Language Intervention for Late Talkers: The Experiences of Speech-Language Pathologists in Malaysia (Intervensi Bahasa untuk Kanak-kanak Lambat Bercakap: Pengalaman Terapis Pertuturan-Bahasa di Malaysia) / Jurnal Sains Kesihatan Malaysia

@#A few studies have investigated the practise patterns of Malaysian speech-language pathologists (SLPs) when working with children with speech and language problems whose language intervention is necessary. However, these studies did not provide in-depth information about the SLPs' experiences as the studies were conducted quantitatively. Moreover, none of the studies focus on late-talkers (LTs), in which intervention for them can vary along a continuum from a wait/ watch-and-see approach to direct intervention. Thus, this study aimed to explore SLPs’ experiences in managing LTs in Malaysia. Twelve SLPs participated in individual, semi-structured phone interviews. They were asked about their experiences in managing LTs. The interviews were recorded, transcribed, and a content analysis was performed. Two themes were identified; a) practises of SLPs and b) challenges faced by SLPs in managing LT cases. The practises of SLPs included conducting assessments, developing intervention plans, providing intervention, sharing information, giving homework, providing support, and managing appointments. The challenges faced were related to parents, other individuals close to LTs, LTs themselves, and resources. Although the SLPs’ practises aligned with the international standard of speech-language pathology service delivery, there is room for improvement, especially in collaborating with parents, as one-to-one direct interventions for LTs might not be suitable due to the challenges related to resources. In addition, a few suggestions related to centred-based care and trusted social media pages can be provided to parents to assist them outside therapy sessions besides initiating the development of awareness programs and information resources for parents and other caregivers.

Validação de conteúdo de protocolo de decanulação de pacientes adultos traqueostomizados / Content validation of the decannulation protocol for adult tracheostomized patients

RESUMO Objetivo Realizar a validação de conteúdo de um protocolo de decanulação de pacientes adultos traqueostomizados. Método Para a validação de conteúdo do protocolo elaborado por fonoaudiólogas foi utilizada a técnica Delphi. Os 11 itens do protocolo foram julgados por peritos, por meio de rodadas via e-mail e foram classificados como adequados, parcialmente adequados ou inadequados, além de fornecerem comentários e sugestões sobre cada item. Foram convidados 30 fonoaudiólogos, 30 fisioterapeutas respiratórios e 30 médicos responsáveis pelo procedimento de traqueostomia e decanulação. O percentual de concordância adotado foi ≥ 80% e o processo foi interrompido quando obtido esse percentual em todos os itens. Resultados Ao final do processo, 24 profissionais participaram da terceira rodada, sendo 46% fonoaudiólogos, 29% fisioterapeutas e 25% médicos. Após as sugestões e comentários dos peritos, dois itens foram mantidos como estavam no protocolo inicial, sete foram reformulados, seis incluídos e dois excluídos. A versão final do protocolo incluiu: identificação, ausência de secreções abundantes, características da secreção, tosse eficaz, capacidade para remover secreções, tolera o balonete desinsuflado, aptidão no processo de decanulação, nível de consciência, troca de cânula para menor calibre, ausência de infecção vigente/ ativa, deglutição espontânea e eficaz de saliva, uso de válvula de fala, aptidão à oclusão da cânula, avaliação da aptidão para decanulação e exames objetivos. Conclusão Por meio da Técnica Delphi houve a validação do conteúdo do instrumento, ocorrendo mudanças substanciais. A próxima etapa de validação do instrumento é a obtenção de evidências de validade em relação a estrutura interna.

ABSTRACT Purpose Perform content validation of a decannulation protocol for tracheostomized adult patients. Methods To validate the content of the protocol developed by speech therapists, the Delphi technique was used. The 11 items of the protocol were judged by experts through rounds via e-mail and were classified as adequate, partially adequate or inadequate, in addition to providing comments and suggestions on each item. 30 speech therapists, 30 respiratory physiotherapists and 30 physicians responsible for the tracheostomy and decannulation procedure were invited. The percentage of agreement adopted was ≥ 80% and the process was interrupted when this percentage was obtained in all items. Results At the end of the process, 24 professionals participated in the third round, being 46% speech therapists, 29% physiotherapists and 25% physicians. After the experts' suggestions and comments, two items were kept as they were in the initial protocol, seven were reformulated, six were included and two were excluded. The final version of the protocol included: identification, absence of abundant secretions, characteristics of the secretion, effective cough, ability to remove secretions, tolerate the deflated cuff, aptitude in the decannulation process, level of consciousness, change of cannula to a smaller caliber, absence of current/active infection, spontaneous and effective swallowing of saliva, use of a speech valve, aptitude for occlusion of the cannula, assessment of aptitude for decannulation and objective examinations. Conclusion Through the Delphi Technique, the content of the instrument was validated, with substantial changes occurring. The next stage of instrument validation is obtaining evidence of validity in relation to the internal structure.

Association between malocclusion, tongue position and speech distortion in mixed-dentition schoolchildren: an epidemiological study

Abstract Background Malocclusions are highly prevalent in childhood and adolescence, being considered a public health problem worldwide, in addition to be considered an important predictor in the tongue position and speech disorders. Objective Evaluate the association of malocclusions with tongue position and speech distortion in mixed-dentition schoolchildren from the south of Brazil. Methodology This cross-sectional study was performed using a database of an epidemiological survey realized in the southern of Brazil, in 2015, for evaluating the dental and myofunctional condition of the mixed-dentition from 7-13 years' schoolchildren. The outcome variables were tongue position and speech distortion, evaluated by a trained and calibrated examiner. Characteristics regarding sociodemographic and oral health measures (Angle's classification of the malocclusion, overjet, overbite, posterior crossbite and respiratory mode) were also assessed. Poisson regression models with adjusted robust variance were used to evaluate the association among predictors variables in the outcomes. Results are presented as prevalence ratio (PR) and 95% confidence interval (95% CI). Results A total of 547 children were evaluated. Schoolchildren who presented anterior open bite (PR 2.36 95%CI 1.59-3.49) and having oral/oral-nasal breathing (RP 2.51 95%CI 1.70-3.71) are more likely to have altered position of the tongue. Both deep bite and being male represent protection factors for the abnormal tongue position. Regarding speech distortion, deep overbite presents a protective relationship to speech distortion (PR 0.41; 95%CI 0.24-0.71), whereas schoolchildren with posterior crossbite were more likely to present this problem (PR 1.77; 95%CI 1.09-2.88). Conclusion Anterior open bite and posterior crossbite were the malocclusions related to speech distortion and/or altered tongue position. Oral/oral-nasal breathing was also related to myofunctional changes. Deep bite malocclusion was a protective factor for both speech problems and altered tongue position when compared to a normal overbite.

Reading comprehension assessment: effect of order of task application / Avaliação da compreensão leitora: efeito da ordem de aplicação das tarefas

ABSTRACT Purpose To investigate the influence of order of reading tasks application on the reading comprehension performance by students with and without reading difficulties. Methods 40 students (4th and 5th grade) were classified according to the presence (Research Group-RG) or absence (Control Group-CG) of reading difficulties. RG-r and CG-r - 20 students (10 for each group) who retold the read text and responded to open-ended questions; RG-q and CG-q - 20 students (10 for each group) who responded to open-ended questions and then retold the read text. The analysis quantified the main idea, details and inferences retold, causal links and retelling reference standard (3-0) was also established from the best to the worst performance. Open-ended questions received one point for each correct answer. Results Open-ended questions influenced only the retelling performance of good readers. A better performance of CG-q was noted for the number of second level links retold (U=50.50, p=0.155), total of links retold (U=23,00, p=0.038) and retelling reference standard (U=24.50, p=0.039). Reading-monitoring strategies are laborious and tend to be less used by students with reading difficulties. This is because these compete directly with low-level skills (decoding and microstructure processing), losing efficiency or being abandoned in the very course of reading. Conclusion There was improvement on the retelling performance of students without reading difficulties when this task was preceded by the open-ended questions, possibly because of the use of monitoring strategies that allowed a better understanding of the link between the retained ideas, improving links and retelling reference standard.

RESUMO Objetivo Estudar a influência da resposta a questões sobre o desempenho na tarefa de reconto após leitura realizada por escolares com e sem dificuldades de leitura. Método Foram agrupados 40 escolares do 4º e 5º ano do Ensino Fundamental segundo a presença (Grupo Pesquisa-GP) ou ausência (Grupo Controle-GC) de alteração na compreensão leitora: GP-r e GC-r - 20 escolares (10 de cada grupo) que responderam a questões abertas e depois recontaram oralmente o texto lido. A análise quantificou no reconto: total de ideias centrais, detalhe e inferências; enlaces e classificou o padrão de compreensão leitora (3-0) do melhor para o pior desempenho. As questões abertas computaram um ponto para cada acerto. Resultados Questões abertas favoreceram apenas o desempenho de bons leitores no reconto. Melhor desempenho foi identificado para GC-r quando considerados os enlaces de segundo nível (U=50.50, p=0.155); total de enlaces (U=23.00, p=0.038) e de padrão do reconto (U=24.50, p=0.039). Estratégias de monitoramento de leitura são laboriosas e tendem a ser menos utilizadas por escolares com dificuldades de leitura. Isso porque essas estratégias competem diretamente com as habilidades de baixa ordem na leitura (decodificação e processamento da microestrutura). Conclusão O desempenho de escolares sem queixas em tarefa de reconto após leitura melhorou quando precedida por respostas a questões abertas, possivelmente por causa das estratégias de automonitoramento da compreensão, que permitiram melhor entendimento das relações entre as ideias retidas.

Study on Assessment and Treatment Patterns of Speech-Language Pathologists in Pediatric Vocal Problem Through Multicenter Survey

BACKGROUND AND OBJECTIVES: Pediatric vocal health problems are relatively common. However, it is not yet well studied whether uniform diagnosis and treatment is done properly in South Korea. The purpose of this study was to investigate the methods that the Korean speech therapists use to diagnose and treat pediatric voice problem. MATERIALS AND METHOD: An anonymous online questionnaire was administered to 32 speech language therapists registered at the Korean laryngeal speech linguistics society detailing demographics, employment institution, general management of pediatric patients with vocal problem including assessment and treatment procedures. RESULTS: Current practice patterns were analyzed on 32 speech language therapists providing services in South Korea mostly working at tertiary university hospital. One third of pediatric patients were assessed without proceeding to treatment. One fifth of patients were treated without assessment. Perceptual assessment was the main pre-treatment assessment methods used. Treatment was done in the following order : Voice rest, SOVT, yawn-sigh and resonant voice. Post-treatment evaluation was used in the following order : Instrumental assessment, clinical judgment, and recording comparison. CONCLUSION: Speech language therapists practice in South Korea mostly follows the ASHA practice guidelines. However, there are still great amount of cases in which only the evaluation was done without appropriate treatment. Further research is needed to make SPLs more systematic and efficient for evaluating and treating pediatric vocal patients.

Evaluation of a Professional Development Model for Enhancing Knowledge, Skill and Confidence in Dysphagia Management / Jurnal Sains Kesihatan Malaysia

There were critical limitations to dysphagia services in Malaysia with speech-language pathologists’ (SLPs) reported lacking skills and confidence in managing the disorder. This study examined the impact of providing professional development training in dysphagia management. Aims were to determine if: (1) delivery of a training series enhances SLPs knowledge in dysphagia management, (2) knowledge translated into improved clinical skills and (3) clinicians’ perception of their knowledge, skills and confidence improved post-training. The study used a single cohort pre- and post-test research design and involved nine Malaysian SLPs. Participants underwent assessment at pre- and immediately post-training and again at one month post-training. At each assessment level, knowledge and skills were assessed via a written examination and observational assessment of clinical performance respectively. Visual analogue scales were used to measure clinician’s perceptions of knowledge, skills and confidence. The training model involved four consecutive; 4-hour week-end workshops with opportunity to apply new knowledge and develop networking in clinical practice in the weekdays between each session. Significant (p < 0.05) improvements in knowledge and clinical skills were observed immediately post- and at one month after training. Clinician’s perceptions of knowledge, skills and confidence were also significantly higher immediately post- and at one month post-training. The current 4-week structured professional development model was found to be effective in enhancing SLPs’ knowledge and skills in dysphagia management and improving their perceptions and confidence. The findings highlight the benefits that can be achieved through well designed professional development programs.

Demencia frontotemporal y esclerosis lateral amiotrófica: presentación de un caso clínico / Frontotemporal dementia and amyotrophic lateral sclerosis: a case report

For a long time amyotrophic lateral sclerosis was seen as an exclusively motor disease, however, a lot of investigations have proved the existence of cognitive symptoms similar to frontotemporal dementia that could precede, coexist or appear after the motor symptoms. We report the case of a 69 years old hispanic man who consults about progressive swallowing impairments. In the speech languagepathologist assessment, we detected cognitive impairments that made necessary to complete the workout with specific test. The results of the assessment, shown disturbance in swallowing with suggestive symptomatology of motor neuron disease, besides cognitive impairments in executive functions, visuospatial abilities, memory, language and behaviors and conductual abnormalities. A few months after speech language pathologist assessment, the diagnosis of amyotrophic lateral sclerosis was given. This case emphasize in the importance of a exhaustive anamnesis and clinical assessment, as well as early diagnosis focused on opportune interventions. Additionally, it’s important to note the need for professionals with update knowledge in neuropsychology, to support interventions.

Durante mucho tiempo se pensó que la esclerosis lateral amiotrófica era una enfermedad exclusivamente motora, sin embargo, diversos estudios han mostrado la existencia de síntomas cognitivos que pueden manifestarse antes, durante o después de los síntomas motores y que serían compatibles con una demencia frontotemporal. Se presenta un caso de un hombre de 69 años que consulta por dificultades de deglución de carácter progresivo. En la evaluación fonoaudiológica se pesquisan dificultades cognitivas, por lo cual se decide aplicar diversas pruebas con el objetivo de aclarar estas alteraciones. Los resultados de la evaluación revelan alteraciones a nivel de deglución, con sintomatologia sugerente de enfermedad de motoneurona, además de alteraciones cognitivas a nivel de funciones ejecutivas, habilidades visuoespaciales, memoria, lenguaje y alteraciones en conducta y comportamiento. En el transcurso de unos meses, posterior a la evaluación fonoaudiológica, se realiza el diagnóstico de esclerosis lateral amiotrófica. Se enfatiza en la importancia de la anamnesis y evaluación clínica, el diagnóstico precoz enfocado en la intervención oportuna y la relevancia de contar con profesionales competentes y capaces, con conocimientos sobre neuropsicología que puedan ser de apoyo para la intervención.

Desplazamiento respecto de los saberes disciplinares de la fonoaudiología / Displacements with respect to disciplinary knowledge of speech, language and voice therapist

Este artículo presenta una serie de propuestas acerca de lo que implica ser fonoaudiólogo/a. Se contextualiza en el marco del proceso de la innovación curricular propuesta por la Universidad de Chile para todas las Carreras, en particular las de la salud y entre ellas Fonoaudiología. Luego de esta contextualización, la idea es presentar un eje de análisis del (posible) saber disciplinar y los supuestos que están en la base de la formación de este profesional. Para ello se realiza un recuento histórico de la profesión. Se consideran las modificaciones contextuales y epistemológicas que sostendrían el saber disciplinar actual y que tendrían relación con el bienestar comunicativo de las personas. Cómo tal éste es un ejercicio inédito en Chile. En él, las personas se enfrentan al dilema de establecer cuál es el saber disciplinar de la profesión de fonoaudiólogo/a, de proponer la episteme de la fonoaudiología. Este enfoque cualitativo de final abierto, no se ha utilizado en estudios anteriores.

This article presents a series of proposals about what it actually means to be a speech pathologist. The theoretical framework that underlies these proposals is based on the curricular innovation process that the careers at the University of Chile are undergoing, especially for those in the health area, including Speech Therapy. The analysis is done on the basis of two main issues: a definition of disciplinary knowledge and the assumptions that underlie the training of professionals pursuing the degree of speech therapists. The article provides a historical account of the development of speech therapy, including the contextual and epistemological changes that may have given rise to the current status and knowledge of this discipline, which are related to the communicative welfare of people. As such, this paper provides new insights into the understanding of the relationships that this discipline may establish in the Chilean context. Thus, professionals are faced up with the dilemma of defining what the key tenets of the disciplinary knowledge of the speech-language pathologist are, and to propose the episteme of speech therapy. This qualitative open ended approach has not been used in previous studies.