Louise Margaret. Cahill

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Purpose: Individuals with acquired communication disorders (ACDs) experience reduced ability to participate independently in activities of daily life, and maintain interpersonal relationships and psychosocial wellbeing. Communication interventions are designed to optimise communication competence in personally relevant everyday activities. However, the assessment tools speech-language pathologists (SLPs) typically utilise to evaluate communication competence in everyday life are not ideal. To explore the range and availability of assessments used in research to examine functional communication in adults with ACDs. Method: Five databases (Medline, CINAHL, EMBASE, SCOPUS and PsycINFO) were searched to identify assessment or intervention studies evaluating functional communication in adults with ACDs. Functional communication tools utilised in each study were identified. Extracted tools were categorised according to type, target population, consideration of multimodal communication, person-specificity, consideration of context, availability, administration/analysis time and availability of normative/psychometric data. Result: Forty functional communication assessment tools were included. Just over half the tools were performance-based (n = 25), examined different modes of communication (n = 26) and/or considered context (n = 23). Only 14 tools were person-specific. Many of the most comprehensive tools were out of print or considered excessively time consuming to administer and analyse. Conclusion: A paucity of accessible, time-efficient yet comprehensive tools to assess functional communication in ACDs may limit clinical practice and client outcomes. More versatile functional communication assessments incorporating individualised contexts, and the use of modern communication technologies are recommended.

This study evaluated the feasibility and outcomes of a telerehabilitation adaptation of the Be Clear speech treatment program for adults with non-progressive dysarthria to determine clinical delivery viability and future research directions. Treatment effects on speech clarity, intelligibility, communication effectiveness, and participation, as well as psychosocial outcomes in 15 participants with non-progressive dysarthria, were explored. Intervention involved daily 1-h online sessions (4 days per week for 4 weeks, totalling 16 sessions) and daily home practice. Outcome measures were obtained at baseline (PRE), post-treatment (POST), and 12 weeks following treatment (FUP). Feasibility measures targeting participant satisfaction, treatment adherence and fidelity, and technical viability were also employed. The programme was feasible concerning technical viability and implementation, treatment adherence and fidelity. High levels of participant satisfaction were reported. Increases in overall ratings of communication participation and effectiveness were identified at POST and FUP. Reductions in speech rate were identified at FUP. Improvements in aspects of lingual and laryngeal function were also noted after treatment. Over time, improvements relating to the negative impact of dysarthria were identified. Naïve listeners perceived negligible changes in speech clarity following treatment. Online delivery of the Be Clear speech treatment program was feasible, and some positive speech benefits were observed. Due to the small sample size included in this research, statistically significant findings related to speech outcomes must be interpreted with caution. An adequately powered randomised controlled trial of Be Clear online is warranted to evaluate treatment efficacy.

Background: To meet rising clinical placement demand caused by increasing health student numbers, the use of paired (two students) rather than single (one student) placement models has been proposed. There is, however, limited research available to inform placement providers about the relative effects of both models on healthcare services, including patient‐ and non‐patient‐related activities and patient occasions of service.Aims: To investigate a key clinical question: Does clinical educator (supervisor) and student time use differ during paired placements compared with single placements? Also to examine the satisfaction levels of clinical educators (CEs) and students with paired and single clinical placement models.Methods & Procedures: Queensland Health speech and language therapists (N = 44) and speech and language therapy students (N = 32) involved in paired or single clinical placements were recruited for this study. CEs and students completed time‐use surveys for 3 days after the midpoint of placements; CEs also completed surveys for 3 matched days during a non‐placement period 3 weeks or more following placements for comparative purposes. CEs and students additionally completed a satisfaction survey at the end of placements. Paired and single CE and student groups were compared for differences in their time‐use and satisfaction levels using non‐parametric statistics.Outcomes & Results: The placement model did not impact on occasions of service provided by CEs (p = 0.931) or students (p = 0.776). It also had no effect on the percentage of time CEs or students engaged in patient‐related activities (p = 0.577; 0.291) and non‐patient‐related activities (p = 0.559; 0.177). On clinical placement days, CEs spent a median 10 minutes longer at work regardless of whether or not it was a paired or single placement, compared with non‐placement days (p = 0.107). CEs and students who had been involved in a paired placement reported the same high levels of placement satisfaction (various measures) as those who had been involved in a single placement.Conclusions & Implications: The paired‐placement model has the potential to increase student placement offers without negatively impacting on clinical service provision including occasions of service, patient or non‐patient‐related activities, or overall CE time spent at work.

The aim of the investigation was to examine the changes in phonation and related quality-of-life in the acute and sub-acute stages of recovery post-cervical spinal cord injury (CSCI). A prospective examination of phonation was conducted using perceptual and instrumental measures of respiratory and laryngeal functioning alongside a quality-of-life rating scale. Change was present across measures for both cases at each time point. Overall, a general pattern of recovery was seen, although some areas deteriorated between 6–12 months. Severity of impairments, extent of change, and impact on quality-of-life differed between the cases. Measures varied in sensitivity to change in function. Phonation can be impaired following both complete and incomplete CSCI, with type and severity of impairment/s undergoing change throughout the acute and sub-acute period post-injury. Spontaneous physiological recovery does not necessarily result in improved phonation and/ or quality-of-life. Potential exists for targeted speech-language therapy in this population, throughout recovery, to best capitalize on the physical changes that are occurring and to maximize functional application of skills to improve quality- of-life. Further research is warranted to examine this recovery period on a larger scale.

We examined the validity and reliability of an Internet-based telehealth system for screening speech intelligibility and oro-motor structure, and function in children with speech disorders. Twenty children aged 4-9 years were assessed by a clinician in the conventional, face-to-face (FTF) manner; simultaneously, they were assessed by a second clinician via the videoconferencing system using a 128-kbit/s Internet connection. Speech intelligibility in conversation was rated and an informal assessment of oro-motor structure and function was conducted. There was a high level of agreement between the online and FTF speech intelligibility ratings, with 70% exact agreement and 100% close agreement (within ± point on a 5-point scale). The weighted kappa statistic revealed very good agreement between raters (kappa = 0.86). Data for online and FTF ratings of oro-motor function revealed overall exact agreement of 73%, close agreement of 96%, moderate or good strength of agreement for six variables (kappa = 0.48–0.74), and poor to fair agreement for six variables (kappa = 0.12–0.36). Intra- and inter-rater reliability measures (ICCs) were similar between the online and FTF assessments. Low levels of agreement for some oro-motor variables highlighted the subjectivity of this assessment. However, the overall results support the validity and reliability of Internet-based screening of speech intelligibility and oro-motor function in children with speech disorders.

The speech disorder associated with Friedreich's ataxia (FRDA) is classically described as ataxic dysarthria. However, variable neuropathology beyond the cerebellum, which may include the corticospinal and corticobulbar tracts, means that the dysarthria can be mixed rather than a pure ataxic dysarthria. To characterize physiological features of the dysarthria associated with FRDA and identify differential patterns of deviation that may occur across the subsystems of the speech-production mechanism in a series of seven case studies. The assessment battery included a perceptual analysis of a speech sample using an interval rating scale, and a range of instrumental measures to investigate the respiratory, laryngeal, velopharyngeal and articulatory systems. The results demonstrated the variability that exists in the dysarthria associated with FRDA, highlighting the existence of differential profiles of speech impairment. A particular distinction was observed between the presence of hypernasality and phonatory dysfunction, as evidenced by the instrumental results. The distinct profiles of dysarthria associated with FRDA indicate that approaches that address multiple subsystems are necessary for the accurate characterization and quantification of the motor speech disorder. Further research is required to investigate the decline in speech function as the disease progresses, as changes in speech function over time may be a good indicator of neurological decline in FRDA.

Electromagnetic articulography (EMA) was used to investigate the tongue kinematics in the dysarthria associated with Friedreich’s ataxia (FRDA). The subject group consisted of four individuals diagnosed with FRDA. Five nonneurologically impaired individuals, matched for age and gender, served as controls. Each participant was assessed using the AG-200 EMA system during six repetitions of the tongue tip sentence Tess told Dan to stay fit and the tongue back sentence Karl got a croaking frog. Results revealed reduced speed measures (i.e., maximum acceleration / deceleration / velocity), greater movement durations and increased articulatory distances for the approach phases of consonant productions. The approach phase, involving movement up to the palate, was more affected than the release phase. It is suggested that deviant lingual kinematics could be the outcome of disturbances to cerebellar function, or possibly in combination with disturbances to upper motor neuron systems.

This study identifies two measures of the effects of Friedreich's ataxia (FRDA) on speech motor control. Speech samples of 17 healthy controls and 37 speakers with dysarthria associated with FRDA were recorded during one structured and one unstructured speaking task. Two measures of spectral variation were used that relate to the rate and range of changes that occur in the spectral envelope. Linear mixed models revealed significant effects of GROUP, TASK, and GROUP*TASK. FRDA speech samples had slower rate of spectral change and reduced spectral range. Healthy speakers produced faster rates of spectral change in read text compared to conversation, but speakers with dysarthria did not. The results suggest that structured speaking tasks which demand large spectral variation may be particularly useful in assessing the dysarthria. It is concluded that the rate of spectral change is a useful measure of dysarthria associated with FRDA.

Articulatory kinematics were investigated using electromagnetic articulography (EMA) in four dysarthric speakers with Friedreich's ataxia (FRDA). Specifically, tongue-tip and tongue-back movements were recorded by the AG-200 EMA system during production of the consonants /t/ and /k/ as produced within a sentence utterance and during a rapid syllable repetition task. The results obtained for each of the participants with FRDA were individually compared to those obtained by a control group (n = 10). Results revealed significantly greater movement durations and increased articulatory distances, most predominantly during the approach phase of consonant production. A task difference was observed with lingual kinematics more disturbed during the syllable repetition task than during the sentence utterance. Despite expectations of slowed articulatory movements in FRDA dysarthria, the EMA data indicated that the observed prolongation of consonant phase durations was generally associated with greater articulatory distances, rather than slowed movement execution.