Speech, Language, and Communication in a Public Health Context: A UK Perspective with Potential Global Application - An Opinion Piece.

Speech and language therapists often contribute to public awareness campaigns as well as supporting, teaching and promoting the facilitation of speech, language, communication, and safe swallowing with the general public and health and social care professionals. These are sometimes considered as public health interventions. It is important to consider the objectives, costs, and impact of this involvement in the same way as reviewing the evidence associated with the more personally targeted interventions with individuals or groups of clients with specific conditions. This opinion piece discusses speech and language therapy in the context of public health, clarifies the terminology, and proposes different approaches to demonstrate its influence associated with its objectives. The content has been informed by a Working Party of the Royal College of Speech and Language Therapists (2017-2018).

Age-related differences in conversational discourse abilities: a comparative study / Diferenças relacionadas à idade nas habilidades do discurso conversacional: um estudo comparativo

ABSTRACT: Conversational discourse (CD) is among the most complex tasks in everyday life and relies on multiple cognitive domains (communicative and executive abilities). Alterations in discourse comprehension and production are often present in pathological aging. However, there is still a need to identify changes in healthy aging. Objective: This study aimed to compare young and older adults for the frequency of impaired communicative behaviors on a CD task. Performance was scored according to the Complementary Procedure of Conversational Discourse Analysis (CPCDA), developed based on the CD task from the Montreal Communication Evaluation Battery. Methods: A total of 95 participants (54 young-adults and 41 older adults) were evaluated. The frequency of communicative behaviors was compared between groups using MANCOVA and Chi-square tests. Results: Young adults showed fewer impairments in expression, pragmatics, cohesion, coherence, comprehension and emotional prosody. Older adults showed higher levels of verbal initiative and had fewer word finding difficulties. Communicative behaviors associated with planning and self-monitoring (e.g. repetition of information and syllabic false starts) appear to be common in the speech of healthy individuals in general. Conclusion: Studies which evaluate both discursive and cognitive skills are required to identify age-related changes. This would allow for the development of screening tools for CD assessment and preventive programs.

RESUMO: O discurso conversacional (DC) está entre as tarefas diárias mais complexas e dependentes de múltiplos domínios cognitivos (habilidades comunicativas e executivas). Alterações na compreensão e produção do discurso são relatadas classicamente durante o envelhecimento patológico. No entanto, ainda é necessário esclarecer mudanças no envelhecimento saudável. Objetivo: Este estudo tem como objetivo comparar jovens adultos e idosos quanto à frequência de comportamento comunicativo desviante em uma tarefa de DC utilizando o Procedimento Complementar de Análise do Discurso Conversacional (PCADC), inspirado na tarefa de DC da Bateria Montreal de Avaliação da Comunicação. Métodos: Um total de 95 indivíduos (54 adultos jovens e 41 idosos) foram avaliados. A frequência dos comportamentos comunicativos desviantes foi comparadas entre os grupos usando análise MANCOVA e Qui-quadrado. Resultados: Adultos jovens apresentaram melhor desempenho nas habilidades comunicativas referentes à: expressão, pragmática, coesão, coerência, compreensão e linguística prosódica e emocional. O grupo de idosos obteve melhor desempenho nas variáveis: "falta de iniciativa verbal" e "procura ou troca palavra" do que os jovens. Itens associados ao planejamento da fala e auto-monitoramento (ex: "repete informações" e "realiza false start"), parecem estar associados a um comportamento comum na fala de indivíduos saudáveis em geral. Conclusão: Estudos que avaliem habilidades discursivas e cognitivas são necessários para identificar mudanças ​​influenciadas pela idade. Dessa forma, seria possível propor uma ferramenta de triagem para avaliação discursiva, bem como programas de intervenção preventiva.

Parent-Implemented Communication Treatment for Infants and Toddlers With Hearing Loss: A Randomized Pilot Trial.

Purpose Despite advances in cochlear implant and hearing aid technology, many children with hearing loss continue to exhibit poorer language skills than their hearing peers. This randomized pilot trial tested the effects of a parent-implemented communication treatment targeting prelinguistic communication skills in infants and toddlers with hearing loss. Method Participants included 19 children between 6 and 24 months of age with moderate to profound, bilateral hearing loss. Children were randomly assigned to the parent-implemented communication treatment group or a "usual care" control group. Parents and children participated in 26, hour-long home sessions in which parents were taught to use communication support strategies. The primary outcome measures were the Communication and Symbolic Behavior Scales (Wetherby & Prizant, 2003), a measure of child prelinguistic skills, and parental use of communication support strategies during a naturalistic play session. Results Parents in the treatment group increased their use of communication support strategies by 17%. Children in the treatment group made statistically significant more gains in speech prelinguistic skills ( d = 1.09, p = .03) as compared with the control group. There were no statistically significant differences in social and symbolic prelinguistic skills; however, the effect sizes were large ( d = 0.78, p = .08; d = 0.91, p = .10). Conclusions This study provides modest preliminary support for the short-term effects of a parent-implemented communication treatment for children with hearing loss. Parents learned communication support strategies that subsequently impacted child prelinguistic skills. Although these results appear promising, the sample size is very small. Future research should include a larger clinical trial and child-level predictors of response to treatment.

[The rehabilitation of the children with a cochlear implant as a way to the promotion of the natural development of the auditory perception, communication, and speech]. / Reabilitatsiia detei s kokhlearnym imalantom kak perevod na put' estestvennogo razvitiia slukhovogo vospriiatiia, kommunikatsii i rechi.

The objective of the present study was to substantiate and present the new approach to the rehabilitation of the children with cochlear implants (CI), the so-called ZP-rehabilitation, with special reference to its principal systemic differences from the 'hearing-speech' rehabilitation. The new method was tested in the course of rehabilitation of 90 deaf and dumb children having cochlear implants since the early and preschool age with the participation of 152 members of their families. As a result of the rehabilitative treatment, all the children included in the study were put on the way of the natural (normal) development of the auditory perception, communication, and speech while all the adults could communicate with the children on the natural sensory basis. It is concluded that the ZP-rehabilitation enables the child with a cochlear implant to embark on the path of the natural (normal) development and to pass (on the new natural sensory basis) through those early stages of ontogenesis that the deaf and dumb child and his relatives had gone through during the preceding period; moreover it helps to rearrange the relations between the child and his family on this new sensory basis.

Gluten- and casein-free diet and autism spectrum disorders in children: a systematic review.

PURPOSE: Effective treatments for core symptoms of autism spectrum disorders (ASD) are lacking. We systematically updated evidence on the effectiveness of a gluten-free and casein-free (GFCF) diet as a treatment for ASD in children. METHODS: The Cochrane Library, MEDLINE, and EMBASE databases were searched up until August 2016, for randomized controlled trials (RCTs); additional references were obtained from reviewed articles. RESULTS: Six RCTs (214 participants) were included. With few exceptions, there were no statistically significant differences in autism spectrum disorder core symptoms between groups, as measured by standardized scales. One trial found that compared with the control group, in the GFCF diet group there were significant improvements in the scores for the 'communication' subdomain of the Autism Diagnostic Observation Schedule and for the 'social interaction' subdomain of the Gilliam Autism Rating Scale. Another trial found significant differences between groups in the post-intervention scores for the 'autistic traits', 'communication', and 'social contact' subdomains of a standardized Danish scheme. The remaining differences, if present, referred to parent-based assessment tools or other developmental/ASD-related features. No adverse events associated with a GFCF diet were reported. CONCLUSIONS: Overall, there is little evidence that a GFCF diet is beneficial for the symptoms of ASD in children.

A household-based study of contact networks relevant for the spread of infectious diseases in the highlands of Peru.

BACKGROUND: Few studies have quantified social mixing in remote rural areas of developing countries, where the burden of infectious diseases is usually the highest. Understanding social mixing patterns in those settings is crucial to inform the implementation of strategies for disease prevention and control. We characterized contact and social mixing patterns in rural communities of the Peruvian highlands. METHODS AND FINDINGS: This cross-sectional study was nested in a large prospective household-based study of respiratory infections conducted in the province of San Marcos, Cajamarca-Peru. Members of study households were interviewed using a structured questionnaire of social contacts (conversation or physical interaction) experienced during the last 24 hours. We identified 9015 reported contacts from 588 study household members. The median age of respondents was 17 years (interquartile range [IQR] 4-34 years). The median number of reported contacts was 12 (IQR 8-20) whereas the median number of physical (i.e. skin-to-skin) contacts was 8.5 (IQR 5-14). Study participants had contacts mostly with people of similar age, and with their offspring or parents. The number of reported contacts was mainly determined by the participants' age, household size and occupation. School-aged children had more contacts than other age groups. Within-household reciprocity of contacts reporting declined with household size (range 70%-100%). Ninety percent of household contact networks were complete, and furthermore, household members' contacts with non-household members showed significant overlap (range 33%-86%), indicating a high degree of contact clustering. A two-level mixing epidemic model was simulated to compare within-household mixing based on observed contact networks and within-household random mixing. No differences in the size or duration of the simulated epidemics were revealed. CONCLUSION: This study of rural low-density communities in the highlands of Peru suggests contact patterns are highly assortative. Study findings support the use of within-household homogenous mixing assumptions for epidemic modeling in this setting.

Assessment of the feasibility and clinical value of further research to evaluate the management options for children with Down syndrome and otitis media with effusion: a feasibility study.

BACKGROUND: There is clinical uncertainty of the benefits and costs of different treatment options for children with Down syndrome who have glue ear. This study was designed to assess the extent of this lack of knowledge and determine if pursuing further information would be practical, beneficial and cost-effective. OBJECTIVES: To assess the level and practical effect of current uncertainty around treatment options for children with Down syndrome and glue ear. To assess the feasibility of studying the options for management of glue ear in children with Down syndrome via a randomised controlled trial (RCT) or multicentre prospective cohort study by evaluating the willingness of (1) parents to agree to randomisation for their children and (2) clinicians to recruit participants to a definitive study. To undertake value of information analyses to demonstrate the potential economic benefit from undertaking further research. DESIGN: A feasibility study exploring the views of parents of children with Down syndrome and professionals who have responsibility for the health and education of children with Down syndrome, on the participation in, and value of, future research into interventions for glue ear. Data were collected from parents via self-completed questionnaires, face-to-face interviews and focus groups and from professionals via online questionnaires and a Delphi review exercise. Development of economic models to represent clinical pathways of care and a RCT informed a value of information (VOI) analysis. SETTING: UK (professionals); East Midlands region of the UK (parents). PARTICIPANTS: Parents of children aged 1-11 years with Down syndrome (n = 156). Professionals including audiologists, ear, nose and throat surgeons, audiological physicians, speech and language therapists, and teachers of the deaf (n = 128). MAIN OUTCOME MEASURES: Quantitative and qualitative data on parental views and experiences of glue ear and its effects; interventions and treatment received; taking part in research and factors that would encourage or discourage participation; and the importance of various outcome domains to them and for their children. For professionals: information on caseloads; approaches to clinical management; opinions on frequency and significance of the consequences of glue ear for this population; importance of different outcome measures; opinions of interventions and their role in future research; views on health research; facilitators and barriers to recruitment, and participation in research involving RCTs. RESULTS: The complexity of the experience and individual characteristics of children with Down syndrome poses challenges for the design of any future research but these challenges were not considered by professionals to raise sufficient barriers to prevent it being undertaken. Parents were generally supportive of the need for, and value of, research but identified practical and emotional issues that would need addressing. Glue ear was considered to impact more on speech, language and communication than on hearing. Outcome measures for future research would need to evaluate these elements but measures should be designed specifically for the population. Parents and professionals identified randomisation as a significant barrier to participation. The VOI analyses identified lack of data as problematic but concluded that a future trial involving surgical intervention would be feasible at costs of < £650,000. CONCLUSIONS: Future research into the benefits of interventions for glue ear in children with Down syndrome would be feasible and could be cost-effective but should be carefully designed to facilitate and maximise participation from parents and professionals responsible for recruitment. FUNDING: The National Institute for Health Research Health Technology Assessment programme.

Adopting public health approaches to communication disability: challenges for the education of speech-language pathologists.

Public health approaches to communication disability challenge the profession of speech-language pathology (SLP) to reconsider both frames of reference for practice and models of education. This paper reviews the impetus for public health approaches to communication disability and considers how public health is, and could be, incorporated into SLP education, both now and in the future. The paper describes tensions between clinical services, which have become increasingly specialized, and public health approaches that offer a broader view of communication disability and communication disability prevention. It presents a discussion of these tensions and asserts that public health approaches to communication are themselves a specialist field, requiring specific knowledge and skills. The authors suggest the use of the term 'communication disability public health' to refer to this type of work and offer a preliminary definition in order to advance discussion. Examples from three countries are provided of how some SLP degree programmes are integrating public health into the SLP curriculum. Alternative models of training for communication disability public health that may be relevant in the future in different contexts and countries are presented, prompting the SLP profession to consider whether communication disability public health is a field of practice for speech-language pathologists or whether it has broader workforce implications. The paper concludes with some suggestions for the future which may advance thinking, research and practice in communication disability public health.

[Self and significant other assessment of hearing device aided communication skills in the elderly with hearing loss]. / Isitme kaybi olan yaslilarda isitme cihazi destekli iletisim becerilerinin kendileri ve yakinlari tarafindan degerlendirilmesi.

OBJECTIVES: This study aims to evaluate the communication problems of elderly before and after using hearing aids. PATIENTS AND METHODS: Thirty hearing aid users and 10 normal hearing control subjects with their relatives were enrolled in the study. Hearing aid users were divided into three subgroups based on the duration of use. Self Assessment of Communication (SAC) and Significant Other Assessment of Communication (SOAC) questionnaires were administered to hearing aid users, control subjects, as well as to their relatives for the evaluation of communication difficulties due to hearing loss. Intra-group comparisons were carried out in the patients using hearing aids, while inter-group comparisons were performed to evaluate the effects of different aided periods on communication skills. RESULTS: It was found that the communication difficulties reduced in the patients who used hearing aid for minimum one month. For the patients with hearing loss, hearing aid use of six months or more increased SAC and SOAC scores to a level comparable with control subjects. CONCLUSION: The present study conclude that the elderly patients of 60 years of age or more with moderate sensorineural hearing loss could catch up their normal hearing peers in their communication skills within six months only if they prescribed and used proper hearing aids.

Effects of early identification and intervention on language development in Japanese children with prelingual severe to profound hearing impairment.

OBJECTIVES: Early identification and intervention for prelingual bilateral severe to profound hearing loss is supposed to reduce the delay in language development. Many countries have implemented early detection and hearing intervention and conducted regional universal newborn hearing screening (UNHS). However, the benefits of UNHS in later childhood have not yet been confirmed, although language development at school age has a lifelong impact on children's future. Our Research on Sensory and Communicative Disorders project attempted to reveal the effects of UNHS and those of early intervention on the development of verbal communication in Japanese children. METHODS: In this study, 319 children with prelingual bilateral severe to profound hearing loss, 4 to 10 years of age, were evaluated with the Test of Question-Answer Interaction Development used as an objective variable. Participation in UNHS and early intervention were used as explanatory variables. The adjusted odds ratio (AOR) was calculated after adjusting several confounding factors with use of logistic regression analysis. In addition, caregivers' answers were obtained by a questionnaire, and the process of diagnosis with and without UNHS was analyzed retrospectively. RESULTS: Early intervention was significantly associated with better language development (AOR, 3.23; p < 0.01). Participation in UNHS may contribute to better language development to some extent (AOR, 1.32), but not one that was statistically significant (p = 0.37). However, UNHS was significantly associated with early intervention (AOR, 20.21; p < 0.001). The questionnaire results indicated a lag in treatment after UNHS in more than 40% of screened cases. CONCLUSIONS: Early intervention strongly influenced language development. It is necessary to ensure that early identification leads directly to early intervention.

Communication needs of nonspeaking hospitalized postoperative patients with head and neck cancer.

Treatment of head and neck cancers is often associated with temporary or permanent speech impairments, limiting patients' ability to self-report critical information during the acute care hospitalization period after surgery. Eleven patients unable to speak after head and neck cancer surgery, eight family caregivers, and eight RNs were included in this descriptive pilot study. All participants completed a researcher-developed 5-item survey (from their perspectives) consisting of questions that explored patients' difficulty in communicating, difficult topics to communicate, and individuals with whom patients had difficulty communicating. Study findings emphasized the importance that patients, family caregivers, and nurse assign to the communication of symptoms experienced during the acute postoperative period. In addition, the RN was identified as the health care team member with whom patients had the most communication difficulties. Findings support the participation of patients, family caregivers, and nurses in the selection and implementation of interventions that enhance communication after surgery.

Application of the World Health Organization (WHO) ICF and ICF-CY to communication disability

La Organización Mundial de la Salud (OMS) ha desarrollado un sistema de clasificación que refleja el estado de salud funcional. La International Classification of Functioning, Disability, and Health (ICF) (2001) y la International Classification of Functioning, Disability, and Health for Children and Youth (ICF-CY) (2007) representan un avance significativo en la comprensión de la salud y la discapacidad funcional en comparación con la clasificación inicial International Classification of Impairments, Disabilities, and Handicaps (ICIDH) realizada por la OMS en 1980. La ICF y la ICF-CY han ido ganando aceptación en los sectores de salud y los campos de rehabilitación de toda Europa. Este artículo describe los fundamentos de la ICF y la ICF-CY, y su posible práctica clínica y educativa, además de influir en la investigación para el estudio de los trastornos de la comunicación. Además, abre un debate sobre las iniciativas de la Unión Europea ante estos sistemas de clasificación y las recientes actividades de la ICF presentadas en España (AU)

The World Health Organization (WHO) has developed a framework and classification system that captures functional health status. The International Classification of Functioning, Disability, and Health (ICF) (2001) and the International Classification of Functioning, Disability, and Health for Children and Youth (ICF-CY ) (2007) represent a significant advancement in the understanding of functional health and disabilities compared to WHO’s initial 1980 International Classification of Impairments, Disabilities, and Handicaps (ICIDH). The ICF and ICF-CY have been gaining acceptance across Europe in all health sectors and rehabilitation fields. This article describes the basics of the ICF and ICF-CY, and their possible clinical, educational, and research influences on the field of communication disorders. In addition, a discussion of European Union based initiatives using these classifications systems is presented, as well as recent ICF activities in Spain (AU)

The role of research methodology in the rational use of technology in monitoring and preventing communication disorders.

Studies showing stronger scientific evidence related to speech, language and hearing pathology (SLP) have an impact on the prevention and rehabilitation of human communication and gained ground in SLP research agenda. In this paper we discuss some aspects and directions that should be considered for in-depth knowledge about speech, language and hearing needs in different population groups (age group, gender and other variables according to specific related disorders) for improved comprehensive care, successful efforts and effective use of financial and human resources. It is also discussed the decision making process for requesting complementary evaluations and tests, from routine to highly complex ones, that should be based on each test and/or procedure and their contribution to the diagnosis and therapeutic planning. In fact, it is crucial to have reliable parameters for planning, preventing and treating human communication and its related disorders. Epidemiology, biostatistics and social sciences can contribute with more specific information in human communication sciences and guide more specific studies on the international science and technology agenda, improving communication sciences involvement in the international health-related scientific scenario.

The role of research methodology in the rational use of technology in monitoring and preventing communication disorders

Studies showing stronger scientific evidence related to speech, language and hearing pathology (SLP) have an impact on the prevention and rehabilitation of human communication and gained ground in SLP research agenda. In this paper we discuss some aspects and directions that should be considered for in-depth knowledge about speech, language and hearing needs in different population groups (age group, gender and other variables according to specific related disorders) for improved comprehensive care, successful efforts and effective use of financial and human resources. It is also discussed the decision making process for requesting complementary evaluations and tests, from routine to highly complex ones, that should be based on each test and/or procedure and their contribution to the diagnosis and therapeutic planning. In fact, it is crucial to have reliable parameters for planning, preventing and treating human communication and its related disorders. Epidemiology, biostatistics and social sciences can contribute with more specific information in human communication sciences and guide more specific studies on the international science and technology agenda, improving communication sciences involvement in the international health-related scientific scenario.

Estudos que demonstram mais evidências científicas associadas ao impacto da Fonoaudiologia na prevenção e reabilitação da comunicação humana vêm ganhando maior espaço na agenda fonoaudiológica. Neste artigo discutimos alguns aspectos relacionados a essa questão, bem como direcionamentos a se-rem considerados para que conhecimento mais detalhado relacionado à Fonoaudiologia em estratos diferentes da população (como faixa etária, sexo, etc. associadas a estes agravos) esteja disponível, a fim de contribuir com a integralidade e efetividade dos recursos humanos e financeiros na atenção à saúde. Além disso, discutimos aspectos inerentes à solicitação de avaliações e exames complementares, os quais variam de baixa a alta complexidade, sendo necessário considerar, entre outros, a característica de cada um destes e sua contribuição no diagnóstico e/ou no planejamento terapêutico fonoaudiológico. É fundamental que contemos com parâmetros confiáveis para o planejamento terapêutico e tratamento dos distúrbios da comunicação humana, bem como fatores associados a estes. A epidemiologia, a bioestatística e as ciências sociais podem contribuir sob diferentes formas para que contemos com dados fonoaudiológicos mais específicos, além de direcionamentos para que os estudos fonoaudiológicos estejam mais diretamente vinculados à Política de Ciência e Tecnologia vigente e ampliem seu espaço no cenário científico internacional.

Communication difficulties in hospitalized older adults with dementia.

Dementia adversely affects patients' receptive and expressive communication abilities, making it more difficult for nurses to assess their needs and provide necessary care. Communication Difficulties: Assessment and Interventions in Hospitalized Older Adults with Dementia outlines questions nurses can use to assess the nature and severity of language deficits, which vary greatly from patient to patient and over the course of the disease. Best-practice techniques for tailoring communication to each patient's abilities are also discussed. For a free online video demonstrating the use of these approaches, go to: (http://links.lww.com/A236).

Assisted living nursing practice: the language of dementia: theories and interventions.

The person with dementia uses behavior to communicate, but their behavior is altered by the combination of neurological damage and impairment, altered interpersonal relationships and reactions of others, and the individual's loss or weakening of their lifelong defenses or coping mechanisms. This article discusses the routes by which behavior can be understood and describes a constellation of needs of a person with dementia that has a unique fit with person-centered care. Three evidence-based models (theories) and interventions specific to dementia behaviors are discussed: the Need-Driven Dementia-Compromised Behavior Model, the Progressively Lowered Stress Threshold Model, and the utilization of self-identity roles. Montessori-based activities are another approach to person-centered dementia care that respect, as do the models, the dignity, worthiness and interests of the person afflicted with dementia. The models discussed in this article all seek to improve the quality of life of the person with dementia. Other than those at the profound end stage of dementia, most sufferers can communicate feelings. Subjective quality of life must be determined based on the self-report of the person suffering with dementia so that treatment interventions and effectiveness are grounded in that person's reality.