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West KM. Treating Pediatric Feeding Disorders and Dysphagia: Evidence-Based Interventions for School-Based Clinicians. Lang Speech Hear Serv Sch 2024; 55:444-457. [PMID: 38198285 DOI: 10.1044/2023_lshss-23-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
PURPOSE Children with pediatric feeding disorder (PFD) and dysphagia are increasingly prevalent in school-based caseloads. This tutorial discusses the current best practices for treating children with PFD and dysphagia as well as considerations for service delivery in educational settings. METHOD The rationale for treating PFD and dysphagia in an educational setting is discussed. A review of various interventions for PFD and dysphagia and a discussion of the available evidence are provided. The principles of experience-dependent neuroplasticity and theory-driven practice are discussed in light of the need for additional empirical research. Practical considerations to enhance evidence-based practice for PFD and dysphagia in educational settings are explored. RESULTS The reader will be able to identify evidence-based interventions for students with PFD and dysphagia and plan for the implementation of these approaches in the school setting. CONCLUSIONS Students with PFD and dysphagia require skilled interventions to support their participation in educationally relevant activities and to promote continued development of feeding and swallowing skills while at school. A discussion of the current evidence for various interventions is provided to promote the utilization of evidence-based interventions in school-based settings.
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Affiliation(s)
- Kristen M West
- Department of Communication Sciences and Disorders, Pennsylvania Western University Edinboro, PA
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2
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Chamun WWA, Ribeiro VV, Madazio G, Behlau M. Mapping of the characteristics in the CoDAS journal publications in the voice area: a scoping review. Codas 2023; 35:e20220088. [PMID: 37283366 PMCID: PMC10266801 DOI: 10.1590/2317-1782/20232022088pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/28/2022] [Indexed: 06/08/2023] Open
Abstract
PURPOSE To map and describe the characteristics present in the publications of the CoDAS journal in the voice segment. RESEARCH STRATEGIES The research was carried on the Scielo database using the descriptor voice. SELECTION CRITERIA CoDAS publications in the field of voice. DATA ANALYSIS Specific data collected according to delineation, summarized by descriptive analysis and analyzed in narrative format. RESULTS Studies published in 2019 and with cross-sectional delineation were more frequent. The most frequent result in the cross-sectional studies was the vocal self-assessment. Most intervention studies were of immediate single-session-only effect. The most frequent procedures in the validation studies were translation and transcultural adaptation. CONCLUSION There was a gradual increase in the number of publications of voice studies, though these had heterogeneous characteristics.
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Affiliation(s)
| | - Vanessa Veis Ribeiro
- Centro de Estudos da Voz - CEV - São Paulo (SP), Brasil.
- Departamento de Fonoaudiologia, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil.
| | | | - Mara Behlau
- Centro de Estudos da Voz - CEV - São Paulo (SP), Brasil.
- Departamento de Fonoaudiologia, Universidade Federal de São Paulo - Unifesp - São Paulo (SP), Brasil.
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Day L, Flynn K. Educating communication sciences and disorders students to use evidence-based practice literature: A collaboration between a library liaison and a CSD professor. COLLEGE & UNDERGRADUATE LIBRARIES 2022. [DOI: 10.1080/10691316.2022.2144579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lance Day
- University Library, Samford University, Birmingham, Alabama, USA
| | - Karen Flynn
- Department of Communication Sciences and Disorders, Samford University, Birmingham, Alabama, USA
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4
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Elman RJ. Still Searching for Understanding: The Importance of Diverse Research Designs, Methods, and Perspectives. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2444-2453. [PMID: 36001820 DOI: 10.1044/2022_ajslp-21-00348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Evidence-based medicine and evidence hierarchies have been widely adopted and have strongly influenced decision making across many fields, including clinical aphasiology. However, questions remain about the creation, usefulness, and validity of current evidence hierarchies. AIMS This article builds on ideas about scientific approaches and evidence originally shared by Elman (1995, 1998, 2006). This article reviews the history of evidence hierarchies and argues that improving the diversity of research designs, methods, and perspectives will improve understanding of the numerous and complex variables associated with aphasia intervention. Researchers and clinicians are encouraged to synthesize diverse types of scientific evidence. It is hoped that this article will stimulate thought and foster discussion in order to encourage high-caliber research of all types. MAIN CONTRIBUTION Concepts from a wide variety of fields including philosophy of science, research design and methodology, and precision medicine are brought together in an attempt to focus research on the scientific understanding of aphasia treatment effects. CONCLUSION It is hoped that by incorporating diverse research designs, methods, and perspectives, clinical aphasiologists will become better able to provide effective, personalized treatments, ensuring that each person with aphasia is able to improve their communication ability and quality of life.
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Connery A, Yaruss JS, Lomheim H, Loucks TM, Galvin R, McCurtin A. Obtaining consensus on core components of stuttering intervention for adults: An e-Delphi Survey with key stakeholders. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:112-127. [PMID: 34818457 DOI: 10.1111/1460-6984.12680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/29/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Evidence-based practice involves the synthesis of multiple forms of evidence to inform clinical decision-making and treatment evaluation. Practice- and patient-based evidence are two forms of evidence that are under-represented in the stuttering literature. The collection of such knowledge is essential to support the design and delivery of effective stuttering interventions for adults. AIMS To build stakeholder consensus on the core components of intervention for adults who stutter, and to establish a guiding framework for the design and development of evidence-based interventions for adults who stutter. METHODS & PROCEDURES Adults who stutter and speech and language therapists (SLTs) with experience in providing stuttering intervention participated in the three-round e-Delphi Survey focused on: (1) identifying key stuttering intervention components, including principles, practices, and structural and contextual elements; and (2) obtaining group consensus on stuttering intervention components. Statements were categorized using the International Classification of Functioning, Disability and Health (ICF) model adapted to the study of stuttering. OUTCOMES & RESULTS A total of 48 individuals agreed to participate: 48/48 (100%) completed the Round 1 questionnaire, 40/48 (83%) responded to Round 2 and 36/40 (90%) participated in Round 3. Following content analysis of Round 1, 101 statements were developed, and consensus was achieved on 89 statements perceived as representing the core components of stuttering intervention for adults. Categorization of these statements reflected the key stuttering intervention components relating to personal reactions to stuttering, limitations in life participation and environmental factors. CONCLUSIONS & IMPLICATIONS Consensus on the core components of stuttering intervention was reached through engagement with key stakeholders. The evidence-based framework presented highlights the range of key intervention components a clinician should consider when designing interventions for adults who stutter. WHAT THIS PAPER ADDS What is already known on the subject Evidence-based practice endorses the synthesis of multiple knowledge forms including research, practice and patient evidence to support clinical decision-making and treatment evaluation. The stuttering literature is characterized by an over-representation of efficacy evidence, with significantly less practice and patient evidence to guide clinical practice. What this paper adds to existing knowledge This study adds valuable practice- and patient-based evidence for effective stuttering intervention components for adults who stutter. These relate to personal reactions to stuttering, limitations in life participation and environmental factors. What are the potential or actual clinical implications of this work? This research presents a stakeholder-informed framework for stuttering intervention to guide SLTs working with adults who stutter in designing evidence-based interventions. The framework supports the adoption of a person-centred approach to intervention to ensure each client's unique needs, preferences, values and desired outcomes are explored and integrated into therapy.
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Affiliation(s)
- Amy Connery
- School of Allied Health, University of Limerick, Limerick, Ireland
- HSE Dublin South West, Tallaght, Dublin, Ireland
| | - J Scott Yaruss
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, USA
| | - Holly Lomheim
- ISTAR-Institute for Stuttering Treatment and Research, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Torrey M Loucks
- ISTAR-Institute for Stuttering Treatment and Research, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Rose Galvin
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Arlene McCurtin
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Health Implementation in Science & Technology Research Group, Health Research Institute, University of Limerick, Limerick, Ireland
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6
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Brundage SB, Ratner NB, Boyle MP, Eggers K, Everard R, Franken MC, Kefalianos E, Marcotte AK, Millard S, Packman A, Vanryckeghem M, Yaruss JS. Consensus Guidelines for the Assessments of Individuals Who Stutter Across the Lifespan. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2379-2393. [PMID: 34516299 PMCID: PMC9132036 DOI: 10.1044/2021_ajslp-21-00107] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 05/24/2023]
Abstract
Purpose This project sought to develop consensus guidelines for clinically meaningful, comprehensive assessment procedures for people who stutter across the lifespan. Method Twelve expert clinicians and researchers who have written extensively about stuttering provided detailed descriptions of the type of data that they routinely collect during diagnostic evaluations of preschool children, school-age children, adolescents, and adults who stutter. Iterative content analysis, with repeated input from the respondents, was used to identify core areas that reflect common domains that these experts judge to be important for evaluating stuttering for varying age groups. Results Six core areas were identified as common components of a comprehensive evaluation of stuttering and people who stutter. These areas should be included to varying degrees depending upon the age and needs of the client or family. The core areas include the following: (a) stuttering-related background information; (b) speech, language, and temperament development (especially for younger clients); (c) speech fluency and stuttering behaviors; (d) reactions to stuttering by the speaker; (e) reactions to stuttering by people in the speaker's environment; and (f) adverse impact caused by stuttering. Discussion These consensus recommendations can help speech-language pathologists who are uncertain about appropriate stuttering assessment procedures to design and conduct more thorough evaluations, so that they will be better prepared to provide individualized and comprehensive treatment for people who stutter across the lifespan.
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Affiliation(s)
- Shelley B. Brundage
- Department of Speech, Language & Hearing Sciences, George Washington University, Washington, DC
| | | | - Michael P. Boyle
- Department of Communication Sciences and Disorders, Montclair State University, Bloomfield, NJ
| | - Kurt Eggers
- Speech-Language Pathology & Audiology, Thomas More University, Antwerp, Belgium
- Speech-Language Pathology, University of Turku, Finland
| | | | - Marie-Christine Franken
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Elaina Kefalianos
- Department of Audiology and Speech Pathology, The University of Melbourne, Parkville, Victoria, Australia
- Speech & Language Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Anne K. Marcotte
- Department of Communication Sciences and Special Education, University of Georgia, Athens
| | - Sharon Millard
- The Michael Palin Centre for Stammering Children, London, United Kingdom
| | - Ann Packman
- Australian Stuttering Research Centre, University of Technology Sydney, New South Wales, Australia
| | - Martine Vanryckeghem
- Department of Communication Sciences and Disorders, University of Central Florida, Orlando
| | - J. Scott Yaruss
- Department of Communicative Sciences & Disorders, Michigan State University, East Lansing
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7
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Hansen H, Erfmann K, Göldner J, Schlüter R, Zimmermann F. Therapeutic relationships in speech-language pathology: a scoping review protocol. JBI Evid Synth 2021; 19:2870-2876. [PMID: 34054031 DOI: 10.11124/jbies-20-00331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this scoping review is to provide an overview of empirical research regarding the therapeutic relationship between speech-language pathologists and their clients of all ages and clinical areas. INTRODUCTION The influence of a positive relationship between professionals and clients on the process and outcome of interventions is well documented for many health professions. However, research in speech-language pathology predominantly focuses on the outcome of specific treatment methods and techniques. The number of empirical research studies on the therapeutic relationship within this research area is increasing. At present, existing research has not been summarized and compared. INCLUSION CRITERIA The review will include all empirical research that addresses the therapeutic relationship between speech-language pathologists and their clients of all ages and clinical areas. Since speech-language pathologists often collaborate intensively with caregivers of their clients, such as parents or partners, these groups will also be included. METHODS Systematic searches will be conducted across seven research databases (ASHAWire, CINAHL, ERIC, Fachportal Pädagogik, LIVIVO, MEDLINE [PubMed], and PsycINFO) and four unpublished/gray literature databases (evidenssst, ndldt, OpenGrey, and SSOAR). Data will be extracted by two independent reviewers for author(s), year of publication, country of origin, research questions, participants, terminology and theoretical foundations, research design, and focus. Central findings concerning the therapeutic relationship on the input-, process-, outcome, and output-level of speech-language interventions will be analyzed. Results will be presented as a narrative summary.
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Affiliation(s)
- Hilke Hansen
- Faculty of Business Management and Social Sciences, Section of Speech and Language Therapy, University of Applied Sciences Osnabrück, Germany
| | - Kerstin Erfmann
- Faculty of Business Management and Social Sciences, Section of Speech and Language Therapy, University of Applied Sciences Osnabrück, Germany
| | - Julia Göldner
- SRH Technical College for Speech and Language Therapy, Bonn, Germany
| | - Rieke Schlüter
- Department of Otorhinolaryngology, Section of Phoniatrics and Pedaudiology, University of Ulm, Ulm, Germany
| | - Franziska Zimmermann
- Faculty of Social Work and Health, HAWK University of Applied Sciences and Arts, Hildesheim, Germany
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8
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Mélotte E, Belorgeot M, Herr R, Simon J, Kaux JF, Laureys S, Sanz LRD, Lagier A, Morsomme D, Pellas F, Gosseries O. The Development and Validation of the SWADOC: A Study Protocol for a Multicenter Prospective Cohort Study. Front Neurol 2021; 12:662634. [PMID: 33995257 PMCID: PMC8116670 DOI: 10.3389/fneur.2021.662634] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: After a coma, patients with severe brain injury may present disorders of consciousness (DOC). A substantial proportion of these patients also suffer from severe dysphagia. Assessment of and therapy for swallowing disabilities of patients with DOC are essential because dysphagia has major functional consequences and comorbidities. Dysphagia evaluation in patients with DOC is impeded by the lack of adapted tools. The first aim of this study was to create a new tool, the SWallowing Assessment in Disorders Of Consciousness (SWADOC), and propose a validation protocol. The SWADOC was developed to help therapists assess factors related to swallowing in patients with DOC. The second aim was to investigate the relationship between patients' level of consciousness and SWADOC items and scores. Method/Design: In this multicenter prospective cohort, 104 patients with DOC will be tested three times over five consecutive days with the SWADOC. Statistical analyses will focus on the reliability and validity of the SWADOC, especially the intrarater and interrater reliability, internal consistency, measures of dispersion, and concurrent validity with the Facial Oral Tract Therapy Swallowing Assessment of Saliva (FOTT-SAS). The level of consciousness will be assessed with the Simplified Evaluation of CONsciousness Disorders (SECONDs) and the Coma Recovery Scale-Revised (CRS-R). Discussion: The assessment of swallowing abilities among patients with DOC is the first necessary step toward the development of a customized dysphagia care plan. A validated scoring tool will be essential for clinicians to better assess dysphagia in patients with DOC and document the evolution of their disorders. Trial Registration: NCT04706689.
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Affiliation(s)
- Evelyne Mélotte
- Physical and Rehabilitation Medicine Department, University Hospital of Liège, Liège, Belgium.,Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Marion Belorgeot
- Physical and Rehabilitation Medicine Department, University Hospital of Nîmes, Nîmes, France
| | - Roxanne Herr
- Department of Speech and Language Pathology, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Jessica Simon
- Psychology and Neuroscience of Cognition, University of Liège, Liège, Belgium
| | - Jean-François Kaux
- Physical and Rehabilitation Medicine Department, University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Leandro R D Sanz
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Aude Lagier
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Liège, Liège, Belgium
| | - Dominique Morsomme
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Liège, Liège, Belgium
| | - Frederic Pellas
- Physical and Rehabilitation Medicine Department, University Hospital of Nîmes, Nîmes, France
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau, University Hospital of Liège, Liège, Belgium
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Fulcher-Rood K, Castilla-Earls A, Higginbotham J. What Does Evidence-Based Practice Mean to You? A Follow-Up Study Examining School-Based Speech-Language Pathologists' Perspectives on Evidence-Based Practice. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:688-704. [PMID: 32176526 DOI: 10.1044/2019_ajslp-19-00171] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose The current investigation is a follow-up from a previous study examining child language diagnostic decision making in school-based speech-language pathologists (SLPs). The purpose of this study was to examine the SLPs' perspectives regarding the use of evidence-based practice (EBP) in their clinical work. Method Semistructured phone interviews were conducted with 25 school-based SLPs who previously participated in an earlier study by Fulcher-Rood et al. 2018). SLPs were asked questions regarding their definition of EBP, the value of research evidence, contexts in which they implement scientific literature in clinical practice, and the barriers to implementing EBP. Results SLPs' definitions of EBP differed from current definitions, in that SLPs only included the use of research findings. SLPs seem to discuss EBP as it relates to treatment and not assessment. Reported barriers to EBP implementation were insufficient time, limited funding, and restrictions from their employment setting. SLPs found it difficult to translate research findings to clinical practice. SLPs implemented external research evidence when they did not have enough clinical expertise regarding a specific client or when they needed scientific evidence to support a strategy they used. Conclusions SLPs appear to use EBP for specific reasons and not for every clinical decision they make. In addition, SLPs rely on EBP for treatment decisions and not for assessment decisions. Educational systems potentially present other challenges that need to be considered for EBP implementation. Considerations for implementation science and the research-to-practice gap are discussed.
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Affiliation(s)
| | - Anny Castilla-Earls
- Department of Communication Sciences and Disorders, University of Houston, TX
| | - Jeff Higginbotham
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
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Kelley ES, Hull G, Eubank A, Roettgen G. Teaching Undergraduate Clinicians Empirically Supported Practices for Preschool Vocabulary Instruction. Lang Speech Hear Serv Sch 2020; 51:353-370. [PMID: 32013722 DOI: 10.1044/2019_lshss-19-00061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose To incorporate evidence-based practice into clinical settings, there is a need for efficient, effective ways to share information from research to speech-language pathologists (SLPs) and to students preparing to become SLPs. The purpose of this study was to implement and evaluate a method for teaching undergraduate student clinicians to use empirically supported practices in vocabulary instruction during shared storybook reading with preschoolers. Method Undergraduate students enrolled in a semester-long preschool practicum participated in the study. In Study 1, 11 students participated in a multiple-baseline, single-case design. In Study 2, an additional 10 students were included in a quasi-experimental group design. All students completed prerecorded, online teaching modules that taught empirically supported practices for teaching vocabulary during shared storybook reading. Half of the students received weekly e-mails with performance feedback. Targeted practices included selection of appropriate vocabulary targets, explicit teaching, and use of interactive teaching strategies. Results In Study 1, treatment effects were observed for targeted practices for many of the student clinicians. In Study 2, group comparisons indicated an effect of e-mail performance feedback for 1 of 3 outcomes with a large effect size. Conclusion Prerecorded teaching modules may be an efficient, effective way to teach specific empirically supported practices to undergraduate student clinicians. E-mail feedback might improve use of taught practices for some students or for some practices. Future studies can examine the potential of these types of teaching modules for other outcomes or with groups of practicing SLPs.
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Affiliation(s)
| | - Greta Hull
- Department of Speech, Language and Hearing Sciences, University of Missouri, Columbia
| | - Abby Eubank
- Department of Speech, Language and Hearing Sciences, University of Missouri, Columbia
| | - Greta Roettgen
- Department of Speech, Language and Hearing Sciences, University of Missouri, Columbia
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11
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Randazzo M. A Survey of Clinicians With Specialization in Childhood Apraxia of Speech. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1659-1672. [PMID: 31487474 DOI: 10.1044/2019_ajslp-19-0034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Little is known about how clinicians develop expertise in childhood apraxia of speech (CAS), a rare speech disorder with heterogeneous presentation. The purpose of this survey study was to examine the beliefs and practices of clinicians specializing in CAS. Method Speech-language pathologists who self-identify as having expertise in CAS (n = 165) completed an online survey regarding influences on clinical practice and beliefs about CAS. Practice patterns and perspectives regarding CAS were analyzed for respondents who self-identify as having expertise in CAS, across 4 experience bands (1-5, 6-10, 11-15, and 15+ years). Results A majority of the respondents to this survey provide treatment to preschool-age children with CAS. Respondents report features used in differential diagnosis aligned with the American Speech-Language-Hearing Association's (2007) technical report, with inconsistency as a key feature. Results suggest that continuing education courses are highly influential in the perceived development of expertise and perspectives regarding CAS. Respondents expressed uncertainty about comorbidity of CAS with other communication disorders. Overall, beliefs and practices are relatively uniform across levels of clinical experience. Conclusions Practices and perspectives of clinicians who self-identify as having expertise with CAS are influenced by factors noted in previous literature. Results of this survey highlight the need for research on the development of expertise in the clinical management of CAS, updated consensus statements that reflect advances in current research, clarification regarding comorbidity of CAS with other communication disorders, and evaluation of continuing education opportunities. Supplemental Material https://doi.org/10.23641/asha.9755459.
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Affiliation(s)
- Melissa Randazzo
- Department of Communication Sciences and Disorders, Adelphi University, Garden City, NY
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12
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Crowe K, Guiberson M. Evidence-Based Interventions for Learners Who Are Deaf and/or Multilingual: A Systematic Quality Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:964-983. [PMID: 31398302 DOI: 10.1044/2019_ajslp-idll-19-0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Many educators and speech-language pathologists have difficulty providing effective interventions to the growing population of d/Deaf and hard-of-hearing (DHH) learners who use more than 1 language. The purpose of this review article was to identify evidence-based interventions for speech, language, and literacy used with DHH multilingual learners (DMLs), monolingual DHH learners, and hearing bilingual learners without hearing loss. Interventions used with these groups can inform the practice of professionals providing services to DMLs. Method This review article considered speech, language, and literacy interventions used with DHH and hearing bilingual learners from birth to 21 years of age. The following electronic databases were searched: Academic Search Complete/EBSCO (CINAHL, Education, ERIC), Linguistics & Language Behavior Abstracts, PsycINFO, and PubMed. Data describing article, participant, methodological, and intervention variables were extracted from studies. The methodological quality of studies was examined using the Council for Exceptional Children's (2014) standards for evidence-based practice in special education. Results A total of 144 studies were reviewed, describing over 9,370 learners aged 1.8-22.0 years. Two studies investigated DMLs, 76 investigated DHH learners, and 67 investigated hearing bilingual learners. A total of 146 different interventions were examined. Most studies reported positive effects. Only 17 studies met all quality indicators specified by the Council for Exceptional Children (2014): 7 examined DHH learners, and 10 examined hearing bilingual learners. There was insufficient evidence for any intervention to be considered an evidence-based intervention, although 6 could potentially contribute to evidence-based practice. Conclusions No evidence-based interventions for DMLs were identified. A small number of interventions examined in high-quality studies of DHH and hearing bilingual learners were identified, which may be appropriate for use with DMLs following further investigation. Supplemental Material https://doi.org/10.23641/asha.9108386.
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Affiliation(s)
- Kathryn Crowe
- School of Teacher Education, Charles Sturt University, Bathurst, New South Wales, Australia
- School of Health Sciences, University of Iceland, Reykjavik
| | - Mark Guiberson
- College of Health Sciences, University of Wyoming, Laramie
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13
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Alary Gauvreau C, Le Dorze G, Kairy D, Croteau C. Evaluation of a community of practice for speech-language pathologists in aphasia rehabilitation: a logic analysis. BMC Health Serv Res 2019; 19:530. [PMID: 31358002 PMCID: PMC6664764 DOI: 10.1186/s12913-019-4338-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 07/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aphasia is a communication disorder affecting participation. Although there are evidence-based practice recommendations about participation and aphasia rehabilitation, it may be challenging for speech-language pathologists to ensure that rehabilitation activities have an impact on the person's participation, in part due to time limitations. Participation remains limited after rehabilitation for persons who have aphasia. Communities of practice (CoPs) are a collaborative knowledge transfer strategy that can be used for evidence-based practice implementation. The aim of this study was to describe the components and evaluate a CoP for speech-language pathologists about participation and aphasia rehabilitation. METHODS Logic analysis was used to determine the adequacy between resources, implemented activities, outputs and short-term outcomes of the CoP. Qualitative and quantitative descriptive data were collected through observation and participants' logbooks. Outputs and outcomes of the CoP were revealed through thematic analysis and interpretation of descriptive statistics. RESULTS Resources including CoP design and educational aims, human and material resources were combined to create various web-based, online and offline activities. Participants invested more time per week than expected in the CoP, shared and created clinical tools and appreciated the array of suggested activities. Participant engagement allowed them to reflect, interact and collaborate with each other. All 13 participants reported they acquired knowledge about clinical tools and 12 mentioned they reflected on their practice. While the CoP was ongoing, six participants noticed evidence-practice gaps, seven prepared to change their practice, and three changed their practice towards including more participation-based considerations. CONCLUSIONS This study showed that speech-language pathologists can include more participation-based approaches in aphasia rehabilitation as a result of participating in a time-bound, web-based CoP.
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Affiliation(s)
- Christine Alary Gauvreau
- School of Speech-Language Pathology and Audiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada. .,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada. .,Jewish Rehabilitation Hospital, Centre intégré de santé et de services sociaux de Laval, Laval, Quebec, Canada.
| | - Guylaine Le Dorze
- School of Speech-Language Pathology and Audiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | - Dahlia Kairy
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | - Claire Croteau
- School of Speech-Language Pathology and Audiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
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Hustad KC, Sakash A, Natzke PEM, Broman AT, Rathouz PJ. Longitudinal Growth in Single Word Intelligibility Among Children With Cerebral Palsy From 24 to 96 Months of Age: Predicting Later Outcomes From Early Speech Production. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:1599-1613. [PMID: 31112444 PMCID: PMC6808366 DOI: 10.1044/2018_jslhr-s-18-0319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/23/2018] [Accepted: 12/27/2018] [Indexed: 05/19/2023]
Abstract
Purpose Children with cerebral palsy (CP) are at risk for significant communication problems. Reduced speech intelligibility is common, even for those who do not have speech motor deficits. Development of intelligibility has not been comprehensively quantified in children with CP; as a result, we are currently unable to predict later speech outcomes. Such information would advance treatment decision making. We sought to examine growth in speech intelligibility among children with CP using a prospective longitudinal design, with a focus on age of crossing target intelligibility thresholds, age of greatest intelligibility growth, and how well intelligibility at 36 months predicted intelligibility at 96 months. Method Sixty-nine children with CP were followed longitudinally between 24 and 96 months of age. A total of 566 time points were examined across children ( M = 8.2 time points per child, SD = 2.6). We fitted a nonlinear random effects model for longitudinal observations and then used the fitted model trajectories to generate descriptive analyses of growth. We used results of the model to generate a set of simulations, which we analyzed to determine how well 36-month intelligibility data predicted 96-month data. Results Half of children crossed 25% and 50% intelligibility thresholds at 36 and 49 months of age, respectively. Slightly more than half of children did not reach 75% intelligibility by 96 months of age. Age of crossing 25%, 50%, and 75% intelligibility thresholds was highly negatively correlated with intelligibly at 96 months. Children had the steepest intelligibility growth at 36 months, followed by 48 and 60 months. Intelligibility at 36 months was highly predictive of intelligibility at 96 months. Conclusions The developmental window from 3 to 5 years constitutes a time of rapid growth in speech intelligibility in children with CP. Children who cross intelligibility thresholds of 25%, 50%, and 75% at earlier ages have better outcomes when they are older; early performance is highly predictive of later speech intelligibility outcomes. Children with CP as a group have delayed speech intelligibility development but are still growing through 96 months of age.
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Affiliation(s)
- Katherine C. Hustad
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Waisman Center, University of Wisconsin–Madison
| | | | | | - Aimee Teo Broman
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Paul J. Rathouz
- Waisman Center, University of Wisconsin–Madison
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison
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Furlong L, Serry T, Erickson S, Morris ME. Processes and challenges in clinical decision-making for children with speech-sound disorders. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2018; 53:1124-1138. [PMID: 30216607 DOI: 10.1111/1460-6984.12426] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 08/05/2018] [Accepted: 08/12/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Children with speech-sound disorders (SSD) constitute a significant proportion of speech-language pathologists' (SLPs) caseloads. Previous research has investigated the clinical practice of SLPs intervening with children with SSD; however, little is known about the clinical decision-making underpinning their practice. AIMS The clinical decision-making of SLPs working with children with SSD was explored to understand how their clinical decisions were influenced by: (1) beliefs about what works in therapy; (2) prior clinical experience; and (3) client and service-related variables. METHODS & PROCEDURES Semi-structured, individual, in-depth interviews were conducted with 11 SLPs. Inductive thematic analysis was used to identify and explore key ideas and themes. OUTCOMES & RESULTS Four themes emerged: (1) clinical decision-making procedures were highly individualized; (2) parental involvement was viewed as central to the success and progression of therapy; (3) therapy procedures were influenced by practice-setting constraints; and (4) engaging in evidence-based practice within clinical settings was perceived as challenging. CONCLUSIONS & IMPLICATIONS In clinical settings, a range of factors influence decision-making and therapy provided by SLPs to children with SSD. These SLPs had a high regard for clients' values and preferences. Prior clinical experiences also shaped clinical practice. Clinical decision-making was influenced by practice-setting constraints. SLPs are under pressure in their workplaces and are struggling to manage the competing demands on their time. Large clinical caseloads, heavy workloads, current service-delivery models and changing family structures are all impacting on the provision of therapy to children with SSD and therapy outcomes. As a profession, there is a need to consider these barriers and identify ways to overcome them in order to assist SLPs to routinely adopt the highest standards of clinical practice for children with SSD.
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Affiliation(s)
- Lisa Furlong
- Discipline of Speech Pathology, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Melbourne, VIC, Australia
| | - Tanya Serry
- Discipline of Speech Pathology, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Melbourne, VIC, Australia
| | - Shane Erickson
- Discipline of Speech Pathology, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Melbourne, VIC, Australia
| | - Meg E Morris
- Discipline of Speech Pathology, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Melbourne, VIC, Australia
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O'Dwyer M, Walsh IP, Leahy MM. The Role of Narratives in the Development of Stuttering as a Problem. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:1164-1179. [PMID: 30347061 DOI: 10.1044/2018_ajslp-odc11-17-0207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 05/18/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Narratives are how people make sense of experiences and give meaning to their lives (Bruner, 1990). Use of narrative therapy (White, 2007) with people who stutter to facilitate the development of preferred stories (as opposed to problem-based stories) has been documented in the literature (Logan, 2013; Ryan, O'Dwyer, & Leahy, 2015). The purpose of this research was to explore the role of narratives in the development of stuttering as a problem for people who stutter. This research sought to describe how these narratives develop and to identify the factors that influence this development. METHOD Narratives from 6 men who stutter were recorded, transcribed, and analyzed using the "Listening Guide" (Brown & Gilligan, 1992). This is a voice-centered relational method. RESULTS Findings indicate interaction between participants' narratives about stuttering and their wider self-narratives. Influencing factors identified include relationships, thoughts and feelings, and the dominant stories about stuttering in relevant social structures. An individual's consciousness of these influences was found to be integral to change in their narratives. CONCLUSIONS The findings point to the importance of considering the environment, including significant relationships and social structures, in our understanding of stuttering. They also provide insights regarding intrapersonal and interpersonal processes, which can influence the development of stuttering or pave the way to stuttering becoming less problematic for the person who stutters.
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Affiliation(s)
- Mary O'Dwyer
- Trinity College Dublin, Ireland
- Cork Kerry Community Healthcare, Tralee, Ireland
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Kelley E, Hull G, Abell M. Teaching Evidence-Based Vocabulary Instruction to Undergraduate Clinicians: A Feasibility Study of Recorded Teaching Modules. ACTA ACUST UNITED AC 2018. [DOI: 10.1044/persp3.sig10.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Elizabeth Kelley
- Department of Communication Science and Disorders, University of Missouri Columbia, MO
| | - Greta Hull
- Department of Communication Science and Disorders, University of Missouri Columbia, MO
| | - Madison Abell
- Department of Communication Science and Disorders, University of Missouri Columbia, MO
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18
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Hamilton MB, Mont EV, McLain C. Deletion, Omission, Reduction: Redefining the Language We Use to Talk About African American English. ACTA ACUST UNITED AC 2018. [DOI: 10.1044/persp3.sig1.107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Eusabia V. Mont
- Department of Hearing and Speech Sciences, University of Maryland College Park, MD
| | - Cameron McLain
- Department of Communication Disorders, Auburn University Auburn, AL
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Dukhovny E, Thistle JJ. An exploration of motor learning concepts relevant to use of speech-generating devices. Assist Technol 2017; 31:126-132. [DOI: 10.1080/10400435.2017.1393845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Elena Dukhovny
- Department of Communicative Sciences and Disorders, California State University, East Bay, Hayward, California, USA
| | - Jennifer J. Thistle
- Department of Communication Sciences and Disorders, Western Washington University, Bellingham, Washington, USA
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Bellon-Harn ML, Azios JH, Dockens AL, Manchaiah V. Speech-language pathologists' preferences for patient-centeredness. JOURNAL OF COMMUNICATION DISORDERS 2017; 68:81-88. [PMID: 28662420 DOI: 10.1016/j.jcomdis.2017.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 06/13/2017] [Accepted: 06/16/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Preferences for patient-centeredness is an important indicator in healthcare service delivery. However, it remains largely unexplored in the field of communication science and disorders. This study investigated speech-language pathologists' (SLPs) preferences for patient-centeredness METHOD: The study involved a cross-sectional survey design. SLPs (n = 102) fully completed the modified Patient-Practitioner Orientation Scale (PPOS; Krupat et al, 2000) and also provided demographic details. Data were analyzed using descriptive statistics, correlation, and linear regression methods. RESULTS Mean PPOS scores indicated that SLPs value patient-centeredness. There was a strong positive correlation among sharing and caring subscales with the full-scale. Results from the linear regression modeling suggested no relationship between demographic factors and preferences for patient-centeredness. CONCLUSIONS SLPs value patient-centeredness, although there may be regional and cultural variations. Qualitative investigations may help uncover dimensions of patient-centeredness that were not captured in the PPOS scale. In addition, further research should explore congruence in preferences for patient-centeredness among SLPs and patients.
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Affiliation(s)
| | | | - Ashley L Dockens
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA
| | - Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA; The Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Audiology India, Mysore, Karnataka, India
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Swift MC, Langevin M, Clark AM. Using critical realistic evaluation to support translation of research into clinical practice. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:335-343. [PMID: 28394187 DOI: 10.1080/17549507.2017.1309067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 03/16/2017] [Indexed: 06/07/2023]
Abstract
A challenge that speech-language pathologists (SLPs) face is the translation of research into clinical practice. While randomised controlled trials (RCTs) are often touted as the "gold standard" of efficacy research, much valuable information is lost through the process; RCTs by nature are designed to wash out individual client factors and contexts that might influence the outcome in order to present the "true" impact of the intervention. However, in the area of behavioural interventions, the interaction of client factors and contexts with the treatment agent can substantially influence the outcome. This paper provides an overview of the theoretical background and methods involved in critical realistic evaluation (CRE) and discusses its current and potential application to speech-language pathology. CRE is based on the premise that a behavioural intervention cannot be evaluated without considering the context in which it was provided. While the ways in which contextual aspects and treatment mechanisms interact may seem endless, CRE methodology attempts to operationalise them into hypotheses to be empirically tested. Research based on these principles has the potential to support clinical translation of research outcomes and reduce the costs of unsuccessful treatment attempts for SLPs, clients and the service provider.
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Affiliation(s)
- Michelle C Swift
- a School of Health Sciences , Flinders University , Adelaide , SA , Australia
- b Department of Communication Sciences and Disorders , University of Alberta , Edmonton , AB , Canada , and
| | - Marilyn Langevin
- b Department of Communication Sciences and Disorders , University of Alberta , Edmonton , AB , Canada , and
| | - Alexander M Clark
- c Faculty of Nursing , 5-166 Edmonton Clinic Health Academy, University of Alberta , Edmonton , AB , Canada
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Rvachew S, Matthews T. Demonstrating treatment efficacy using the single subject randomization design: A tutorial and demonstration. JOURNAL OF COMMUNICATION DISORDERS 2017; 67:1-13. [PMID: 28460270 DOI: 10.1016/j.jcomdis.2017.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 03/23/2017] [Accepted: 04/10/2017] [Indexed: 06/07/2023]
Abstract
Single case research refers to the broader category of research designs in which each case serves as his or her own control. A single subject randomization design is a specific form in which sessions are randomly allocated to treatment conditions within subjects. Two tutorials on the application of these designs are provided. In the single subject randomized phase design, baseline probes are administered repeatedly during a no-treatment or usual care phase; subsequently probes are administered repeatedly during the treatment phase of the experiment; the starting point for the treatment phase is determined by random selection. In the single subject randomized alternation design, any session can be randomly allocated to any treatment condition. In either case, the test statistic can be the mean of probe performance during the treatment sessions after subtracting the baseline mean. The significance of the obtained test statistic is determined by resampling test. Specifically, the obtained test statistic is interpreted relative to a distribution of test statistics generated by all possible random allocations. This distribution yields a P value which represents the probability of obtaining a test statistic as large as that obtained by the selected allocation. In addition to the tutorials, two experiments using these designs with a single 8-year-old participant with Childhood Apraxia of Speech are presented to demonstrate the utility of these designs and the application of the associated statistical analysis procedures.
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Affiliation(s)
- Susan Rvachew
- School of Communication Sciences and Disorders, McGill University, Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Canada.
| | - Tanya Matthews
- School of Communication Sciences and Disorders, McGill University, Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Canada
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McCulloch J, Swift MC, Wagnitz B. Case file audit of Lidcombe program outcomes in a student-led stuttering clinic. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:165-173. [PMID: 27070028 DOI: 10.3109/17549507.2016.1159336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/24/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE The current study aimed to benchmark clinical outcomes for preschool-aged clients (2;0-5;11 years old) that attended a student-led clinic and undertook the Lidcombe Program. METHOD A case file audit was undertaken for all preschool clients who attended the clinic between February 2008 and February 2013 and commenced the Lidcombe Program. Clients were grouped according to Stage 1 completion. A mixed ANOVA was used to test for differences between the groups in initial and final percentage syllables stuttered (%SS). Associations between case variable factors and treatment duration were investigated using Pearson correlations. RESULT Clients who completed Stage 1 had final %SS and severity rating (SR) scores comparable to the literature; however, the median Stage 1 duration was greater. Over half of the clients (57%) withdrew prior to completing Stage 1. These clients had a significantly higher %SS at final treatment session than their completing peers. Initial %SS and SR scores were the only case variables associated with treatment duration. CONCLUSION Students can achieve the same short-term treatment outcomes for children who stutter using the Lidcombe Program as the current published literature; however, treatment duration is greater and may impact completion. Implications of this for clinical education are discussed.
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Affiliation(s)
- Julia McCulloch
- a Flinders University, School of Health Sciences - Speech Pathology , Adelaide , South Australia , Australia
| | - Michelle C Swift
- a Flinders University, School of Health Sciences - Speech Pathology , Adelaide , South Australia , Australia
| | - Bianca Wagnitz
- a Flinders University, School of Health Sciences - Speech Pathology , Adelaide , South Australia , Australia
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Assessment and Rehabilitation of Social Cognition Impairment after Brain Injury: Surveying Practices of Clinicians. BRAIN IMPAIR 2017. [DOI: 10.1017/brimp.2016.34] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives: This study examined the current assessment practices of clinicians working with people with social cognition impairment following traumatic brain injury.Method: Two hundred and sixty clinicians completed an on-line survey that was disseminated through professional brain injury organisations. Of respondents around 90% were allied health clinicians, with the remainder comprising medical, nursing and academia.Main outcomes: The four areas of social cognition that were routinely assessed across the disciplines were insight, disinhibition, anger and social adjustment. The least routinely assessed areas were theory of mind and alexithymia. The test suggested most likely to identify social cognition impairments was The Awareness of Social Inference Test, although only 8% of clinicians responded to this question. Clinicians preferred informal assessment methods over standardised assessment methods for identifying social cognition rehabilitation goals. Higher levels of education were associated with greater use of standardised assessment modalities. Whilst there was paucity of responses overall, TBI Express was most commonly used for social cognition rehabilitation.Conclusions: Considering the high prevalence of social cognition impairments in this population, formal assessment is extremely limited. The under-utilisation of assessment tools is problematic for the assessment and rehabilitation initiatives offered to people with TBI. These results have implications for the training of clinicians working in brain injury rehabilitation.
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Edwards J, Dukhovny E. Technology Training in Speech-Language Pathology: A Focus on Tablets and Apps. ACTA ACUST UNITED AC 2017. [DOI: 10.1044/persp2.sig10.33] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Use of tablet computers has become ubiquitous in speech-language pathology assessment and intervention. With hundreds of applications of variable quality available, clinical training programs have the added responsibility of teaching students systematic, critical-thought-driven approaches to technology selection and evaluation. The purpose of this article is two-pronged: (1) we describe a systematic approach to tablet/app implementation piloted within the Norma S. and Ray R. Rees Speech, Language, and Hearing Clinic at California State University, East Bay and, (2) we present the results of a survey that identifies current practices in app selection in other university clinics.
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Joginder Singh S, Chan MY, Ahmad Rusli Y. Practise patterns of Malaysian speech-language pathologists in managing children with speech and language delay/disorder. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 18:560-570. [PMID: 27063683 DOI: 10.3109/17549507.2016.1139624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Children with speech and language delay/disorder (SLD) in the developing language stage (DLS) are one of the largest populations served by speech-language pathologists (SLPs) working in paediatric settings. The aim of this study was to investigate the practise patterns adopted by Malaysian SLPs when managing these children. METHOD A web-based questionnaire was developed to obtain information about SLPs' practises during assessment, planning and treatment. RESULT A total of 53 SLPs completed the questionnaire. When assessing the children, participants either always or usually involved parents, suggesting that they understood the importance of family involvement in services provided. When planning goals, the SLPs relied mostly on their clinical experience and less on research evidence. Participants reported that, most often, they employed a one-to-one approach when providing treatment. There was, however, great variation in the frequency of treatment provided, reflecting the different workplaces of participants. CONCLUSION Generally, findings from this study indicated that some practises employed by Malaysian SLPs when managing children with SLD in the DLS are on par with the best practise guidelines, but there is still room for improvement in certain areas such as team collaboration and evidence-based practise. Clinical and research implications are discussed.
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Affiliation(s)
| | - Min Yen Chan
- a Universiti Kebangsaan Malaysia , Kuala Lumpur , Malaysia
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Dockens AL, Bellon-Harn ML, Manchaiah V. Preferences to Patient-Centeredness in Pre-Service Speech and Hearing Sciences Students: A Cross-Sectional Study. J Audiol Otol 2016; 20:73-9. [PMID: 27626079 PMCID: PMC5020576 DOI: 10.7874/jao.2016.20.2.73] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/04/2016] [Accepted: 05/04/2016] [Indexed: 12/14/2022] Open
Abstract
Background and Objectives Patient-centeredness is a critical approach to rehabilitation in allied health professions and is an imperative component of evidence-based practice. However, it is unknown if patient-centeredness is valued by students enrolled in allied health. This study was aimed at determining preferences to patient-centeredness in pre-service speech and hearing students in the field of speech and hearing sciences. Subjects and Methods Pre-service speech and hearing students (n=93) completed the Patient-Practitioner Orientation Scale (PPOS) and were grouped according to low, medium, or high exposure to curriculum content. Results Across exposure levels, students exhibited high preference to patient centeredness with a mean PPOS score of 4.13 (standard deviation–0.5). A pairedsample t-test revealed a significant difference (p≤0.0001) between the caring and sharing subscales of the PPOS with lower mean scores on the caring subscale. No significant differences were noted across levels of exposure for sharing subscale, caring subscale, or PPOS full-scale. Conclusions Results suggest a need for curriculum enhancement focused on improved caring and empathy.
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Affiliation(s)
- Ashley L Dockens
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA
| | | | - Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA.; The Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.; Audiology India, Mysore, Karnataka, India
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Adams C, Gaile J, Lockton E, Freed J. Integrating Language, Pragmatics, and Social Intervention in a Single-Subject Case Study of a Child With a Developmental Social Communication Disorder. Lang Speech Hear Serv Sch 2016; 46:294-311. [PMID: 26252361 DOI: 10.1044/2015_lshss-14-0084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 06/25/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This clinical focus article presents an illustration of a complex communication intervention, the Social Communication Intervention Programme (SCIP), as delivered to a child who has a social communication disorder (SCD). The SCIP intervention combined language processing and pragmatic and social understanding therapies in a program of individualized therapy activities and in close liaison with families. METHOD The study used an enhanced AB single-subject design in which an 8-year-old child with an SCD participated in 20 therapy sessions with a specialist speech-language pathologist. A procedure of matching assessment findings to intervention choices was followed to construct an individualized treatment program. Examples of intervention content and the embedded structure of SCIP are illustrated. Observational and formal measurements of receptive and expressive language, conversation, and parent-teacher ratings of social communication were completed before therapy, after therapy, and at a 6-month follow-up session. RESULTS Outcomes revealed change in total and receptive language scores but not in expressive language. Conversation showed marked improvement in responsiveness, appreciation of listener knowledge, turn taking, and adaptation of discourse style. Teacher-reported outcomes included improved classroom behavior and enhanced literacy skills. Parent-reported outcomes included improved verbal interactions with family members and personal narratives. CONCLUSIONS This clinical focus article demonstrates the complexity of needs in a child with an SCD and how these can be addressed in individualized intervention. Findings are discussed in relation to the essential nature of language support including pragmatic therapy for children with SCDs. Discussion of the role of formal and functional outcome measurement as well as the proximity of chosen outcomes to the intervention is included.
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Jerger S, Thorne JC. Exploring the Utility of a School-Age Narrative Microstructure Index: Proportion of Restricted Utterances. Lang Speech Hear Serv Sch 2016; 47:171-80. [PMID: 27045171 DOI: 10.1044/2015_lshss-15-0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 09/01/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This research attempted to replicate Hoffman's 2009 finding that the proportion of narrative utterances with semantic or syntactic errors (i.e., ≥ 14% "restricted utterances") can differentiate school-age children with typical development from those with language impairment with a sensitivity of 83% and specificity of 88%. METHOD Methods similar to Hoffman (2009) were used to evaluate an existing set of narratives from 16 age-matched pairs of 8- to 9-year-old children, half with known language impairment. Transcripts were segmented into T-units; a code of [RESTRICTED] was assigned to any utterance with semantic or syntactic errors. RESULTS A Welch's t test for independent samples revealed a statistically significant difference in the mean proportion of restricted utterances between the two groups after accommodation for an outlier with typical development. A cutoff of ≥ 14% restricted utterances replicated Hoffman's (2009) sensitivity but not specificity. Post hoc analysis of specific error types found sensitivity and specificity rates similar to Hoffman's as well as a significant difference in means when using a proportion of sentence-internal morphosyntactic errors. CONCLUSION Results support further exploration of utterance-level error coding for diagnostic purposes and future development of this approach to meet clinical assessment needs.
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McCurtin A, Carter B. 'We don't have recipes; we just have loads of ingredients': explanations of evidence and clinical decision making by speech and language therapists. J Eval Clin Pract 2015; 21:1142-50. [PMID: 25545738 DOI: 10.1111/jep.12285] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2014] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Research findings consistently suggest that speech and language therapists (SLTs) are failing to draw effectively on research-based evidence to guide clinical practice. This study aimed to examine what constitutes the reasoning provided by SLTs for treatment choices and whether science plays a part in those decisions. METHOD This study, based in Ireland, reports on the qualitative phase of a mixed-methods study, which examined attitudes underpinning treatment choices and the therapy process. SLTs were recruited from community, hospital and disability work settings via SLT managers who acted as gatekeepers. A total of three focus groups were run. Data were transcribed, anonymized and analysed using thematic analysis. RESULTS In total, 48 participants took part in the focus groups. The majority of participants were female, represented senior grades and had basic professional qualifications. Three key themes were identified: practice imperfect; practice as grounded and growing; and critical practice. Findings show that treatment decisions are scaffolded primarily on practice evidence. The uniqueness of each patient results in dynamic and pragmatic practice, constraining the application of unmodified therapies. CONCLUSION The findings emerging from the data reflect the complexities and paradoxes of clinical practice as described by SLTs. Practice is pivoted on both the patient and clinician, through their membership of groups and as individuals. Scientific thinking is a component of decision making; a tool with which to approach the various ingredients and the dynamic nature of clinical practice. However, these scientific elements do not necessarily reflect evidence-based practice as typically constructed.
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Affiliation(s)
- Arlene McCurtin
- Clinical Therapies, University of Limerick, Limerick, Ireland
| | - Bernie Carter
- School of Health, University of Central Lancashire, Preston, UK.,Children's Nursing Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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McCurtin A, Clifford AM. What are the primary influences on treatment decisions? How does this reflect on evidence-based practice? Indications from the discipline of speech and language therapy. J Eval Clin Pract 2015; 21:1178-89. [PMID: 26032767 DOI: 10.1111/jep.12385] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 11/26/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Four pillars of evidence underpin evidence-based behavioural practice: research evidence, practice evidence, patient evidence and contextual evidence. However, it is unknown which of these pillars or other factors are used by clinicians such as speech and language therapists (SLTS) when making treatment choices. The aim of this study was to identify the factors underpinning SLTs' treatment decisions and contextualize findings in terms of evidence-based practice (EBP). METHODS Ethical approval was obtained for the electronic questionnaire-based study. A questionnaire was designed, piloted and then sent via gatekeepers to SLTs to ascertain agreement with a range of statements potentially underpinning treatment choices. RESULTS A total of 249 respondents completed the survey. The respondents defined themselves as dynamic and pragmatic practitioners with an appreciation for the four pillars of EBP. Using factor analysis, treatment decisions were found to rely primarily on practice evidence and pragmatic considerations. Qualifications, clinical experience and the patient group an SLT works with further influenced attitudes and treatment decisions. Those with additional qualifications and experience were identified as more autonomous, more scientific in their treatment choices and less influenced by patient preferences. CONCLUSION Factors influencing decision making did not clearly align with the four pillars of EBP, the principal influences being practice evidence and pragmatic constraints. The findings of this study have implications for understanding why specific treatment choices are made. Attempts to improve practice should focus on a range of evidence sources and take into account clinician's specific needs depending on career stage, post-qualification status and patient group factors of their practice.
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Affiliation(s)
- Arlene McCurtin
- Clinical Therapies, University of Limerick, Limerick, Ireland
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Farquharson K, Tambyraja SR, Logan J, Justice LM, Schmitt MB. Using Hierarchical Linear Modeling to Examine How Individual SLPs Differentially Contribute to Children's Language and Literacy Gains in Public Schools. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2015; 24:504-516. [PMID: 26125629 DOI: 10.1044/2015_ajslp-14-0055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 05/25/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE The purpose of this study was twofold: (a) to determine the unique contributions in children's language and literacy gains, over 1 academic year, that are attributable to the individual speech-language pathologist (SLP) and (b) to explore possible child- and SLP-level factors that may further explain SLPs' contributions to children's language and literacy gains. METHOD Participants were 288 kindergarten and 1st-grade children with language impairment who were currently receiving school-based language intervention from SLPs. Using hierarchical linear modeling, we partitioned the variance in children's gains in language (i.e., grammar, vocabulary) and literacy (i.e., word decoding) that could be attributed to their individual SLP. RESULTS Results revealed a significant contribution of individual SLPs to children's gains in grammar, vocabulary, and word decoding. Children's fall language scores and grade were significant predictors of SLPs' contributions, although no SLP-level predictors were significant. CONCLUSIONS The present study makes a first step toward incorporating implementation science and suggests that, for children receiving school-based language intervention, variance in child language and literacy gains in an academic year is at least partially attributable to SLPs. Continued work in this area should examine the possible SLP-level characteristics that may further explicate the relative contributions of SLPs.
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Swartz B, Ratcliff A, Ivanitskaya L. Correlation of Attitudes and Beliefs With Actual Abilities of Speech-Language Pathology Students Regarding Aspects of Information Literacy. ACTA ACUST UNITED AC 2015. [DOI: 10.1044/cicsd_42_f_215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Biancone TL, Farquharson K, Justice LM, Schmitt MB, Logan JAR. Quality of language intervention provided to primary-grade students with language impairment. JOURNAL OF COMMUNICATION DISORDERS 2014; 49:13-24. [PMID: 24731592 DOI: 10.1016/j.jcomdis.2014.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 02/28/2014] [Accepted: 03/15/2014] [Indexed: 06/03/2023]
Abstract
UNLABELLED This study had two aims: (a) to describe the quality of language intervention provided by school-based speech-language pathologists (SLPs) to children with language impairment in the primary grades with respect to the quality of emotional support, instructional support, and proactive management during SLP-child interactions, and (b) to determine if key characteristics of the SLPs are predictors of variance in intervention quality. Participants were 174 children nested within 40 SLPs' caseloads from various districts in two Midwestern states involved in a larger study of speech-language therapy practices in the public schools. A total of 208 videotaped language intervention sessions were coded for emotional support, instructional support, and proactive management using the Classroom Assessment Scoring System (CLASS; Pianta, La Paro, & Hamre, 2008). The quality of language intervention varied widely and was generally mid-range to high with respect to emotional support and proactive management, and low to mid-range in terms of instructional support. The quality of interactions varied and a large percentage of the observed variance in quality was attributed to SLPs. Time pressure was a strong predictor of the quality of emotional support, instructional support, and proactive management, and job satisfaction was a significant predictor of instructional support and proactive management. This descriptive information about school-based language intervention highlights the impact of the individual SLP in terms of the quality of the interactions taking place and the potential need to ease job pressures and promote job satisfaction. LEARNING OUTCOMES Readers will be able to: (1) identify and define three aspects of SLP-child interaction quality during intervention as framed in this study using the CLASS observation tool (Pianta, La Paro, et al., 2008); (2) discuss the relevance of those three aspects of quality to children with LI; and (3) identify SLP-level factors that significantly predict SLP-student interaction quality during intervention for children with LI.
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Apel K. Clinical Scientists Improving Clinical Practices: In Thoughts and Actions. Lang Speech Hear Serv Sch 2014; 45:104-9. [DOI: 10.1044/2014_lshss-14-0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose
In this article, the author comments on aspects of Kamhi's (2014) article, which caused the author to think more deeply about definitions of language, theories of learning, and how these two core components of intervention prepare clinical scientists as they search the literature for new knowledge. Interprofessional collaborative practice as a model for team-based intervention in school settings is also discussed.
Method
The article addresses aspects of Kamhi's article that aligned or did not align with the author's definition of language and theory of learning and explains why considering these alignments is important for clinical scientists. Two challenges to staying current with the research base are also described, and suggestions are offered for addressing these challenges. Finally, the article provides an overview of interprofessional collaborative practice.
Conclusion
Clinical scientists should continue to strive to use their knowledge of what language is and how it is learned, combined with the best available scientific information, to best serve their clients. Combining their thoughts and actions, they undoubtedly will continuously improve their clinical practices.
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Affiliation(s)
- Kenn Apel
- University of South Carolina, Columbia
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Kamhi AG. Improving Clinical Practices for Children With Language and Learning Disorders. Lang Speech Hear Serv Sch 2014; 45:92-103. [DOI: 10.1044/2014_lshss-13-0063] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose
This lead article of the Clinical Forum addresses some of the gaps that exist between clinical practice and current knowledge about instructional factors that influence learning and language development.
Method
Topics reviewed and discussed include principles of learning, generalization, treatment intensity, processing interventions, components of language therapy, grammar goals, and goal prioritization for students with language and learning difficulties.
Conclusion
The gaps that exist between current knowledge about learning, language development, and clinical practice often do not receive as much attention as the gaps in the evidence base that addresses the efficacy and effectiveness of language intervention practices and service delivery models. Fortunately, clinicians do not have to wait for future intervention studies to apply their knowledge of learning and language development to clinical practices.
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Hinckley JJ. A case for the implementation of cognitive-communication screenings in acute stroke. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 23:4-14. [PMID: 23813197 DOI: 10.1044/1058-0360(2013/11-0064)] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE The purpose of this article was to illustrate the importance of the implementation of cognitive-communication screenings in acute stroke and to discuss the need for further research on whether and how these screenings are implemented. Cognitive-communication screenings after stroke are the subject of existing practice guidelines and are supported by accumulated evidence. METHOD The author uses an autoethnographic narrative--a tool founded in phenomenology--to provide an in-depth description of the experiences of a family in which one member experienced right-hemispheric stroke. She uses systematic introspection to produce a narrative using literary techniques. RESULTS The narrative illustrates the experiences of one family when one of their members has a right-hemisphere stroke, and cognitive-communication impairments are never formally identified by professionals involved in the patient's care. CONCLUSIONS The narrative is linked to the published literature and the importance of identifying and managing cognitive-communication impairments after stroke. A model of implementation science is presented as one way to consider the challenges clinicians face when attempting to implement evidence-based practices. The model and examples from other fields show avenues for further research.
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O'Brian S, Iverach L, Jones M, Onslow M, Packman A, Menzies R. Effectiveness of the Lidcombe Program for early stuttering in Australian community clinics. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2013; 15:593-603. [PMID: 23691980 DOI: 10.3109/17549507.2013.783112] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study explored the effectiveness of the Lidcombe Program for early stuttering in community clinics. Participants were 31 speech-language pathologists (SLPs) using the Lidcombe Program in clinics across Australia, and 57 of their young stuttering clients. Percentage of syllables stuttered (%SS) was collected 9 months after beginning treatment along with information about variables likely to influence outcomes. The mean %SS for the 57 children 9 months after starting treatment was 1.7. The most significant predictor of outcome was Lidcombe Program Trainers Consortium (LPTC) training. The children of trained SLPs (n = 19), compared to the children of untrained SLPs, took 76% more sessions to complete stage 1, but achieved 54% lower %SS scores, 9 months after starting treatment. Results suggest that outcomes for the Lidcombe Program in the general community may be comparable to those obtained in clinical trials when SLPs receive formal training and support.
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Affiliation(s)
- Sue O'Brian
- Australian Stuttering Research Centre, The University of Sydney, Sydney , Australia
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Cheung G, Trembath D, Arciuli J, Togher L. The impact of workplace factors on evidence-based speech-language pathology practice for children with autism spectrum disorders. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2013; 15:396-406. [PMID: 22967045 DOI: 10.3109/17549507.2012.714797] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Although researchers have examined barriers to implementing evidence-based practice (EBP) at the level of the individual, little is known about the effects workplaces have on speech-language pathologists' implementation of EBP. The aim of this study was to examine the impact of workplace factors on the use of EBP amongst speech-language pathologists who work with children with Autism Spectrum Disorder (ASD). This study sought to (a) explore views about EBP amongst speech-language pathologists who work with children with ASD, (b) identify workplace factors which, in the participants' opinions, acted as barriers or enablers to their provision of evidence-based speech-language pathology services, and (c) examine whether or not speech-language pathologists' responses to workplace factors differed based on the type of workplace or their years of experience. A total of 105 speech-language pathologists from across Australia completed an anonymous online questionnaire. The results indicate that, although the majority of speech-language pathologists agreed that EBP is necessary, they experienced barriers to their implementation of EBP including workplace culture and support, lack of time, cost of EBP, and the availability and accessibility of EBP resources. The barriers reported by speech-language pathologists were similar, regardless of their workplace (private practice vs organization) and years of experience.
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Chan AK, McCabe P, Madill CJ. The implementation of evidence-based practice in the management of adults with functional voice disorders: a national survey of speech-language pathologists. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2013; 15:334-344. [PMID: 23642210 DOI: 10.3109/17549507.2013.783110] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study examined Australian speech-language pathologists' (SLPs) use of evidence-based practice (E(3)BP) when treating adults with functional voice disorders (FVDs). It was hypothesized that SLPs would report using the available evidence to care for their clients but may be limited by time and skills. Fifty-eight SLPs completed a 26-item survey. A combination of indirect and direct voice therapy was most frequently reported, with hum and nasal consonants, pitch extension, elimination of glottal attack, and diaphragmatic breathing being the most frequently used techniques. In the absence of higher levels of evidence, 98% of respondents reported they relied on clinical experience to guide their clinical decision-making. Despite a lack of research evidence supporting this decision, SLPs also reported simultaneously using a combination of direct voice therapies to cater to the needs of their individual clients. Barriers to EBP were lack of time, specialty training and high quality evidence. To improve SLPs' management of adults with FVDs, it is suggested that SLPs need both greater access to voice training and to use practice-based evidence by actively collecting and reporting clinical data.
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Ratcliff A, Swartz B, Ivanitskaya L. Information Literacy Skills in Speech-Language Pathology Students: Skill Differences Across Academic Levels. ACTA ACUST UNITED AC 2013. [DOI: 10.1044/cicsd_40_s_31] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Bland MD, Sturmoski A, Whitson M, Harris H, Connor LT, Fucetola R, Edmiaston J, Huskey T, Carter A, Kramper M, Corbetta M, Lang CE. Clinician adherence to a standardized assessment battery across settings and disciplines in a poststroke rehabilitation population. Arch Phys Med Rehabil 2013; 94:1048-53.e1. [PMID: 23415809 DOI: 10.1016/j.apmr.2013.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 01/30/2013] [Accepted: 02/01/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVES (1) To examine clinician adherence to a standardized assessment battery across settings (acute hospital, inpatient rehabilitation facilities [IRFs], outpatient facility), professional disciplines (physical therapy [PT], occupational therapy, speech-language pathology), and time of assessment (admission, discharge/monthly), and (2) to evaluate how specific implementation events affected adherence. DESIGN Retrospective cohort study. SETTING Acute hospital, IRF, and outpatient facility with approximately 118 clinicians (physical therapists, occupational therapists, speech-language pathologists). PARTICIPANTS Participants (N=2194) with stroke who were admitted to at least 1 of the above settings. All persons with stroke underwent standardized clinical assessments. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Adherence to Brain Recovery Core assessment battery across settings, professional disciplines, and time. Visual inspections of 17 months of time-series data were conducted to see if the events (eg, staff meetings) increased adherence ≥5% and if so, how long the increase lasted. RESULTS Median adherence ranged from .52 to .88 across all settings and professional disciplines. Both the acute hospital and the IRF had higher adherence than the outpatient setting (P≤.001), with PT having the highest adherence across all 3 disciplines (P<.004). Of the 25 events conducted across the 17-month period to improve adherence, 10 (40%) resulted in a ≥5% increase in adherence the following month, with 6 services (60%) maintaining their increased level of adherence for at least 1 additional month. CONCLUSIONS Actual adherence to a standardized assessment battery in clinical practice varied across settings, disciplines, and time. Specific events increased adherence 40% of the time with those gains maintained for >1 month 60% of the time.
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Affiliation(s)
- Marghuretta D Bland
- Program in Physical Therapy, Washington University, Saint Louis, MO 63108, USA.
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Stephens D, Upton D. Speech and language therapists’ understanding and adoption of evidence-based practice. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2012. [DOI: 10.12968/ijtr.2012.19.6.328] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Dominic Upton
- Institute of Health and Society, University of Worcester, Worcester
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McCurtin A, Roddam H. Evidence-based practice: SLTs under siege or opportunity for growth? The use and nature of research evidence in the profession. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2012; 47:11-26. [PMID: 22268898 DOI: 10.1111/j.1460-6984.2011.00074.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Speech and language therapists are encouraged to be evidence-based practitioners in contemporary clinical practice. This apparently signifies their commitment to 'good' practice. An examination of evidence-based practice (EBP) and its adoption in clinical practice is therefore warranted. AIMS This paper aims to explore EBP, specifically research evidence, as related to the field of speech and language therapy (SLT), using profession specific and cross-disciplinary examples. It asks the reader to consider whether research evidence contributes positively to SLT practice, or adds to the demands placed on clinicians? METHODS & PROCEDURES A review of the literature on the nature and use of research evidence in the field of speech and language therapy and related health professions was undertaken using multiple databases (Cochrane, Medline, Cinahal, BioMed, Trip, Dare) and the following up of references provided within texts and articles. This paper asks the reader to consider the topic from the perspective of the nature of research produced, the barriers perceived, and the use of research evidence by SLTs and the allied health professions. OUTCOMES & RESULTS The uptake of research evidence in the profession is similar to other health professions and continues to be problematic. There are multiple reasons why this is so, originating from both the nature and use of research. CONCLUSIONS & IMPLICATIONS Research evidence is one of the pillars of EBP. Despite problems with the nature and use of such evidence, it has a positive contribution to make to clinical practice as it provides for a scientific touchstone. However, it may be that the speech and language therapist and not the research evidence is the primary pivot upon which scientific practice is based.
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Affiliation(s)
- Arlene McCurtin
- Clinical Therapies, University of Limerick, Limerick, Ireland.
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Myers L, Davies-Jones C, Chiat S, Joffe V, Botting N. 'A place where I can be me': a role for social and leisure provision to support young people with language impairment. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2011; 46:739-750. [PMID: 22026574 DOI: 10.1111/j.1460-6984.2011.00048.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The long-term well-being of children with language impairment is an area of increasing interest to families, educators and employers as language impairment is often life-long. Furthermore, language impairment and psychiatric difficulty are known to overlap in both populations originally diagnosed as having language impairment and those receiving mental health services. However, there are currently little data available about the wider quality of life for people with language impairment, especially from the perspective of the young people themselves. There is a dearth of information about community-based activities provided for the support and leisure of this population. The Afasic Youth Project meets once a week and is one of only a handful of such groups across the United Kingdom. METHODS & PROCEDURES This study reports the experiences and views of 19 young people aged 13-23 years attending a leisure provision for young people with primary communication needs. The views of 20 parents were also gained. Interviews with young people and parents were based on items used in the Manchester Language Study in which a large group of young people with a history of language difficulties (n= 130) and typically developing 16-year-olds (n= 109) expressed their views on a range of quality of life measures. This allows a context against which to evaluate the responses of the young people in the study. An additional section of the interview was designed to address the young people's views on the Afasic Youth Project specifically. OUTCOMES & RESULTS Social patterns of the young people were very similar to those reported by the Manchester Language Study indicating that they are a group relatively representative of the language impairment population. A number of positive themes emerged in relation to the club, which included freedom to be true to self, and meeting similar individuals. Interestingly, parents expressed some similar themes, but also had additional thoughts about the group, including the need to meet other parents in similar situations and the belief that the group was aiding social development. CONCLUSIONS & IMPLICATIONS The analysis suggests that community-based social and leisure provision is an important 'missing' service for young people with language impairment, providing an alternative to school-based activities and support older teenagers beyond compulsory education. There is a pressing need to investigate the potential role of such facilities given that recent research into language impairment has clearly shown associations with long-term and wide-ranging social and emotional risk.
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Affiliation(s)
- Lucy Myers
- Language and Communication Science, City University, London, UKAfasic Youth Project, London, UK
| | - Clare Davies-Jones
- Language and Communication Science, City University, London, UKAfasic Youth Project, London, UK
| | - Shula Chiat
- Language and Communication Science, City University, London, UKAfasic Youth Project, London, UK
| | - Victoria Joffe
- Language and Communication Science, City University, London, UKAfasic Youth Project, London, UK
| | - Nicola Botting
- Language and Communication Science, City University, London, UKAfasic Youth Project, London, UK
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Lof GL. Science-based practice and the speech-language pathologist. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2011; 13:189-196. [PMID: 21054232 DOI: 10.3109/17549507.2011.528801] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Evidence-based practice (EBP) is a well established concept in the field of speech-language pathology. However, evidence from research may not be the primary information that practitioners use to guide their treatment selection from the many potential options. There are various alternative therapy procedures that are strongly promoted, so clinicians must become skilled at identifying pseudoscience from science in order to determine if a treatment is legitimate or actually quackery. In order to advance the use of EBP, clinicians can gather practice-based evidence (PBE) by using the scientific method. By adhering to the principles of science, speech-language pathologists can incorporate science-based practice (SBP) into all aspects of their clinical work.
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Affiliation(s)
- Gregory L Lof
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, 36 1st Ave, Boston, MA 02129-4557, USA.
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Roulstone S. Evidence, expertise, and patient preference in speech-language pathology. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2011; 13:43-48. [PMID: 21329410 DOI: 10.3109/17549507.2010.491130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A consideration of evidence-based practice has led many to debate the nature of evidence. Rejecting the idea that randomized controlled trials should be the only legitimate source of evidence, writers have argued that other types of research and knowledge should be considered legitimate sources of evidence. This paper suggests that one should draw on systematic research, including qualitative research, for evidence, and that other types of knowledge such as craft and practice knowledge are part of the profession's expertise. This paper argues that evidence and expertise are both required for evidence-based practice to occur. Finally, a consideration of patients' values and expectations is explored as a third component of evidence-based practice. The paper argues that all three components are necessary for evidence-based practice.
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Abstract
This study seeks to determine whether there is evidence to support the effectiveness of a 2-week intensive therapy program that aims to enhance fluency and reduce the impact of stuttering on both parents and children. Fifteen children who attended two courses were monitored for a period of time before the course began to obtain baseline measures, at the start and end of the course and at intervals up to 1-year post therapy. Measures included beyond clinic speech measures as well as parents’ and children’s perceptions of the stuttering and its impact. Results provide evidence supporting the effectiveness of the program and indicate that further research is warranted. Limitations of the design and methods are discussed.
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Affiliation(s)
- Sharon K Millard
- The Michael Palin Centre for Stammering Children, Finsbury Health center London, UK
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Abstract
Purpose
In this article, I question how practitioners can balance the certainty and confidence that they can help their patients with the uncertainty that makes them continually question their beliefs and assumptions.
Method
I compare the mechanisms of science and models of clinical practice that may help practitioners achieve the right balance between total acceptance of the status quo and an open willingness to explore and accept new ideas.
Conclusion
Clinical practice, unlike science, has no independent self-correction mechanism that leads to consensus about best clinical practices. Evidence-based models provide principles and guidelines for clinical practice, but ultimately, clinical decisions may be influenced most by a practitioner’s epistemology (belief systems) and propensity for rational thinking.
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