Practice Patterns of Speech-Language Pathologists in Pediatric Vocal Health.

PURPOSE: The purpose of this study was to investigate current practices of speech-language pathologists (SLPs) in the management of pediatric vocal health, with specific analysis of the influence of clinical specialty and workplace setting on management approaches. METHOD: American Speech-Language-Hearing Association-certified clinicians providing services within the United States (1%-100% voice caseload) completed an anonymous online survey detailing clinician demographics; employment location and service delivery models; approaches to continuing professional development; and specifics of case management, including assessment, treatment, and discharge procedures. RESULTS: Current practice patterns were analyzed for 100 SLPs (0-42 years of experience; 77 self-identifying as voice specialists) providing services in 34 U.S. states across a range of metropolitan and nonmetropolitan workplace settings. In general, SLPs favored a multidisciplinary approach to management; included perceptual, instrumental, and quality of life measures during evaluation; and tailored intervention to the individual using a combination of therapy approaches. In contrast with current practice guidelines, only half reported requiring an otolaryngology evaluation prior to initiating treatment. Both clinical specialty and workplace setting were found to affect practice patterns. SLPs in school settings were significantly less likely to consider themselves voice specialists compared with all other work environments. Those SLPs who considered themselves voice specialists were significantly more likely to utilize voice-specific assessment and treatment approaches. CONCLUSION: SLP practice largely mirrors current professional practice guidelines; however, potential exists to further enhance client care. To ensure that SLPs are best able to support children in successful communication, further research, education, and advocacy are required.

Epidemiology of Vocal Health in Young Adults Attending College in the United States.

Purpose: The purpose of this study was to document typical vocal health characteristics (including voice-related activities, behaviors, and symptomatology) of young adults attending college and to determine lifetime and point prevalence rates of voice disorders. Method: Undergraduates at University of Wisconsin-Madison completed an anonymous online survey detailing vocal use, symptomatology, impact, sociodemographics, and voice-related quality of life. Univariate analyses and multivariate regression models isolated risk factors for lifetime and point prevalence rates of a voice disorder. Results: Vocal health and associated factors were analyzed for 652 students (predominantly 18-25 years of age). Lifetime prevalence rate of a voice disorder was 33.9% (point prevalence = 4.45%). Change in voice function (odds ratio [OR] = 2.77), seasonal or chronic postnasal drip (OR = 2.11), hoarseness (OR = 2.08), and restrictions to social activity (OR = 2.07; all p < .05) were identified as the strongest predictors of disorder. A total of 46% of students reported some form of voice problem in the past year, most frequently lasting between 1 and 6 days (39%). Voice usage in social and work settings exceeded demands in the classroom. Conclusions: Young adults in college frequently experience disturbances to vocal health; however, this is not usually perceived to interfere with communication. Relative weighting of risk factors appears to differ from older adults, highlighting the need for individualized evaluation and management, with reference to age-appropriate normative reference points.

Comparative analysis of clinical profile: Chronic cough vs paradoxical vocal fold motion.

BACKGROUND: Ongoing contention surrounding typical demographic and clinical attributes of chronic cough (CC) and paradoxical vocal fold motion (PVFM) impedes timely diagnosis and optimum patient care. Designed to reduce preventable patient morbidity through improved recognition and differentiation, the current study aimed to determine representative clinical profiles for CC and PVFM, with identification of distinctive attributes from the general population and risk factors associated with each diagnosis. METHODS: Self-reported medical questionnaires, demographic and lifestyle attributes of CC and PVFM cases from a disease-specific outcomes database were compared to US population data and published normative values. Univariate comparison and multivariate regression modelling of age, sex, alcohol intake, smoking, Reflux Symptom Index (RSI), Voice Handicap Index (VHI), and Generalized Anxiety Disorder 7-item Scale (GAD-7) determined distinguishing features between the clinical groups, including odds ratios for presenting with CC versus PVFM. RESULTS: Clinical profiles developed from 283 (128 CC, 155 PVFM) adults (18-91 years) were significantly different from the general population across each demographic, lifestyle and clinical variable (all p < .01), with the exception of obesity. Age (55.39 ± 13.54 vs 45.07 ± 16.51 years, p < .01) and mean RSI score (21.5 ± 9.02 vs 18.1 ± 9.08, p < .01) most reliably distinguished CC from PVFM, with those aged 60-69 years (OR = 9.45) most likely to be diagnosed with CC. CONCLUSIONS: Standard clinical profiles of CC and PVFM are distinct from the general population, aiding determination of relative probabilities and risk factors in the differential diagnostic process. Variations between CC and PVFM were subtle, reliably distinguished by age and relative severity of laryngopharyngeal reflux symptomatology.

Spinal cord injury (SCI) rehabilitation: systematic analysis of communication from the biopsychosocial perspective.

PURPOSE: Communication is powerful predictor of health-related quality of life and overall well-being, yet its role in promoting rehabilitation outcomes in spinal cord injury (SCI) is rarely mentioned. This article systematically analyzes and synthesizes literature from multiple disciplines according to a biopsychosocial perspective, providing an evidence base for clinical practice and clear direction for future research. METHOD: Systematic literature review and analysis, incorporating mapping to International Classification of Functioning, Disability and Health (ICF) codes. RESULTS: In total 4338 entries were retrieved from CINAHL, PsychInfo, Medline, PubMed and SpeechBite databases for the period 1990-2014. A total of 115 treatment and observational studies (quantitative and qualitative) detailed aspects of communication according to structure, function, activity, participation and environmental factors; evident of the complex interactions between communicative function with daily living after SCI. CONCLUSIONS: Communication is a relative strength in SCI, key to empowerment, independence, social interaction, and well-being, yet its potential to enhance SCI rehabilitation outcomes remains largely underexplored and untapped. Through elucidating interactions between communication and functioning, the adapted ICF framework affords clinicians and researchers insight into areas of intervention most likely to result in widespread gains. Conscious consideration should be given to the role of communication, within an integrative, strengths-based, multidisciplinary approach to clinical practice and future research. Implications for Rehabilitation Communication fosters empowerment, independence and greater participation in life roles; recognized as a powerful predictor of health-related quality of life and overall well-being. The ICF framework elucidates influences to communicative function, and components which are influenced by communication, providing valuable insight for clinicians and researchers. Therapeutic and research endeavors guided by existing ICF core sets are at risk of failing to consider communication, thereby limiting rehabilitation outcomes. Tapping the potential of communication as a relative strength within SCI rehabilitation holds considerable promise, within integrative, strengths-based, multidisciplinary approaches to clinical practice and future research.

Systemic hydration: relating science to clinical practice in vocal health.

OBJECTIVES: To examine the current state of the science regarding the role of systemic hydration in vocal function and health. STUDY DESIGN: Literature review. METHODS: Literature search spanning multiple disciplines, including speech-language pathology, nutrition and dietetics, medicine, sports and exercise science, physiology, and biomechanics. RESULTS: The relationship between hydration and physical function is an area of common interest among multiple professions. Each discipline provides valuable insight into the connection between performance and water balance, as well as complimentary methods of investigation. Existing voice literature suggests a relationship between hydration and voice production; however, the underlying mechanisms are not yet defined and a treatment effect for systemic hydration remains to be demonstrated. Literature from other disciplines sheds light on methodological shortcomings and, in some cases, offers an alternative explanation for observed phenomena. CONCLUSIONS: A growing body of literature in the field of voice science is documenting a relationship between hydration and vocal function; however, greater understanding is required to guide best practice in the maintenance of vocal health and management of voice disorders. Integration of knowledge and technical expertise from multiple disciplines facilitates analysis of existing literature and provides guidance as to future research.