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Background: Aspiration pneumonia (AP) is a subset of pneumonia caused by the aspiration of food and fluids to the lungs and is highly prevalent in the older population. Oropharyngeal dysphagia (OD) is one of the risk factors for AP and it is also associated with malnutrition, dehydration and poor functional outcomes. As pneumonia is the second most common infection in nursing homes (NHs) and OD represents a major concern to NH staff, good practices for the prevention of AP in older adults at risk of OD are needed. Purpose: The aim of this modified e‐Delphi study is to build consensus among a panel of experts regarding a set of recommendations for NH staff on good practices to prevent AP in older adults at risk of OD living in NHs. The objective of this paper is to establish the methodology inherent to the Delphi study. Methods: An online modified Delphi study will be developed in three rounds. Criteria for the Delphi panel participants include holding a master's or doctoral degree in OD or speech and language therapy; or having 10 or more years of experience in OD; or having at least one scientific publication related to OD. A previously described modified Delphi methodology will be used to achieve consensus (75% agreement). An additional round will be performed to collect the experts' perspectives regarding the priority for application of each recommendation previously validated. Discussion: This protocol aimed to describe the methodology of a future Delphi study on the prevention of AP, seeking to fulfil the gap in the literature regarding this topic. The modified Delphi technique is a widely used method for collecting experts' opinion in health sciences, but the absence of standardised guidelines allows some heterogeneity between studies with the same aim. WHAT THIS PAPER ADDS: What is already known on the subject: Aspiration pneumonia (AP) is related to three main risk factors: impaired safety of swallow, impaired nutritional status and poor oral health. It is known that being dependent for feeding is one of the main risk factors for AP and around 50% of nursing home (NH) residents need feeding assistance. Thus, it is important to promote specialised intervention and care by the NH staff for preventing AP. What this paper adds to existing knowledge: It is hypothesised that increasing the knowledge of NH staff regarding the best practices for preventing AP in older adults at risk of oropharyngeal dysphagia (OD) will improve outcomes such as quality of life, incidence of AP and mortality. What are the potential or actual clinical implications of this work?: The recommendations resulting from this study will address a current gap in healthcare practice of NH staff regarding older adults at increased risk for OD and, consequently, for AP. [ABSTRACT FROM AUTHOR]

Background: Acquired laryngotracheal stenosis (LTS) is a rare condition that causes breathlessness and dyspnoea. Patients have reconstructive airway surgery to improve their breathing difficulties, but both LTS and the surgery can cause voice difficulties. The existing evidence base for management of voice difficulties for adults with LTS focuses on symptoms. There is limited information to provide clinical guidance for speech and language therapists (SLTs) and a limited understanding of the impact of voice changes on adults with LTS. Aim: To investigate the lived experience of adults with laryngotracheal stenosis (LTS), who have had reconstructive surgery; here focussing on voice concerns with the aim of guiding clinical care for SLTs. Methods and Procedures: A phenomenological, qualitative study design was used. Focus groups and semi‐structured interviews were completed with adults living with LTS who had had reconstructive surgery. Audio recordings were transcribed and inductive thematic analysis was used by the research team to identify themes and sub‐themes. Outcomes and Results: A total of 24 participants (five focus groups and two interviews) took part in the study before thematic saturation was identified in analysis. Three main themes were identified specific to the experience of living with LTS: the Medical, Physical and Emotional journey. All participants referenced voice difficulties as they related to each of these overall themes. Sub‐themes directly related to voice included experience of surgery, information provision, staff expertise/complacency, symptoms, symptom management, identity, support networks, impact on life and living with a chronic condition. Conclusions and Implications: In this qualitative study participants have described the integral part voice difficulties play in their lived experience of LTS and reconstructive surgery. This is considered in the context of their clinical care and the need for individualised management and information provision throughout the course of their condition. The broader research literature relating to voice difficulties is explored with links made to people with LTS and recommendations made for future research into people living with LTS and dysphonia. What this paper adds: What is already known on this subject: Adults with laryngotracheal stenosis (LTS) experience voice changes as a result of their condition, and the surgeries necessary as a treatment. These changes can lead to altered pitch, vocal fatigue, loss of pitch range and loss of volume control. Although there are known psychosocial implications both to living with a chronic condition and voice difficulties there has been no research exploring this in adults with LTS, and there is minimal clinical guidance for speech and language therapists (SLTs) working with these patients. What this paper adds to existing knowledge: This research is the first study to explore the lived experience of adults with LTS who undergo reconstructive surgery, focusing on their voice concerns. This study demonstrates the multifactorial impacts of voice changes on all aspects of the lives of adults with LTS and the need for individualised information provision and clinical care to help support them. What are the potential or actual clinical implications of this work?: Adults with LTS want expert SLTs to facilitate their care and support them throughout their LTS journey alongside other support networks. They want to be carefully prepared for reconstructive surgery and given clear information about symptoms and management of their voice difficulties. This has led to the reorganisation of the care pathway at our centre, and the introduction of a patient‐led pretreatment session. [ABSTRACT FROM AUTHOR]

Background: People with post‐stroke dysphagia often require informal care from family to facilitate safe swallowing, modify food/drink or administer tube‐feeds. Previous survey studies have found dysphagia may increase family caregiver burden. However, the experiences of family members in this population have not been fully explored. Aims: To explore family members' experiences of living with a spouse with post‐stroke dysphagia. Methods & Procedures: This exploratory qualitative study used one‐to‐one semi‐structured interviews to explore family members' experiences. They were asked open questions about previous eating routines, dysphagia onset, their role and future hopes. Interviews were audio‐recorded, transcribed and analysed thematically with an inductive approach to determine key features of family members' experiences. Outcomes & Results: Five spouses aged 70–93 years participated. Their relatives' strokes happened 3 months to 3 years before the interview. Five themes were identified: 'I do all of it'; making sense of dysphagia; emotional responses; reflecting on relationships; and redefining lifestyle. Conclusions & Implications: It is important to consider family members' perspectives as they often provide vital care to loved‐ones with dysphagia. In relation to eating and drinking, maintaining elements of previous routines seems important to families. Healthcare professionals should consider these when making recommendations for rehabilitation. Family members have differing perspectives of the comparative impact of dysphagia; patient and family priorities should be explored for healthcare professionals to provide better‐targeted support. What this paper adds: What is already known on the subject: Informal caregivers, often spouses, play a vital role in supporting the health and well‐being of older people with health conditions. The presence of post‐stroke dysphagia may present increased challenges for the informal caregiver. There are limited studies qualitatively exploring the experiences of informal caregivers in this population. What this paper adds to existing knowledge: Current health and social care provision for this population leaves informal caregivers feeling they have been left to manage dysphagia alone. Informal caregivers demonstrate a breadth of knowledge about their spouse's dysphagia, problem‐solving effective solutions. Informal caregivers have a range of interpretations of the nature and cause of dysphagia; leading to miscommunication with health professionals and complex emotional responses. What are the potential or actual clinical implications of this work?: Healthcare professionals might consider ways in which to support dysphagic patients' families later in their care pathway, through scheduling reviews or running dysphagia patient and family groups. Health and social care professionals and policymakers should learn from informal caregivers' expertise to promote better health and quality‐of‐life outcomes for the patient and caregiver. Equal, open conversations between health and social care professionals and patients/families on their understanding of dysphagia may help informal caregivers to better voice their concerns and support mutual understanding. This has implications for adherence to recommendations, psychological well‐being and patient safety. [ABSTRACT FROM AUTHOR]

Background: Assessing the speech production of multilingual children is challenging for speech‐language therapists (SLTs) around the world. Scientific recommendations to improve clinical practice are available, but their implementation has mostly been described in studies from English‐speaking countries. Aims: This survey aimed to describe the perspectives and practices of SLTs in assessing the speech production of multilingual children in French‐speaking Belgium. Methods & Procedures: An online survey was completed by 134 SLTs in French‐speaking Belgium. Outcomes & Results: SLTs predominantly used norm‐referenced assessment approaches, which are not recommended for use with multilingual children, and lacked necessary training and resources to implement recommended practices in the assessment of speech production of multilingual children. The shift towards more appropriate practices with multilingual children seems to be in its infancy among SLTs in French‐speaking Belgium. Some challenges identified by the SLTs were common to those in other countries and languages, such as the difficulty to distinguish between speech differences and speech disorders. Other challenges were specific to the French language and/or the Belgian context, such as the lack of appropriate tools in French. Conclusions & Implications: Action is required to improve clinical practice in assessing the speech production of multilingual children in French‐speaking contexts: better training for SLTs regarding linguistic diversity, more implementation research in the field of SLT, and advocacy for linguistic diversity with decision makers. What this paper adds: What is already known on this subject: Existing research indicates that assessing the speech production of multilingual children is challenging for speech‐language therapists (SLTs). Scientific recommendations for best practices have been published, and the shift to more appropriate assessment practices may be progressing differently across countries. SLTs' practices have been described in surveys, mostly conducted in English‐speaking countries. Although French is the fifth most spoken language in the world, data about SLTs' perspectives and practices in French‐speaking regions are scarce. What this study adds: The implementation of recommended practices in assessing multilingual children's speech production was limited among SLTs in French‐speaking Belgium. The norm‐referenced approach to assessment was predominant and few SLTs used recommended practices (e.g., criterion‐referenced measures, dynamic assessment, assessment of the child's speech production in the home language). Some challenges were identified that related specifically to practices in French‐speaking contexts (e.g., lack of French tools) and Belgian context (e.g., health policies unfavourable to multilingualism). These findings confirm that specific understanding of a situation is needed to develop context‐ and/or language‐specific solutions—and ultimately improve clinical practice. What are the clinical implications of this work?: SLTs in French‐speaking Belgium require specific training and support to provide appropriate assessment of speech production in multilingual children. Efforts to improve practices in French‐speaking contexts should focus on increasing understanding and consideration of cultural and linguistic diversity at all levels of the child's environment. Evidence‐based knowledge, assessment tools and multilingual resources are available to SLTs on websites in French and in English. [ABSTRACT FROM AUTHOR]

Background: People with post‐stroke aphasia (PWA) are more likely to experience serious mood disorders compared with those without. Emotional regulation may be important for influencing life participation after stroke. Understanding emotional regulation in the context of aphasia is important for promoting personally defined recovery, psychological well‐being and life participation. Aims: To explore how individuals experience and regulate negative emotional responses to aphasia as part of re‐engaging with life. Methods & Procedures: In‐depth semi‐structured qualitative interviews with 14 PWA were conducted. The focus and design were developed with public and patient involvement contributors. Reflexive thematic analysis was applied. Outcomes & Results: Analysis generated three themes, which captured inherent diversity across participants in terms of emotional experiences, responses and regulation strategies: (1) emotional upheaval at all stages of recovery; (2) regulating emotional upheaval; and (3) discerning possibilities for life participation. Emotional regulation occurred both within and without the context of formal support services. Conclusions & Implications: Individuals may be differently (en)abled in responding positively, with implications for aphasia psychological support and self‐management interventions. The findings may inform future interventions to optimize well‐being and personally meaningful outcomes for PWA. WHAT THIS PAPER ADDS: What is already known on the subject: PWA experience significant psychosocial upheaval and are at risk of mood disorders. Emotional regulation may be important for influencing one's emotional state, social participation and relationships after stroke. There is a need to better understand the ways in which PWA experience and regulate their emotions to develop better support for personally defined recovery. What this paper adds to existing knowledge: PWA may experience significant and pervasive mood disorders in the long term after stroke. This may be compounded by worries for their children's well‐being. Some, but not all, regulate emotions by drawing on positivity, determination, gratitude or stoicism. Having (supportive) opportunities to experience the impact of aphasia is important for discerning helpful strategies and participation opportunities. What are the potential or actual clinical implications of this work?: Confronting altered abilities requires supportive, responsive opportunities sensitive to emotional responses. Opportunities for peer support and/or meaningful emotional support and compassion from family and friends are important therapeutic targets. Therapeutic input should pay attention to any familial and parenting concerns that may be compounding low mood. Although emotional regulation and recovery may occur without formal support, mental health services must be organized in such a way that PWA can access as needed. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapists (SLTs) and care home activities staff play key roles in managing and supporting the communication needs of older residents in care homes. However, the current practice and perspectives of these two professions in the United Kingdom has not been examined. Aims: To investigate the practice patterns and views of SLTs and activities staff working in UK care homes for older adults in relation to residents' communication needs. Methods and Procedures: Two online surveys, with 63 questions (SLT survey) and 46 questions (activities staff survey) in total, were created using the online platform Qualtrics. Participants were asked to consider their routine practice before COVID‐19. Results were analysed using descriptive statistics and qualitative content analysis. Outcomes and Results: A total of 116 valid responses were received from SLTs and 29 valid responses from activities staff. A high level of communication needs in care homes was reported by both participant groups, as was insufficient time and resources and lack of managerial encouragement in this area. SLTs reported that the majority of referrals to their service from care homes was for swallowing needs (70%). Cognitive communication difficulty was the most commonly reported communication need by SLTs (65%). Most SLTs (73%–87%) provided some level of communication intervention and considered management of residents' communication needs to be both part of the SLT role and a good investment of their time. Lack of confidence setting goals and providing direct intervention for communication needs was reported, with 25% feeling stressed at the thought of this. The main themes from free text responses about SLT service improvement were increased staff training, funding (of resources and specialist posts) and changes to service provision (referral criteria and accessibility/awareness of SLT service). Hearing impairment was the communication need most commonly reported by activities staff (43%). Participants demonstrated relatively high awareness of communication difficulty in residents and reported high levels of knowledge and confidence identifying and supporting residents' communication. Most (79%–89%) considered identifying and supporting the communication needs of residents to be part of their role and expressed interest in receiving further training in communication support. The reported activities staff data set may be positively biased. Conclusions and Implications: SLTs and activities staff were highly motivated to support the communication needs of care home residents. Increased training, time and resources dedicated to managing the communication needs of residents emerged as opportunities for service improvement across both data sets. WHAT THIS PAPER ADDS: What is already known on the subject: There is a high level of communication need amongst older care home residents. Social interaction and relationships are important factors contributing to quality of life in this population and rely on successful communication. Speech and language therapists (SLTs) and activities staff play key roles in managing and supporting the communication needs of this client group, but the current practice and perspectives of these professions in the United Kingdom has not been examined. What this study adds: A high level of communication need in care home residents was identified by both SLT and activities staff and both participant groups were motivated to address, identify and manage this need. However, insufficient time and resources, as well as a perceived lack of encouragement from managers to provide communication support/intervention, were reported by both groups. SLT practice was constrained by referral criteria and care pathways, which differed between services. Suggestions for SLT service improvement are reported. Clinical implications of this study: Targeted, ongoing staff training is required in care homes to improve the communication environment and develop care home staff capacity to support residents' communication needs. There is also a call for service level improvements to increase the range of SLT practice in care homes, including a greater focus on communication needs and more specialist (e.g., dementia) SLT roles. [ABSTRACT FROM AUTHOR]

Background: An increasing number of children in the UK and Ireland are growing up speaking more than one language. The many advantages of bilingualism are acknowledged; however, this increased linguistic diversity presents particular challenges for speech and language therapists (SLTs). The case is often more complex with speakers of minority languages such as Welsh and Irish, which are acquired almost exclusively in bilingual contexts. Lack of appropriate standardized assessments for bilinguals is a key issue for SLTs internationally; however, little is known about the practices, personal perspectives or wider challenges faced by SLTs in assessing minority language skills. We focus on SLTs working with English–Irish bilinguals across Northern Ireland (NI) and the Republic of Ireland (ROI) where status, use and exposure to Irish differ significantly. Aims: To investigate the perceptions and practices of SLTs in NI and the ROI in the assessment of bilingual English–Irish‐speaking children. Methods & Procedures: A 33‐item online survey was distributed to SLTs working with children in community settings in NI and the ROI. Outcomes & Results: A total of 181 SLTs completed the survey. The majority of respondents had bilingual English–Irish‐speaking children on their caseloads; however, less than one‐quarter had assessed Irish language skills. Responses indicate confusion as to whether best‐practice guidelines applied in this particular context where the majority of speakers have English as their first language and limited domains of exposure to Irish outside of the education system. Resources available to assess Irish language skills were found to be limited. Informal analysis of language samples emerged as the most popular assessment tool. SLTs in the ROI had a significantly higher level of competence in the Irish language than SLTs in NI. This reduced the challenge of assessment. Many SLTs reported scoring assessments standardized on monolingual populations when assessing English language skills in bilingual English–Irish‐speaking children. Conclusions & Implications: Our findings highlight the challenges faced by SLTs in meeting best‐practice guidelines in the assessment of speakers of minority languages such as Irish. Further work is needed to ensure clinicians and other professionals have access to information and enhanced training on bilingual language acquisition in minority language contexts and implications for assessment and diagnosis. This study underlines the need for further research on the acquisition of minority languages as well as the development of alternative assessment tools to assist SLTs in meeting the needs of this population. What this paper adds: What is already known on the subject: Existing research indicates that SLTs face challenges in assessing bilingual clients. Lack of assessment resources is a global issue, particularly with respect to minority languages. Emerging research indicates that SLTs and other professionals are dissatisfied with current resources for assessing Irish‐speaking bilinguals and are struggling to meet best‐practice guidelines. What this paper adds to existing knowledge: The status of the Irish language differs significantly between NI and the ROI, while English is the dominant language in both areas. This study provides the first exploration of current assessment practices for bilingual English–Irish‐speaking children as reported by SLTs across both regions. The challenges of assessing bilingual clients in many other countries are mirrored by SLTs in NI and the ROI. The majority of children acquiring Irish are doing so in a specific context: the immersion education setting. This raises uncertainty for SLTs about whether the definition of bilingualism actually applies. Despite clinicians and clients sharing the same majority language, the complexity of minority language assessment remains. What are the potential or actual clinical implications of this work?: SLTs require specific support and resources to help them meet the assessment needs of bilingual English–Irish‐speaking children. Ongoing education and training are required for clinicians and other professionals to facilitate understanding of the complexities surrounding bilingual speakers of minority languages and the application of best‐practice guidelines. A greater understanding of the context in which children are acquiring Irish and the impact this may have on their acquisition of English would further support clinicians in identifying speech, language and communication needs in this population. [ABSTRACT FROM AUTHOR]

Background: Intelligibility and comprehensibility in speech disorders can be assessed both perceptually and instrumentally, but a lack of consensus exists regarding the terminology and related speech measures in both the clinical and scientific fields. Aims: To draw up a more consensual definition of intelligibility and comprehensibility and to define which assessment methods relate to both concepts, as part of their definition. Methods & Procedures: A three‐round modified Delphi consensus study was carried out among clinicians, researchers and lecturers engaged in activities in speech disorders. Outcomes & Results: Forty international experts from different fields (mainly clinicians, linguists and computer scientists) participated in the elaboration of a comprehensive definition of intelligibility and comprehensibility and their assessment. While both concepts are linked and contribute to functional human communication, they relate to two different reconstruction levels of the transmitted speech material. Intelligibility refers to the acoustic–phonetic decoding of the utterance, while comprehensibility relates to the reconstruction of the meaning of the message. Consequently, the perceptual assessment of intelligibility requires the use of unpredictable speech material (pseudo‐words, minimal word pairs, unpredictable sentences), whereas comprehensibility assessment is meaning and context related and entails more functional speech stimuli and tasks. Conclusion & Implications: This consensus study provides the scientific and clinical communities with a better understanding of intelligibility and comprehensibility. A comprehensive definition was drafted, including specifications regarding the tasks that best fit their assessment. The outcome has implications for both clinical practice and scientific research, as the disambiguation improves communication between professionals and thereby increases the efficiency of patient assessment and care and benefits the progress of research as well as research translation. What this paper adds: What is already known on the subject: Intelligibility and comprehensibility in speech disorders can be assessed both perceptually and instrumentally, but a lack of consensus exists regarding the terminology and related speech measures in both the clinical and scientific fields. What this paper adds to existing knowledge: This consensus study allowed for a more consensual and comprehensive definition of intelligibility and comprehensibility and their assessment, for clinicians and researchers. The terminological disambiguation helps to improve communication between experts in the field of speech disorders and thereby benefits the progress of research as well as research translation. What are the potential or actual clinical implications of this work?: Unambiguous communication between professionals, for example, in a multidisciplinary team, allows for the improvement in the efficiency of patient care. Furthermore, this study allowed the assessment tasks that best fit the definition of both intelligibility and comprehensibility to be specified, thereby providing valuable information to improve speech disorder assessment and its standardization. [ABSTRACT FROM AUTHOR]

Background: Stroke and aphasia can have a profound impact on people's lives, and depression is a common, frequently persistent consequence. Social networks also suffer, with poor social support associated with worse recovery. It is essential to support psychosocial well‐being post‐stroke, and examine which factors facilitate successful adjustment to living with aphasia. Aims: In the context of a feasibility randomized controlled trial of peer‐befriending (SUPERB), this qualitative study explores adjustment for people with aphasia in the post‐acute phase of recovery, a phase often neglected in previous research. Methods & Procedures: Semi‐structured interviews were conducted with 20 people with aphasia and 10 significant others, who were purposively sampled from the wider group of 56 people with aphasia and 48 significant others. Interviews took place in participants' homes; they were analysed using framework analysis. Outcomes & Results: Participants with aphasia were 10 women and 10 men; their median (interquartile range—IQR) age was 70 (57.5–77.0) years. Twelve participants had mild aphasia, eight moderate–severe aphasia. Significant others were six women and four men with a median (IQR) age of 70.5 (43–79) years. They identified a range of factors that influenced adjustment to aphasia post‐stroke. Some were personal resources, including mood and emotions; identity/sense of self; attitude and outlook; faith and spirituality; and moving forward. Significant others also talked about the impact of becoming carers. Other factors were external sources of support, including familial and other relationships; doctors, nurses and hospital communication; life on the ward; therapies and therapists; psychological support, stroke groups; and community and socializing. Conclusions & Implications: To promote adjustment in the acute phase, hospital staff should prioritize the humanizing aspects of care provision. In the post‐acute phase, clinicians play an integral role in supporting adjustment and can help by focusing on relationship‐centred care, monitoring mental health, promoting quality improvement across the continuum of care and supporting advocacy. What this paper addsWhat is already known on the subjectAnxiety and depression are common consequences of stroke, with depression rates high at 33% at 1 year post‐onset. There is evidence that the psychological needs of people with aphasia are even greater than those of the general stroke population. Social support and social networks are also negatively impacted. Few studies have examined adjustment when people are still in hospital or in the early stages of post‐stroke life in the community (< 6 months). Further, many stroke studies exclude people with aphasia.What this paper adds to existing knowledgeAdjustment to living with stroke and aphasia begins in the early stages of recovery. While this partly depends on personal resources, many factors depend on external sources of help and support. These include doctors, nurses and hospital communication, their experience of life on the ward, and their therapists' person‐centred care.What are the potential or actual clinical implications of this work?Clinicians play an integral role in facilitating people with aphasia to utilize their personal resources and support systems to adjust to life after stroke. They can help by focusing on relationship‐centred care, monitoring mental health, promoting quality improvement across the continuum of care and supporting advocacy. [ABSTRACT FROM AUTHOR]

Background: Parent–child interaction therapies are commonly used by speech and language therapists (SLTs) when providing services to young children with language learning difficulties. However, the way parents react to the demands of such interventions is clearly important, especially for those from socially disadvantaged backgrounds. Parents play a central role in the therapy process so to ensure parent engagement, and to maximize intervention effectiveness, parents' views must be considered. Aims: To explore the expectations and experiences of parents from socially disadvantaged backgrounds who had taken part in a parent–child interaction programme aimed at promoting language development in 2–3 year olds with language difficulties. Methods & Procedures: The sample included parents who had a child aged 2–3 years and had attended a parent–child interaction programme to promote their child's language development. Parents were eligible to take part if they were living in the 30% most deprived areas in a city in the North of England that constituted the study site. Ten parents participated in a qualitative semi‐structured face‐to‐face interview in the home. Framework analysis was used to analyse the interview transcripts. Outcomes & Results: Parents' expectations before taking part in parent–child interaction interventions contribute to how they may engage throughout the intervention process. Barriers include parents' uncertainty about the nature of the intervention and differing attitudes regarding intervention approaches and strategies. Facilitators during the intervention process include gaining support from other parents, reassurance from the SLT regarding their child's language development, and their own ability to support their child's language learning, as well as increased confidence in how they support their child's development. Conclusions & Implications: Parents respond very differently to parent–child interaction intervention for children with language difficulties, depending on their expectations and attitudes towards intervention. Thus, it is critical that these different perspectives are understood by practitioners before intervention commences to ensure successful engagement. What this paper addsWhat is already known on this subjectParent–child interaction interventions are widely used to promote child language development. Parents play a central role in the therapy process of such interventions, so to maximize effectiveness, parents must be appropriately 'engaged' in that intervention. This involves attending, fully participating and having appropriate attitudinal and/or emotional involvement. The reciprocal nature of engagement means that parents are more likely to become engaged in intervention over time when they are supported by their SLT.What this paper adds to existing knowledgeParental expectations about the intervention process vary considerably and often need to be negotiated before the start of intervention. Reassurance and supporting positive attitudes to co‐working with their SLT may be particularly important for families living with social disadvantage. Supporting parent engagement in parent–child interaction programmes can contribute to the parents' capability to continue implementing language‐promoting strategies outside the intervention context and beyond the end of therapy.What are the potential or actual clinical implications of this work?Parents have different expectations regarding programme involvement. Therefore, having a two‐way, open dialogue between parents and SLTs from the beginning is clearly important, not only as a way of sharing information but also to build on parents' understanding of what the intervention will involve and trust that the SLT will be able to deliver the intervention in collaboration with the parent. SLTs can enhance parent engagement by supporting parents to feel confident and providing reassurance in terms of their child's development and how they can support their child's language learning. [ABSTRACT FROM AUTHOR]

Background: Communication is at the heart of relationships, especially for couples. When language is altered, as it is in aphasia, communication in couples can be affected. Aims: To explore how members of a couple perceive the impact of aphasia on their communication. Methods & Procedures: Nine French‐speaking couples participated in the study. One member of each couple had chronic stroke‐related aphasia, which varied in type and severity. The 18 participants took part in individual semi‐structured interviews to understand their perspective on communication within their couple. The interviews were recorded, transcribed and analysed with a qualitative thematic analysis. Outcomes & Results: Three main themes emerged: (1) experiencing limitations in conversation; (2) assuming changed speaking and listening roles; and (3) experiencing new emotions, feelings and reactions in communication. Couples experienced diminished frequency and duration of conversations as well as restrained topics after the onset of aphasia. Ten participants reported that each member's communication role of listener versus speaker had changed, and that the person with aphasia became a less active participant. Communication was described as 'positive' before aphasia and 'fine' to 'difficult' following aphasia. Persons with aphasia and spouses expressed experiencing difficulties managing emotions related to communication. Frustration and caution towards the other member of the couple had been associated with aphasia. In addition, five spouses reported that they refrained from initiating discussions on specific topics in order to maintain a positive relationship with the person with aphasia. Conclusion & Implications: The results describe some of the consequences of aphasia on communication in couples. Clinicians could use interviews to understand the impact of aphasia on a couple's communication. This may help to design communication partner training (CPT) that better aligns with the particular needs of couples living with aphasia, acknowledging the importance of emotional dimensions of relationships. What this paper addsWhat is already known on the subjectThe general psychosocial impacts of aphasia on persons with aphasia and spouses are known. Their conversations have been described and used as a focus for CPT. However, CPT may be difficult to implement in clinical settings.What this paper adds to the existing knowledgeThis paper provides in‐depth descriptions of perceived changes in relational or transactional communication by the PWA and their spouse. The frequency, duration and topics of conversations changed and emotions such as frustration and caution appeared. Participants assumed changed speaking and listening roles.What are the potential or actual clinical implications of this work?The participants' description of communication could be used by speech–language pathologists when conducting CPT to illustrate how aphasia affects communication in couples. Emotions emerging as a result of changes in communication following aphasia should be assessed before CPT and could be a starting point to work on communication. This could support clients' commitment in CPT. [ABSTRACT FROM AUTHOR]

Background: Interest in how stroke survivors might be better supported to manage life after stroke has grown rapidly in recent years, with a particular emphasis on enabling 'self‐management'. Post‐stroke communication difficulties may pose a unique barrier to longer term adaptation and adjustment. It is important to understand how stroke survivors with communication difficulties manage life after stroke and what support may be needed to facilitate this process. Aims: To explore how stroke survivors with communication difficulties manage life after stroke in the first year. Methods & Procedures: A cross‐sectional qualitative study involving in‐depth semi‐structured interviews with stroke survivors with communication difficulties (aphasia, dysarthria or apraxia of speech) and/or their family members at single time points during the first year post‐stroke. A total of 21 participants (14 stroke survivors and seven family members) took part in interviews for the study. Interview data were analysed using thematic analysis. Outcome & Results: A total of six themes were identified: (1) strategies to manage changes to communication; (2) testing communication outside of the home; (3) balancing support and independence; (4) hope for recovery; (5) obtaining support from healthcare professionals; and (6) adapting activities and keeping busy. Stroke survivors with communication difficulties and their family members undertook significant work (practical, relational, emotional) to manage their condition. Adaptation and adjustment was often facilitated by 'doing'; testing out which activities could be managed independently and which required additional support. Some stroke survivors and their family members demonstrated considerable resourcefulness and creativity in developing strategies to manage their communication difficulties. Despite the work undertaken, many expressed a lack of confidence in their ability and feelings of powerlessness and abandonment at the point of discharge from community services. Conclusions & Implications: Stroke survivors and their family members develop personally meaningful and context‐specific strategies to adjust to and manage life after stroke. Future interventions should recognize, support and build upon the active work already undertaken by stroke survivors with communication difficulties and their families. Further support before and around the point of discharge from community services may be needed to help build confidence and skills to manage in the longer term. The benefit of a supported self‐management approach for stroke survivors with communication difficulties should be further investigated. [ABSTRACT FROM AUTHOR]

Background: Access to treatments for mood disorders may pose a challenge to individuals with compromised communication ability. Speech–language pathologists (SLPs) have previously reported that their clients with aphasia decline formal psychological support; however, their role in their clients' help‐seeking has not been explored. Aims: To investigate SLPs' perspectives on how they currently support help‐seeking for mood problems in people with aphasia and factors they perceive to be impacting service uptake. Methods & Procedures: A qualitative interview study was conducted. SLPs in Australia working with people with aphasia in a clinical role were recruited. Transcripts of the interviews were subject to qualitative analysis to identify relevant themes. Outcomes & Results: Eighteen interviews were conducted. One overarching theme and three sub‐themes were identified as central to SLPs' experience. The overarching theme was of a 'double whammy' impact on help‐seeking: people with aphasia were subject to universal barriers associated with seeking help as well as additional barriers imposed by compromised communication. Three themes contributed to the overarching theme: (1) SLPs' understanding of barriers and facilitators to patients with aphasia seeking help; (2) the role of the SLP as a skilled helper for mood management; and (3) mood and communication as competing rehabilitation priorities. Conclusions & Implications: SLPs report both universal barriers to help‐seeking and those specific to their clients with aphasia and attempts to overcome these; however, there appears to be a dearth of accessible mental health services for people with aphasia known to SLPs, including psychological/counselling professionals who are skilled in communicating with people with aphasia. Health professionals working within and across post‐stroke and mental health services should recognize that people with post‐stroke aphasia are susceptible to a decline in mental health, are amenable to formal (and tailored) psychological support, and can be supported to seek help. [ABSTRACT FROM AUTHOR]

Background: Children with speech‐sound disorders (SSD) constitute a significant proportion of speech–language pathologists' (SLPs) caseloads. Previous research has investigated the clinical practice of SLPs intervening with children with SSD; however, little is known about the clinical decision‐making underpinning their practice. Aims: The clinical decision‐making of SLPs working with children with SSD was explored to understand how their clinical decisions were influenced by: (1) beliefs about what works in therapy; (2) prior clinical experience; and (3) client and service‐related variables. Methods & Procedures: Semi‐structured, individual, in‐depth interviews were conducted with 11 SLPs. Inductive thematic analysis was used to identify and explore key ideas and themes. Outcomes & Results: Four themes emerged: (1) clinical decision‐making procedures were highly individualized; (2) parental involvement was viewed as central to the success and progression of therapy; (3) therapy procedures were influenced by practice‐setting constraints; and (4) engaging in evidence‐based practice within clinical settings was perceived as challenging. Conclusions & Implications: In clinical settings, a range of factors influence decision‐making and therapy provided by SLPs to children with SSD. These SLPs had a high regard for clients' values and preferences. Prior clinical experiences also shaped clinical practice. Clinical decision‐making was influenced by practice‐setting constraints. SLPs are under pressure in their workplaces and are struggling to manage the competing demands on their time. Large clinical caseloads, heavy workloads, current service‐delivery models and changing family structures are all impacting on the provision of therapy to children with SSD and therapy outcomes. As a profession, there is a need to consider these barriers and identify ways to overcome them in order to assist SLPs to routinely adopt the highest standards of clinical practice for children with SSD. [ABSTRACT FROM AUTHOR]

Background Conversation therapy for aphasia is a complex intervention comprising multiple components and targeting multiple outcomes. UK Medical Research Council (MRC) guidelines published in 2008 recommend that in addition to measuring the outcomes of complex interventions, evaluation should seek to clarify how such outcomes are produced, including identifying the hypothesized mechanisms of change. Aims To identify mechanisms of change within a conversation therapy for people with aphasia and their partners. Using qualitative methods, the study draws on behaviour change theory to understand how and why participants make changes in conversation during and after therapy. Methods & Procedures Data were derived from 16 participants (eight people with aphasia; eight conversation partners) who were recruited to the Better Conversations with Aphasia research project and took part in an eight session conversation therapy programme. The dataset consists of in-therapy discussions and post-therapy interviews, which are analysed using Framework Analysis. Outcomes & Results Seven mechanisms of conversational behaviour change are identified and linked to theory. These show how therapy can activate changes to speakers' skills and motivation for using specific behaviours, and to the conversational opportunities available for strategy use. Conclusions & Implications These clinically relevant findings offer guidance about the processes involved in producing behavioural change via conversation therapy. A distinction is made between the process involved in motivating change and that involved in embedding change. Differences are also noted between the process engaged in reducing unhelpful behaviour and that supporting new uses of compensatory strategies. Findings are expected to have benefits for those seeking to replicate therapy's core processes both in clinical practice and in future research. [ABSTRACT FROM AUTHOR]