New graduates' perceptions of preparedness to provide speech-language therapy services in general and dysphagia services in particular

Graduate Students' Perceived Preparedness and Confidence to Work With Individuals Who Use Augmentative and Alternative Communication

PURPOSE

Previous research shows that practicing speech-language pathologists do not feel confident working with augmentative and alternative communication (AAC) users. Studies examining the content of speech-language pathology graduate programs show that there has been an increase in AAC coursework and experiences offered during graduate training. What has not yet been determined is whether these requirements have influenced students' feelings of preparedness to work with AAC users. The purpose of this study was to examine speech-language pathology master's students' perceived preparedness and confidence to work with AAC users in relation to their educational experiences.

METHOD

A total of 726 graduate students completed a 25-item survey that solicited descriptions of their AAC training, coursework, and clinical experience, as well as their preparedness and confidence to work with AAC users after graduation.

RESULTS

Analyses revealed statistically significant relationships between types and number of types of training experiences with feelings of preparedness and confidence. Results indicated that many participants did not feel prepared or confident to work with AAC users after graduation and that those with a greater variety of training experiences felt more prepared and confident to work with AAC users after graduation.

CONCLUSION

The results enhance our understanding of the types and number of types of clinical experiences that might increase students' preparedness and confidence to work with AAC users.

Contextualising clinical reasoning within the clinical swallow evaluation: A scoping review and expert consultation

Background

This study explored the available literature on the phenomenon of clinical reasoning and described its influence on the clinical swallow evaluation. By exploring the relationship between clinical reasoning and the clinical swallow evaluation, it is possible to modernise the approach to dysphagia assessment.

Objectives

This study aimed to contextualise the available literature on clinical reasoning and the CSE to low-middle income contexts through the use of a scoping review and expert consultation.

Method

A scoping review was performed based on the PRISMA-ScR framework. The data was analysed using thematic analysis. Articles were considered if they discussed the clinical swallow evaluation and clinical reasoning, and were published in the last 49 years.

Results

Through rigorous electronic and manual searching, 12 articles were identified. This review made an argument for the value of clinical reasoning within the clinical swallow evaluation. The results of the study revealed three core themes related to the acquisition, variability and positive impact of clinical reasoning in the clinical swallow evaluation.

Conclusion

The results of this review showed that the clinical swallow evaluation is a complex process with significant levels of variability usually linked to the impact of context. This demonstrates that in order to deliver effective and relevant services, despite challenging conditions, healthcare practitioners must depend on clinical reasoning to make appropriate modifications to the assessment process that considers these salient factors.

A retrospective review of speech-language therapy services provided to adult inpatients at a central-level hospital in Gauteng, South Africa

Background

The quadruple burden of disease (BoD) and multimorbidity reflected in South Africa’s public health sector challenges speech-language therapists (SLTs) to optimise patient management in this context. For planning and delivery of appropriate services, it is important to understand the profile of speech-language therapy (SLT) patients and the public healthcare services provided by SLTs.

Objectives

This study aimed to describe the prevalence of inpatient adult speech, language and swallowing disorders associated with various medical conditions and South Africa’s BoD, in addition to the target areas and duration of SLT interventions provided at a central public hospital.

Method

A retrospective review was conducted on records of 2549 adult inpatients who received SLT services between January 2014 and December 2015 at Chris Hani Baragwanath Academic Hospital. Data, including demographics, medical and SLT diagnoses, and treatment recommendations, were analysed using descriptive and inferential statistics.

Results

Non-communicable diseases (NCDs) were most prevalent (77.48%), with multimorbidity of BoD categories in 29.27% of patients. Cerebrovascular disease (CeVD) comprised 52.45% patients, with CeVD, traumatic brain injury, other neurological conditions, cancer and burns comprising 88.74% patients. More than a third of the patients with CeVD were < 56 years (n = 486; 36.35%). Dysphagia (48.96%), aphasia (30.95%) and dysarthria (23.62%) were the most common, with 44.68% of patients having multiple SLT diagnoses. The number of SLT sessions significantly correlated with SLT comorbidity (r_s = 0.4200; p = 0.0000), but not BoD comorbidity (r_s = 0.0049; p = 0.8058).

Conclusion

Speech-language therapy patients reflected a heavy NCD burden and multimorbidity. Provision of SLT services should take into consideration a profile of increased complexity of medical conditions and SLT diagnoses.

Paediatric dysphagia within the context of South Africa's quadruple burden of disease, seen at a tertiary level hospital

Purpose: To inform service provision, this study explored feeding and swallowing difficulties in children within the context of South Africa's quadruple burden of disease (BOD) (i.e. conditions characterised as communicable, non-communicable, maternal and/or perinatal and trauma).Method: A retrospective chart review of 1432 paediatric inpatients (under 12 years of age) who met the inclusion criteria of presenting with dysphagia and being referred for speech-language pathology services was conducted.Result: Participants with diagnoses within the maternal and/or perinatal BOD category were noted most frequently (61.2%), followed by non-communicable (59.7%), communicable (43.4%) and trauma (4.2%). The majority of participants were under 1 year of age (82.2%) and 56.2% presented with comorbidities in multiple BOD categories. Mortality was 5.9%, with a higher rate (67.7%) in more complex cases. Mortality was associated with non-communicable BOD (p = 0.001), and maternal and/or perinatal BOD (p = 0.003). Pharyngeal phase swallowing difficulties were a significant risk for mortality (OR = 2.96; 95% CI: 1.01-8.65, p = 0.047).Conclusion: The majority of children with dysphagia presented with multiple comorbidities and were at high risk for mortality. Education and service delivery models should be designed to improve health outcomes and reduce mortality rates.

The value of a short practical training course for newly qualified therapists working with children with cerebral palsy in South Africa

Background

Cerebral palsy (CP) is the most common and most complex disabling disorder in children. Newly qualified therapists are expected to manage CP despite feeling inexperienced and inadequately prepared. Short postgraduate practical training courses could potentially help bridge this readiness gap. However, the value of these short courses in addressing the knowledge and experience gap is unknown.

Objectives

To establish the value of a short practical training course on the self-perceived readiness of newly qualified South African trained therapists to work with children with CP.

Method

Secondary analysis of records on therapists’ immediate evaluation of a short practical training course on CP management was completed. The analysis included records from 11 courses collected over a 2-years period (2015–2017). Paired t-tests were used to determine the change in knowledge in the quantitative questionnaire. Qualitative data were analysed inductively to determine themes.

Results

The majority of therapists had their expectations met by the course. Therapists’ self-perceived level of knowledge about various aspects of CP after the course changed significantly. Therapists appreciated the adult teaching and learning methods, conducive learning environment, the relevant and organised content and holistic approach of the course. They demonstrated readiness to adopt positive attitudes, perceptions and practice following the course.

Conclusion

A short practical postgraduate training course in CP is valuable in addressing the self-perceived lack of readiness amongst therapists with little experience in this area. It is capable of improving the knowledge and changing attitudes, perceptions and practice intentions positively, and thereby potentially improving the quality of service offered to children with CP.

Community service speech language therapists practising in adult dysphagia: Is the healthcare system failing them?

Performing community service is a necessity prior to practising speech language therapy in South Africa. This system allows for improved access to these specialised services in the more rural areas. The current challenges of practising in complex settings with little access to mentorship can result in these community service therapists feeling underprepared to assess and manage patients presenting with adult dysphagia (swallowing disorders). This paper explores this topic through the theoretical lens of decision-making, from both clinical and academic perspectives. It aims to pose potential solutions on how to better transform the current practices to be contextually responsive to these challenges.

The cat on a hot tin roof? Critical considerations in multilingual language assessments

Background

In speech-language pathology (SLP), there is a paucity of resources to provide just and equitable services to South Africa’s culturally and linguistically diverse population. Although South Africa is a multilingual country, English remains the dominant language. However, there is limited research on resources for English additional language (EAL) speakers.

Objectives

This article addresses this gap by presenting the results of a critique of a commonly used language screening tool, the Renfrew Action Picture Test (RAPT), on EAL speakers.

Method

This tool is used as an example to broadly critique the use of culturally biased assessment instruments with EAL speakers from an indigenous linguistic and cultural background. It is administered to children who are EAL speakers and then critiqued by the children too. Their voice, often ignored in research, is central to the research. A mixed methods approach is used, including focus groups and test administration. This article is based on the results of the thematic analysis used to closely examine the patterns that emerge.

Results

A key finding is that the cultural and linguistic background of the child assessed cannot be disregarded, as it plays a crucial role in understanding the response of the child. The interpretation of the response of the child to the presented material of the language assessment tool significantly influences the result of the assessment.

Conclusion

The speech language therapist has a responsibility to avoid skewed results based on uninformed interpretation of the response of the child. These findings provide useful insights for clinicians regarding culture-fair assessment.

Poor consistency in evaluating South African adults with neurogenic dysphagia

BACKGROUND

Speech-language therapists are specifically trained in clinically evaluating swallowing in adults with acute stroke. Incidence of dysphagia following acute stroke is high in South Africa, and health implications can be fatal, making optimal management of this patient population crucial. However, despite training and guidelines for best practice in clinically evaluating swallowing in adults with acute stroke, there are low levels of consistency in these practice patterns.

OBJECTIVE

The aim was to explore the clinical practice activities of speech-language therapists in the clinical evaluation of swallowing in adults with acute stroke. Practice activities reviewed included the use and consistency of clinical components and resources utilised. Clinical components were the individual elements evaluated in the clinical evaluation of swallowing (e.g. lip seal, vocal quality, etc.)Methods: The questionnaire used in the study was replicated and adapted from a study increasing content- and criterion-related validity. A narrative literature review determined what practice patterns existed in the clinical evaluation of swallowing in adults. A pilot study was conducted to increase validity and reliability. Purposive sampling was used by sending a self-administered, electronic questionnaire to members of the South African Speech-Language-Hearing Association. Thirty-eight participants took part in the study. Descriptive statistics were used to analyse the data and the small qualitative component was subjected to textual analysis.

RESULTS

There was high frequency of use of 41% of the clinical components in more than 90% of participants (n = 38). Less than 50% of participants frequently assessed sensory function and gag reflex and used pulse oximetry, cervical auscultation and indirect laryngoscopy. Approximately a third of participants showed high (30.8%), moderate (35.9%) and poor (33.3%) consistency of practice each. Nurses, food and liquids and medical consumables were used usually and always by more than 90% of participants.

CONCLUSION

Infrequent use of clinical components and high variability in clinical practice among speech-language therapists calls for uniform curricula in the clinical evaluation of swallowing at South African universities and for continued professional development post-graduation. Different contexts and patient symptoms contribute towards varied practice; however, there is still a need to improve consistency of practice for quality health care delivery. A research-based policy for the clinical swallowing evaluation for a resource-limited context is also needed.

Development of a clinical feeding assessment scale for very young infants in South Africa

Background

There is a need for validated neonatal feeding assessment instruments in South Africa. A locally developed instrument may contribute to standardised evaluation procedures of high-risk neonates and address needs in resource constrained developing settings.

Objective

The aim of the study was to develop and validate the content of a clinical feeding assessment scale to diagnose oropharyngeal dysphagia (OPD) in neonates.

Method

The Neonatal Feeding Assessment Scale (NFAS) was developed using the Delphi method. Five international and South African speech-language therapists (SLTs) formed the expert panel, participating in two rounds of electronic questionnaires to develop and validate the content of the NFAS.

Results

All participants agreed on the need for the development of a valid clinical feeding assessment instrument to use with the neonatal population. The initial NFAS consisted of 240 items across 8 sections, and after the Delphi process was implemented, the final format was reduced to 211 items across 6 sections. The final format of the NFAS is scored using a binary scoring system guiding the clinician to diagnose the presence or absence of OPD. All members agreed on the format, the scoring system and the feeding constructs addressed in the revised final format of the NFAS.

Conclusion

The Delphi method and the diverse clinical and research experience of participants could be integrated to develop the NFAS which may be used in clinical practice in South Africa or similar developing contexts. Because of demographically different work settings marked by developed versus developing contexts, participants did not have the same expectations of a clinical dysphagia assessment. The international participants contributed to evidence-based content development. Local participants considered the contextual challenges of South African SLTs entering the field with basic competencies in neonatal dysphagia management, thereby justifying a comprehensive clinical instrument. The NFAS is aimed at clinicians working in Neonatal Intensive Care Units where they manage large caseloads of high-risk neonates. Further validation of the NFAS is recommended to determine its criterion validity in comparison with a widely accepted standard such as the modified barium swallow study.