ABSTRACT

To address the need for interventions targeting social emotional development and mental health of young children in South Africa, the Mazi Umntanakho (‘know your child’) digital tool was co-designed, and piloted with caregivers and 3–5-year-old children involved in home visiting programmes promoting early childhood development. The aim of this study was to qualitatively evaluate the feasibility and acceptability of this tool in four urban and four rural low-income communities, from the perspective of home visitors and caregivers. Focus groups were conducted with home visitors (n = 117) and caregivers (n = 72). Issues relating to the feasibility of implementing the tool included timing of using the tool, technical and social implementation challenges, WhatsApp as the preferred platform, and participants' recommendations for future implementation. Overall, the tool was acceptable for home visitors and caregivers and was perceived to have a positive impact on children's development, and the relationship between caregivers and children.

Abstract

Background

Children born with cleft palate ± lip (CP ± L) are at risk of speech sound disorder (SSD). Up to 40% continue to have SSD at age 5–6 years. These difficulties are typically described as articulatory in nature and often include cleft speech characteristics (CSC) hypothesized to result from structural differences. In non-CP ± L SSD comorbidity with language difficulties is often reported. There is growing evidence of concomitant language difficulties in children with CP ± L and of a higher prevalence of developmental speech errors in children compared with non-CP ± L peers. The impact of underlying phonological and language skills on speech production in children with CP ± L is poorly understood.

Aims

To investigate language outcomes in children with CP ± L and the relationship to speech production, by answering the following research questions: (1) Does the profile of language skills in children with CP ± L differ from normative samples? (2) Do children with CP ± L and SSD have poorer language skills than those with typically developing speech? (3) Is there an association between language skills and speech profile in children with CP ± L at age 5–8 years?

Methods & Procedures

In this prospective cross-sectional, observational study, 95 participants were recruited from regional cleft lip and palate services in the UK. They were aged 5;0–7;11 with non-syndromic CP ± L. Those with a syndromic diagnosis, global learning disability, sensorineural hearing loss and first language other than English were excluded. Assessments of speech (Diagnostic Evaluation of Articulation and Phonology—DEAP) and language (Clinical Evaluation of Language Fundamentals—5th UK edition—CELF) were completed. Language outcomes were analysed and compared with normative samples and according to speech error analysis.

Outcomes & Results

Average language scores were within the expected range. For those presenting with SSD, language scores were significantly lower than those with typically developing speech. Analysis of speech errors showed four distinct speech profiles: typical speech, CSC only, developmental speech characteristics (DSC), and combined CSC + DSC. Language scores were lower for participants with DSC (±CSC). A significant association was found between the presence of CSC + DSC and expressive language outcomes (odds ratio (OR) = 10.82; 95% confidence interval (CI) = 2.42, 48.32, p = 0.002).

Conclusions & Implications

An association between language skills and speech production was observed. The distribution of speech errors in children with CP ± L varied with a high level of DSC as well as CSC. Those with CSC + DSC had significantly lower language scores than those with typically developing speech or CSC only. Speech and language therapists working with this caseload should be alerted to potential ongoing phonological and language difficulties in children presenting with this profile.

WHAT THIS PAPER ADDS

What is already known on this subject

Children born with CP ± L are known to be at risk of SSD. There is also evidence of language delay in the early years. Evidence for persistent language difficulties is equivocal but some studies have shown a higher than average prevalence of developmental phonological errors in addition to cleft articulation errors in speech production.

What this paper adds to the existing knowledge

This study investigates links between speech development and language skills in children aged 5–8 years with non-syndromic CP ± L. It adds to our understanding of the nature of SSD in children with CP ± L and in particular the relationship between language skills and speech production. It shows that children with CP ± L have varied speech profiles and that those presenting with delayed phonological processes are also at risk of language difficulties.

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

Speech and language therapists working with children with CP ± L should be aware of the varied nature of SSD in this population. They should be alert to the need for additional assessment of language for those presenting with delayed phonological processes and the implications this has for educational attainment.

Abstract

Background

There is a growing body of evidence showing the value of community singing-based rehabilitation on psychosocial well-being and communication for people with post-stroke communication impairment (PSCI). However, there has been little consideration of the potential value an inpatient aphasia-friendly choir may have through the perspective of the stroke multidisciplinary team (MDT).

Aims

To explore the experiences and views of the MDT on the role an established inpatient aphasia-friendly choir, at a stroke rehabilitation centre in South Wales, UK, may play in the rehabilitation of people with PSCI.

Methods & Procedures

Eight participants were recruited from the stroke rehabilitation centre's MDT. Semi-structured interviews were conducted and the verbatim transcripts were analysed using thematic analysis according to Braun and Clark's work of 2006.

Outcomes & Results

Four main themes were identified: (1) breaking down social isolation barriers; (2) patient voice and patient choice; (3) collective well-being and engagement; and (4) the therapeutic benefits across the MDT. The experiences and perceptions overlap, highlighting the wide-reaching therapeutic benefits of singing collaboratively.

Conclusions & Implications

This research enables us to discover more about how the inpatient aphasia-friendly choir may enhance an individual's well-being, communication and confidence, and their overall rehabilitation from the MDT's perspective. By increasing our understanding of which aspects of the aphasia-friendly choir are most valued, future choir sessions can be better tailored to patients’ needs. Additionally, the findings presented here could be taken forward and included in future speech and language therapy interventions, leading to increased patient ownership, not only of the choir but also of their other therapy goals.

WHAT THIS PAPER ADDS

What is already known on this subject

Previous research suggests positive implications for therapeutic collaborative singing on psychosocial well-being and communication for people with PSCI. There has been little consideration of the potential value an inpatient aphasia-friendly choir may have through the lens of the stroke MDT. The aim of this research was to explore the experiences and views of the MDT on the role an established inpatient aphasia-friendly choir may play in the rehabilitation of people with PSCI.

What this paper adds to the existing knowledge

This research highlights the benefits of an inpatient aphasia-friendly choir for an individual's well-being, communication and confidence. An increased understanding enables future choir sessions to be better tailored to patients’ needs.

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

Participating in the choir was felt to offer an increased opportunity for functional therapy goals in an inpatient setting. The MDT frequently discussed the choir's ability to ‘normalise’ therapeutic approaches for the patients. A greater understanding of the choir participants empowers therapists to personalise therapy plans further, facilitating effectiveness, efficiency and holistic practice.

Abstract

Background

Global aphasia is a severe communication disorder affecting all language modalities, commonly caused by stroke. Evidence as to whether the functional communication of people with global aphasia (PwGA) can improve after speech and language therapy (SLT) is limited and conflicting. This is partly because cognition, which is relevant to participation in therapy and implicated in successful functional communication, can be severely impaired in global aphasia. Cognitive treatments that aim to improve functional communication for people with aphasia do exist, but few have been trialled with PwGA and no studies have robustly demonstrated gains.

Aim

This study aimed to explore the effect of a novel non-linguistic cognitive intervention on the functional communication skills of PwGA.

Method

A non-linguistic intervention, developed to target cognitive skills underpinning functional communication, was delivered to six participants three times weekly for up to 6 weeks (depending on the rate of progression through the intervention programme). All participants met the criteria for global aphasia following screening with the Western Aphasia Battery Bedside Record Form. A multiple baseline case series design was employed to investigate changes in functional communication using the American Speech and Hearing Association Functional Assessment of Communication (ASHA-FACS). Secondary outcome measures were auditory comprehension and informal tests of non-verbal cognition. Statistical analyses of change after intervention were performed using the Wilcoxon signed-ranks test and weighted statistics.

Results

Participants completed the intervention programme in an average of nine sessions. Four out of six participants made statistically significant gains in functional communication as measured by communication independence (amount of assistance or prompting required) on the ASHA-FACS. Five of six participants made statistically significant gains in non-verbal semantics, two in non-verbal reasoning and two in auditory comprehension.

Conclusion

The findings provide preliminary evidence that a non-linguistic cognitive intervention delivered with a dose replicable in clinical practice can improve functional communication and non-verbal cognition in some PwGA. This finding contrasts with much existing evidence suggesting that improvements in global aphasia can be achieved only after intensive or prolonged input over many years.

WHAT THIS PAPER ADDS

What is already known on the subject

People with global aphasia (PwGA) have the potential to make impairment level gains after intensive or prolonged speech and language therapy (SLT). However, evidence of functional communication gains is limited. Cognition plays an important role in functional communication, particularly the ability to switch to alternative means of communication and switch modalities.

What this study adds

Contrary to many previous studies, the findings indicate that PwGA can benefit from SLT and make functional communication gains with a relatively low dose of intervention. The findings highlight cognitive skills that appear relevant to basic functional communication abilities in PwGA. These are: attention, visual perception, semantics and non-verbal problem solving.

What are the clinical implications of this work?

This work suggests that clinicians should offer cognitive, non-linguistic interventions to PwGA and consider delivering intervention using little to no verbal language.

Abstract

We compared referrals and connection to care between perinatal patients: 90 receiving OB/GYN care in clinics with integrated behavioral health consultants with infant mental health specialization (IMH-BHC), and 68 receiving traditional care, in the United States. Participants identified as: Native American/Alaskan native, 1.90%; Asian, .63%; African American, 58.23%; Middle Eastern, 6.96%; African National/Caribbean Islander, .63%; Latin-American, 8.86%; and White, 28.48%.

Approximately 80% of families in each group were offered referrals. By design, intervention women received mental health services during pregnancy; 16% of women in either group received postpartum mental health services. Intervention group participants were over three times as likely to engage in IMH home visiting. Treatment families were less likely to follow up with infant referrals, but also had fewer infant emergency room visits.

All intervention participants met with an IMH-BHC prior to recruitment; however, only 20% self-reported encounters with a mental health professional, indicating these interactions may not be identified by the participants as mental health care; therefore, openness to treatment may be increased for women who feel stigma around mental health care.

Given the importance of perinatal mental health, OB/GYN clinics and others serving perinatal patients may consider integrating IMH providers as part of the care team.

ملخص

تُعد التدخلات الثنائية التي تستهدف الصحة النفسية للوالدين والعلاقة بين الوالدين والرضيع أمراً بالغ الأهمية نظراً للعواقب المحتملة للمرض النفسي واضطراب العلاقة بين الوالدين والرضيع والأسرة في فترة ما حول الولادة. تصف هذه الورقة البحثية نموذج الرعاية من الحمل إلى الأبوة(P2P) ، وهو برنامج مجتمعي ثنائي قائم على العلاقة بين الوالدين والرضيع مصمم لدعم الأسر الضعيفة في غرب أستراليا في سياق الحاجة المحددة لبناء قدرات القوى العاملة. تم إجراء دراسة تقييمية عملية للخدمة، وتحليل البيانات السريرية الروتينية التي تم جمعها من 105 من الأزواج الذين أكملوا مقاييس ما قبل التدخل وبعده، بما في ذلك مقياس إدنبرة للاكتئاب بعد الولادة، ومقياس فحص القلق في فترة ما حول الولادة، ومقياس العلاقات بين الأمهات والأشياء—نموذج قصير. أشارت تحليلات مؤشر التغيير الموثوق به إلى انخفاض قبلي وبعدي في أعراض الاكتئاب والقلق في الفترة المحيطة بالولادة لـ 71% و68% من العينة على التوالي. كما أظهرت النتائج تحسينات كبيرة قبلية وبعدية بأحجام تأثير متوسطة (r = −.46, r = − .32) لتصورات تقديم الرعاية للرضيع. توفر هذه النتائج دليلًا مؤقتاً على أن نموذج الرعايةP2P قد يكون فعالاً في تحسين الصحة النفسية للوالدين وتصورات تقديم الرعاية. ويلزم إجراء المزيد من البحوث لتقييم فعالية نموذج الرعاية من شخص إلى شخص فيما يتعلق بتعزيز رفاهية الأسرة، وإبلاغ السياسات وتطوير خدمات الصحة النفسية.

摘 要

我们比较了在美国接受围产期护理的患者中, 90名在设有专注于婴儿心理健康的综合行为健康顾问(IMH-BHC)的妇产科诊所接受护理的患者(干预组), 与68名接受传统护理的患者(对照组)在转诊和接受护理方面的差异。参与者的族裔分布如下:美洲原住民/阿拉斯加原住民1.90%;亚洲裔0.63%;非裔美国人58.23%;中东裔6.96%;非洲裔/加勒比岛民0.63%;拉丁美洲裔8.86%;白人28.48%。

约80%的家庭获得了转诊服务, 且干预组与对照组之间无显著差异。按照研究设计, 干预组女性在怀孕期间接受心理健康服务;两组中16%的女性接受产后心理健康服务。干预组的参与者接受IMH家访的可能性是对照组的三倍以上。尽管如此, 干预组家庭较少跟进婴儿的转诊服务, 其婴儿急诊室就诊次数也较少。

所有干预组参与者在招募前均与IMH-BHC会面;然而, 只有20%的参与者自述与心理健康专业人士有过接触, 这表明她们可能没有将这些互动视为心理健康护理;因此, 对于那些因心理健康污名化而犹豫接受帮助的女性来说, 这种模式可能提高她们对治疗的接受度。

鉴于围产期心理健康的重要性, 妇产科诊所及其他服务围产期患者的医疗机构可以考虑将IMH提供者整合到护理团队中。

Résumé

Nous avons comparé les références et les liens aux soins entre des patientes périnatales: 90 de ces patientes ont reçu des soins d'obstétrique et de gynécologie dans des cliniques avec des consultations en santé comportementale intégrées spécialisées en santé mentale infantile (IMH-BHC), et 68 de ces patientes ont reçu des soins traditionnels, cela aux États-Unis. Les participants se sont identifiées en tant que: autochtones américaines/alaskiennes, 1, 90 %; asiatiques, 0, 63 %; afro-américaines, 58, 23 %; du Moyen-Orient, 6, 96 %; d'Afrique ou des Caraïbes, 0, 63 %; latines-américaines, 8, 86 %; et blanches, 28, 48 %. Environ 80 % des familles ont été envoyées consulter, sans différences de groupe. Selon la structure de l’étude, les femmes du groupe d'intervention ont reçu des services de santé mentale pendant la grossesse; 16 % des femmes des deux groupes ont reçu des services de santé mentale après l'accouchement. Les participantes du groupe d'intervention se sont avérés être plus de trois fois plus à même de participer à la visite à domicile de santé mentale du nourrisson. Les familles du groupe de traitement se sont avérées moins à même de s'engager dans le suivi avec les nourrissons envoyés consulter mais ont aussi fait preuve de moins de visites aux Urgences pour les nourrissons. Toutes les participantes à l'intervention ont rencontré un IMH-BHC avant le recrutement. Cependant seules 20 % d'entre elles ont rapporté avoir rencontré un professionnel de la santé mentale, ce qui montre que ces interactions ne peuvent pas être identifiées par les participantes comme étant des soins en santé mentale; Par conséquent, l'ouverture au traitement peut être plus grande pour les femmes qui ressentent une stigmatisation des soins de santé mentale. Compte tenu de l'importance de la santé mentale périnatale, les cliniques d'obstétrique et de gynécologie et les autres services qui servent les patients périnataux peuvent envisager d'intégrer des prestataires de santé mentale du nourrisson dans leur équipe de soins.

Zusammenfassung

Wir verglichen die Überweisungen und die Anbindung an die Versorgung zwischen perinatalen Patient:innen in den USA: 90, die in Kliniken mit integrierten verhaltensmedizinischen Beratern mit Spezialisierung auf die psychische Gesundheit von Säuglingen (IMH-BHC) gynäkologische Betreuung erhielten, und 68, die auf herkömmliche Weise betreut wurden. Die Teilnehmenden identifizierten sich als: Ureinwohnende Amerikas/Alaskas, 1,90 %; Asiat:innen, 0,63 %; Afroamerikaner:innen, 58,23 %; aus dem Nahen Osten, 6,96 %; aus Afrika/von karibischen Inseln, 0,63 %; Lateinamerikaner:innen, 8,86 %; und Weiße, 28,48 %. Etwa 80 % der Familien wurde eine Überweisung angeboten, wobei es keine Gruppenunterschiede gab. Die Frauen der Interventionsgruppe erhielten während der Schwangerschaft psychische Gesundheitsbetreuung; 16 % der Frauen in beiden Gruppen nahmen nach der Geburt psychische Gesundheitsbetreuung in Anspruch. In der Interventionsgruppe war eine Teilnahme an IMH-Hausbesuchen mehr als drei Mal so wahrscheinlich. In den Familien der Interventionsgruppe war die Wahrscheinlichkeit geringer, dass weitere Überweisungen für das Kind erfolgten, aber Säuglinge wurden auch seltener in die Notaufnahme gebracht. Alle Teilnehmerinnen der Interventionsgruppe hatten vor der Rekrutierung einen IMH-BHC aufgesucht; allerdings berichteten nur 20 % von Begegnungen mit einer psychosozialen Fachkraft, was darauf hindeutet, dass diese Interaktionen von den Teilnehmerinnen möglicherweise nicht als psychische Gesundheitsversorgung wahrgenommen wurden. Daher könnte die Offenheit für eine Behandlung bei Frauen, die Stigma um Themen psychischer Gesundheit empfinden, erhöht sein. Angesichts der Bedeutung perinataler psychischer Gesundheit sollten gynäkologische Kliniken und andere Stellen, die perinatale Patientinnen betreuen, in Erwägung ziehen, IMH-Fachkräfte in ihr Behandlungsteam zu integrieren.

抄録

私達は、周産期患者における紹介とケアとの継続性について、次の2グループ間で比較した。すなわち、米国の乳幼児精神保健専門統合行動健康コンサルタント(IMH-BHC)がいるクリニックで産婦人科医療を受けている90人と、従来の医療を受けている68人である。参加者は以下のように識別された。アメリカ先住民/アラスカ先住民1.90％、アジア人0.63％、アフリカ系アメリカ人58.23％、中東系6.96％、アフリカ系アメリカ人/カリビアンアイランダー0.63％、ラテン系アメリカ人8.86％、白人28.48％。

約80％の家族が紹介され、グループ差はなかった。デザインとして、介入群の女性は妊娠中にメンタルヘルスサービスを受け、いずれの群でも16％の女性が産後にメンタルヘルスサービスを受けた。介入群の参加者は、IMH家庭訪問に参加する傾向が3倍以上であった。治療の家族は乳幼児紹介によるフォローアップを受ける傾向が低かったが、乳幼児の救急外来受診も少なかった。介入参加者全員が、募集前にIMH-BHCと面談した。しかしながらメンタルヘルス専門家との面談を自己報告したのはわずか20％であった。これは、これらの面談が参加者にメンタルヘルスケアとして認識されていない可能性を示している。したがって、メンタルヘルスケアに後ろめたさをを感じている女性にとっては、治療への風通しが高まる可能性がある。

周産期メンタルヘルスの重要性を考慮すると、産婦人科クリニックや周産期患者にサービスを提供する他の機関は、ケアチームの一部としてIMHプロバイダーを統合することを検討してもよいであろう。

Resumen

Comparamos referencias profesionales y conexiones con el servicio de cuidado a pacientes perinatales: 90 que recibían cuidado obstétrico/ginecológico (OB/GYN) en clínicas con integrados consultores sobre la actitud en cuanto a salud, especializados en salud mental infantil (IMH-BHC), y 68 que recibían el servicio de cuidado tradicional, en Estados Unidos. Las participantes se identificaban así: indígena norteamericana/nativa de Alaska, 1.90%; asiática, 0.63%; afroamericana, 58.23%; del medio oriente, 6.96%; nativa de África/islas del Caribe, 0.63%; latinoamericana, 8.86%; blanca, 28.48%.

A aproximadamente 80% de las familias se les ofreció referencia profesional, sin distinción de grupo. Según diseño, las mujeres de la intervención recibieron servicios de salud mental durante el embarazo; 16% de las mujeres en un grupo o el otro recibió servicios de salud mental después del parto. Quienes participaban en la intervención estaban más de tres veces dispuestas a recibir visitas de salud mental infantil (IMH) a casa. Las familias en el tratamiento estuvieron menos propensas a dar seguimiento a referencias profesionales, pero también tuvieron menos visitas con el infante a la sala de urgencia.

Todas las participantes en la intervención se reunieron con un IMH-BHC antes del reclutamiento; sin embargo, sólo 20% auto reportaron encuentros con un profesional de salud mental, lo que indica que las participantes pudieran no identificar estas interacciones como cuidado de salud mental; por tanto, la disposición al tratamiento pudiera incrementarse para mujeres que ven como estigma el cuidado de salud mental.

Dada la importancia de la salud mental perinatal, las clínicas OB/GYN y otras oficinas que les sirven a pacientes perinatales pudieran considerar integrar profesionales IMH como parte del equipo de cuidado.

Abstract

Background

Late side effects of head and neck cancer treatment commonly affect swallowing function. Late radiation-associated dysphagia (late-RAD) often presents years post-treatment when patients have been discharged from their multidisciplinary team. Timely symptom management may provide important physical and emotional support, potentially reducing the overall healthcare burden. Speech and language therapists (SLTs) are key in the assessment and management of dysphagia but there is no current guidance in the late-RAD setting.

Aims

The primary objective was to establish how late-RAD is assessed in both existing literature and by UK SLT. The study also aimed to explore UK SLT approaches to management.

Methods

A dual methodology approach was taken. A scoping review (SR) of PubMed, Scopus, CINAHL, Web of Science and Embase databases was conducted between November and December 2022. Eligibility criteria included studies reporting dysphagia outcomes >2 years post-treatment with narrative data synthesis. Also, a survey of SLTs working in the United Kingdom was conducted between November 2023 and February 2024. Respondents were questioned about their current pathways and service provision for patients with late-RAD.

Main Contribution

The SR included 39 studies. Dysphagia was assessed using three different toxicity grades; five patient-reported outcome measures (PROMs) and five clinical assessments. Five studies were multidimensional in their approach to data collection, whilst nine used PROMs alone and four used a toxicity grade alone. The survey received 56 responses. Only six respondents reported an existing late effect clinic (all tumour sites) in their region. A wide range of measures were used to assess dysphagia including 12 different PROMs. Instrumental assessments were used by most (98% Videofluoroscopy; 82% Fibreoptic Endoscopic Evaluation of Swallowing). Rehabilitation was offered by 86% and this was intensive in 34%. Late-RAD patient information was routinely provided by 35 respondents and usually within 1 year of treatment completion.

Conclusion

A wide range of assessment methods and outcome measures were used to report dysphagia in existing literature but often in a unidimensional approach. In the United Kingdom, SLTs also use a variety of assessment tools and regularly offer intensive rehabilitation. Without consensus on how we measure late-RAD, synthesising evidence to guide service provision is challenging.

WHAT THIS PAPER ADDS

What is already known on the subject

Late-RAD significantly affects swallowing function, often necessitating enteral feeding which in turn impacts emotional and health-related quality of life. There is no existing guidance on optimum pathways, assessment methods or effective treatment options.

What this paper adds to existing knowledge

This study highlights the lack of consensus in the evidence base regarding how to assess and measure late-RAD. In the United Kingdom, referral pathways are not well defined and there is wide variation on provision of information and specialist assessment and management of late-RAD.

What are the potential or clinical implications of this work?

Challenges in synthesising existing studies translate to variations in practice due to a lack of guidelines. Without a robust evidence base, patients will experience geographical variation in how they are supported with their late-RAD symptoms.

Abstract

Background

Individuals with dementia have communication limitations resulting from cognitive impairments that define the syndrome. Whereas there are numerous cognitive assessments for individuals with dementia, there are far fewer communication assessments. The Profiling Communication Ability in Dementia (P-CAD) was developed to address this gap.

Aims

The purpose of this study was to examine the concurrent validity, longitudinal validity and inter- and intra-rater reliability of the P-CAD in a population of people with dementia and their communication partners.

Method

The P-CAD was administered to 122 people with dementia and their communication partners in Ireland (n = 100) and Canada (n = 22), over a 12-month period. To establish concurrent validity of the P-CAD, scores were compared to scores obtained from existing standardized instruments including the Functional Linguistic Communication Inventory (FLCI), the Mini-Mental State Examination (MMSE-2) and Global Deterioration Scale (GDS). Inter-rater reliability and responsiveness (longitudinal validity) were analysed using data from a subgroup of participants.

Outcomes & Results

Overall P-CAD test scores were significantly correlated with FLCI (n = 122; r = 0.875; p < 0.001) and MMSE-2 total scores (n = 122; r = 0.857; p < 0.001). Levels of communication support categories on the P-CAD correlated with GDS rankings (n = 122; rho = −0.539; p < 0.001) and MMSE-2 total scores (n = 122; rho = 0.680, p < 0.001). Inter-rater reliability tested for 20 participants in the Irish sample revealed high levels of agreement between raters in scoring the GDS (n = 20; ICC = 0.969, p < 0.001), MMSE-2 (n = 20; ICC = 0.997, p < 0.001), FLCI (n = 20; ICC = 0.999, p < 0.001) and P-CAD (n = 20; ICC = 0.981, p < 0.001). To establish longitudinal validity to examine if the P-CAD was responsive to changes in cognitive-communication function over time, 12 participants in the Irish sample repeated all tests 3 months after the initial testing. No statistically significant differences in test scores were found for the 12 participants who completed follow-up measures at this time point in any of the three scales. It was not possible to determine sufficient responsiveness as correlations between the change in P-CAD scores over 3 months were insignificant for both the change in MMSE-2 scores (rho = −0.130, p = 0.704) and the FLCI scores (rho = 0.221, p = 0.513).

Conclusions & Implications

In this study, P-CAD has demonstrated good concurrent validity and inter-rater reliability in samples collected in two countries with English-speaking participants. The P-CAD is appropriate for use to evaluate communication abilities of people with dementia, including during conversational interactions with caregivers.

WHAT THIS PAPER ADDS

What is already known on the subject

Dementia alters the communication function of the person with dementia and impacts interactions with others. Speech and language therapists (SLTs) provide specific recommendations on communication function and support. However, they have limited access to comprehensive communication assessments to guide intervention.

What this paper adds to the existing knowledge

This validation study has confirmed that Profiling Communication Ability in Dementia (P-CAD) is a valid and reliable tool for SLTs to profile the communication abilities of people with dementia. It identifies the type and levels of communication support required as dementia progresses. The inclusion of communication partners in the study confirms their important role in providing conversation support to people with dementia.

What are the potential or clinical implications of this work?

The P-CAD is a clinical resource for dynamic communication assessment, which identifies key areas of retained ability to guide communication support and individualised intervention. It can be used with people at different stages and severity of dementia across a range of clinical settings. The P-CAD summary, which is part of the P-CAD, can be shared with family members and healthcare teams to enhance communication access for the person as dementia progresses.