Normative Voice Range Profile of the Young Female Voice.

OBJECTIVES: Normative data are important in the clinical setting of Speech and Language Pathology. The purpose of this study was to develop a normative reference dataset of voice range profiles from young females. STUDY DESIGN: Descriptive study including a prospective collection of voice range profile data. METHODS: Voice range profile recordings from 39 females with healthy voices aged 18 to 28 years were conducted. Seven voice range profile variables were analyzed: minimum and maximum fundamental frequency and intensity, semitone and intensity ranges, and voice range profile area. Descriptive statistical methods were applied. RESULTS: An age-specific voice range profile normative dataset was established. The mean values and standard deviations were as follows: semitone range 34.7 ± 3.9 ST, minimum fundamental frequency 143.6 ± 21.7 hertz, maximum fundamental frequency 1063.5 ± 160 hertz, intensity range 65.6 ± 5.0 dB, minimum intensity 43.2 ± 2.5 dB SPL, maximum SPL 108.9 ± 5.1 dB SPL, and voice range profile area 1346 ± 222 cells. CONCLUSION: A normative dataset usable for optimization of future voice assessments has been established. It may especially benefit evaluation and treatment planning for younger females suffering from vocal fold nodules.

Barriers to Voice Therapy Attendance in a Language-Diverse Population.

OBJECTIVES/HYPOTHESIS: Voice therapy is an effective treatment for many voice disorders, but success depends on attendance and adherence. Many factors hinder treatment attendance, and language discordance with the provider may present an additional obstacle to attending therapy. This study evaluates factors associated with voice therapy attendance at a language-diverse, safety-net hospital. STUDY DESIGN: Retrospective chart review. METHODS: Retrospective review of adult patients referred to speech language pathology for treatment of voice disorders from January, 2018 to April, 2019. Primary spoken language, interpreter collaboration, and patient demographics were obtained from medical records. Multivariate analysis compared patient factors with voice therapy attendance versus nonattendance. RESULTS: Of 422 patients, 219 (52%) attended at least one therapy session, whereas 203 (48%) did not attend (n = 120) or schedule therapy (n = 83). In multivariate analysis, only the association between public insurance and nonattendance was statistically significant (P = .016). After adjusting for interpreter use and interval between referral and first appointment, patients with private health insurance were 2.35 times more likely to attend therapy compared to those with public insurance (95% confidence interval: 1.18-4.71). Non-English language; interpreter collaboration; distance from hospital; and patient demographics, including age, gender, ethnicity, and birthplace, did not significantly correlate with attendance. CONCLUSIONS: In a culturally and language-diverse cohort of dysphonic patients, individuals with public health insurance were significantly less likely to attend voice therapy. Language-discordant therapy and interpreter collaboration was not a statistically significant barrier to therapy attendance. Additional investigation is warranted to optimize allocation of voice therapy resources for those with public health insurance and for diverse speakers of all languages. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1835-1839, 2021.

Dotación fonoaudiológica para la atención de pacientes adultos en hospitales de alta complejidad en Chile / Speech and language therapists for attending adult patients in high-complexity hospitals in Chile

A nivel internacional se propone un mínimo de un profesional fonoaudiólogo por cada diez camas críticas o más, dependiendo de la complejidad de cada institución. En Chile no existen lineamientos similares, no obstante, el Ministerio de Salud ha generado recomendaciones para el cálculo de la brecha profesional según número y complejidad de las camas hospitalarias. El objetivo de este estudio es estimar el número de fonoaudiólogos y horas de contratación teóricas requeridas para la atención de pacientes adultos hospitalizados en instituciones públicas de alta complejidad en Chile. Para ello se realizó un estudio descriptivo, observacional, transversal. Se incluyeron todos los hospitales públicos de alta complejidad del país, excluyendo aquellos pediátricos y psiquiátricos. Como instrumentos se utilizaron el documento "Modelo de Gestión Red de Rehabilitación" del Ministerio de Salud, la base de datos actualizada del total de camas de la red hospitalaria y el software Microsoft Excel. El estudio fue aprobado por Comité Ético Científico del Hospital San Juan de Dios. En total 59 de 188 hospitales existentes en Chile fueron incluidos. De acuerdo con el análisis realizado basado en el número de camas en Chile, se requieren aproximadamente 269 fonoaudiólogos contratados 44 horas semanales para la atención de pacientes adultos en hospitales de alta complejidad. De ellos 104 se ubican en la Región Metropolitana; alrededor de 31 en la Región del BíoBío y cerca de 24 en la Región de Valparaíso. Se sugiere la revisión de las orientaciones ministeriales y la realización de un segundo estudio sobre la brecha profesional existente en Chile con los datos obtenidos.

International institutions have suggested one Speech and Language Therapist per ten critical beds, and possibly even more forhigh-complexity institutions. However, there are no similar recommendations in Chile, although the Ministry of Health has developed recommendations to calculate the number of professionals required according to the number and type of clinical bed. The aim of this study is to describe the number of Speech and Language Therapists along with the number of theorical working hours per week required for the attention of hospitalised adult patients in high-complexity hospitals in Chile, for which a descriptive, observational and transversal study was performed. High-complexity hospitals were included, excluding psychiatric and paediatric institutions. Microsoft Excel, the "Modelo de Gestión Red de Rehabilitación" guideline from the Ministry of Health, and the updated database of the clinical network beds were also used. This study was previously approved by a Research Ethics Committee from Hospital San Juan de Dios, and a total of 59 out of 188 hospitals were included. According to the analysis based on features of the clinical beds, 269 Speech and Language Therapists are required for 44 hours per week to attend adult patients in high-complexity hospitals across the country. Of the 269 professionals, 104 are needed in the Metropolitan region, approximately 31 in the Bío-Bío region and circa 24 in the Valparaíso region. According to these results, it is suggested the Ministry review its guidelines and undertake a further project in order to identify the current professional gap in Chile.

Cough reflex testing in acute stroke: A survey of current UK service provision and speech and language therapist perceptions.

BACKGROUND: Silent aspiration (SA)-airway entry of food, drink or other material without a cough response-is common post-stroke. Clinical swallowing examination misses up to 40% of dysphagic patients with SA. This may put these patients at risk of aspiration pneumonia, prolonged length of hospital stay and increased healthcare costs. After stroke, the laryngeal cough reflex is frequently impaired with significant relationships between pneumonia rates and reduced cough strength and sensitivity. There has been a significant amount of recent interest in cough reflex testing (CRT) as a potential means to improve clinical identification of patients at risk of SA. However, there is a lack of consensus regarding the methodology and protocols for use of CRT with widely varying outcomes reported in the literature. AIMS: To provide an overview of current practice in the UK with regards to clinical use of CRT by speech and language therapists (SLTs) in acute stroke settings and to explore the perceptions regarding its potential application in clinical dysphagia management and the barriers and facilitators associated with adopting CRT in clinical practice. METHODS & PROCEDURES: A cross-sectional web-based survey was developed, piloted and delivered. The survey targeted all UK-based SLTs working in acute stroke settings. OUTCOMES & RESULTS: A total of 129 SLTs with varying levels of experience of CRT from all regions of the UK responded. Only four SLT services in the UK were reported to be currently using CRT clinically with acute stroke patients. A total of 29% of respondents who were not using CRT were considering introducing CRT into their service's dysphagia protocol. Variation was reported in the procedures and protocols. Overall, users reported improved confidence in the clinical detection of SA and felt that the introduction of CRT had improved their patient-related outcomes. Issues included difficulties procuring citric acid, implications for SLT time (including service set-up and delivery of CRT) and restricted access to instrumental assessments. CONCLUSIONS & IMPLICATIONS: This survey gives valuable insight into the current practice and perceptions of SLTs in the UK working in acute stroke settings in relation to CRT. It highlights discrepancies between reported approaches and recommendations from existing guidelines and validation studies. The variation in responses indicates a need to develop a consensus statement and further research to guide practice. What this study adds What is already known on the subject CRT is gaining popularity as a screening tool for the clinical identification of SA with acute stroke patients. However, there is a lack of consensus in the literature regarding the methodology and protocols with widely varying outcomes. Further work needs to be done to standardize its use, especially if it is to be incorporated into dysphagia protocols for use in the acute stroke setting. What this paper adds to existing knowledge This survey of SLTs working in acute stroke settings highlights variability in practice in CRT service delivery in the UK, reflecting findings from the existing CRT literature. What are the potential or actual clinical implications of this work? The findings of this study support the need for further research relating to clinical screening tests for SA and standardization of methodology and protocols for CRT use if its use is to be continued clinically.

Telepractice for the Delivery of Pediatric Feeding Services: A Survey of Practice Investigating Clinician Perceptions and Current Service Models in Australia.

The provision of speech-language pathology (SLP) services via telepractice is expanding. However, little is known about the use of telepractice to deliver pediatric feeding services. The current study aimed to investigate SLPs perceptions, and current use of, telepractice in pediatric feeding. An electronic survey was distributed to SLPs with pediatric feeding experience within Australia. Questions pertained to general demographics, feeding experience, telepractice experience and perceptions of telepractice. Most questions were multiple choice, with some short response questions. Eighty-four complete responses were received. Overall, 41% of the cohort were interested in providing telepractice services but only 20% reported experience delivering pediatric feeding services via telepractice. Most telepractice users reported commencing telepractice services within the last 12 months. Most clinicians identified a range of age groups and feeding services that they believed could be offered via telepractice and a range of benefits to telepractice feeding services were identified. Benefits included natural environment, reduced distance and travel, opportunities to increase services and increased supervision and support. Although most respondents reported access to technology, most had difficulty accessing this on a daily basis to establish regular telepractice services. Clinician concerns regarding the safety and efficacy of conducting pediatric feeding assessments via telepractice were also identified. Overall, although the delivery of pediatric feeding services via telepractice remains limited, many clinicians were interested in using telepractice and had positive perceptions regarding its use. Continued efforts to enhance clinician access to technology and further evidence for the efficacy of this service delivery model for pediatric feeding will aid clinical implementation.

The Correlation of English Language Proficiency and Indices of Stress and Anxiety in Migrants from Puerto Rico after Hurricane Maria: A Preliminary Study.

OBJECTIVE: Using validated psychological assessment instruments, this study examined the psychological distress associated with potential language barriers experienced by over 135 000 Puerto Rican residents who either temporarily or permanently migrated to the continental United States with the landfall of Hurricane Maria in 2017. METHODS: Participants were Puerto Rican residents (n = 107) who remained in Puerto Rico (control) or left the island for at least 3 months because of Hurricane Maria (migrants). Participants completed an online survey in their preferred language (Spanish or English), which assessed self-reported English language proficiency, Kessler Psychological Distress Scale (K6), Posttraumatic Stress Disorder Checklist for DSM 5, Patient Health Questionnaire 9-item depression scale, and the Generalized Anxiety Disorder 7-item scale. It was hypothesized that migrants with lower self-reported English proficiency would have comparatively higher indices of post-disaster distress than those with a higher proficiency. RESULTS: Dividing the migrant group by preferred language for questionnaire completion, the Fisher's exact test showed significant differences in prevalence of severe mental distress, as defined by K6 scores above 13, between the Spanish-preferring migrants (30.4%), English-preferring migrants (0%), and controls (9.6%). CONCLUSION: Our results support a possible correlation between decreased language proficiency in post-disaster migrants and a higher risk factor for severe mental distress.

Speech-language therapists with Ph.D. in Brazil: profile from 1976 to 2017. / Fonoaudiólogos Doutores no Brasil: perfil da formação no período de 1976 a 2017.

PURPOSE: To investigate the association of variables gender, year of the thesis defense, type and location of the teaching institution, the thesis subject and the program in which the thesis was developed. METHODS: Data were collected through consultation of the Lattes Platform of the National Council for Scientific and Technological Development (1976-2017). Filters were activated to follow the inclusion criteria: is Brazilians with a degree in Speech-Language Therapy, and also with a PhD degree. The established variables were recorded in the STATA/IC 14.2 software, and a descriptive analysis of the data and trend of them were performed. RESULTS: Most of the 1,125 subjects who composed the sample were female, graduated in a public higher education institution, located in the Southeast region, and defended their thesis in a Program related to ​​Health Sciences, or in Speech-language therapy. CONCLUSION: The profile found is similar to the profile of previous studies, and it shows the significant growth of speech-language therapists with PhD degrees in research activities and qualified scientific production.

OBJETIVO: investigar, no grupo de fonoaudiólogos brasileiros titulados doutores, as variáveis sexo, ano de defesa da tese, tipo e localização da instituição de ensino, inserção do programa em que a tese foi desenvolvida e temática da mesma. MÉTODO: os dados foram levantados por meio de consulta à Plataforma Lattes do Conselho Nacional de Desenvolvimento Científico e Tecnológico − CNPq (1976-2017). Filtros foram acionados para seguir os critérios de inclusão: ter formação em Fonoaudiologia, ser brasileiro e ter se titulado doutor. As variáveis estabelecidas foram registradas no programa STATA/IC 14.2 e foi realizada análise descritiva dos dados e da tendência de crescimento do número de teses. RESULTADOS: dentre os 1.125 profissionais que compuseram a amostra, a maioria era do sexo feminino, titulou-se em instituição de ensino superior pública, localizada na região Sudeste, e defendeu temática em Programa pertencente à área de Ciências da Saúde, sobre Linguagem e Audiologia. CONCLUSÃO: o perfil encontrado se assemelha a levantamentos realizados anteriormente e evidencia o contínuo crescimento significativo de fonoaudiólogos doutores, fato que garante a inserção do fonoaudiólogo em atividades de pesquisa e produção científica qualificada.

A Survey of Clinicians With Specialization in Childhood Apraxia of Speech.

Purpose Little is known about how clinicians develop expertise in childhood apraxia of speech (CAS), a rare speech disorder with heterogeneous presentation. The purpose of this survey study was to examine the beliefs and practices of clinicians specializing in CAS. Method Speech-language pathologists who self-identify as having expertise in CAS (n = 165) completed an online survey regarding influences on clinical practice and beliefs about CAS. Practice patterns and perspectives regarding CAS were analyzed for respondents who self-identify as having expertise in CAS, across 4 experience bands (1-5, 6-10, 11-15, and 15+ years). Results A majority of the respondents to this survey provide treatment to preschool-age children with CAS. Respondents report features used in differential diagnosis aligned with the American Speech-Language-Hearing Association's (2007) technical report, with inconsistency as a key feature. Results suggest that continuing education courses are highly influential in the perceived development of expertise and perspectives regarding CAS. Respondents expressed uncertainty about comorbidity of CAS with other communication disorders. Overall, beliefs and practices are relatively uniform across levels of clinical experience. Conclusions Practices and perspectives of clinicians who self-identify as having expertise with CAS are influenced by factors noted in previous literature. Results of this survey highlight the need for research on the development of expertise in the clinical management of CAS, updated consensus statements that reflect advances in current research, clarification regarding comorbidity of CAS with other communication disorders, and evaluation of continuing education opportunities. Supplemental Material https://doi.org/10.23641/asha.9755459.

Speech and language therapy for primary progressive aphasia across the UK: A survey of current practice.

BACKGROUND: Primary progressive aphasia (PPA) describes a heterogeneous group of language-led dementias. People with this type of dementia are increasingly being referred to speech and language therapy (SLT) services. Yet, there is a paucity of research evidence focusing on PPA interventions and little is known about SLT practice in terms of assessment and provision of intervention. AIMS: To survey the practices of SLTs in the areas of assessment and intervention for people with PPA. METHODS & PROCEDURES: A 37-item, pilot-tested survey was distributed electronically through the Royal College of Speech and Language Therapists (RCSLT), Clinical Excellence Networks (CENs) and social media networks. Survey items included questions on care pathways, assessment and intervention approaches, and future planning. Analysis was conducted using descriptive statistics and thematic analysis. OUTCOMES & RESULTS: A total of 105 SLTs completed the survey. Respondents reported more frequently using formal assessment tools designed for stroke-related aphasia than for dementia. Informal interviews were reportedly always used during assessment by almost 80% of respondents. Respondents were significantly more likely to use communication partner training than impairment-focused interventions. Goal attainment was the most commonly used outcome measure. Respondents provided 88 goal examples, which fell into six themes: communication aid; conversation; functional communication; impairment focused; specific strategy; and communication partner. Additionally, respondents reported addressing areas such as future deterioration in communication and cognition, decision-making and mental capacity, and driving. Ten (9.4%) respondents reported the existence of a care pathway for people with PPA within their service. CONCLUSIONS & IMPLICATIONS: This survey highlights the range of current PPA assessment and intervention practices in use by the respondents. Communication partner training is commonly used by the surveyed SLTs, despite the lack of research evidence examining its effectiveness for PPA. There is a need to develop evidence-based care pathways for people with PPA in order to advocate for further commissioning of clinical services.

A National Survey of Speech-Language Pathologists' Engagement in Interprofessional Collaborative Practice in Schools: Identifying Predictive Factors and Barriers to Implementation.

Purpose This study examined the models of collaboration used by school-based speech-language pathologists (SLPs) during the provision of special education services including factors predicting use of the interprofessional collaborative practice (IPP) model and barriers to collaboration. Method School-based SLPs responded to a survey on models of collaboration within their work setting. Anchored vignettes were created to determine their engagement in 3 different models (i.e., multidisciplinary, interdisciplinary, and interprofessional) used in the provision of special education services during evaluation and intervention. Predictive factors supporting and/or hindering the use of IPP were identified. Results Results demonstrated low percentages of school-based SLPs engaging in IPP during initial evaluations (8%), eligibility meetings (43%), and intervention sessions (14%). Three factors predicted use of IPP in schools: prior training in collaboration, years of experience, and educational setting. The most frequently cited barriers to SLPs' engagement in collaboration included time constraints/scheduling (48%), resistance from other professionals (23%), and lack of support from employers/administration (11%). Conclusions The results of the current study indicated that systemic change is needed at both the university and public school levels. At the university level, preprofessional students need collaborative learning opportunities that are integrated across programs and colleges. School-based SLPs and other education professionals could benefit from job-embedded learning focused on IPP to increase their knowledge and engagement in IPP and improve student outcomes. Supplemental Material https://doi.org/10.23641/asha.9340760.

Speech-Language Clinicians Working with Deaf Children: A Qualitative Study in Context.

Students who are deaf or hard of hearing (DHH) increasingly attend local public schools, in which speech and language clinicians (SLCs) may lack experience with the individualized needs of a heterogeneous student population. This study explored the experiences of SLCs with students who are DHH in three different types of educational settings. Fourteen SLCs were interviewed and discussed a case study. Responses were transcribed, data coded, and emergent themes identified. Analysis was verified through triangulation of data and trustworthiness strategies. Results indicated that the skill sets of SLCs working with children who were DHH were dependent on contextual factors, such as educational placement and communication mode used, and that development of these skills requires direct experience, collaboration, and structural supports. Institutions across the deaf education spectrum should consider forming alliances to improve information-sharing and collaborative learning in order to improve service delivery in all settings.

Use of images of patients in social networks: how do speech-language therapists perceive and act? / Uso de imagens de pacientes em redes sociais: como percebem e agem os fonoaudiólogos?

PURPOSE: Investigating the perception and self-reported behavior of speech-language therapist about ethical and legal aspects related to the use of images of patients in social networks, comparing such findings with sociodemographic data. METHODS: An online questionnaire with 13 questions was the instrument used to collect data related to the demographic data of the participants and to the perception of speech-language therapists. The questionnaire was available on the Google Forms platform e was answered by 765 participants. RESULTS: Most participants agreed that the Code of Ethics of Speech-Language Pathology gives information about the use of images in social networks (67.98%), that the publication of photos and / or videos of patients in social networks without authorization by written is an ethical infraction (93.33%) and that the image´s rights is guaranteed by the Brazilian Constitution (89.94%). 18.56% of speech-language pathologists stated that they had never used the Code of Ethics in Speech-Language Pathology. Concerning the exhibition of images in social networks, 5.1% stated that they had shown on their social networks photographs and / or videos without authorization, and 21.18% did so with only verbal authorization. Almost all participants (95.16%) mentioned having seen photographs or videos of patients on virtual social networks posted by speech-language therapist. CONCLUSION: It was possible to verify the relevance of the results obtained and the impact of the research to encourage reflection on the subject.

OBJETIVO: Investigar a percepção e a conduta autodeclarada de fonoaudiólogos sobre aspectos éticos e legais relacionados ao uso de imagens de pacientes em redes sociais, comparando tais achados com dados sociodemográficos. MÉTODO: Para a coleta de dados, utilizou-se um questionário online disponibilizado na plataforma do GoogleDrive, que continha 13 questões abrangendo dados sociodemográficos e questões voltadas para a percepção de fonoaudiólogos quanto ao assunto estudado. A amostra da pesquisa foi composta por 765 participantes. RESULTADOS: A maior parte dos respondentes concordou, em algum grau, que o Código de Ética da Fonoaudiologia esclarece sobre o uso de imagens em redes, assim como a publicação de fotos e/ou vídeos de pacientes em redes sociais sem autorização por escrito, constitui infração ética e o direito de imagem está garantido pela Constituição Brasileira. Apenas 18,6% dos fonoaudiólogos afirmaram nunca terem recorrido ao Código de Ética em Fonoaudiologia. Quanto à exibição de fotografias ou vídeos em redes sociais, 5,1% afirmaram ter publicado, em alguma frequência, sem autorização e 21,18% o fizeram apenas com autorização verbal. Praticamente todos os participantes mencionaram já ter visto fotografias ou vídeos de pacientes em redes sociais virtuais postados por fonoaudiólogos. CONCLUSÃO: Foi possível notar a relevância do estudo para impulsionar debates sobre o assunto e a essencialidade de novos estudos no tema abordado.

Augmentative and alternative communication in the Philippines: a survey of speech-language pathologist competence, training, and practice.

A cross-sectional survey study was undertaken to describe the perceived competence, pre- and post-professional training, and practice of Filipino speech-language pathologists (SLPs) in augmentative and alternative communication (AAC). Printed and electronic questionnaires were distributed to all SLPs in the Philippines with at least 1 year of practice experience. A total of 152 (47%) questionnaires were returned. Based on these data, 108 respondents (71%) practiced AAC, but most (range = 59-89%) did not perceive themselves to be competent in working with various client populations with complex communication needs. A majority (range = 70-93%) of the respondents reported limited pre-professional training in all AAC content areas, and at least 82% strongly desired continuing education in almost all areas of AAC. Almost 90% of respondents only occasionally (53%) or rarely (36%) recommended AAC, and 82% considered it as a last resort. Major practice challenges reported were families' negative attitudes toward AAC and lack of AAC-specific interdisciplinary collaboration. Infrequent use of high-tech AAC was also reported. The findings suggest various ways through which AAC education and services in the Philippines may be enhanced. They also imply the need for further research on alternative service delivery models, as well as additional members of the AAC team.

What are the usual assessment practices in adult non-progressive dysarthria rehabilitation? A survey of Australian dysarthria practice patterns.

This aim of this study was to identify assessment practices for non-progressive dysarthria used by Australian speech-language pathologists (SLPs) and to describe these practices within the framework of the World Health Organization's International Classification of Functioning Disability, and Health (ICF). A 23-item online survey was distributed to Australian SLPs, with 56 responses suitable for data analysis. The majority of SLPs prescribed 'high importance' to the assessment of impairment to speech function (96%, n = 54), activity limitations (91%, n = 51) and participation in society (91%, n = 51) in non-progressive dysarthria. However, reported assessment selection for non-progressive dysarthria focused largely on impairment and intelligibility, with assessments addressing participation restrictions being under-utilised. There was also a preference for informal assessment tools across all ICF domains. Over half (69%, n = 37) indicated that current assessment tools for non-progressive dysarthria generally do not meet their needs, with key issues being time-factors and inadequate sensitivity. There was variability in the use of outcome measures for non-progressive dysarthria, with workplace setting, time constraints and a perceived lack of relevance being the most commonly reported barriers to implementation.

Children as curators: how to incorporate young visitors' voices into the elaboration and evaluation of a microbiology exhibition / Crianças como curadores: como incorporar as vozes dos jovens visitantes na elaboração e avaliação de uma exibição de microbiologia

Abstract Studies of museum publics are relatively recent, and studies of child visitors are even more recent. In this paper we summarize the types of exhibition evaluations mentioned in the literature and present an evaluation process for an exhibition about microbiology developed for and with input from 4-to-6-year-old children. As a case study we analyzed an exhibition entitled "The Giant World of Microbes." Audio and video interviews were recorded with child visitors, and the stimulated recall technique was also employed. The data indicate the importance of interactive activities in enhancing child motivation and providing pertinent routes to follow when preparing an exhibition geared toward children.

Resumo Os estudos sobre exibições em museus são relativamente recentes, e estudos sobre crianças visitantes são mais recentes ainda. Este trabalho faz um resumo dos tipos de avaliações de exibição mencionados na literatura e apresenta um processo de avaliação para uma exibição de microbiologia desenvolvida para, e com o auxilio de, crianças entre 4 e 6 anos. Como estudo de caso analisamos uma exibição intitulada "O Mundo Gigante dos Micróbios". Foram gravadas entrevistas de áudio e vídeo com os visitantes mirins, e também se utilizou a técnica de estimulação da memória. Os dados indicam a importância das atividades interativas no fortalecimento da motivação das crianças e oferecem caminhos pertinentes a seguir na elaboração de exibições focadas no público infantil.

Understanding Dysphagia Care in the Community Setting.

Factors including health policy reform and the aging population are increasing demand for quality healthcare in the community. People with dysphagia are supported by speech-language pathologists (SLPs) in hospital and community settings; however, little is known about the nature of dysphagia services offered by SLPs in the community. The aim of this study was to investigate SLP services and practices provided to community-based adults with dysphagia. A national cohort (n = 144) of SLPs working with community-based clients with dysphagia completed an online survey. Results revealed that clients with neurological conditions comprised the largest proportion of the caseload. Primary referral sources were family doctors (42.4%) or other health professionals (37.5%), with low rates of self-referral. Services were primarily delivered via individual sessions (84.1%), usually within the client's home (80% saw clients at home). While many clinicians were using both clinical and instrumental assessments, half had to refer clients to the other services to access instrumental assessment. Most provided assessment and rehabilitation services, though a few (28.5%) reported using formal outcome or quality-of-life measures. Only 43.8% referred or encouraged clients or caregivers to access support or social groups and a few SLPs incorporated social participation or client well-being aspects in treatment. Speech-language pathology (SLP) practices in the community appear similar to what occurs in the acute setting, which are inherently biomedical. This may not be optimal care for clients with dysphagia who live at home and their caregivers. Further exploration about what clients and caregivers want from community-based SLP services is warranted.

Barriers and facilitators to meeting aphasia guideline recommendations: what factors influence speech pathologists' practice?

PURPOSE: To explore factors influencing Australian speech pathologists' guideline recommended aphasia management practices. METHODS: Semi-structured interviews were conducted with hospital-based speech pathologists (n = 20). Interviews focused on barriers and facilitators to implementing recommendations related to five practice areas: Aphasia-friendly Information; Collaborative Goal Setting; Timing of Therapy; Amount and Intensity of Therapy; and Conversation Partner Training. RESULTS: Speech pathologists working only in inpatient rehabilitation settings reported performing the recommended behaviours consistently, and identified few implementation barriers. However, clinicians working in the acute setting reported performing the majority of behaviours inconsistently or rarely. Seven (of 14) Theoretical Domains Framework domains were identified as key influencing factors. Three of these - "Environmental Context and Resources," "Beliefs about Consequences," and "Social Influences" - were consistently reported as influencing practice across all five behaviours. Other important domains included "Knowledge", "Beliefs about Capabilities," "Goals," and "Social/Professional Role and Identity", which each influenced at least two practice behaviours. CONCLUSIONS: Speech pathologists report a number of key factors influencing their practice, which differ in how they influence behaviours (i.e., a factor may be a barrier or a facilitator) depending on the behaviour and clinical setting. Future implementation interventions need to account for the strong influence of beliefs and social influences on speech pathology practice, which may facilitate successful implementation. Implications for rehabilitation Speech pathologists' aphasia management practices are often inconsistent with guideline recommendations. Environmental and contextual barriers were identified for all guideline-recommended practices that were investigated; however, these barriers did not necessarily impede implementation for speech pathologists working in inpatient rehabilitation settings. Strategies to improve both team functioning (social influences) and the belief systems of individual clinicians (beliefs about consequences) should be considered to improve speech pathologists' implementation of guideline-recommended aphasia practices.

Medicine Administration in People with Parkinson's Disease in New Zealand: An Interprofessional, Stakeholder-Driven Online Survey.

Medicine administration errors are twice as frequent in people with dysphagia than in those without. Medicine administration is particularly critical for people with Parkinson's disease where late, or missed doses reduce medicine effectiveness and impact on the quality of life. The aim of this study was to explore the current medicine administration practices of people with Parkinson's disease in New Zealand. A self-administered online survey was developed by an interprofessional group including people with Parkinson's disease (the primary stakeholders), speech-language pathologists and pharmacists. The survey was administered using a cross-sectional study design and asked respondents about self-reported swallowing difficulties [using Eating Assessment Tool (EAT-10)], medicine regimes and strategies used to swallow medicines. Seventy-one people with Parkinson's disease responded to the survey (69% male, mean age 72 years, mean years with Parkinson's disease 9 years). Respondents reported complex daily multi-medicine consumption (mean no. of pills 11, range 2-25). Analyses showed that 57% of respondents scored outside the normal range for EAT-10 (> 3) with 57% complaining of difficulties with pills. Many respondents admitted to missing medicines and requiring external reminders. Multiple strategies for swallowing pills were described including crushing tablets, using yoghurt or fruit juice, and swallowing strategies (such as head tilt, effortful swallow, chin down and altered pill placement in the mouth). Medicine administration is complex and challenging for people with Parkinson's disease. The development of educational packages for people with Parkinson's disease, their carers and health professionals is much needed.

Urban-Rural Differences in Service Utilization and Costs of Care for Racial-Ethnic Groups Hospitalized With Poststroke Aphasia.

OBJECTIVE: Although residence is a key contributor to cost and utilization in stroke patient care, its contribution to the care of persons with aphasia (PWA) is unknown. The objective of this study was to use discharge-level hospital inpatient data to examine the influence of patient residence (rural vs urban) and race-ethnicity on service utilization and cost of care among PWA. DESIGN: Cross-sectional. SETTING: Administrative data from acute care hospitals in the state of North Carolina. PARTICIPANTS: Individuals (N=4381) with poststroke aphasia. INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Length of stay (LOS), speech-language pathology (SLP) service utilization, costs of care. METHODS: The 2011-2012 Healthcare Cost and Utilization Project State Inpatient Database data were analyzed to examine the effect of rural or urban residence on LOS, SLP service utilization, as well as total inpatient and SLP service costs. These outcomes were further analyzed across both residence and racial groups (non-Hispanic white and non-Hispanic black). Outcomes were analyzed using generalized linear model. RESULTS: Both rural and urban black PWA experienced longer average LOS after controlling for demographics, illness severity, and the hospital where they received care. Rural blacks experienced longer LOS, received greater SLP services, and incurred greater average total hospital costs than their rural white counterparts after adjusting for differences in their demographics and stroke or illness severity. The differences were attenuated after controlling for the hospital where they received care. CONCLUSIONS: For PWA, race-ethnicity has a larger effect on average total medical costs, SLP service utilization, and LOS than residence. It is unclear how and why blacks with aphasia have greater service utilization and costs in acute care, yet their aphasia outcomes are worse. Future studies are required to explore potential factors such as quality of care.

The Role of Rehabilitation Specialists in Canadian NICUs: A 21st Century Perspective.

Rehabilitation specialists are an integral part of the team in the neonatal intensive care unit (NICU). New approaches to rehabilitation practice in the NICU have evolved over the past decade that aim to promote child health and development. AIMS: The aim of this study was to describe the current roles of the occupational therapist (OT), physical therapist (PT) and speech-language pathologist (SLP) in Canadian NICUs as compared to the roles documented in an earlier national survey conducted 15 years ago. METHODS: A telephone survey was conducted across Canadian NICUs and each telephone interview was recorded by a research assistant. In total, 42 questionnaires were completed across 25 health care institutions. RESULTS: Eighty percent of the PT, 93.7% of OT and 50% of SLP provided direct services to neonates in the NICU. The results demonstrated that the therapists were involved with case discussion (85.7%), decision-making (97.6%), referrals to other services (97.6%) and discharge planning (97.6%). Splinting (87.5%) and feeding (100%) were most often carried out by OT, whereas chest physiotherapy (65%) and range of motion (100%) were predominantly provided by PT. Changes in the role of rehabilitation specialists over the last decade predominantly included enhanced collaboration with the NICU team, more frequent use of standardized outcome measures and use of interventions supported by evidence. CONCLUSION: In comparison with results of the previous survey of rehabilitation practices in Canadian NICUs, rehabilitation specialists now have more dedicated time in the NICU and more frequently use standardized measures and apply interventions that are supported by recent scientific studies.