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This paper examines how power and knowledge are involved in the workings of speech and language therapy and in the work of speech and language therapists (SLTs). The paper draws on Foucault for its conceptual frame, with reference to his exposition of governmentality, biopolitics and pastoral power. Based on interviews with thirty-three SLTs in the UK, the findings show that evidence-based practice (EBP) is ever-present in speech and language therapy, despite its apparent absence; and that its power circulates in a multitude of ways. EBP as a process, and not an outcome, was workable. When competent practice was at risk, however, the SLTs challenged the dominance of EBP by saying it needed to 'get real' but then were troubled when it did. Working the 'wise' - those people involved with the client, including the SLTs themselves - was key to speech and language therapy; as was the making of subjects into biopolitical objects. At its most rewarding, but also most personally challenging, the work of SLTs involves mediating between different ways of being in the world and reimagining life, personhood and citizenship; to capture this complex labour process, the paper introduces the term 'pastoral labour'. • Uses Foucauldian lens to examine how power and knowledge govern the work of SLTs. • Evidence-based practice discriminates against some clients, it needs to 'get real'. • Reflective practice can inhibit the sharing of clinical practice knowledge. • SLTs' work means working the 'wise' i.e. other professionals, family, and themselves. • Pastoral labour - labour mediates knowledges and knowing in the 'making' of citizens. [ABSTRACT FROM AUTHOR]

Aim: To examine interrater agreement and validity of the Functional Communication Classification System (FCCS) for young children with cerebral palsy (CP) aged 2 or 3 years.Method: Speech-language pathologist (SLP) and parent FCCS ratings for 31 children with CP (aged 2y, n=16; aged 3y, n=15; 18 males, 13 females) were examined for interrater agreement using a weighted Cohen's kappa statistic. Relationships between FCCS (SLP) ratings and: (1) concurrent validity with the Language Use Inventory, a standardized pragmatic assessment for children aged 18 to 47 months, (2) gross motor and fine motor function, (3) associated impairments (visual and intellectual), and (4) primary expressive communication mode were examined using Spearman's correlation coefficients.Results: Almost perfect interrater agreement between SLP and parent FCCS ratings were found (kw =0.94). Correlations with FCCS (SLP) were excellent for pragmatic function (rs =-0.83, p<0.001), intellectual function (rs =0.89, p<0.001), and primary expressive communication mode (rs =0.92, p<0.001). Correlations were good for gross motor function (rs =0.72, p<0.001) and visual impairment (rs =0.70, p<0.001) and fair for fine motor function (rs =0.53, p<0.002). Analysis was unwarranted for epilepsy (n=1 out of 31) and hearing-associated impairments (n=0 out of 31).Interpretation: The FCCS has excellent interrater agreement and validity for communication classification of children with CP aged 2 or 3 years and is highly suitable for surveillance and research purposes. What this paper adds The Functional Communication Classification System (FCCS) is a valid instrument for children with cerebral palsy (CP) aged 2 or 3 years. Excellent agreement exists between speech-language pathologist and parent FCCS ratings. The FCCS has excellent correlation with intelligence, pragmatic function, and primary expressive mode. Stronger correlations with the Gross Motor Function Classification System and vision exist for children aged 2 or 3 years. Weaker correlations with manual ability exist when compared to older children with CP. [ABSTRACT FROM AUTHOR]

Performed urgently or out of necessity, tracheostomy is one of the most traumatic surgeries that seriously affects the patient's quality of life. It has a profound impact on the ability to communicate and on self-esteem, so that the patient can experience a storm of emotions and major changes that can affect their existence. The patient with tracheostomy is a special patient with special needs. The care of such a patient involves a constant multidisciplinary effort supported by specialists in many fields: ENT specialists, oncologists, radiotherapists, anesthetists, neurosurgeons, general surgeons, physiotherapists, speech therapists, nutritionists especially psychotherapists. Tracheostomy affects the basic needs of the individual: communication, nutrition, sexuality, social relationships. Numerous studies show that patients with tracheostomy show a high level of psychological distress. Depression, anxiety, low selfesteem, frustration, alienation, isolation, tendency to suicide are the negative consequences of this mutilating surgery. Perceived as a permanent disability, tracheostomy requires special care from a psychological point of view. Sometimes, however, it is observed that both patients and their families are not sufficiently informed about the management of tracheostomy. Due to lack of means or staff, not enough emphasis is placed on preoperative training so that the patient fully understands both the benefits and the disadvantages of this surgical technique. Therefore, often the patient's family, which later assumes the role of caregivers of the tracheotomized, perceives it as a burden, excessive fatigue, helplessness, abandonment from society. This paper aims to highlight the importance of pre- and postoperative psychological training of both the patient and his family and to demonstrate that tracheostomy care can be one of the most suggestive examples of interdisciplinarity that seeks to provide effective solutions in this regard. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this systematic review was to review and synthesize the current evidence on speech and language outcomes of children with Obstructive Sleep Apnea (OSA), or more broadly sleep-disordered breathing.Method: A comprehensive literature search was conducted across 5 databases. Studies were selected based on the following criteria: 1) peer-reviewed research published between 2000 and 2020, 2) available in English or accessible non-English data, 3) children aged 2-13 years diagnosed with Sleep Disordered Breathing (SDB) or OSA, and 4) speech and language outcomes examined within research.Results: Studies were appraised using PEDro-P and the overall certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Six studies met the current review selection criteria: one paper examined speech outcomes and the remaining five examined receptive and expressive language outcomes. The overall quality of the body of evidence was rated as very low, with methodological weaknesses present in study designs and sample sizes.Conclusion: Speech and language difficulties are common in children with OSA/SDB, in addition to neurocognitive and/or neurobehavioral issues. Further investigation of specific speech and language skills, which are compromised in this population, is needed to guide clinical practice and decision making, with particular involvement from speech-language pathologists. [ABSTRACT FROM AUTHOR]

Background: Subjective well‐being (SWB) and quality of life (QOL) are intricately related constructs. Recent research shows both constructs share some facets, but are distinct entities. It is unclear, both internationally and in the Netherlands, if and how SLTs address SWB in clinical practice. The current study was set up to explore Dutch SLTs' perceptions of SWB in relation to the management of people with aphasia. Aims: To describe how Dutch SLTs, working with people with aphasia in a private practice or a healthcare setting, address patient's SWB during diagnosis and treatment, and to identify barriers and facilitators they experience when addressing SWB. Methods & Procedures: A qualitative research design with a phenomenological approach was used. SLTs from private practices and healthcare settings were invited to participate in individual interviews and a focus group. The data were analysed thematically using a combination of inductive and deductive methods. Outcomes & Results: Eight SLTs participated in the study. The SLTs' experiences were captured in four themes that emerged from the data: (1) SWB is a multifaceted concept and depends on patient‐specific factors: premorbid factors, life priorities and time post‐stroke; (2) SLTs experience more responsibility for patients' SWB than their profession allows; (3) collaboration between SLTs and patients, patients' network and other healthcare professionals is required to address SWB during diagnosis and treatment; and (4) misinterpretations are inevitable when SLTs or the patients' network address patients' SWB. Conclusions & Implications: The results showed that SLTs feel responsible for addressing SWB in the management of people with aphasia. Their perception of the concept of SWB is similar to the definition used in the literature and is multifaceted. They feel responsible for the part of SWB that is related to communicative functioning, but less so for the more heuristic aspects of SWB. This is related to their experienced limitation of influence on SWB, which for some leaves them feeling out of depth and uncertain about boundaries between professionals. Addressing SWB in a multidisciplinary team is therefore considered important in order to adequately and fully capture someone's SWB and reduce to clinicians' experienced burden and responsibility. What this paper addsWhat is already known on this subjectRecent studies suggest that quality of life measures may lack facets related to subjective well‐being (SWB). Aphasia is likely to impact on SWB of a stroke survivor, but it is unclear if and how SWB is addressed by speech and language therapists in diagnosis, and treatment of Dutch PWA.What this study addsThis study provides insight into the operationalization of SWB in Dutch clinical practice, including barriers SLTs experience when addressing SWB.Clinical implications of this studyMonitoring and influencing SWB of people with aphasia is a complex process, that SLTs consider only possible in multi‐disciplinary teams. Clear guidelines on roles and responsibilities between various disciplines involved are necessary to improve care for people with aphasia. [ABSTRACT FROM AUTHOR]

Patients undergoing curative (chemo)radiotherapy ((C)RT) for head and neck cancer (HNC) who experience or are at risk of developing dysphagia are often provided with pre-treatment swallow exercises (SE), in line with consensus opinion for best practice. Evidence of SE efficacy is limited, with adherence cited as a confounding factor. We evaluated SE adherence in our patient group with the aim of proposing opportunities for improvement. A 16 item questionnaire was developed with input from patients, speech and language therapists (SLTs) and oncologists, including quantitative and qualitative questions covering demographics, patient reported swallow function, understanding of and confidence with SE, frequency of completion, and resources that could improve adherence. The questionnaire was offered in paper or electronic format (Civica Software) to patients who completed (C)RT over a 3-month period. All patients had received swallow exercises as per our standard protocol with advice to complete them 7-10 times per day, supported by a written leaflet and regular SLT review during treatment. Of 39 patients who completed (C)RT, 90% (n=35) completed the questionnaire; 51% (n=18) treated with primary (C)RT and 46% (n=16) post-operative (C)RT. Swallowing difficulties were reported by 31% (n=11) pre-(C) RT, rising to 71% (n=25) at end of treatment. Almost all (94%, n=33) stated they understood the rationale for SE. Frequency of completion was variable (Table 1). Treatment toxicities were reported as barriers to adherence by 51% (n=18). Over a third of patients (37%, n=13) felt only somewhat, slightly or not at all confident they were completing SE correctly. Regarding resources that would improve adherence, a leaflet with written instructions and pictures or diagrams was selected most frequently (46%, n=16), a website/app with videos was also popular (29%, n=10). 80% (n=28) planned to continue SE after treatment. 83% (n=29) rated their overall experience of SE and advice as either good or very good. A questionnaire offers a simple way to obtain a snapshot view of current experience, and our high response rate suggests results are reliable. Our findings suggest that our current recommendation of SE completion 7-10 times per day is not achievable for most patients; a change in recommendation to 3-5 times per day is supported by recent evidence and encourages self-efficacy. At least a third of patients lacked confidence in completing SE, and we are focusing on this by developing new pictorial, online and video resources. Our survey indicated high overall satisfaction with our current service despite variable adherence. Future work will evaluate the impact of service improvements on patient outcomes. [ABSTRACT FROM AUTHOR]

People with communication impairment need an alternative communication channel to complete daily activities. Augmentative and alternative communication (AAC) systems can help provide a communication medium to support such users. The involvement of speech and language pathologists (SLPs) who work in rehabilitation centers can help develop better solutions. This paper presents the development of an AAC tablet application that uses pictures on the screen and voice feedback to help children with language impairment improve the efficiency in their communication. The proposed solution maps the sentences commonly used by children into appealing symbols. The children can use these symbols instead of constructing sentences from scratch, as done by most of the previously proposed solutions in the literature. The application was evaluated by SLPs on six children with language impairment. This research presents a design methodology when providing such a solution for touch screen devices for people with language impairment. A set of accessibility guidelines is proposed for AAC computer-based solutions, which can help researchers and practitioners. The obtained results prove that the proposed system improves the children’s stimulation to communicate and decreases communication time. Such a solution can assist therapists as a resource to improve their patients’ communication. [ABSTRACT FROM AUTHOR]

Within the framework of the Carcinologic Speech Severity Index (C2SI) INCa Project, we collected a large database of French speech recordings aiming at validating Disorder Severity Indexes. Such a database will be useful for measuring the impact of oral and pharyngeal cavity cancer on speech production. It will permit to assess patients' quality of life after treatment. The database is composed of audio recordings from 134 sessions and associated metadata. Several intelligibility and comprehensibility levels of speech functions have been evaluated. Acoustics and prosody have been assessed. Perceptual evaluation rates from both naive and expert juries are being produced. Automatic analyzes are being carried out. It is intended to provide speech therapists and physicians with objective tools, which take into account the intelligibility and comprehensibility of patients which received cancer treatment (surgery and/or radiotherapy and/or chemotherapy). The aim of this paper is to justify the necessity of such a corpus and to present its data collection. This C2SI corpus will be available to the scientific community through the Scientific Interest Group Parolothèque. [ABSTRACT FROM AUTHOR]

Modern speech-language pathology practices (SLPPs) have adopted tablet games in recent years. Research is needed to take advantage of the potential benefits tablets can offer and to explore the factors that influence its introduction. This paper discusses a survey that was conducted to investigate the factors that influence speech-language pathologists’ (SLPs) beliefs and the actual use of tablets in SLPPs. The results of the survey, conducted among Slovenian SLPs, indicated that their most positive beliefs concerning tablets relate to social influence. Specifically, the beliefs relate to children’s interest and practice with tablets and have a significant impact on the decision-making of SLPs concerning introducing tablets in therapy. Conversely, SLPs’ most negative beliefs relate to the conditions for facilitating tablet use, particularly the lack of Slovenian applications. This paper discusses a separate case study that was conducted in which tablet game-supported therapy was introduced to a group of 44 children. The case study results indicated that the children accepted the use of tablet games for therapy purposes and the games had a positive impact on the children’s motivation and satisfaction. [ABSTRACT FROM AUTHOR]

Abstract: Background: Clinical placements are crucial to the development of skills and competencies in speech–language pathology (SLP) education and, more generally, a requirement of all health professional training programmes. Literature from medical education provides a context for understanding how the environment can be vital to all students’ learning. Given the increasing costs of education and demands on health services, students who struggle or fail on clinical placement place an additional burden on educators. Therefore, if more is known or understood about these students and their experience in relation to the clinical learning environment, appropriate strategies and support can be provided to reduce the burden. However, this literature does not specifically explore marginal or failing students and their experience. Aims: To review existing research that has explored failing and struggling health professional students undertaking clinical placements and, in particular, SLP students. Methods & Procedures: A critical narrative review was undertaken. Three electronic databases, ProQuest, CINAHL and OVID (Medline 1948–), were searched for papers exploring marginal and failing students in clinical placement contexts across all health professions, published between 1988 and 2017. Data were extracted and examined to determine the breadth of the existing research, and publications were critically appraised and major research themes identified. Main Contribution: Sixty‐nine papers were included in the review. The majority came from medicine and nursing in the United States and United Kingdom, with other allied health disciplines less well represented. The review identified key themes with the majority of papers focused on identification of at risk students and support and remediation. The review also highlighted the absence of literature relating to the student voice and in the allied health professions. Conclusions & Implications: This review highlighted the limited research related to failing/struggling student learning in clinical contexts, and only a handful of papers have specifically addressed marginal or failing students in allied health professions. The complexity of interrelated factors in this field has been highlighted in this review. Further research needs to include the student's voice to develop greater understanding and insights of struggle and failure in clinical contexts. [ABSTRACT FROM AUTHOR]

Background Following content analyses of the first 30 years of the UK speech and language therapy professional body's journal, this study was conducted to survey the published work of the speech (and language) therapy profession over the last 50 years and trace key changes and themes. Aim To understand better the development of the UK speech and language therapy profession over the last 50 years. Methods & Procedures All volumes of the professional journal of the Royal College of Speech and Language Therapists published between 1966 and 2015 ( British Journal of Communication Disorders, European Journal of Communication Disorders and International Journal of Language and Communication Disorders) were examined using content analysis. The content was compared with that of the same journal as it appeared from 1935 to 1965. Outcomes & Results The journal has shown a trend towards more multi-authored and international papers, and a formalization of research methodologies. The volume of papers has increased considerably. Topic areas have expanded, but retain many of the areas of study found in earlier issues of the journal. Conclusions & Implications The journal and its articles reflect the growing complexity of conditions being researched by speech and language therapists and their professional colleagues and give an indication of the developing evidence base for intervention and the diverse routes which speech and language therapy practice has taken over the last 50 years. [ABSTRACT FROM AUTHOR]

Background: Silent aspiration (SA)—airway entry of food, drink or other material without a cough response—is common post‐stroke. Clinical swallowing examination misses up to 40% of dysphagic patients with SA. This may put these patients at risk of aspiration pneumonia, prolonged length of hospital stay and increased healthcare costs. After stroke, the laryngeal cough reflex is frequently impaired with significant relationships between pneumonia rates and reduced cough strength and sensitivity. There has been a significant amount of recent interest in cough reflex testing (CRT) as a potential means to improve clinical identification of patients at risk of SA. However, there is a lack of consensus regarding the methodology and protocols for use of CRT with widely varying outcomes reported in the literature. Aims: To provide an overview of current practice in the UK with regards to clinical use of CRT by speech and language therapists (SLTs) in acute stroke settings and to explore the perceptions regarding its potential application in clinical dysphagia management and the barriers and facilitators associated with adopting CRT in clinical practice. Methods & Procedures: A cross‐sectional web‐based survey was developed, piloted and delivered. The survey targeted all UK‐based SLTs working in acute stroke settings. Outcomes & Results: A total of 129 SLTs with varying levels of experience of CRT from all regions of the UK responded. Only four SLT services in the UK were reported to be currently using CRT clinically with acute stroke patients. A total of 29% of respondents who were not using CRT were considering introducing CRT into their service's dysphagia protocol. Variation was reported in the procedures and protocols. Overall, users reported improved confidence in the clinical detection of SA and felt that the introduction of CRT had improved their patient‐related outcomes. Issues included difficulties procuring citric acid, implications for SLT time (including service set‐up and delivery of CRT) and restricted access to instrumental assessments. Conclusions & Implications: This survey gives valuable insight into the current practice and perceptions of SLTs in the UK working in acute stroke settings in relation to CRT. It highlights discrepancies between reported approaches and recommendations from existing guidelines and validation studies. The variation in responses indicates a need to develop a consensus statement and further research to guide practice. What this study addsWhat is already known on the subjectCRT is gaining popularity as a screening tool for the clinical identification of SA with acute stroke patients. However, there is a lack of consensus in the literature regarding the methodology and protocols with widely varying outcomes. Further work needs to be done to standardize its use, especially if it is to be incorporated into dysphagia protocols for use in the acute stroke setting.What this paper adds to existing knowledgeThis survey of SLTs working in acute stroke settings highlights variability in practice in CRT service delivery in the UK, reflecting findings from the existing CRT literature.What are the potential or actual clinical implications of this work?The findings of this study support the need for further research relating to clinical screening tests for SA and standardization of methodology and protocols for CRT use if its use is to be continued clinically. [ABSTRACT FROM AUTHOR]

Background: Providing aphasia care in multilingual and multicultural settings necessitates increased attention in light of current migration and globalisation patterns. Delivering care that is meaningful and appropriate for people living with aphasia becomes challenging in cases where speech-language therapists are not able to speak the languages of people with aphasia, and in instances where there is a shortage of therapeutic resources. Traditional approaches to aphasia management thus require rethinking. The South African context embodies some of these challenges, with a lack of sufficient speech-language therapists and many unable to speak the languages of the majority population. Aims: Drawing from a framework of Ethics of Care and extending it to include the notion of community, this paper proposes a model of what a "community of care" might look like for people living with aphasia in diverse contexts. Several examples from a synthesis of qualitative studies conducted in the diverse South African context are used to illustrate and expand on a model of community of care. This work has explored communication opportunities and social activities across a range of community and residential care settings, incorporating the perspectives of people with aphasia, speech-language therapists and community members involved in caring for people with aphasia. Main contribution: A "community of care" perspective involves a broader conceptualisation of the care team and its contributors, including people such as employed caregivers who can potentially play an important role in the rehabilitation process. Similarly, a broader view of context is required, in particular its role in facilitating or inhibiting communication opportunities through focusing on aspects such as community activities, place of abode, and contextual nuances. "Care" needs to be considered as extending beyond the therapy room or rehabilitation centre, and group therapy may play a particular role in contributing to a sense of community for people with aphasia and meeting cultural needs. Tools such as narrative and ethnographic approaches may facilitate a stronger focus on the lifeworld of the person with aphasia and thus also strengthen a community of care perspective. Conclusions: A community of care perspective builds on existing approaches to aphasia management that consider the broader context and community. The potential role of the speech-language therapist in enabling a community of care for people with aphasia in multicultural settings is considered. [ABSTRACT FROM AUTHOR]

Background: Prognostication is a complex clinical task that involves forming a prediction about recovery and communicating prognostic information to patients and families. In aphasia, recovery is difficult to predict and evidence‐based guidance on prognosis delivery is lacking. Questions about aphasia prognosis commonly arise, but it is unknown how speech pathologists formulate and deliver information about expected recovery. An understanding of current practice in prognostication is needed to develop evidence‐based guidelines for this process, and is necessary in order to ensure successful future implementation of recommended practice regarding prognosis delivery. Aims: To identify the factors speech pathologists consider important when responding to questions about aphasia prognosis; to examine how they respond in different scenarios; and to evaluate their current attitudes towards aphasia prognostication. Methods & Procedures: A total of 54 speech pathologists participated in an online survey featuring hypothetical aphasia prognosis delivery scenarios, short‐response questions and ratings. Open responses were analysed thematically. Multiple‐choice responses were analysed using descriptive statistics and non‐parametric tests. Outcomes & Results: Speech pathologists regarded factors relating to the nature and severity of post‐stroke deficits, an individual's level of motivation and the availability of social support as most important for forming an aphasia prognosis. When delivering prognostic information, considerations of the recipient's emotional well‐being, hope and expectations, and comprehension of information were regarded as most important. Speech pathologists' prognosis responses varied in content and manner of communication. The content of the responses included predictions of recovery and information about various attributes and activities contributing to recovery. Prognostic information was most frequently communicated through qualitative probability expressions, general statements and uncertainty‐based expressions. A need for more professional support in aphasia prognostication was indicated. Conclusions & Implications: There is variation in the way speech pathologists respond to questions about aphasia prognosis, and it is unknown how these conversations affect people with aphasia and their significant others. Further research to understand speech pathologists' clinical reasoning and professional support needs, and the perspectives of people living with aphasia, may help to develop an evidence‐based approach to prognostication in aphasia. What this paper addsWhat is already known on this subjectQuestions about aphasia prognosis are difficult to answer. Current methods for predicting aphasia recovery are yet to demonstrate the reliability and individual specificity required for clinical application. At present, there is no evidence‐based guidance or support for prognosis delivery in aphasia.What this study adds to existing knowledgeThere is variation in the way speech pathologists predict aphasia recovery, the prognostic information they deliver and the manner in which they communicate prognoses. Current approaches to aphasia prognostication are reliant on experience and professional judgement, and speech pathologists desire more support for undertaking this task.What are the potential or actual clinical implications of this work?Speech pathologists lack a consistent approach to aphasia prognostication and desire more support in this task. The present findings offer insight into clinician attitudes and practice, and provide a direction for future research to establish best‐practice guidelines for this complex and demanding area of aphasia management. [ABSTRACT FROM AUTHOR]

Background: Pharyngeal fricative is one typical compensatory articulation error of cleft palate speech. It passively influences daily communication for people who suffer from it. The automatic detection of pharyngeal fricatives in cleft palate speech can provide information for clinical doctors and speech-language pathologists to aid in diagnosis.Results: This paper proposes two features (CSIFs: correlation of signals in independent frequency bands; OSPP: octave spectrum prominent peak) to detect pharyngeal fricative speech. CSIFs feature is proposed to detect the distribution characteristics of frequency components in pharyngeal fricative speech caused by the changed place of articulation and movement of articulators. While OSPP is presented to reflect the concentration degree of prominent peak which is closely related to the place of articulation in pharyngeal fricative, both features are investigated to relate to the altered production process of pharyngeal fricative. To evaluate the capability of these two features to detect pharyngeal fricative, we collected a speech database covering all the types of initial consonants in which pharyngeal fricatives occur. In this detection task, the classifier used to discriminate pharyngeal fricative speech and normal speech is based on ensemble learning.Conclusion: The detection accuracy obtained with CSIFs and OSPP features ranges from 83.5 to 84.5% and from 85 to 87%, respectively. When these two features are combined, the detection accuracy for pharyngeal fricative speech ranges from 88 to 89%, with an AUC (area under the receiver operating characteristic curve) value of 93%. [ABSTRACT FROM AUTHOR]

Background: The Royal College of Speech and Language Therapists (RCSLT) celebrates its 75th anniversary in 2020. The historical study of speech and language therapy (SLT) has been very limited. A small number of publications have traced the changes in the profession over time, but to date there has been no comprehensive work undertaken to gain an insight into the experiences of UK speech therapists who entered the newly formed profession after 1945. Aims: To use an oral history methodology to explore the life stories of early members of the profession. Methods & Procedures: Participants were recruited through RCSLT networks. Interviews were held across England and Scotland. Conversations were audio recorded and analysed using thematic network analysis. Archive material was used to complement participants' narratives. Outcomes & Results: Participants were 19 women who qualified between 1945 and 1968. Three global themes emerged: personal, professional and political stories. On a personal level, each reported steps towards autonomy and agency within the social constraints they experienced. Professionally, all commented on the vast expansion in the range of identifiable clinical fields between 1945, when the first participant qualified, and 2008, when the last participant retired. Politics and social policies impacted upon their lives and, sometimes to their surprise, the participants found themselves campaigning politically in pursuit of fairness for their profession. Conclusions & Implications: This paper offers a unique insight into the challenges and achievements participants experienced over their careers as early practitioners in the UK profession. [ABSTRACT FROM AUTHOR]

Background: Simulation‐based learning provides students with a safe learning environment, guaranteed exposure to specific clinical scenarios and patients, time for reflection and repetition of tasks, and an opportunity to receive feedback from multiple sources. Research including studies specific to allied health training programmes have demonstrated that simulation‐based learning also helps increase learners' confidence and reduces anxiety related to clinical environments, activities and skills. Such evidence, together with increasing challenges in provision of workplace clinical education, has supported an expansion of integrating simulation‐based learning into university curricula. Aims: To provide detailed information about the processes and considerations involved in the development of a simulation‐based learning programme for speech–language pathology. Methods & Procedures: Through reflection on the development process of a 5‐day simulation‐based learning programme, and in light of existing research in simulation, this paper outlines the important steps and considerations required for the development of a simulation‐based learning programme to support student competency development in adult speech pathology range of practice areas. Main Contribution: A proposed framework for the development of future simulation‐based learning programmes in speech–language pathology. Conclusions & Implications: The framework can be applied to simulation‐based learning for university programmes and/or workplace training in speech–language pathology and across several other health disciplines. [ABSTRACT FROM AUTHOR]

In this paper we address the topic of laughter/humour in young children's speech, which may or may not recognize the humour effect, caused in others and/or themselves. The work parts from an interactionism perspective on language acquisition, which allows to reflecting about the singularity of children's speech and on subjectivation process in the child. Excerpts of dialogue between a child and an adult/therapist have been analysed, where child's diverging segmentations from expected ones produce humour effects on both, or either of them. In addition, we consider which traits of therapist and child's interaction would allow us to discern the differences between the language clinician's interpretation and the psychoanalyst's -one -when clinical work on autism is at issue-, taking into account that the concept of subject of unconsciousness is involved. [ABSTRACT FROM AUTHOR]

This paper aims at discussing some theoretical-methodological aspects related to the way children's speech data are approached in language diagnostic procedures by speech-language pathologists. It is assumed the deep discontinuity between living speech and speech registers: there is a marked difference between these two instances. The questions raised in this article are: i) what, from living speech, remains accessible to the researcher?, and ii) what remains from living speech in the clinician's listening when he deals with recorded speech materials? I discuss the relevance of recording and transcription of dialogues in the construction of language evaluation procedures. This work is of a theoretical nature. Segments of clinical sessions will be presented to illustrate the discussion. It is concluded that living speech remains alive in the listening of the clinician and affects diagnosis decisions -listening must be theoretically instituted to be considered clinical in a strict sense. [ABSTRACT FROM AUTHOR]

More than 2 million people in the United States are living with some form of aphasia, a communication disorder that has been associated with high incidence of clinical depression. Despite their large numbers, persons with aphasia have received little clinical attention from psychologists and other mental health providers. The life participation interventions and supported communication methods developed and routinely employed by speech–language pathologists could assist mental health professionals in addressing the needs of this underserved population. This paper examines the psychological challenges facing individuals living with aphasia and the factors contributing to depressive symptoms among those with significant communication loss. In addition, it explores the potential compatibility between life participation interventions developed by speech–language pathologists and evidence-based cognitive–behavioral interventions for depression, such as behavioral activation. Specific adaptations to behavioral activation for individuals experiencing aphasia-related depressive symptoms are explored, along with strategies for integrating supported communication in the provision of mental health treatment. [ABSTRACT FROM AUTHOR]

Aim: A scoping review was conducted to examine and evaluate empirical data on the communication profile of Angelman syndrome beyond the described dissociation between receptive language and speech.Method: Three databases (PsycINFO, Embase, and Web of Science) were searched to retrieve articles investigating communication in Angelman syndrome. Seventeen articles investigating the broader communication profile were found; their methodology was evaluated against quality criteria.Results: Despite the absence of speech, individuals with Angelman syndrome have a wide repertoire of non-verbal communicative behaviours, mainly characterized by gestures, although advanced forms such as symbolic communication are used by some individuals. The use of communicative forms differs between the genetic aetiologies of Angelman syndrome; individuals with non-deletion aetiologies typically have greater communicative abilities.Interpretation: The broader communication profile of Angelman syndrome is characterized by diverse and multimodal abilities, including some use of symbolic forms of communication that appears atypical given the absence of speech. This is suggestive of a probable dissociation between speech and other expressive forms of communication, indicating an isolated speech production impairment. This highlights a need in this population for alternative communication and specific input from services tailored to support the nuances of the communication profile of Angelman syndrome.What This Paper Adds: Although absent speech is near universal, a diverse profile of other communicative abilities has been reported. Parental reporting has been predominantly used to assess the communication profile of Angelman syndrome. Literature that investigates the specificities and possible dissociations in such a communication profile is limited. [ABSTRACT FROM AUTHOR]

Teaching voice is the professional voice; often different in quality from our day-to-day speaking voice, and is supposed to be subjected to vocal abuse, misuse and overuse. This paper aims towards highlighting the various classroom determinants that may impact teacher's voice and how these impacts can affect the daily activities in terms of functional emotional and psychosocial aspects. To understand the same, a cross sectional prospective study was conducted across eight English medium institutions of Indore (a city in central India) region. The study was carried out in three phases: formulation of a questionnaire, data collection (through administration of the questionnaire and VHI among sixty school teachers) followed by data analysis, to determine whether any association exists between the various classroom determinants and voice impairment. Significant association was found between determinants like teaching experience; number of classes, duration of breaks, use of any alternate method of teaching and alternate use of any amplification device with physical, emotional and functional aspects of life. The findings holistically indicate that various factors within the classroom environment only has a significant bearing on the voice disturbances of a school teacher's life thus deteriorating their quality of life. Thus it is substantial to begin a training programme by speech language pathologists in order to heighten awareness among teachers. After all voice disturbances are a real and treatable condition and with the right amount of training can be avoided. [ABSTRACT FROM AUTHOR]

Intelligibility of speech is a key outcome in speech and language therapy (SLT) and research. SLT students frequently participate as raters of intelligibility but we lack information about whether they rate intelligibility in the same way as the general public. This paper aims to determine if there is a difference in the intelligibility ratings made by SLT students (trained in speech related topics) compared to individuals from the general public (untrained). The SLT students were in year 2 of a BSc programme or the first 6 months of a MSc programme. We recorded 10 speakers with Parkinson's disease (PD) related speech reading aloud the words and sentences from the Assessment of Intelligibility of Dysarthric Speech. These speech recordings were rated for intelligibility by 'trained' raters and 'untrained' raters. The effort required to understand the speech was also reported. There were no significant differences in the measures of intelligibility from the trained and untrained raters for words or sentences after adjusting for speaker by including them as a covariate in the model. There was a slight increase in effort reported by the untrained raters for the sentences. This difference in reported effort was not evident with the words. SLT students can be recruited alongside individuals from the general public as naïve raters for evaluating intelligibility in people with speech disorders. [ABSTRACT FROM AUTHOR]

Automatic hypernasality detection in cleft palate speech can facilitate diagnosis by speech-language pathologists. This paper describes a feature-independent end-to-end algorithm that uses a convolutional neural network (CNN) to detect hypernasality in cleft palate speech. A speech spectrogram is adopted as the input. The average F1-scores for the hypernasality detection task are 0.9485 and 0.9746 using a dataset that is spoken by children and a dataset that is spoken by adults, respectively. The experiments explore the influence of the spectral resolution on the hypernasality detection performance in cleft palate speech. Higher spectral resolution can highlight the vocal tract parameters of hypernasality, such as formants and spectral zeros. The CNN learns efficient features via a two-dimensional filtering operation, while the feature extraction performance of shallow classifiers is limited. Compared with deep neural network and shallow classifiers, CNN realizes the highest F1-score of 0.9485. Comparing various network architectures, the convolutional filter of size 1 × 8 achieves the highest F1-score in the hypernasality detection task. The selected filter size of 1 × 8 considers more frequency information and is more suitable for hypernasality detection than the filters of size 3 × 3, 4 × 4, 5 × 5, and 6 × 6. According to an analysis of hypernasality-sensitive vowels, the experimental result concludes that the vowel /i/ is the most sensitive vowel to hypernasality. Compared with state-of-the-art literature, the proposed CNN-based system realizes a better detection performance. The results of an experiment that is conducted on a heterogeneous corpus demonstrate that CNN can better handle the speech variability compared with the shallow classifiers. [ABSTRACT FROM AUTHOR]

Aim: To examine psychometric properties and clinical utility of the Functional Communication Classification System (FCCS) for classifying observable communication function in children with cerebral palsy (CP) aged 5 to 18 years.Method: Eighty-two children (38 males, 44 females) with CP in six age groups (5y [n=15], 8y [n=14], 10y [n=14], 12y [n=14], 15y [n=11], and 17y [n=14]) were assessed by a speech-language pathologist (SLP) and parent for FCCS ratings. Data were compared with: (1) everyday communication function, assessed using the Clinical Evaluation of Language Fundamentals - Fourth Edition Pragmatics Profile (CELF-4 PP) for familiar and unfamiliar partners; (2) motor speech, gross and fine motor function; and (3) associated impairments, including epilepsy, intelligence, hearing, and vision. Interrater agreement was calculated for FCCS ratings using kappa (κ) statistics. Relationships between FCCS ratings and other measures were examined using Spearman's correlation coefficient.Results: Almost perfect interrater agreement was demonstrated between SLP and parent FCCS ratings (κw =0.96). Correlations were excellent between FCCS ratings with CELF-4 PP ratings, motor speech, and intellect; moderate with gross and fine motor function; and fair with other associated impairments (hearing, visual, and epilepsy). There was no correlation between age and FCCS.Interpretation: The FCCS is a reliable and valid communication classification system for children with CP aged 5 to 18 years, and highly suitable for surveillance, research, and clinical purposes.What This Paper Adds: The Functional Communication Classification System (FCCS) is valid and reliable for communication classification in children with cerebral palsy. Excellent agreement is present between speech language pathologists and parents. The FCCS shows excellent correlation with pragmatics, motor speech, and intelligence. The FCCS is moderately correlated with gross and fine motor function. The FCCS has fair correlation with epilepsy, hearing, and vision. [ABSTRACT FROM AUTHOR]

This paper presents the design of an automatic voice quality analysis system for the assessment of voice pathologies, which emulates the perceptual capabilities of a human evaluator according the GRB scale. For this purpose, a novel methodology based on multiple sets of characteristics, ordinal classification and Gaussian regression is proposed. In particular, a reduced subset of characteristics is identified, and the regressor is used to convert the discrete perceptual scale to a continuum, more in agreement to the nature of the problem under study. The robustness of the system is evaluated in several cross-dataset experiments. Similarly, a clinical evaluation of the predictions provided by the system is carried out. Results indicate that the proposed methodology is proficient in modelling the perceptual capabilities of the human evaluator. They also show that it is possible to extend the GRB scale to a continuum through regression techniques while maintaining the consistency of the results. On average, the deviation between the labels assessed by the expert and the ones provided by the system is of about 0.5 units (in a scale from 0 to 3) for G and B , and of 0.7 units for R. Similarly, the deviation of the labels predicted by the system in the clinical assessment trials is about 0.3 units for G , 0.4 units for B , and 0.5 units for R. • It is possible to emulate, with a high degree of success, the perceptual capabilities of a speech therapist evaluating voices by means of the GRB scale, using Pattern Recognition techniques. • The perceptual capabilities of an expert assessing voice can be emulated. • The GRB scale can be extended to a continuum through regression techniques. • The proposed system has been shown to perform consistently in a clinical setting. [ABSTRACT FROM AUTHOR]

Background: New graduate transition into the workforce is challenging and can involve managing ethical tensions. Ethical tensions cause new graduates to doubt their capabilities due to their lack of experience. To support new graduates, we need to know what these ethical tensions are. Objectives: To explore the ethical tensions perceived to occur in practice for new graduate health professionals. Research design: This qualitative systematic review involved a search of five databases (Medline, EMBASE, AMED, CINAHL and Scopus) which resulted in the retrieval of 3554 papers. After the two-phased screening process, eight studies were identified that met the inclusion criteria and had rich data on the review question. Articles were read several times, critically appraised and analysed through thematic analysis. Ethical considerations: No ethical approval was required for the systematic review. The review was conducted following well-established reporting guidelines enabling transparency and rigour. Findings: Studies originated from Australia, United States, Iran and China. One study included speech pathologists and seven were with nurses. Four themes included the following: (1) enduring an unknown workplace culture that generates uncertainty without support for new graduates; (2) being vulnerable because of distress from bullying, exclusion and being a scapegoat; (3) constraining systems and institutional restrictions that cause dilemmas; and (4) experiencing disillusionment from lost ideals about ethical practice. Discussion: This review has brought to light the vulnerability of new graduates to negative workplace culture and collegial incivility. In addition, new graduates are subjected to ethical tensions created by institutional constraints which can create dilemmas and uncertainties through practice that does not align with what they anticipated. Conclusion: Understanding ethical tensions experienced by new graduates enables provision of informed support. There needs to be considerable cultural change for orientation and socialisation of new graduates to enable them to learn and manage ethical tensions. [ABSTRACT FROM AUTHOR]

Introduction: Feeding is a vital need and an activity which is performed throughout the entire life. However, feeding is so much more for an infant: a pleasurable, emotional and physical contact with their mother/caregiver as well as comfort resulting from a successful feeding process and feeling of satiety. Prerequisites of successful feeding from the very beginning are: presence of adaptive and protective reflexes as well as anatomic and functional integrity of different organs and organ systems. In high risk infants there are many possible obstacles from the earliest stages of feeding development. Objective: The aim of this paper is to present the importance of early assessment and intervention procedures performed by a speech and language therapist. These procedures serve the purpose of timely and early recognition and treatment of feeding-sucking- swallowing disorders in high risk infants. Conclusions: The most common feeding problems seen in clinical practice are delayed readiness for oral feeding, suckingswallowing- breathing coordination problems, delayed feeding development, food selectivity, delayed oral-motor skill acquisition, dysphagia, prolonged meal duration and aversive reactions to feeding. Early speech therapy intervention is focused on early evaluation and treatment of feeding disorders as well as on supporting parents/caregivers. Parent counseling and education on optimal feeding techniques is of outmost importance. That kind of support leads to reduction of parent/caregiver's stress, which could possibly affect the quality of parent-child interaction and long-term child development. Parent support also lead to increased parent/ caregiver's self-confidence in providing support in feeding. [ABSTRACT FROM AUTHOR]

Background: The purpose of this paper is to describe the content and process of a literacy and language support model that was implemented with young children from marginalised communities, where no access to speech and language pathologist (SLP) services exists. The importance of language for literacy development is emphasised with explicit strategies for classroom application. Method: The SLP introduced an intervention programme to Early Childhood Development (ECD) kindergarten teachers, as part of a pre- and post-test literacy study. The strategies included oral reading, one-on-one reading and paired-reading. The participants provided informed consent. The intervention was presented to the experimental (Exp) group during the study process and to the comparison group after the study was completed. Results: Post-intervention findings revealed a significant improvement in the Exp group scores on concepts about print. The ECD teachers reported a difference in the children's awareness of printed materials, confirming that the approaches introduced by the SLP are central in teachers' instruction. This finding supports the contribution that emergent literacy and language support models would have for children, especially those from marginalised communities, where access to resources are limited. Furthermore, the collaboration between SLP and the ECD staff will strengthen these support structures. Thus, explicit early intervention develops skills for school-readiness and academic success; this forms part of the solution in providing early access to language and literacy programmes in developing countries. [ABSTRACT FROM AUTHOR]

Investigating children's feelings and attitudes toward talking assists speech–language pathologists (SLPs) to understand experiences of communication and the impact of speech sound disorders (SSD). This, in turn, can assist SLPs in identifying appropriate intervention for children with SSD that addresses the needs of children, and their communication partners. This paper draws on data from the Sound Start Study in Australia to explore the attitudes toward talking of 132 preschool-aged children with SSD and the relationship between children's attitudes, speech accuracy, and parent-reported intelligibility and participation. The study revealed most of the children with SSD had a positive attitude toward talking. There was a significant relationship between children's attitudes toward talking and speech accuracy. Furthermore, there was a significant relationship between speech accuracy and parents' perceptions of intelligibility and participation. However, there was no significant relationship between children's attitudes and parents' perceptions. These results highlight similarities and differences between attitudes and experiences of preschool-aged children, their performance on clinical measures, and their parents' perceptions, indicating the need for SLPs to consider each of these areas during assessment and intervention. [ABSTRACT FROM AUTHOR]

Background: Access to timely and appropriate speech–language pathology (SLP) services is a significant challenge for many families. Telehealth has been used successfully to treat a range of communication disorders in children and adults. Research examining the use of telehealth for children with autism has focused largely on diagnosis, parent‐implemented interventions, and behavioural interventions involving interactions between clinicians and parents. There is, however, very limited research into the use of telehealth directly to assess or intervene with children with autism. This paper reports the outcomes of a study of telehealth language assessments with primary school‐aged children with autism. Aims: To evaluate the reliability and feasibility of telehealth language assessments for school‐aged children with autism. Methods & Procedures: The language skills of 13 children with autism aged 9–12 who attended mainstream schools or support classes were assessed using the Clinical Evaluation of Language Fundamentals—4th Edition. An SLP delivered and scored four subtests of the assessment via telehealth from a remote location. A second SLP at the same location as the child co‐scored the online subtests to provide a measure of reliability and delivered the remaining subtests. The local SLP completed checklists in both conditions to provide observations regarding behaviour. Parent feedback was elicited via survey. Outcomes & Results: There was strong interrater reliability between the telehealth and face‐to‐face conditions (correlation coefficients ranged from r = 0.919 to 0.990 across the subtests and Core Language Score) and good agreement between clinicians on all measures. Analysis using the Wilcoxon Signed Rank test indicated no significant differences in children's behaviour between the telehealth and face‐to‐face conditions, although variation between individuals was observed. Parents provided generally positive feedback about the use of telehealth for the assessments. Conclusions & Implications: The findings of this study provide preliminary support the use of telehealth assessments of school‐aged children with autism. Comparison of telehealth and face‐to‐face assessment scores showed high agreement and correlation, and while the children showed individual differences in their behaviour during the telehealth sessions, there was no clear difference between the conditions at the group level. The findings suggest that telehealth may present a reliable and feasible approach to the assessment of language for children with autism in some circumstances as a primary or adjunct service model, while acknowledging that individual differences among these children may be important to consider when planning both assessment and intervention via telehealth. [ABSTRACT FROM AUTHOR]

This article presents quantitative findings from a mixed method study that aimed to explore the status quo of interprofessional collaboration (IPC) in a Health Trust, located in a trilingual region in Northern Italy. The survey targeted seven health professions (physicians, nurses, dieticians, occupational therapists, physiotherapists, speech therapists, and psychologists). The survey was distributed online to more than 5,000 health professionals and completed by 2,238. This paper presents results on the frequency of collaboration as well as data from a multiple-group measurement scale for assessing IPC. Descriptive statistics were calculated for continuous variables while categorical data were analysed as counts and percentages. Pearson's Chi-square test and Fisher's exact test were calculated while Mann Whitney and Kruskal Wallis tests were applied to analyse statistical differences in IPC between groups according to sociodemographic variables. In general, our survey data showed that participants, perceived IPC in a positive way, even if the analysis indicated heterogeneity in the level of collaboration expressed. We also found that not all professions had an opportunity to collaborate with others. In addition, we found evidence to suggest that the way health care is organised impacted on perceptions of collaboration between the health professionals in this study. This study provides an initial insight into the perceived levels of IPC within a North Italian context. As such, it offers an account of the strengths and weaknesses of IPC from seven different professional groups based in this region of Europe. [ABSTRACT FROM AUTHOR]

Background: Following a content analysis of the first 10 years of the UK professional journal Speech, this study was conducted to survey the published work of the speech (and language) therapy profession in the 20 years following the unification of two separate professional bodies into the College of Speech Therapists. Aim: To understand better the development of the speech (and language) therapy profession in the UK in order to support the development of an online history of the speech and language therapy profession in the UK. Methods & Procedures: The 40 issues of the professional journal of the College of Speech Therapists published between 1946 and 1965 (Speech and later Speech Pathology and Therapy) were examined using content analysis and the content compared with that of the same journal as it appeared from 1935 to the end of the SecondWorldWar (1945). Outcomes & Results: Many aspects of the journal and its authored papers were retained from the earlier years, for example, the range of authors' professions, their location mainly in the UK, their number of contributions and the length of papers. Changes and developments included the balance of original to republished papers, the description and discussion of new professional issues, and an extended range of client groups/disorders. Conclusions & Implications: The journal and its articles reflect the growing maturity of the newly unified profession of speech therapy and give an indication both of the expanding depth of knowledge available to speech therapists and of the rapidly increasing breadth of their work over this period. [ABSTRACT FROM AUTHOR]

Background: Mobile Technologies are pervading many areas of speech language therapy. A large number of apps have been developed for use by and for people with aphasia. Despite their availability, it’s unclear which design principles were followed to create these apps and which users were targeted for these apps. Aims: The aim of this paper is to introduce the use of claims analysis as an approach for user-centred design for clients with aphasia and for the speech-language pathologists (SLPs) who treat them. We aim, through the use of a single worked-example, to show how claims can influence the design of a treatment app. Methods & Procedures: The paper is divided into two parts. Part 1 describes the claims analysis method we used to research SLP and client needs. Part 2 shows how claims were considered and integrated into the design of an app for speech-language therapy. This app, BangaSpeak, is offered as one example of how designers can simultaneously consider the needs of two different types of users: clients with aphasia and SLPs. Conclusions: This paper shows how development teams can capture the needs of users separate from requirements. Finally, it outlines the design of one app for use in aphasia treatments. We believe that this approach can serve as a model for other development teams to follow. [ABSTRACT FROM PUBLISHER]

Speech-language pathologists (SLPs) are working with an increasing number of families from culturally and linguistically diverse backgrounds as the world's population continues to become more internationally mobile. The heterogeneity of these diverse populations makes it impossible to identify and document a one size fits all strategy for working with culturally and linguistically diverse families. This paper explores approaches to practice by SLPs identified as specialising in multilingual and multicultural practice in culturally and linguistically diverse contexts from around the world. Data were obtained from ethnographic observation of 14 sites in 5 countries on 4 continents. The sites included hospital settings, university clinics, school-based settings, private practices and Indigenous community-based services. There were 652 individual artefacts collected from the sites which included interview transcripts, photographs, videos, narrative reflections, informal and formal field notes. The data were analysed using Cultural-Historical Activity Theory ( Engeström, 1987 ). From the analysis six overarching Principles of Culturally Competent Practice (PCCP) were identified. These were: (1) identification of culturally appropriate and mutually motivating therapy goals, (2) knowledge of languages and culture, (3) use of culturally appropriate resources, (4) consideration of the cultural, social and political context, (5) consultation with families and communities, and (6) collaboration between professionals. These overarching principles align with the six position statements developed by the International Expert Panel on Multilingual Children's Speech (2012) which aim to enhance the cultural competence of speech pathologists and their practice. The international examples provided in the current study demonstrate the individualised ways that these overarching principles are enacted in a range of different organisational, social, cultural and political contexts. Tensions experienced in enacting the principles are also discussed. This paper emphasises the potential for individual SLPs to enhance their practice by adopting these overarching principles to support the individual children and families in diverse contexts around the world. [ABSTRACT FROM AUTHOR]

Background: Communication partner training (CPT) is a widely recognized approach in aphasia; yet, the critical ingredients that contribute to successful CPT remain unclear. Further scrutiny of theoretical constructs, rationales, approaches, and outcomes is needed in order to further the development of CPT and ensure effective and efficient practices. Aims: The objective of this introduction is to describe the rationale and create a context for the papers in this special issue on CPT in aphasia. Main Contribution: This introduction defines CPT, briefly describes significant research and approaches to CPT in aphasia, and explains how the concepts of complexity, alignment, and enrichment might expand our understanding of CPT and contribute to innovative research and practice in the area. Conclusions: This introduction and special issue expands our understanding of CPT and challenges clinicians and researchers to consider additional perspectives on CPT. By considering additional perspectives a greater appreciation of the critical elements of CPT will be possible. [ABSTRACT FROM AUTHOR]

Abstract: Background: When planning evidence‐based intervention services for children with phonology‐based speech sound disorders (SSD), speech and language therapists (SLTs) need to integrate research evidence regarding service delivery and intervention intensity within their clinical practice. However, relatively little is known about the optimal intensity of phonological interventions and whether SLTs’ services align with the research evidence. Aims: The aims are twofold. First, to review external evidence (i.e., empirical research evidence external to day‐to‐day clinical practice) regarding service delivery and intervention intensity for phonological interventions. Second, to investigate SLTs’ clinical practice with children with phonology‐based SSD in Australia, focusing on service delivery and intensity. By considering these complementary sources of evidence, SLTs and researchers will be better placed to understand the state of the external evidence regarding the delivery of phonological interventions and appreciate the challenges facing SLTs in providing evidence‐based services. Methods & Procedures: Two studies are presented. The first is a review of phonological intervention research published between 1979 and 2016. Details regarding service delivery and intervention intensity were extracted from the 199 papers that met inclusion criteria identified through a systematic search. The second study was an online survey of 288 SLTs working in Australia, focused on the service delivery and intensity of intervention provided in clinical practice. Main Contributions: There is a gap between the external evidence regarding service delivery and intervention intensity and the internal evidence from clinical practice. Most published intervention research has reported to provide intervention two to three times per week in individual sessions delivered by an SLT in a university clinic, in sessions lasting 30–60 min comprising 100 production trials. SLTs reported providing services at intensities below that found in the literature. Further, they reported workplace, client and clinician factors that influenced the intensity of intervention they were able to provide to children with phonology‐based SSD. Conclusions & Implications: Insufficient detail in the reporting of intervention intensity within published research coupled with service delivery constraints may affect the implementation of empirical evidence into everyday clinical practice. Research investigating innovative solutions to service delivery challenges is needed to provide SLTs with evidence that is relevant and feasible for clinical practice. [ABSTRACT FROM AUTHOR]

Abstract: Background: The critical role of phonetic transcription in the assessment, diagnosis and management of speech disorders is well established and thus pre‐registration degrees dedicate numerous hours to phonetic training. However, this training is not always fully used in clinical work and clinicians may find it difficult to maintain their skills, suggesting a ‘theory/practice gap’. Aims: This paper surveys speech and language therapists’ (SLTs) views of their training, practice and maintenance of transcription in order to investigate the posited theory/practice gap and to explore how education in phonetics is translated into practice. Methods & Procedures: A total of 759 SLTs from the UK were surveyed via an online questionnaire. Multiple‐choice questions were analysed using descriptive statistics, and free‐text comments were analysed thematically. Outcomes & Results: Thirty‐five per cent of SLTs found learning phonetics quite easy, and 30% quite difficult. Respondents suggested that more time was needed to practise transcription in and out of the classroom; nevertheless, the majority felt at least equipped to undertake transcription after their training. A total of 75% of SLTs require transcription for their role, with 61% using it often or all the time. Some 45% use a mix of broad and narrow transcription, with 41% using only broad transcription. Those not using narrow transcription attributed this to lack of confidence. A total of 57% of SLTs did not feel supported to maintain transcription skills in the workplace, and 80% had never attended a refresher course in transcription, with 75% wishing to do so. Conclusions & Implications: As many clinicians found it difficult to learn transcription, there is an opportunity to provide more transcription practice both in and beyond the classroom. Despite most clinicians feeling equipped to undertake transcription upon completion of their training, and a large majority requiring transcription for their role, a theory/practice gap is apparent in the relatively small number of clinicians using narrow transcription exclusively, and those not using it expressing lack of confidence in their skills. Additionally, as many clinicians have never attended refresher training in transcription, and rely on their course notes to maintain their skills, more provision of opportunities for revision should be made available. With clinicians remembering a need for more practice during their training, and expressing a desire for more training opportunities in practice, there is an opportunity for clinicians, educators and regulatory bodies to work together to provide packages of transcription training material that can be used by students and practitioners to maintain and extend their skills. [ABSTRACT FROM AUTHOR]

Computer-Assisted Pronunciation Training (CAPT) systems aim to help a child learn the correct pronunciations of words. However, while there are many online commercial CAPT apps, there is no consensus among Speech Language Therapists (SLPs) or non-professionals about which CAPT systems, if any, work well. The prevailing assumption is that practicing with such programs is less reliable and thus does not provide the feedback necessary to allow children to improve their performance. The most common method for assessing pronunciation performance is the Goodness of Pronunciation (GOP) technique. Our paper proposes two new GOP techniques. We have found that pronunciation models that use explicit knowledge about error pronunciation patterns can lead to more accurate classification whether a phoneme was correctly pronounced or not. We evaluate the proposed pronunciation assessment methods against a baseline state of the art GOP approach, and show that the proposed techniques lead to classification performance that is more similar to that of a human expert. [ABSTRACT FROM AUTHOR]

Traditionally speech-language pathology, along with other educational and rehabilitation-based professions, has approached disability from a deficits-based or medical-model perspective with an aim toward normalizing or ameliorating a child's atypical behaviors or performance. However, an alternative perspective rooted in a social model of disability has been growing for several decades. This model argues that although an individual may experience challenges due to a specific impairment (motor, communication, social), their true disability results from the barriers to access and opportunity created by society, and seeks to identify ways to break down such barriers and capitalize on an individual's strengths to meet individual challenges. Although self-advocates in the disability community first proposed the social model of disability in the 1970s, it remains unfamiliar to many clinicians and educators. As such, this paper aims to introduce clinicians to models of disability, with recognition of disability from a cultural lens, and acknowledgment of disability's intersectionality with ethnicity, social class, and gender. The role of speech-language pathologists in promoting self-advocacy, activism within the disability community, and the shifting role of teaching (aid) is then discussed through a strengths-based lens. [ABSTRACT FROM AUTHOR]

Background: Primary progressive aphasia (PPA) with its three variants is a progressive neurodegenerative dementia in which language impairment is the first and most dominant symptom. Traditionally, speech-language pathologists who deliver therapy to adults with acquired neurogenic language disorders shy away from treatment of progressive aphasia as there is no promise of lasting effects and only limited data regarding treatment efficacy. Aims: This paper comprises the most current review of the literature focused on treatment of naming impairments in PPA, and aims to encourage and assist clinicians in selecting intervention approaches for individuals with PPA. It highlights current trends and challenges in delivering successful therapy for naming deficits in PPA. Main Contribution: We reviewed papers that reported different forms of naming therapy for patients with PPA, which included interventions that, although not always aimed directly at anomic deficits, brought about improvement in naming. Immediate gains, maintenance, and generalisation effects are summarised, along with a variety of approaches and methodologies that can be applied to the PPA population. We also provide a list of factors that were found to contribute to the success of therapy and to the maintenance and/or generalisation of treatment gains. Conclusions: Current literature delivers encouraging evidence for clinicians wanting to provide naming therapy to patients with PPA. Although PPA is a progressive disorder, both the immediate treatment effects and, in many cases, maintenance results show that improvements are possible. The issues of generalisation of naming gains beyond the clinician’s office still require more studies to determine the best conditions, designs, and patient suitability. [ABSTRACT FROM AUTHOR]

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. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Verb processing is largely described across languages as being impaired in agrammatic aphasia, i.e., non-fluent aphasia with so-called “telegraphic style”. Although both lexical and morphosyntactic errors have been reported in the literature, this paper questions the claim that impaired access to verbs is a hallmark of this clinical syndrome. Aims: The present study aims to assess how agrammatic verb processing is impaired in two languages with distinct grammatical properties: Basque and French, and to test hypotheses that suggested an access deficit to verbs on this new database. Moreover, the nature of agrammatic verb errors is analysed from an interdisciplinary neuropsycholinguistic perspective according to which aphasic symptoms should be interpretable at different levels of organisation of language processing involving neural, cognitive and linguistic aspects. Methods & Procedures: A protocol built on Basque and French grammatical properties was designed in order to assess whether errors are specific to verbs, whether they are lexical or morphosyntactic and whether the verb argument structure complexity increases lexical and morphosyntactic processing difficulties, in both production and comprehension. One Basque-speaking and one French-speaking patient with agrammatism and matched controls were assessed on various oral tasks (object and action naming; sentence production and comprehension; prepositional phrase production), each of them containing 20 pictures displayed on a computer. Data were collected using a digital recorder. Outcomes & Results: Results show that agrammatic speakers produced many lexical verbs of every argument structure type. Errors were specifically morphosyntactic and increased with the verb argument structure complexity. However, verb errors were different in Basque and French due to their distinct morphosyntactic properties. In addition, whereas errors appeared in French in the use of prepositions, case morphology was well preserved in Basque, raising the issue of considering distinct neurocognitive mechanisms underlying different morphological systems. Conclusions: This paper supports the view that Basque and French agrammatic data collected from this study do not result from a lexical-access deficit. However, this interpretation depends on how one considers inflected verbs to be processed (endolexicon or exolexicon), as addressed in the discussion. In conclusion, a “post-lexical access” deficit is rather suggested, that is prior to morphophonological encoding, and affects abstract morphosyntactic operations required to implement the verb argument structure. [ABSTRACT FROM AUTHOR]

Purpose -- This paper aims to introduce the open communication tool (OCT) as described in "From 'What do you do?' to 'a leap of faith': developing more efficient indirect intervention for adults with learning disabilities". Design/methodology/approach -- Qualitative data from a study identifying barriers to effective intervention was used to create a model of working practice. Findings -- This paper introduces a model of addressing intervention which could be used by the broader multidisciplinary team to increase successful intervention outcomes and pinpoint concerns about care providers who do not enhance communication effectively. Originality/value -- The authors suggest that a more consistent and robust approach to delivering indirect intervention could be used to bridge communication gaps between healthcare providers and commissioners/monitoring bodies of services for people with learning disabilities. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to analyse some of the factors which affect the implementation and outcomes of indirect intervention for people with learning disabilities in residential homes and day centres. Design/methodology/approach – Data were gathered through a series of semi-structured interviews which were transcribed and analysed according to the principles of grounded theory. In total, four carers/support workers and three speech and language therapists (SLTs) were interviewed. Findings – Analysis of the data indicated distinct areas where intervention breakdown could occur, some of which were within the SLTs' control and some of which were not. Originality/value – This paper builds on previous research to identify barriers to successful therapy outcomes and develops a way of looking at these barriers which can inform intervention planning and delivery. [ABSTRACT FROM AUTHOR]

Background: The role of speech pathologists working in the acute hospital setting has evolved away from service provision to people with aphasia and their families towards a stronger focus on dysphagia. Evidence-based practice (EBP) can be conceptualised as the integration of four streams of evidence: research-based clinical evidence, clinical expertise, patient preferences and values, and the practice context. EBP is an important tenet in current healthcare. However, it is not clear whether speech pathologists in the acute setting are using EBP to support their aphasia management. Not adopting evidence-based approaches to care has the potential to result in a negative impact on people with aphasia and their families, healthcare services, and speech pathologists, who experience a sense of dissonance related to their current service provision This paper explores acute aphasia management through an EBP lens in an attempt to better understand this dilemma. Aims: This paper applies the conceptual framework of EBP to acute aphasia management. An extensive, systematically conducted review of the international literature relating to health professionals was undertaken. The findings are presented as a narrative literature review. Main Contribution: This paper describes and evaluates how the different streams of research evidence, clinical expertise, patient preferences and values, and the practice context contribute to speech pathologists' management of acute aphasia. Further, the paper identifies current gaps in the literature and suggests a research agenda for the field. Conclusions: Little is known about how speech pathologists integrate and implement the different streams of evidence in EBP, and how these contribute to acute aphasia practice. Speech pathologists report that clinical guidelines containing low-level evidence are the main source of research information. Other sources of knowledge include colleagues, professional development events, and websites. Additional challenges to the management of people with aphasia in the acute hospital setting may be posed by the physical environment, the culture of the acute hospital setting, and the provision of leadership to support evidence-based approaches to care. The challenge of using a person-centred approach to care for people with aphasia is acknowledged. Further research exploring speech pathologists' perceptions of their role in acute aphasia management, the clinical decision-making process of speech pathologists in relation to acute aphasia management, and the experiences of people with aphasia and their families in the acute setting is required. This will allow for the design of patient-centred approaches to care, and enable the implementation of evidence-based acute aphasia management. [ABSTRACT FROM AUTHOR]

Background Aphasia is a common consequence of stroke. Despite receiving specialised training in communication, speech-language pathology students may lack confidence when communicating with People with Aphasia (PWA). This paper reports data from secondary outcome measures from a randomised controlled trial. Objective The aim of the current study was to examine the effects of communication partner training on the communication skills of speech-language pathology students during conversations with PWA. Method Thirty-eight speech-language pathology students were randomly allocated to trained and untrained groups. The first group received a lecture about communication strategies for communicating with PWA then participated in a conversation with PWA (Trained group), while the second group of students participated in a conversation with the PWA without receiving the lecture (Untrained group). The conversations between the groups were analysed according to the Measure of skill in Supported Conversation (MSC) scales, Measure of Participation in Conversation (MPC) scales, types of strategies used in conversation, and the occurrence and repair of conversation breakdowns. Results The trained group received significantly higher MSC Revealing Competence scores, used significantly more props, and introduced significantly more new ideas into the conversation than the untrained group. The trained group also used more gesture and writing to facilitate the conversation, however, the difference was not significant. There was no significant difference between the groups according to MSC Acknowledging Competence scores, MPC Interaction or Transaction scores, or in the number of interruptions, minor or major conversation breakdowns, or in the success of strategies initiated to repair the conversation breakdowns. Conclusion Speech-language pathology students may benefit from participation in communication partner training programs. [ABSTRACT FROM AUTHOR]