Abstract

Background

In children with a cleft palate with or without a cleft lip (CP±L), some evidence exists for superior results of high-intensity speech intervention (HISI) compared with low-intensity speech intervention (LISI) on speech and health-related quality of life (HRQoL). However, the existing research often involves small sample sizes. Additionally, therapy in these studies is typically administered by researchers with extensive experience in treating speech disorders in these children. In contrast, first-line speech–language pathologists (SLPs) often possess considerably less experience in treating these children and clinical practice is subject to a wider array of environmental influences. Moreover, there are insufficient data on the cost-effectiveness of HISI compared with LISI. So far, these factors have hampered the implementation of HISI in clinical cleft practice.

Aims

The purpose of this study is twofold: (1) to compare the effectiveness of HISI and LISI on a larger societal scale, as delivered by first-line SLPs, on speech and HRQoL in Belgian Dutch-speaking children with a CP±L; and (2) to evaluate the cost-effectiveness.

Methods & Procedures

This study consists of a large-scale, longitudinal, two-centre randomized controlled trial to investigate the effectiveness of HISI and LISI. Children with a CP±L, aged between 4 and 12 years, are randomly assigned to one of the two intervention groups. A sample size calculation determined that 35 participants per group are needed to ensure adequate statistical power. Children in the HISI group will receive intervention with a session duration of 30 min, a dose frequency of five sessions per week and a total intervention duration of 8 weeks (two 4-week blocks with a rest period of 12 weeks). Children in the LISI group will receive intervention with a session duration of 30 min, a dose frequency of two sessions per week and a total intervention duration of 20 weeks. The cumulative intervention intensity is kept constant. Each child will receive identical phonetic–phonological speech intervention provided by first-line community SLPs in private practices. Speech samples and patient- and caregiver-reported outcome measures will be collected on multiple data points before, during and after the intervention period. The cost-effectiveness will be evaluated by applying a cost-effectiveness and cost-utility analysis.

Outcomes & Results

It is hypothesized that HISI will lead to superior speech outcomes in terms of consonant production and proficiency, resonance, speech understandability and speech acceptability, as well as improved HRQoL compared with LISI. Additionally, HISI is expected to be cost-effective compared with LISI.

Conclusions & Implications

This project contributes to the development of evidence-based clinical practice guidelines regarding speech intervention intensity in children with a CP±L.

WHAT THIS PAPER ADDS

What is already known on the subject

Speech intervention for children with a CP±L is traditionally provided once or twice per week for 30 min for months or years by first-line community SLPs in private practices or rehabilitation services. However, scientific evidence supporting the effectiveness of this rather low intervention intensity is limited. In recent decades, the focus has shifted to HISI, in which intervention sessions are concentrated within a short period of time, as a more promising intervention intensity. Several studies regarding HISI have shown promising results on speech and HRQoL in children with a CP±L compared with LISI. Clustering sessions also have the potential to be more cost-effective than LISI since fewer sessions are required to achieve the same outcomes, thus reducing the financial burden. However, comprehensive evaluations of cost-effectiveness are lacking. Therefore, before HISI can be implemented in clinical practice, more evidence is needed regarding its effectiveness and cost-effectiveness compared with LISI.

What this paper adds to the existing knowledge

The current project will compare the effectiveness of HISI and LISI in Belgian Dutch-speaking children with a CP±L aged between 4 and 12 years old. For this purpose, a large-scale randomized controlled trial will be performed. Primary outcome measures will include perceptual assessments of speech, while secondary outcome measures will assess multiple dimensions related to HRQoL, such as difficulties with speaking, emotional well-being, perceptions and attitudes related to speech through various psychosocial outcome measures. Additionally, the cost-effectiveness of both intervention intensities will be compared.

What are the potential or actual clinical implications of this work?

Providing more evidence regarding HISI can facilitate the implementation of this intervention model in first-line cleft speech care. This project has the potential to offer a solution to prolonged speech intervention by achieving satisfactory results more quickly, which could significantly reduce the duration of intervention and the associated financial burden.

Abstract

Background

Stroke care in the UK was significantly affected by the COVID-19 pandemic, with many services switching to telehealth. Post-pandemic, a UK survey of speech and language therapists (SLTs) working with people with aphasia (PWA) showed the vast majority planned to continue to use telehealth alongside in-person intervention. Telehealth is considered a cost-effective and feasible method of service delivery; however, there is limited evidence to support its use in the assessment of people with post-stroke aphasia.

Aims

To investigate what barriers and facilitators SLTs experience when administering telehealth assessments to PWA and to explore SLTs’ perspectives on what makes for a positive patient experience.

Methods & Procedures

Focus groups (dyadic/triadic) were conducted via videoconferencing. Transcripts were analysed using framework analysis. Inclusion criteria for participants were SLTs working in the UK with PWA, with experience of using telehealth assessment.

Outcomes & Results

A total of 14 SLTs participated across six groups. Seven themes were identified: assessment; technology; factors specific to PWA; factors specific to family, carers and their environment; factors specific to SLTs; benefits of telehealth assessment; and what telehealth would look like in an ideal world. Facilitators to telehealth assessment included good internet connectivity, access to a helper, adapted assessments, preparation and training PWA to use telehealth platforms. Barriers included reduced control over the environment, having a cognitive impairment, aphasia severity, low beliefs in competence using technology and challenges with managing the emotional needs of PWA during telehealth assessment. A strong therapeutic relationship, offering choice and flexibility in assessment administration, promoted a positive patient experience.

Conclusions & Implications

This study provides new insights into the current use of telehealth assessment with PWA by SLTs in the UK. Barriers and facilitators identified can support the implementation of telehealth assessment in SLT services. Providing a positive patient experience when using telehealth assessment is important to SLTs, with patient choice a key factor. Further research is indicated to increase the range of standardized assessments for telehealth assessment and investigate the efficacy of a hybrid model approach to service delivery.

WHAT THIS PAPER ADDS

What is already known on the subject

There is emerging evidence for the use of telehealth assessment as a feasible and appropriate means of service delivery for SLTs. However, little is known about SLTs’ experience of delivering telehealth assessments to PWA.

What this paper adds to existing knowledge

This study identified both the facilitators and barriers experienced by SLTs when using telehealth assessment with PWA. Practical advice and considerations for telehealth administration are provided.

What are the potential or actual clinical implications of this work?

Resources are required for the implementation of SLT telehealth assessments, particularly in training for both PWA and SLTs, assessments designed for telehealth and accessible telehealth platforms. A hybrid approach to assessment could be beneficial for both PWA and clinicians, retaining the advantages with the acknowledgement that telehealth may not be suitable for all.

Abstract

Background

In aged-care settings, direct care staff play a crucial role in supporting older people with communication needs. Many direct care staff, however, have unmet skill needs in interpersonal, intercultural, and intergenerational communication. Communication Partner Training (CPT) provides a potential solution. However, it is not known if existing programs address the diverse communication needs encountered in aged-care settings. We sought to identify the key features of existing CPT programs to determine their suitability for the Australian aged-care context.

Aims

To identify existing CPT programs relevant to aged-care settings and to describe their content and format.

Methods

A scoping review was conducted in alignment with the Joanna Briggs Manual for Evidence Synthesis and Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews reporting guidelines. Using a systematic search, we identified peer-reviewed articles from five electronic databases: PubMed, PsycINFO, Embase, Cochrane and CINAHL. All retrieved articles were screened by title and abstract; 20% were independently screened by a second reviewer. All full-text articles were independently assessed by two reviewers. Data describing the content and format of identified CPT programs was extracted using the Intervention Taxonomy and an author-developed tool.

Main Contribution

This review highlights critical gaps in existing CPT programs for aged-care settings. Identified programs were predominantly disorder-specific (79%), with the vast majority focusing on conditions like dementia or aphasia and failing to address broader communication needs arising from personal, social and environmental factors. Notably, no programs addressed intercultural communication, despite known cultural and linguistic diversity among aged-care workers and recipients in countries such as Australia. Furthermore, few (9%) included intergenerational communication considerations. Most programs relied on in-person delivery methods (67%), often led by health professionals (71%), which may be impractical for resource-constrained and geographically dispersed aged-care services. Furthermore, reported outcome measures varied (187 across 90 articles), and few evaluated both trainee and client (the ‘dyad’) outcomes. These findings underscore the need for comprehensive, scalable and contextually relevant CPT programs to address the complex communication challenges seen in aged-care settings.

Conclusions

There is a need for a comprehensive CPT program that is fit-for-purpose for direct care staff in aged-care settings. This program should address the multifaceted and intersecting communication support needs of aged-care recipients, including intercultural and intergenerational communication differences. The program should also incorporate resource-feasible delivery methods and evaluate dyadic communication outcomes. Closing these gaps is vital to enhancing quality of care and life for older adults in aged-care settings.

WHAT THIS PAPER ADDS

What is already known on the subject

Many older Australians have complex, unmet communication support needs. In aged-care settings, direct care staff play a crucial role in supporting older people to communicate. Many aged-care workers, however, have their own unmet skill needs in interpersonal, intercultural and intergenerational communication. Communication partner training (CPT) provides a potential solution. However, it is not known if existing programs address the diverse communication support needs encountered in aged-care settings.

What this paper adds to existing knowledge

Using a scoping review methodology, we identified and described CPT programs for direct support staff who work with older adults. Most CPT programs were disorder-specific and targeted communication needs in dementia or aphasia. As aged-care recipients have multifaceted, complex and intersecting communication support needs, these programs may fall short of addressing the training needs of aged-care workers. The mode of training delivery was predominately in-person and health professional-led. Such delivery modes may not support implementation given resource constraints across the Australian aged-care sector. CPT that can be feasibly implemented in aged-care settings to address complex and intersecting communication support needs is required.

What are the potential or actual clinical implications of this work?

Our analysis highlights the need for comprehensive, disorder-agnostic CPT tailored for aged-care staff to address diverse communication support needs. This CPT should consider scalable delivery modes effective across Australia's vast geography and limited trainer availability. It must include outcome measures reflecting the perspectives of communication support partners—older Australians in aged care with communication challenges. To tackle the health, personal and environmental communication barriers in aged care, a fit-for-purpose CPT program, co-designed with key stakeholders, is essential to ensure the training is both feasible and acceptable to meet the unmet needs of intended end-users.

Abstract

Background

The implicit learning deficit hypothesis claims that impaired implicit learning underlies deficits in social-communicative abilities associated with developmental language disorder (DLD). However, previous research testing this hypothesis revealed inconsistent results and largely used process-impure sequential learning tasks.

Aims

This study further tested the hypothesis using a novel process-pure implicit associative learning task.

Methods and Procedures

The performance of 9- to 13-year-old children with (N = 60) and without DLD (typically developing, TD, N = 52) on a contingency learning task (CLT) was compared. The task entailed the incidental learning of the contingency between simultaneously presented figure-colour combinations. Also, the association of CLT performance with three aspects of social-communicative abilities was assessed: facial emotion recognition ability, social responsiveness and language abilities.

Outcomes and Results

Compared to the TD group, the DLD group performed equally on the CLT but showed worse performance on the measures of emotion recognition and social abilities. In neither group was CLT performance significantly related to any of the three social-communicative abilities.

Conclusions and Implications

These results do not support the implicit learning deficit hypothesis. The demonstrated intact implicit learning ability suggests the potential of using interventions to improve social-communicative abilities in children with DLD that are based on incidental or implicit learning rather than on intentional or explicit learning.

WHAT THIS PAPER ADDS

What is already known on the subject

Individuals with developmental language disorder (DLD) not only have linguistic problems but also impaired abilities in social and emotional domains. According to the implicit learning deficit hypothesis, these impairments are largely due to a compromised ability to incidentally or implicitly learn regularities of stimuli or events occurring in daily life. However, research examining this hypothesis has yielded mixed results.

What this paper adds to existing knowledge

This study contributes to the discussion about the presence or absence of a domain-general implicit learning deficit in individuals with DLD, and corresponding potential clinical implications. For this, in addition to measures of language, emotion recognition and social abilities, a novel incidental learning task was used that was held to provide a more process-pure measure of incidental and implicit learning compared to previous research. The collective results do not support the claim of a domain-general implicit learning deficit underlying the social-communicative and -emotional problems in DLD.

What are the potential or actual clinical implications of this work?

Current interventions to improve language, social and emotional abilities in children with DLD are largely based on relatively effortful strategies involving explicit instruction and feedback. The present evidence of intact incidental and implicit learning abilities supports the examination of possible novel interventions that are based on relatively effortless implicit learning strategies, which may be more in line with how these abilities are acquired in daily life.

Abstract

Background

Children with syntactic impairment associated with autism spectrum disorder and developmental language disorder benefit from speech and language therapy intervention. Despite that, few studies focus on the clinical practice of the speech and language therapist (SLT).

Aim

The aim of the study is to explore the clinical practice of SLTs with preschool-age children with syntactic impairment.

Methods & Procedures

A cross-sectional survey was carried out in Portugal, using a questionnaire designed specifically for this study. The survey is composed of 109 questions divided into eight sections. A total of 357 participants responded, representing 10% of the total population of SLTs in Portugal.

Outcomes & Results

Considering the academic background, 46% of SLTs held a master's degree and only 19% attended complementary training in syntax. Regarding professional experience, 92% of SLTs work with preschool-age children with syntactic impairment. Between 89% and 91% of the SLTs report that they have never used any specific program, method or approach for syntactic intervention. Over 40% of SLTs report not feeling confident in assessing syntactic skills, while 43% report not feeling confident in intervening. Between 92% and 98% of SLTs report the need to obtain more academic knowledge and practical training.

Conclusions & Implications

In Portugal, there seems to be a lack of scientific evidence regarding the procedures used in the clinical practice of SLTs in preschool-age children with syntactic impairment. This fact may relate to the need felt by SLTs for more academic and practical training. The current findings highlight the need to address training in syntactic disorder within graduate and postgraduate programs.

WHAT THIS PAPER ADDS

What is already known on the subject

Children with autism spectrym disorder (ASD) and children with developmental language disorder (DLD) experience language disorders, which in turn may have an impact on their socialisation and behaviour, namely when they have syntactic impairment. It is proven that these children benefit from speech and language therapy. Several studies analyse the effectiveness of assessment and intervention procedures in speech and language therapy, defining evidence-based best practices. Thus, there is a lot of research into how SLTs should conduct assessment and intervention. There is, however, little research about SLTs clinical practices.

What this paper adds to existing knowledge

This study paints a broad picture of the clinical practice of SLTs in Portugal, bringing insights specifically into their syntactic domain assessment and intervention practices with preschool-age children. This study also serves to identify the perceived needs of SLTs regarding the syntactic domain, related to academia, complementary training and day-to-day practice in the assessment and intervention of these children.

What are the potential or actual clinical implications of this work?

There are some studies of the assessment and intervention clinical practices of SLTs as well as methods, programs and approaches for syntactic impairment clinical practice with preschool-age children with ASD and children with DLD. However, most of the studies are for the English language. Through this study, it was understood that SLTs in Portugal have a low level of confidence in assessing and intervening with this population. SLTs have identified the need for additional training and theoretical knowledge which can contribute to the adaptation of current academic curricula and broaden the complementary training opportunities.

Abstract

Background

Stuttering development in preschool children might be influenced by parents' concern, awareness and knowledge. Indirect treatment may therefore be appropriate. Intervention in a group format has been shown to be positive for stuttering and an online procedure increases the accessibility of the intervention.

Aims

The aim of this study was to investigate whether an online indirect group treatment for children who stutter could increase parents’ knowledge and confidence in managing the stuttering, reduce the impact of stuttering on the child and parents as well as reduce stuttering severity.

Methods and Procedures

All children having an ongoing contact with a speech-language pathologist at the included clinics and meeting the inclusion criteria were invited to participate in the study. The participants were five families with children, aged 3:7–4:5, who had been stuttering for at least 12 months. Treatment consisted of six weekly online group sessions for parents, followed by 15 weeks of home consolidation. A single-subject research design replicated across participants was used to investigate changes over baseline, treatment and consolidation phase. The outcome measures were Palin Parent Rating Scales and severity ratings of stuttering reported by parents. Mean values of each week's daily parent ratings of stuttering were used and converted to defined scale steps. Changes in all variables were visually analysed for each participant. Scale steps representing the mean values from baseline measurements were compared with those from the consolidation phase to analyse changes in scale steps (clinical relevance).

Outcome and Results

The findings indicate increased parents’ knowledge about stuttering and confidence in how to support their child, as well as a positive trend in the impact of stuttering on child and parents, and stuttering severity, during the intervention. The size of the changes in the included outcome measures (e.g., from low to high or very high) varied between participants. The changes were clinically relevant in one to three, out of four, outcome measures for each child, also for those at risk of persistent stuttering.

Conclusions and Implications

The online group format can be an effective way to increase parents’ ability to handle the child's stuttering at an early stage. Further studies are needed to ensure what treatment effects can be expected, following this indirect online format.

WHAT THIS PAPER ADDS

What is already known on the subject

Indirect therapy involving parents has been shown to benefit preschool children who stutter. These therapies typically include providing information about stuttering, teaching strategies for managing stuttering and improving overall communication skills.

What this paper adds to existing knowledge

This study evaluates a novel form of online group therapy (involving five families) which has not been previously studied. The results demonstrate that most of the parents gain knowledge and confidence in managing their child's speech disorder. Additionally, some parents report a reduced negative impact of stuttering on both the child and the family after the treatment.

What are the potential or actual clinical implications of this work?

This approach can be a valuable tool for speech and language therapists working with preschool children who stutter. The online format offers a practical option for families who face challenges attending in-person sessions, while also providing opportunities to connect with other parents in similar situations.

Abstract

Background

Telehealth placements in speech and language therapy provide crucial opportunities for both learning and service delivery when clinicians, students and/or clients are separated by factors such as distance or illness. While the use of telehealth placements has increased in recent times, they remain a relatively underexplored phenomenon with limited information available about the perceptions and experiences of practice educators and students.

Aims

The aim of this study was to explore experiences of telehealth-delivered speech and language therapy services and tele-supervision from the perspective of speech and language therapy students and practice educators.

Methods and procedures

This study used a sequential exploratory mixed methods design with a questionnaire study followed by a series of focus groups with Australian speech and language therapy educators and speech pathology students. Different questionnaires were used with students (n = 56) and practice educators (n = 27); each explored perceptions of interaction, engagement and student learning via multiple-choice and open-ended questions. Multiple-choice answers were analysed descriptively; open-ended questions were analysed with qualitative content analysis. The results informed the focus group questions. Separate focus groups were held with students (n = 17) and practice educators (n = 20); each explored student learning and development as well as educator supervisory practices. Data were analysed inductively using thematic network analysis.

Outcomes and results

Responses from both student and practice educator questionnaires indicated that students develop some different skills on telehealth placements compared to in-person placements and telehealth placements were more suitable for some students compared to others. We constructed 12 basic themes related to student and educator practices, student learning, client care, perceptions about telehealth, and location of educator and student. These were grouped into three organising themes: processes, perceptions, place. The organising themes were summarised into the overarching theme ‘telehealth and in-person placements: same, same, but different’.

Conclusions and implications

This study adds to the growing body of literature indicating that telehealth placements can meet student learning needs. It suggests that both educators and students need to learn new skills or adapt their current practices to engage in these placements. This paper includes recommendations for how to manage the different practices required by universities, educators and students to promote successful telehealth placements, particularly when the educator and student are not co-located.

WHAT THIS PAPER ADDS

What is already known on this subject

Telehealth use has increased dramatically since the COVID-19 pandemic, both for clinical services and student placements in allied health services in general as well as speech and language therapy (SLT). Student placements conducted via telehealth are beneficial for student learning but some skills such as communication and interpersonal interaction develop differently. Placements can involve students delivering clinical services via telehealth and/ or remote student supervision (tele-supervision).

What this paper adds to existing knowledge

By drawing on the perspectives of students and practice educators, this paper demonstrates that the processes used for supervision, planning and clinical services are different in telehealth compared to in-person placements. It reveals that SLT students and educators have strongly held perceptions about the value and equivalence of telehealth placements that change over the course of a telehealth placement. This paper suggests placements that combine telehealth with tele-supervision are more complex and have fewer opportunities for incidental learning and developing professional workplace skills than placements where the educator and student providing telehealth services are co-located.

What are the potential or actual clinical implications of this work?

This paper will help universities, professional organisations and practice educators disentangle placements where students deliver services using telehealth from those where students also receive tele-supervision. This work identifies common perceptions about telehealth placements that educators can use to guide discussions with students, and guide the selection of effective work practices for students and educators during telehealth placements.

Abstract

Background

Owing to the COVID-19 pandemic, speech-language therapists faced challenges in reaching children with developmental language disorders (DLDs) for a certain period. This unexpected change also had a profound impact on parents of children with DLDs. Despite its significance, there is limited research exploring the experiences of parents who were unable to consult with specialists and their perspectives on telepractice services.

Aims

The primary objective of this study is to investigate the experiences of parents with children diagnosed with DLD (n = 5) related to accessing experts during the COVID-19 pandemic.

Methods and Procedures

Prior to the onset of pandemic-related closures, assessments for children with DLDs were conducted, and plans for initiating their therapies were in place. Parents of children who were unable to commence therapy were invited to participate in the study. Interpretative phenomenological analysis principles were employed to analyse the collected data.

Outcomes and Results

The findings are analysed under four themes. Parents initially expressed the negative impact of being unable to reach experts, which led them to independently support their children's language development. Despite reservations about telepractice, parents were willing to participate. However, they reported feeling unprepared for the abrupt transition to telepractice, particularly regarding the technical requirements, which were limited in availability.

Conclusions and Implications

Maintaining communication with parents, particularly during crisis periods, is crucial for children in need of speech and language therapy. Providing parents with information about the therapy process, their child's language disorder, and the potential use of telepractice is essential. This approach ensures that we can offer effective support for the children.

WHAT THIS PAPER ADDS

What is already known on the subject

During COVID-19, parents of children with developmental language disorders who were undergoing therapy experienced adverse effects. They struggled to assist their children with communication issues and were unable to seek services.

What this paper adds to existing knowledge

If their children are unable to receive language and speech therapy, parents may attempt to resolve the issue on their own. It is a difficult scenario for both parents and children. To support families in this situation, alternatives ought to be sought.

What are the potential or actual clinical implications of this work?

It is possible to make improvements to current procedures and carry out research to inform families on what to do when they are left alone with their children. Future telepractice research will benefit from the development of useful tools and insightful investigations.

Abstract

Background

People with an acquired brain injury (ABI) can struggle to use social media after their injury, due to changes in their cognitive-communication skills, and would like help to improve their skills and connectivity. A focus group study in one Australian brain injury rehabilitation service recently found that ABI rehabilitation professionals are restrictive or reactive (rather than proactive) in their approach to supporting people in using social media after an ABI; however, it is unknown whether this finding reflects practice internationally.

Aim

To survey a larger international cohort of rehabilitation professionals working with people after ABI to understand their views and experiences of social media use after ABI and to explore ways of addressing social media use during rehabilitation.

Methods and Procedures

Participants were recruited via social media posts and email invitations between July 2020 and July 2022 to complete an online survey of 27 questions across three categories, ‘Demographic Information’ (5 questions), ‘Own social media use’ (12 questions), and ‘Perspectives on social media use after ABI’ (10 questions). Directed content analysis was used to explore and interpret the data.

Results

Of the 83 rehabilitation professionals who responded to the survey, 68 data sets met eligibility criteria for analysis. Most respondents were aged between 25 and 55 years (86%), and practiced across Australia (53%), the United Kingdom (24%), the United States (16%), Canada (3%), the European Union (3%) and Asia (1%). Most were speech pathologists (68%), occupational therapists (9%) or clinical neuropsychologists (7%). The mean length of experience working with people with ABI was 14.3 years (SD = 10.6). Participants identified benefits in social media use during ABI rehabilitation for social connection and inclusion, whilst also highlighting the risks and their own limitations in knowledge and expertise. Clinical guidance, policy, funding and resources were recommended to support clinicians to successfully address social media goals during rehabilitation.

Conclusion

Rehabilitation professionals recommend that social media use be routinely considered during rehabilitation after ABI and report that they need greater access to knowledge, expertise, resources and policy to support this in clinical practice. Addressing social media goals in rehabilitation was reported to be complex and challenging yet rewarding for all involved. Ongoing robust research is urgently required to give rehabilitation professionals an evidence-based framework and resources for assessment and intervention in this space.

WHAT THIS PAPER ADDS

What is already known on the subject

People with an acquired brain injury (ABI) experience challenges in using social media safely and meaningfully after their injury. With little guidance available to support clinical practice, ABI rehabilitation clinicians feel uncertain in their approach to addressing social media goals and want greater access to knowledge, expertise and resources.

What this paper adds to existing knowledge

This paper provides confirmation of previous work exploring how social media is addressed during rehabilitation and extends on our knowledge through surveying a larger cohort of international ABI rehabilitation professionals. Rehabilitation professionals report that inclusion in online communities is now central to many people's social and occupational endeavours and recommend that social media use be routinely considered during rehabilitation after ABI. When incorporating the use of social media into rehabilitation, clinicians report positive outcomes despite the complexity and challenges faced in doing so.

What are the potential or actual clinical implications of this work?

Respondents in this study suggested potential approaches and strategies for rehabilitation professionals to consider when supporting social media use after ABI. However, ongoing robust research is urgently required to give rehabilitation professionals an evidence-based framework and resources for assessment and intervention of social media communication skills after brain injury.

Abstract

Background

Videofluoroscopic swallow studies (VFSS) are multidisciplinary swallowing assessments led by speech-language therapists (SLTs). The purpose of oesophageal screening in VFSS is to guide further diagnostic assessment and treatment of possible oesophageal abnormalities. Yet, internationally standard protocols and clinical pathways for oesophageal screening in VFSS have not been established.

Aim(s)

The aim of this study was to refine and optimise oesophageal screening in VFSS at one Australian metropolitan hospital by incorporating expertise of the multidisciplinary dysphagia team.

Methods and Procedures

Focus groups/semi-structured interviews were conducted with SLTs, radiologists (RADs), gastroenterologists (GEs), referring medical officers (MEDs) and medical radiation technicians (MRTs, also known as radiographers) working in VFSS. Interview questions explored oesophageal screening approaches, interpretation and reporting practices, GE referral criteria and clinical recommendations. Data were analysed via qualitative content analysis to determine meaning units, sub-categories, and categories.

Outcomes and Results

Twenty-six health professionals were interviewed (n = 8 SLTs, n = 6 RADs, n = 5 MEDs, n = 4 MRTs, n = 3 GEs). Four categories were identified: (1) oesophageal screening in VFSS adds clinical information but has limitations; (2) specific knowledge, skills and organisational factors are needed to optimise oesophageal screening, including in procedure, interpretation, reporting, GE referral pathway and intervention selection; (3) multidisciplinary consensus is needed regarding normal versus abnormal oesophageal transit and GE referral criteria; and (4) patient context, preferences and reported symptoms should primarily guide dysphagia decision-making. Each category had several component subcategories. The local clinical pathway (also known as care pathway or care map) for oesophageal screening in VFSS was refined by incorporating multidisciplinary dysphagia team expertise.

Conclusions and Implications

There was a willingness from the multidisciplinary dysphagia team to refine the local clinical pathway for oesophageal screening in VFSS. Detailed clinical pathways that guide workflow and decision-making should be considered when introducing oesophageal screening into VFSS protocols.

WHAT THIS PAPER ADDS

What is already known on the subject

Despite the recognised benefits of including oesophageal screening in VFSS, there has been limited uptake of oesophageal screening protocols internationally. Implementation research is needed that supports clinicians to embed oesophageal screening into routine VFSS practice.

What this study adds

This is the first published study that explores in-depth the perspectives of the multidisciplinary dysphagia team regarding oesophageal screening in VFSS.

What are the clinical implications of this work?

This study proposes a clinical pathway refined by the multidisciplinary dysphagia team to support clinicians in embedding oesophageal screening and its findings into routine dysphagia practice.

Abstract

Background

Delayed auditory feedback (DAF) has been used in the treatment of stuttering, providing different results across different populations and age groups.

Aims

This study examines the impact of delayed auditory feedback (DAF) on stuttering-like disfluencies (SLDs) in the spontaneous speech of Jordanian individuals who stutter.

Methods & Procedures

A cross-sectional experimental design was employed to analyse the effects of DAF on the conversational speech of 35 participants (9 females, 26 males) with persistent developmental stuttering, aged 5–29 years (M = 13.1, SD = 6.1). The Stuttering Severity Instrument was used to assess the severity of stuttering. Participants who met the inclusion criteria were asked to talk about general topics of their interests during two different listening conditions (with DAF and without DAF).

Outcomes & Results

No significant DAF effects were found on SLDs in terms of duration [p = 0.18] (blocks, prolongations) and repetition [p = 0.22] (sound repetition, syllable repetition, word repetition). Neither severity nor age affected the use of DAF on SLDs.

Conclusions & Implications

The study concludes that DAF did not result in a significant decrease in SLDs in the spontaneous speech of participants. These findings highlight the limited effect of DAF in reducing stuttering in this specific population.

WHAT THIS PAPER ADDS

What is already known on the subject

Delayed auditory feedback (DAF) has been shown to reduce stuttering frequency by between 60% and 80%. Furthermore, DAF mediates an immediate improvement in the fluency of speech without affecting speech naturalness (Ritto, Juste, and Andrade, 2015). Van Borsel et al. (2003) concluded that DAF offers an effective tool to reduce stuttering when it is applied as the only treatment outside a clinical environment. They also found that fluency is enhanced when DAF is consistently used over a longer period of time.

What this paper adds to existing knowledge

This study uses only spontaneous monologue because it was indicated in some previous Arabic studies that the tendency to produce more stuttering in Arabic during oral reading compared to conversational speech may be influenced by a unique, language-specific feature of stuttering in Arabic which is diglossia. (Alshatti, et al., 2022). This means that the coexistence of two varieties of the same language (Modern Standard Arabic versus Dialectical Arabic) could potentially affect the stuttering severity depending on the type of speech sample collected. To remove the impact of the type of speech sample, reading was excluded from the purpose of the current study.

What are the potential or actual clinical implications of this work?

Nonetheless, the findings of the current study, along with the individual variability of sample sizes in previous studies, support a cautious approach to the use of DAF as a therapeutic intervention for stuttering. In the study of Buzzeti & Oliveira, 2018, the effects were limited to word repetitions. In another study by Stuart et al. (2008), no reduction was found in any of the three measured core behaviours of stuttering (sound prolongations, sound repetitions, and inaudible blocks) during an oral reading task while using the frequency-altered feedback which is similar to DAF.

Abstract

Introduction

Life with aphasia affects the whole family with shorter, less frequent conversations, frustration, reduced social networks, isolation and tension in relationships. Evidence suggests communication partner training (CPT) benefits families. However, expected improvements are poorly articulated. The Aphasia Partnership Training (APT) project aimed to identify target outcomes of a new family dyad CPT programme through persons with aphasia (PWA), family member and speech and language therapist (SLT) consensus.

Method

Consensus on desired outcomes was achieved through nominal groups with 20 people with mild to severe aphasia across five groups and 10 family members of people with mild to severe aphasia across three groups, each facilitated by —two to three SLTs. Twelve CPT researchers 16 clinical SLTs with experience of CPT participated in a three-round eDelphi to gain consensus on outcomes they perceived most likely to change. Results were triangulated using a convergence coding scheme to demonstrate agreement, partial agreement, dissonance or silence amongst the three stakeholder groups.

Results

All stakeholders agreed ‘conversation’ and ‘thoughts and feelings’ were very important outcomes of APT/very likely to change (agreement). Change in ‘relationships’ was very important to family members, important to PWA and considered very likely to change by SLTs (partial agreement). Change in ‘language’ (specifically talking) was very important to PWA, but not important to family members, and SLTs were uncertain about language improvement from APT (dissonance). Each outcome construct is illustrated by specific examples generated and agreed by all stakeholder groups.

Conclusions

We should aim to achieve improvements in conversation and thoughts and feelings with CPT, consider the impact on relationships and investigate the potential for language improvement (talking) as an outcome of APT. Outcome measures can be selected based on good coverage of examples generated within these constructs, ensuring they are meaningful to PWA and family members.

WHAT THIS PAPER ADDS

What is already known on the subject

We know that people with aphasia (PWA) and their family members often find it difficult to communicate together with wide-reaching consequences. We know that communication partner training (CPT) benefits families as demonstrated in two systematic reviews of 56 small studies. We also know what outcomes PWA and their families want from speech and language therapy in general, but there is little clarity in the literature about what outcomes are expected from CPT specifically.

What this paper adds to existing knowledge

This paper highlights the outcomes PWA, family members and speech and language therapists expect from a new CPT programme called Aphasia Partnership Training. These outcomes can be considered for all family dyad CPT programmes.

What are the potential or actual clinical implications of this work?

The outcomes identified through the stakeholder consensus presented from this study can be used to set goals and monitor the success of CPT, help PWA and family members decide whether they want to participate in a communication partner intervention, and ensure that measures used to evaluate the success of CPT interventions are meaningful to PWA and their families.

Abstract

Background

The challenge of assessing all languages of multilingual children by clinicians who do not speak the children's heritage languages is a global problem amplified by the increase in recent migration as well as a lack of available assessment tools.

Aim

To evaluate the feasibility of using a novel scoring schema to assist English-speaking speech and language therapists (SLTs) practising in Ireland in scoring Polish Sentence-Repetition (SRep) Tasks in collaboration with Polish language teachers, and to profile and compare children's language performance across their languages using this scoring schema.

Methods and Procedures

LITMUS SRep in English and Polish was completed by 15 typically-developing children (aged 5–8 years) and 12 children with suspected Developmental Language Disorder (DLD) (aged 5–8 years). Scoring of the Polish SRep was completed collaboratively by a monolingual English-speaking SLT and a Polish language teacher and was compared to the scoring completed by Polish linguists.

Outcomes and Results

Findings indicated that the two scoring methods gave comparable outcomes. Individual participants’ performance varied across the Polish and English SRep with some performing better in Polish, some in English and some with a relatively balanced performance across languages.

Conclusions and Implications

Using pre-recorded sentences in conjunction with the novel scoring schema presented in this study has the potential to support SLTs to increase accuracy in diagnosing DLD and reduce both over- and underdiagnosis of multilingual children. Scoring guidelines need to incorporate crosslinguistic influence across languages of bilingual children while clearly outlining language specific clinical markers for DLD.

WHAT THIS PAPER ADDS

What is already known on this subject

Assessment of multilingual children's language skills and diagnosing Developmental Language Disorder (DLD) is extremely complex due to the heterogeneity associated with their language development. In Ireland, SLTs are largely monolingual English speakers and assessment of heritage languages (HL) is difficult due to a lack of available assessment tools and an increase in the number of languages spoken due to migration. Therefore, investigating ways of multilingual language assessment by monolingual English-speaking clinicians is crucial.

What this paper adds to the existing knowledge

Language processing tasks have demonstrated their utility and accuracy for language assessment in the research. This is the first study to use Sentence-Repetition (SRep) Tasks for both languages of Polish-English speaking children living in Ireland in which the researcher is a monolingual English-speaking SLT and the SRep Tasks are scored using a novel scoring schema with the assistance of a Polish language teacher.

What are the potential or actual clinical implications of this work?

SRep Tasks demonstrate the potential to assist in the assessment and diagnosis of DLD in the Polish-English speaking population in Ireland by English-speaking therapists in collaboration with a Polish language speaker. In this way, both the dominant societal language English and the HL Polish can be assessed to increase the accuracy of diagnosis of DLD. This study contributes towards the development of a SRep tool for use clinically by SLTs in Ireland. Further research is needed to create error profiles reflective of the specific Polish-English speaking population in Ireland.

Abstract

Purposes

The effect of intervening on narrative skills in Chinese-speaking school-age children with developmental language disorder (DLD) is underexplored.

Methods

The aim of the present study was to investigate the effectiveness of narrative intervention on written narratives of Chinese children with and without DLD and to explore the potential differences in response to the intervention between the two groups of children. Children with DLD (N = 22; M age = 9.28, SD = 1.00) and controls (N = 22; M age = 9.82, SD = 1.09) were measured on written narratives in pre- and post-tests. Repeated measures analysis of variance was performed with test time (two levels: pre vs. post) as a within-subject factor and language group as a between-subject factor (two levels: children with DLD and control) on the micro and macro indices of written narratives.

Results

Analysis of the written narratives revealed that the intervention had an impact on story grammar, story pattern, total T-units, use of mental state words, and conjunctions. Differences between language groups were observed in story pattern, mean length of T-unit, and causal density.

Discussion

The results confirm the effectiveness of narrative intervention in enhancing the narrative skills of Chinese-speaking school-age children with and without DLD. Moreover, the results shed light on the core deficits experienced by Chinese-speaking school-age children with DLD.

WHAT THIS PAPER ADDS

What is already known on this subject

By implementing narrative intervention, teachers or speech-language pathologists can efficiently impart a wide range of academically and socially significant language skills to a diverse group of children with and without developmental language disorder (DLD). Despite the cultural variations and linguistic diversity, it is reasonable to teach mainstream narrative structure to children. The published narrative-based intervention programs like Supporting Knowledge in Language and Literacy (SKILL) have been proven effective in improving narrative abilities in different modes, including the one-to-one basis, small group, and classroom-based instruction. Moreover, SKILL can promote the narrative abilities of typically developing children, children with DLD, and children with autism.

What this study adds

The present study is one of the initial endeavours to adapt the framework of SKILL in a narrative intervention program on a cohort of Mandarin-speaking children and seeks to examine the impact of narrative intervention. The findings in the present study should provide an effective model of intervention to facilitate the development of narrative skills for Chinese-speaking school-age children. Developing narrative intervention programs for Mandarin-speaking school-age children with and without DLD makes important clinical contributions.

What are the clinical implications of this study?

The findings in the present study should provide an effective model of intervention to facilitate the development of narrative skills for Chinese-speaking school-age children. children with DLD lagged significantly in the intervention on narrative skills indexed by story pattern, mean length of T-unit, and clausal density, indicating children with DLD have pronounced difficulties in these indices. These narrative indices could be potential linguistic markers that can be used to discriminate children at risk of DLD.

Abstract

Background

An emerging body of literature explores the impact of living with developmental language disorder (DLD) on children, individuals and families. This work has identified a range of challenges and strengths. However, there is limited evidence from the DLD community about the impacts of living with DLD in relation to parenting.

Aims

We explored the perspectives of caregivers in response to an open-text survey question: “What is most rewarding and challenging about being a parent to a child with DLD?”

Methods & Procedures

Respondents were caregivers of children with DLD who had signed up to Engage with Developmental Language Disorder. Qualitative content analysis was used to explore the open-ended responses from 112 parents who completed the yearly survey (child average age = 9.6 years; SD = 3.5 years, 46.9% female). Most caregivers lived in the United Kingdom, but we also had responses from around the world.

Outcomes & Results

For ‘rewards’, 52 codes and seven higher-order categories were identified. These comprised the many rewards experienced from caring for a child with DLD, including seeing and celebrating progress, celebrating their child's personality and being proud to be their child's parent. Caregivers mentioned the positives gained from learning about DLD and working together with their child to help them achieve their potential. They reflected on the supportive nature of the ‘right’ environment, in particular the school context and social connectedness. For ‘challenges’, 84 codes and 11 higher-order categories were identified. Caregivers often noted the lack of awareness of DLD amongst the community and professionals in general, within the school system and amongst teachers. Caregivers reported support and information about DLD were difficult to find and were impacted by a constant need for advocacy. They reflected on the increased time needed to support their child and worried about their child's social and community participation. Many commented on the impact of DLD on the family and the mental health and well-being of both them and their children.

Conclusions & Implications

Hearing the views of caregivers of children with DLD is key because shared decision-making is central to client-centred care. Furthermore, ‘client perspectives’ are a cornerstone of evidence-based practice. There is much to take from the responses and for professionals to reflect on and use. Collaboration with children, young people and families is needed for effective advocacy, and to develop awareness of DLD.

WHAT THIS PAPER ADDS

What is already known on the subject

An emerging body of literature has explored the impact of living with developmental language disorder (DLD) on the child, the individual and the family. This work has identified a range of challenges and strengths. These are important considerations to support the evidence-based practice of those working with the DLD community from planning treatment goals to designing and providing services.

What this paper adds to existing knowledge

Caregivers highlighted a range of rewards in parenting a child with DLD. They also identified a wide range of challenges, including a lack of awareness and support from professionals, the constant need for advocacy and the impact on the family as well as the impact on the mental health of their child and themselves as parents.

What are the potential or actual clinical implications of this work?

Shared decision-making is central to client-centred and family-centred care, and client perspectives are a key aspect of evidence-based practice. There is much for clinicians and practitioners to take from this data set of parent perspectives. The findings from this study will guide researchers and clinicians to reflect on how to work in collaboration with individuals with DLD and their families, including in their design and delivery of services and advocacy to continually raise awareness of DLD.

Abstract

Background

People with right hemisphere damage (PwRHD) are often reported to produce tangential or irrelevant utterances. This may be related to their conversational difficulties, including performance in making relevant responses to questions. Clinical interactions represent a major type of communicative activity that PwRHD frequently attend and where they need to answer questions raised by clinicians. So far very little is known about how PwRHD accomplish question–response sequences in such institutional interactions.

Aims

To examine question–response sequences between participants with right hemisphere damage (RHD) and clinicians. To investigate how potentially tangential talk of the former that ensues after the clinicians’ questions may affect their responses to questions in clinical interactions. To identify problems incurred by those utterances as responses and how clinicians utilize conversational practices to manage them.

Methods & Procedures

Drawing on purposive sampling, the study used four recorded interactions between clinicians and participants with RHD as data. The data were transcribed and analysed within the framework of conversation analysis. The study focuses on question–response sequences where participants with RHD produce potentially tangential utterances as responses to questions raised by the clinicians.

Outcomes & Results

Tangential utterances produced by participants with RHD occur either as overall non-conforming answers to the questions (i.e., not conforming to the normative expectations for the action type and/or grammatical form of response in the clinical setting), or non-conforming extension after type-conforming answers. The clinicians often orient to the overall non-conforming answers as problematic and utilize a set of practices to pursue adequate responses.

Conclusions & Implications

The study presents a new approach to understanding tangential talk associated with RHD, framing it as non-conforming answers within question–response sequences. It also describes management practices employed by the clinicians to cope with them. The results add to knowledge about the communication profile of PwRHD, particularly in goal-oriented interactions. They may provide a reference for assessment and intervention for difficulties of PwRHD in accomplishing question–response sequences. The study also suggests that the assessment of conversational behaviours of the clinical group should be placed within wider sequences and specific communicative activities.

WHAT THIS PAPER ADDS

What is already known on the subject

PwRHD are often reported to produce tangential or irrelevant utterances. They also exhibit differences and challenges in complying with rules in conversational interactions.

What this study adds to the existing knowledge

By using conversation analysis to examine question–response sequences between PwRHD and clinicians, the study investigates how potentially tangential utterances of the former may affect their responses to questions in clinical interactions. It presents a perspective on tangential talk by describing how PwRHD make non-conforming answers to questions. It also describes clinicians’ management practices of the phenomenon. This study extends the literature addressing conversational behaviours of PwRHDs in institutional interactions.

What are the potential or actual clinical implications of this work?

The results add to knowledge about the communication profile of PwRHD, especially in terms of accomplishment of the question–answer sequence type. Difficulties in providing conforming answers to questions should be considered as a potential target in assessment and intervention for conversational difficulties of the clinical group. The study suggests assessment of conversational behaviours of PwRHD should be placed within wider sequences and specific communicative activities.

Abstract

Purposes

Investigating the contribution of each component of the Western Aphasia Battery (WAB) to the aphasia quotient (AQ) helps better understand the mechanisms of change in the AQ. Previous studies on patients with English-speaking aphasia have shown that spontaneous speech contributes the most to the AQ. However, the same conclusion may not be applicable to Chinese-speaking patients with aphasia because of the differences between Chinese and English languages. The primary objective of this study was to investigate differences between Chinese and English people with aphasia in the contribution of WAB components to the AQ. The second objective was to explore the effect of aphasia severity to the AQ.

Methods

A total of 94 patients with Mandarin aphasia participated in this study. The Lmg and Pmvd algorithms based on relative weight analysis were conducted to calculate the contributions of the four main components and 10 subtests of the WAB to the AQ. Lmg measures the relative importance of each variable by allocating the explanatory power of the model, while Pmvd analyses through a decomposition method based on statistical explanatory quantities. In addition, the same method was applied to the severe, moderate and mild aphasia groups.

Results

Of the four main components, naming contributed the most to the AQ, followed by spontaneous speech, listening comprehension and repetition. Object naming contributed the most among the 10 subtests. Among the different severity groups, naming contributed the most to the severe and moderate groups, while spontaneous speech contributed the most to the mild group.

Conclusions

There were significant differences between Chinese and English patients with aphasia in terms of the contribution of each component of the WAB to the AQ. In Chinese, the largest contributor is naming, as opposed to spontaneous speech in English. Therefore, in a cross-linguistic context, it is important to carefully consider the impact of language differences, as this may help explain and understand the severity of Chinese aphasia.

WHAT THIS PAPER ADDS

What is already known on the subject

Among native English-speaking patients with mild aphasia, Spontaneous Speech test contributed most to the aphasia quotient of the Western Aphasia Battery. However, it is not known whether this finding applies to Chinese-speaking patients with aphasia as well as those with moderate-to-severe aphasia.

What this study adds to the existing knowledge

The subjects of our study were native speakers of Chinese with aphasia, and the results showed that the scores of the Naming test contributed the most to the total score. Further studies found that when grouped by severity, the Spontaneous Speech test contributed the most to the total score in the mild group, and the Naming test contributed the most to the total score in the moderate and severe groups.

What are the clinical implications of this work?

Patients with Chinese aphasia of different severity effectively improve their aphasia quotient in different ways. Mild patients correspond to spontaneous speech while moderate to severe patients correspond to naming. This may provide suggestions for the rehabilitation of patients.

International Journal of Language &Communication Disorders, Volume 60, Issue 2, March/April 2025.

International Journal of Language &Communication Disorders, Volume 60, Issue 1, January/February 2025.

Abstract

Introduction

Children's early language and communication skills are efficiently measured using parent report, for example, communicative development inventories (CDIs). These have scalable potential to determine risk of later language delay, and associations between delay and risk factors such as prematurity and poverty. However, there may be measurement difficulties in parent reports, including anomalous directions of association between child age/socioeconomic status and reported language. Findings vary on whether parents may report older infants as having smaller vocabularies than younger infants, for example.

Methods

We analysed data from the UK Communicative Development Inventory (Words and Gestures); UK-CDI (W&G) to determine whether anomalous associations would be replicated in this population, and/or with gesture. In total 1204 families of children aged 8–18 months (598 girls, matched to UK population for income, parental education and ethnicity as far as possible) completed Vocabulary and Gesture scales of the UK-CDI (W&G).

Results

Overall scores on the Gesture scale showed more significant relationships with biological risk factors including prematurity than did Vocabulary scores. Gesture also showed more straightforward relationships with social risk factors including income. Relationships between vocabulary and social risk factors were less straightforward; some at-risk groups reported higher vocabulary scores than other groups.

Discussion

We conclude that vocabulary report may be less accurate than gesture for this age. Parents have greater knowledge of language than gesture milestones, hence may report expectations for vocabulary, not observed vocabulary. We also conclude that gesture should be included in early language scales partly because of its greater, more straightforward association with many risk factors for language delay.

WHAT THIS PAPER ADDS

What is already known on the subject

We already know that it is possible to measure children's early communicative skills using parent-completed inventories (Communicative Development Inventories, CDIs) and that some aspects of early communication can predict which children are likely to go on to have long-lasting communicative development difficulties. We also know that most uses of CDIs include only vocabulary, not early gesture. In addition, child-related and family-related variables such as prematurity, family history of language disorder and socioeconomic status may be related to communication development.

What this paper adds to existing knowledge

We looked at a large sample (N = approx. 1200) of families representative of the UK population with an infant aged 8 through 18 months and asked them about their infant's comprehension and production vocabulary as well as their early gesture skills. Gesture was more closely related to possible risk factors for communication development difficulties, for example, family history of communication difficulties, prematurity and multiple birth status. Vocabulary was only related in a straightforward way to family history and had complex relationships to socioeconomic differences. Families with different economic backgrounds may approach questions about their child's development in different ways.

What are the potential or actual clinical implications of this work?

We suggest that clinicians need to ensure that not only vocabulary but also gesture ability is assessed when looking at very early communication skills. We also suggest that gesture may be more predictive of later communicative development difficulties, and that clinicians need to be sure that parents are clear on how vocabulary questions are asked and what exactly is required of them in answering these types of questions.