1
|
Sutt AL, Cornwell PL, Hay K, Fraser JF, Rose L. Communication Success and Speaking Valve Use in Intensive Care Patients Receiving Mechanical Ventilation. Am J Crit Care 2022; 31:411-415. [PMID: 36045040 DOI: 10.4037/ajcc2022516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Communication with patients receiving mechanical ventilation in an intensive care unit can be challenging. Once a patient is tracheostomized, a speaking valve may enable restoration of verbal communication. To date, no data are available on the effect of speaking valves on communication success in intensive care units. OBJECTIVE The aim of this prospective cohort study was to measure communication success before and during speaking valve use for intensive care patients being weaned from mechanical ventilation, from both the nurses' and the patients' perspectives. METHODS In a prospective cohort study, consecutive eligible patients and their nurses were asked to complete newly developed questionnaires on communication success before and while patients used a speaking valve (6 questions for patients, 5 questions for nurses, answers on a 10-point scale with 10 the best score). The Wilcoxon signed rank test was used to analyze score differences. RESULTS For all questionnaire items, both patients (n = 25) and nursing staff (n = 52) reported significantly higher communication success during speaking valve use. Nurses understood moderately well that their patients were in pain (median [IQR], 5.8 [4.7-7.4]) even before speaking valve use. Most patients found it challenging to say something quickly even while using a speaking valve (6.9 [5.7-10.0]). Overall, speaking valve use markedly increased communication success. CONCLUSION A speaking valve should be considered for patients with a tracheostomy as soon as possible to improve their communication success.
Collapse
Affiliation(s)
- Anna-Liisa Sutt
- Anna-Liisa Sutt is a speech pathologist, Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia and an industry fellow, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Petrea L Cornwell
- Petrea L. Cornwell is an associate professor, School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Karen Hay
- Karen Hay is a statistician, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - John F Fraser
- John F. Fraser is director, Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia and a professor, Faculty of Medicine, University of Queensland
| | - Louise Rose
- Louise Rose is a professor, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| |
Collapse
|
2
|
Abstract
PURPOSE Literature to date describing the lived experience of dysphagia has predominantly focussed on the clinical populations of stroke and head and neck cancer. The current study aimed to understand the experience of people with dysphagia of varying aetiologies living at home in the community. METHOD Using a qualitative descriptive approach grounded in phenomenology, individuals with dysphagia were interviewed (n = 15) about their experiences living with and managing dysphagia at home. RESULT Thematic analysis revealed an overarching theme of "Journey of discovery - learning to live with dysphagia," which described the process of managing dysphagia at home. This theme was characterised by three subthemes: (1) The story of dysphagia; (2) Engaging with support networks; and (3) Limited community awareness of dysphagia. CONCLUSION This study highlights a range of psychosocial impacts individuals with dysphagia living at home may experience. Participants described how managing other health conditions alongside dysphagia influenced their perspectives about dysphagia. speech-language pathologists must consider individual client health priorities and provide support for not just the physical but also the psychosocial needs of clients. The reduced profile of dysphagia in our communities continues to be an ongoing barrier for clients with dysphagia and their families.
Collapse
Affiliation(s)
- Simone R Howells
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - Petrea L Cornwell
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queesland, Brisbane, Australia
| | - Pim Kuipers
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Australia
| |
Collapse
|
3
|
Howells SR, Cornwell PL, Ward EC, Kuipers P. Living with Dysphagia in the Community: Caregivers "do whatever it takes.". Dysphagia 2020; 36:108-119. [PMID: 32333212 DOI: 10.1007/s00455-020-10117-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 04/15/2020] [Indexed: 11/24/2022]
Abstract
The psychological and psychosocial impacts of dysphagia on patients are well documented, however, caregiver perspectives have received limited attention and findings have been predominantly in the head and neck cancer population. The aim of this study was to understand the experience of supporting a person with dysphagia of varying aetiologies in the community from the caregiver perspective. Using a qualitative descriptive approach grounded in phenomenology, caregivers of a person with dysphagia living at home were interviewed (n = 15). Thematic analysis revealed an overarching theme of "You do whatever it takes," describing the caregiver experience of supporting a family member/friend with dysphagia at home. This theme was underpinned by three subthemes where caregivers described (1) being a caregiver; (2) support networks; and (3) practicalities of living with dysphagia. Caregivers voiced a range of pertinent issues experienced when caring for a family member/friend with dysphagia including how personal attributes and life experience impact the caregiver role. Demonstrated through the practical and emotional supports caregivers provided, it was apparent they are instrumental in supporting a family member/friend with dysphagia to live at home and in the community successfully. Through understanding the caregiver experience, health professionals will be in a better position to involve and support caregivers who play a vital role in those living with dysphagia in the community. Incorporating caregivers as direct recipients of dysphagia services will ensure the practical and psychosocial needs of caregivers are addressed, enabling optimal care for people with dysphagia living at home.
Collapse
Affiliation(s)
- Simone R Howells
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia. .,School of Allied Health Sciences, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia.
| | - Petrea L Cornwell
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, PO Box 6053, Buranda, QLD, 4102, Australia.,School of Health and Rehabilitation Sciences, The University of Queesland, St Lucia Campus, St Lucia, QLD, 4072, Australia
| | - Pim Kuipers
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia.,Centre for Functioning and Health Research, Metro South Hospital and Health Service, PO Box 6053, Buranda, QLD, 4102, Australia
| |
Collapse
|
4
|
Howells SR, Cornwell PL, Ward EC, Kuipers P. Dysphagia care for adults in the community setting commands a different approach: perspectives of speech-language therapists. Int J Lang Commun Disord 2019; 54:971-981. [PMID: 31479197 DOI: 10.1111/1460-6984.12499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/11/2019] [Accepted: 07/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Descriptions of community-based speech-language therapy (SLT) dysphagia practices and services are underrepresented in the research literature, despite the prevalence of dysphagia in the community. Owing to a globally ageing population and government drives to support people to remain living at home rather than in hospital or aged care, there is a growing need for SLT services to be responsive to the needs of clients living at home in the community, referred to in this study as 'community-based clients'. Exploration of current SLT services and dysphagia care practices for this population may identify ways services can be designed and enhanced to better meet the needs of clients and carers. AIMS To explore the nature (i.e., characteristics) of dysphagia services and SLT clinical practices for adults with dysphagia living at home in the community. METHODS & PROCEDURES Using a qualitative descriptive approach positioned within an explanatory sequential mixed methods design, this study explored SLT services and practices for adults with dysphagia living in the community to explain further and elaborate on findings from an earlier quantitative study. A total of 15 SLTs working with community-based clients with dysphagia were recruited using purposive representative sampling. Content analysis was used to explore the data. OUTCOMES & RESULTS The overarching theme of community commands a different approach and was illustrated by three subthemes that highlighted how and why a different approach to dysphagia care in the community setting was necessary: (1) skills and mindset require adaptation in the community context; (2) values and approaches are different in the community context; and (3) organizational influences impact service delivery in the community context. From the data, it is apparent that the work undertaken in the community setting differs from dysphagia care in other settings and requires adapted SLT skills, values and approaches that encompass holistic care, client autonomy and carer engagement. SLT practices are also informed by organizational influences such as policies and resourcing, which in some services were enablers, while for others these presented challenges. CONCLUSIONS & IMPLICATIONS Community-based SLT services must continue to foster flexible, responsive practices by SLTs to ensure the needs of clients and carers are met now and in future.
Collapse
Affiliation(s)
- Simone R Howells
- Menzies Health Institute, Griffith University, Gold Coast Campus, QLD, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, QLD, Australia
| | - Petrea L Cornwell
- Menzies Health Institute, Griffith University, Gold Coast Campus, QLD, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, QLD, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Buranda, QLD, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia Campus, St Lucia, QLD, Australia
| | - Pim Kuipers
- Menzies Health Institute, Griffith University, Gold Coast Campus, QLD, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Buranda, QLD, Australia
| |
Collapse
|
5
|
Wall LR, Nund RL, Ward EC, Cornwell PL, Amsters DI. Experiences of communication changes following spinal cord injury: a qualitative analysis. Disabil Rehabil 2019; 42:2271-2278. [PMID: 30696290 DOI: 10.1080/09638288.2018.1557264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Voice and communication changes can occur following cervical spinal cord injury due to dysfunction of the respiratory and phonatory subsystems. Few studies have explored the "lived experience" of communication changes post cervical spinal cord injury. Furthermore, the impacts of these changes on community activity/participation and requirements for psychosocial adjustment have not been well-elucidated. The current study explored the experience of communication changes in non-ventilated individuals following cervical spinal cord injury, using a biopsychosocial framework.Materials and Methods: Semi-structured interviews were conducted with 14 community-dwelling non-ventilated individuals with cervical spinal cord injury. Thematic analysis was undertaken using an inductive approach. Themes were subsequently coded against domains of the World Health Organization International Classification of Functioning Disability and Health model, using established linking rules.Results: Four main themes were identified: (1) how communication has changed; (2) difficulties getting the message across, (3) the multifactorial impact of communication changes on everyday life; and (4) strategies/support to adjust to communication changes. Communication changes had multifaceted effects on participants' functioning, and were represented equally across the Body Functions (12 codes), Activities/Participation (12 codes), and Environmental Factors (11 codes) domains of the model.Conclusions: Individuals with cervical spinal cord injury perceive and experience meaningful changes on communication function post-injury, with salient impacts to daily-living and social participation.IMPLICATIONS FOR REHABILITATIONAs a result of communication changes post-injury, individuals with cervical spinal cord injury experience several challenges across a variety of domains in daily lifeThe current study highlights the benefit of using a biopsychosocial framework, such as The International Classification of Functioning, Disability and Health (ICF), to consider the complex and diverse impact of communication changes on the functioning of individuals with cervical spinal cord injury, as well as the influence of environmental factors, on rehabilitation planningThe current data demonstrates the need for increased involvement of speech-language pathologists as core members of the multidisciplinary team, and for acute awareness by all health professionals of the potential impact of communication changes on rehabilitation and psychosocial adjustment in individuals with cervical spinal cord injury.
Collapse
Affiliation(s)
- Laurelie R Wall
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Brisbane, Australia
| | - Rebecca L Nund
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Brisbane, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Brisbane, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Petrea L Cornwell
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Australia.,Behavioural Basis of Health, Griffith University, Brisbane, Australia
| | - Delena I Amsters
- Spinal Outreach Team, Queensland Spinal Cord Injuries Service, Brisbane, Australia
| |
Collapse
|
6
|
Howells SR, Cornwell PL, Ward EC, Kuipers P. Understanding Dysphagia Care in the Community Setting. Dysphagia 2019; 34:681-691. [DOI: 10.1007/s00455-018-09971-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/31/2018] [Indexed: 02/06/2023]
|
7
|
Sutt AL, Anstey CM, Caruana LR, Cornwell PL, Fraser JF. Corrigendum to "Ventilation distribution and lung recruitment with speaking valve use in tracheostomised patient weaning from mechanical ventilation in intensive care" [Journal of Critical Care 40 (2017) 164-170]. J Crit Care 2018; 48:481. [PMID: 30245080 DOI: 10.1016/j.jcrc.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Anna-Liisa Sutt
- Speech Pathology Department, The Prince Charles Hospital, Brisbane, Australia; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia..
| | - Chris M Anstey
- School of Medicine, The University of Queensland, Brisbane, Australia.; Critical Care Research Group, Sunshine Coast University Hospital, Nambour, Australia
| | - Lawrence R Caruana
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia
| | - Petrea L Cornwell
- Allied Health Research Collaborative, Metro North HHS, Brisbane, Australia; School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| |
Collapse
|
8
|
Newman CS, Cornwell PL, Young AM, Ward EC, Mcerlain AL. Accuracy and confidence of allied health assistants administering the subjective global assessment on inpatients in a rural setting: a preliminary feasibility study. Nutr Diet 2017; 75:129-136. [PMID: 28748600 DOI: 10.1111/1747-0080.12370] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 03/26/2017] [Accepted: 06/07/2017] [Indexed: 01/04/2023]
Abstract
AIM Malnutrition has a significant impact on patient outcomes and duration of inpatient stay. However, conducting timely nutrition assessments can be challenging for rural dietitians. A solution could be for allied health assistants (AHAs) to assist with these assessments. The present study aimed to assess the accuracy and confidence of AHAs trained to conduct the subjective global assessment (SGA) compared with dietitians. METHODS A non-inferiority study design was adopted. Forty-five adult inpatients admitted to a rural and remote health service were assessed independently by both a trained AHA and dietitian within 24 hours. The order of assessment was randomised, with the second assessor blind to the outcome of the initial SGA. Levels of agreement were examined using kappa and percent exact agreement (PEA; set a priori at ≥80%). Rater confidence after each assessment was assessed using a 10-point scale. RESULTS Agreement for overall SGA ratings was high (kappa = 0.84; PEA 84.4%). PEA for individual sub-components of the SGA ranged from 66.4 to 86.7%. Where discrepancies were identified in global SGA ratings, AHAs provided a more severe rating of malnutrition than dietitians. AHAs reported significantly lower confidence than dietitians (t = 4.49, P < 0.001), although mean confidence for both groups was quite high (AHA=7.5, dietitians = 9.0). CONCLUSIONS Trained AHAs completed the SGA with similar accuracy to dietitians. Using AHAs may help facilitate timely nutrition assessment in rural health services when a dietitian is not physically present. Further investigation is required to determine the benefits of incorporating this extended role into rural and remote health-care services.
Collapse
Affiliation(s)
- Cristal S Newman
- Community and Allied Health, Roma Hospital, Roma, Queensland, Australia
| | - Petrea L Cornwell
- Metro North Hospital and Health Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Adrienne M Young
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Functioning & Health Research (CFAHR), Queensland Health, Brisbane, QLD, Australia
| | | |
Collapse
|
9
|
Worboys T, Brassington M, Ward EC, Cornwell PL. Delivering occupational therapy hand assessment and treatment sessions via telehealth. J Telemed Telecare 2017; 24:185-192. [PMID: 29278981 DOI: 10.1177/1357633x17691861] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Telehealth offers a solution to assist delivery of occupational therapy (OT) services for hand therapy in rural and remote locations. However, there is currently no evidence to validate this service model. The aim of this study was to examine the validity of clinical decisions made during hand therapy sessions conducted via telehealth compared to a traditional clinical model (TCM) assessment, and explore patient and clinician satisfaction. Methods Eighteen patients referred for hand therapy to a rural/remote hospital-based outpatient service were assessed simultaneously via telehealth and a TCM assessment. An allied health assistant supported data collection at the patient end. Hand function was assessed using a range of objective measures, subjective scales and patient reported information. Minimal level of percent exact agreement (PEA) between the telehealth OT (T-OT) and the TCM-OT was set at ≥80%. Results Level of agreement for all objective measures (dynamometer and pinch gauge reading, goniometer flexion and extension, circumference in millimetres) ranged between 82% and 100% PEA. High agreement (>80% PEA) was also obtained for judgements of scar and general limb function, exercise compliance, pain severity and sensitivity location, activities of daily living and global ratings of change (GROC) scores. There was 100% PEA for overall recommendations. Minimal technical issues were experienced. Patient and clinician satisfaction was high. Discussion Clinical decisions made via telehealth were comparable to the TCM and consumers were satisfied with telehealth as a service option. Telehealth offers the potential to improve access to hand therapy services for rural and remote patients.
Collapse
Affiliation(s)
- Tess Worboys
- Occupational Therapy Department, Charleville Hospital, South West Hospital and Health Service, Queensland, Australia
| | - Melinda Brassington
- Occupational Therapy Department, Charleville Hospital, South West Hospital and Health Service, Queensland, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland, Australia
- The University of Queensland, School of Health & Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Petrea L Cornwell
- Allied Health Research Collaborative, Metro North Hospital and Health Service, Queensland, Australia
- Menzies Health Institute of Queensland, Griffith University, Queensland, Australia
| |
Collapse
|
10
|
Ward EC, Jarman L, Cornwell PL, Amsters DI. Impact of voice and communication deficits for individuals with cervical spinal cord injury living in the community. Int J Lang Commun Disord 2016; 51:568-580. [PMID: 27113443 DOI: 10.1111/1460-6984.12232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 11/30/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Post-spinal cord injury (SCI), individuals may exhibit mild to moderate impairments in aspects of speech influenced by impaired respiratory support. However, limited research has been conducted into the impact of these impairments on activity and participation when living in the community. AIMS To examine the nature and extent of voice and communication function in a group of individuals with cervical SCI living in the community, and to explore participant perceptions of the impact of these deficits on levels of activity and participation. METHODS & PROCEDURES Participants included 14 individuals who had sustained a SCI above C8 level and had returned to living in the community. All completed a series of speech and voice assessments, the Voice Handicap Index, the Australian Therapy Outcome Measures Voice scale, four voice perception questions, and the General Short Form of the Communicative Participation Item Bank. OUTCOMES & RESULTS As a group, participants were found to have reduced vocal intensity and phonatory duration. Vocal quality was mildly altered in 93% and pitch control, breath support for speech, speech rate and phrase length impacted in one-quarter or more of the group. All reported impacts, though three individuals reported that their impairments had more extensive impact on communication in daily life. CONCLUSIONS & IMPLICATIONS Individuals post-SCI experience mild speech and voice deficits that can have negative impacts on functional communication. The monitoring of communication function may help to identify those individuals who could benefit from additional support and intervention on return to community life.
Collapse
Affiliation(s)
- Elizabeth C Ward
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Brisbane, QLD, Australia
| | - Leigh Jarman
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Petrea L Cornwell
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD, Australia
- Behavioural Basis of Health, Griffith University, Brisbane, QLD, Australia
| | - Delena I Amsters
- Spinal Outreach Team, Queensland Spinal Cord Injuries Service, Brisbane, QLD, Australia
| |
Collapse
|
11
|
Cornwell PL, Cowie B, Geraghty R. Examining nurse-led dysphagia screening tools in the general medical hospital population. Speech, Language and Hearing 2016. [DOI: 10.1080/2050571x.2016.1204747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
12
|
Pryor LN, Ward EC, Cornwell PL, O'Connor SN, Chapman MJ. Establishing phonation using the Blom®tracheostomy tube system: A report of three cases post cervical spinal cord injury. Speech, Language and Hearing 2016. [DOI: 10.1080/2050571x.2016.1196035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
13
|
Sutt AL, Caruana LR, Dunster KR, Cornwell PL, Anstey CM, Fraser JF. Speaking valves in tracheostomised ICU patients weaning off mechanical ventilation--do they facilitate lung recruitment? Crit Care 2016; 20:91. [PMID: 27038617 PMCID: PMC4818462 DOI: 10.1186/s13054-016-1249-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 02/19/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients who require positive pressure ventilation through a tracheostomy are unable to phonate due to the inflated tracheostomy cuff. Whilst a speaking valve (SV) can be used on a tracheostomy tube, its use in ventilated ICU patients has been inhibited by concerns regarding potential deleterious effects to recovering lungs. The objective of this study was to assess end expiratory lung impedance (EELI) and standard bedside respiratory parameters before, during and after SV use in tracheostomised patients weaning from mechanical ventilation. METHODS A prospective observational study was conducted in a cardio-thoracic adult ICU. 20 consecutive tracheostomised patients weaning from mechanical ventilation and using a SV were recruited. Electrical Impedance Tomography (EIT) was used to monitor patients' EELI. Changes in lung impedance and standard bedside respiratory data were analysed pre, during and post SV use. RESULTS Use of in-line SVs resulted in significant increase of EELI. This effect grew and was maintained for at least 15 minutes after removal of the SV (p < 0.001). EtCO2 showed a significant drop during SV use (p = 0.01) whilst SpO2 remained unchanged. Respiratory rate (RR (breaths per minute)) decreased whilst the SV was in situ (p <0.001), and heart rate (HR (beats per minute)) was unchanged. All results were similar regardless of the patients' respiratory requirements at time of recruitment. CONCLUSIONS In this cohort of critically ill ventilated patients, SVs did not cause derecruitment of the lungs when used in the ventilator weaning period. Deflating the tracheostomy cuff and restoring the airflow via the upper airway with a one-way valve may facilitate lung recruitment during and after SV use, as indicated by increased EELI. TRIAL REGISTRATION Anna-Liisa Sutt, Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN ACTRN12615000589583. 4/6/2015.
Collapse
Affiliation(s)
- Anna-Liisa Sutt
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia. .,School of Medicine, University of Queensland, Brisbane, Australia. .,Speech Pathology Department, The Prince Charles Hospital, Brisbane, Australia.
| | - Lawrence R Caruana
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia
| | - Kimble R Dunster
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,Science & Engineering Faculty, Queensland University of Technology, Brisbane, Australia
| | - Petrea L Cornwell
- Allied Health Collaborative, Metro North HHS, Brisbane, Australia.,School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Chris M Anstey
- School of Medicine, University of Queensland, Brisbane, Australia.,Critical Care Research Group, Sunshine Coast University Hospital, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| |
Collapse
|
14
|
Pryor LN, Ward EC, Cornwell PL, O'Connor SN, Chapman MJ. Clinical indicators associated with successful tracheostomy cuff deflation. Aust Crit Care 2016; 29:132-7. [PMID: 26920443 DOI: 10.1016/j.aucc.2016.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/09/2015] [Accepted: 01/12/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Tracheostomy cuff deflation is a necessary stage of the decannulation pathway, yet the optimal clinical indicators to guide successful cuff deflation are unknown. OBJECTIVES The study aims were to identify (1) the proportion of patients tolerating continuous cuff deflation at first attempt; (2) the clinical observations associated with cuff deflation success or failure, including volume of above cuff secretions and (3) the predictive capacity of these observations within a heterogeneous cohort. METHODS A retrospective review of 113 acutely tracheostomised patients with a subglottic suction tube in situ was conducted. RESULTS Ninety-five percent of patients (n=107) achieved continuous cuff deflation on the first attempt. The clinical observations recorded as present in the 24h preceding cuff deflation included: (1) medical stability, (2) respiratory stability, (3) fraction of inspired oxygen ≤0.4, (4) tracheal suction ≤1-2 hourly, (5) sputum thin and easy to suction, (6) sputum clear or white, (7) ≥moderate cough strength, (8) above cuff secretions ≤1ml per hour and (9) alertness≥eyes open to voice. Using the presence of all 9 indicators as predictors of successful cuff deflation tolerance, specificity and positive predictive value were 100%, although sensitivity was only 77% and negative predictive value 19%. Refinement to a set of 3 clinically driven criteria (medical and respiratory stability, above cuff secretions ≤1ml/h) provided high specificity (100%), sensitivity (95%), positive predictive value (100%) and an improved negative predictive value (55%). CONCLUSIONS Key criteria can help guide clinical decision-making on patient readiness for cuff deflation.
Collapse
Affiliation(s)
- Lee N Pryor
- Royal Adelaide Hospital, Intensive Care Unit, SA, Australia; The University of Queensland, School of Health & Rehabilitation Sciences, QLD, Australia.
| | - Elizabeth C Ward
- The University of Queensland, School of Health & Rehabilitation Sciences, QLD, Australia; Centre for Functioning & Health Research (CFAHR), QLD, Australia
| | - Petrea L Cornwell
- The Prince Charles Hospital, Metro North Hospital and Health Service, QLD, Australia; School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, QLD, Australia
| | - Stephanie N O'Connor
- Royal Adelaide Hospital, Intensive Care Unit, SA, Australia; The University of Adelaide, School of Medicine, SA, Australia
| | - Marianne J Chapman
- Royal Adelaide Hospital, Intensive Care Unit, SA, Australia; The University of Adelaide, School of Medicine, SA, Australia
| |
Collapse
|
15
|
Earl BJ, Lazzarini PA, Kinnear EM, Cornwell PL. Prevalence of active foot disease and foot disease risk factors in a subacute inpatient rehabilitation facility: a cross-sectional prevalence study. J Foot Ankle Res 2014; 7:41. [PMID: 25328541 PMCID: PMC4200129 DOI: 10.1186/s13047-014-0041-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 10/02/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Australian subacute inpatient rehabilitation facilities face significant challenges from the ageing population and the increasing burden of chronic disease. Foot disease complications are a negative consequence of many chronic diseases. With the rapid expansion of subacute rehabilitation inpatient services, it seems imperative to investigate the prevalence of foot disease and foot disease risk factors in this population. The primary aim of this cross-sectional study was to determine the prevalence of active foot disease and foot disease risk factors in a subacute inpatient rehabilitation facility. METHODS Eligible participants were all adults admitted at least overnight into a large Australian subacute inpatient rehabilitation facility over two different four week periods. Consenting participants underwent a short non-invasive foot examination by a podiatrist utilising the validated Queensland Health High Risk Foot Form to collect data on age, sex, medical co-morbidity history, foot disease risk factor history and clinically diagnosed foot disease complications and foot disease risk factors. Descriptive statistics were used to determine the prevalence of clinically diagnosed foot disease complications, foot disease risk factors and groups of foot disease risk factors. Logistic regression analyses were used to investigate any associations between defined explanatory variables and appropriate foot disease outcome variables. RESULTS Overall, 85 (88%) of 97 people admitted to the facility during the study periods consented; mean age 80 (±9) years and 71% were female. The prevalence (95% confidence interval) of participants with active foot disease was 11.8% (6.3 - 20.5), 32.9% (23.9 - 43.5) had multiple foot disease risk factors, and overall, 56.5% (45.9 - 66.5) had at least one foot disease risk factor. A self-reported history of peripheral neuropathy diagnosis was independently associated with having multiple foot disease risk factors (OR 13.504, p = 0.001). CONCLUSION This study highlights the potential significance of the burden of foot disease in subacute inpatient rehabilitation facilities. One in eight subacute inpatients were admitted with active foot disease and one in two with at least one foot disease risk factor in this study. It is recommended that further multi-site studies and management guidelines are required to address the foot disease burden in subacute inpatient rehabilitation facilities.
Collapse
Affiliation(s)
- Brenton J Earl
- />Department of Podiatry, Metro North Hospital and Health Service, Queensland Health, Brisbane, Queensland 4032 Australia
- />School of Medicine, Flinders University, Adelaide, South Australia 5001 Australia
| | - Peter A Lazzarini
- />Department of Podiatry, Metro North Hospital and Health Service, Queensland Health, Brisbane, Queensland 4032 Australia
- />Allied Health Research Collaborative, Metro North Hospital and Health Service, Queensland Health, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, Queensland 4032 Australia
- />School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland 4059 Australia
| | - Ewan M Kinnear
- />Department of Podiatry, Metro North Hospital and Health Service, Queensland Health, Brisbane, Queensland 4032 Australia
| | - Petrea L Cornwell
- />Allied Health Research Collaborative, Metro North Hospital and Health Service, Queensland Health, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, Queensland 4032 Australia
- />Griffith Health Institute, Behavioural Basis of Health, Griffith University, Brisbane, Queensland 4122 Australia
| |
Collapse
|
16
|
Cornwell PL, Ward EC, Lim Y, Wadsworth B. Impact of an abdominal binder on speech outcomes in people with tetraplegic spinal cord injury: perceptual and acoustic measures. Top Spinal Cord Inj Rehabil 2014; 20:48-57. [PMID: 24574822 DOI: 10.1310/sci2001-48] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND An abdominal binder (AB) is routinely used for patients who have suffered a spinal cord injury (SCI) resulting in tetraplegia. It is thought to restore abdominal pressure and consequently improve breathing capacity and reduce postural hypotension in patients who do not have functioning abdominal muscles. OBJECTIVE To examine the early effects of an AB on respiratory and speech outcomes. METHODS Thirteen individuals who sustained an acute motor complete SCI between C3 and T1 were assessed after a 6-week trial of using an elasticized AB from the time of first mobilizing in an upright wheelchair. Assessments were made using spirometry and perceptual and acoustics speech measures based on sustained phonation, sentence recitation, and passage reading. RESULTS Significant improvements were found in the AB-on condition for 3 of 5 respiratory parameters (vital capacity, forced vital capacity, and forced expiratory volume in 1 second). Predominantly mild voice and speech dysfunction were noted in participants. No significant difference was found for any of the acoustic and perceptual speech parameters (maximum phonation time, vocal intensity for sentence recitation, perceptual speech characteristics, or vocal quality) between the AB conditions. CONCLUSIONS Despite the finding that an AB results in significant improvements in respiratory function for individuals with tetraplegic SCI, the current study did not provide evidence that an AB improves speech production.
Collapse
Affiliation(s)
- Petrea L Cornwell
- Allied Health Research Collaborative, Metro North Hospital & Health Service , Brisbane , Australia ; Behavioural Basis of Health, Griffith Health Institute, Griffith University , Brisbane , Australia
| | - Elizabeth C Ward
- School of Health & Rehabilitation Sciences, The University of Queensland , Brisbane , Australia ; Centre for Functioning and Health Research, Metro South Hospital & Health Service , Brisbane , Australia
| | - Yujun Lim
- School of Health & Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
| | - Brooke Wadsworth
- School of Health & Rehabilitation Sciences, The University of Queensland , Brisbane , Australia ; Department of Physiotherapy, Princess Alexandra Hospital, Metro South Hospital & Health Service , Brisbane , Australia
| |
Collapse
|
17
|
Wadsworth BM, Haines TP, Cornwell PL, Rodwell LT, Paratz JD. Abdominal Binder Improves Lung Volumes and Voice in People With Tetraplegic Spinal Cord Injury. Arch Phys Med Rehabil 2012; 93:2189-97. [DOI: 10.1016/j.apmr.2012.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 05/29/2012] [Accepted: 06/18/2012] [Indexed: 11/30/2022]
|
18
|
Rumbach AF, Ward EC, Cornwell PL, Bassett LV, Muller MJ. Physiological Characteristics of Dysphagia Following Thermal Burn Injury. Dysphagia 2011; 27:370-83. [DOI: 10.1007/s00455-011-9376-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 11/05/2011] [Indexed: 12/01/2022]
|
19
|
Doig E, Fleming J, Kuipers P, Cornwell PL. Comparison of rehabilitation outcomes in day hospital and home settings for people with acquired brain injury – a systematic review. Disabil Rehabil 2010; 32:2061-77. [DOI: 10.3109/09638281003797356] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
20
|
Doig E, Fleming J, Cornwell PL, Kuipers P. Qualitative Exploration of a Client-Centered, Goal-Directed Approach to Community-Based Occupational Therapy for Adults With Traumatic Brain Injury. Am J Occup Ther 2009; 63:559-68. [DOI: 10.5014/ajot.63.5.559] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVES. We explored the clinical application of goal-directed therapy in community-based rehabilitation from the perspective of clients with traumatic brain injury (TBI), their significant others, and their treating occupational therapists.
METHOD. Twelve people with TBI and their significant others completed an outpatient, goal-directed, 12week occupational therapy program. Semistructured interviews with 12 participants, 10 significant others, and 3 occupational therapists involved in delivering the therapy programs explored their experiences of goal-directed therapy.
RESULTS. Participants, their significant others, and therapists described goal-directed therapy positively, expressing satisfaction with progress made.
CONCLUSION. Goals provide structure, which facilitates participation in rehabilitation despite the presence of barriers, including reduced motivation and impaired self-awareness. A therapist-facilitated, structured, goal-setting process in which the client, therapist, and significant others work in partnership can enhance the process of goal setting and goal-directed rehabilitation in a community rehabilitation context.
Collapse
Affiliation(s)
- Emmah Doig
- Emmah Doig is PhD Candidate, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland 4062 Australia;
| | - Jennifer Fleming
- Jennifer Fleming, PhD, is Senior Research Fellow in Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland and the Princess Alexandra Hospital, Brisbane
| | - Petrea L. Cornwell
- Petrea L. Cornwell, PhD, is Research Fellow in Speech Pathology, School of Health and Rehabilitation Sciences, The University of Queensland and the Princess Alexandra Hospital, Brisbane
| | - Pim Kuipers
- Pim Kuipers, MA, Grad Dip Rehab, PhD, is Senior Research Fellow, Centre for Remote Health, Joint Centre of Flinders University and Charles Darwin University, Alice Springs, Northern Territory, Australia
| |
Collapse
|
21
|
Abstract
The current case report provides a comprehensive description of the persistent dysarthria and dysphagia evident in a 7.5 year old child treated for recurrent posterior fossa tumour (PFT). AC was assessed on a comprehensive perceptual and instrumental test battery incorporating all components of the speech production system (respiration, phonation, resonance, articulation and prosody) 2 years and 4 months following completion of her treatment. The nature of her swallowing impairment was investigated through the use of videofluoroscopic evaluation of swallowing (VFS). A mild dysarthria with ataxic and LMN components was identified, although overall speech intelligibility was not affected. A moderate dysphagia was also identified with impairment in all three phases of the swallowing process; oral preparatory, oral and pharyngeal. Dysarthria and dysphagia as persistent sequelae in children treated for PFT have implications for the long-term management of these children. The need for appropriate treatment regimes, as well as pre-surgical counselling regarding dysarthria and dysphagia as possible outcomes following surgery are highlighted.
Collapse
Affiliation(s)
- Petrea L Cornwell
- Motor Speech Research Unit, Department of Speech Pathology and Audiology, University of Queensland, Brisbane, Queensland 4072, Australia.
| | | | | | | |
Collapse
|
22
|
Abstract
PRIMARY OBJECTIVE To investigate the nature of the motor speech impairments and dysarthria that can arise subsequent to treatment for childhood mid-line cerebellar tumours (CMCT). RESEARCH DESIGN The motor speech ability of six cases of children with CMCT was analysed using perceptual and physiological measures and compared with that of a group of non-neurologically impaired children matched for age and sex. MAIN OUTCOME AND RESULTS Three of the children with CMCT were perceived to exhibit dysarthric speech, while the remaining three were judged to have normal speech. The speech disorder in three of the children with CMCT was marked by deviances in prosody, articulation and phonation. The underlying pathophysiology was linked to cerebellar damage and expressed as difficulty in co-ordinating the motor speech musculature as required for speech production. These deficits were not identified in the three non-dysarthric children with CMCT. CONCLUSION Differential motor speech outcomes occur for children treated for CMCT and these are discussed within the realm of possible mechanisms responsible for these differences. The need for further investigation of the risk factors for development of motor speech impairment in children treated for CMCT is also highlighted.
Collapse
Affiliation(s)
- Petrea L Cornwell
- Department of Speech Pathology & Audiology, University of Queensland, Brisbane, Queensland, Australia.
| | | | | |
Collapse
|
23
|
Turner BJ, Fleming JM, Ownsworth TL, Cornwell PL. The transition from hospital to home for individuals with acquired brain injury: a literature review and research recommendations. Disabil Rehabil 2009; 30:1153-76. [PMID: 17852241 DOI: 10.1080/09638280701532854] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To review the literature relating to the transition from hospital to home for individuals with acquired brain injury (ABI) and make recommendations concerning the future direction of transition-specific research. METHOD Relevant research articles were identified through searching existing database systems and by reviewing the reference lists of identified articles. Only articles in which the results directly related to individuals with ABI from the time of discharge to 1 year post-discharge were included in the review. RESULTS/DISCUSSION A total of 50 articles were identified as meeting the criteria for inclusion in the review. The methodological quality of included articles was evaluated using a set of specific criteria. The articles were classified into the following categories: (i) The perspectives of individuals with ABI and their caregivers; (ii) outcomes for individuals with ABI following transition; (iii) post-discharge services; and (iv) transitional living services/programmes. The majority of articles were based on samples of individuals with stroke, typically aged over 65 years. A common theme identified in the review was that the transition from hospital to home is typically perceived as an exciting yet difficult period for individuals and their families and as such, post-discharge support is critical. CONCLUSION Further ABI transition-specific research is necessary in order to: (i) Develop a comprehensive theoretical framework of the transition phase; and (ii) facilitate both the validation of current intervention strategies and the development of innovative/tailored intervention approaches.
Collapse
Affiliation(s)
- Benjamin J Turner
- Dvision of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.
| | | | | | | |
Collapse
|
24
|
Foster MM, Cornwell PL, Fleming JM, Mitchell GK, Tweedy SM, Hart AL, Haines TP. Better than nothing? Restrictions and realities of enhanced primary care for allied health practitioners. Aust J Prim Health 2009. [DOI: 10.1071/py08065] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Participation of allied health professionals (AHP) in the Enhanced Primary Care (EPC) program is increasing. However, access to allied health services is strictly delineated under the EPC program and AHP face unique practice realities in providing care to patients with chronic conditions. This paper examines the discretionary practices adopted by AHP in response to the realities at the policy–practice interface and situates the discussion within a description of their experiences with EPC. Semistructured telephone interviews were conducted with a purposive sample of fifteen AHP. Participants were selected from a larger cohort who responded to a questionnaire about EPC. The EPC program was perceived as a positive start, although some aspects were problematic. Participants reported that the restriction on the number of subsidised sessions was not conducive to providing a good allied health service to patients with complex care needs and remuneration was not commensurate with the nature and scope of treatment required. The AHP in this study spoke of the dilemma of wanting to assist patients but at the same time to operate a financially viable business. Moreover, their experience was that multidisciplinary team care was implied rather than reality. Abbreviated care practices, reasonable solutions for access, and entrepreneurial practices were strategies used to manage the policy–practice tensions.
Collapse
|
25
|
McAuliffe MJ, Cornwell PL. Intervention for lateral /s/ using electropalatography (EPG) biofeedback and an intensive motor learning approach: a case report. Int J Lang Commun Disord 2008; 43:219-29. [PMID: 17852524 DOI: 10.1080/13682820701344078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Visual biofeedback using electropalatography (EPG) has been beneficial in the treatment of some cases of lateral /s/ misarticulation. While EPG intervention is motorically based, studies have not commonly employed a motor learning approach to treatment. Furthermore, treatment success is measured primarily by change to EPG tongue-palate contact patterns and listener ratings conducted by speech-language therapists. Studies have not commonly measured articulatory change without the palate in-situ using acoustic analysis and non-professional listeners. AIMS To determine if an intensive treatment programme including both visual biofeedback (EPG) and traditional articulation techniques within a motor learning paradigm would result in functional improvement to /s/ articulation in an 11-year-old girl with persistent lateral misarticulation. METHODS & PROCEDURES Treatment involved 12 sessions of therapist-delivered treatment over 4 weeks followed by a 6-week home programme. Outcomes of the treatment programme were measured primarily using naive listener ratings and acoustic analysis of /s/ spectra. OUTCOMES & RESULTS Improvements to both the perceptual and spectral characteristics of /s/ articulation occurred following the treatment programme. CONCLUSIONS The study highlighted the benefit of an intensive approach to intervention incorporating both visual biofeedback and traditional articulation approaches. The inclusion of a 6-week structured home-programme was beneficial and resulted in consolidation of treatment gains.
Collapse
Affiliation(s)
- Megan J McAuliffe
- Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand.
| | | |
Collapse
|
26
|
Cornwell PL, Murdoch BE, Ward EC, Kellie S. Acoustic Investigation of Vocal Quality following Treatment for Childhood Cerebellar Tumour. Folia Phoniatr Logop 2004; 56:93-107. [PMID: 15001825 DOI: 10.1159/000076061] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The aim of the study was firstly to document the acoustic parameters of voice using the Multidimensional Voice Program (MDVP, Kay Elemetrics) in a group of children with dysarthria subsequent to treatment for cerebellar tumour (CT). Then, secondly, compare the acoustic findings to perceptual voice characteristics as described by the GIRBAS (grade, instability, roughness, breathiness, asthenicity, strain). The assessments were performed on 29 voice samples; 9 cerebellar tumour participants with dysarthria, and 20 control participants. None of the control voices were rated as exhibiting any of the six parameters described by the GIRBAS, while 7 of the CT participants were noted to have at least a mild voice disorder. Roughness, instability, breathiness and asthenicity were all identified as voice characteristics in the CT voice samples. Acoustically, the CT voice samples differed significantly from the controls' voices on frequency and amplitude perturbation measures. Our findings confirmed voice dysfunction as a component of dysarthria in children treated for cerebellar tumour, and discussed the links between acoustic and perceptual descriptions.
Collapse
Affiliation(s)
- Petrea L Cornwell
- Motor Speech Research Unit, Department of Speech Pathology and Audiology, University of Queensland, Brisbane, Australia.
| | | | | | | |
Collapse
|
27
|
Cornwell PL, Murdoch BE, Ward EC, Kellie S. Perceptual evaluation of motor speech following treatment for childhood cerebellar tumour. Clin Linguist Phon 2003; 17:597-615. [PMID: 14977025 DOI: 10.1080/0269920031000111339] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The speech characteristics, oromotor function and speech intelligibility of a group of children treated for cerebellar tumour (CT) was investigated perceptually. Assessment of these areas was performed on 11 children treated for CT with dysarthric speech as well as 21 non-neurologically impaired controls matched for age and sex to obtain a comprehensive perceptual profile of their speech and oromotor mechanism. Contributing to the perception of dysarthria were a number of deviant speech dimensions including imprecision of consonants, hoarseness and decreased pitch variation, as well as a reduction in overall speech intelligibility for both sentences and connected speech. Oromotor assessment revealed deficits in lip, tongue and laryngeal function, particularly relating to deficits in timing and coordination of movements. The most salient features of the dysarthria seen in children treated for CT were the mild nature of the speech disorder and clustering of speech deficits in the prosodic, phonatory and articulatory aspects of speech production.
Collapse
Affiliation(s)
- Petrea L Cornwell
- Motor Speech Research Unit, Department of Speech Pathology and Audiology, The University of Queensland, Brisbane, Australia.
| | | | | | | |
Collapse
|
28
|
Abstract
The present case report describes the presence of a persistent dysarthria and dysphagia as a consequence of surgical intervention for a choroid plexus papilloma (CPP). WM was a nine year ten month old male who at the time of the present study was seven years post-surgery. A comprehensive perceptual and instrumental test battery was used to document the nature of the dysarthria incorporating all components of speech production including respiration, phonation, resonance, articulation, and prosody. The nature of the dysphagia was evaluated through the use of videofluoroscopic evaluation of swallowing (VFS). Assessments confirmed the presence of a LMN dysarthria, marked by deficits in phonation, respiration, and prosody. Dysphagia assessment revealed deficits in oral preparatory, oral and pharyngeal stages of the swallow. The presence of persistent dysarthria and dysphagia in this case has a number of important implications for the management of children undergoing surgery for fourth ventricle CPPs, in particular the need for appropriate treatment, as well as counselling prior to surgery of the possible negative outcomes related to speech and swallowing.
Collapse
Affiliation(s)
- P L Cornwell
- Department of Speech Pathology and Audiology, University of Queensland, Brisbane, Australia
| | | | | | | |
Collapse
|