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Purpose: To investigate perspectives of multiple stakeholders involved in development and delivery of Vietnam's first speech-language pathology degrees and derive recommendations for future degrees in Vietnam and other Majority World countries. Methods: An exploratory-descriptive qualitative research design using focus groups and individual semi-structured interviews in the preferred language (English or Vietnamese) was used, with 70 participants from five stakeholder groups: project managers, students, academic educators, placement supervisors and interpreters. Transcriptions were analysed using thematic network analysis. Results: Analysis identified five organising themes: (1) People enjoyed working with/learning from others; (2) Benefits from/to stakeholders; (3) The pandemic impacted program delivery and learning; (4) Practical challenges; (5) Preparation with flexibility required for success and sustainability. From the five organising themes, one synthesising global theme was developed, conveying that satisfying international collaborations require preparation, support, high quality interpreting, and management of challenges. Conclusions: Recommendations highlight the need for preparation, collaboration, support to manage challenges, flexibility, recognition for placement supervisors and high-quality interpreting. The recommendations are of relevance to other organisations engaged in development of professional degrees in Majority World countries. Future research would benefit from a critical investigation of the diverse perspectives of stakeholders involved in the development and implementation of international curricula. IMPLICATIONS FOR REHABILITATION: Many Majority World countries are seeking to develop university degrees to build a workforce of speech-language pathologists to provide services to people with communication and swallowing disabilities Collaborative relationships, flexibility, and delineation of roles and commitments are vital to partnership success Conceptualisation of rehabilitation services in cross-cultural contexts must privilege the knowledge, experiences and preferences of local partners Local capacity building will support training programs and rehabilitation services that are sustainable and culturally relevant. [ABSTRACT FROM AUTHOR]

Introduction: Collaborative approaches in speech‐language pathology (SLP) aim to integrate the experience of clients and people important to them by including these stakeholders actively in decision making. This inclusion can lead to more effective, engaging, and safer SLP practice. A variety of collaborative approaches have evolved in response to sociocultural contexts, and as a result, there are many different approaches currently in use such as co‐design, co‐production, and co‐creation. However, despite widening acceptance and utilisation of collaborative approaches, the use and evidence for these in SLP literature have not been considered collectively. The current study aims to explore how collaborative approaches, used to develop products or services in SLP, are reported in literature. Methods: Using narrative review methodology, a systematic search of three databases and hand searching were conducted to explore how collaborative approaches, used to develop products or services, are reported in SLP. Search terms reflected the breadth of collaborative approaches and the diverse nature of SLP across clinical practice. Following screening of initial data, 59 articles were identified for data extraction and narrative synthesis. An internationally recognised reporting checklist for stakeholder involvement called the Guidance for Reporting Involvement of Patients and the Public, Version 2 (GRIPP2), informed the reviewing process in addition to qualitative description. Results: Collaborative approaches across SLP practice were found to be diverse as were the terminology and tools used for collaboration. Two‐thirds of the studies were published after 2020. The timing and involvement of stakeholders in collaborative approaches varied greatly; however, most stakeholder involvement was found in the conducting of research activities, compared to other areas such as planning, analysis, and reporting. The GRIPP2 review indicated strengths and opportunities in reporting of stakeholder involvement. When stakeholder involvement was rigorously reported it could include reflection on how stakeholders contributed within their communication abilities and how this contribution benefited the study. Conclusion: Collaborative approaches reported in SLP focused on valuing and respecting people with living experience of communication and swallowing difficulties. This narrative review contributes to the resources available to support decision‐making and working together with stakeholders, encouraging SLPs to reflect, consider the context and respond. Future research could continue to strengthen consistency in terminology for collaborative approaches, use frameworks to plan and report stakeholder involvement and carefully consider involvement across the research continuum. WHAT THIS PAPER ADDS: What is already known on this subject: There is an expectation that health services include stakeholders in development and evaluation of services. Collaborative approaches in speech‐language pathology (SLP) aim to integrate the lived experience of people with communication and swallowing difficulties and those important to them. These approaches, including but not limited to, co‐design, co‐production and participatory action research, have shared philosophies of being community‐driven, strengths based and inclusive (Loeffler & Bovaird, 2021). What this paper adds to existing knowledge: This study contributes information about current SLP practice when collaborative approaches have been employed to develop a product or service. The study maps diverse collaborative approaches and their frequency in the literature, as well as the various stakeholders involved, using the Guidance for Reporting Involvement of Patients and the Public, Version 2 (GRIPP2) checklists to guide the review of reporting stakeholder involvement. What are the potential or actual clinical implications of this work?: This synthesis of literature supports researchers and clinicians in making intentional decisions in implementation and reporting of collaborative approaches. This decision‐making can strengthen the implementation of collaborative approaches, which has implications for person‐centred care in SLP. [ABSTRACT FROM AUTHOR]

Culture mediates how all people think and communicate and intercultural communication skills are required for effective collaboration. This study (2017–2021) explored intercultural communication with 40 participants in one very remote First Nations Australian community in Northern Australia. We explored the perspectives of both Yolŋu (First Nations Australian people from North-East Arnhem Land) and Balanda (non-Indigenous people, in this case Australian) on interactions during early childhood assessments of Yolŋu children (0–6 years). Our intercultural research team used a culturally responsive form of video-reflexive ethnography, a Yolŋu approach to in-depth discussion and collaborative analysis. In this article, we explore nine intercultural communication processes that were recognized and enacted by study participants. Each process is represented by a metaphor drawn from water traveling in North-East Arnhem Land. We share these processes so that others may consider exploring their relevance in other intercultural communication contexts. [ABSTRACT FROM AUTHOR]

Purpose: There is poor reporting of the cost of simulation and greater transparency is needed. The primary study aim was to conduct a financial analysis of the university/training institution costs associated with a 5-day simulation-based learning program for speech–language pathology students. The secondary aim was to consider the economic costs of the model. Method: Costs associated with the delivery of a 5-day simulation-based learning program for speech–language pathology students from six Australian universities were collected regarding: (a) pre-program training, (b) personnel, (c) room hire, (d) equipment, and (e) consumables. Both financial costs and economic costs (Australian dollar, at June 2017) were calculated per university site, and per student. Result: The simulation program was run 21 times involving 176 students. Average total financial cost per program ranged from $4717 to $11 425, with cost variation primarily attributed to local labour costs and various use of in-kind support. Average financial cost per student was $859 (range $683–$1087), however this was almost double ($1461 per student, range $857–$2019) in the economic cost calculation. Personnel was the largest contributing cost component accounting for 76.6% of financial costs. Personnel was also the highest contributing cost in the economic analysis, followed by room hire. Conclusion: This study provides clarity regarding financial and economic costing for a 5-day simulation-based learning program. These data can help universities consider potential up-front financial costs, and well as strategies for financial cost minimisation, when implementing simulation-based learning within the university context. [ABSTRACT FROM AUTHOR]

Background: Speech sound disorders (SSDs) are the most common form of communication disorders in children. SSD have an impact on children's abilities to make themselves understood to their listeners and can influence a child's social and emotional well‐being as well as their academic achievements. Therefore, it is important to identify children with an SSD early, in order to provide appropriate intervention. A wealth of information on best practice in the assessment of children with SSD is available in countries where the speech and language therapy profession is well established. In Sri Lanka, there is a paucity of research evidence supporting assessment practices that are culturally and linguistically appropriate in SSDs. Therefore, clinicians rely on informal assessment methods. There is a need to understand more about how clinicians in Sri Lanka assess this caseload in order to get general agreement regarding comprehensive and consistent procedures for assessment of paediatric SSD in Sri Lanka. This would support speech and language therapists' (SLTs') clinical decision‐making in relation to choice of appropriate goals and intervention for this caseload. Aim: To develop and gain consensus on an assessment protocol for Sri Lankan children with SSD that is culturally appropriate and based on existing research. Method: A modified Delphi method was utilised to gather data from clinicians currently working in Sri Lanka. The research involved three rounds of data collection, exploring current assessment practices in Sri Lanka, ranking these in order of priority and establishing consensus on a proposed assessment protocol. The proposed assessment protocol was based on the results of the first and second rounds as well as previously published best practice guidelines. Outcome and Results: The proposed assessment protocol achieved consensus in relation to content, format and cultural appropriateness. SLTs affirmed the usefulness of the protocol within the Sri Lankan context. Further research is required to assess the feasibility and effectiveness of this protocol in practice. Conclusions & Implications: The assessment protocol supports practicing SLTs with a general guide to assessing children with suspected SSDs in Sri Lanka. The application of this protocol built upon consensus enables clinicians to improve their individual practice patterns based on best practice recommendations in the literature and the evidence on culturally and linguistically appropriate practices. This study has identified the need for further research in this area, including the development of culturally and linguistically specific assessment tools that would complement the use of this protocol. What this paper adds: What is already known on the subject: The assessment of children with speech sound disorders (SSDs) requires a comprehensive and holistic approach due to their heterogeneous nature. Although there is evidence to support the assessment of paediatric SSDs in many countries where the profession of speech and language therapy is established, there is limited evidence to support the assessment of children with SSDs in Sri Lanka. What this study adds: This study provides information about current assessment practices in Sri Lanka and consensus on a proposed culturally appropriate protocol for the assessment of children with SSDs in this country. What are the clinical implications of this work?: The proposed assessment protocol provides speech and language therapists in Sri Lanka with a guide for assessment of paediatric SSDs to support more consistent practice in this area. Future evaluation of this preliminary protocol is required; however, the methodology used in this research could be applied to the development of assessment protocols for other range of practice areas in this country. [ABSTRACT FROM AUTHOR]

This study explored intercultural communication from the perspectives of partners from different cultural and linguistic backgrounds. We used a culturally responsive form of video-reflexive ethnography to study intercultural communication processes between Yolŋu, pronounced Yolngu (First Nations people from the region that is now called North-East Arnhem Land, Northern Territory, Australia) and Balanda (non-Indigenous people). Yolŋu and Balanda researchers worked collaboratively throughout the study (2017–2021). In a very remote Yolŋu community in northern Australia, five early childhood assessment interactions were recorded and analysed by the 40 Yolŋu and Balanda participants. Researchers analysed data collaboratively using an approach aligned with constructivist grounded theory. We connected key research findings about intercultural communication processes to a place-based metaphor which foregrounds Yolŋu cultural knowledge and encourages reflection on deeper ways of thinking about how we connect, collaborate and communicate interculturally. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to explore the use of myofunctional devices (MDs) by speech-language pathologists (SLPs) to gain a better understanding of how SLPs are utilizing these in the treatment of their patients. Method: Eleven SLPs from four countries participated in semistructured interviews. The interview transcripts were analyzed using qualitative content analysis. Participants' responses were coded and categorized to identify key themes related to the use of MDs in therapy. Results: Five key themes, composed of 11 main categories and 54 subcategories, were identified. Themes highlighted variability in the use of MDs, including the type of device, application of the device, and dosage. Successful outcomes with the use of MDs were influenced by clinical experience and training, a multidisciplinary approach, along with client/family adherence to therapy. Participants frequently described the use of MDs as one component of an overall therapy program and reported on the need for further research to guide the use of MDs in speech-language pathology treatment. Conclusions: The use of MDs in speech-language pathology practice is often related to the expertise and experience of the SLP. Although SLPs report positive clinical outcomes, there remains a need for further research to support the use of MDs in therapy. [ABSTRACT FROM AUTHOR]

Background: Poor oral health is a known predictor of aspiration pneumonia in vulnerable populations such as the elderly and chronically ill and has been linked to systemic disease, morbidity, and mortality. Reduced oral health not only places individuals at a greater risk of aspiration pneumonia but may result in pain or poorer dentition which can impact on mastication and swallowing. Consequences of this may include reduced oral intake, malnutrition, poorer health outcomes, and reduced quality of life. Few evidence-based protocols exist to manage oral care in aged care populations, and maintenance of good oral hygiene is difficult for nursing and care staff to facilitate. However, a recent literature review found that improvements in oral hygiene, oral behaviors, and swallowing, along with breathing and speech have been found to be associated with the use of myofunctional devices due to positive changes in orofacial functions such as lip seal, mastication, swallowing, and nasal breathing patterns. The primary aim of this study is to assess the feasibility of using a myofunctional device to improve oral care and swallowing function in an aged care population. Methods/design: This project is a feasibility study that involves a 5-week intervention for oral hygiene and dysphagia for residents >65 years old in an aged care setting. Feasibility will be determined by the acceptability of the intervention, study recruitment and retention, and adherence to the intervention. Feasibility testing will also include an evaluation of clinical outcome measures, and sensitivity to detect changes in oral health and swallowing in an aged care population. Discussion: The results of this trial will provide important information regarding the feasibility of utilizing a myofunctional device to improve oral care and dysphagia in elderly patients in an aged care facility. This knowledge will further guide and inform design of a larger trial or future research. Trial registration: This trial was registered August 10, 2021, with the Australian New Zealand Clinical Trials Registry and allocated the ACTRN: ACTRN12621001359820. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the complexity of stuttering behavior. It described and classified the complexity of stuttering behavior in relation to age, behavioral treatment outcomes, stuttering severity, anxiety-related mental health, impact of stuttering, and gender. Method: For this study, a taxonomy was developed--LBDL-C7--which was based on the Lidcombe Behavioral Data Language of stuttering. It was used by five experienced judges to analyze the complexity of stuttering behavior for 84 adults and adolescents before and after speech restructuring treatment. Data were 3,100 stuttering moments, which were analyzed with nominal logistic regression. Results: The complexity of stuttering behavior appears not to change as a result of treatment, but it does appear to change with advancing age. Complexity of stuttering behavior was found to be independently associated with clinician stuttering severity scores but not with percentage of syllables stuttered or self-reported stuttering severity. Complexity of stuttering behavior was not associated with gender, anxiety, or impact of stuttering. Conclusion: Clinical and research applications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Speech Pathology programs usually send students to workplaces to learn clinical skills necessary for practice. During COVID-19, programs needed to respond quickly to ensure that students continued to gain the necessary experiences and skills required to progress through their program and graduate as clinicians, while simultaneously complying with COVID-19 requirements. Case studies from seven different universities in Australia, Ghana and Hong Kong described the diverse ways in which placements were adapted to be COVIDsafe, taking into account local needs. Some practices which had been included in placement education prior to the pandemic, such as telepractice and simulation-based learning, were extended and developed during this time. Educators, students, clinicians and clients responded to the rapidly changing needs of the time with flexibility and innovation, utilising a variety of technologies and tools to support case-based and virtual learning opportunities. Feedback from these diverse stakeholders about the experiences was positive, despite inevitable limitations and less-than-ideal circumstances. The positive findings provided insights for consideration in the future: could strategies implemented in response to the pandemic continue to be incorporated into placement experiences, enhancing current prompted exceptional responses; flexibility and innovation were accelerated in response to the pandemic and may transform future placement-based learning opportunities. [ABSTRACT FROM AUTHOR]

Living in the transformative age is one of disruption, change, and infinite opportunity. However, living in a cloud-based world with self-driving cars, advanced robotics, artificial intelligence, e-health, 3-D printing, and COVID-19 can also be somewhat daunting, challenging, and even confronting. As speech-language pathologists, researchers, educators, and advocates, we need to be agile, more creative and connected to data, experiences, and people. Now more than ever, these connections will enable transformation and ensure the future of our profession. speech-language pathologists are now practising on a global scale, in multiple languages and unique contexts, and the education of our future workforce is critical. Over the past 10 years, there has been rapid growth in the number of speech-language pathology training programs delivered by universities in Australia, as well as a significant shift in the demand for services and changing employment opportunities. In Australia, the profession has been planning for the future; Making Futures Happen, Building a Future workforce, and re-developing our Professional Standards. But, are we really cognisant of the global challenges and opportunities for our profession? Do we really value global connectivity? In this discussion paper, authentic examples and plausible scenarios are being used to explore the global transformation of the speech-language pathology profession. Each will highlight some of the political, economic, societal, cultural, and technological influences on speech-language pathology research, teaching, and practices that are driving development, change, and innovation. Readers will be challenged to consider how thinking globally, with a focus on context, translation, and connection will enable them to rise to the challenges we face today and forge new paths for the future. [ABSTRACT FROM AUTHOR]

The purpose of this study was to use psychological measures of pre-schoolers who stutter and their parents to inform causal theory development and influence clinical practices. This was done using data from a substantive clinical cohort of children who received early stuttering treatment. The cohort (N = 427) comprised parents and their children who were treated with the Lidcombe Program, the Westmead Program, and the Oakville Program. The study incorporated demographic information, stuttering severity, and child and parent psychological measures prior to treatment. The cohort revealed nothing unusual about behavioural and emotional functioning, or the temperaments, of pre-school children that would influence treatment, be targeted during treatment, or influence causal theory development. However, a third of parents were experiencing moderate to high life stressors at the time of seeking treatment, and half the parents failed first-stage screening for Anankastic Personality Disorder. The present results are consistent with a number of previous reports that showed that the population of pre-schoolers who stutter have no unusual psychological profiles. Hence, these results suggest that the association between mental health and stuttering later in life is a consequence of the disorder rather than being a part of its cause. The finding of the life stress of parents who seek stuttering treatment for pre-school children has potential clinical importance and warrants further investigation. Further psychological research is required about parents of pre-school children who stutter, because half the parents in the cohort failed the screener for Anankastic Personality Disorder. This is of interest because a previous study associated screening failure for another personality disorder (Impulsive Personality Disorder) with treatment dropout for early childhood stuttering. [ABSTRACT FROM AUTHOR]

Background: Research suggests that some speech–language pathologists are uncomfortable treating people who stutter. Accessing quality clinical education experiences in stuttering is difficult given the ongoing rise in students enrolled in speech–language pathology programmes and the limited number of stuttering‐specific placements available. Simulation‐based learning is a viable option for providing speech–language pathology students with practical experience in a safe learning environment. Whilst research has found that simulation‐based learning experiences in stuttering assist in the development of students' clinical skills, students' perceptions of participating in stuttering simulation‐based learning are yet to be explored. Aims: To investigate speech–language pathology students' comfort, anxiety, knowledge and confidence in the management of stuttering at the commencement of an academic stuttering course and before and following participation in a stuttering simulation‐based learning programme. Methods & Procedures: This study used a cross‐sectional survey design. Participants were 105 undergraduate and graduate entry masters speech–language pathology students enrolled at an Australian university. Students engaged in a stuttering simulation‐based learning programme embedded within an existing academic course on the management of stuttering. A purposefully developed survey was administered at three time points: pre‐course (T1), pre‐simulation (T2) and post‐simulation (T3) in order to explore students' comfort and anxiety levels, and perceptions of their knowledge and confidence in stuttering management. Descriptive statistics were used to report the medians and range of students' responses. Changes across all time points and between each of the time points were determined using the Friedman test and the Wilcoxon signed rank test, respectively. Outcomes & Results: Statistically significant differences (p < 0.001) were observed on all matched survey items (n = 96) across all time points. Between each time point, a significant difference in students' perceived knowledge levels was found with small to large effect sizes. However, there was no difference in students' perceived comfort and anxiety levels between the time points of pre‐course and pre‐simulation. Open‐ended responses on the post‐simulation survey revealed that students valued learning about stuttering within a simulation‐based learning environment. Conclusions & Implications: Simulation‐based learning experience in stuttering management was valued by students. When accompanied by theoretical content, participation in a stuttering simulation‐based learning programme supported students to feel more comfortable and less anxious about working with people who stutter. This finding has implications for the development of clinical skills in the assessment and treatment of adults who stutter. WHAT THIS PAPER ADDS: What is already known on this subject: Simulation is a teaching approach used within speech–language pathology to support the development of students' clinical skills. Simulation provides a safe learning environment for students, an opportunity for repeated practice and is valued by students. What this paper adds to existing knowledge: This study explored students' perceptions of their comfort, anxiety, knowledge and confidence in working with people who stutter before and following participation in a simulation‐based learning programme. It describes a stuttering simulation‐based learning programme that can be embedded into speech–language pathology programme curricula. What are the potential or actual clinical implications of this work?: The stuttering simulation‐based learning programme detailed in this study can be applied and embedded in speech–language pathology curricula. It can be used to support the development of students' confidence in the assessment and management of stuttering. [ABSTRACT FROM AUTHOR]

Background: Simulation‐based learning can be used in university programmes to provide speech–language pathology students with essential clinical experiences. However, limited research has explored the use of simulation to support students' development of skills in clinical practice with people who stutter. Aims: (1) To evaluate students' clinical skills in managing stuttering within a simulation‐based learning programme; (2) to develop an assessment tool, the Standardised Patient Interview Rating Scale for Stuttering (SPIRS‐Stuttering); and (3) to conduct a preliminary investigation of its validity in measuring students' performance. Methods & Procedures: Speech–language pathology students (n = 114) participated in a simulation‐based stuttering programme in addition to academic coursework in fluency disorders. Students' clinical skills were assessed over two simulation sessions using the SPIRS‐Stuttering tool, adapted from an earlier iteration of the SPIRS tool. Content validity, intra‐rater reliability and internal consistency of the SPIRS‐Stuttering tool were also explored. Outcomes & Results: Students demonstrated a statistically significant improvement in stuttering clinical skills between sessions 1 and 4 of the simulation‐based stuttering programme. Good content validity was achieved for the SPIRS‐Stuttering tool with a low level of intra‐rater reliability and variable internal consistency. Conclusions & Implications: This study identified that students' clinical skills in stuttering improved during participation in a simulation‐based programme undertaken in conjunction with an academic course on fluency disorders. The results of this study support the inclusion of this learning modality in university programme curricula. Whilst the SPIRS‐Stuttering tool enabled assessment of speech–language pathology students' clinical skills in stuttering management, further exploration of reliability is required. What this paper adds: What is already known on this subject: Within speech–language pathology, simulation‐based learning is a teaching approach used in university clinical programme curricula. Simulation‐based learning is used as an opportunity for students to gain specific clinical skills, particularly if clinical experiences are readily not available. Research in speech–language pathology has revealed that students value simulation because it provides a safe learning environment. What this study adds to existing knowledge: There are fewer opportunities for students to gain clinical experience in the management of stuttering in adults. This study explored students' clinical skill development within a stuttering simulation‐based learning programme. Additionally, it detailed the development and preliminary investigation of validity of the SPIRS‐Stuttering, an assessment tool used in a simulation‐based learning environment. What are the potential or actual clinical implications of this work?: Students' clinical skills in the assessment and management of stuttering in adults, as measured by the SPIRS‐Stuttering, improved during participation in the stuttering simulation‐based learning programme. Further investigation of validity of the SPIRS‐Stuttering tool is required to confidently measure students' performance. The stuttering simulation‐based learning programme can be used to provide students with an opportunity to develop their clinical skills in stuttering, a practice area in speech–language pathology that is not always available to students. [ABSTRACT FROM AUTHOR]

Simulation is increasingly used within speech-language pathology education. Research has primarily explored students' perceptions of learning in simulation. The aim of this study was to determine if speech-language pathology students achieved a statistically-equivalent level of competency when a mean of 20% of placement time was replaced with simulation compared to placements without a simulation component. This non-inferiority randomised controlled trial involved students from six Australian universities. Students were randomised to either a simulation + traditional placement group attending 5 days of simulation prior to their traditional placement, or a traditional only placement group. Their end-placement clinical competency was assessed using Competency Assessment in Speech Pathology (COMPASS®). Final data were available for 325 students: 150 students in traditional placements, 138 students in protocol-compliant simulation + traditional placements, and 37 students in non-protocol simulation + traditional placements. There were no statistically significant differences between groups (traditional vs protocol-compliant simulation + traditional Mann–Whitney–Wilcoxon z = 1.23, df = 286, p = 0.22; traditional vs intention-to-treat simulation + traditional Mann–Whitney–Wilcoxon z = 0.23, df = 323, p = 0.81). This research contributes to the evidence base which suggests that simulation can partially replace traditional placement time for speech-language pathology students without loss of competency, substantiating its value as an alternative placement model in speech-language pathology programmes. [ABSTRACT FROM AUTHOR]

Purpose: A growing number of speech-language pathologists (SLPs) are using orofacial myofunctional therapy (OMT) and/or myofunctional devices (MDs) in the treatment of their clients. However, governing bodies suggest SLPs carefully consider the availability and quality of evidence in the utilization of these therapies in speech-language pathology treatment. The purpose of this study was to review the existing evidence for OMT and MDs used by SLPs. Method: A systematic quantitative review was conducted using key search terms in three electronic platforms housing multiple databases, along with a hand search, to identify additional literature. All studies published in English in full text were included if they reported pre- and posttreatment data of OMT and/or MDs provided by an SLP. Data were extracted and analyzed by the first author and confirmed by the co-authors. Results: Twenty-eight studies met the criteria for inclusion in the review. Two thirds were published in the last decade and involved the use of OMT/MDs targeting multiple areas of speech pathology intervention within the same study, that is, swallowing, breathing, oral hygiene, and speech production. Majority of studies were rated as low level of evidence. All studies used OMT, with very few using MDs. While the assessment, treatment protocols, and outcome measures were highly variable, all of the studies reported an improvement in the function of the orofacial systems posttreatment. Few studies reported long-term follow-up data. Almost half of the studies recommended the use of OMT/MDs in a multidisciplinary/interdisciplinary team or in conjunction with other therapy. Conclusions: There has been an increase in literature over the last decade in SLPs’ use of OMT; however, there are only a small number of studies to date that explore the use of MDs. There is a growing body of evidence to support the use of OMT and MDs within a multidisciplinary team for people with communication and swallow difficulties. However, development of future research should consider investigating assessment and outcome measures, optimal dosage, and service delivery. [ABSTRACT FROM AUTHOR]

Background: Information is available about what predicts Lidcombe Program treatment time, but nothing is known about what predicts treatment prognosis. Aims: To investigate the predictors of treatment dropout and treatment outcome for children who were treated for early stuttering with the Lidcombe Program (N = 277). Methods & Procedures: A total of 32 variables were used as predictors in regression analyses of short‐ and medium‐term Lidcombe Program outcome, and of treatment dropout. Outcomes & Results: Regression analyses associated children who have better language skills and easy temperament with better treatment outcome, although only a small portion of the variance of treatment outcome was accounted for by these variables. There was an association between treatment dropout and parental scores on a personality screening tool relating to their impulsivity. Conclusions & Implications: Variables identified as predictors of Lidcombe Program treatment outcome were statistically significant, but not clinically significant. They did not account for a clinically substantive portion of treatment outcomes. Findings about parental impulsivity and their relationship with intervention drop‐out require replication with prospective methods and comprehensive assessment of parent psychological status. This is particularly important because parents are involved in conducting all early interventions. What this paper addsWhat is already known on the subjectInformation is available about what predicts Lidcombe Program treatment time, but nothing is known about what predicts Lidcombe Program treatment outcome.What this paper adds to existing knowledgeThere are predictors of Lidcombe Program treatment outcome that are statistically significant, but none are clinically significant.What are the potential or actual clinical implications of this work?Clinicians can tell parents that nothing has been found that can assist with making prognostic indications about treatment outcome for their children. [ABSTRACT FROM AUTHOR]

Despite the cultural and linguistic diversity of the Australian population, research suggests that speech pathologists do not feel confident when providing services to Cultural and Linguistic Diversity (CALD) clients and would benefit from further education and training in this area. Cultural empathy has been described as a precursor to cultural competence and previous research has demonstrated the positive impact on nursing students' cultural empathy toward CALD clients following an interactive cultural simulation experience. This study investigated the feasibility and effectiveness of an online cultural simulation activity in developing the cultural empathy of speech pathology students. Students completed an online cultural simulation in their own time, followed by a tutorial debrief. Both the simulation and debrief were considered to comprise the 'simulation activity'; which was a component of a first-year introduction to clinical practice course. Participants completed a pre-survey and post-survey, containing the Comprehensive Empathy Scale (CES) and demographic questions. Results were analysed using the Wilcoxon Signed Rank test and a Paired Sample t-test, and a power analysis was conducted to direct future studies. Ten students participated and improved an average of 11.3 on the CES (p=0.14). A power analysis revealed that a minimum of 45 participants would be needed in future studies to observe any statistically significant results. The online application of the cultural simulation activity was feasible, and results indicate an improvement in cultural empathy, although the improvement did not reach statistical significance. Implications for future studies are discussed. [ABSTRACT FROM AUTHOR]

Due to increased student numbers and workforce limitations, speech pathology students have fewer opportunities to develop skills in working with adult populations in traditional clinical placements. Using simulation-based learning has proven to be advantageous in other disciplines. The use of simulation to develop clinical skills in speech pathology range of practice areas, including speech, language and swallowing in adults, has been less well researched. The aim of this study was to investigate students’ overall perceptions about simulation-based learning, particularly their confidence related to specific clinical skills and perceived anxiety about working with adult clients. Six final year speech pathology students enrolled in either a 4-year undergraduate or 2.5-year masters program participated in this research. Students engaged in five simulation-based learning activities across one day. Purposefully developed pre- and post- surveys were completed to explore students’ anxiety levels and perceptions of confidence regarding clinical skills across domains of foundation knowledge, case history, assessment, intervention, interaction and clinical reasoning, and anxiety levels. The Satisfaction with Simulation Experience (SSE) Scale was completed post simulation experience. Students also participated in a focus group discussion following the simulation experience. Student median ratings of clinical skills improved from pre- to post simulation across the six domains. All students reported that the simulation-based learning experience was valuable and reported increased levels of confidence and enhanced preparedness for their clinical placements. Findings from this study suggested that students value simulation based learning and future research should explore learning outcomes from a longer, more intensive simulation program. [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]

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]

Purpose: There is a paucity of evidence to guide treatment for children with co-occurring stuttering and speech sound disorder. Some guidelines suggest treating the two disorders simultaneously using indirect treatment approaches; however, the research supporting these recommendations is over 20 years old. In this clinical case series, we investigate whether these co-occurring disorders could be treated concurrently using direct treatment approaches supported by up-to-date, high-level evidence, and whether this could be done in an efficacious, safe and efficient manner. Method: Five pre-school-aged participants received individual concurrent, direct intervention for both stuttering and speech sound disorder. All participants used the Lidcombe Program, as manualised. Direct treatment for speech sound disorder was individualised based on analysis of each child’s sound system. Result: At 12 months post commencement of treatment, all except one participant had completed the Lidcombe Program, and were less than 1.0% syllables stuttered on samples gathered within and beyond the clinic. These four participants completed Stage 1 of the Lidcombe Program in between 14 and 22 clinic visits, consistent with current benchmark data for this programme. At the same assessment point, all five participants exhibited significant increases in percentage of consonants correct and were in alignment with age-expected estimates of this measure. Further, they were treated in an average number of clinic visits that compares favourably with other research on treatment for speech sound disorder. Conclusion: These preliminary results indicate that young children with co-occurring stuttering and speech sound disorder may be treated concurrently using direct treatment approaches. This method of service delivery may have implications for cost and time efficiency and may also address the crucial need for early intervention in both disorders. These positive findings highlight the need for further research in the area and contribute to the limited evidence base. [ABSTRACT FROM PUBLISHER]

Purpose: Case-study methodology studying change is often used in the field of speech-language pathology, but it can be criticized for not being statistically robust. Yet with the heterogeneous nature of many communication disorders, case studies allow clinicians and researchers to closely observe and report on change. Such information is valuable and can further inform large-scale experimental designs. In this research note, a statistical analysis for case-study data is outlined that employs a modification to the Reliable Change Index (Jacobson & Truax, 1991). The relationship between reliable change and clinical significance is discussed. Example data are used to guide the reader through the use and application of this analysis. Method: A method of analysis is detailed that is suitable for assessing change in measures with binary categorical outcomes. The analysis is illustrated using data from one individual, measured before and after treatment for stuttering. Conclusions: The application of this approach to assess change in categorical, binary data has potential application in speech-language pathology. It enables clinicians and researchers to analyze results from case studies for their statistical and clinical significance. This new method addresses a gap in the research design literature, that is, the lack of analysis methods for noncontinuous data (such as counts, rates, proportions of events) that may be used in case-study designs. [ABSTRACT FROM AUTHOR]

With increasing multiculturalism, speech-language pathologists (SLPs) are likely to work with stuttering clients from linguistic backgrounds that differ from their own. No research to date has estimated SLPs' reliability when measuring severity of stuttering in an unfamiliar language. Therefore, this study was undertaken to estimate the reliability of SLPs' use of a 9-point severity rating (SR) scale, to measure severity of stuttering in a language that was different from their own. Twenty-six Australian SLPs rated 20 speech samples (10 Australian English [AE] and 10 Mandarin) of adults who stutter using a 9-point SR scale on two separate occasions. Judges showed poor agreement when using the scale to measure stuttering in Mandarin samples. Results also indicated that 50% of individual judges were unable to reliably measure the severity of stuttering in AE. The results highlight the need for (a) SLPs to develop intra- and inter-judge agreement when using the 9-point SR scale to measure severity of stuttering in their native language (in this case AE) and in unfamiliar languages; and (b) research into the development and evaluation of practice and/or training packages to assist SLPs to do so. [ABSTRACT FROM AUTHOR]

Speech sound disorders reportedly co-occur in young children who stutter at a substantial rate. Despite this, there is a paucity of scientific research available to support a treatment approach when these disorders co-exist. Similarly, little is known about how clinicians are currently working with this caseload given that best practice for the treatment of both disorders in isolation has evolved in recent years. This study used a qualitative approach to explore current clinical management and rationales when working with children who have co-occurring stuttering and speech sound disorder. Thirteen participant SLPs engaged in semi-structured telephone interviews. Interview data were analysed based on principles derived from grounded theory. Several themes were identified including multi-faceted assessment, workplace challenges, weighing-up the evidence, and direct intervention. The core theme, clinical reasoning, highlighted the participants' main concern, that not enough is known about this caseload on which to base decisions about intervention. There was consensus that little is available in the research literature to guide decisions relating to service delivery. These findings highlight the need for further research to provide evidence-based guidelines for clinical practice with this caseload. [ABSTRACT FROM AUTHOR]

Thousands of North American clinicians have trained for the Lidcombe Program of Early Stuttering Intervention, yet there are no benchmark data for that continent. This retrospective file audit includes logistical regression of variables from files of 134 children younger than 6 years who completed Stage 1 of the Lidcombe Program. Benchmarking data for clinic visits to Stage 2 is available for these files. Meta-analysis supplements worldwide Lidcombe Program benchmark data. The median number of clinic visits to Stage 2 was 11. High pre-treatment stuttering severity predicted more clinic visits than low severity. A trend toward statistical significance was found for the frequency of clinic visits. Frequent attendance of mean less than 11 days was associated with longer treatment times than infrequent attendance of mean 11 days or more. Results for North America were consistent with benchmark data from the UK and Australia. The mean attendance trend is clinically important and requires further investigation because of its potential clinical significance. [ABSTRACT FROM AUTHOR]

The Lidcombe Program is an early childhood stuttering treatment delivered by parents in the child's everyday environment, under the guidance of a speech-language pathologist (SLP). Given the parents' central role in the treatment delivery, the way it is implemented away from the clinic and away from the SLP's input is very important. And yet, to date there has been very little investigation into this process. This study investigated to what extent parents deliver contingencies for stuttering and stutter-free speech, in structured and unstructured conversations, as directed in the treatment manual. Participants were three mothers and their children who were receiving the Lidcombe Program. They recorded two treatment sessions each week and completed a daily treatment diary. The recordings were analysed for the use of parent verbal contingencies (PVCs). This method detected differences in PVC delivery by the mothers both across and within cases over time. The results show that valuable information can be gained from analysing home treatment sessions in this way and with a few modifications this methodology would be useful in larger scale studies. The strengths and limitations of this methodology are discussed with future larger studies of this type recommended. [ABSTRACT FROM AUTHOR]

Objectives: Stuttering has been associated with a range of anxiety disorders, including social phobia. In the general community, anxiety disorders are frequently associated with increased rates of mood and substance use disorders. Therefore, in the present study, the authors sought to determine the rate of mood and substance use disorders among adults who stutter. Method: The study employed a matched case-control design. Participants included 92 adults seeking treatment for stuttering and 920 age- and gender-matched controls. Mental health assessments were conducted via a computerized psychiatric diagnostic interview. Conditional logistic regression models were used to estimate odds ratios for the prevalence of mood and substance use disorders in both groups. Results: When compared with matched controls, adults seeking treatment for stuttering had twofold increased odds of meeting criteria for a 12-month diagnosis of any mood disorder but were not found to report significantly higher lifetime prevalence rates for any substance use disorder. Conclusions: Although adults who stutter in the present study were characterized by significantly higher rates of mood disorders than matched controls, they do not appear to self-medicate with substances such as alcohol. Results are discussed in terms of treatment implications and possible reasons why adults who stutter may avoid alcohol. [ABSTRACT FROM AUTHOR]

Objectives: Stuttering has been associated with a range of anxiety disorders, including social phobia. In the general community, anxiety disorders are frequently associated with increased rates of mood and substance use disorders. Therefore, in the present study, the authors sought to determine the rate of mood and substance use disorders among adults who stutter. Method: The study employed a matched case-control design. Participants included 92 adults seeking treatment for stuttering and 920 age- and gender-matched controls. Mental health assessments were conducted via a computerized psychiatric diagnostic interview. Conditional logistic regression models were used to estimate odds ratios for the prevalence of mood and substance use disorders in both groups. Results: When compared with matched controls, adults seeking treatment for stuttering had twofold increased odds of meeting criteria for a 12-month diagnosis of any mood disorder but were not found to report significantly higher lifetime prevalence rates for any substance use disorder. Conclusions: Although adults who stutter in the present study were characterized by significantly higher rates of mood disorders than matched controls, they do not appear to self-medicate with substances such as alcohol. Results are discussed in terms of treatment implications and possible reasons why adults who stutter may avoid alcohol. [ABSTRACT FROM AUTHOR]

Purpose: In this study, the authors investigated the efficacy of video self-modeling (VSM) following speech restructuring treatment to improve the maintenance of treatment effects. Method: The design was an open-plan, parallel-group, randomized controlled trial. Participants were 89 adults and adolescents who undertook intensive speech restructuring treatment. Post treatment, participants were randomly assigned to 2 trial arms: standard maintenance and standard maintenance plus VSM. Participants in the latter arm viewed stutter-free videos of themselves each day for 1 month. Results: The addition of VSM did not improve speech outcomes, as measured by percent syllables stuttered, at either 1 or 6 months postrandomization. However, at the latter assessment, self-rating of worst stuttering severity by the VSM group was 10% better than that of the control group, and satisfaction with speech fluency was 20% better. Quality of life was also better for the VSM group, which was mildly to moderately impaired compared with moderate impairment in the control group. Conclusions: VSM intervention after treatment was associated with improvements in self-reported outcomes. The clinical implications of this finding are discussed. [ABSTRACT FROM AUTHOR]