Talking points: Oral histories of Australian and British speech-language pathologists who qualified in the three decades after 1945.

Purpose: There has been limited academic exploration of the history of speech-language pathology (SLP). This article uses oral histories to explore the experiences reported by speech-language pathologists who began to practise in Australia and Britain, two politically related, but geographically very distant and distinct countries, in the first three decades after the Second World War.Method: Archived oral history transcripts from eight Australian and sixteen British speech-language pathologists were analysed using thematic network analysis (TNA).Result: Two global themes are reported, "personal stories" and "professional stories". Transcripts revealed the ways in which participants negotiated the social and cultural expectations of their time and place and how they developed professional identity and autonomy as their careers progressed. While there were many commonalities, there were both between- and within-group differences in the ways the two cohorts reported the details of their career progression.Conclusion: This article offers a picture of the challenges and experiences of Australian and British speech-language pathologists in the second half of the twentieth century. It highlights some of the changes over time and forms the basis for comparison with current working practices in the two countries.

Phonetic Transcription for Speech-Language Pathology in the 21st Century.

The past few decades have seen rapid changes in speech-language pathology in terms of technology, information on speech production and perception, and increasing levels of multilingualism in communities. This tutorial provides an overview of phonetic transcription for the modern world, both for work with clients, and for research and training. The authors draw on their backgrounds in phonetics, phonology and speech-language pathology, and their crosslinguistic project in the phonological acquisition of children with typical versus protracted phonological development. Challenges and solutions are presented, as well as resources for further training of students, clinicians and researchers.

Speech pathology management of non-progressive dysarthria: a systematic review of the literature.

Purpose: The purpose of this study is to conduct a systematic review of interventions for the treatment of non-progressive dysarthria in adults.Materials and methods: Five electronic databases (PubMed, Embase, CINAHL, PSYCINFO, Cochrane Collaboration) were searched for all studies that described and evaluated treatment used for non-progressive dysarthria in adults. Studies were included if (1) participants were adults (18+ years) with a confirmed diagnosis of non-progressive dysarthria, (2) participants received intervention with pre-post outcome data, and (3) the article was published between 2006 and 2017 (including early online publications). Data extracted included the number of participants; etiology; dysarthria type and severity; age; gender; presence of a control group; intervention tasks, frequency and duration; outcome measures; and conclusions. Data extraction was completed by a member of the research team independently and crosschecked by another team member.Results: Of the 6728 articles identified, 21 met the inclusion criteria. The predominant study design was a case study or case series. The methodological quality of the studies varied. Typically, the interventions included impairment-based and activity level tasks targeting conversation. Approximately half of the interventions adhered to a treatment manual.Conclusions: The evidence base to guide treatment for non-progressive dysarthria is increasing, with interventions showing promise in results, participant numbers, and positive participant feedback.Implications for rehabilitationThe evidence base to guide treatment for non-progressive dysarthria is increasing, but remains limited.The majority of evidence is of moderate methodological quality.The emergence of new research indicates that health professionals need to be continuously aware and critically appraise new literature in the area.

Moving Beyond Traditional Understandings of Evidence-Based Practice: A Total Evidence and Knowledge Approach (TEKA) to Treatment Evaluation and Clinical Decision Making in Speech-Language Pathology.

Evidence-based practice (EBP) is a well-established framework for supporting clinical decision making in the discipline of speech-language pathology. The benefits of using evidence to inform clinical practice are acknowledged by clinicians and researchers alike. Even so, after over two decades of EBP advocacy, much clinical uncertainty remains and models supporting the evaluation of interventions require review and reconsideration. The EBP model, while promoting positive principles, can be argued to be conceptually flawed because it suffers from a lack of attention to and explicit valuing of other forms of knowledge crucial to the formation of realistic and judiciously informed decisions. We propose that the evaluation of interventions would be better supported by an explicit knowledge management approach reflecting a range of evidence and knowledge. One worked example is presented to demonstrate what using such an approach can produce in terms of intervention information.

Using Telegraphic Input With Children With Language Delays: A Survey of Speech-Language Pathologists' Practices and Perspectives.

Purpose Speech-language pathologists (SLPs) often simplify their language input when talking to young children with language delays, but there is some controversy regarding whether simplified input should be telegraphic (e.g., Ball under, Doggie go, More toy) or grammatical (e.g., The ball went under; Go, Doggie! More toys). The purpose of this study was to evaluate SLPs' practices and perspectives on using telegraphic input when working with children with language delays at the prelinguistic, one-word, or two-word stages of spoken language development. Method Practicing SLPs were recruited from a university-sponsored professional development conference focused on current best practices in speech-language pathology. Respondents completed an online survey that included questions about their own practices, as well as their overall perspectives on the usefulness of simplifying language input in different ways. Results The vast majority of SLPs (82%) reported using telegraphic input. SLPs reported using telegraphic input more frequently when prompting for verbal imitations than when describing play or providing a directive/request. Surprisingly, only 30% of SLPs who reported using telegraphic input felt that it was useful. SLPs reported that receptive language is the most important child characteristic to consider when deciding what kind of language input to provide. Conclusions These findings suggest the need for more purposeful clinical decision making in the context of providing simplified language input. In addition, in-depth, qualitative studies are needed to characterize the complex interactions among beliefs, experiences, practices, and perspectives pertaining to simplified language input.

Elizabeth Usher memorial lecture: Expanding scope of practice - inspiring practice change and raising new considerations.

As the speech-language pathology (SLP) profession matures and evolves, there will continue to be an ongoing need for practice change. Practice change has many drivers: consumer need; an advancing evidence base; clinical innovations; financial efficiency; local service needs; population change; government policy etc. If we are to continue to have a profession with a strong identity and the capacity to make meaningful contributions to the modern education and healthcare landscape, then practice change is a necessity. To achieve practice change we must step away from long-held traditional paradigms and service delivery models. We need a workforce that is ready, committed and willing to accept change. We need organisations that are willing and open to adopt new service models, and we must have the evidence base to support these new roles and responsibilities. Making change to ensure clinicians are working to full scope or considering extended scope models (when appropriate) is actively encouraged to help achieve a more client-centred, cost-effective health service. In this discussion paper, the benefits, issues and impacts of expanding scope of practice are discussed, and ways that individual clinicians, services, training institutions, and researchers can help support the future growth of our profession are highlighted.

Perception of speech and language pathologists towards augmentative and alternative communication in Pakistan.

OBJECTIVE: To determine the level of understanding and use of augmentative and alternative communication devices in Pakistani speech pathologists.. METHODS: The cross-sectional survey was conducted from January to June 2015 in six major cities of Pakistan: Islamabad, Rawalpindi, Lahore, Karachi, Quetta and Peshawar. It comprised speech and language pathologists who were asked to fill a questionnaire that consisted of10 questions. Data was analysed using SPSS17. Result: Overall calculated mean and standard error of mean from the respondents who agreed and strongly agreed regarding understanding, opinion-assessment and treatment about augmentative and alternative communication was153±36.373 and 12.124 respectively. RESULTS: Of the 132 subjects, 68(51.5%) were in the education group and 64(48.5%) in the control group. Postintervention, 11(16.2%) women in the education group and 37(57.8%)in the control group developed severe preeclampsia. Subsequently, 44(64.7%) in the education group had no preeclampsia. The corresponding number in the control group was 15(23.4%). CONCLUSIONS: Speech pathologists had understanding of assessing and working with individuals using augmentative and alternative communication.

Is the speech-language pathology profession prepared for an ageing population? An Australian survey.

PURPOSE: This study profiled the demographic characteristics and practice patterns of speech-language pathologists working with older Australians to inform future workforce planning and service development in response to an ageing population and aged care sector reform. METHOD: Data were collected through snowball distribution of an online survey comprising six sections: demographic details; caseload and service delivery practices, degree of inter-professional practice; engagement with professional development and support; and assessment and management of swallowing, mealtime and communication difficulties. All data were analysed using descriptive statistics and chi-square to determine the independence of key variables. RESULT: Data from 145 speech-language pathologists highlight the need for increased numbers of clinicians working outside of metropolitan areas and greater workforce diversity, along with increased incentive, supervision and inter-professional support for new graduate and early career clinicians considering working outside of hospital settings. To ensure evidence-based practice, further research into the validity of current assessment and intervention methods used across aged care settings is needed. CONCLUSION: The findings highlight the need for an extended scope of practice and improved models of support for speech-language pathologists working with older people to better respond to the needs of an ageing population and on-going aged care sector reform.

Managing and supporting quality-of-life issues in dysphagia: A survey of clinical practice patterns and perspectives in the UK, Ireland and South Africa.

BACKGROUND: There is increasing recognition that dysphagia has significant implications for a person's psychological well-being, social participation and quality of life (QOL). However, a paucity of research exists regarding the clinical management of this area. To inform future research and the development of appropriate and beneficial resources and guidelines, a better understanding of the current practice of speech and language therapists (SLTs) in this area would be useful. This information will highlight current challenges to clinical practice and the ongoing development needs of the profession, which are, as of yet, undocumented. AIMS: To determine the practices of SLTs when addressing QOL issues in individuals with dysphagia, the beliefs of SLTs regarding the impact of dysphagia on QOL, the current trends in assessing and managing QOL in dysphagia, and if variations in beliefs and practices in this area exist. METHODS & PROCEDURES: An anonymous cross-sectional, non-experimental survey study was used. The survey consisted of 18 questions exploring participants' beliefs and opinions regarding dysphagia and QOL, current clinical practice in the area, perceived facilitators and barriers, and education, training and development needs. The survey was created on Survey Monkey and disseminated by e-mail link to SLT professional bodies. Purposive and snowball sampling were used and participants self-selected based on the information provided alongside the e-mail link. Inclusion criteria for the study were a qualification in speech and language therapy, proficiency in the English language, and access to a computer with the internet. OUTCOMES & RESULTS: A total of 148 SLTs working across the UK, Ireland and South Africa completed the survey. Over 90% of respondents believe that dysphagia has a negative impact on QOL, but only 25% are currently satisfied with the amount of clinical time they can dedicate to this area. Staffing, resources, a lack of best-practice guidelines and disease-specific QOL assessment tools were cited as contributing factors. A number of facilitators and barriers to best practice were also highlighted. Based on these findings, professional development actions for the future are suggested. CONCLUSIONS & IMPLICATIONS: SLTs believe they have an important role to play in supporting QOL issues in dysphagia. However, it is reported that the area is currently under-developed, under-resourced and under-supported. Increased awareness raising of the role of SLT, alongside the development of best-practice guidelines and disease-specific QOL assessment tools, will enhance the quality of care that can be offered in this area.

Current Practice of Child Grammar Intervention: A Survey of Speech-Language Pathologists.

Purpose: The aim of this study was to better understand current grammatical intervention approaches. Despite grammatical language being a common weakness among children with language impairment, relatively little is known about current grammatical intervention practices of speech-language pathologists (SLPs). Such information is needed to guide the development and evaluation of grammatical interventions and to identify areas in which the current practice is not empirically supported. Method: Participants included 338 SLPs working primarily with children. Participants completed an online survey regarding their implementation of nine different grammatical intervention components, including goals, procedures, dosage, agents, contexts, goal attack strategies, service delivery models, activities, and outcome measurements. Participants also indicated how they would alter the intervention setting and dosage if resources were unlimited. Results: We grouped participants based on the ages of children that represent the largest percentage of their caseload resulting in an early education group (n = 114) and an elementary group (n = 224). We aggregated responses from each question to gain an estimate of current implementation practices associated with each intervention component queried. Conclusions: This study provides general guidelines of current clinical practices to help guide research on grammatical interventions for children and to promote successful translation and implementations of evidence-based treatment approaches. Results may also help clinicians and researchers better understand misalignments between empirically supported intervention approaches and current approaches for treating grammatical weaknesses.

The Effect of Improved Dysphagia Care on Outcome in Patients with Acute Stroke: Trends from 8-Year Data of a Large Stroke Register.

BACKGROUND: Early dysphagia screening and appropriate management are recommended by current guidelines to reduce complications and case fatality in acute stroke. However, data on the potential benefit of changes in dysphagia care on patient outcome are limited. Our objective was to assess the degree of implementation of dysphagia guidelines and determine the impact of modifications in dysphagia screening and treatment practices on disease complications and outcome in stroke patients over time. METHODS: In this prospective register-based study ("Stroke Register of Northwestern Germany"), all adult stroke patients admitted to 157 participating hospitals between January, 2008 and December, 2015 were included (n = 674,423). Dysphagia incidence upon admission, the proportion of patients receiving a standardized swallowing screening, and the percentage of dysphagic patients being referred to a speech language therapist (SLT) for treatment were obtained per year. Pneumonia rate, modified Rankin Scale (mRS) at discharge, and in-hospital mortality were compared between groups of dysphagic vs. non-dysphagic patients over time. RESULTS: Screening proportions continuously increased from 47.2% in 2008 to 86.6% in 2015. But the proportion diagnosed with dysphagia remained stable with about 19%. The number of dysphagic patients receiving SLT treatment grew from 81.6 up to 87.0%. Pneumonia incidence was higher in dysphagic stroke cases (adjusted OR 5.4 [5.2-5.5], p < 0.001), accompanied by a worse mRS at discharge (adjusted OR for mRS ≥3: 3.1 [3.0-3.1], p < 0.001) and higher mortality (adjusted OR 3.1 [3.0-3.2], p < 0.001). The order of magnitude of these end points did not change over time. CONCLUSION: Although advances have been made in dysphagia care, prevalent screening and treatment practices remain insufficient to reduce pneumonia rate, improve functional outcome, and decrease case fatality in dysphagic stroke patients. More research is urgently needed to develop more effective swallowing therapies.

The Future of Pediatric Speech-Language Pathology in a More Collaborative World.

Examining interprofessional practice through the lens of speech-language pathology identifies a number of challenges to and opportunities for interprofessional practice. While practitioners believe they practice interprofessionally, health services are often distributed across a network within which collaboration can falter. Certain professions, like speech-language pathology, are well-positioned to work across this network and improve care. Barriers to collaboration are interpersonal, structural, regulatory, and governmental. To enhance interprofessional practice, students should receive interprofessional education; practitioners should engage in interprofessional continuing education based on their practice environment; and leaders and researchers should identify frameworks to support better interprofessional practice.

Automatic speech recognition: A primer for speech-language pathology researchers.

Automatic speech recognition (ASR) is increasingly becoming an integral component of our daily lives. This trend is in large part due to recent advances in machine learning, and specifically in deep learning, that have led to accurate ASR across numerous tasks. This has led to renewed interest in providing technological support to populations whose speech patterns are atypical, including identifying the presence of a specific pathology and its severity, comparing speech characteristics before and after a surgery and enhancing the quality of life of individuals with speech pathologies. The purpose of this primer is to bring readers with relatively little technical background up to speed on fundamentals and recent advances in ASR. It presents a detailed account of the anatomy of modern ASR, with examples of how it has been used in speech-language pathology research.

Speech-Language Pathologists' Use of Intelligibility Measures in Adults With Dysarthria.

PURPOSE: Speech-language pathologists (SLPs) who work with adults with dysarthria were surveyed to investigate trends of clinical practice for assessing speech intelligibility. METHOD: Two hundred ninety-six SLPs responded to an online survey October 22-November 30, 2015. RESULTS: Findings showed that 35% of SLPs lacked access to any standardized assessments of intelligibility, with 66% of these implicating cost as the main reason. Work settings played a role, as all SLPs working in Veterans Affairs hospitals and 97% of SLPs working in university or research clinics reported access to at least one formal assessment. Even with access to formal tools to measure intelligibility, most SLPs preferred less formal measures. It is surprising to note that many SLPs reported using physical examinations (e.g., of cranial nerves and oral mechanisms) to measure speech intelligibility. CONCLUSIONS: Results indicate the need to increase SLP familiarity with, and access to, currently available standardized assessments, as well as to improve education regarding the fundamental need to rate speech to assess intelligibility. Clinicians may also benefit from new standardized methods to objectively assess intelligibility that are accessible, practical, and efficient.

Reflexiones para mejorar la práctica logopédica / Ideas on how to improve speech therapy practice

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Análisis bibliométrico de la Revista de Logopedia, Foniatría y Audiología: 2000-2016 / Bibliometric analysis of the Revista de Logopedia, Foniatría y Audiología: 2000-2016

Introducción. El objetivo de este trabajo es presentar la producción científica de la Revista de Logopedia, Foniatría y Audiología (RLFA). Metodología. Se desarrolla un estudio descriptivo-retrospectivo de la RLFA a partir de los 344 artículos recogidos en los 108 números publicados en el período comprendido entre los años 2000 y 2016, ambos incluidos. Resultados. Siguiendo el criterio del índice de colaboración, la RLFA se encuentra en vías de madurez científica. Además, se observa un buen patrón de ajuste a la ley de Lotka. En los 344 artículos analizados se han citado 961 revistas diferentes, destacándose Journal of Speech and Hearing Disorders como la primera, seguida de Journal of Speech Language and Hearing Research y de Brain and Language. Además, se han producido 43 artículos con colaboración internacional entre diferentes instituciones. Discusión y conclusiones. Se proponen una serie de sugerencias que la RLFA puede considerar con el propósito de alcanzar una mayor difusión y reconocimiento en el ámbito internacional (AU)

Introduction. The aim of this paper is to present the scientific production of Revista de Logopedia, Foniatría y Audiología (RLFA). Methodology. A descriptive-retrospective study of the RLFA was developed based on the 344 articles collected in the 108 issues published between the years 2000 and 2016, inclusively. Results. Following the criterion of the Collaboration Index, RLFA is in the process of scientific maturity. In addition, a good pattern adjusted to Lotka's Law is observed. In the 344 articles analysed, 961 different journals have been cited, highlighting the Journal of Speech and Hearing Disorders, followed by Journal of Speech Language and Hearing Research, and Brain and Language. In addition, 43 articles have been written with international collaboration between different institutions. Discussion and conclusions. A series of suggestions are proposed for the RLFA to consider in order to achieve greater coverage and recognition at international level (AU)

Content analysis of the professional journal of the Royal College of Speech and Language Therapists, III: 1966-2015-into the 21st century.

BACKGROUND: Following content analyses of the first 30 years of the UK speech and language therapy professional body's journal, this study was conducted to survey the published work of the speech (and language) therapy profession over the last 50 years and trace key changes and themes. AIM: To understand better the development of the UK speech and language therapy profession over the last 50 years. METHODS & PROCEDURES: All volumes of the professional journal of the Royal College of Speech and Language Therapists published between 1966 and 2015 (British Journal of Communication Disorders, European Journal of Communication Disorders and International Journal of Language and Communication Disorders) were examined using content analysis. The content was compared with that of the same journal as it appeared from 1935 to 1965. OUTCOMES & RESULTS: The journal has shown a trend towards more multi-authored and international papers, and a formalization of research methodologies. The volume of papers has increased considerably. Topic areas have expanded, but retain many of the areas of study found in earlier issues of the journal. CONCLUSIONS & IMPLICATIONS: The journal and its articles reflect the growing complexity of conditions being researched by speech and language therapists and their professional colleagues and give an indication of the developing evidence base for intervention and the diverse routes which speech and language therapy practice has taken over the last 50 years.

Dysphagia Management in the Schools: Past, Present, and Future.

As the number of speech-language pathologists (SLPs) responsible for swallowing and feeding services in the educational setting increases, guidance informing this specialized practice continues to emerge. Although SLPs have provided dysphagia management for children in medical settings for many years, the extension of dysphagia services to the schools is comparatively new. This shift in care delivery for what was previously a hospital-based practice is now occurring more frequently, and in an environment void of extensive medical supports (i.e., the schools). With this transition, evidence-based approaches tailored to children with dysphagia receiving intervention in the school setting are paramount. Components that appear critical to this evolving specialty area include research, best practice guidelines, knowledge and skills training, and collaboration across professionals. This article addresses these pertinent issues by reflecting upon the past, reviewing the present, and planning for the future.

Instrumental Assessment of Pediatric Dysphagia.

Speech-language pathologists (SLPs) have fulfilled primary roles in the evaluation and management of children with feeding/swallowing disorders for more than five decades. The increased incidence and prevalence of newborns, infants, and children with feeding and swallowing disorders has resulted in increased use of instrumental swallowing evaluations. The videofluoroscopic swallow study and fiberoptic endoscopic evaluation of swallowing are the two most commonly used swallowing assessments by SLPs, with ultrasound used less frequently. This article focuses on updates over the past decade in the procedures and utility of instrumental assessments of swallowing function, and identifies future directions that may enable us to meet the needs of the children who are in our care to attain functional outcomes.