Decision making and the bedside assessment: The Speech Language Therapists' thinking when making a diagnosis at the bed

Evaluation of reliability and validity of the Serbian Aphasia Screening Test

PURPOSE

A rise in strokes worldwide means that the number of people affected by aphasia is increasing. Early and accurate diagnosis of aphasia is crucial for recovery. Presently, there are no dedicated screening tests tailored for evaluating aphasia in Serbian-speaking individuals. This paper presents and describes the psychometric properties of the Serbian Aphasia Screening Test (SAST), a novel aphasia screening tool designed specifically for Serbian speakers. This initiative fills the gap in aphasia assessment tools for the Serbian population, providing a comprehensive and culturally sensitive approach to the evaluation of language disorders.

METHOD

Data using the SAST were collected from 240 participants: 120 Serbian speakers with aphasia after stroke compared to 120 neurotypical individuals. The assessment included the following subtests: conversation, verbal automatized sequences, auditory comprehension, visual confrontation naming, responsive naming, repetition of words, repetition of sentences, oral word reading, oral sentence reading, reading comprehension, and writing. The main objectives were to ascertain the psychometric qualities of the SAST, including inter-rater reliability of scoring, test-retest reliability, reliability of the individual subtests, overall test reliability, and inter-correlations among subtests. Additionally, the study evaluated the discriminatory capability of the SAST in distinguishing between individuals with aphasia and neurotypical controls, as well as between individuals with different types of aphasia.

RESULTS

The findings revealed that the SAST has excellent inter-rater reliability, test-retest reliability, and internal consistency. There were statistically significant differences between individuals with aphasia and neurotypical controls on all SAST subtests. Furthermore, the study identified significant differences in language profiles among participants with different types of aphasia. The significant correlations between scores on the SAST and on the Boston Diagnostic Aphasia Examination (BDAE) suggest good convergent validity of the SAST.

CONCLUSIONS

The results underscore the robust psychometric properties of this novel screening assessment (SAST) and its ability to effectively discriminate between diverse linguistic abilities within different aphasia syndromes in Serbian speaking individuals.

Swallowing and feeding of young children on high-flow oxygen therapy

BACKGROUND

 Oral feeding practices of young patients on high-flow oxygen (HFO2) have been controversial. Limited literature exists on this topic, but new studies suggest introducing oral feeds.

OBJECTIVE

 This study aims to describe the changes in swallowing and feeding of a group of young children on HFO2.

METHOD

 Twelve participants (mean age 34.17 months [s.d. = 3.97]) on HFO2 were assessed clinically at the bedside using the Schedule of Oral Motor Assessment. Assessments were conducted twice to determine the change in characteristics: upon approval from the managing doctor when respiratory stability on HFO2 was achieved and for a second time on the last day of receiving HFO2 (mean 2.6 days apart). Patients received standard in-patient care and speech therapy intervention.

RESULTS

 Most participants displayed typical oral motor function at initial and final assessments for liquid, puree and semi-solid consistencies. Purees and soft solid consistencies were introduced to most participants (n = 11, 91.7%). Solids and chewables were challenging for all participants during both assessments. Half of the participants displayed gagging and a wet vocal quality with thin liquids at the initial assessment only.

CONCLUSION

 This small-scale study found that HFO2 should not preclude oral diets, but in this sample, small amounts of oral feeding could be introduced with caution, in an individualised manner, and with a collaborative multidisciplinary approach. Further research is essential.Contribution: Partial oral feeding of specific consistencies was possible during the assessment of young paediatric in-patients on HFO2. Monitoring of individual patient characteristics and risk factors by a specialist feeding team is essential.

Exploring perceptions of factors aiding the development of critical thinking in adult dysphagia: A study among fourth-year speech-language pathology students

BACKGROUND

The assessment and management of adult dysphagia in South Africa is complex as appropriate intervention requires a balance of theoretical knowledge and critical thinking to ensure service delivery is appropriate within a resource-constrained health care system. Critical thinking involves the skilful evaluation of information to make informed decisions for effective assessment and intervention. It is imperative for Speech-Language Pathologists (SLPs) to cultivate these skills from an early stage in their careers. This study therefore aims to investigate the factors perceived to enhance critical thinking to shed light on how students transition theory into clinical decision-making. This is vital to inform future practice in the realm of dysphagia and to enhance Speech Therapy education.

METHODS

A qualitative research design was utilised to identify what facilitators assist SLP students to develop critical thinking skills in adult dysphagia. Data were gathered from students across three universities. Fifteen participants answered a self-developed online survey, and of those, four participated in a follow-up focus group. The data were analysed using a top-down approach and reflexive thematic analysis.

RESULTS AND DISCUSSION

The results revealed that viewing videos on instrumental assessment measures, case studies and peer learning were perceived to expand critical thinking theoretically. Similarly, critical thinking was best supported in clinical contexts, which provided opportunities to observe expert clinicians at the bedside, obtain individual feedback and access supervision.

CONCLUSION

The findings yielded recommendations for clinical educators involved in dysphagia training. This is necessary to better prepare SLP students to provide contextually relevant and responsive dysphagia services.

Utility of modified Mann assessment of swallowing ability (MMASA) in predicting aspiration risk and safe swallow in stroke patients

Introduction

Aspiration pneumonia is one of the commonest causes of post-stroke mortality. We may be able to reduce this morbidity and mortality by assessing the risk of aspiration in stroke patients. Assessment of this risk can be done using a physician-administered screening protocol to assess dysphagia. A score of ≥95 is a good cut off to detect patients who can take oral feeds safely.

Objectives

The primary objective was to predict aspiration risk using the Modified Mann Assessment Swallowing Ability (mMASA) scale. The secondary objective was to predict the safety of oral feeds using the same scale.

Materials and Methods

An analytical cross-sectional study was conducted at a tertiary care rehabilitation centre in South India. A total of 100 stroke patients who underwent stroke rehabilitation in the study institution were divided into patients who were able to eat orally or not based on the mMASA scale. Demographic and stroke characteristics were recorded. The mMASA score was calculated and those with a score of ≥95 were given oral feeds. Those who scored <95 were given swallow therapy and re-evaluated in 2 weeks. Also, the mMASA score below which the patient was likely to develop aspiration pneumonia was detected using the receiver operating characteristic curve (ROC).

Results

Out of the 100 patients, 37 patients had a score of ≥95 and were started on oral feeds and had no complications; the rest were started on 2 weeks of swallow therapy. On re-evaluation after swallow therapy, 12 more were started on oral feeds. The remaining 51 patients did not reach the cut-off score of ≥95 and were continued on nasogastric tube feeding. A total of 11 patients developed features of aspiration pneumonia; all of them belonged to the group of 51 patients who consistently had a mMASA score <95. The ROC curve determined that a score of <89 was a good cut off to predict patients who are at high risk of aspiration.

Conclusion

The scale can be used to predict the likelihood of aspiration and readiness to start oral feeds in sub-acute stroke patients.

Students’ experiences of using a writing-intense programme to facilitate critical thinking skills on an online clinical training platform: A pilot study

Background: Coronavirus disease 2019 (COVID-19) and the subsequent lockdown altered traditional clinical training for speech language pathology students, thus forcing training institutions to implement innovative and responsive clinical training strategies in the midst of the pandemic. As such, a writing-intense programme was piloted in an online clinical training programme with second-year speech language pathology students.Objectives: This study explored speech language pathology students’ experiences with a writing programme used during an online clinical training programme implemented during the COVID-19 pandemic.Method: The study used a qualitative survey design. Purposive convenient sampling was used to recruit 29 second-year speech language pathology students. Online student reflections guided by 10 open-ended questions were used to elicit responses from students. Data were analysed using deductive thematic analysis.Results: Findings revealed that the written component of the programme facilitated the acquisition of clinical knowledge and improved clinical processes of writing among students. Feedback that students received on their written tasks improved learning. The clinical component of the course enabled students to learn in a less stressful environment and helped them gain confidence in their knowledge and clinical skills. Connectivity challenges and the lack of motivation from some students negatively impacted the programme.Conclusion: Using a writing programme to clinically train students can have positive effects in applying theory to clinical application because it affords students time to consolidate and process theory with practice as the jump from first year to second year can be cognitively taxing. A writing-intense programme can also improve students’ writing skills.