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Objective: The Bilancio Logopedico Breve (BLB)-swallowing subtest is a non-validated baseline Italian protocol widely used for clinical swallow examination (CSE). The aim of the study was to critically analyze the clinical utility of the items of BLB based on 5-years clinical experience in an intensive rehabilitation facility. Methods: In this retrospective study, 407 patients with different diagnoses were included. Clinical data, BLB assessment at admittance and discharge, signs of dysphagia during fiberoptic endoscopic evaluation of swallowing (FEES) and diet recommendations were extracted. A univariate analysis was performed to investigate the items associated with the decision of nutrition method and diet type, the presence of penetration or aspiration on FEES, and an improvement in diet type during the hospital stay. Results: Oral motor skills, dentition, voluntary cough, gag reflex, swallow trigger and signs of aspiration with liquid and/ or puree consistencies items showed significant associations with the decision of oral nutrition and/or to the type of oral diet, and with an evolution in the diet type. Gag reflex, swallow trigger and signs of aspiration with liquid and/or puree consistencies were significantly associated with penetration or aspiration at FEES. Pathological reflexes, lip sealing during swallowing, laryngeal excursion and oral residue items displayed poor associations with the clinical outcomes considered. Conclusion: The present findings support the use of BLB in the clinical practice as a guideline for CSE despite its limitations. Results should guide the revision of the protocol, preliminary to an advisable validation process of the tool.

Idiopathic Parkinson disease (IPD) affects multiple aspects of a person’s daily functioning. The current study examined the effects of a multidisciplinary intervention program, including recreational therapy (RT) and speech therapy, among individuals with IPD or PD plus conditions over 16 weeks. The study included six participants with IPD and a participant with progressive supranuclear palsy (PD plus condition). Participants with IPD attended a weekly LOUD Crowd® program consisting of different speech and cognitive activities. In addition, all seven participants attended an RT intervention focusing on fall prevention education and implementing balance, strength, and endurance routines. Results indicated improvements in dynamic balance, reduced fall risk, cognition, swallowing, and voice-related outcomes. In conclusion, a multidisciplinary intervention program is beneficial for individuals with PD or PD plus conditions.

Our systematic review and meta-analysis of pharyngeal electrical stimulation (PES) and neuromuscular electrical stimulation (NMES) in patients with oropharyngeal dysphagia (OD) is the first paper (Part I) [...]. ispartof: JOURNAL OF CLINICAL MEDICINE vol:11 issue:12 ispartof: location:Switzerland status: published

Objective: To determine the effects of behavioural interventions in people with oropharyngeal dysphagia. Methods: Systematic literature searches were conducted to retrieve randomized controlled trials in four different databases (CINAHL, Embase, PsycINFO, and PubMed). The methodological quality of eligible articles was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2), after which meta-analyses were performed using a random-effects model. Results: A total of 37 studies were included. Overall, a significant, large pre-post interventions effect size was found. To compare different types of interventions, all behavioural interventions and conventional dysphagia treatment comparison groups were categorised into compensatory, rehabilitative, and combined compensatory and rehabilitative interventions. Overall, significant treatment effects were identified favouring behavioural interventions. In particular, large effect sizes were found when comparing rehabilitative interventions with no dysphagia treatment, and combined interventions with compensatory conventional dysphagia treatment. When comparing selected interventions versus conventional dysphagia treatment, significant, large effect sizes were found in favour of Shaker exercise, chin tuck against resistance exercise, and expiratory muscle strength training. Conclusions: Behavioural interventions show promising effects in people with oropharyngeal dysphagia. However, due to high heterogeneity between studies, generalisations of meta-analyses need to be interpreted with care.

English Language Learners (ELLs) with Selective Mutism (SM) mirror their typically developing, bilingual peers who are going through the silent period. The silent period is a normal phenomenon characterized by decreased expressive language and a general lack of communication that is temporary. Understanding second language acquisition and differentiating SM from the silent period, however, is critical to reduce over- and under-identification of children for services. Whereas bilingual children with SM do not speak in either of their languages, bilingual children in the silent period are only silent in their second language. Although limited information exists regarding assessment and treatment for SM in ELLs, general assessment and intervention strategies are available. The notion of selective stimulability (how stimulable a child with SM is for expressive communication) may be used in assessment in order to encourage children with SM to communicate expressively when using speech and language protocols and for determining prognosis for treatment. Guidelines for differential diagnosis of SM and the silent period are offered in this paper, including a case example of the use of selective stimulability in a speech-language assessment of a Spanish-speaking child. Moreover, additional information related to the assessment process and implications for intervention are provided.

Dental impaction is usually asymptomatic. In most cases it is recognized by chance by general dentists or orthodontists, when a patient arrives your office for a routine check-up. Mandibular third molars are the most commonly impacted teeth. Very few studies have been done to assess the prevalence of impacted premolars in inverted position. This study aims to approach the planning, diagnosis and surgical treatment of a case of premolar held in reverse position through extra oral access. Key words: Tooth impaction; impacted premolars; pathology; migration; surgical treatment

OBJECTIVE:To identify core practices for workforce management of communication and swallowing functions in COVID-19 positive patients within the ICU. DESIGN:A modified Delphi methodology was utilized, with 3 electronic voting rounds. AGREE II and an adapted COVID-19 survey framework from physiotherapy were used to develop survey statements. Sixty-six statements pertaining to workforce planning and management of communication and swallowing function in the ICU were included. SETTING:Electronic modified Delphi process. PARTICIPANTS:35 speech-language pathologists (SLPs) from 6 continents representing 12 countries. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:The main outcome was consensus agreement, defined a priori as ≥70% of participants with a mean Likert score ≥7.0 (11-point scale: "0" = strongly disagree, "10" strongly agree). Prioritization rank order of statements in a 4th round was also conducted. RESULTS:SLPs with a median of 15 years ICU experience, working primarily in clinical (54%), in academic (29%) or managerial (17%) positions, completed all voting rounds. After the third round, 64 statements (97%) met criteria. Rank ordering identified issues of high importance. CONCLUSIONS:A set of global consensus statements to facilitate planning and delivery of rehabilitative care for patients admitted to the ICU during the COVID-19 pandemic were agreed by an international expert SLP group. Statements focus on considerations for workforce preparation, resourcing and training, and the management of communication and swallowing functions. These statements support and provide direction for all members of the rehabilitation team to use for patients admitted to the ICU during a global pandemic.

The American Speech-Language-Hearing Association (ASHA) initially implemented a Code of Ethics in 1952, and has periodically revisited the content of the document with revisions to reflect the expanding scope of practice within speech-language pathology and audiology and to clarify certain concepts. Code revision is a cyclical mandated task of the ASHA Board of Ethics conducted to assure accuracy, currency, and completeness of this most important document (Solomon-Rice & O’Rourke, 2016). The current version of the Code of Ethics (2016) was modified from the previous version (2010r), with an updated preamble, definitions of related vocabulary, and re-organized language in the principles. The new code, which supports collaboration, competence, and responsibility, serves as the ethical underpinning for students and clinical fellows, practicing clinicians, researchers, supervisors, and administrators. It is incumbent on ASHA members to encode this information, and incorporate ethical practices across the span of their careers. The current article will summarize the changes between the 2010r and 2016 versions of the ASHA Code of Ethics for practicing speech-language pathologists and audiologists and students studying in these fields. Managers may benefit from this tutorial in order to be familiar with the standards to which their speech-language pathologists and audiologists must abide. Official clarification regarding the ASHA Code of Ethics should be directed to the ASHA Director of Ethics at ethics@asha.org.

In an era of growing numbers of linguistically and culturally diverse students in the U.S. schools, classroom teachers are in the position of taking the initial role in identifying and assessing bilingual students' language proficiency and development. Oftentimes, teachers and other school personnel face challenges related to adequately meeting the language needs of children who are English Language Learners (ELLs). In many cases, children are often over- or under-identified for language-related support services and assessments. School teachers may benefit from this overview of tips and suggestions related to making important decisions related to the language needs of bilingual children. A personal account as well as questions and discussions related to language difference and language disorder are offered, including suggestions for teachers who work with ELLs.

The domestic use of firewood represents a socio-ecological condition that causes important health effects, mainly in rural areas of developing countries. The purpose of the study was to evaluate the exposure to polycyclic aromatic hydrocarbons (PAHs) in women and children, as well as the concentration of PM2.5 inside dwellings of indigenous people who reside in Tocoy, San Antonio, San Luis Potosí, Mexico. With the results, the perspective of parents for making decisions with regards to the environmental health of children due to risks of exposure to toxins was analyzed. 1-hydroxypyrene (1-OHP) was used as an exposure biomarker to PAHs, and the 24-hour PM2,5 was measured inside indigenous dwellings using Minivol® equipment. 100 % of the studied dwellings used biomass for cooking and 70 % burned garbage in their homes. Levels of 1-OHP of 1.15 (0.28-2.1) and 1.04 (0.28-3.62) μmol/ mol creatinine were found in women and children respectively. In addition, mean PM2.5 concentrations of 93.3 ± 3.6 μg/m3 were detected. Finally, it was shown that 90 % of caregivers say that children spend more time in the kitchen area and the backyard, which are poorly or not adapted to child safety. This indigenous community is an example of the health risks associated with indoor air pollution in Mexico. Therefore, intervention programs aimed at reducing exposure to these toxins in vulnerable populations are required, starting with the education of caregivers. El uso doméstico de leña representa una condición socioecológica con importantes efectos sobre la salud, principalmente en las zonas rurales de los países en desarrollo. El objetivo del estudio fue evaluar la exposición a hidrocarburos aromáticos policíclicos (HAP) en mujeres y niños, así como la concentración de PM2,5 en interiores de viviendas indígenas de Tocoy, San Antonio, San Luis Potosí, México. Con los resultados, se analizó la perspectiva de los padres para la toma de decisiones en la atención a la salud ambiental infantil por riesgos de exposición a tóxicos. Utilizamos el 1-hidroxipireno como un biomarcador de exposición a HAP y se evaluaron las PM2,5 de 24 horas en interiores de viviendas indígenas mediante equipos Minivol®. El 100 % de las viviendas estudiadas utilizaban biomasa para la cocción de sus alimentos y el 70 % quemaban basura en sus hogares. Se encontraron niveles de 1-OHP en mujeres y niños de 1,15 (0,28-2,1) y 1,04 (0,28-3,62) μmol/mol creatinina respectivamente. Además, se detectaron concentraciones medias de PM2,5 de 93,3 ± 3,6 μg/m3. Finalmente se mostró que el 90 % de los cuidadores indican que el niño se concentra en el área de la cocina y traspatio, existiendo poca o nula adaptación para la seguridad del niño. Esta comunidad indígena es un ejemplo de los riesgos en salud asociados a contaminación de aire de interiores en México; por consiguiente se requiere de programas de intervención dirigidos a reducir la exposición a estos tóxicos en poblaciones vulnerables, iniciando por la educación de los cuidadores. O uso doméstico de lenha representa uma condição socio-ecológica com importantes efeitos sobre a saúde, principalmente nas zonas rurais dos países em desenvolvimento. O objetivo do estudo foi avaliar a exposição a hidrocarbonetos aromáticos policíclicos (HAPs) em mulheres e crianças, bem como a concentração de PM2.5 em interiores de habitações indígenas de Tocoy, San Antonio, San Luis Potosí, México. Com os resultados, analisou-se a perspetiva dos pais para a tomada de decisões relativamente à saúde ambiental infantil por riscos de exposição a tóxicos. Utilizámos o 1-hidroxipireno como um biomarcador de exposição a HAPs e avaliaram-seas PM2,5 de 24 horas no interior das habitações indígenas com o equipamento Minivol®. Em 100 % das habitações estudadas era utilizada biomassa para a cocção dos alimentos e em 70 % dos lares eram queimados resíduos.Encontraram-se níveis de 1-OHP em mulheres e crianças de 1,15 (0,28-2,1) e 1,04 (0,28-3,62) μmol/mol creatinina respetivamente. Além disso, foram encontradas concentrações médias de PM2.5 de 93,3 ± 3,6 μg/m3. Por fim, apurou-se que 90 % dos cuidadores indicam que as crianças se encontram na área da cozinha e logradouro, existindo pouco ou nenhum cuidado para a proteção das mesmas. Esta comunidade indígena é um exemplo dos riscos em saúde associados a contaminação do ar interior no México; indicando que são necessários programas de intervenção destinados a reduzir a exposição de populações vulneráveisa estes tóxicos, iniciando pela educação dos cuidadores.

Objective We aimed to evaluate the use of an electrocardiogram (EKG) electrode over decannulation dressings covering the stoma to improve speech intelligibility and volume and reduce air escape by facilitating identification of the “sweet spot” of the dressing. No objective data exist for patient outcomes with use of the EKG electrode dressing. Methods This prospective study included head and neck oncology patients at a tertiary hospital who received a tracheostomy. A standard tracheostomy decannulation dressing was placed followed by an EKG electrode. A speech pathologist evaluated speech volume via sound-level meter and captured speech intelligibility for random sentence-level speech. A blinded reviewer scored speech samples for intelligibility. Patients completed a 4-question satisfaction survey. Results Four patients completed the study. Based on the survey, the patients favored the button, with the lowest scores being 8.5 out of 10. Speech understanding was 48.5% without the button and 83% with the button. Normal speech volume was 73.75 dB without the button and 77.75 dB with the button. Loud speech volume was 80.75 dB without the button and 87 dB with the button. Discussion This pilot study shows objective benefits of the EKG button as well as improved patient satisfaction. Inexpensive and low maintenance, the EKG electrode provides better occlusion of stoma dressing with easier localization. Implications for Practice Dissemination of our results will aim to improve quality and patient outcomes following decannulation.

This study examined consumer satisfaction with speech-language therapy services in two university clinics as reported by 96 clients and caregivers. Satisfaction was related to student speech-language pathologists' communication with clients and families. Explaining clients' communication problems, discussing session objectives, describing progress, providing home programming, and offering strategies for maintaining skills after discharge contributed to perceptions of effective service. Survey findings hold implications for supervision of student clinicians. Positive feedback confirms that students are providing quality service and supervisors are teaching clinical skills and managing service delivery. Feedback that points out deficiencies can help students and supervisors set goals for improvement.

Without the supports of IEP programming, high school graduates on the autism spectrum may struggle. Here are five ways speech-language pathologists in schools can help them transition to what's next.

Children with autism demonstrate significant and lifelong difficulties understanding and communicating emotional content. Their ability to establish mutually satisfying relationships is often severely impaired. Although numerous methods have been developed to address the social–communicative aspects of this neurological impairment, few methods have been developed that assist the child with autism in making contact with his/her world and thus establish a foundation through which relationships can be developed. Gestalt therapy provides a rich context in which the child can explore and develop his/her emotional base. This paper examines the application of Gestalt therapy to the treatment of children with autism.

People with communication and cognitive-linguistic problems often have difficulty participating in group activities. This article describes a program developed to facilitate participation in group activities by using students to provide individual support within the context of language stimulation activities.

Supervisors of student speech-language clinicians face dilemmas in deciding how to resolve problems when proteges experience difficulties during therapy sessions with clients. Decisions must consider appropriate levels of supervisor intrusiveness and the extent to which intrusions negatively affect client therapy and proteges' professional development. Using a writing prompt directed to speech-language supervisors of three different types (on-campus university supervisors, off-campus university supervisors, and cooperating clinicians), the current investigation found that five supervisory behaviors of six previously observed during critical teaching incidents in public school settings are used in speech-language contexts. Each is discussed; implications and recommendations follow.

Breve vue d'ensemble theorique des relations d'interaction et d'interdependance entre l'apprentissage par l'enfant des habiletes langagieres et les autres aires du developpement (motrice cognitive, sociale, emotionnelle, le jeu). Etablissement de sequences developpementales dans chacun de ces domaines, et mise en correspondance

Even though the workload approach is a preferred way to think about structuring a work day, many SLPs still aren't using it. Here are some ways to help get the ball rolling.

How does autism-related content in New York graduate speech-language pathology programs stack up?

A thank-you letter from a graduating student was just what this school-based SLP needed at the end of a long busy year.

Seasonal variation is a key factor regulating energy metabolism and reproduction in several mammals, including bats. This study aimed to track seasonal changes in the energy reserves of the insectivorous bat Molossus molossus associated with its reproductive cycle. Adult males were collected during the four neotropical annual seasons in Viçosa - MG, Brazil. Blood and tissues were collected for metabolic analysis and testes were removed for histology and morphometry. Our results show that liver and breast muscle glycogen concentrations were significantly lower in winter. The adiposity index was significantly higher in the fall compared to winter and spring. Seminiferous tubules were greater in diameter in animals captured in fall and winter, indicating a higher investment in spermatic production during these seasons. The percentage of Leydig cells was higher in summer compared to fall and winter. We suggest that M. molossus presents a type of seasonal reproduction with two peaks of testicular activity: one in fall, with higher sperm production (spermatogenesis), and another in summer, with higher hormone production (steroidogenesis). The metabolic pattern may be associated with reproductive events, especially due to the highest fat storage observed in the fall, which coincides with the further development of the seminiferous tubules. A variação sazonal é um fator chave na regulação do metabolismo energético e da reprodução em vários mamíferos, incluindo os morcegos. O objetivo deste estudo foi avaliar as reservas energéticas do morcego insetívoro Molossus molossus ao longo das estações anuais associadas ao seu ciclo reprodutivo. Foram coletados machos adultos durante as quatro estações anuais na cidade de Viçosa - MG, Brasil. Para as análises metabólicas foram coletados tecidos e sangue, e os testículos foram removidos para análises histológicas e morfométricas. Os resultados mostram que as concentrações de glicogênio no fígado e músculo peitoral foram significativamente menores no inverno. O índice adiposo foi significativamente maior no outono em relação ao inverno e primavera. Os túbulos seminíferos apresentaram maiores diâmetros nos animais coletados no outono e inverno, indicando um maior investimento na produção espermática durante estas estações. A porcentagem de células de Leydig foi maior no verão em comparação com outono e inverno. Sugere-se que M. molossus apresenta um tipo de reprodução sazonal com dois picos de atividade testicular: uma no outono, com maior produção de espermatozóides (espermatogênese), e outra no verão, com maior produção de hormônio (esteroidogênese). O padrão metabólico pode estar associado a eventos reprodutivos, especialmente devido ao maior armazenamento de gordura observado no outono, que coincide com o desenvolvimento dos túbulos seminíferos.

Do you get as excited as we do about going to big conferences like ASHA? There's so much going on: Professional learning and access to cutting-edge research. People from all over the world sharing their passion for what they do. And networking, networking, networking.

Providers may have a more difficult time linking new diagnosis codes to appropriate billing codes.

Graduate student clinicians and clinical supervisors completed a Likert Scale regarding the importance of selected variables in student clinician/supervisor interaction. An independent means t-test was computed for each of the 25 items. A one-way ANOVA combining both groups was computed to establish values in an Scheffe test for multiple comparisons. Respondents also rank-ordered five dimension of clinician/supervisor interaction: nonverbal, verbal, accessibility, respect/attention and competency/professionalism.

Seventy-two college students (36 male, 36 female) responded to Likert Scales of Summated Ratings and semantic differential scales which pertained to their gernal perceptions of the oral communication skills of adult male and adult female speakers. Generally, respondents differed more significantly on items regarding male speakers. Discussion focuses on genderlect in today's society and the need for student clinicians to be aware of that particular issue as well as their own commnication styles. Also noted is the need for institutions of higher education to emphsasize oral communication as an important component in academic programs.

PURPOSE: The aim of this study was to investigate the relationship among physiological factors, age, sensory over-responsivity (SOR) and food selectivity in children with autism spectrum disorders (ASD).METHODS: One hundred forty-one parents of children with ASD were recruited through a national autism organization, Autism Speaks, to fill out a survey regarding their child’s mealtime behavior. Survey contained items to measure the severity of food selectivity behavior, the presence of physiological factors (i.e., reflux,constipation, food allergies and the need for a specialized diet) and sensory over-responsivity (SOR). Results were analyzed using Chi Square, ANOVA and logistic regression.RESULTS: No relationship between physiological factors and level of food selectivity was found. Older children in the 3-9 year old range did not have more foods in their diet repertoire than younger children. Finally, children with fewer than 10 and those with 11-20 foods in their diet (i.e., severe food selectivity and moderate food selectivity respectively) were found to have significantly higher scores on a measure of SOR when compared to children with 21+ foods (typical selectivity).CONCLUSIONS: When addressing food selectivity in children with ASD, consideration of the possibility that the child may not outgrow restricted diets is warranted. Also, treatment for food selectivity may be more effective if SOR is included in protocol.

The question of tube feeding often presents great challenges for the physician. Catholic moral teaching can be of great help to all people of good will in meeting this challenge. The Church teaches that tube feeding is, in principle, ordinary care and hence morally obligatory. How should clinicians go about deciding when to recommend tube feeding in a manner that serves the best interests of the patient and is in harmony with the Church's teaching? A PEG tube should be recommended when a patient is not eating or drinking adequately, has more than a short-term need, is not imminently dying, and has no contraindication to a PEG. This article presents a step-by-step discussion of the decision-making process to assist physicians and other health-care professionals. A decision tree is included that is clinically focused, practical, and straightforward. The authors represent a broad range of Catholic clinical experience. Practical suggestions are offered regarding how to go about discussing this difficult subject with patients and their families. The issues of patient refusal, advance directives, and physician recusal from care are addressed. A chronological reading list on the subject of PEG tubes is provided.

Looking for SLP student loan forgiveness in your state? See how two states forged ahead to develop their own programs.

In your busy workday, it's easy to be sidetracked by your workload and the challenges that brings. Allow yourself to see the difference you make.

Regularly reaching across disciplinary lines may at first seem daunting. But when you see how much it helps clients, it becomes second nature.

In an evaluation of the least restrictive diet for a patient without teeth, bedside and instrumental exams don't always tell the whole story.

Paperwork to document students' IEP progress is necessary, but it needn't be a nightmare.

In 2000, the Swedish parliament accepted a bill proposing that there should be full accessibility in society for individuals with disabilities by the end of 2010. In the years since, progress has been made. In Sweden, for example, accessibility to public transportation has been improved thanks to elevators and ramps, and pavement curbs have been lowered at crossings to facilitate wheelchair mobility. Public premises are now built or renovated with accessibility goals in mind. However, when it comes to efforts to improve accessibility for individuals with less visible disabilities, such as communication disorders, the rate of change is not as rapid.

This SLP said the schools just weren't for her. But her sister knew better.

A talk with Melissa Primus, president of the Iowa Speech-Language Hearing Association

MSHA monitors bills introduced in the state legislature that could have a positive or negative impact on our profession in the areas of delivery of services, conditions of services or licensure.