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.

Tube feeding in advanced dementia: Insights from South African speech-language therapists.

BACKGROUND:  Speech-language therapists (SLTs) may recommend tube feeding even with minimal research evidence of its effectiveness, and an understanding of SLTs' perceived practices is warranted. OBJECTIVES:  To qualitatively describe a sample of South African SLTs' perceived practices regarding feeding tube placement in people with advanced dementia. METHOD:  Semi-structured online interviews were conducted via Microsoft Teams. Eight South African SLTs with a particular interest in advanced dementia, in public and private settings, were recruited. Data were analysed using inductive reflexive thematic analysis. RESULTS:  Three main themes were identified: (1) factors influencing SLTs' decisions for feeding tube placement in people with advanced dementia; (2) nature of clinical setting and SLTs' decision-making and (3) SLTs' considerations to improve management of people with advanced dementia. Existing local palliative care guidelines were not employed in decisions about tube feeding. Most participants did not recommend tube feeding during end-of-life care. Perceived burden of care influenced participants' decisions about tube feeding. CONCLUSION:  Speech-language therapists in South Africa likely have an increased reliance on clinical experience rather than recent research and guidelines for decisions about feeding tube placement. Findings accentuate the importance of clinical supervision, mentoring and continuous professional development in the workplace. The findings are an urgent call to action to improve SLTs' overall practices and ethical service delivery for people with advanced dementia and their families.Contribution: Factors and needs regarding SLTs' decision-making about feeding tubes in people with advanced dementia are highlighted.

Vocal Characteristics across English-Northern Sotho Bilingual Speakers: A Comparative Study.

INTRODUCTION: Bilinguals constitute a significant portion of speech-language pathologists' (SLPs) caseloads. Insight into the cross-linguistic effect on voice is needed to guide SLPs to make linguistically appropriate observations when working with heterogenous populations. METHOD: Nineteen female English-Northern Sotho bilinguals performed three speech tasks (reading, picture description, and monologue) in each language. Acoustic analysis of mean fundamental frequency (f0), intensity, and articulation rate was conducted with Praat. A panel of blinded listeners reached consensus after independently reviewing the recordings during perceptual analysis of voice quality, resonance, and glottal attack. RESULTS: The following statistically significant differences were found across and within the languages: The mean f0 was 204.61 Hz in the Northern Sotho picture description yet 196.50 Hz in the English picture description. The mean intensity of reading in Northern Sotho was 66.38 dB whereas the mean intensity of reading in English was 65.09 dB. Articulation rate was 3.78 syllables/s in English passage reading and 3.41 syllables/s in Northern Sotho passage reading. Within English, passage reading elicited a significantly quicker articulation rate than the picture description (3.34 syllables/s) and monologue (3.46 syllables/s). Within Northern Sotho, mean f0 was 203.83 Hz in passage reading yet 191.11 Hz in the monologue. Perceptual voice quality, glottal attack, and resonance were comparable across languages. CONCLUSION: Relationships between languages spoken, task performance, and vocal characteristics were observed in English-Northern Sotho bilingual females. SLPs must consider the interaction of language, task performance, and vocal characteristics when working with bilingual clients.

Experiences of acquired brain injury one-month post-discharge from acute hospitalisation.

Background: Healthcare professionals may have a preconceived idea about life after an acquired brain injury (ABI). Understanding lived experiences of individuals with ABI and their significant others, post-hospitalisation, may improve communication between healthcare professionals and individuals directly influenced by the ABI. Objective: To describe perceived experiences of individuals with ABI, and their significant others, regarding rehabilitation services and returning to daily activities, one-month post-discharge from acute hospitalisation. Method: Semi-structured interviews, via an online platform, expanded on the experiences of six dyads (individuals with an ABI and their significant others). Data were thematically analysed. Results: Six main themes emerged that best described participants' experiences; two of which were shared between individuals with ABI and their significant others (SO). Individuals with an ABI acknowledged recovery as their priority and highlighted the importance of patience. The need for counselling and additional support from healthcare professionals and peers arose. The SO expressed a need for written information, improved communication from healthcare professionals, and education regarding the implications of an ABI. The coronavirus disease 2019 (COVID-19) pandemic negatively influenced all participants' overall experiences, mainly because of termination of visiting hours. Psychosocial intervention would have been beneficial to all participants. Faith influenced most participants' attitudes towards recovery and adapting post-ABI. Conclusion: Most participants accepted their new reality but required additional support to cope emotionally. Individuals with an ABI would benefit from opportunities to share experiences with and learn from others in a similar situation. Streamlined services and improved communication may alleviate anxiety among families during this crucial transitional period. Contribution: This article provides valuable information on the perspectives and experiences of individuals with ABI and their significant others during the transition from acute hospitalisation. The findings can assist with the continuity of care, integrative health and supportive strategies during the transition period post-ABI.

Psychosocial care of people with aphasia: Practices of speech-language pathologists in South Africa.

Purpose: The study aimed to explore the practices of a sample of South African speech-language pathologists (SLPs) in providing psychosocial care to people with aphasia. People with aphasia are at risk of adverse psychosocial disruptions and access to appropriate support may be particularly challenging for individuals with compromised communication abilities. The study considered the multilingual and multicultural context of South Africa. By understanding current practices, direction for improved psychosocial care to clients as well as support to SLPs is highlighted.Method: A 20-item previously published online survey was completed by 56 South African SLPs. Purposive and snowball sampling were used to recruit participants. Descriptive and inferential statistics, and qualitative content analysis, were used.Result: Respondents recognised addressing psychosocial wellbeing to be very important. A variety of psychosocial approaches were used in practice. However, 67.9% of the sample felt ill-equipped to provide psychosocial care to people with aphasia. Further barriers included: time/caseload pressures (60.7%) and feeling out of their depth (48.2%). Enablers were: access to more training opportunities (89.3%), adequate time (62.5%), and ongoing support from skilled professionals (55.4%). The majority of respondents also perceived mental health professionals to have limited expertise in working with people with aphasia, making onward referral challenging.Conclusion: Respondents support people with aphasia's psychosocial wellbeing by employing counselling strategies, including family, and person-centred goal-setting. However, many challenges to the provision of psychosocial care to people with aphasia were identified. To improve services, more training opportunities, improved role definition and interprofessional collaboration, are required.

Nurses' knowledge of stroke-related oropharyngeal dysphagia in the Eastern Cape, South Africa.

BACKGROUND: Early identification of stroke-related oropharyngeal dysphagia (OPD) using screening by nurses can prevent adverse patient outcomes in lower middle-income countries. Nurses are essential in the OPD management team and should ideally be able to screen and prioritise dysphagia management in stroke patients. OBJECTIVE: The aim of this research was to describe nurses' practices related to identification and management of patients with stroke-related OPD. METHODS: Qualified nurses from various healthcare levels in the Eastern Cape, South Africa were invited to complete a previously published hard copy survey on the signs and symptoms, complications and management of stroke-related OPD. A sample of 130 participants completed the survey. RESULTS: The mean scores of correct responses for each section were: 8.7/13 (66.7%) for signs and symptoms, 4.7/10 (47.3%) for complications and 3.8/7 (54.2%) for management practices. Statistically, there were no differences between the levels of healthcare for the signs and symptoms section and the complications section. Regarding management of OPD, secondary-level (S) nurses demonstrated significantly better knowledge than primary-level (P) and tertiary-level (T) nurses (S-P: p = 0.022; S-T: p = 0.010). Secondary-level nurses also scored significantly higher across all three sections (S-P: p = 0.044; S-T: p = 0.025) than those at the other levels. CONCLUSIONS: The study found that nurses across all levels of healthcare had only moderate knowledge regarding identification and management of stroke-related OPD. Interdisciplinary collaboration between nurses and speech-language therapists may improve nurses' knowledge in identification and management of stroke-related OPD in lower middle-income settings such as South Africa.

Perspectives of working-age adults with aphasia regarding social participation.

BACKGROUND: Working-age adults with aphasia experience difficulties in social participation, specifically fulfilling social roles and reintegrating into communities. Literature regarding social participation of people with aphasia (PWA) is predominantly based on studies conducted in high-income countries (HIC), limiting generalisability of findings. Perspectives of social participation are influenced by person, place and cultural background warranting investigation in heterogeneous low- and middle-income countries (LMICs), like South Africa. OBJECTIVES: Describe perspectives of working-age adults with aphasia regarding social participation within the first 2 years post-incident. METHOD: Semi-structured interviews gained perspectives of 10 working-age adults (with mild to moderate aphasia) using principles of supported conversation for adults with aphasia. Data were thematically analysed to describe participants' perspectives of social participation. RESULTS: Seven themes were identified pertaining to participants' perspectives of social participation. Participants considered rehabilitation services, faith-related activities and returning to work as valued areas of social participation. Previous interests, presence of support and characteristics of communication partners determined their preference and willingness to participate with others. Finally, personal attitudes and feelings continued to influence their perspectives of social participation, as well as their motivation to participate. CONCLUSION: Successful social participation was dependent on the PWA's perceived value of social activities and presence of support from significant others. Speech-language therapists are in the ideal position to facilitate PWA's communication abilities and their experience of successful participation through the implementation of person-centered care and community-led intervention. This study provided a preliminary investigation of social participation in South Africa and further investigation is warranted.

Responsive communication coaching for early childhood practitioners in underserved South African contexts: Clinical perspectives.

Children spend longer hours with early childhood development (ECD) practitioners who are well-placed to facilitate critical early language development. ECD classrooms include a growing number of children at risk for communication delays. Greater collaboration between speech-language therapists (SLTs) and ECD practitioners is needed. Research highlights that responsivity coaching improves communication development. Therefore, responsive communication coaching was identified as a possible approach to early communication development within the classroom. This clinical perspective serves as a reflection on the programme by examining ECD practitioners' perceptions thereof. Responsive communication coaching was identified as a means to improve practitioner-student collaboration within classrooms. This reflection aimed to describe ECD practitioners' perceptions of responsive communication coaching implemented by student SLTs. Early childhood development practitioners were recruited from three sites in low to middle socio-economic settings, where most children were English additional language learners. Coaching was presented to 15 practitioners via 16 sessions conducted by student SLTs under supervision. Practitioners completed a custom-designed survey regarding their skill development and experiences of the coaching. All practitioners expressed benefit from coaching. Half of the practitioners (50%) rated coaching as very helpful, while 37% perceived it as helpful. The remaining practitioners (13%), based at the special needs preschool, perceived coaching as quite helpful. Thematic analysis identified the following benefits: enhanced interaction, improvements in children's communication and the use of responsive communication strategies. Speech-language therapists need to collaborate with and support ECD practitioners in novel ways. The exploratory findings suggest that ECD practitioners benefit from SLT student-led responsive communication coaching sessions.

Significance of speech production errors on cross-linguistic processing in Sepedi-English individuals with bilingual aphasia: a case series analysis.

BACKGROUND: Bilingual aphasia forms a significant part of speech-language pathologists' (SLP) caseload, globally, and specifically in South Africa. Few tools supporting clinical decision-making are available due to limited understanding of typical and disordered cross-linguistic processing (how the languages interact). Speech errors may provide insight about "hidden" bilingual mechanisms. OBJECTIVES: To determine what speech errors can impart about cross-linguistic processing, as well as, associated language and impairment variables in Sepedi-English individuals with aphasia. METHOD: The case series included six participants, purposively selected from three rehabilitation sites in South Africa. Detailed language and clinical profiles were obtained. Participants performed a confrontation naming task in their most dominant (MDL) and less dominant language (LDL). Responses were audio recorded, transcribed, and analyzed for overall accuracy and error type in MDL and LDL; verified by a Sepedi-speaking linguist and a qualified SLP. RESULTS: (1) No statistically significant differences in MDL-LDL naming accuracy were found, supporting recent literature of simultaneous inter-activation of both languages and shared word retrieval mechanisms. All types of speech errors occurred, and semantic errors were produced most frequently and consistently in each participant's MDL and LDL. (2) Language proficiency, language recovery patterns, and aphasia type (Broca's and Anomic) and severity (mild and/or moderate) appeared to be more strongly linked to cross-linguistic processing than Sepedi-English linguistic differences and age of acquisition of both languages. CONCLUSIONS: Participants with bilingual aphasia may use typical cross-linguistic and word retrieval mechanisms, concurring with current theories of bilingualism. Findings are preliminary, warranting investigations of other language tasks, modalities, pairs, and related variables.

The Effect of Hydration on Voice Quality in Adults: A Systematic Review.

OBJECTIVES: We aimed to critically appraise scientific, peer-reviewed articles, published in the past 10 years on the effects of hydration on voice quality in adults. STUDY DESIGN: This is a systematic review. METHODS: Five databases were searched using the key words "vocal fold hydration", "voice quality", "vocal fold dehydration", and "hygienic voice therapy". The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed. The included studies were scored based on American Speech-Language-Hearing Association's levels of evidence and quality indicators, as well as the Cochrane Collaboration's risk of bias tool. RESULTS: Systemic dehydration as a result of fasting and not ingesting fluids significantly negatively affected the parameters of noise-to-harmonics ratio (NHR), shimmer, jitter, frequency, and the s/z ratio. Water ingestion led to significant improvements in shimmer, jitter, frequency, and maximum phonation time values. Caffeine intake does not appear to negatively affect voice production. Laryngeal desiccation challenges by oral breathing led to surface dehydration which negatively affected jitter, shimmer, NHR, phonation threshold pressure, and perceived phonatory effort. Steam inhalation significantly improved NHR, shimmer, and jitter. Only nebulization of isotonic solution decreased phonation threshold pressure and showed some indication of a potential positive effect of nebulization substances. Treatments in high humidity environments prove to be effective and adaptations of low humidity environments should be encouraged. CONCLUSIONS: Recent literature regarding vocal hydration is high quality evidence. Systemic hydration is the easiest and most cost-effective solution to improve voice quality. Recent evidence therefore supports the inclusion of hydration in a vocal hygiene program.

Social participation in working-age adults with aphasia: an updated systematic review.

BACKGROUND: A previous systematic review found limited data regarding social participation in working-age people with aphasia (PWA). A review of recent studies may reveal more information on challenges in reestablishing social roles. METHOD: The aim was to provide an updated systematic review on social participation in PWA under 65 years of age. Studies from 2005 to 2017 were searched from Scopus, Pubmed, and Psychinfo. Search terms were derived from the International Classification of Functioning, Disability and Health (ICF) and the Aphasia- Framework for Outcomes Measures (A-FROM). Aspects of domestic life, interpersonal relations and interactions, education and employment, and community, civic, and social life were investigated. RESULTS: From 2864 initial hits, 11 studies were identified, all of which were on the American Speech-Language-Hearing Association (ASHA) Level III of evidence. The studies indicated that participation in domestic life is reduced and PWA showed reduced social networks, loss of friendships and changes in the quality of marital relations. Few PWA returned to work or spent time on education. Limitations in community, civic, and social life were noted and there were contradictory findings on the impact of contextual factors on social participation. There was an increase in research into contextual factors impacting on social participation in PWA and in the use of conceptual frameworks in the last decade. CONCLUSIONS: While the ICF conceptual framework is increasingly used, no studies used the A-FROM. There is greater use of standardized assessments and larger sample sizes.