system, (3) perceived ease of use of the VR system, (4) their willingness to continue using VR, and (5) the factors they perceived as challenges or facilitators to adopting this VR technology. CONCLUSIONS: Overall, participants in this study found the VR experience to be enjoyable and were impressed by the realism of the VR application designed for communication rehabilitation. This study highlighted personally relevant, immersive VR interventions with different levels of task difficulty that could enhance technology uptake in the context of communication rehabilitation. However, it is essential that VR hand controller technology is refined to be more naturalistic in movement and able to accommodate user capabilities.

Assessment of communication competence in acquired communication disorders: A systematic scoping review.

PURPOSE: Individuals with acquired communication disorders (ACDs) experience reduced ability to participate independently in activities of daily life, and maintain interpersonal relationships and psychosocial wellbeing. Communication interventions are designed to optimise communication competence in personally relevant everyday activities. However, the assessment tools speech-language pathologists (SLPs) typically utilise to evaluate communication competence in everyday life are not ideal. To explore the range and availability of assessments used in research to examine functional communication in adults with ACDs. METHOD: Five databases (Medline, CINAHL, EMBASE, SCOPUS and PsycINFO) were searched to identify assessment or intervention studies evaluating functional communication in adults with ACDs. Functional communication tools utilised in each study were identified. Extracted tools were categorised according to type, target population, consideration of multimodal communication, person-specificity, consideration of context, availability, administration/analysis time and availability of normative/psychometric data. RESULT: Forty functional communication assessment tools were included. Just over half the tools were performance-based (n = 25), examined different modes of communication (n = 26) and/or considered context (n = 23). Only 14 tools were person-specific. Many of the most comprehensive tools were out of print or considered excessively time consuming to administer and analyse. CONCLUSION: A paucity of accessible, time-efficient yet comprehensive tools to assess functional communication in ACDs may limit clinical practice and client outcomes. More versatile functional communication assessments incorporating individualised contexts, and the use of modern communication technologies are recommended.

"It's really exciting to think where it could go": a mixed-method investigation of clinician acceptance, barriers and enablers of virtual reality technology in communication rehabilitation.

PURPOSE: Acquired communication disorders can result in significant barriers to everyday life activities, and commonly require long-term rehabilitation. This research aimed to investigate usability, acceptance, barriers and enablers to the use of immersive virtual reality (VR) technology for communication rehabilitation from the perspective of speech-language pathologists (SLPs). METHODS: Semi-structured interviews and surveys (system usability and motion sickness) were carried out with 15 SLPs following their participation in communication activities typical of daily life, experienced within an immersive VR kitchen environment. RESULTS: The system usability scores were average. In addition, motion sickness symptoms were low after interaction with the VR system. The main findings from semi-structured interviews are discussed across five main themes: (i) attitude towards the use of VR in communication rehabilitation (ii) perceived usefulness of VR (iii) perceived ease of use of VR (iv) intention to use VR, and (v) clinical adoption barriers and enablers. CONCLUSIONS: Overall, participants were positive about VR and its potential applications to communication rehabilitation. This study provides a foundation to inform the design, development, and implementation of a VR system to be used in the rehabilitation of individuals with acquired communication disorders.IMPLICATIONS FOR REHABILITATIONVirtual Reality applications could simulate social communication situations within the clinic.VR could be used as a rehabilitation tool for communication assessment and/or outcome measure.VR requires customisation to the specific communication rehabilitation needs of the client.Participants identified barriers and enablers to adoption of VR by speech-language pathologists.

Student Perceptions of Simulation to Enhance Clinical Readiness for Assessment and Management of Adults With Voice Disorders.

BACKGROUND: Simulation is a safe, supported, and accessible learning method for students to gain skills and experience, especially in difficult to access range of practice areas such as voice. OBJECTIVE: The study aimed to explore change in students' perceptions of knowledge, confidence, anxiety, and clinical readiness for assessment and management of an adult with a voice disorder after participation in simulation-based learning activities. METHODS: Participants (N = 113) were students enrolled in a mandatory course dedicated to the voice and voice disorders. Students completed 32 hours of academic coursework which included lectures and tutorials and two 30-minute simulation-based learning activities with a standardized patient playing the role of an adult with a voice disorder. The impact of the simulation-based learning activities on student perceptions of their knowledge, confidence, anxiety, and clinical readiness for work within the area of voice were surveyed at three time points: (1) pre lectures, (2) post lectures but pre simulation, and (3) post simulation. Change across time was analyzed using repeated measures analysis of variance with post hoc Bonferroni adjustment. RESULTS: All students perceived significant (P ≤ 0.001) positive changes in knowledge and confidence across time points for all activities, except for writing an assessment report. Anxiety related to the management of a client with a voice disorder fluctuated significantly (P ≤ 0.001) throughout the program. Overall, the majority (>90%) of students agreed or strongly agreed that the simulation-based learning activities were useful and helped them to develop clinical skills, apply content taught in lectures, and gain confidence and interest in voice. CONCLUSION: This study supports incorporation of simulation-based learning as part of students' clinical preparation for the assessment and management of voice disorders.

Substrates of speech treatment-induced neuroplasticity in adults and children with motor speech disorders: A systematic scoping review of neuroimaging evidence.

Purpose: Neuroimaging may provide clinical evidence for speech treatment-induced neuroplasticity. This review aimed to report the current scope of evidence relating to brain changes identified using neuroimaging techniques, following effective speech intervention in adults and children with motor speech disorders (MSD).Method: Studies were retrieved from five electronic databases (PubMed, CINAHL, EMBASE (Medline), SCOPUS, and Web of Science) and a general internet search.Result: Seven studies met the inclusion criteria. Using structural or functional neuroimaging techniques, five studies reported on the effects of the Lee Silverman Voice Treatment for dysarthria in adults and children, one study on the outcome of rhythmic-melodic voice training in adults with apraxia of speech, and one study on the effects of Prompts for Restructuring Oral Muscular Phonetic Targets therapy in children with idiopathic apraxia of speech. Identified brain changes included: enhanced white matter tract integrity; normalisation of baseline cortical activity; right-hemisphere shifts in re-organisation; perilesional activations; and cortical thinning.Conclusion: The current review identified preliminary evidence for treatment-dependent brain changes in adults and children with MSD. Although important to interpret within the context of Phase I research, the identification of therapeutic effects across seven heterogeneous studies suggests that treatment-induced improvements in speech performance are underpinned by demonstrable alterations in brain structure and/or function. Future research is required to better define these mechanisms of neuronal re-organisation in individuals receiving treatment for MSD, including their prognostic potential.

Simulation can replace part of speech-language pathology placement time: A randomised controlled trial.

PURPOSE: Simulation is increasingly used within speech-language pathology education. Research has primarily explored students' perceptions of learning in simulation. The aim of this study was to determine if speech-language pathology students achieved a statistically-equivalent level of competency when a mean of 20% of placement time was replaced with simulation compared to placements without a simulation component. METHOD: This non-inferiority randomised controlled trial involved students from six Australian universities. Students were randomised to either a simulation + traditional placement group attending 5 days of simulation prior to their traditional placement, or a traditional only placement group. Their end-placement clinical competency was assessed using Competency Assessment in Speech Pathology (COMPASS®). RESULT: Final data were available for 325 students: 150 students in traditional placements, 138 students in protocol-compliant simulation + traditional placements, and 37 students in non-protocol simulation + traditional placements. There were no statistically significant differences between groups (traditional vs protocol-compliant simulation + traditional Mann-Whitney-Wilcoxon z = 1.23, df = 286, p = 0.22; traditional vs intention-to-treat simulation + traditional Mann-Whitney-Wilcoxon z = 0.23, df = 323, p = 0.81). CONCLUSION: This research contributes to the evidence base which suggests that simulation can partially replace traditional placement time for speech-language pathology students without loss of competency, substantiating its value as an alternative placement model in speech-language pathology programmes.

Technology-enabled management of communication and swallowing disorders in Parkinson's disease: a systematic scoping review.

BACKGROUND: Communication and swallowing disorders are highly prevalent in people with Parkinson's disease (PD). Maintenance of functional communication and swallowing over time is challenging for the person with PD and their families and may lead to social isolation and reduced quality of life if not addressed. Speech and language therapists (SLTs) face the conundrum of providing sustainable and flexible services to meet the changing needs of people with PD. Motor, cognitive and psychological issues associated with PD, medication regimens and dependency on others often impede attendance at a centre-based service. The access difficulties experienced by people with PD require a disruptive service approach to meet their needs. Technology-enabled management using information and telecommunications technologies to provide services at a distance has the potential to improve access, and enhance the quality of SLT services to people with PD. AIMS: To report the status and scope of the evidence for the use of technology in the management of the communication and swallowing disorders associated with PD. METHODS & PROCEDURES: Studies were retrieved from four major databases (PubMed, CINAHL, EMBASE and Medline via Web of Science). Data relating to the types of studies, level of evidence, context, nature of the management undertaken, participant perspectives and the types of technologies involved were extracted for the review. MAIN CONTRIBUTION: A total of 17 studies were included in the review, 15 of which related to the management of communication and swallowing disorders in PD with two studies devoted to participant perspectives. The majority of the studies reported on the treatment of the speech disorder in PD using Lee Silverman Voice Treatment (LSVT LOUD® ). Synchronous and asynchronous technologies were used in the studies with a predominance of the former. There was a paucity of research in the management of cognitive-communication and swallowing disorders. CONCLUSIONS & IMPLICATIONS: Research evidence supporting technology-enabled management of the communication and swallowing disorders in PD is limited and predominantly low in quality. The treatment of the speech disorder online is the most developed aspect of the technology-enabled management pathway. Future research needs to address technology-enabled management of cognitive-communication and swallowing disorders and the use of a more diverse range of technologies and management approaches to optimize SLT service delivery to people with PD.

Speech outcomes in Parkinson's disease after subthalamic nucleus deep brain stimulation: A systematic review.

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is effective in reducing motor symptoms for many individuals with Parkinson's disease (PD). However, STN DBS does not appear to influence speech in the same way, and may result in a variety of negative outcomes for people with PD (PWP). A high degree of inter-individual variability amongst PWP regarding speech outcomes following STN DBS is evident in many studies. Furthermore, speech studies in PWP following STN DBS have employed a wide variety of designs and methodologies, which complicate comparison and interpretation of outcome data amongst studies within this growing body of research. An analysis of published evidence regarding speech outcomes in PWP following STN DBS, according to design and quality, is missing. This systematic review aimed to analyse and coalesce all of the current evidence reported within observational and experimental studies investigating the effects of STN DBS on speech. It will strengthen understanding of the relationship between STN DBS and speech, and inform future research by highlighting methodological limitations of current evidence.