PURPOSE: This pilot study aimed to (a) investigate opportunities for immersive Virtual Reality (VR) technology in communication, physical, and visual rehabilitation by examining the interaction of people without disabilities in a range of structured virtual environments; and (b) validate research protocols that might be used to evaluate the physical, visual, and verbal interaction of users in virtual worlds, and their safety while using the technology. METHODS: Thirteen adults identifying as people without disability were exposed to VR via a head-mounted display. A video-review method was used to qualitatively code and analyse each participant's communication, movement, orientation, and support needs. RESULTS: All participants oriented to their virtual environments sufficiently to use applications. Their spoken language was effective for interaction, although unconventional social behaviours were also observed. Two participants reported minor adverse reactions consistent with mild cybersickness. CONCLUSION: The results provide insight into the types of environments and characters that support the greatest communicative, physical, and visual interaction in immersive VR. The tested protocols are useful to assess safety when using VR, and to observe communicative, physical, and visual interaction with virtual environments and characters. Implications for future research and use of VR with people with communication, physical and visual disability are discussed.
Safe use of virtual reality in rehabilitation requires careful assessment. Comprehensive observational protocols were sufficient to manage safety concerns.Rehabilitation applications need rapid responsivity in verbal interactions to ensure users are immersed in interactions.Non-verbal cues from virtual avatars best direct user attention in the environment.Novice virtual reality users largely controlled technology using their dominant hand. They could control VR successfully with one hand.
BACKGROUND: A recent literature review identified that past research has described the impacts of dysphagia on quality of life; but there is limited research on these impacts from the perspective of people with dysphagia, their supporters and allied health professionals. Recent qualitative research has provided details about these perspectives, but researchers have also called for verification of these findings with a larger group of participants. AIMS: To expand upon the findings of the prior qualitative research on the views of people with dysphagia, supporters of people with dysphagia, and allied health professionals on the impacts of dysphagia and texture-modified food on quality of life. METHODS & PROCEDURES: An online survey of adults with dysphagia (n = 30), supporters of people with dysphagia (n = 4) and allied health professionals (n = 18) was conducted between November 2021 and February 2022. Categorical questions were analysed descriptively and open-ended questions were analysed for content categories of meaning. OUTCOMES & RESULTS: Participants with dysphagia reported that dysphagia and texture-modified foods had a greater impact on their physical health than on their choice and control or social engagement. Supporters and allied health professionals viewed that dysphagia impacted the physical health and their choice and control of people with dysphagia. Across groups, participants considered that mealtime enjoyment, participation, and inclusion were influenced by the control the person had over their meals, the accessibility of the mealtime environment, and the attitudes of others. CONCLUSIONS & IMPLICATIONS: Dysphagia and its interventions negatively impact quality of life for people with dysphagia. People with dysphagia were the most affected by the physical impacts of dysphagia. Their perspectives contrasted with those of supporters and allied health professionals in some domains, highlighting the need for people with dysphagia to be included in research. Future research exploring how these perspectives are integrated into person-centred dysphagia management is warranted. WHAT THIS PAPER ADDS: What is already known on the subject Recent qualitative research has provided insights into the impacts of dysphagia on quality of life from the perspective of people with dysphagia, supporters of people with dysphagia, and allied health professionals. However, the small scale of these studies means that further research is needed with a larger group of people with dysphagia, supporters of people with dysphagia, and allied health professionals. What this paper adds to existing knowledge This paper verifies and extends upon the findings of prior qualitive research on the views of people with dysphagia, supporters of people with dysphagia, and allied health professionals on the impacts of dysphagia and its interventions on quality of life, participation, and inclusion. What are the potential or actual clinical implications of this work? This research shows the importance of supporters of people with dysphagia and allied health professionals discussing mealtime quality of life with the person with dysphagia so that their perspectives are considered in the mealtime decision-making process. Furthermore, people with dysphagia should be able to specify strategies they want to trial to enhance their mealtime participation and inclusion.
BACKGROUND: Undertaking voice and communication training is an important part of the gender-affirming journey for many trans, gender-diverse and non-binary individuals. Training supports the alignment of voice with gender identity helping to reduce gender dysphoria as individuals are better able to connect with their voices. However, for training to be effective, regular practice is needed and the demands of training can often be difficult to meet. AIMS: To investigate the interest, attitudes and perspectives on the use of immersive virtual reality (VR) to support gender-affirming voice and communication training by transgender, gender non-binary and gender-diverse people, and speech-language pathologists providing gender-affirming voice and communication training. METHODS & PROCEDURES: A mixed-methods survey (i.e., collecting quantitative data through multiple-choice question and qualitative data through free text questions) was hosted online from 23 August to 21 September 2021. A total of 17 questions asked about technology use, and attitudes and perspectives towards VR. The survey included video examples of three different voice-activated VR applications to prompt participant responses about the technology. OUTCOMES & RESULTS: A total of 70 survey responses were included in the analysis. All participants had previous experience using smart phones, but only 27.2% had previously used VR. Four key themes were identified relating to potential uptake of VR in gender-affirming voice and communication training: (1) general audience appeal, (2) perceived therapeutic value, (3) exposure to or protection from harm and (4) relatability to real life. CONCLUSIONS & IMPLICATIONS: VR games may represent a viable option to support practice of voice exercises. Gamification through VR is likely to motivate some to increase frequency of practice. VR applications that are used in voice training need to be fit-for-purpose, and detailed co-design is necessary to build appropriate applications for future use. This study provides a foundation to inform the design, development and implementation of VR applications to be used in gender-affirming voice training. WHAT THIS PAPER ADDS: What is already known on the subject? Speech-language pathologists work closely with transgender and gender-diverse individuals to help them achieve gender congruent voice and communication. Clients need to undertake regular and ongoing practice outside of training sessions to achieve and maintain their ideal voice. Motivation and adherence to regular practice sessions remain an ongoing challenge. What this study adds to the existing knowledge This study explores the use of immersive VR technologies to create safe, motivating and enjoyable environments to encourage regular practice of gender-affirming voice and communication exercises. It engages stakeholders in an early-stage participant-involved design to gauge interest in, and perspectives on, VR and technology-based training support tools. The results suggest that voice-activated VR applications would highly motivate some individuals if they were appropriately designed but would not be ideal for all. What are the actual and clinical implications of this work? Immersion in VR can be a highly motivating tool to enhance adherence to practice schedules for some individuals. However, tools need to be specifically designed with outcomes in mind to be fit-for-purpose, to support individual goals and to minimize the risk of harm. The few existing VR voice-activated applications that are available require further assessment, and redesign through co-design with users to functionally and safely support gender-affirming voice and communication training.
BACKGROUND: Narrative discourse is central to effective participation in conversations. When discourse is assessed in people with communication disability, structured tasks (e.g., picture descriptions) provide experimental control, while unstructured tasks (e.g., personal narratives) represent more natural communication. Immersive virtual reality (VR) technology may provide a solution by creating standardized experiences for narrative retell, therefore balancing ecological validity and experimental control in discourse assessment. Research is needed to understand how VR immersion affects narrative retell, first for adults with no communication disability, before application with adults with aphasia or related communication disability. AIMS: To assess (1) the effects of VR immersion on the linguistic content and structure of narrative retells in a healthy adult population; and (2) whether VR immersion can influence the way a narrative is retold so that the speaker conveys their own experience, rather than the experience of the characters they are watching. METHODS & PROCEDURES: In this pilot cohort study, 13 healthy adult participants with no reported communication disability watched an animated short film and a comparable immersive VR short film in a randomized order. Participants were asked to retell the events of the story after each condition in as much detail as possible. OUTCOMES & RESULTS: Mean length of utterance (in morphemes) was significantly higher in the video condition compared with the VR condition. Significantly more first-person pronouns were used in the VR condition compared with the video condition. No other measures of linguistic content or structure were significantly different between the VR and video conditions. CONCLUSIONS & IMPLICATIONS: Increased morpho-syntactic length and complexity in the video condition may suggest effects of elicitation stimulus on the narrative produced. The larger number of first-person pronouns in the VR condition may reflect that participants experienced a sense of presence in the virtual environment, and therefore were able to retell their communication experience rather than narrating the experiences of characters from an external perspective. Given the increasing need for more functional assessment of discourse in people with communication disability, further research is needed to validate these findings. WHAT THIS PAPER ADDS: What is already known on this subject As an ecologically valid tool, discourse analysis is often used to assess daily communicative exchanges in adults with acquired communication disability. Clinicians and researchers using narrative discourse assessment must balance the experimental control and diagnostic reference sample capabilities of structured tasks with the ecological validity and real-life transferability of unstructured personal narratives. What this study adds to existing knowledge This study explores the use of immersive VR technologies to create standardized, replicable, immersive experiences as a foundation for narrative discourse assessment. It highlights how the 'sense of presence' in a virtual world can prompt healthy adult speakers to retell a narrative of a personal experience that can be replicated for many different participants. The results suggest that immersive VR narrative assessment for adults with communication disability may balance ecological validity with measurement reliability in discourse assessment. What are the potential or actual clinical observations of this work? Immersion in VR resulted in the production of narratives with morpho-syntactic features that aligned with typical narrative generation, rather than retell. Participants used more first-person pronouns, suggesting retelling of personal experience. Though further study is needed, these preliminary findings suggest clinicians can use immersive VR stimuli to generate structured story generations that balance experimental and diagnostic control with ecological validity in narrative discourse assessment for adults with communication disability.
Communication Disorders , Virtual Reality , Humans , Adult , Immersion , Pilot Projects , Reproducibility of Results
BACKGROUND: Dysphagia impacts negatively on quality of life, however there is little in-depth qualitative research on these impacts from the perspective of people with dysphagia. AIMS: To examine the lived experiences and views of people with lifelong or ongoing dysphagia on the impacts of dysphagia and its interventions on quality of life, and barriers and facilitators to improved quality of life related to mealtimes. METHODS & PROCEDURES: Nine adults with lifelong or acquired chronic dysphagia engaged in in-depth interviews and a mealtime observation. The observations were recorded and scored using the Dysphagia Disorders Survey (DDS). Interviews were recorded, transcribed and de-identified before content thematic and narrative analysis, and verification of researcher interpretations. OUTCOMES & RESULTS: Participants presented with mild to severe dysphagia as assessed by the DDS. They viewed that dysphagia and its interventions reduced their quality of life and that they had 'paid a high price' in terms of having reduced physical safety, reduced choice and control, poor mealtime experiences, and poor social engagement. As part of their management of dysphagia, participants identified several barriers to and facilitators for improved quality of life including: being involved in the design of their meals, being adaptable, having ownership of swallowing difficulties, managing the perceptions of others and resisting changes to oral intake. CONCLUSIONS & IMPLICATIONS: This research improves understanding of the primary concerns of people with dysphagia about their mealtime experiences and factors impacting on their quality of life. Clinicians working with people with dysphagia need to consider how self-determination, autonomy and freedom of choice could be improved through involvement in food design of texture-modified foods. It is important that future research considers the views of health professionals on how these findings could impact on policy and practice particularly in ways to address the barriers and enhance facilitators to improved quality of life for people with dysphagia. WHAT THIS PAPER ADDS: What is already known on the subject Dysphagia impacts on quality of life, particularly as the severity of the dysphagia increases. Research to date has focused on people with dysphagia associated with an acquired health condition and has used quantitative assessment methods to measure quality of life. What this paper adds to existing knowledge This study provides a qualitative examination of the impacts of dysphagia on quality of life from the perspective of people with lifelong or ongoing acquired dysphagia and their supporters. This study also provides qualitative insights into the barriers and facilitators of mealtime-related quality of life. What are the potential or actual clinical implications of this work? Health professionals should engage in open communication with their clients with dysphagia regarding the impacts of dysphagia on their lifestyle and quality of life. By considering these impacts, health professionals may be able to recommend interventions that are more acceptable to the person with the dysphagia which may have a positive impact on their mealtime experience.
Deglutition Disorders , Humans , Adult , Deglutition Disorders/therapy , Deglutition , Quality of Life , Health Personnel , Qualitative Research
There is a well-established body of evidence demonstrating alcohol is a compounding factor increasing both the occurrence and the severity of domestic violence in intimate relationships. The COVID-19 pandemic and associated public health measures such as lockdowns and social distancing have contributed to a rise in domestic violence. Yet, despite the closure of public drinking venues and substantial changes to the home drinking landscape, the role of alcohol in domestic violence has received little attention from both the alcohol and domestic violence fields. In this commentary, we argue that the pandemic has magnified existing silences across these fields, resulting in missed opportunities for intervention. The implications for home drinking in particular on domestic violence deserve greater focus in research and policy.
COVID-19 , Domestic Violence , Humans , Pandemics , Communicable Disease Control , Public Health
BACKGROUND: Evidence-based recommendations for a core outcome set (COS; minimum set of outcomes) for aphasia treatment research have been developed (the Research Outcome Measurement in Aphasia-ROMA, COS). Five recommended core outcome constructs: communication, language, quality of life, emotional well-being and patient-reported satisfaction/impact of treatment, were identified through three international consensus studies. Constructs were paired with outcome measurement instruments (OMIs) during an international consensus meeting (ROMA-1). Before the current study (ROMA-2), agreement had not been reached on OMIs for the constructs of communication or patient-reported satisfaction/impact of treatment. AIM: To establish consensus on a communication OMI for inclusion in the ROMA COS. METHODS & PROCEDURES: Research methods were based on recommendations from the Core Outcome Measures in Effectiveness Trials (COMET) Initiative. Participants with expertise in design and conduct of aphasia trials, measurement instrument development/testing and/or communication outcome measurement were recruited through an open call. Before the consensus meeting, participants agreed on a definition of communication, identified appropriate OMIs, extracted their measurement properties and established criteria for their quality assessment. During the consensus meeting they short-listed OMIs and participants without conflicts of interest voted on the two most highly ranked instruments. Consensus was defined a priori as agreement by ≥ 70% of participants. OUTCOMES & RESULTS: In total, 40 researchers from nine countries participated in ROMA-2 (including four facilitators and three-panel members who participated in pre-meeting activities only). A total of 20 OMIs were identified and evaluated. Eight short-listed communication measures were further evaluated for their measurement properties and ranked. Participants in the consensus meeting (n = 33) who did not have conflicts of interest (n = 29) voted on the top two ranked OMIs: The Scenario Test (TST) and the Communication Activities of Daily Living-3 (CADL-3). TST received 72% (n = 21) of 'yes' votes and the CADL-3 received 28% (n = 8) of 'yes' votes. CONCLUSIONS & IMPLICATIONS: Consensus was achieved that TST was the preferred communication OMI for inclusion in the ROMA COS. It is currently available in the original Dutch version and has been adapted into English, German and Greek. Further consideration must be given to the best way to measure communication in people with mild aphasia. Development of a patient-reported measure for satisfaction with/impact of treatment and multilingual versions of all OMIs of the COS is still required. Implementation of the ROMA COS would improve research outcome measurement and the quality, relevance, transparency, replicability and efficiency of aphasia treatment research. WHAT THIS PAPER ADDS: What is already known on this subject International consensus has been reached on five core constructs to be routinely measured in aphasia treatment studies. International consensus has also been established for OMIs for the three constructs of language, quality of life and emotional well-being. Before this study, OMIs for the constructs of communication and patient-reported satisfaction/impact of treatment were not established. What this paper adds to existing knowledge We gained international consensus on an OMI for the construct of communication. TST is recommended for inclusion in the ROMA COS for routine use in aphasia treatment research. What are the potential or actual clinical implications of this work? The ROMA COS recommends OMIs for a minimum set of outcomes for adults with post-stroke aphasia within phases I-IV aphasia treatment research. Although not intended for clinical use, clinicians may employ the instruments of the ROMA COS, considering the quality of their measurement properties. The systematic inclusion of a measure of communication, such as TST, in clinical practice could ultimately support the implementation of research evidence and best practices.
Aphasia , Communication , Quality of Life , Adult , Humans , Activities of Daily Living , Aphasia/diagnosis , Aphasia/therapy , Delphi Technique , Language , Outcome Assessment, Health Care/methods , Research Design , Treatment Outcome
PURPOSE: To understand the views of people with dysphagia and their supporters on the feasibility of using 3D food printing to improve the visual appeal of texture-modified foods and their mealtime experiences. MATERIALS AND METHODS: Nine people with dysphagia and four of their supporters engaged in a virtual 3D food printing experience and interview over Zoom© about their impressions and usability of the printer and potential for it to improve their mealtime experiences. The in-depth interviews were analysed using thematic analysis and usability heuristics. RESULTS: Four content themes in the interviews impacted on the feasibility of 3D food printing. They related to the practicality, design acceptability, population suitability, and cost of 3D food printing. Usability heuristic analysis revealed that print quality, user control, error prevention, and handling of food consistencies would impact on use. Perceived low efficiency and increased time required to create food shapes meant participants were cautious in their overall impressions of the role of the device. CONCLUSION: After an immersive virtual experience with a 3D food printer, people with dysphagia and their supporters identified a wide range of usability issues that would need to be addressed prior to implementation and in the future design of user-friendly 3D food printers for people with dysphagia. Future research should include people with dysphagia and their supporters in 3D food printer design and implementation trials.Implications for Rehabilitation3D food printing may provide people with dysphagia who require texture-modified food a way to produce visually appealing texture-modified food if usability issues are addressed.3D food printing could improve participation in meal preparation if the person with dysphagia chooses the food and the shape and size of the printed food shape.
Background: Augmented reality (AR) technologies may provide immersive visual supports that foster active user engagement in activities. However, there is little research examining the use of AR as a visual support to guide its use in research or therapy settings.Aims: To investigate the development and use of AR for delivering visual supports in an immersive environment, using the Microsoft® HoloLens2® and Microsoft® Dynamics 365 Guides® software.Method: In a duo-ethnography, two speech-language pathologists who were novice users of the HoloLens2®, examined the affordances of the device for potential use in future research with people with neurodevelopmental disability. In a proof-of-concept study, an AR application was designed by the first author and used by two researchers in a duo-ethnography. The first and second author tested the AR guide and reflected on opportunities and barriers to further use of AR technology, specifically the HoloLens2®, to support people with disability to participate and be included in meaningful activities.Results: The guide created provided situated visual instructions, video models, and holographic symbols to direct the second author in making of a cup of tea. While a moderate level of technological literacy was needed to establish and install a guide, effective use could be established with minimal training.Discussion & conclusions: AR guides offer a situated and integrated means of providing visual support to people with disabilities. This proof-of-concept study justifies further testing and evaluation of AR as an assistive technology for people with neurodevelopmental disability.IMPLICATIONS FOR REHABILITATIONEmerging immersive Augmented Reality technology provides new opportunities to create integrated visual supports that function within the user's environment to enable active participation in activities and interactions.Visual supports integrated with the user's environment may better support people with disability to actively engage and attend to objects and to their communication partners.While new and emerging technologies like Augmented Reality are largely untested for disability support, they offer opportunities to enable participation in independent activities.
Purpose: Qualitative research methods, grounded in an inductive analytic paradigm, increasingly inform clinical practice in the field of speech-language pathology. Social media research, often including qualitative methods, provides a valuable way to connect and listen to the voices of people with communication disabilities. With growing empirical evidence on the ways that people with communication disabilities use social media, and recognition of both benefits and limitations of its use, it is important to consider what will support clinicians to translate this work conceptually and safely into clinical practice.Method: In this paper, we use the tools of metaphor and arts-based knowledge translation to promote the translation of evidence into social media practice.Results: With social media being an important ecosystem to grow and nurture in speech-language pathology, a "picturing a social media garden" metaphor is proposed to further research translation. The metaphor will be used to frame strategies for applying qualitative techniques for speech-language pathologists to consider how to use social media in clinical and professional practice, as well as citing supporting literature to guide further reading.Conclusion: The suggested approaches could augment existing methods of assessment and intervention for people with communication disabilities and provide support for clinicians who want to develop their own strategy for using social media, build a vibrant social media ecosystem, and integrate social media interventions into their clinical services.
Communication Disorders , Social Media , Speech-Language Pathology , Humans , Speech , Gardens , Ecosystem
PURPOSE: Much is promised in relation to the use of three-dimensional (3D) food printing to create visually appealing texture-modified foods for people with dysphagia, but little is known of its feasibility. This study aimed to explore the perspective of allied health professionals on the feasibility of using 3D food printing to improve quality of life for people with dysphagia. METHOD: Fifteen allied health professionals engaged in one of four 2-hr online focus groups to discuss 3D food printing for people with dysphagia. They discussed the need to address the visual appeal of texture-modified foods and watched a video of 3D food printing to inform their discussions on its feasibility. Focus group data were transcribed verbatim, de-identified, and analyzed using thematic content analysis. Participants verified summaries of the researchers' interpretation of the themes in the data. RESULTS: Participants suggested that 3D food printing could improve the mealtime experience for people with dysphagia but noted several barriers to its feasibility, including the time and effort involved in printing the food and in cleaning the printer. They were not convinced that 3D-printed food held higher visual appeal or looked enough like the "real food" it represented. CONCLUSIONS: Allied health professionals considered that 3D food printing could benefit people with dysphagia by reducing the negative impacts of poorly presented texture-modified foods. However, they also considered that feasibility barriers could impede uptake and use of 3D food printers. Further research should consider the views of people with dysphagia and address barriers reported in this study.
Deglutition Disorders , Allied Health Personnel , Deglutition Disorders/therapy , Humans , Meals , Printing, Three-Dimensional , Quality of Life
PURPOSE: Virtual reality (VR) lends itself to communication rehabilitation by creating safe, replicable, and authentic simulated environments in which users learn and practice communication skills. The aim of this research was to obtain the views of health professionals and technology specialists on the design characteristics and usability of a prototype VR application for communication rehabilitation. MATERIALS AND METHODS: Nine professionals from different health and technology disciplines participated in an online focus group or individual online interview to evaluate the application and use of the VR prototype. Data sources were analysed using a content thematic analysis. RESULTS: Four main themes relating to VR design and implementation in rehabilitation were identified: (i) designing rehabilitation-focused virtual worlds; (ii) understanding and using VR hardware; (iii) making room for VR in rehabilitation and training; and (iv) implementing VR will not replace the health professional's role. DISCUSSION: Health professionals and technology specialists engaged in co-design while evaluating the VR prototype. They identified software features requiring careful consideration to ensure improved usability, client safety, and success in communication rehabilitation outcomes. Continuing inclusive co-design, engaging health professionals, clients with communication disability, and their families will be essential to creating useable VR applications and integrating these successfully into rehabilitation. Implications for rehabilitationHealth and technology professionals, along with clients, are integral to the co-design of new VR technology applications.Design of VR applications needs to consider the client's communication, physical, cognitive, sensory, psychosocial, and emotional needs for greater usability of these programs.Realism and authenticity of interactions, characters, and environments are considered important factors to allow users to be fully immersed in virtual simulations to enhance rehabilitation.
Purpose Spoken discourse analysis is commonly employed in the assessment and treatment of people living with aphasia, yet there is no standardization in assessment, analysis, or reporting procedures, thereby precluding comparison/meta-analyses of data and hindering replication of findings. An important first step is to identify current practices in collecting and analyzing spoken discourse in aphasia. Thus, this study surveyed current practices, with the goal of working toward standardizing spoken discourse assessment first in research settings with subsequent implementation into clinical settings. Method A mixed-methods (quantitative and qualitative) survey was publicized to researchers and clinicians around the globe who have collected and/or analyzed spoken discourse data in aphasia. The survey data were collected between September and November 2019. Results Of the 201 individuals who consented to participate, 189 completed all mandatory questions in the survey (with fewer completing nonmandatory response questions). The majority of respondents reported barriers to utilizing discourse including transcription, coding, and analysis. The most common barrier was time (e.g., lack of time). Respondents also indicated that there was a lack of, and a need for, psychometric properties and normative data for spoken discourse use in the assessment and treatment of persons with aphasia. Quantitative and qualitative results are described in detail. Conclusions The current survey study evaluated spoken discourse methods in aphasia across research and clinical settings. Findings from this study will be used to guide development of process standardization in spoken discourse and for the creation of a psychometric and normative property database. Supplemental Material https://doi.org/10.23641/asha.166395100.
Aphasia , Aphasia/diagnosis , Humans , Psychometrics , Surveys and Questionnaires
Inequalities in alcohol-related health harms have been repeatedly identified. However, the socioeconomic distribution of alcohol-related violence (violence committed by a person under the influence of alcohol)-and of subtypes such as alcohol-related domestic violence-remains under-examined. To examine this, data are drawn from nationally representative victimisation survey, the Crime Survey for England and Wales, from years 2013/14 to 2017/18. Socioeconomic status specific incidence and prevalence rates for alcohol-related violence (including subtypes domestic, stranger, and acquaintance violence) were created. Binomial logistic regressions were performed to test whether the likelihood of experiencing these incidents was affected by socioeconomic status when controlling for a range of pre-established risk factors associated with violence victimisation. Findings generally show lower socioeconomic groups experience higher prevalence rates of alcohol-related violence overall, and higher incidence and prevalence rates for alcohol-related domestic and acquaintance violence. Binomial logistic regression results show that the likelihood of experiencing these types of violence is affected by a person's socioeconomic status-even when other risk factors known to be associated with violence are held constant. Along with action to address environmental and economic drivers of socioeconomic inequality, provision of publicly funded domestic violence services should be improved, and alcohol pricing and availability interventions should be investigated for their potential to disproportionately benefit lower socioeconomic groups.
Alcohol Drinking/epidemiology , Violence , Adult , Crime Victims , Domestic Violence , England/epidemiology , Female , Humans , Male , Risk Factors , Socioeconomic Factors , Wales/epidemiology
Purpose The heterogeneous nature of measures, methods, and analyses reported in the aphasia spoken discourse literature precludes comparison of outcomes across studies (e.g., meta-analyses) and inhibits replication. Furthermore, funding and time constraints significantly hinder collecting test-retest data on spoken discourse outcomes. This research note describes the development and structure of a working group, designed to address major gaps in the spoken discourse aphasia literature, including a lack of standardization in methodology, analysis, and reporting, as well as nominal data regarding the psychometric properties of spoken discourse outcomes. Method The initial initiatives for this working group are to (a) propose recommendations regarding standardization of spoken discourse collection, analysis, and reporting in aphasia, based on the results of an international survey and a systematic literature review and (b) create a database of test-retest spoken discourse data from individuals with and without aphasia. The survey of spoken discourse collection, analysis, and interpretation procedures was distributed to clinicians and researchers involved in aphasia assessment and rehabilitation from September to November 2019. We will publish survey results and recommend standards for collecting, analyzing, and reporting spoken discourse in aphasia. A multisite endeavor to collect test-retest spoken discourse data from individuals with and without aphasia will be initiated. This test-retest information will be contributed to a central site for transcription and analysis, and data will be subsequently openly curated. Conclusion The goal of the working group is to create recommendations for field-wide standards in methods, analysis, and reporting of spoken discourse outcomes, as has been done across other related disciplines (e.g., Consolidated Standards of Reporting Trials, Enhancing the Quality and Transparency of Health Research, Committee on Best Practice in Data Analysis and Sharing). Additionally, the creation of a database through our multisite collaboration will allow the identification of psychometrically sound outcome measures and norms that can be used by clinicians and researchers to assess spoken discourse abilities in aphasia.
Aphasia , Aphasia/diagnosis , Aphasia/therapy , Humans , Psychometrics , Surveys and Questionnaires
Background: Technology devices and applications including virtual reality (VR) are increasingly used in healthcare research and practice as tools to promote health and wellbeing. However, there is limited research examining the potential for VR to enable improved communication for people with communication disability.Aims: To review: (a) current research using VR in speech-language pathology; and (b) the ethical and safety considerations of VR research, to inform an agenda for future research applying VR in the field of speech-language pathology.Main contribution: This review reveals that there is an emergent body of literature applying VR to improve or develop physical, psychological and communication interventions. Use of non-immersive virtual environments to provide speech-language pathology assessment or intervention for people with communication disability has demonstrated positive outcomes, with emerging evidence of the transfer of functional communication skills from virtual to real-world environments. However, the use of VR technology and immersive virtual environments in communication disability practice and research introduces safety and ethical issues that must be carefully considered.Conclusions: Research employing VR is in its infancy in the field of speech-language pathology. Early evidence from other healthcare disciplines suggests that VR is an engaging means of delivering immersive and interactive training to build functional skills that can be generalized to the real world. While the introduction of new technology requires careful consideration of research ethics and patient safety, future VR communication research could proceed safely with adequate engagement of interdisciplinary teams and technology specialists.Implications for rehabilitationImmersive virtual reality may be used in rehabilitation to simulate natural environments to practice and develop communication skills.The sense of immersion that can be achieved using virtual reality may promote the generalization of skills learnt during clinical rehabilitation to real-world situations.Ethical and safety considerations, including cybersecurity and cybersickness, must be carefully monitored during all virtual reality research.
Communication Disorders/rehabilitation , Virtual Reality Exposure Therapy/methods , Humans , Virtual Reality Exposure Therapy/instrumentation
AIMS: To examine the impact of non-dependent parental drinking on UK children aged 10-17. METHODS: Cross-sectional survey of UK parents and their children in 2017 (administered to one parent in a household, then their child, totaling 997 adults and 997 children), providing linked data on parental drinking from parent and child perspectives. The survey included measures of parents' alcohol consumption and drinking motivations (both reported by parents) and children's exposure to their parent's drinking patterns and children's experiences of negative outcomes following their parent's drinking (both reported by children), plus sociodemographic measures. RESULTS: Logistic regression analysis indicates a significant positive association between parental consumption level and children reporting experiencing negative outcomes. Witnessing a parent tipsy or drunk and having a parent who reported predominantly negative drinking motives were also associated with increased likelihood of children reporting experiencing negative outcomes. Age was also associated, with older children less likely to report experiencing negative outcomes following their parent's drinking. CONCLUSIONS: Findings suggest levels of and motivations for parental drinking, as well as exposure to a parent tipsy or drunk, all influence children's likelihood of experiencing negative outcomes.
Alcohol Drinking/psychology , Parents/psychology , Adolescent , Adult , Age Factors , Child , Cross-Sectional Studies , Female , Humans , Male , Motivation
Purpose The purpose of this study was to conduct an integrative review of original research, across adult populations relating to fatal or nonfatal choking on food, to understand ways to respond to and prevent choking incidents. Method Four scientific databases (CINAHL, Medline, Web of Science, and EMBASE) were searched for original peer-reviewed research relating to fatal or nonfatal choking on foods. Data were extracted on study characteristics; factors leading up to, events at the time of, and actions taken after the choking incident; and impacts of choking incidents. An integrative review of the findings across studies identified several risk factors and recommendations to reduce the risk of choking. Results In total, 52 studies met the criteria for inclusion in this review, of which 31 were quantitative, 17 were qualitative, and 4 were of a mixed methods design. Studies reported the observations and narratives of bystanders or researchers, or else were large-scale autopsy studies, and included both the general public and people at risk of dysphagia. A range of food types were involved, and several actions were reported in response to food choking. Strategies to reduce the risk of choking were identified in the studies and are presented in 5 main categories. Conclusions Factors leading up to choking incidents extend well beyond the individual to the environment for mealtimes; the provision of appropriate mealtime assistance and oral care; and regular monitoring of general health, oral health, and medications. Bystanders' increased awareness and knowledge of how to respond to choking are vital. The results of this review could be used to inform service policy and training, for individuals at risk of choking, the people who support them, and the general public. Further research is needed to explore choking prevention and airway protection in individuals with dysphagia. Supplemental Material https://doi.org/10.23641/asha.8121131.
Airway Obstruction/prevention & control , Meals , Oral Health , Humans , Qualitative Research , Risk Factors
OBJECTIVES: To integrate findings on the information infrastructure for people with intellectual or developmental disability (I/DD) living in supported accommodation, to understand how documentation use impacts person-centred support. METHODS: We conducted an integrative literature review. Following screening by two independent reviewers, we included English language peer-reviewed empirical studies (n = 34) on documentation use for people with I/DD in domestic-scale supported accommodation. We appraised quality and extracted information for iterative comparative thematic and content analysis. RESULT: All studies reported written documentation regarding either the person with disability or the residence. Eighteen studies focused on health-specific information. We identified three key themes impacting on the person-centred support; 1) level of inclusion and independence of people with I/DD, 2) the culture of support within group homes, and 3) the quality use of information. CONCLUSIONS: Information infrastructure is closely aligned with the support culture in residences and can affect whether and to what extent key stakeholders (i.e., people with I/DD, family members) are involved in making decisions about healthcare and support needs. PRACTICE IMPLICATIONS: Surveying local service health information infrastructure can provide crucial insights which can be leveraged to improve the safety and quality of supports provided for people living in supported accommodation.
Disabled Persons , Documentation , Patient-Centered Care , Residential Facilities/standards , Decision Making , Humans , Organizational Culture , Patient Safety , Quality Improvement
BACKGROUND: Patients with communication disability, associated with impairments of speech, language, or voice, have a three-fold increased risk of adverse events in hospital. However, little research yet examines the causal relationship between communication disability and risk for specific adverse events in hospital. OBJECTIVE: To examine the impact of a patient's communication disability on their falls risk in hospital. METHODS: This systematic review examined 61 studies on falls of adult hospital patients with communication disability, and patients at high risk of communication disability, to determine whether or not communication disability increased risk for falls, and the nature of and reasons for any increased risk. RESULTS: In total, 46 of the included studies (75%) reported on participants with communication disability, and the remainder included patients with health conditions placing them at high risk for communication disability. Two thirds of the studies examining falls risk identified communication disability as contributing to falls. Commonly, patients with communication disability were actively excluded from participation; measures of communication or cognition were not reported; and reasons for any increased risk of falls were not discussed. CONCLUSIONS: There is some evidence that communication disability is associated with increased risk of falls. However, the role of communication disability in falls is under-researched, and reasons for the increased risk remain unclear. Practical applications: Including patients with communication disability in falls research is necessary to determine reasons for their increased risk of adverse events in hospital. Their inclusion might be helped by the involvement of speech-language pathologists in falls research teams.
Accidental Falls/statistics & numerical data , Communication Disorders , Hospitals/statistics & numerical data , Humans , Patient Safety/standards
