The prevalence of voice disorders for people aged >65 years is four times higher than for the population at large. The most common cause of dysphonia in this group is presbyphonia, the preferred ...first-line treatment for which is voice therapy with a speech-language pathologist. This systematic review seeks to identify how voice therapy affects multidimensional voice outcomes in people with presbyphonia.
A systematic search of CINAHL, Embase, Emcare, MEDLINE, and Google Scholar was conducted in March 2023. Comparative and noncomparative studies of voice therapy in participants aged >50 years with presbyphonia were considered for inclusion. No limitations were placed on date or language of publication. Study quality and risk of bias were assessed with the Cochrane Risk of Bias 2 tool and the Methodological Index for Non-Randomized Studies. Subgroup analysis was used to compare studies based on participant sex, intervention duration, study design, and intervention content. Interventions were specified using the Rehabilitation Treatment Specification System (RTSS) employing a consensus methodology among reviewers. The results were synthesized utilizing meta-analysis when outcomes were adequately specified and narrative analysis when they were not.
Twenty-three studies were included with 1050 subjects (mean age: 72.5 ± 8.6 years; 51% female). The most reported intervention was vocal function exercises. Per the RTSS, 14 interventions employed a predominantly Organ Functions approach, and the 14 remaining interventions employed a Skills & Habits approach. Meta-analysis confirmed posttherapy improvement in patient-related outcome measures of 0.93 standard mean difference (P < 0.00001, 95% confidence interval CI: 0.70-1.17); studies with predominantly males and with longer treatment periods were associated with larger improvements, while randomized controlled trials reported more modest improvements. Meta-analysis also identified a mean posttherapy increase in maximum phonation time (MPT) of 5.37 seconds (P < 0.00001, 95% CI: 3.52-7.22). Treatments with an Organ Functions focus resulted in greater gains in MPT than those with a Skills & Habits focus (7.52 seconds versus 2.90 seconds). Finally, meta-analysis identified reductions in acoustic perturbation measures (jitter: 0.62%, P < 0.001, 95% CI: 0.26%-0.97%; shimmer 1.05%, P < 0.00001, 95% CI: 0.67%-1.44%). Narrative synthesis further identified improvement in auditory-perceptual voice quality in all active treatment groups as well as improved glottal function in most studies that reported this.
Despite the uncertainty around internal validity introduced by the inclusion of a wide range of study designs, there is convincing evidence that voice therapy for presbyphonia results in significant improvement in patient-reported, aerodynamic, acoustic, and expert-rated voice outcomes. Treatments with an Organ Functions focus may better address the underlying physiological deficits of presbyphonia, although future comparative studies with multidimensional voice assessment are warranted.
In this paper, we investigate the relevance of using a parental questionnaire (HEGA) to gather information on children's language experience in Basque and early language development in order to ...better interpret language performance in that language. Both this questionnaire and use of language assessment in Basque are needed in the Basque Country, where multilingualism is well attested. The questionnaire was developed after the PaBiQ with additional questions meant to reflect the Basque context, notably its schooling linguistic model. The HEGA was administered to the parents of 186 bilingual children of the Northern Basque Country (age 4;2-9;1) whose language skills in Basque were assessed via a new test battery targeting different linguistic domains (HIGA). Several significant correlations were found between exposure to, and use of Basque and performance in lexical and morphosyntactic production and comprehension. Mixed-effect regression analyses revealed that language experience in Basque, and particularly the fact of being schooled entirely in Basque, were strong predictors of lexical and morphosyntactic outcomes. In contrast, phonological performance, as measured by nonword repetition, appeared to be less impacted by language experience in Basque. Finally, two children were identified as being at risk of language impairment, due to low language performance in Basque despite extended language experience. These results have important implications for clinicians and educators, in particular for detecting language difficulties in Basque-speaking bilingual children. They also show the need for assessing language abilities in Basque for children growing up in a solid Basque-speaking environment.
Background: Stroke causes communication impairments but we lack the real-world population-level data needed to inform inpatient and community services. Aims: To establish prevalence of aphasia and ...dysarthria within inpatient stroke survivors, describe those affected, the amount of therapy they receive and their outcomes.
Methods & Procedures: Secondary analysis of data from the Sentinel Stroke National Audit Programme, England, Wales and Norther Ireland, including inpatient stroke survivors after 72 hours, with completed National Institute of Health Stroke Scale data (communication items), excluding those already discharged, not conscious or with incomplete data.
Outcomes & Results: 64% of the 88,974 stroke survivors meeting our criteria were communication impaired: 28% had both aphasia and dysarthria, 24% had dysarthria only and 12% had aphasia only. Those in the older age range and with more severe stroke were more likely to have a communication impairment and had a worse outcome than those without communication impairment. On average, those with both communication impairments had a 21 day length of stay and 10 minutes of speech and language therapy for communication and/or dysphagia per day of stay.
Conclusions: Communication impairment is common during the inpatient phase of stroke care yet average therapy provision is below the recommended levels and is likely to include dysphagia assessment and intervention. Dysarthria is reported as more prevalent than aphasia at this early stage, although this is not necessarily diagnosed by a speech and language therapist. The most common presentation is to have a combination of aphasia and dysarthria for which there is limited clinical guidance.
Primary progressive aphasia (PPA) is a language-led dementia associated with Alzheimer's pathology and fronto-temporal lobar degeneration. Multiple tailored speech and language interventions have ...been developed for people with PPA. Speech and language therapists/speech-language pathologists (SLT/Ps) report lacking confidence in identifying the most pertinent interventions options relevant to their clients living with PPA during their illness trajectory.
The aim of this study was to establish a consensus amongst 15 clinical-academic SLT/Ps on best practice in selection and delivery of speech and language therapy interventions for people with PPA. An online nominal group technique (NGT) and consequent focus group session were held. NGT rankings were aggregated and focus groups video recorded, transcribed, and reflexive thematic analysis undertaken.
The results of the NGT identified 17 items. Two main themes and seven further subthemes were identified in the focus groups. The main themes comprised (1) philosophy of person-centredness and (2) complexity. The seven subthemes were knowing people deeply, preventing disasters, practical issues, professional development, connectedness, barriers and limitations, and peer support and mentoring towards a shared understanding.
This study describes the philosophy of expert practice and outlines a set of best practice principles when working with people with PPA.
Implications for rehabilitation
Primary progressive aphasia (PPA) describes a group of language led dementias which deteriorate inexorably over time.
Providing speech and language therapy for people with PPA is complex and must be person centred and bespoke.
This study describes the philosophy of expert practice and outlines a set of best practice principles for speech and language therapists/pathologists working with people with people with PPA.
Acquired communication disorders can result in significant barriers to everyday life activities, and commonly require long-term rehabilitation. This research aimed to investigate usability, ...acceptance, barriers and enablers to the use of immersive virtual reality (VR) technology for communication rehabilitation from the perspective of speech-language pathologists (SLPs).
Semi-structured interviews and surveys (system usability and motion sickness) were carried out with 15 SLPs following their participation in communication activities typical of daily life, experienced within an immersive VR kitchen environment.
The system usability scores were average. In addition, motion sickness symptoms were low after interaction with the VR system. The main findings from semi-structured interviews are discussed across five main themes: (i) attitude towards the use of VR in communication rehabilitation (ii) perceived usefulness of VR (iii) perceived ease of use of VR (iv) intention to use VR, and (v) clinical adoption barriers and enablers.
Overall, participants were positive about VR and its potential applications to communication rehabilitation. This study provides a foundation to inform the design, development, and implementation of a VR system to be used in the rehabilitation of individuals with acquired communication disorders.
IMPLICATIONS FOR REHABILITATION
Virtual Reality applications could simulate social communication situations within the clinic.
VR could be used as a rehabilitation tool for communication assessment and/or outcome measure.
VR requires customisation to the specific communication rehabilitation needs of the client.
Participants identified barriers and enablers to adoption of VR by speech-language pathologists.
Comprehensively and systematically map peer-reviewed studies of hippotherapy published over 30 years, from 1980 through 2018, from the perspective of a phased scientific approach to developing ...complex interventions as a guide to future research and practice.
A systematic mapping review of research of hippotherapy was conducted. Searches of nine databases produced 3,528 unique records; 78 full-text, English-written studies were reviewed, the earliest of which was published in 1998. Data relevant to study aims were extracted electronically from these studies and analyzed using queries and pivot tables.
Children with cerebral palsy and physical therapists were most prevalent as participants and providers. Equine movement was hippotherapy's core component and mechanism. Early-phase outcomes-oriented research predominated. "Hippotherapy" was ambiguously defined as treatment strategies and comprehensive professional services, even as interventions grew more distinctive and complex. A treatment theory and proof of concept related to motor outcomes were established, and efficacy research with comparison conditions emerged.
Continuing research of complex interventions that integrate hippotherapy, equine movement as a therapy tool, is warranted. Attention to gaps in foundational scientific work concurrent with continued piloting and efficacy work will help to identify the most promising interventions worthy of replication, evaluation and widespread adoption.
IMPLICATIONS FOR REHABILITATION
To advance the evidence base of complex interventions that incorporate hippotherapy:
*Proponents of hippotherapy need to define and represent hippotherapy to the public and in practice and research contexts as a therapy tool involving the use of the movement of horses by qualified professionals, rather than simply as a generic therapy with the help of a horse or simulated horse;
*Providers of hippotherapy need to identify their professional degrees and certifications, and explicate their disciplinary perspectives that influence their selected components of intervention, related methods, and outcomes; and
*Providers and researchers need to partner to develop an enablement theory of hippotherapy that links improved body functions with improved participation in everyday life and quality of life.
To investigate perspectives of multiple stakeholders involved in development and delivery of Vietnam's first speech-language pathology degrees and derive recommendations for future degrees in Vietnam ...and other Majority World countries.
An exploratory-descriptive qualitative research design using focus groups and individual semi-structured interviews in the preferred language (English or Vietnamese) was used, with 70 participants from five stakeholder groups: project managers, students, academic educators, placement supervisors and interpreters. Transcriptions were analysed using thematic network analysis.
Analysis identified five organising themes: (1) People enjoyed working with/learning from others; (2) Benefits from/to stakeholders; (3) The pandemic impacted program delivery and learning; (4) Practical challenges; (5) Preparation with flexibility required for success and sustainability. From the five organising themes, one synthesising global theme was developed, conveying that satisfying international collaborations require preparation, support, high quality interpreting, and management of challenges.
Recommendations highlight the need for preparation, collaboration, support to manage challenges, flexibility, recognition for placement supervisors and high-quality interpreting. The recommendations are of relevance to other organisations engaged in development of professional degrees in Majority World countries. Future research would benefit from a critical investigation of the diverse perspectives of stakeholders involved in the development and implementation of international curricula.
Background
Face‐to‐face class suspensions during the coronavirus disease (COVID‐19) pandemic in 2019 increased telepractice in speech and language therapy. However, little is known about speech and ...language therapists’ (SLTs) perceived effectiveness of telepractice and its antecedents.
Aims
To examine the use of telepractice and the factors affecting its perceived effectiveness in Hong Kong mainstream schools during COVID‐19.
Methods & Procedures
Seventy‐two school‐based Hong Kong SLTs completed a 110‐item online survey with six structural components: (1) concerns, (2) adoption, (3) student selection criteria, (4) perceived effectiveness, (5) continuous professional development and (6) attitudes/beliefs.
Outcomes & Results
Over 90% of respondents adopted telepractice during the pandemic. Confirmatory factor analysis identified reliable constructs from their component measures. These participants reported great telepractice difficulties (especially in therapy preparation and managing students’ attention and/or communication). Mixed‐response analysis revealed that psychosocial factors (i.e., students’ engagement and SLTs’ attitudes towards telepractice) but not professional practice skill factors (i.e., student client selection criteria and SLTs’ years of experience in school settings) contributed to SLTs’ self‐perceived effectiveness of telepractice.
Conclusions & Implications
Our findings suggest that psychosocial factors play a more important role than professional practice skill factors in the self‐perceived effectiveness of telepractice.
WHAT THIS PAPER ADDS
What is already known on the subject
Previous surveys reported that although SLTs were interested in using telepractice before the COVID‐19 pandemic, they showed concern about its effectiveness, resulting in a low adoption rate. One critical question naturally arises: What factors may affect the perceived effectiveness of telepractice by SLTs?
What this paper adds to existing knowledge
This study demonstrates for the first time that despite the high adoption rate of telepractice during the COVID‐19 pandemic, school‐based SLTs exhibited great difficulties, and the SLTs’ self‐perceived effectiveness of telepractice was related to psychosocial factors instead of professional practice skill factors.
What are the potential or actual clinical implications of this work
Professional support is needed to alter the attitudes of SLTs towards telepractice for enhancing their self‐perceived effectiveness and positive clinical practice experience.
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