The therapeutic link in the speech therapy clinic: a necessary reflection. / O vínculo terapêutico na clínica fonoaudiológica: uma reflexão necessária.

PURPOSE: To understand the meanings that the therapeutic bond assumes for clinical speech therapists. METHODS: The research was approved by the Ethics Committee, being of a transversal character, with a quantitative-qualitative approach in the Content Analysis. The research with the participation of 96 clinical speech therapists, registered in the Speech Therapy Council of the 3rd region (CRFa 3), which covers the States of Paraná and Santa Catarina. RESULTS: Of the 96 speech therapists included, a significant part of the participants defined the therapeutic bond as a relationship/interaction. Regarding the role of the bond for the speech therapy clinical work, most professionals declared theirs as a fundamental basis and another part of the bond is necessary for the evolution/development of the patient. CONCLUSION: It is possible to understand that, according to the therapeutic patients, it is essential to sustain, maintain the clinical work for users, impacting the resignification of the complaint and the minimization of the users' suffering.

OBJETIVO: Compreender os sentidos que o vínculo terapêutico assume para fonoaudiólogos clínicos. MÉTODO: A pesquisa foi aprovada por Comitê de ética, sendo de caráter transversal, de abordagem quanti-qualitativa, pautada na Análise do Conteúdo. A pesquisa contou com a participação de 96 profissionais fonoaudiólogos clínicos, inscritos no Conselho de Fonoaudiologia da 3ª região (CRFa 3), o qual abrange os Estados do Paraná e de Santa Catarina. RESULTADOS: Dos 96 fonoaudiólogos incluídos, parte significativa dos participantes definiram o vínculo terapêutico como sendo relação/interação. Referente ao papel do vínculo para o trabalho clínico fonoaudiológico, a maioria dos profissionais o descreveu como base fundamental e outra parte deles afirmou que tal vínculo é necessário para a evolução/desenvolvimento do paciente. CONCLUSÃO: É possível compreender que, de acordo com os participantes, a relação terapêutica é essencial para a sustentação e manutenção do trabalho clínico fonoaudiológico, impactando na ressignificação da queixa e na minimização do sofrimento dos usuários.

The Implementation of Telepractice in Speech Language Pathology in Hong Kong During the COVID-19 Pandemic.

Introduction: The aim of this study was to investigate the accelerated emergence of telepractice in speech language pathology during the coronavirus disease 2019 (COVID-19) pandemic in Hong Kong-a small city with limited accessibility concern that telepractice has not been widely implemented. Method: An online survey of speech therapists in Hong Kong was conducted between February and March in 2020. The survey comprised up to 15 questions to assess participants' demographics, existing service delivery in telepractice, perception, and their training and knowledge on telepractice. Results: One hundred thirty-five speech (n = 135) speech language pathologists responded to the survey. About one-third (34.8%; n = 47) of participants reported having provided services through telepractice, whereas 72.3% of them started in <3 months and half of them considered it was less effective than face-to-face service. Among the other participants (n = 88), 83% of them indicated that unsuitable patient type and age as the main reason for not providing telepractice. The majority of participants had no prior training for delivering telepractice, and focused on technology when asked about their desired training. Knowledge of participants on telepractice was found only to align fairly with international guidelines. Discussions: The survey findings suggested that telepractice provision in Hong Kong was different from that of other countries where telepractice has been well established, due to the accelerated emergence by the COVID-19 pandemic. Conclusions: The study showed how the development of telepractice would be like in a short time frame, and findings on perception and desired training could be a reference for a better establishment of this model of service.

Brief Report: Speech and Language Therapy in Children with ASD in an Aquatic Environment: the ASLT (Aquatic Speech and Language Therapy) Program.

Although water-based approaches have been shown to be beneficial for children with Autism Spectrum Disorder (ASD), no study thus far has directly investigated the effects of such intervention programs on language skills. The present study aims to evaluate the efficacy of the Aquatic Speech and Language Therapy (ASLT) program, which is a new, exclusively aquatic intervention program designed especially for children with ASD. The effects of ASLT were compared to the outcome of a similar classroom-based intervention, in two groups of children with ASD matched for age, gender, and expressive/receptive vocabulary. Our findings show that ASLT results in significantly greater improvement of vocabulary measures, thus providing direct evidence of water-based intervention's beneficial effects on language skills in ASD.

Supporting language development in Lebanese preschools: SLT and pre-KT practice and perception of roles.

BACKGROUND: Speech and language therapists (SLTs) are increasingly engaging in school-based interventions targeting children with language difficulties. Collaborative work between teachers and SLTs has shown to be beneficial in fostering language development in all children. Both groups of professionals have different but complementary roles in offering language support, according to children's needs. Effective collaboration between SLTs and teachers requires both parties to understand their roles and practices in schools. However, little is known about language support practices in Lebanese preschools and the roles of SLTs in these contexts. AIMS: (1) To explore the perceptions and reported practices among preschool teachers (pre-KTs) to support language development; (2) to investigate the current practices of SLTs in preschools; and (3) to understand pre-KTs' and SLTs' perceptions of the SLTs' role in Lebanese preschools. METHOD & PROCEDURES: Using a quantitative method, the study reports the results of two questionnaires (one for pre-KTs and one for SLTs) that were developed based on a review of the academic literature and adapted to the contextual realities. Questionnaires were completed in hard or soft copy by pre-KTs and through an online survey by SLTs. OUTCOMES & RESULTS: The questionnaires were completed by 1259 out of 1442 pre-KTs from 175 Lebanese preschools, and by 200 out of 391 SLTs from across Lebanon. First, the findings show that both professional groups recognize they have a role in supporting language development. Second, differences in reported practices were identified regarding language strategies for children with communication needs. In particular, pre-KTs reported less use of specific language strategies targeting children with language difficulties, while SLTs reported that their practices in schools remain primarily focused on children with communication needs. Finally, the analysis of perceptions showed a lack of acknowledgement of the SLTs' role in the prevention of communication and language disorders among all children. CONCLUSIONS & IMPLICATIONS: This study provides an overview of the perceptions and reported practices of language development support in Lebanese preschools. The majority of SLTs and pre-KTs acknowledge their role in supporting language development. However, the slight differences in perceptions of SLT roles in prevention interventions highlight the necessity for SLTs to promote their active involvement in services targeting all children. Future research will investigate how SLTs are beginning to reconceptualize their role in intervention for preschool children. This will help to better define SLTs' roles and responsibilities in educational settings and foster effective professional collaboration. What this paper adds What is already known on the subject Collaboration between teachers and SLTs has been shown to be beneficial in supporting language among all children. The way SLTs and pre-KTs view each other's roles could result in more effective professional collaboration. The SLT profession in Lebanon emerged about 20 years ago, yet SLTs are still struggling to define a framework for the scope of their practice in Lebanese preschools and to increase awareness of the relevance of their intervention in language. What this paper adds to existing knowledge The results revealed that there are major agreements between pre-KTs and SLTs concerning the support of language development in preschools. However, the findings highlight slight differences in the perception of the SLTs' role in the prevention of communication, language and literacy disorders in educational settings. It seems that their role is more commonly acknowledged for children with identified language and communication needs. Moreover, despite the strong agreement between both professionals on the role of the SLT to target all children, SLTs' practices in preschools are still mostly limited to meeting only referred and diagnosed needs in children. What are the potential or actual clinical implications of this work? This study's findings contribute to a better understanding of the perceptions regarding the roles and practices of both groups of professionals in language development. The differences in how the SLTs' roles are perceived could lead to a more difficult implementation of collaborative language practices in preschools. It is therefore necessary to ensure a better understanding of the roles played by professionals, who could receive the relevant training in undergraduate education programmes. There is also a pressing need to provide a clearer definition of SLTs' roles in educational settings by reconceptualizing them into a preventive approach in collaboration with teachers.

Perceived barriers to compliance with speech-language therapist dysphagia recommendations of South African nurses.

BACKGROUND: Literature has shown that there is limited compliance amongst nurses with the dysphagia recommendations made by speech-language therapists (SLTs). Poor compliance could have a significant impact on the health outcomes of patients with dysphagia. OBJECTIVES: This study aimed to determine the specific barriers to compliance with dysphagia recommendations experienced by South African nurses, with the goal of identifying viable strategies to overcome these barriers. METHOD: This cross-sectional study made use of a self-administered questionnaire to obtain quantitative data on nurses' perceptions of barriers to the implementation of SLT dysphagia recommendations. Eighty-one nurses were recruited from two tertiary hospitals in two South African provinces. Descriptive statistics were used to analyse the reported barriers to compliance. RESULTS: Three main barriers to compliance were identified, namely a lack of knowledge regarding dysphagia, patient-related barriers and workplace concerns. Knowledge barriers included poor familiarity with the role of the SLT in dysphagia management, lack of knowledge regarding SLT terminology, disagreement with dysphagia recommendations and insufficient dysphagia training. Workplace concerns included staff shortages, heavy workloads and time constraints. Poor patient cooperation was emphasised as a patient-related barrier. CONCLUSION: For dysphagia recommendations to be followed by nurses, SLTs need to be aware of the barriers experienced by nurses within the relevant facility. Speech-language therapists need to consider the provision of appropriate in-service dysphagia training and include nurses in the decision-making process when recommendations are made. Speech-language therapists need to consider their role in both clear communication with the nurses and the development of supporting material, such as glossaries and visual aids.

Dysphagia services in the era of COVID-19: Are speech-language therapists essential?

In the era of coronavirus disease 2019 (COVID-19), many healthcare professionals are being faced with the question of what is considered to be an essential service. This opinion paper has attempted to answer this complex question by understanding the potential relationship between dysphagia and COVID-19 and how speech-language therapists (SLTs) in South Africa should tackle this. It also aims to answer the question through the lens of a risk-benefit discussion based around practices and decision-making. Important gaps in the field relating to how SLT practices need to move forward during this challenging time have also been highlighted. Reflective questions that can assist SLTs when seeing dysphagia cases have been provided.

Dysphagia and mealtime difficulties in dementia: Speech and language therapists' practices and perspectives.

BACKGROUND: There is increasing recognition of the impact that dementia has upon swallowing and at mealtimes, and the significant effect this can have on people with dementia's health and well-being. However, there remains a paucity of evidence for assessment and intervention practices for dysphagia and mealtime difficulties. Furthermore, there is a limited understanding of how speech and language therapists (SLTs) support people with these dementia-related issues and what are the barriers and facilitators to practice. Further research is therefore needed to guide policy as well as service guideline and delivery development. AIMS: To establish the current practices of SLTs managing dementia-related dysphagia and mealtime difficulties in the UK and Republic of Ireland (ROI), and to establish their opinions and experiences of what challenges or supports to practice they have encountered. METHODS & PROCEDURES: An anonymous, cross-sectional web-based survey was developed and distributed to SLTs working in the UK and ROI. Respondents completed a questionnaire that consisted of open and closed questions across nine topic areas. Closed responses were evaluated using descriptive statistics; open-ended questions were analysed using conventional content analysis. OUTCOMES & RESULTS: A total of 310 people accessed the survey, and 125 respondents completed it fully. While respondents agreed on their role in dysphagia management, they varied in their views on the extent of their role in managing mealtime difficulties. Additionally, their self-rated knowledge of mealtime difficulties in dementia was lower than their dysphagia knowledge. The respondents predominantly based their management decisions on their clinical experience of working with people with dementia. They primarily used compensatory strategies and frequently cited the need for family and care staff training. Respondents also highlighted barriers to effective management and training provision such as inefficient referral systems, a lack of carer knowledge and lack of SLT resources. CONCLUSIONS & IMPLICATIONS: The results provide valuable insight into the issues facing SLTs practising in this area. The SLTs surveyed considered dysphagia a core part of their role when supporting people with dementia; however, respondents' views on mealtime difficulties varied. This highlights the need to establish consensus guidelines on the SLT's role in order to avoid variations in service delivery that could negatively impact the health and well-being of people with dementia. Moreover, further research to develop efficient and effective training for care staff supporting mealtime difficulties and dysphagia is essential. What this paper adds What is already known on the subject Research indicates that people with dementia develop dysphagia and mealtime difficulties as dementia progresses. SLTs often manage these, but there is no research on the effective assessment and management procedures, or guidance on best practice. What this paper adds to existing knowledge This paper provides an understanding of the variation in practice across the UK and ROI. Respondents described barriers to delivering an effective service and frequently linked these to the SLTs' resources as well as service constraints. What are the potential or actual clinical implications of this work? These findings support the need for future research to develop guidelines for SLT practice in this area. They also support the need to examine resource allocation and workforce management to enable SLTs to manage dementia-related dysphagia and mealtime difficulties effectively.

Autistic adults' views of their communication skills and needs.

BACKGROUND: Autistic people require varying levels of support at different stages of their lives. Yet, the healthcare needs of autistic adults are largely unmet. Speech and language therapy (SLT) is one healthcare service that has an important role in supporting autistic people: both with initial diagnosis, and with the ongoing support needed to navigate different communicative challenges across the lifespan. Despite recommendations for such support, currently there is no clear SLT pathway for autistic adults, and a lack of established approaches to support autistic adults' speech, language and communication needs. AIMS: To seek autistic adults' views on (1) their communication skills and support needs; (2) the type of support SLT could offer; and (3) how such support could be provided. METHODS & PROCEDURES: A total of 18 autistic adults were interviewed in their preferred mode of communication (e.g., face to face, phone call, text messaging, e-mail), expressing their views on their communication skills and needs. Interview data were analysed using thematic analysis. OUTCOMES & RESULTS: Autistic adults presented complex views on communication, identifying the benefits of communication, while also emphasizing the significant negative impact that communication difficulties can have on their everyday lives. Identifying a range of internal (e.g., personal feelings) and external (e.g., the communication partner) factors, they highlighted the need for support at both individual levels (for specific life situations) and broader societal levels (to increase awareness and acceptance of communication difficulties). CONCLUSIONS & IMPLICATIONS: Considering the negative impact that communication difficulties can have for autistic adults, a need for support was emphasized. Despite recognition of this need within current legislation (in the UK) and positive steps toward providing support, more needs to be done. As experts in supporting individuals with communication difficulties, speech and language therapists could play a pivotal role in providing support at an individual level, as well as increasing awareness of communication differences more widely. What this paper adds What is already known on this subject There is a growing population of autistic adults with unmet support needs. A core characteristic of autism is difficulty with neurotypical social communication and interaction, which persists into adulthood and impacts across various life domains. What this paper adds to existing knowledge Autistic adults outlined the types of communication difficulties they experience, and how these can negatively impact on physical and mental health. Results highlight how these difficulties are not just rooted within the person themselves but can be influenced by external factors (e.g., the environment and the communication partner). What are the potential or actual clinical implications of this work? Some autistic adults may benefit from direct support from SLT services. However, increased awareness and respect for communication differences at a broader societal level is also needed. Speech and language therapists can play an important role in increasing this level of awareness, positively highlighting differences in communication and ways to support people with communication difficulties/differences.

A survey of cognitive-communication difficulties following TBI: are families receiving the training and support they need?

BACKGROUND: Whilst research into the wide-ranging needs of family members following traumatic brain injury (TBI) is well established, investigation into the specific needs of families in relation to supporting cognitive-communication difficulties, relationships and social participation is limited. AIMS: To identify the family needs for cognitive-communication difficulties following TBI and to explore whether current services are meeting these needs. METHODS & PROCEDURES: Following a successful pilot, family members from the UK and Australia were invited via posters, social media and e-mail to take part in an anonymous, communication needs survey. Data arising from the thirty two closed questions (six eligibility, nine demographic and seventeen needs questions) were analysed using SPSS descriptive statistics. Data arising from one open question were analysed using qualitative content analysis. OUTCOMES & RESULTS: A total of 102 family members from the UK (n = 89, 87%) and Australia (n = 13, 13%) completed the survey. The majority of respondents were female (n = 76; 75%), between the ages of 30 and 69 (n = 88; 87%), and either a parent or a partner of the person following TBI (n = 78;76%). Respondents rated information about expected recovery from cognitive-communication difficulties and training in helpful strategies as their most important needs. The majority of respondents (more than 60%) were not satisfied that any of their cognitive-communication needs had been fully met and high levels of unmet need remained evident at three years or more post-injury. Written information, communication partner training and counselling were identified as key supports. CONCLUSIONS & IMPLICATIONS: Families report high levels of unmet need for managing cognitive-communication difficulties following TBI. Access to written information and communication partner training should be available to families at various time points following TBI and not just in the early stages. What this paper adds What is already known on this subject Attempting to support a person who has cognitive-communication difficulties following TBI has been found to be highly burdensome for family members. However, few studies have asked how families perceive their needs in relation to cognitive-communication difficulties or measured how well current services are meeting their needs. What this paper adds to existing knowledge This study demonstrates that current speech and language therapy services are not yet meeting the needs of the relatives of individuals with cognitive-communication difficulties following TBI. Important insights into the information, training and support families' rate as important are identified in addition to how these needs develop over time. What are the potential or actual clinical implications of this work? Speech and language therapy service design requires to reflect the ongoing nature of familial needs for cognitive-communication difficulties following TBI. Families require access to appropriate literature, speech and language therapy support, and communication partner training in the longer term, not just in the acute phase.

Factors contributing to clinician training and development in the clinical area of laryngectomy and tracheoesophageal voice.

BACKGROUND: It has long been recognized that tracheoesophageal speech (TES) rehabilitation after laryngectomy is a specialized area of practice for speech and language therapist (SLTs) due to the complex nature of patient presentation and the invasive components of the SLT's role in this area. Therefore, postgraduate experience and training is required to work competently and safely in this clinical area. However, it is generally acknowledged that the steps and processes followed by individual clinicians to achieve this training and clinical skill development are inconsistent and vary widely across services. There is a need to identify critical elements deemed most beneficial to clinical skill development in order to inform future training models. AIMS: To explore clinicians' perceptions of factors that contribute to training and clinical skills development in the area of TES rehabilitation post-laryngectomy. METHODS & PROCEDURES: All participants were SLTs working in an Australian clinical service, with a current or recent clinical caseload that included patients using TES. A total of 36 SLTs were recruited and then grouped by level of experience (novice n = 15, intermediate n = 7, experienced n = 14). Each participant took part in one small focus group with other participants of similar experience level. Ten focus groups were conducted, each of approximately 60 min in duration. A semi-structured interview guide was used to facilitate the discussion of issues relating to training in this area. Thematic analysis was used to analyse transcripts and identify themes. OUTCOMES & RESULTS: Interviews identified six key themes, including: Learning with and from others; Formal programmes; Hands-on learning; Processes that influence training; and Individual influences. SLTs reported both positive issues and elements that were challenging across all five themes. The final (sixth) theme was identified regarding clinician perceptions of how this area differed to specialized training in other areas of the profession. The majority of themes were discussed equally by clinicians across all three experience levels. CONCLUSIONS & IMPLICATIONS: Participants across all experience levels identified that multiple factors contributed to clinicians successfully gaining skills, understanding and competency when working in TES rehabilitation post-laryngectomy. These factors, when fully considered and incorporated into future SLTs training pathways and opportunities, have the potential to optimize competency, skill acquisition and maintenance in this area. What this paper adds What is already known on this subject While studies have considered the training, preparation and knowledge base of SLTs working in the clinical area of TES, the focus has predominantly been at the immediate postgraduate level or assessment of university course work. No studies have used a qualitative methodology to consider the reflections and perceptions of clinicians' training pathways and training needs across all levels of experience for this clinical area. What this paper adds to existing knowledge The results of this study build upon the existing body of literature regarding education and training in this area, determining factors SLTs feel are required to successfully gain skills, understanding and competency when working in TES rehabilitation. The findings highlight that training pathways and methods in this clinical area are an ongoing consideration for SLTs regardless of experience level and have the ability to impact on future competency programmes, training opportunities and delivery methods in this area. What are the potential or actual clinical implications of this work? Effective and ongoing postgraduate training programmes and professional development opportunities have the potential to positively impact on professional competence and confidence, patient safety and overall service delivery. Hence, the themes generated from this research highlight essential factors to include within training and professional development programmes for SLTs in TES rehabilitation. This information can be used to help optimize current training pathways for all experience levels.

The COVID-19 pandemic and the implementation of telehealth in speech-language and hearing therapy for patients at home: an experience report. / Pandemia do COVID-19 e implementação de telefonoaudiologia para pacientes em domicílio: relato de experiência.

We present an experience report on the implementation of real-time telehealth in speech-language and hearing therapy for patients who were previously seen on an outpatient basis in a primary health care service. The Speech-Language Therapy (SLT) team was monitoring twenty-five users when the first cases of COVID-19 were notified in southern Brazil. Of these, it was judged that twelve patients required at least a monitoring call every two weeks. Teleconsultations were available in this first stage, on an emergency basis, during the implementation of the project in this format. The idea was to guarantee, due to the suspension of the SLT sessions, the maintenance of the care service for patients who could suffer worsening of their cases or even comorbidities. The appointments were carried out by video calls by SLT students, therapists of the extension project, and supervised by a speech-language therapist, synchronously. All conversations and orientations during the teleconsultation were conducted as calmly as possible and, in the case of infant patients, permeated by some playful activities. Telehealth has shown to be an efficient resource for the care of patients with SLT demands, enabling remote care with the same quality as face-to-face care. Besides, it has relevant potential, once there is a significant number of patients, who need SLT assessment and live in regions where there is a shortage of qualified professionals.

Apresentamos um relato de experiência de implementação de telefonoaudiologia em tempo real para pacientes que anteriormente eram atendidos em ambulatório em um serviço de atenção primária em saúde. No total, 25 usuários estavam sendo acompanhados pela equipe de fonoaudiologia quando da notificação dos primeiros casos de COVID-19 no sul do Brasil. Destes, julgou-se que 12 pacientes demandavam teleatendimento, pelo menos, quinzenalmente. A teleconsulta disponibilizada nesta primeira etapa, em caráter emergencial na implementação do projeto neste formato, a fim de garantir a manutenção dos atendimentos de pacientes que poderiam sofrer agravamento ou mesmo comorbidades associadas à suspensão da fonoterapia, foram realizadas por telefone, com vídeo, por estudantes de fonoaudiologia, extensionistas do projeto e supervisionadas por um fonoaudiólogo, de forma síncrona. Todas as conversas e orientações durante a teleconsulta são encaminhadas com a maior calma possível e, no caso de pacientes infantis, permeadas por algumas atividades lúdicas. A telessaúde tem se mostrado um recurso eficiente para atendimento de pacientes com demandas fonoaudiológicas, possibilitando o atendimento remoto com a mesma qualidade que o atendimento presencial. Além disso, tem potencial relevante, considerando que há um número significativo de pacientes que precisam de avaliação fonoaudiológica e residem em regiões nas quais há escassez de profissionais qualificados.

Use of Imitation Training for Targeting Grammar: A Narrative Review.

Purpose The purpose of this narrative review was to examine the evidence for imitation training for targeting grammar in children with developmental language disorder. Method Studies investigating imitation training were compiled from two databases-PsycINFO and Linguistics and Language Behavior Abstracts-as well as from reference lists of several books and articles reviewing language therapy. Results Twenty-one studies were reviewed. We summarized the demographic and methodological characteristics of the included studies. We identified substantial differences in the implementation of imitation training across the studies and noted a lack of studies considering how those differences might affect therapy outcome. Studies showed a rapid increase in the production of grammatical targets during imitation training activities, higher performance relative to a control group that did not receive any therapy, and generalization to untrained exemplars. However, the studies did not unequivocally link the increased performance to the imitation training therapy. Studies also showed limited generalization to conversational speech. Conversationally based therapy resulted in faster or higher usage in conversational speech, while imitation training resulted in faster immediate gains in usage during therapy trials. Conclusion We believe that imitation training can continue to be a useful tool in a speech-language pathologist's toolbox, but with suggested modifications. Specifically, we suggest use of imitation training as a means for rapidly achieving production of previously absent grammatical targets. However, we do not recommend sole or long-term use of imitation training for working on grammar. Further research is needed to refine our use of the procedure.

Pandemia do COVID-19 e implementação de telefonoaudiologia para pacientes em domicílio: relato de experiência / The COVID-19 pandemic and the implementation of telehealth in speech-language and hearing therapy for patients at home: an experience report

RESUMO Apresentamos um relato de experiência de implementação de telefonoaudiologia em tempo real para pacientes que anteriormente eram atendidos em ambulatório em um serviço de atenção primária em saúde. No total, 25 usuários estavam sendo acompanhados pela equipe de fonoaudiologia quando da notificação dos primeiros casos de COVID-19 no sul do Brasil. Destes, julgou-se que 12 pacientes demandavam teleatendimento, pelo menos, quinzenalmente. A teleconsulta disponibilizada nesta primeira etapa, em caráter emergencial na implementação do projeto neste formato, a fim de garantir a manutenção dos atendimentos de pacientes que poderiam sofrer agravamento ou mesmo comorbidades associadas à suspensão da fonoterapia, foram realizadas por telefone, com vídeo, por estudantes de fonoaudiologia, extensionistas do projeto e supervisionadas por um fonoaudiólogo, de forma síncrona. Todas as conversas e orientações durante a teleconsulta são encaminhadas com a maior calma possível e, no caso de pacientes infantis, permeadas por algumas atividades lúdicas. A telessaúde tem se mostrado um recurso eficiente para atendimento de pacientes com demandas fonoaudiológicas, possibilitando o atendimento remoto com a mesma qualidade que o atendimento presencial. Além disso, tem potencial relevante, considerando que há um número significativo de pacientes que precisam de avaliação fonoaudiológica e residem em regiões nas quais há escassez de profissionais qualificados.

ABSTRACT We present an experience report on the implementation of real-time telehealth in speech-language and hearing therapy for patients who were previously seen on an outpatient basis in a primary health care service. The Speech-Language Therapy (SLT) team was monitoring twenty-five users when the first cases of COVID-19 were notified in southern Brazil. Of these, it was judged that twelve patients required at least a monitoring call every two weeks. Teleconsultations were available in this first stage, on an emergency basis, during the implementation of the project in this format. The idea was to guarantee, due to the suspension of the SLT sessions, the maintenance of the care service for patients who could suffer worsening of their cases or even comorbidities. The appointments were carried out by video calls by SLT students, therapists of the extension project, and supervised by a speech-language therapist, synchronously. All conversations and orientations during the teleconsultation were conducted as calmly as possible and, in the case of infant patients, permeated by some playful activities. Telehealth has shown to be an efficient resource for the care of patients with SLT demands, enabling remote care with the same quality as face-to-face care. Besides, it has relevant potential, once there is a significant number of patients, who need SLT assessment and live in regions where there is a shortage of qualified professionals.

Interactive Storybook Reading Instruction for Preschoolers Who Are Deaf and Hard of Hearing: A Multiple Probe Across Behaviors Analysis.

Purpose: Interactive storybook reading (ISR) improves the picture labeling vocabulary of children who are deaf and hard of hearing (DHH). Vocabulary knowledge consistently predicts the later reading achievement of children who are DHH. In this study, ISR was modified to include teaching word meanings along with the vocabulary picture label. Method: A multiple probe across behaviors single-case experimental design was implemented to determine the effects of ISR with word meaning instruction on picture labeling and word meaning knowledge of 6 preschoolers who are DHH and use spoken English. The student and teacher participants engaged in ISR for 15-20 min a day, 4 days a week for 3 weeks. Results: A functional relation was established between ISR and the increase in the preschoolers' word labeling and meaning knowledge. The preschoolers' word knowledge was generalized and was maintained over time. Conclusions: ISR may be an effective vocabulary labeling and word meaning instructional strategy for young children who are DHH and use spoken English. Teachers and related service providers who work with this population may want to implement ISR with word meaning in 1-to-1 or small groups to individualize the target vocabulary and maximize the benefit. Future researchers should replicate this to expand its generalizability to other subpopulations of children who are DHH.

Clinicians' views of the training, use and maintenance of phonetic transcription in speech and language therapy.

BACKGROUND: The critical role of phonetic transcription in the assessment, diagnosis and management of speech disorders is well established and thus pre-registration degrees dedicate numerous hours to phonetic training. However, this training is not always fully used in clinical work and clinicians may find it difficult to maintain their skills, suggesting a 'theory/practice gap'. AIMS: This paper surveys speech and language therapists' (SLTs) views of their training, practice and maintenance of transcription in order to investigate the posited theory/practice gap and to explore how education in phonetics is translated into practice. METHODS & PROCEDURES: A total of 759 SLTs from the UK were surveyed via an online questionnaire. Multiple-choice questions were analysed using descriptive statistics, and free-text comments were analysed thematically. OUTCOMES & RESULTS: Thirty-five per cent of SLTs found learning phonetics quite easy, and 30% quite difficult. Respondents suggested that more time was needed to practise transcription in and out of the classroom; nevertheless, the majority felt at least equipped to undertake transcription after their training. A total of 75% of SLTs require transcription for their role, with 61% using it often or all the time. Some 45% use a mix of broad and narrow transcription, with 41% using only broad transcription. Those not using narrow transcription attributed this to lack of confidence. A total of 57% of SLTs did not feel supported to maintain transcription skills in the workplace, and 80% had never attended a refresher course in transcription, with 75% wishing to do so. CONCLUSIONS & IMPLICATIONS: As many clinicians found it difficult to learn transcription, there is an opportunity to provide more transcription practice both in and beyond the classroom. Despite most clinicians feeling equipped to undertake transcription upon completion of their training, and a large majority requiring transcription for their role, a theory/practice gap is apparent in the relatively small number of clinicians using narrow transcription exclusively, and those not using it expressing lack of confidence in their skills. Additionally, as many clinicians have never attended refresher training in transcription, and rely on their course notes to maintain their skills, more provision of opportunities for revision should be made available. With clinicians remembering a need for more practice during their training, and expressing a desire for more training opportunities in practice, there is an opportunity for clinicians, educators and regulatory bodies to work together to provide packages of transcription training material that can be used by students and practitioners to maintain and extend their skills.

Exploring accounts of collaborative working between speech and language therapists and stroke association communication support coordinators following stroke.

In the United Kingdom, speech and language therapists (SLTs) and Stroke Association communication support coordinators (CSCs) are both employed to provide services for people with communication difficulties following stroke. There is very little literature of this type of collaborative working. This research is unique because it explores collaborative working between SLTs who are employed by the National Health Service and CSCs who are employed by the Stroke Association. Five CSCs and seven SLTs from the East of England participated in a series of in-depth interviews. Data were analysed using thematic analysis informed by an interpretative phenomenological approach. The analysis suggested complex negotiation processes occur at a number of different levels. These levels include negotiation of individual relationships between SLTs and CSCs, negotiating the particular challenges involved in working across organisations and professions, and the need for both roles to negotiate and promote the value of their services at a societal level. The findings of this research are discussed in relation to existing theories and research within the field of collaborative working. Clinical applications are suggested for collaborative working within communication services. We propose that our findings may have relevance to other individuals and organisations delivering services collaboratively.

Formación parental para mejorar las técnicas del lenguaje narrativo de sus hijos con discapacidad intelectual / Training parents to enhance narrative language skills in their children with intellectual disability

El presente estudio analizó la utilización de la formación parental y la intervención del lenguaje narrativo realizada por los padres, para incrementar la comprensión y la producción del lenguaje narrativo en niños con discapacidad intelectual. Catorce niños con discapacidad intelectual, y sus padres, tomaron parte en el estudio. Los padres participaron en un taller en vivo para aprender los métodos de intervención del lenguaje narrativo, y recibieron un paquete de materiales y dos libros preseleccionados. Tras la sesión, completaron la formación en casa con sus hijos durante un periodo de ocho semanas. A los niños se les realizaron pruebas previas y finales, sobre técnicas del lenguaje narrativo. Durante el estudio, los padres enviaron un informe semanal al investigador principal, y completaron una encuesta a la conclusión de la intervención. Los padres reportaron resultados positivos en cuanto a mejora del conocimiento sobre técnicas del lenguaje narrativo, y fueron capaces de incorporar los materiales suministrados y las técnicas aprendidas para incrementar la comprensión y la producción de lenguaje por parte de sus hijos (AU)

The present study investigated the use of parent training and parent-delivered narrative language intervention to increase narrative language comprehension and production in children with intellectual disability. Fourteen children with intellectual disability and their parents took part in the study. Parents participated in a live workshop to learn the methods for narrative language intervention and were provided with a packet of materials and two preselected books. After the session, they completed the training at home with their children over a period of 8 weeks. Children were pre tested and post tested for narrative language skills. Parents reported to the primary investigator weekly during the study and completed a survey following the conclusion of the intervention. Parents reported positive outcomes in that they gained knowledge of narrative language skills and were able to incorporate the materials provided and techniques learned to increase their child’s language comprehension and production (AU)

Intervention in reading processes in pupils with Specific Language Impairment (SLI) / Intervención en procesos lectores en alumnado con Trastorno Específico del Lenguaje

BACKGROUND: Children with Specific Language Impairment (SLI) encounter significant difficulties in learning to read. The aim of this research was to determine the efficacy of an intervention program on reading processes (letter identification, lexical processes, syntactic processes and semantic processes) in children with SLI. METHOD: The sample consisted of a total of 34 pupils diagnosed with SLI and 34 children with typical language development. For the selection of the sample, the CELF-3 test, the Peabody test, the Hearing Association and Visual Association subtests of the ITPA and the K-BIT Intelligence test were used. The intervention program consisted of 144 sessions of 40 minutes each, in which oral language activities were combined with other activities related to the automation of basic reading processes and reading sentences and texts. RESULTS: Significant gains were also made in the group of children with SLI versus controls in lexical, syntactic, and semantic reading processes.CONCLUSIONS: A combined program of both oral language and reading skills improves reading achievement in pupils with SLI

ANTECEDENTES: los niños con Trastorno Específico del Lenguaje (TEL) tienen importantes dificultades para el aprendizaje de la lectura. El objetivo de esta investigación ha sido comprobar la eficacia de un programa de intervención sobre los procesos lectores (identificación de letras, procesos léxicos, procesos gramaticales y procesos semánticos) en niños con TEL. MÉTODO: la muestra estuvo compuesta por un total de 34 alumnos diagnosticados con TEL y 34 niños con un desarrollo típico del lenguaje. Para la selección de la muestra se utilizaron los tests CELF-3, Peabody, las subpruebas de Asociación Auditiva y de Asociación Visual del ITPA y el Test de Inteligencia K-BIT. El programa de intervención constó de 144 sesiones, de 40 minutos de duración cada una, en el que se combinaron actividades de lenguaje oral con otras destinadas a la automatización de procesos lectores básicos y de lectura de frases y textos.RESULTADOS: los niños con TEL obtuvieron ganancias significativas frente a los controles en los procesos lectores léxicos, sintácticos y semánticos. CONCLUSIONES: un programa combinado de lenguaje oral y lectura mejora el rendimiento lector en alumnado con TEL

Propuesta didáctica de estimulación de la competencia lingüística y del lenguaje infantil: estudio de validez / Teaching proposal of stimulation of the linguistic´s competence and the infant´s speech: validity study

En base a la teoría sólida y consolidada de la inclusión, la cual está adquiriendo cada vez mayor fuerza en el ámbito educativo, la presente Propuesta Didáctica pretende ofrecer una respuesta válida para los profesionales que consideren mejorar los niveles de competencia lingüística de sus alumnos de Educación Infantil así como participar de manera activa en la prevención e intervención temprana de los aspectos lingüísticos y su problemática en dicha etapa, metodología que emana de esta nueva manera de entender la práctica educativa. Todo ello, en un marco de actuación cooperativo entre maestros y especialistas, para prevenir los factores de exclusión académica, social y emocional que pudieran derivar no sólo de una problemática focalizada, sino también de las diferencias del nivel madurativo y lingüístico encontradas cuando los niños acceden a estas aulas (AU)

Taking into account the solid and consolidated theory of inclusion, which is playing a relevant role in the educational field, the present didactic proposal aims at offering a valid response to those professionals aiming at improving their students´ linguistic competence in nursery levels, as well as taking part in an active way in the prevention and early intervention of the linguistic aspects and its negative consequences at this stage. This is a methodology that originates from this new way of understanding the teaching process. All this happens in a cooperative context among tutor and teachers of specific areas, in order to prevent factors of academic, social and emotional exclusion that could derive not only from a focalized issue, but also from the differences in the child´s psychological and linguistic development found when the children begin this early educational stage (AU)