The World Report on Disability: an impetus to reconceptualize services for people with communication disability

Participation, equality, and justice in Rwanda for people who experience communication disability: Achieving Sustainable Development Goal 16

PURPOSE

The right to communicate, by any means, is key to participation in peaceful and just societies. Participation relies on societal equality which, in turn, depends upon consensus that everyone has the same rights, as well as responsibility to uphold the rights of all. People who experience communication disability are, however, often invisible, misunderstood, stigmatised, and under-enumerated, particularly in resource-limited settings, including humanitarian contexts. A lack of identification and understanding of needs exclude this group from equal societal participation and exposes them to risks, including sexual and gender-based violence (SGBV), which has no place in a peaceful, just, and fair society.In this commentary we explore the importance of the full inclusion and participation of people who experience communication disability, to the fulfilment of Sustainable Development Goal (SDG) 16.

RESULT

There is a lack of specialist assistance for people who experience communication disability in resource-limited and humanitarian contexts. A broader approach to community and service-provider capacity-building on communication disability demonstrates potential to build stronger institutions and increase societal inclusion and participation, thereby reducing exposure to risks, such as SGBV. Such approaches include increasing public understanding and use of accessible communication strategies, as well as addressing negative attitudes/behaviours and fear.

CONCLUSION

Speech-language pathologists (SLPs) must be prepared to expand their spheres of influence and develop long-term relationships with stakeholders who can instigate change. This may involve de-emphasising our SLP credentials, instead rebranding ourselves as inclusion specialists, with a focus on communication disability.Increased inclusion, participation, and protection are achievable for people who experience communication disability if they are understood, counted, and served appropriately. This requires alignment of communication rights agendas with international development priorities. As such, this commentary paper focuses on peace, justice, and strong institutions (SDG16) and simultaneously addresses aspects of good health and wellbeing (SDG 3), gender equality (SDG 5), reduced inequalities (SDG 10), and partnerships for the goals (SDG 17).

Ameliorating poverty-related communication and swallowing disabilities: Sustainable Development Goal 1

PURPOSE

More than 700 million people globally are still living in extreme poverty. No poverty (Sustainable Development Goal 1, SDG 1), is considered to be the greatest global challenge. This paper aims to outline the effects of poverty on communication and swallowing disabilities across the lifespan and steps to take for its amelioration.

RESULT

Poverty and disability are in a vicious cycle with each being a cause for and a consequence of the other. Poverty has incontrovertible and significant ramifications for communication and swallowing disabilities across the lifetime from pregnancy to old age. The individual, family and social burden and costs of these disabilities have lifelong economic and social consequences.

CONCLUSION

Considering poverty is a known and important determinant of communication and swallowing disabilities, the most potent weapon is to focus on preventing and ameliorating poverty-related communication and swallowing disabilities in children. A call to action is issued to speech-language pathologists to take steps towards this goal. This commentary paper focusses on Sustainable Development Goal of no poverty (SDG 1) and also addresses zero hunger (SDG 2), reduced inequalities (SDG 10), and climate action (SDG 13).

Automated phonological analysis and treatment target selection using AutoPATT

Automated analyses of speech samples can offer improved accuracy and timesaving advantages that streamline clinical assessment for children with a suspected speech sound disorder. In this paper, we introduce AutoPATT, an automated tool for clinical analysis of speech samples. This free, open-source tool was developed as a plug-in for Phon and follows the procedures of the Phonological Analysis and Treatment Target Selection protocol, including extraction of a phonetic inventory, phonemic inventory with corresponding minimal pairs, and initial consonant cluster inventory. AutoPATT also provides suggestions for complex treatment targets using evidence-based guidelines. Automated analyses and target suggestions were compared to manual analyses of 25 speech samples from children with phonological disorder. Results indicate that AutoPATT inventory analyses are more accurate than manual analyses. However, treatment targets generated by AutoPATT should be viewed as suggestions and not used to substitute necessary clinical judgement in the target selection process.

Opportunities to Enhance Children's Communication Development at School in Underserved Communities

PURPOSE

Alternative service delivery approaches are required to provide support for children with communication difficulties in underserved communities. Schools have a unique set of assets that can be utilized to provide this support. This study explored what the education sector and classrooms in the early years of schooling offer as support for children with communication difficulties in an underserved Majority World country, the Maldives. The objective was to identify opportunities to enhance support provided for these children.

METHOD

A qualitative multimethod approach was used involving (a) 520 min of classroom observational data from four remote schools, (b) interviews with four special education needs teachers, and (c) an interview with a Ministry of Education official. Classroom observational data were analyzed using the Communication Supporting Classroom Observation Tool. Deductive content analysis was used to analyze the interview data.

RESULTS

The support system aimed to reflect the Inclusive Education Policy of the Maldives. The Ministry of Education official and teachers raised concerns regarding lack of allied health services such as speech-language therapy in schools. Teachers frequently used certain communication supporting interactions such as imitation in classrooms. Missed opportunities to enhance communication were observed, including limited use of some interaction features such as modeling language, limited planned opportunities for children to interact in class, and limited resources in the environment to develop communication in Grade 1 and 2 compared to preschool.

CONCLUSION

Findings suggest building capacity among teachers and training teachers on identified classroom communication support areas to enhance support for children with communication difficulties. Supplemental Material https://doi.org/10.23641/asha.17003980.

Successes and challenges of speech language therapy service provision in Western Kenya: Three case studies

Background

The need for communication-related services in sub-Saharan Africa to support individuals experiencing communication disability is a longstanding and well-documented situation. We posit the inequities highlighted by coronavirus disease 2019 (COVID-19) make this a relevant time for speech language therapists and the professional bodies that govern us to broadly consider our roles and practices in education, health and disability in local, national and global contexts.

Objective

To illustrate what services developed with local knowledge can look like in Kenya in order to promote dialogue around alternative speech language therapy models, particularly in contexts where there are insufficient services, few trained speech language therapists and limited structures to support the emerging profession.

Method

This article examines three clinical case studies from Western Kenya, using a conceptual framework for responsive global engagement.

Results

Service needs in Western Kenya well exceed a direct one-on-one model of care that is common in the minority world. The service delivery models described here emphasise training, skills sharing and engaging the myriad of communication partners available to individuals with communication disabilities.

Conclusion

We offer up these case studies of collaborative practice as contextual realities that may be present in any speech language therapy programming in under-resourced communities. We dispel the idea that success in this work has been linear, progressed on planned time frames or come to fruition with targeted goal attainment. The fact that our relationships have endured in these communities since 2007 is our primary success.

Optimising existing speech-language therapy resources in an underserved community: A study of the Maldives

BACKGROUND

People living in Majority world countries face complex challenges regarding speech-language therapy services. As traditional individualised service delivery approaches may not suit the needs of the population, customised solutions are needed.

AIM

This study explored speech-language therapy and related resources available in the Maldives, a Majority world country, as seen by local government representatives and service providers. The goal was to identify service delivery approaches for children with communication difficulties that could yield the most out of existing resources.

METHOD

Semi-structured interviews were conducted with six service providers (three speech-language therapists (SLTs), three representatives from Non-Governmental Organisations (NGOs) related to disabilities) and six local government representatives (atoll councillors) of the Maldives. Interview questions related to services available for children with communication difficulties. The data were analysed via deductive content analysis.

RESULTS

SLTs predominantly delivered traditional individualised and rehabilitative therapy. Services were unevenly distributed across the Maldives with some atolls receiving no services. Support was available from community groups and atoll councillors in some atolls, for instance to access aids provided by the government. Some NGOs were trialling alternative service delivery approaches by conducting programs for parents and teachers in atolls. Participants suggested several possible measures including increasing awareness of speech-language therapy and communication difficulties amongst communities, engaging active community groups to support interventions and allowing less qualified professionals to provide services. The costs related to access and provide services were noted as a challenge.

CONCLUSION

While this study discovered limitations, the existing resources that were identified can be better directed to reach more children who require services in the Maldives. The following potential alternative service delivery approaches were derived from the results: focusing on prevention, using public health approaches to train families and teachers, creating awareness, building capacity within the community, and adopting cost-effective approaches to provide services.

What are the implications of climate change for speech and language therapists?

BACKGROUND

The emerging global issue of climate change has large-scale effects on health and well-being, including communication disorders. The broad range of the speech and language therapy profession's scope of practice incorporates prevention, advocacy and equality in service delivery. These act as a springboard for involvement in climate change and health.

AIMS

This is an appeal to speech and language therapists (SLTs) to focus and take action on this issue and its considerable effects on communication and swallowing disorders.

METHODS & PROCEDURES

This article discusses the importance of taking a public health position on prevention and equality of services to manage environmental determinants of communication and swallowing disorders. It also describes the extent to which climate change affects these disorders and exacerbates the inequality of healthcare services in low- and middle-income countries.

MAIN CONTRIBUTION

Five strategies are provided for action on fulfilling therapists' roles in reducing the incidence, development and exacerbation of climate-related communication and swallowing disorders, as well as the role of SLTs in acting as advocates. The case is made for expanding the scope of services to focus on prevention and service equality so as to best meet the needs of the wider community.

CONCLUSIONS & IMPLICATIONS

Despite other challenges currently facing SLTs, climate change and its increasing effects on communication disorders and dysphagia is difficult to ignore. SLTs owe it to their clients, the wider community, low- and middle-income countries, the economy, and the future to take action. What this paper adds What is already known on the subject Multiple studies published in peer-reviewed scientific journals show that climate change is extremely likely to be due to human activities. The global effects will be higher temperatures, changes in precipitation, more droughts and heatwaves, stronger and more intense hurricanes, and a rising sea level which directly threaten the health of entire populations. Other health professions are beginning to take climate change into account in training and practice. What this paper adds to existing knowledge Many disorders of communication and swallowing are caused or exacerbated by the effects of climate change. Increasing temperatures, extremes of precipitation, population displacement and air pollution contribute to cardiovascular and cerebrovascular events, respiratory disease, malnutrition, premature birth, air- and water-borne diseases, and mental illness. These may affect the communication and swallowing abilities across the lifespan, but particularly those of children and older adults. What are the potential or actual clinical implications of this work? SLTs' roles in prevention, advocacy and education act as a starting point for involvement in climate change and health. Three practical strategies for action include educating SLTs and other health professionals on climate change and its effects on communication and swallowing, promoting awareness with clients and their families, and gathering and disseminating reliable data.

How aware is the public of the existence, characteristics and causes of language impairment in childhood and where have they heard about it? A European survey

Public awareness of language impairment in childhood (Developmental Language Disorder (DLD)) has been identified as an important determiner of research and clinical service delivery, yet studies directly assessing public awareness are lacking. This study surveyed awareness across 18 countries of Europe.

METHOD

A questionnaire developed by an international team asked whether respondents had heard of language impairment affecting children, what they thought its manifestations and causes were and where they had heard of it. Respondents were also asked whether they had heard of autism, dyslexia, ADD/ADHD and speech disorder. The questionnaire was administered to members of the public in 18 European countries. A total of 1519 responses were obtained, spanning 6 age groups, 4 educational level groups and 3 income level groups.

RESULTS

Across all but one country, significantly fewer people had heard of language impairment than any of the other disorders (or 60 % compared to over 90 % for autism). Awareness tended to be lowest in Eastern Europe and greatest in North-Western Europe, and was influenced by education level, age and income level. People in countries with overall low and overall high awareness differed in their views on manifestations and causes. People had heard of language impairment and autism the same way - most frequently through the media, including Internet, and less frequently through their child's school or a medical professional.

DISCUSSION

The study confirms that awareness of language impairment and knowledge of the breadth of its manifestations are low. It also suggests opportunities for how to increase awareness, including greater media coverage of language impairment and more efficient use of venues such as schools and healthcare. Ways in which cultural and linguistic differences may influence public awareness efforts are discussed, including the translatability of clinical labels and scientific terms. These may impact the acceptance of a common term and definition across all countries. As awareness campaigns are gaining momentum, the findings of this study can serve as a baseline against which to compare future findings.

Sustainable Delivery of Speech-language Therapy Services in Small Island Developing States Using Information and Communication Technology - A Study of the Maldives

Small Island Developing States (SIDS), a subgroup of Majority world countries, face complex challenges providing equitable access to speech-language therapy (SLT) services. Increasing use of information and communication technology (ICT) to enhance SLT services is seen in the Minority world. This study explored the potential of using ICT to provide sustainable SLT services in one SIDS, the Maldives. A mixed method approach was used integrating data from (a) 21 online documents, (b) interview with an ICT official, and (c) surveys of 13 island councillors and 73 parents of children with communication difficulties. Almost 100% of the population had access to mobile phones and mobile broadband internet. Most parents were active and frequent ICT users. The government provided financial aid for people with disabilities which could be utilised to access ICT for services. Asynchronous service delivery using accessible ICT and parents as agents of service delivery can potentially enhance SLT services.

Guidelines for child health: language development on focus

Language disorders impact on child overall development. Policy directives for the child guide on ways to follow up child development for greater efficiency and effectiveness. The aim of this paper was to identify the policies positions of the proposals on the attention to language problems in the child health field. From a documental research, national and international guidelines were reviewed in order to identify actors, objectives, contexts, motivations, arguments, justifications and proposals regarding the follow of child development and child language. We performed a critical analysis in order to explain these positions and place on discussion the arguments that support them. The results point out to consensual aspects that place the problems of child development as vulnerabilities producers. Language problems cross the boundaries of political, scientific and social matters. These issues are challenges to interdisciplinary and intersectoral work and guide the need to promote the most effective responses of public policy for people requiring language support. The link of this discussion with the concepts of life cycle and human development for achieving full citizenship requires further deepening.

Self-help and help-seeking for communication disability in Ghana: implications for the development of communication disability rehabilitation services

BACKGROUND

In low and middle-income countries, such as Ghana, communication disability is poorly recognised and rehabilitation services for people with communication disability are limited. As rehabilitation services for communication disability develop, and the profession of speech-language pathology grows, it is important to consider how services can most appropriately respond to the needs and preferences of the community. Understanding the ways in which people currently self-help and seek help for communication disability is central to developing services that build on existing local practices and are relevant to the community.

METHODS

A qualitative descriptive survey was used to explore likely self-help and help-seeking behaviours for communication disability, in Accra, Ghana. The survey required participants to describe responses to hypothetical scenarios related to communication disability. A mix of theoretical sampling and convenience sampling was used. Qualitative content analysis was used to analyse data and develop categories and subcategories of reported self-help behaviours and sources of help and advice for communication disability.

RESULTS

One hundred and thirty-six participants completed the survey. Results indicated that community members would be likely to engage in a variety self-help strategies in response to communication disability. These included working directly with a person with a communication disability to attempt to remediate a communication impairment, altering physical and communication environments, changing attitudes or care practices, educating themselves about the communication disability, providing resources, and responding in spiritual ways. Participants indicated that they would seek help for communication disability across a range of sectors - including the Western healthcare, religious, and traditional sectors.

CONCLUSIONS

Understanding existing community actions to self-help and help-seek may allow emerging communication rehabilitation services, including the profession of speech-language pathology, to build on existing community practices in resource-limited contexts such as Ghana.

The Consequences of the Consequences: The Impact of the Environment on People With Aphasia Over Time

Understanding the impact of the environment on the participation of people with aphasia depends on one's perspective. A long-term perspective provides a unique insight into the myriad of ways in which the environment can influence the participation of people living with aphasia over decades. In this article, the authors present the real-life story of "Hank," who has lived with aphasia for more than 15 years. The authors consider how 2 different conceptual frameworks-the International Classification of Functioning, Disability and Health and the Social Determinants of Health-account for Hank's experience. The International Classification of Functioning, Disability and Health is useful to conceptualize the range of factors that influence living with aphasia at a particular point in time. In contrast, the Social Determinants of Health is useful to conceptualize the cumulative impact of living with aphasia on long-term health and well-being. Viewing aphasia as a social condition that impacts social determinants of health has potentially wide ranging implications for service design and delivery and the role of speech-language pathologists.

Evaluation of an Expert System for the Generation of Speech and Language Therapy Plans

BACKGROUND

Speech and language pathologists (SLPs) deal with a wide spectrum of disorders, arising from many different conditions, that affect voice, speech, language, and swallowing capabilities in different ways. Therefore, the outcomes of Speech and Language Therapy (SLT) are highly dependent on the accurate, consistent, and complete design of personalized therapy plans. However, SLPs often have very limited time to work with their patients and to browse the large (and growing) catalogue of activities and specific exercises that can be put into therapy plans. As a consequence, many plans are suboptimal and fail to address the specific needs of each patient.

OBJECTIVE

We aimed to evaluate an expert system that automatically generates plans for speech and language therapy, containing semiannual activities in the five areas of hearing, oral structure and function, linguistic formulation, expressive language and articulation, and receptive language. The goal was to assess whether the expert system speeds up the SLPs' work and leads to more accurate, consistent, and complete therapy plans for their patients.

METHODS

We examined the evaluation results of the SPELTA expert system in supporting the decision making of 4 SLPs treating children in three special education institutions in Ecuador. The expert system was first trained with data from 117 cases, including medical data; diagnosis for voice, speech, language and swallowing capabilities; and therapy plans created manually by the SLPs. It was then used to automatically generate new therapy plans for 13 new patients. The SLPs were finally asked to evaluate the accuracy, consistency, and completeness of those plans. A four-fold cross-validation experiment was also run on the original corpus of 117 cases in order to assess the significance of the results.

RESULTS

The evaluation showed that 87% of the outputs provided by the SPELTA expert system were considered valid therapy plans for the different areas. The SLPs rated the overall accuracy, consistency, and completeness of the proposed activities with 4.65, 4.6, and 4.6 points (to a maximum of 5), respectively. The ratings for the subplans generated for the areas of hearing, oral structure and function, and linguistic formulation were nearly perfect, whereas the subplans for expressive language and articulation and for receptive language failed to deal properly with some of the subject cases. Overall, the SLPs indicated that over 90% of the subplans generated automatically were "better than" or "as good as" what the SLPs would have created manually if given the average time they can devote to the task. The cross-validation experiment yielded very similar results.

CONCLUSIONS

The results show that the SPELTA expert system provides valuable input for SLPs to design proper therapy plans for their patients, in a shorter time and considering a larger set of activities than proceeding manually. The algorithms worked well even in the presence of a sparse corpus, and the evidence suggests that the system will become more reliable as it is trained with more subjects.

Evidence-based intervention for preschool children with primary speech and language impairments: Child Talk – an exploratory mixed-methods study

Background

The Child Talk study aimed to develop an evidence-based framework to support the decision-making of speech and language therapists (SLTs) as they design and plan interventions appropriate to the needs of individual children with primary speech and language impairments and their families. The need for early identification and effective intervention for these children continues to be a government policy priority because of the link between children’s early speech and language skills and their broader well-being and outcomes in later life. The first phase of Child Talk sought to map and describe current SLT practice for these children; identify and summarise the existing research evidence relating to practice; and investigate the perspectives of parents, early years practitioners, preschool children and ‘underserved’ communities on speech and language therapy. The second phase of Child Talk focused on the development of a toolkit – assessment tools, outcome measures and a data set – to support future service and economic evaluations of the framework.

Methods

Child Talk adopted a mixed-methods design. Quantitative methods included surveys and investigated the prevalence and patterns of intervention usage; qualitative data collection methods included focus groups, interviews and reflection to investigate participants’ perspectives and understandings of interventions. Data analysis methods included descriptive and inferential statistics, thematic and content analysis and framework analysis. Participants were recruited nationally through six NHS sites, professional bodies, parent groups and advertising. Participants included SLTs (n = 677), parents (n = 84), preschool children (n = 24), early years practitioners (n = 31) and ‘underserved’ communities (n = 52).

Key findings

Speech and language therapy interventions were characterised in terms of nine themes, viewed as comprehensive and inclusive by practitioners. Relevant assessments, interventions and outcome domains were identified for the nine themes. Areas of tacit knowledge and underspecified processes contributed to variability in the detail of the framework. Systematic reviews identified 58 relevant and robust studies (from 55,271 papers retrieved from the initial literature search). The number of studies relevant to each theme varied from 1 to 33. Observational data on preschool children’s perspectives on speech and language therapy interventions revealed the dynamic nature of their interaction with different activities and people within therapy sessions. Parents’ experiences of speech and language therapy were generally positive although some reported that the rationale for therapy was not always clear. Parental perspectives in underserved communities suggested that, although parents were confident about how to support children’s language development, they were less informed about the nature of language impairments and the function of speech and language therapy. The availability of information regarding resources directed towards speech and language therapy services was poor. In particular, services lacked both a culture of collecting outcome data routinely and measures of professional input and costs associated with their activities.

Conclusion

A descriptive framework of SLT practice has been developed to support the discussions between therapists and families when making decisions regarding the selection of interventions and outcome measures. Further research is needed to address gaps in the intervention framework and evaluate its effectiveness and cost-effectiveness in improving outcomes for preschool children with primary speech and language impairments.

Study registration

This study is registered as PROSPERO CRD42013006369.

Funding

The National Institute for Health Research Programme Grants for Applied Research programme.

Creating communicatively accessible healthcare environments: perceptions of speech-language pathologists

There is a growing body of research that indicates that a person with a communication disability communicates and participates more effectively given a communicatively accessible environment. If this research is to be translated into practice then one needs to determine who will take on the role of creating communicatively accessible environments. This research adopted a qualitative methodology to explore the perceptions of speech-language pathologists about working to create communicatively accessible healthcare settings. Fifteen speech-language pathologists in three focus groups participated in this research. The focus group discussions were transcribed and analysed thematically. Thematic analysis indicated that speech-language pathologists believe there are four main benefits in creating communicatively accessible healthcare environments. These are Benefits for all people: Access for all, Benefits for healthcare administrators, Benefits for those wanting to improve communication with patients, and Benefits to the capacity to provide communicatively accessible environments. However, they believe these benefits can only be achieved if; The communication resources are available, Skilled, knowledgeable and supportive healthcare providers are available; and Systems are in place to support a whole-of-hospital approach. This research supports the development of a new role to improve the communicative accessibility of healthcare settings.

Longitudinal study of language therapy in 142 children and adolescents with autism spectrum disorders

The last 25 years produced important changes in the Speech Language intervention for children with Autism Spectrum Disorders in the whole world. They refer to diagnostic criteria, research methods and systematization of data about diagnostic and intervention processes. In this context, the first results about the use of a recording system used on a specialized service highlights the importance of including information about each intervention process on reliable and accessible systems. This procedure allows the association among several types of data and studies with large populations, something that is not usual in the field.