Simulation of other-initiated repair using AAC.

This simulation study assessed the ability of Speech-Output Technologies (SOTs) to keep in-time during conversational repair. Fifty-eight Other Initiated Repair (OIR) initiators were collected from transcripts of repair interaction sequences collected from past research. A range of selection latencies were then used to calculate simulated utterance composition delays for the OIR initiators using two popular SOT software apps, with and without the use of word prediction. To determine whether OIR utterances could be produced within a socially sensitive temporal gap, composition delay was compared to a conservative temporal limit obtained for oral communicators (Kendrick, 2015). Even at the fastest 0.5 s selection latency level, utterance-level composition delays for both SOTs were substantially greater than the OIR limit set for this study. Next, AAC production rate data spanning a variety of technologies, access methods, tasks and user profiles was obtained from the literature. Communication performance for these groups was then evaluated against the identified temporal OIR limit. None of the user groups were found to be capable of producing full OIR utterances within the temporal limits of oral-speech conversation, with most unable to type even a single selection within these bounds. Because of the frequency and importance of repair in conversation, these results have important implications for designing devices to enable their users to successfully engage in such important conversational activities.

Influence of hierarchy on risk communication during robot-assisted surgery: a preliminary study.

INTRODUCTION: A hierarchical structure is where all individuals are organized according to importance and are subordinate to a single person. In the operating room (OR), this structure may negatively impact the quality of communication and jeopardize patient safety. We examined how the surgical team's hierarchical relationships affect the frequency and timing of risk communication, and their influence on situational awareness (SA) in the OR. METHODS: Overhead cameras and lapel microphones were used to record the OR environment. Recordings and transcriptions of 10 robot-assisted prostatectomies were examined for risk utterances among team members. Utterances were classified by sender-recipient exchange, timing (determined by phrasing to be proactive or reactive to an error/negative event), and the Oxford Non-Technical Skills (NOTECHS) SA score. Surgeon's and trainee surgeon's utterances were classified by their on-console status. Chi-square tests were used to determine associations between dependent factors, and ANOVAs were used to evaluate the effect of hierarchy and timing on NOTECHS score. RESULTS: Of 4,583 examined utterances, 329 (7%) were risk-related. There was no significant difference in utterance frequency based on hierarchical status of sender and recipient (p = 0.16). Utterances made by the surgeon or trainee surgeon had higher NOTECHS scores when off versus on the console (scores: 1.8 vs 2.4, p < 0.01). These utterances were more reactive on the console (32%) and proactive off the console (28%). Proactive utterances had higher NOTECHS scores than reactive utterances (scores: 2.5 vs 1.8, p < 0.01). CONCLUSION: The surgical hierarchy significantly impacted the frequency of risk communication within the OR. Timing and on-console status further influenced the efficacy of risk communication.

Interaction symmetry: Assessing augmented speaker and oral speaker performances across four tasks.

This investigation examined the impact of speech-generating devices (SGDs) on the interaction dynamics (i.e., symmetry) of augmented speakers and their conversation partners while performing several interaction tasks. This study involved 20 dyads: 10 in which one individual had ALS and primarily used an SGD for communication while the other participant primarily used speech (AS group); and 10 in a control group comprised of individuals who used speech as a primary means of communication (OS group). Interactions between participants in the AS group were compared across four tasks (i.e., map, retell, sequencing, and personal narrative). These results were also compared to performances of participants in the OS group performing the same tasks. Task completion times, talk times, contribution types (i.e., main/repair), and contribution functions (i.e., presentation/acceptance) were used to index symmetry performance patterns across tasks for the 20 dyads. Within- and between-group comparisons were significant in differentiating the two groups in terms of the ways in which they were able to adapt to different interaction task dynamics. Findings suggest symmetry is a useful metric for identifying the constraining influence of carrying out in-person interactions with an SGD.

The structure of participants' turn-transition practices in aided conversations that use speech-output technologies.

Using the concepts and principles of conversation analysis (CA), this paper examines the everyday, unscripted, spontaneous conversations between 4 males who communicated with the aid of speech-output technologies and their mothers. The analyses focused on describing the conversationalists' various actions in aided turn-transition processes, resulting in a 3-part turn-transition structure used to accomplish aided turn initiation. Despite the challenges to conversational progress, the participants did not consider the conversational speed a challenge. The participants and their mothers were oriented to the progression of the aided conversation by creating interaction practices to achieve successful turn-transitions. By understanding the structural characteristics of fluent aided conversations, it may be possible to develop effective interaction strategies for communication partners and for augmentative and alternative communication technologies that are intentionally designed to facilitate interactive communication.

Designing interaction, voice, and inclusion in AAC research.

The ISAAC 2016 Research Symposium included a Design Stream that examined timely issues across augmentative and alternative communication (AAC), framed in terms of designing interaction, designing voice, and designing inclusion. Each is a complex term with multiple meanings; together they represent challenging yet important frontiers of AAC research. The Design Stream was conceived by the four authors, researchers who have been exploring AAC and disability-related design throughout their careers, brought together by a shared conviction that designing for communication implies more than ensuring access to words and utterances. Each of these presenters came to AAC from a different background: interaction design, inclusive design, speech science, and social science. The resulting discussion among 24 symposium participants included controversies about the role of technology, tensions about independence and interdependence, and a provocation about taste. The paper concludes by proposing new directions for AAC research: (a) new interdisciplinary research could combine scientific and design research methods, as distant yet complementary as microanalysis and interaction design, (b) new research tools could seed accessible and engaging contextual research into voice within a social model of disability, and

Clinical Insights Into the Use of Speech Amplification Devices for Managing Hypophonia: Interviews With Speech-Language Pathologists.

PURPOSE: The purpose of this qualitative interview study was to identify themes regarding considerations in the usage of speech amplification device usage for people with Parkinson's disease (PD) and hypophonia from the perspective of speech-language pathologists (SLPs). METHOD: Eligible participants included SLPs currently practicing in the United States or Canada with experience working with clients with PD for at least 2 years. Ten SLPs participated in 60-min interviews conducted via Zoom. A semistructured interview guide was created prior to the interviews. The interviews were transcribed following their completion, and an iterative coding process was used to identify themes using thematic analysis. RESULTS: Three main themes were identified from the interviews. The first theme encapsulated how clinicians described amplification devices as a potential treatment tool, which highlighted the nuances that may impact selecting an amplification device as a treatment option such as increased hypophonia or dysarthria severity and cognitive decline. The second theme highlighted how device selection depends on the individual needs of the user. Individual client characteristics (such as disease symptoms and individual needs and preferences) may impact the choice of amplification device. The last theme outlined the importance of involving family members in all stages of device use and involving other health care team members on a case-by-case basis. CONCLUSIONS: The insights provided by the SLP participants help to understand the clinical decisions that are made when determining device candidacy, selecting a device, and evaluating device success. These insights can be used to improve research studies of augmentative management of hypophonia and guide more personalized management decisions.

Speech Amplification Device Usage for the Management of Hypophonia: A Survey of Speech-Language Pathologists.

PURPOSE: The purpose of this study was to survey speech-language pathologists (SLPs) who assess and treat people with Parkinson's disease (PD) to gather insights into their decision making regarding their use or potential use of speech amplification technology for the management of hypophonia. METHOD: A total of 111 SLPs who were currently practicing in the United States or Canada and had experience working with clients with PD for at least 2 years completed an anonymous Qualtrics survey. Questions were designed to probe the following areas: (a) degree of familiarity with amplification devices as a form of treatment for PD, (b) attitudes and perceptions of the implementation of these devices for PD, and (c) factors that influence the clinical decision to prescribe such devices. RESULTS: Most participants (75; 71%) reported they had considered prescribing a device to at least one client with PD. When asked at which stages of speech or voice impairment they would consider the use of an amplification device for clients with PD, the most common response was for clients with moderate or severe hypophonia who were not stimulable for louder speech. However, 36 (32%) respondents indicated they would also consider an amplification device for clients who were stimulable for louder speech with severe hypophonia. When asked to rank the most important factors they would weigh when considering the prescription of an amplification device, they ranked the client's preference and comfort level as the most important consideration. CONCLUSION: This study provides valuable clinical insights regarding how SLPs can approach utilizing speech amplification devices in the therapy environment.

Evaluating user-personas as supplementary tools in AAC intervention and clinician decision making.

Models used for the design and service delivery of Augmentative and Alternative Communication (AAC) systems are limited. There are no standardized protocols for gathering user requirements beyond clinical/diagnostic information relating to AAC access needs (i.e., physical and cognitive capabilities). Nonetheless, information on the social, cultural, and psychological aspects of technology orientation and use are important to understanding how an AAC system will complement the user's lifestyle, personal goals, values, and activities. Persona development is a user-centered design method that creates descriptive user models of different segments of a user population. Personas describe users' personal characteristics, and the ways in which they think, behave, and engage in activities (with or without technology). The objective of this study is to investigate the utility of user personas as a supplementary tool to aid SLPs in AAC assessment and service delivery.Three personas of individuals with Amyotrophic Lateral Sclerosis (ALS) were developed and validated in our prior research. Twelve SLPs engaged in mock AAC assessments of the three ALS case studies under two conditions: with or without the use of personas as a supplemental informational tool. By and large, there were no statistically significant differences between groups across objective measures; however, interview sessions with the SLP participants revealed benefits to using personas during clinical decision-making, particularly for training novice SLPs. Discussion also focuses on ways in which user personas can be adapted and improved to mitigate some of the challenges and risks identified.

The active role of interpreters in medical discourse - An observational study in emergency medicine.

OBJECTIVE: To study communicative tasks executed and related strategies used by patients, health professionals, and medical interpreters. METHODS: English proficient and limited English proficient emergency department patients were observed. The content of patient-hospital staff communication was documented via pen and paper. Key themes and differences across interpreter types were established through qualitative analysis. Themes and differences across interpreter type were vetted and updated through member checking interviews. RESULTS: 6 English proficient and 9 limited English proficient patients were observed. Key themes in communicative tasks included: establishing, maintaining, updating, and repairing understanding and rapport. All tasks were observed with English proficient and limited English proficient patients. The difference with limited English proficient patients was that medical interpreters played an active role in completing communicative tasks. Telephone-based interpreters faced challenges in facilitating communicative tasks based on thematic comparisons with in-person interpreters, including issues hearing and lost information due to the lack of visual cues. CONCLUSIONS: Professional interpreters play an important role in communication between language discordant patients and health professionals that goes beyond verbatim translation. PRACTICAL IMPLICATIONS: Training for interpreters and health professionals, and the design of tools for facilitating language discordant communication, should consider the role of interpreters beyond verbatim translation.

"Put the what, where? Cut here?!" challenges to coordinating attention in robot-assisted surgery: a microanalytic pilot study.

INTRODUCTION: During robot-assisted surgery (RAS), changes to the operating room configuration pose challenges to communication by limiting team members' ability to see one another or use gesture. Referencing (the act of pointing out an object or area in order to coordinate action around it), may be susceptible to miscommunication due to these constraints. OBJECTIVES: Explore the use of microanalysis to describe and evaluate communicative efficiency in RAS through examination of referencing in surgical tasks. METHODS: All communications during ten robot-assisted pelvic surgeries (radical cystectomies and prostatectomies) were fully transcribed. Forty-six referencing events were identified within these and subjected to a process of microanalysis. Microanalysis employs detailed transcription of speech and gesture along with their relative timing/sequencing to describe and analyse interactions. A descriptive taxonomy for referencing strategies was developed with categories including references reliant exclusively on speech (anatomic terms/directional language and context dependent words (CD)); references reliant exclusively on gesture or available aspects of the environment (point/show, camera focus/movement in the visual field and functional movement); and references reliant on the integrated use of speech and gesture/environmental support (integrated communication (IC)). Frequency of utilisation and number/percent 'miscommunication', were collated within each category when miscommunication was defined as any reference met with incorrect or no identification of the target. RESULTS: IC and CD were the most frequently used strategies (45% and 26%, respectively, p≤0.01). Miscommunication was encountered in 22% of references. The use of IC resulted in the fewest miscommunications, while CD was associated with the most miscommunications (42%). Microanalysis provided insight into the causes and nature of successful referencing and miscommunication. CONCLUSIONS: In RAS, surgeons complete referencing tasks in a variety of ways. IC may provide an effective means of referencing, while other strategies may not be adequately supported by the environment.

What Does Evidence-Based Practice Mean to You? A Follow-Up Study Examining School-Based Speech-Language Pathologists' Perspectives on Evidence-Based Practice.

Purpose The current investigation is a follow-up from a previous study examining child language diagnostic decision making in school-based speech-language pathologists (SLPs). The purpose of this study was to examine the SLPs' perspectives regarding the use of evidence-based practice (EBP) in their clinical work. Method Semistructured phone interviews were conducted with 25 school-based SLPs who previously participated in an earlier study by Fulcher-Rood et al. 2018). SLPs were asked questions regarding their definition of EBP, the value of research evidence, contexts in which they implement scientific literature in clinical practice, and the barriers to implementing EBP. Results SLPs' definitions of EBP differed from current definitions, in that SLPs only included the use of research findings. SLPs seem to discuss EBP as it relates to treatment and not assessment. Reported barriers to EBP implementation were insufficient time, limited funding, and restrictions from their employment setting. SLPs found it difficult to translate research findings to clinical practice. SLPs implemented external research evidence when they did not have enough clinical expertise regarding a specific client or when they needed scientific evidence to support a strategy they used. Conclusions SLPs appear to use EBP for specific reasons and not for every clinical decision they make. In addition, SLPs rely on EBP for treatment decisions and not for assessment decisions. Educational systems potentially present other challenges that need to be considered for EBP implementation. Considerations for implementation science and the research-to-practice gap are discussed.

Diagnostic Decisions in Child Language Assessment: Findings From a Case Review Assessment Task.

Purpose The current study used a case review diagnostic assessment task to examine the diagnostic decisions speech-language pathologists (SLPs) working in the United States made after reviewing child language cases. Method Fourteen SLPs were given 5 case studies that presented either congruent or incongruent results between standardized testing and informal measures. After reviewing the assessment data, SLPs were asked to make a diagnostic decision. Results Unanimous consensus regarding diagnostic decisions was found when the assessment data were congruent. When the data were incongruent, unanimous consensus was not achieved. Standardized testing seemed to guide the diagnostic decision. This pattern of reliance on standardized testing was evident even when 80% of SLPs reviewed informal language data. In 97% of cases, a standardized test was used to guide clinical decision making. Conclusion Three patterns of clinical decision making in child language assessment emerged: (a) use of both standardized testing and informal measures, (b) a reported concern tool as a 1st step in the process, and (c) standardized testing as the most influential data for guiding diagnostic decisions. Although this study provides initial evidence regarding the process of diagnostic decision making, future studies should examine decision making in real time to further validate the implicit rules used during decision making. Supplemental Material https://doi.org/10.23641/asha.7991174.

Whole utterance approaches in AAC.

Increased communication rate has long been a goal of both individuals who use AAC and device manufacturers. There is evidence that utterance-based approaches have the potential to deliver faster rates without loss of coherence. An overview of the historical development of devices that embody such approaches is set out here. This account focuses on the theoretical origins of utterance-based devices (UBDs) and the range of approaches that these have produced. Next, the issue of a causal relationship between conversational rate and positive attributions is addressed. Three recent studies supporting a causal relationship are described, followed by an account of a direct comparison between a UBD and a word construction system in office environments that involved a mix of transactional communication and social chat. Conversational rate and perceived communicative competence were both higher when the UBD was used. Finally, some issues for the future development of UBDs are discussed.

School-Based Speech-Language Pathologists' Perspectives on Diagnostic Decision Making.

Purpose: This study used a structured open interview approach to elicit information from school-based speech-language pathologists (SLPs) regarding their assessment practices for children with suspected language impairment. Method: Phone interviews were conducted with 39 school-based SLPs who were employed across the United States. The interviews explored assessment topics related to assessment tool selection and rationale and the integration of assessment data to determine treatment eligibility. Results: The results of this study suggest that SLPs use both standardized testing and informal testing for their diagnostic procedures. Standardized testing appears to be the tool that drives diagnostic decisions regarding eligibility and severity. Informal measures, such as parent/teacher interviews and language sampling, were used by school-based SLPs to gather information regarding naturalistic language use; however, they seem less important in the diagnostic decision-making process. Also, SLPs reported completing language sample transcription and analysis in real time while interacting with a child. Conclusions: School-based SLPs appear to rely on the results from standardized testing when determining treatment eligibility for children with language impairment. The reliance on standardized testing appears to be driven by institutional policies. We discuss the potential impact of federal/state/district guidelines on diagnostic decisions and consider the research-to-practice gap.

Access to augmentative and alternative communication: new technologies and clinical decision-making.

Children with severe physical impairments require a variety of access options to augmentative and alternative communication (AAC) and computer technology. Access technologies have continued to develop, allowing children with severe motor control impairments greater independence and access to communication. This article will highlight new advances in access technology, including eye and head tracking, scanning, and access to mainstream technology, as well as discuss future advances. Considerations for clinical decision-making and implementation of these technologies will be presented along with case illustrations.