What is Effective in Massage Therapy? Well, "It Depends ": a Qualitative Study of Experienced Orthopaedic Massage Therapists.

Background: Massage has been used as a treatment for musculoskeletal pain throughout history and across cultures, and yet most meta-analyses have only shown weak support for the efficacy of massage. There is a recognised need for more research in foundational questions including: how massage treatments are constructed; what therapists actually do within a treatment, including their clinical reasoning; and what role therapists play in determining the effectiveness of a massage treatment. Purpose: The aim of this study was to explore what experienced orthopaedic massage therapists consider to be the aspects of their work that contribute to effectiveness. Setting and Participants: Semi-structured interviews were conducted via Zoom with six experienced orthopaedic massage therapists in Australia. Research Design: The interviews were analysed using inductive thematic analysis, seeking insights that might be practically applied, rather than theory-driven interpretations. Results: The participants focused on the underlying differences between clients, between therapists, and between treatments, and clearly indicated that this concept of "difference" was foundational to their view of their work and was the underlying context for the comments they made. Within that frame of "difference", three key themes were interpreted from the data: (1) "Everyone is different so every treatment is different": how they individualised treatment based on these differences; (2) "How therapists cope with difference": how they managed the challenges of working in this context; and (3) "What makes a difference": the problem-solving processes they used to target each treatment to meeting the client's needs. Conclusions: Participants did not identify specific techniques or modalities as "effective" or not. Rather, a therapist's ability to provide effective treatment was based on an iterative process of treatment and assessment that allowed them to focus on the individual needs of the client. In this case "effectiveness" could be considered a process rather than a specific massage technique.

Intervention for residual speech errors in adolescents and adults: A systematised review.

When speech sound errors persist beyond childhood they are classified as residual speech errors (RSE) and may have detrimental impacts on an individual's social, educational and employment participation. Despite this, individuals who present with RSE are usually not prioritised on large caseloads. The aim of this literature review was to examine what intervention approaches are available in remediating RSE, and how effective are they for adolescents and adults? A systematised review was undertaken. Comprehensive and systematic searching included search of terms across seven databases, forward and reverse citation searching, and key author contact. Thirty articles underwent critical appraisal before data extraction. Inductive thematic analysis was done before completion of a narrative review. Twenty-three (76.6%) of the articles were from the US and most studies involved intervention for 'r' (90%). Intervention approaches for RSE involved traditional articulation therapy, auditory perceptual training, instrumental approaches, and approaches based on principles of motor learning. Twenty-one studies (70%) investigated the use of more than one intervention approach. Measures of intervention efficacy varied between studies; however, any intervention approach tended to be more successful if delivered in a more intensive schedule. A variety of approaches can be used for RSE, but a combination of high intensity, traditional therapy with adjunctive instrumental biofeedback may be most effective, especially with highly motivated individuals. Unfortunately, this usually requires costly equipment and training to implement. More information about the best dosage and intensity intervention for RSE, evaluated for a larger number of phonemes across other languages and dialects is required.

Family-centred practice in speech-language pathology practice with children and young people in out-of-home care in Australia: A scoping review.

Purpose: Communication difficulties are more common in children or young people (CYP) who have lived in out-of-home care (OOHC) compared to the general population. Principles of family-centred practice (FCP) are frequently utilised by speech-language pathologists (SLPs) when working with CYP with communication difficulties. The aim of this scoping review was to describe how the principles of FCP are applied in the literature to speech-language pathology practice with CYP aged 0-18 in OOHC in Australia.Method: A scoping review protocol was applied to identify published literature related to Australian speech-language pathology practice with CYP in OOHC. Four databases were searched with no date limitations and five publications were included after quality appraisal.Result: Data extraction and thematic analysis identified several major themes: sharing information, liaison and working together, and responding to the CYP's behaviour as non-verbal communication to inform decision making. However, only one study referenced FCP explicitly.Conclusion: The review found that Australian SLPs are implementing FCP when working with CYP with communication difficulties in OOHC. However, scope for potential improvement was identified in the application of FCP principles with respect to the CYPs' birth parents and cultural representatives, as well as the goal setting and evaluation phases of the clinical cycle.

Attitudes toward the use of low-tech AAC in acute settings: a systematized review.

The purpose of this systematized review was to investigate how attitudes toward low-tech AAC might be impacting its use in acute care settings. A comprehensive and systematic search of databases identified 23 articles for inclusion. Thematic analysis using the World Health Organization International Classification of Functioning, Disability and Health (ICF) framework facilitated a narrative synthesis of findings. Results suggest that in acute care settings (a) adult patients, families, nursing staff, medical team, and allied health professionals all have opportunities to use but do not regularly engage with AAC; (b) individuals reject low-tech AAC devices for a variety of reasons, including that they are not useful, necessary, suitable, or appropriate in settings such as intensive care units; (c) negative attitudes toward AAC are linked to a lack of initial training and ongoing support, perceived impersonal content, limited functionality, and a lack of consistent availability; and (d) positive attitudes toward low-tech AAC are more prevalent when training and support are offered, low-tech AAC effectiveness is demonstrated, and organizational, financial, and procedural commitments are provided. Limitations of the research are highlighted and future research opportunities are identified.

Fijian school students' Fiji English speech sound acquisition.

Purpose: The aim of this study was to investigate Fijian students' acquisition of Fiji English speech sounds.Method: Participants were 72 multilingual students (5-10 years) living in Fiji who spoke the Fijian or Fiji Hindi dialects of Fiji English. The students' productions of single words from the Diagnostic Evaluation of Articulation and Phonology (DEAP) were analysed according to dialect using the Children's Independent and Relational Phonological Analysis (CHIRPA).Result: Most English consonants were acquired by 6;0. English consonants that were not in the inventories of Fijian or Fiji Hindi were the last acquired, while those that were common between English and the two languages were some of the earlier acquired consonants. Percentage of consonants correct (PCC) for Fiji English was significantly lower for Grade 1 students (M = 93.01, SD = 0.07) in comparison to Grade 4 students (M = 99.03, SD = 0.01). Plosive and nasal sounds were acquired by 90% of the students earlier than fricative, approximant and affricate sounds, though acquisition of some plosive and fricative sounds varied between Fiji English dialects. All word-initial consonant clusters were acquired by 90% of the students by 9;6, with r-clusters tending to be the latest acquired. The acquisition of word-final consonant clusters was highly variable as students often produced appropriate dialectal variants.Conclusion: Multilingual Fijian children may acquire English specific sounds later than their monolingual English-speaking peers. Consideration of the language environment and analysis of the speech sample with reference to the child's dominant English dialect is imperative for valid identification of speech sound disorder (SSD) in children who speak different dialects of English.

Advancing Workplace Diversity Through the Culturally Responsive Teamwork Framework.

Purpose Diversification of the profession is an important element of combating racism, bias, and prejudice in the speech-language pathology workforce at national and systemic levels. However, national and systemic change needs to be combined with equipping individual speech-language pathologists to adapt to the challenges that they face to engaging in culturally responsive practice. This paper presents four interacting levels of practice within the Culturally Responsive Teamwork Framework (CRTF): (a) intrapersonal practices, (b) interpersonal practices, (c) intraprofessional practices, and (d) the interprofessional practices. Conclusion CRTF is a practical, strengths-based framework that draws on international research and expertise to expand personal and professional practice and describe critical behaviors within the workplace that can be used to promote principles of evidence-based practice and social justice, especially when working with people from nondominant cultural or linguistic groups.

Waiting lists and prioritization of children for services: Speech-language pathologists' perspectives.

BACKGROUND: Waiting lists occur when the availability of speech-language pathology services does not meet the demand. Speech-language pathologists (SLPs) commonly manage waiting lists and their consequences using prioritization. AIMS: The aims of this study were to: (1) describe speech-language pathology waiting lists for children and factors associated with their presence in workplaces throughout the world, and (2) describe factors considered in and influencing SLPs' prioritization of children for services. METHODS: A questionnaire about pediatric waiting lists and prioritization was completed by 267 SLPs from 10 countries working in health, disability, education, and private sectors. Valid responses to closed questions from 264 SLPs were analyzed quantitatively. RESULTS: Most (73.6 %) SLPs reported having a waiting list in their workplace. Waiting lists were most common in community health centres (97.4 %). Waiting times ranged from 0 to 42 months (M = 8.09, SD = 5.84). High priority was assigned to infants (77.4 %), toddlers (65.3 %), children with feeding difficulties (88.5 %), and children who stutter (47.4 %). Prioritization parameters ranked as most important were: severity (M = 4.34), availability of resources (M = 4.11), diagnosis (M = 4.04), and age (M = 3.91). CONCLUSIONS: Many workplaces have long waiting lists for speech-language pathology services. Young children, feeding, and stuttering were most often considered high priority; however, prioritization can be complex, implicit, and influenced by external factors. Collaborative development of explicit, transparent waiting list and prioritization guidelines within workplaces, and the development and evaluation of active waiting strategies for children and families are recommended.

Communication Capacity Research in the Majority World: Supporting the human right to communication specialist services.

Receipt of accessible and appropriate specialist services and resources by all people with communication and/or swallowing disability is a human right; however, it is a right rarely achieved in either Minority or Majority World contexts. This paper considers communication specialists' efforts to provide sustainable services for people with communication difficulties living in Majority World countries. The commentary draws on human rights literature, particularly Article 19 of the Universal Declaration of Human Rights and the Communication Capacity Research program that includes: (1) gathering knowledge from policy and literature; (2) gathering knowledge from the community; (3) understanding speech, language and literacy use and proficiency; and (4) developing culturally and linguistically appropriate resources and assessments. To inform the development of resources and assessments that could be used by speech-language pathologists as well as other communication specialists in Fiji, the Communication Capacity Research program involved collection and analysis of data from multiple sources including 144 community members, 75 school students and their families, and 25 teachers. The Communication Capacity Research program may be applicable for achieving the development of evidence-based, culturally and linguistically sustainable SLP services in similar contexts.

Communication disability in Fiji: Community self-help and help-seeking support.

PURPOSE: To understand how a Fijian community supports people with communication disability (PWCD) and whether their support is associated with participant demographics. METHOD: Thematic analysis of 144 questionnaires that asked about participants' actions to support a fictional child and adult with communication disability. RESULT: Participant responses fell into two categories: what they would do directly (self-help) and people and places where they would seek assistance (help-seeking). Self-help behaviours included: making a change to their own communication style or mode; trying to change their own and others' behaviour; teaching new skills; praying; changing the physical environment; seeking information independently; assessing or observing; and, using traditional medicine, western medicine, or traditional belief practices. Help-seeking behaviours included seeking help from: other community members; education professionals; a professional in another country; spiritual leaders; traditional belief practitioners; traditional medicine practitioners; western health care practitioners; or, an alternative provider (e.g. home, orphanage, nursing home). Younger participants and those of iTaukei Fijian ethnicity were more likely to seek help from other community members. CONCLUSION: This Fijian community actively supports people with communication disability within available networks. Development of speech-language pathology services for people with communication disability living in similar communities should harness the informal knowledge within these networks.

Validation of the Intelligibility in Context Scale for school students in Fiji.

Fiji is a multilingual nation with few assessment tools addressing children's communication. This article describes the validation of the Intelligibility in Context Scale for Fiji English, Standard Fijian, and Fiji Hindi. Informants were caregivers of 65 typically developing multilingual children (aged 5;3-10;5) attending a Fiji primary school. The students spoke an average of 2.9 languages (range = 1-5). Their main language was Standard Fijian (41.5%), Fiji Hindi (23.1%), Fiji English (20.0%), or Fijian dialect (15.4%). An ICS mean score of 4.6 was obtained for main language (ICS-ML) and 4.4 for Fiji English (ICS-FE) indicating that students were usually to always intelligible. There were no significant differences between main language, number of languages spoken, gender, age, or socio-economic status. Both scales had good internal consistency, but were not correlated with speech accuracy measures possibly due to ceiling effects. Further validation with younger children is recommended. The ICS may be a useful tool for Fiji with comparative results to other international studies.

Services for people with communication disability in Fiji: barriers and drivers of change.

CONTEXT: The World Health Organization's World report on disability calls upon all nations to 'remove the barriers which prevent [people with disabilities] from participating in their communities; getting a quality education, finding decent work, and having their voices heard' (p. 5). People with communication disability (PWCD), as a consequence of their atypical communication, may be more likely to be excluded from society, and denied their basic human rights, than other people with disability. Fiji, a multicultural and multilingual nation in the south-western Pacific Ocean, has limited services for PWCD. Service providers in Fiji include disability care workers, special education teachers, traditional healers, and a small number of visiting volunteer speech-language pathologists. This paper outlines the historical and current barriers to, and drivers of change for, service development for PWCD in Fiji. ISSUES: Five barriers to service development for PWCD in Fiji were identified. (1) A major structural barrier is the small population size to develop appropriate infrastructure including professional education programs. (2) Geographical barriers include the dispersed geography across 300 islands, low population density, the rural-urban divide, and risk of disaster from cyclones and flooding. (3) Linguistic diversity, while culturally important, can present a barrier to the provision of quality services that are available in the languages spoken by PWCD. (4) Cultural barriers include historical political instability, although Fiji has become more stable due to the recent democratic elections. The social climate affects development of services that are appropriate for different dominant cultural groups. (5) Financial barriers include low gross domestic product, low financial security and low human development index; however, the financial outlook for Fiji is steadily improving due to the change in political stability. LESSONS LEARNED: Three levels of drivers of change were identified. Macro-level drivers included Fiji's endorsement of international policy and increased globalisation (eg tourism). Meso-level drivers of change included receipt of foreign aid and support from international non-government organisations, development of disability-inclusive legislation and policy within Fiji, and strengthening of government policies that support disabled people's organisations. Micro-level drivers of change included establishment of disabled people's organisations by consumers, adoption of disability-inclusive policy and procedures by service providers, and changes in the perceptions of disability within the general community. Fijian prevalence data confirms that there is an underserved population of PWCD in need of specialist services. Significant advocacy work in the disability field by Fijian and international disabled people's organisations has led to the Fiji government signing international policy (eg Convention on the Rights of Peoples with Disabilities), inclusion of disability rights in national legislation (eg 2013 Constitution of Fiji Islands) and localised policy and practice documentation (eg inclusive education policy by the Fiji Islands Ministry of Education). Continued service development is required if Fijians with communication disability are to have their needs met. The drivers of change at all levels are positioned well to overcome current barriers to change; however, a coordinated approach including macro-, meso-, and micro-level drivers is required to ensure the future development of adequate services for PWCD in Fiji.