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Background: In 2016/17, the CATALISE Consortium published the results of a multinational and multidisciplinary Delphi consensus study, representing agreement among professionals about the definition and process of identification of children with Developmental Language Disorder (DLD) (Bishop et al., 2016, 2017). The extent to which the current clinical practice of UK speech and language therapists (SLTs) reflects the CATALISE consensus statements is unknown. Aims: To investigate how UK SLTs' expressive language assessment practices reflect the CATALISE documents' emphasis on the functional impairment and impact caused by DLD, by examining: whether multiple sources of assessment information are gathered; how standardised and non‐standardised sources are combined in clinical decision‐making, and how clinical observation and language sample analysis are utilised. Methods and Procedures: An anonymous, online survey was carried out between August 2019 and January 2020. It was open to UK‐based paediatric SLTs who assess children up to age 12 with unexplained difficulties using language. Questions probed different aspects of expressive language assessment which are referred to in the CATALISE consensus statements and supplementary comments, and asked about participants' familiarity with the CATALISE statements. Responses were analysed using simple descriptive statistics and content analysis. Outcomes and Results: The questionnaire was completed by 104 participants, from all four regions of the United Kingdom, working in a range of clinical settings with different levels of professional experience of DLD. The findings indicate that clinical assessment practices broadly align with the CATALISE statements. Although clinicians carry out standardised assessments more frequently than other types of assessment, they also gather information from other sources and use this alongside standardised test scores to inform clinical decisions. Clinical observation and language sample analysis are commonly utilised to evaluate functional impairment and impact, along with parent/carer/teacher and child report. However, asking about the child's own perspective could be more widely utilised. The findings also highlight a lack of familiarity with the details of the CATALISE documents among two thirds of the participants. Conclusions and Implications: Assessment practices broadly align with the CATALISE statements, but there is a need for greater clarity regarding terminology and the assessment of functional language impairment and impact. This research should prompt discussion in the profession about how to further develop and adopt expressive language assessment practices which reflect the CATALISE consensus and support effective assessment. What This Paper Adds: What is already known on the subject: The CATALISE consortium documents on Developmental Language Disorder (DLD) were published in 2016/17. The extent to which expressive language assessment practice in the United Kingdom reflects the new definition and statements on assessment has not previously been investigated. What this paper adds to existing knowledge: This survey indicates that speech and language therapists in the United Kingdom assessing children for DLD mostly balance standardised language test scores with other sources of information in clinical decision‐making, and utilise clinical observation and language sample analysis to consider functional impairment and the impact of the language disorder. However, important questions are raised regarding the robustness and objectivity with which these key parameters are currently defined and evaluated. What are the potential or actual clinical implications of this work?: Clinicians, individually and at service level, are encouraged to reflect on their assessment of functional impairment and the impact of language disorder and to take steps to incorporate this where necessary. Professional guidance and clinical tools to facilitate robust, objective assessment would support clinical practice that aligns with expert consensus. [ABSTRACT FROM AUTHOR]

Background: Maintenance of speech outcomes following speech‐language therapy (SLT) in Parkinson's disease (PD) is an unmet expectation of people with PD (PWPD) and poorly defined in SLT practice. PD Check‐In, a model for supported self‐managed maintenance of speech following Lee Silverman Voice Treatment (LSVT) LOUD was investigated. Aims: To investigate the impact of the semi‐structured component of PD Check‐In on the adoption of self‐management concepts and behaviours and the identification of facilitators, barriers and strategies for speech maintenance by PWPD over 24 months post‐treatment. Methods and procedure: Following LSVT LOUD, 16 PWPD participated in individual PD Check‐In semi‐structured discussions with a SLT at 6 and 12 weeks, and 6, 12 and 24 months post treatment. A two‐stage qualitative content analysis was applied: directed content analysis using categories from the theoretical framework of PD Check‐In followed by inductive content analysis to identify subcategories. Outcomes and results: Statements from PWPD indicated adoption of seven concepts of self‐management across participants and across time. Six concepts from the theoretical framework of PD Check‐In (partnerships, self‐reflection, maintenance barriers and facilitators, revision of LSVT LOUD skill, goal setting and maintenance strategies), and one new category, participation, emerged from the analysis. Self‐reflection, maintenance facilitators and barriers and participation were most prevalent in discussions. PWPD identified facilitators, barriers and strategies for maintenance across time points. Conclusions and implications: Statements from PWPD indicated a positive impact of SLT‐supported self‐management of speech using self‐tailored strategies for sustainable maintenance according to their individual circumstances and needs. WHAT THIS PAPER ADDS: What is already known on this subject: People with Parkinson's disease (PWPD) have expressed their need for speech‐language therapy (SLT) services that are accessible for the duration of the condition and responsive to their expectation of maintaining speech following treatment. Outcomes for maintenance of the treatment effect following Lee Silverman Voice Treatment (LSVT) LOUD are variable. What this paper adds to existing knowledge: This study presents the outcomes of five PD Check‐In interventions delivered in semi‐structured discussions between PWPD and a SLT over 24 months following LSVT LOUD for the development of self‐management skills and behaviours. PWPD adopted self‐management positively using self‐tailored strategies for sustainable maintenance according to their individual circumstances and needs. What are the potential or actual clinical implications of this work?: PWPD responded positively to the individual development of self‐management skills and behaviours over time. Individuality and flexible responsivity are features of PD Check‐In which resonate with PWPD and speak to SLT supported self‐managed maintenance of speech as a long‐term model for PD. [ABSTRACT FROM AUTHOR]

Background: Early language delay is exacerbated by social disadvantage. Factors such as parents' low levels of literacy, confidence and self‐perception can affect the capacity to act on advice received, critical to empowerment. Methods used to achieve successful health outcomes in socially disadvantaged clinical populations may need enhancing. Aims: To compare the impact of standard parent‐based intervention (PBI) to enhanced PBI for young children with speech, language and communication needs (SCLN) and their families living in more socially disadvantaged populations. Methods and Procedures: A multicentre clustered blind randomised controlled trial was used to compare the effect of parent‐based group interventions to improve early language development with children (mean age 27.5 months) from more socially disadvantaged populations with an expressive vocabulary of 40 or less single words. Intervention sessions were delivered by a speech and language therapist, over a 20‐week period. Participants received one of two interventions: (1) Standard Care – indirect group PBI – (PBI) (2) Enhanced Care: indirect group enhanced PBI – (EPBI). Both standardised and non‐standardised measures were used as outcomes. Parent engagement in the intervention was captured through analysis of attendance and the Parent Activation Measure – Speech & Language Therapy (PAM‐SLT) (Insignia Health, 2014). The PAM measures a person's knowledge, skills and confidence to manage their own health and well‐being (NHS England, 2018). In this study, activation referred to parents' knowledge, skills and confidence to manage their child's language development. Outcomes and Results: One hundred fifty‐five participants were randomised at baseline. Children in both groups made significant improvements in the outcome on MacArthur‐Bates Communicative Development Inventories Sentence Length, from pre‐intervention to post‐intervention and 6 months post‐intervention (p < 0.05). Changes in vocabulary and expressive language skills were more equivocal, showing wide variation in confidence intervals for both groups. Where parents attended at least one intervention session almost all effect sizes were in favour of the EPBI intervention. Parents' activation levels significantly increased for both groups (EPBI p < 0.001, PBI p = 0.003), with a moderate effect size in favour of EPBI (Hedges' G 0.37, confidence interval –0.02 to 0.76), although wide variation was found. Conclusions and Implications: This trial provides some evidence of facilitating the language development of children with SLCN from more socially disadvantaged areas through supporting caregivers. However, we found variation in outcomes; some children made excellent progress, whilst others did not. Further exploration of parent engagement and its relationship to child language outcomes will be valuable to understanding more about mechanisms of change in interventions that involve parents. WHAT THIS PAPER ADDS: What is already known on the subject: Speech, language and communication needs (SLCN) have a knock‐on effect on emotional well‐being, school readiness, literacy and school attainment, putting children at increased risk of long‐term consequences such as poor literacy, mental health problems and unemployment. In disadvantaged areas, the prevalence of language difficulties is higher than elsewhere. Factors such as parents' low levels of literacy, confidence and self‐perception can affect the capacity to act on advice received, critical to empowerment. What this paper adds to existing knowledge: Children with SLCN from more socially disadvantaged areas can make improvements in their language development through parent intervention, although wide individual variation was found. There was some evidence that children achieve better outcomes with EPBI, which employed an interagency collaborative approach. Parent's engagement (activation levels) increased significantly over time with intervention, with the increase twice as big for EPBI. What are the potential or actual clinical implications of this work?: This trial provides some evidence that it is possible to facilitate the language development of children from more socially disadvantaged areas through supporting their caregivers. Further research would be useful to determine whether increases in parent engagement are related to adherence to intervention and change in child outcomes. [ABSTRACT FROM AUTHOR]

Background: People with behavioural variant frontotemporal dementia, Lewy body dementia, posterior cortical atrophy and young onset Alzheimer's disease may experience language and communication difficulties. However, the role of speech and language interventions for people with these non‐language led dementias has received little attention. Aims: This study aimed to explore the experiences and perspectives of people living with these conditions, and their families, regarding their language and communication difficulties and how speech and language therapy could address these needs. Methods: This study employed a qualitative design to explore the experiences of people living with or caring for somebody with behavioural variant frontotemporal dementia, Lewy body dementia, posterior cortical atrophy or young onset Alzheimer's disease, and to understand their opinions about speech and language therapy. Participants were recruited from a support service connected to a dementia clinic to attend one of five focus group meetings. Videorecorded focus groups and interviews were transcribed, and reflexive thematic analysis was used to analyse data from people affected by each type of dementia. Results: A total of 25 participants were recruited to the study, with representation across the different forms of non‐language led dementias. The four main themes identified were: (1) communication difficulties as a key difficulty, (2) loss and loneliness, (3) speech and language therapy, and (4) the role of the caregiver. Sixteen subthemes were also identified which highlighted individual issues across disease types. Discussion: Although all the forms of dementia studied here are not considered to be language‐led, people with these conditions and/or their care partners identified speech, language and communication as common challenges. These communication difficulties were reported to have a negative impact on their social participation and mental health and participants felt speech and language interventions could help. There is a need for research exploring speech and language interventions developed for and with people with non‐language led dementias and their care partners, to ensure they meet the needs of the people they are designed for. WHAT THIS PAPER ADDS: What is already known on the subject: People with primary progressive aphasia present with speech, language and communication difficulties, and several speech and language interventions have been developed to meet the needs of this population. However, people with non‐language led dementias may also experience speech, language and communication difficulties, and little is known about interventions that may address these difficulties. What this paper adds to existing knowledge: People living with or caring for somebody with behavioural variant frontotemporal dementia, Lewy body dementia, posterior cortical atrophy and young onset Alzheimer's disease report experiencing speech, language and communication difficulties that impact on the person with dementia's social participation and mood. Participants in this study also shared their opinions about how speech and language interventions could help, from the earliest stages of the disease. What are the potential or actual clinical implications of this work?: Speech and language therapists need to address the individual speech, language and communication needs of people with dementias, even those that are not thought to be language‐led. Current speech and language therapy service provision does not meet the needs of people with non‐language led dementias and further research is required to develop interventions and services to meet these needs. [ABSTRACT FROM AUTHOR]

Aim: Evidence shows that 20%–30% of patients who aspirate do so silently. Research to date has not demonstrated clear evidence to indicate which patients are at higher risk of silent aspiration. Our aim was to use univariate logistic regression analysis of retrospective case review to determine potential patterns of silent aspiration. Materials and methods: We conducted a retrospective analysis of 455 fiberoptic endoscopic evaluation of swallowing (FEES) reports. The patients were divided into four groups: G1 – neurological diseases (n = 93), G2 – head and neck surgery (n = 200), G3 – gastroenterological diseases (n = 94) and G4 – other patients (n = 68). Data included the occurrence or absence of saliva penetration or aspiration, of silent fluid/solid food penetration or aspiration, type of penetration or aspiration, occurrence of cranial nerve paresis, radiotherapy and tracheostomy. Univariate logistic regression was used to evaluate independent risk factors of silent aspiration in the study population. Three models with different independent variables were considered. Results: There is a statistically significant difference in the frequency of occurrence of silent penetration and aspiration within the groups (p < 0.001), with intraglutative being most frequent. Fluid and food penetration and aspiration correlated with saliva penetration and aspiration in all groups (p < 0.001). Cranial nerve paresis (IX and X), radiotherapy and tracheostomy correlate with saliva penetration and aspiration (p = 0.020 for cranial nerve paresis; p = 0.004 for radiotherapy; p < 0.001 for tracheostomy). One hundred and fifteen patients (45.81%) in the subgroup of patients with intraglutative aspiration had cranial nerve paresis (IX, X or IX–X). Conclusions: Patients who should be prioritised or considered to be at a higher need of instrumental swallowing evaluation are those with IX and X cranial nerve paresis, tracheostomy and those who have had radiotherapy, with saliva swallowing problems, especially after paraganglioma, thyroid and parathyroid glands and middle and posterior fossa tumour surgery. WHAT THIS PAPER ADDS: What is already known on the subject: Clinical signs of penetration or aspiration include coughing, throat clearing and voice changes, while silent penetration or aspiration patients aspirate without demonstrating any clinical symptoms. The most common consequences of silent aspiration include aspiration pneumonia, recurrent lower respiratory tract infections and respiratory failure. Additionally, malnutrition and dehydration can be indicators of silent aspiration. Patients may unknowingly reduce their oral intake and lose weight. Retrospective studies have shown that 20%–30% of patients aspirate silently (e.g. patients after stroke, acquired brain injury, head and neck cancer treatment, prolonged intubation). Clinical examination of swallowing can miss up to 50% of cases of silent aspiration. What this paper adds to existing knowledge: Currently, silent aspiration is often discussed in neurological literature, but its applications to head and neck surgery are limited. In this study, we identify head and neck surgery patients who should be prioritised or considered to be in higher need of instrumental swallowing evaluation due to a higher risk of silent aspiration. What are the potential or actual clinical implications of this work?: Post‐treatment structural changes can result in lower cranial nerve paresis (IX, X, XII) and face injury, in which vagus and glossopharyngeal nerves are injured. After tracheostomy and radiotherapy, patients with problems swallowing saliva need careful clinical examination, particularly cranial nerve examination. [ABSTRACT FROM AUTHOR]

Background: Maternal input plays an important role in influencing linguistic development during the first years of life, and it is evident that mothers adapt their language according to their child's characteristics. Recently, it was demonstrated that maternal input addressed to children with sex chromosome trisomies (SCTs) at 8 months of age is prosodically and functionally different from that addressed to typically developing (TD) peers. Aims: The study aimed at analysing maternal input at 24 months when the presence of a language delay could be more evident than during the preverbal stage. We were interested in examining if maternal input was influenced by a diagnosis of SCT (by comparing children with SCT and TD children) or by children's linguistic level (by comparing children with weak lexical ability versus children with typical lexical ability regardless of the presence of genetic diagnosis). Methods and Procedures: Forty‐four mother–child dyads in which the children had an SCT and 20 mother–child dyads in which the children were TD participated in the study. Of these 64 dyads, 23 children (21 with SCTs and two TD children) formed the group of children with weak lexical ability (children with a vocabulary size lower than 50 words at 24 months). Maternal utterances were collected during one video‐recorded play session and were then coded considering both the linguistic and functional features of the input. Outcomes and Results: The results showed that the input addressed to 24‐month‐old children with SCTs is as rich and complex as that addressed to TD peers. Moreover, no significant differences in the functions expressed by maternal input were found (all ps > 0.05). Comparing the children with weak lexical ability and the children with typical lexical ability in our sample, having a poor vocabulary at 24 months of age showed a significant influence on the maternal input features: the input addressed to children with weak lexical ability was characterised by a higher presence of attention getters (U = 217.00, p = 0.007) and a lower proportion of questions (U = 236.00, p = 0.017) than that of mothers of typically‐talking children. Conclusions and Implications: At 24 months of age, it seems that the presence of a language delay and not belonging to the clinical group of children with SCTs influences the functional characteristics of the maternal input. It is important to support the parents of children with SCTs during the communication process and later during their child's development, leading them to observe their children's manifested skills rather than looking for possible predicted difficulties. WHAT THIS PAPER ADDS: What is already known on the subject: Studies in the literature demonstrated how mothers can generally adapt their input to their child's characteristics. To our knowledge, only two recent studies analysed the maternal input addressed to children with SCT at 8 months of age, highlighting significant differences. What this paper adds to existing knowledge: The maternal input addressed to children with SCT at 24 months of age is not different from that addressed to TD children. At 24 months of age, the mothers adapt their input to the verbal competence shown by their child (weak lexical ability versus typically‐talking), while belonging to the clinical group does not show an influence. What are the potential or actual clinical implications of this work?: All the participants of the present study received prenatal diagnosis disclosure by an expert team of professionals, and they were all involved in a longitudinal study aimed at monitoring the children's development and supporting their parents. These results show that giving clear and complete information about possible development paths to parents of children with SCTs during diagnosis disclosure is crucial. Moreover, supporting the parents during the communication process and later during their child's development is fundamental, leading them to observe their children's manifested skills rather than looking for possible predicted difficulties. [ABSTRACT FROM AUTHOR]

Background and Objectives: Evidence suggests telehealth in speech and language therapy can enhance access to care, cost‐effectiveness and satisfaction. However, little is known about use of telehealth in the United Kingdom. Moreover, many assessments/outcome measures for aphasia have been tested for face‐to‐face administration only, posing challenges to reliable use within the telehealth context. We explored the experiences and views of speech and language therapists (SLTs) working with people with aphasia on using telehealth to conduct assessments/outcome measures, perceived barriers and facilitators in telehealth, and their priorities for research in telehealth aphasia assessment. Method: We explored views of UK SLTs through an online cross‐sectional survey (2021) delivered through the Qualtrics platform. The survey covered three main areas: (i) participant demographics; (ii) experience of using telehealth and doing telehealth assessments with people with aphasia post‐stroke during the COVID‐19 pandemic; and (iii) plans for telehealth post‐pandemic. Response formats included yes/no, multiple choice, 5‐point Likert scales and open‐ended text responses. The survey was expected to take no more than 10 min to complete. Survey data were analysed through descriptive statistics and content analysis of open‐ended questions. Results: One hundred twenty‐four SLTs responded to the survey. The majority (>80%) used telehealth during the COVID‐19 pandemic and >90% planned to continue to use telehealth in the future. The most used platforms were Zoom, Microsoft Teams and Attend Anywhere. Access to internet and telehealth platforms, and practical problems (e.g., difficulties sharing resources online, limited functionality of telehealth platforms for assessment) were common barriers. Therapists highlighted that training, resources and materials that assist the administration of assessments were important. Most participants responded that there was a need for existing measures to be tested for administration via telehealth (n = 68, 70.8%). Participants overall felt there was a need for online interactive assessments, more online resources that have been trialled for use via telehealth, accessible formats for resources for people with aphasia and clear instructions for how people with aphasia can access resources. Conclusions: This study provides new insights into the current use of telehealth assessment with people with aphasia in the United Kingdom and directions for future research. Barriers and facilitators identified can support the implementation of telehealth assessment in SLT services. WHAT THIS PAPER ADDS: What is already known on the subject: The use of telehealth in speech and language therapy has advantages in terms of access to care, cost‐effectiveness and satisfaction with care. However, little is known about the use of telehealth in aphasia rehabilitation in the United Kingdom, especially in the area of assessment and outcome measurement. What this paper adds to existing knowledge: This study identified that the majority (>80%) of aphasia therapists used telehealth during the COVID‐19 pandemic and >90% planned to continue to use telehealth in the future. A need was identified for existing measures to be tested for administration via telehealth and for training, resources (e.g., online interactive assessments) and materials (e.g., accessible formats for people with aphasia). What are the potential or actual clinical implications of this work?: To facilitate the successful implementation of telehealth assessment, there is a need for measures validated for use via telehealth and more online resources that have been trialled for use via telehealth. [ABSTRACT FROM AUTHOR]

Background: Pictures drawn by people with aphasia (PWA) are often more challenging to understand than those drawn by healthy people. There are two types of objects: those that tend to be drawn symbolically (symbolically drawn objects—SOs) and those that are likely to be drawn realistically (realistically drawn objects—ROs). Aims: To compare the identification rate and number of misunderstanding types between SOs and ROs drawn by PWA and healthy controls (HCs). To reveal trends in the misunderstandings of drawings by PWA, and to identify the language or cognitive abilities related to the identification rate of pictures drawn by PWA. Methods & Procedures: We designed a drawing task involving SOs and ROs. A total of 18 PWA and 30 HCs completed the task, and respondents identified the drawings. The identification rate and number of misunderstandings were analysed with two‐way analysis of variance (ANOVA) including group (PWA and HCs) and object type (SOs and ROs). The misunderstandings were divided into four categories varying in semantic and morphological similarity; these ratios were examined with a chi‐square test. The relationships of language and cognitive abilities with the identification rate were investigated with multiple regression analyses. Outcomes & Results: There was a significant effect of the interaction between group and object type on the identification rate (F(1.1387) = 3.90, Mean Squared Error (MSE) = 4139.67, p = 0.04): the identification rates for ROs were lower in the PWA than in the HCs. For the number of misunderstanding types, an interaction was observed between group and object type (F(1.56) = 8.26, MSE = 26.93, p < 0.01): the number of misunderstanding types for ROs in the PWA was greater than that in the HCs. The misunderstanding patterns differed between ROs and SOs (χ2(3) = 694.30, p < 0.001, V = 0.37). ROs were semantically related, whereas SOs were morphologically related. The identification rates of ROs and SOs were correlated only with Kanji writing scores (ROs: β = 3.66, p = 0.01; SOs: β = 6.57, p < 0.01). Conclusions & Implications: In drawings by the PWA, SOs had a higher identification rate, while ROs had a lower identification rate and a greater variety of misunderstandings. SOs may increase drawing motivation. Interventions to improve the identifiability of SOs and ROs should reflect each character. Identification rates were correlated only with Kanji writing scores. The PWA, whose native language was Japanese and had preserved Kanji writing abilities, and their communication abilities may be increased through drawing. WHAT THIS PAPER ADDS: What is already known on the subject: PWA often have impaired drawing abilities and draw pictures that third parties misinterpret. Some objects tend to be drawn symbolically, and some are drawn realistically. However, it is not clear whether there is a difference between these types of drawings depicted by PWA in identifiability and the tendency to be misunderstood by ordinary people. In addition, the relationships between language or cognitive abilities and the identification rate of drawn pictures are not clear. What this paper adds to the existing knowledge: The identification rate differed between SOs and ROs. In drawings by PWA, SOs had a higher identification rate, while ROs had a lower identification rate and the greatest variety of misunderstandings. Approximately half of the misunderstandings were related to the target object. SOs tended to be confused with morphologically related objects, while ROs tended to be confused with semantically related objects. Identification rates were correlated only with Kanji writing scores. What are the potential or actual clinical implications of this work?: To motivate PWA's drawing, it is suitable to begin with SOs. Examining drawing ability from the perspective of SOs and ROs increases the chance of identifying drawing ability. PWA whose native language is Japanese and have preserved Kanji writing abilities may be able to increase their communication abilities through drawing. [ABSTRACT FROM AUTHOR]

Background: Training parents to implement language and communication intervention strategies is an effective approach to promote language development for children with language delay. Aims: This study introduces an online parent training program conducted in Hubei province, China, which was designed to help parents of language‐delayed children with a diagnosis of autism spectrum disorder (ASD), developmental language disorder (DLD) or global developmental delay (GDD) apply language intervention strategies into daily interactions and promote their children's language development at home. Methods & Procedures: The Bethel Hearing and Speaking Training Center Family Training for Early Communication & Language Development (Bethel Family Training Program, BFT) (Bethel HSTC, 2020) was designed to improve the language and communication skills for children with language delay in a naturalistic way. The caregivers (including parents, grandparents and other main caregivers) participated in an 8‐h online program, including lectures on milestones in child language development, common misunderstandings of child language development, and three basic family language intervention strategies ('Looking together, playing together, and talking together') incorporating active learning through video analysis and discussion. Tongji Hospital in Hubei then continued with 3 months of online home intervention monitoring to all the caregivers via weekly online Q&As led by BFT certified speech therapists' team. The Gesell Developmental Schedules (GDS) was carried out before the online parent training program and after the 3‐month online home intervention monitoring. Outcomes & Results: 146 families whose children aged 12–68 months with language delay participated in the online training program. The results of the GDS assessments conducted before and after the program showed that not only did the developmental quotient (DQ) of language improve, but so did the DQ of social behaviour and adaptive behaviour (p < 0.001). There is no between‐group difference in the application of three strategies between the ASD group and the DLD or GDD group (p > 0.05). Furthermore, both caregivers' ability to apply 'looking together, playing together, talking together' strategies and the effective interaction time played important roles in improving the child's language abilities. Conclusion & Implications: The online parent training focusing on improving daily interaction with children through speech–language stimulation strategies promoted the development of language skills. It is an economic and practical approach for children with language delay who have limited access to local language intervention programs. WHAT THIS PAPER ADDS: What is already known on the subject: Parent‐implemented language intervention is an effective approach at improving children's language development. Telepractice is an appropriate model of service delivery for audiologists and speech–language therapists and may be the primary mode of service delivery or may supplement in‐person services. What this paper adds to the existing knowledge: This paper explores the effectiveness of an online parent training program and provides new evidence that online training on language support strategies (looking together, playing together, talking together) followed by home intervention monitoring works for Mandarin‐speaking children and it is equally effective for children with ASD and non‐ASD diagnosis. What are the potential or actual clinical implications of this work?: Developmental behavioural paediatricians and speech–language therapists in countries and areas that lack sufficient training resource for every child will have the option to deliver parent training and home intervention monitoring online, which will save time and cost considerably while offering convenience. [ABSTRACT FROM AUTHOR]

Background: Cognitive–communication difficulties are often associated with dementia and can impact a person's ability to participate in meaningful conversations. This can create challenges to families, reflecting the reality that people living with dementia rarely have just one regular conversation partner, but interact with multiple family members. To date, there is limited evidence of the impact of changes in communication patterns in families. A family systems approach, with foundations in psychology, can be used to explore the impact of communication difficulties on multiple different family members, including the person living with dementia and potential coping strategies used by individuals, together with the family as a whole. Methods & Procedures: A systematic review of primary qualitative research was conducted to identify and examine research exploring communication and interaction within families living with dementia. Studies were identified through a comprehensive search of major databases and the full‐text articles were subject to a quality appraisal. We conducted a thematic analysis on the literature identified to consider the role of families in supporting communication for people with dementia. Outcomes & Results: The searches identified 814 possible articles for screening against the eligibility criteria. Nine articles were included in the final review. Three major themes emerged from the analysis of the included studies: (1) 'identities changing' reflected how interactions within the family systems impacted on identities; (2) 'loss' reflected the grief experienced by families due to changes in communication; and (3) 'developing communication strategies' highlighted strategies and approaches that families affected by dementia may use organically to engage in meaningful interactions and maintain connection. Only one study explicitly used a family systems approach to understand how families manage the changes in interaction resulting from dementia. Conclusions & Implications: The findings may usefully inform the clinical practice of speech and language therapists in terms of communication strategies and coping mechanisms that may be advised to facilitate connection in families living with dementia. Further research using a family systems approach to exploring communication in dementia may help to support the implementation of family‐centred practice as recommended in policy. What this paper adds: What is already known on the subject: There is increasing recognition of the impact of dementia on whole families and the need for family‐centred interventions to enhance quality of life. However, much of the research to date that explores communication within families affected by dementia examines interaction between dyads, largely overlooking the roles and skills of other familial communication partners. To the authors' knowledge, there has been no previous review of the literature using a family systems approach, which has the potential to inform clinical practice of those working in dementia care. What this paper adds to existing knowledge: The review examines and understands what is known about the approaches used by families affected by communication changes resulting from dementia to preserve connection. It collates the evidence from qualitative studies examining approaches and strategies used by individual conversation partners, including people with dementia, as well as the family system as a whole, to facilitate meaningful interactions, and proposes recommendations for clinicians working in this field. Furthermore, we consider the potential benefits of using a family systems approach to understand the context of people living with dementia and how this could enhance communication, personhood and well‐being. What are the potential or actual clinical implications of this work?: This review highlights practical conversation strategies and interactional approaches that may serve to enhance communication and preserve relationships between people with dementia and their family members. Such techniques have the potential to be advised by Speech and Language Therapists working in dementia care as part of tailored, relationship‐centred care and support that they provide. [ABSTRACT FROM AUTHOR]

Background: In 2016–17 an important consensus was established regarding the use of the diagnostic label 'developmental language disorder' (DLD) to describe children with a persistent language problem having a functional impact on communication or learning and in the absence of any other biomedical condition. Despite this consensus, past research has revealed ongoing uncertainty regarding when to use the DLD label among speech–language pathologists (SLPs). Aims: In response to this uncertainty, a survey of SLPs was conducted aimed at investigating which types of clinical language profiles, and specific assessment results, were viewed as warranting the diagnostic label DLD. Methods & Procedures: SLPs were presented with 10 childhood language profiles and assessment results. Participants reviewed each case and described if they felt a diagnosis of DLD was warranted, which presented symptoms were consistent/inconsistent with DLD and if further information/testing was desired. Additionally, participants provided details regarding their personal diagnostic processes. Outcomes & Results: Results indicated a general consensus among SLPs as to when the DLD label should be applied. However, free‐text responses demonstrated considerable variation between clinicians regarding symptoms of importance, points of contention/confusion in language profiles and minimal assessment results viewed as necessary in the diagnostic process. Conclusions & Implications: This detailed look at the assessment/diagnostic process for DLD provides valuable insight into how to build further practice consistency in the provision of the diagnostic label DLD, especially in cases of complex language profiles and assessment results. WHAT THIS PAPER ADDS: What is already known on this subject: The label DLD should be used as a diagnostic label to describe children with persistent language problems having a functional impact on communication or learning and in the absence of any biomedical condition. However, in current clinical practice, actual use of the label is inconsistent and SLPs face a number of challenges in diagnosing DLD. What this paper adds to the existing knowledge: This investigation provides clarity regarding which complexities in paediatric language profiles are most challenging for SLPs when determining if a child does/does not have DLD. Additionally, details regarding current assessment beliefs and practices are explored. What are the practical and clinical implications of this work?: By providing a detailed look at the diagnostic processes of practising SLPs, valuable insight is provided into how to build further practice consistency and confidence in the provision of the diagnostic label DLD, especially in cases of complex language profiles and assessment results. [ABSTRACT FROM AUTHOR]

Introduction: Speech Language Therapy First Point of Contact Clinic (SLT‐FPOCC) models can assist assessment of low‐risk patient populations referred to ear, nose and throat (ENT) services. To further improve ENT waitlist management and compliance with best‐practice care, consideration of other low‐risk populations that could be safely managed through this service model is needed. The aims of this paper are to evaluate the clinical and service outcomes of completing vocal cord check (VCC) assessments for patients' pre and post thyroid/parathyroid surgery within an SLT‐FPOCC model and examine consumer perceptions. Methods & Procedures: The service followed existing SLT‐FPOCC procedures, with ENT triaging referrals, then SLT completing pre‐ and postoperative VCC assessment (interview, perceptual assessment, flexible nasendoscopy), with assessment data later reviewed by ENT to diagnose laryngeal pathology. Clinical and service outcomes were collected prospectively. Patients completed an anonymous post‐service satisfaction survey. Results: Of the first 100 patients referred for preoperative VCCs, SLT assessment identified 42 with dysphonia and 30 reporting dysphagia, while ENT confirmed 9 with significant preoperative anatomical findings. Eighty‐three underwent surgery, with 63 (95 nerves at surgical risk) returning for a postoperative VCC. Postoperative VCC identified three temporary neuropraxias (3.2%) and three unilateral vocal fold paresis (3.2%). Patients were highly satisfied with the service. All 163 pre‐/postoperative VCCs were completed with no adverse events. Conclusion & Implications: The current data support SLT‐FPOCC service expansion to include pre and post thyroid/parathyroid surgery VCC checks, with positive consumer perception. The model supports delivery of best practice management (i.e., pre‐ and postoperative VCC) for patients receiving surgery for thyroid/parathyroid dysfunction, and associated efficiencies for ENT services. WHAT THIS PAPER ADDS: What is already known: Assessment of laryngeal function via flexible nasoendoscopy is recommended best practice for patients pre and postthyroid/parathyroid surgery, as recurrent laryngeal nerve injury is a low incidence (<10%), yet well‐recognised risk of these surgeries. Traditionally, general surgeons refer presurgical patients to ear, nose and throat (ENT) for vocal cord check (VCC) assessment. However, with access to specialist outpatient services under increasing pressure, there is growing support for utilisation of other health professionals, such as speech‐language therapists working in first point of contact (FPOCC) models, to assist with the administration of pre‐ and postsurgical assessments of such low‐risk populations. What this study adds: This work expands on the emerging body of evidence for speech language therapy (SLT) led FPOCC models within ENT outpatient services, providing clinical and service outcomes to support the safety of a new model designed to administer VCCs for patients pre and post thyroid/parathyroid surgery. Adopting a similar model to a prior published SLT‐led FPOCC model, the trained SLT completes the pre‐ and postsurgical VCC including flexible nasoendoscopy and videostroboscopy, with images and clinical information then presented to ENT for diagnosis and management planning. This study also provides the first data on consumer perceptions of this type of service model. Clinical implications of this study: Data on 100 consecutive presurgical patients revealed positive service findings, supporting the safety of this model. Nature and incidence of clinical findings pre and post surgery were consistent with previously published studies using traditional models of care (i.e., ENT completing the flexible nasendoscopy). Consumer perception was positive. This model enables delivery of pre‐and postsurgical assessments for patients receiving thyroid/parathyroid surgery, consistent with best practice care, and reduces burden on ENT services. In total 163 ENT appointments were avoided with this model, with positive implications for ENT waitlist management. [ABSTRACT FROM AUTHOR]

Background: Although existing studies have shown that both repetitive transcranial magnetic stimulation (rTMS) and music therapy have advantages in the treatment of non‐fluent aphasia, the efficacy of the combination of these two methods remains to be investigated. Aims: To investigate the clinical efficacy of low‐frequency rTMS combined with music therapy on language function and depression in patients with non‐fluent aphasia after stroke. Methods & Procedures: A single‐blind parallel randomised controlled trial was conducted. Sixty patients (mean duration = 93.78 days) with non‐fluent aphasia after stroke were randomly divided into a traditional therapy group (n = 20), a music therapy group (n = 20) and a combined therapy group (n = 20, 1 Hz). The language function and depression were evaluated before and 3 weeks after treatment with the Chinese version of the Western Aphasia Battery scale, Boston Diagnostic Aphasia Examination scale and Stroke Aphasic Depression Questionnaire Hospital Version scale. Outcomes & Results: The combined therapy group was significantly better in all outcomes than the traditional therapy group and was significantly better in depression than the music therapy group. The music therapy group was significantly better in repetition and depression than the traditional therapy group. Language improvement was positively correlated with depression improvement. For adverse events, only two patients in the combined therapy group showed slight dizziness during rTMS treatment and their symptoms improved after rest. Conclusions & Implications: Our preliminary randomised controlled study indicates that low‐frequency rTMS combined with music therapy is feasible and safe in improving language function and depression in non‐fluent aphasia patients after stroke. WHAT THIS PAPER ADDS: What is already known on this subject: Repetitive transcranial magnetic stimulation (rTMS) and music therapy respectively have advantages in the treatment of non‐fluent aphasia after stroke, but whether the combination of the two methods is more effective is still unknown. What this paper adds to the existing knowledge: This is one of the first randomised control trials to investigate whether the clinical efficacy of low‐frequency rTMS combined music therapy for non‐fluent aphasia is better. The findings show that low‐frequency rTMS combined music therapy is superior to traditional therapy in spontaneous speech, auditory comprehension, repetition, naming, aphasia quotient, functional language level and depression, and superior to music therapy in depression, while music therapy is superior to traditional therapy in repetition and depression. What are the potential or actual clinical implications of this work?: Low‐frequency rTMS combined music therapy may be a better method for treatment of non‐fluent aphasia. [ABSTRACT FROM AUTHOR]

Background: Telehealth for paediatric speech and language therapy became one of the most salient modes of service delivery during the COVID‐19 pandemic. Evidence for speech and language therapy services via telehealth in comparison to face‐to‐face delivery demonstrates promising outcomes, and studies have begun to explore practitioner and client experiences. However, across the literature, many critical elements of services are overlooked, and there is a need to frame the evidence base within a theoretical model that can draw out practical implications that consider the range of factors having an impact on clinical implementation in real‐world contexts. The APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side‐effects, and Equity) criteria offer such a model. The current study explored practising UK speech and language therapists' (SLTs) clinical experience of telehealth through the lens of the APEASE criteria and aimed to identify recommendations for future service provision from the practitioner perspective. Methods: An online survey structured using the APEASE criteria was developed in collaboration with the UK Royal College of Speech and Language Therapists. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using reflexive thematic analysis. Results: Four hundred and thirty‐eight qualified and practicing UK paediatric SLTs completed the survey. Telehealth was broadly acceptable and practicable to SLTs yet there remains some uncertainty about its efficacy and cost‐effectiveness compared to face‐to‐face interventions and how equitable it is for different population groups. SLTs reported that effective implementation of telehealth services was dependent upon several contextual factors; affordability was a perceived barrier to clients having access to telehealth resources, intervention via telehealth was perceived as more acceptable than assessment, and whilst many SLTs welcomed aspects of telehealth, there were concerns about the physical and mental health consequences for practitioners. Six themes for the future development of telehealth in paediatric speech and language therapy were identified: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance. Conclusions: Outcomes highlight promising, concerning and uncertain aspects of telehealth in paediatric speech and language therapy. SLTs value a flexible and tailored approach to service delivery and recommend that effective leadership, clear communication, ongoing policy and guidance development, upskilling of users and careful evaluation of impact are required to ensure optimal implementation. The APEASE criteria offer a valuable opportunity to enhance and streamline practice and research to ensure sustainable implementation of telehealth in the paediatric speech and language therapy services of tomorrow. WHAT THIS PAPER ADDS: What is already known on this subject: The COVID‐19 pandemic led to the increased use of telehealth as a main mode of service delivery in paediatric speech and language therapy. Pre‐COVID‐19, evidence for the use of telehealth in this field included small‐scale experimental studies that reported on children with particular disorders and explored telehealth outcomes in comparison to face‐to‐face delivery. The realities of at‐scale clinical practice were not well‐represented, and critical elements of service such as cost‐effectiveness were often overlooked in the paediatric literature. Furthermore, despite emerging global evidence for temporary telehealth responses to the crisis in speech and language therapy, the long‐term and future use of telehealth remains unclear. What this paper adds to existing knowledge: The current study applied the lens of the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side‐effects, and Equity) criteria, which were used in this case to consider socioeconomic, ecological and cultural factors to capture an overarching understanding of the use of telehealth in paediatric speech and language therapy, and to inform the role of telehealth in future, longer‐term and at‐scale service development. Results indicated emerging trends in UK paediatric speech and language therapists' (SLTs') perceptions of telehealth and SLTs perceived a hybrid approach to service delivery, combining mostly face‐to‐face services with some telehealth, was likely to continue in the future. We identified six themes to guide the future development of telehealth in paediatric speech and language therapy services: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance. What are the potential or actual clinical implications of this work?: UK SLTs believe that speech and language therapy services using telehealth should be reflective, tailored and flexible to meet the requirements and circumstances of the children, young people and families served, as well as the physical and emotional needs of practitioners. SLTs recommend that this service development is clearly communicated to all stakeholders and suggested that those using telehealth should be supported through appropriate training, and ongoing effectiveness should be monitored. Telehealth is here to stay and the APEASE criteria offer a unique opportunity to ensure sustainable models of service delivery; to support co‐ordinated leadership at the local, national and international levels and the development of policy and clinical guidance. [ABSTRACT FROM AUTHOR]

Background: The aim of many interventions used by speech and language therapists (SLTs) is to change behaviours related to communication and interaction. Parent‐led language interventions for children in the early years (0–5 years) rely on SLTs supporting parents to change their behaviour in child‐focused interactions to effect a change in the child's communication. Therapeutic techniques used by SLTs in parent‐led language interventions are largely underspecified, impacting on intervention reporting, replication, trialling and development. The Behaviour Change Technique Taxonomy Version 1 (BCTTv1) offers a method of describing intervention techniques developed for use in public health interventions, but with several examples of its application to speech and language interventions. Aims: To identify behaviour change techniques (BCTs) from the BCTTv1 occurring in parent‐led language interventions for children in the early years. Methods & Procedures: A literature search identified relevant descriptions of parent‐led language interventions. These were coded using the BCTTv1. A reliability check was carried out on 10% of the descriptions. To confirm the use of identified BCTs in clinical practice, results of the literature search were triangulated with an online survey of SLTs, and observations of SLTs delivering parent‐led language intervention. Outcomes & Results: A total of 84 papers containing descriptions of 45 interventions were coded; 62 SLTs responded to the survey and three SLTs were observed delivering parent‐led language intervention. A total of 24 BCTs were identified in the literature search, replicated in the observations and verified by SLTs in the survey. BCTs were identified at two levels: Level 1 SLT implemented to change parent interactive behaviour; and Level 2 parent implemented to change child communicative behaviour. Conclusions & Implications: The BCTTv1 is a useful starting place for describing parent‐led language interventions. With some additions and adjustments, BCTs identified in this study were immediately recognized by practitioners and can easily be adopted into practice. WHAT THIS PAPER ADDS: What is already known on this subject: Techniques used in SLT interventions are often not clearly described. The BCTTv1 has been used to clarify technique descriptions with success in a small number of SLT disciplines, but not yet in parent‐led language interventions for preschoola children. What this paper adds to the existing knowledge: This paper constitutes the first research into quantifying the techniques used in parent‐led language interventions using the BCTTv1. What are the potential or actual clinical implications of this work?: This paper provides a clear list of techniques used by SLTs implementing interventions for preschool children, which can be immediately adopted and used in practice. It also highlights potential adjustments and gaps in the BCTTv1 in relation to SLT which can contribute to future iterations. [ABSTRACT FROM AUTHOR]

Background: The Pediatric Eating Assessment Tool (PEDI‐EAT‐10) is a reliable and valid tool for rapid identification of dysphagia in patients aged 18 months to 18 years. Aims: To translate and adapt the PEDI‐EAT‐10 into the Italian language and evaluate its validity and reliability. Methods & Procedures: The translation and cross‐cultural adaptation of the tool consisted of five stages: initial translation, synthesis of the translations, back translation, expert committee evaluation and test of the prefinal version. The internal consistency of the translated tool was analysed in a clinical group composed of 200 patients with special healthcare needs aged between 18 months and 18 years. They were consecutively enrolled at the Rare Disease Unit, Paediatrics Department, Fondazione Policlinico Agostino Gemelli‐IRCCS, Rome. For test–retest reliability, 50 caregivers filled in the PEDI‐EAT‐10 questionnaire for a second time after a 2‐week period. Construct validity was established by comparing data obtained from patients with data from healthy participants (n = 200). The study was approved by the local ethics committee. Outcomes & Results: Psychometric data obtained from patients (104 M; mean age = 8.08 ± 4.85 years; median age = 7 years) showed satisfactory internal consistency (Cronbach's α = 0.89) and test–retest reliability (Pearson r = 0.99; Spearman r = 0.96). A total of 30% of children were classified as having a high risk of penetration/aspiration. The Italian PEDI‐EAT‐10 mean total score of the clinical group was significantly different from that resulting from healthy participants. Conclusions & Implications: The PEDI‐EAT‐10 was successfully translated into Italian, validated and found to be a reliable one‐page rapid screening tool to identify dysphagia in children and adolescents with special needs. What this paper adds: What is already known on the subject: The PEDI‐EAT‐10 is a valid and reliable quick discriminative paediatric tool for identifying penetration/aspiration risks. What this paper adds to the existing knowledge: In the present study we successfully translated and adapted the PEDI‐EAT‐10 into the Italian language. What are the potential or actual clinical implications of this work?: This translation and adaptation increase access to valid feeding and swallowing assessment for children of Italian‐speaking families. In addition, the I‐PEDI‐EAT‐10 can suggest further assessment of patients' swallowing abilities. [ABSTRACT FROM AUTHOR]

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

Background: Many speech sound disorder (SSD) interventions with a long‐term evidence base are 'new' to clinical practice, and the role of services in supporting or constraining capacity for practice change is underexplored. Innovations from implementation science may offer solutions to this research–practice gap but have not previously been applied to SSD. Aim: To explain variation in speech and language therapy service capacity to implement new SSD interventions. Methods & Procedures: We conducted an intensive, case‐based qualitative study with 42 speech and language therapists (SLTs) in three NHS services (n = 39) and private practice (n = 3) in Scotland. We explored therapists' diverse experiences of SSD practice change through individual interviews (n = 28) or self‐generated paired (n = 2) or focus groups (n = 3). A theoretical framework (Normalization Process Theory) helped us understand how the service context contributed to the way therapists engaged with different practice changes. Outcomes & Results: We identified six types ('cases') of practice change, two of which involved the new SSD interventions. We focus on these two cases ('Transforming' and 'Venturing') and use Normalization Process Theory's Cognitive participation construct to explain implementation (or not) of new SSD interventions in routine practice. Therapists were becoming aware of the new interventions through knowledge brokers, professional networks and an intervention database. In the Transforming case, new SSD interventions for selected children were becoming part of local routine practice. Transforming was the result of a favourable service structure, a sustained and supported 'push' that made implementation of the new interventions a service priority, and considerable collective time to think about doing it. 'Venturing' happened where the new SSD interventions were not a service priority. It involved individual or informal groups of therapists trying out or using one or more of the new interventions with selected children within the constraints of their service context. Conclusions & implications: New, evidence‐based SSD interventions may be challenging to implement in routine practice because they have in common a need for therapists who understand applied linguistics and can be flexible with service delivery. Appreciating what it really takes to do routine intervention differently is vital for managers and services who have to make decisions about priorities for implementation, along with realistic plans for resourcing and supporting it. WHAT THIS PAPER ADDS: What is already known on the subject: Many SSD interventions have an evidence base but are not widely adopted into routine clinical practice. Addressing this is not just about individual therapists or education/training, as workplace pressures and service delivery models make it difficult to change practice. What this paper adds to the existing knowledge: This paper applies innovations from implementation science to help explain how what is going on in services can support or constrain capacity for implementing evidence‐based SSD interventions. What are the potential or actual clinical implications of this work?: Service managers and therapists will have a clearer idea of the time and support they may realistically have to invest for new SSD interventions to be used routinely. [ABSTRACT FROM AUTHOR]

Background: Stroke profoundly affects quality of life (QOL), including loss of employment, reduced social activity, shrinking social networks and low mood. Dysgraphia (impaired writing) is a common symptom of aphasia yet is rarely targeted in rehabilitation. Recent technological advances might challenge this, since much communication is now conducted digitally through writing. The rehabilitation of writing may therefore help to address the wider consequences of stroke and aphasia. Aims: Can assistive technology (AT) training for people with dysgraphia: (1) improve written output, and are gains achieved only with AT? (2) improve reading comprehension scores, and are gains achieved only with AT? and (3) affect social participation, mood or QOL Methods and Procedures: Design A mixed‐methods, repeated measures, small group study design was adopted (qualitative outcomes will be reported elsewhere). Participants: Recruited from community settings, for example, Stroke Association communication support groups. Inclusion criteria: over 18 years old, aphasia due to stroke, acquired dysgraphia, writing more impaired than speech, fluent English prior to stroke, access to computer and Internet. Exclusion criteria: currently receiving speech and language therapy, significant cognitive impairment, neuromuscular/motor‐speech impairments/structural abnormalities, developmental dyslexia, uncorrected visual/auditory impairments. Procedures: Screening and diagnostic assessments at time T1 (first baseline). Outcome measures at T1; repeated at T2 (second baseline), T3 (end of intervention), T4 (3‐month follow up). Social participation assessment and cognitive monitoring at T2, T3, T4. Intervention: Seven–ten hours individual therapy weekly and additional email support. Participants were trained to operate Dragon NaturallySpeaking (speech to text package) and ClaroRead (read writing aloud). Outcome measures were administered on pen and paper (control) and on computer, with AT enabled only at T3, T4. Outcomes and Results: Computer narrative writing was significantly improved by AT training (Friedman's χ2 (3) = 8.27, p = 0.041), indicating a compensatory effect of AT. Though reading comprehension significantly improved in the computer condition (Friedman's χ2 (3) = 21.07, p = 0.001), gains could not be attributed to the AT. Gains were achieved only when measures were administered on the keyboard, with AT enabled. Thus, a compensatory rather than remediatory effect was suggested. Social network size significantly increased; there were no significant changes in mood/QOL. Individual success rates varied. Conclusion and Implications: The customisable AT training was acceptable to participants and resulted in significantly improved narrative writing. Compensatory AT interventions are a useful adjunct to remediatory writing interventions and may particularly support functional writing. WHAT THIS PAPER ADDS: What is already known on this subject: Writing is rarely spared in aphasia and may present as the most impaired communication modality. Yet, people with aphasia report that writing is seldom included in their rehabilitation. Many communication activities are now conducted digitally through writing, therefore rehabilitation of this is more important than ever before. This study sought to address whether an assistive technology (AT) software package can improve writing and whether any changes were compensatory or remediatory. What this study adds to existing knowledge: This group study found that AT training led to gains in written discourse and social network in people with aphasia and dysgraphia. Gains were not replicated in handwritten tasks, suggesting this was a compensatory therapeutic approach. What are the clinical implications of this work?: AT programs such as this may present speech and language therapists with a practical, pragmatic adjunct to writing or typing therapy, particularly for clients with chronic, intractable impairments for whom remediatory therapy may have a low chance of success. [ABSTRACT FROM AUTHOR]

Background: Dementia is a cognitive decline that leads to the progressive deterioration of an individual's ability to perform daily activities independently. As a result, a considerable amount of time and resources are spent on caretaking. Early detection of dementia can significantly reduce the effort and resources needed for caretaking. Aims: This research proposes an approach for assessing cognitive decline by analysing speech data, specifically focusing on speech relevance as a crucial indicator for memory recall. Methods & Procedures: This is a cross‐sectional, online, self‐administered. The proposed method used deep learning architecture based on transformers, with BERT (Bidirectional Encoder Representations from Transformers) and Sentence‐Transformer to derive encoded representations of speech transcripts. These representations provide contextually descriptive information that is used to analyse the relevance of sentences in their respective contexts. The encoded information is then compared using cosine similarity metrics to measure the relevance of uttered sequences of sentences. The study uses the Pitt Corpus Dementia dataset for experimentation, which consists of speech data from individuals with and without dementia. The accuracy of the proposed multi‐QA‐MPNet (Multi‐Query Maximum Inner Product Search Pretraining) model is compared with other pretrained transformer models of Sentence‐Transformer. Outcomes & Results: The results show that the proposed approach outperforms the other models in capturing context level information, particularly semantic memory. Additionally, the study explores the suitability of different similarity measures to evaluate the relevance of uttered sequences of sentences. The experimentation reveals that cosine similarity is the most appropriate measure for this task. Conclusions & Implications: This finding has significant implications for the early warning signs of dementia, as it suggests that cosine similarity metrics can effectively capture the semantic relevance of spoken language. The persistent cognitive decline over time acts as one of the indicators for prevalence of dementia. Additionally early dementia could be recognised by analysis on other modalities like speech and brain images. WHAT THIS PAPER ADDS: What is already known on this subject: It is already known that speech‐ and language‐based detection methods can be useful for dementia diagnosis, as language difficulties are often early signs of the disease. Additionally, deep learning algorithms have shown promise in detecting and diagnosing dementia through analysing large datasets, particularly in speech‐ and language‐based detection methods. However, further research is needed to validate the performance of these algorithms on larger and more diverse datasets and to address potential biases and limitations. What this paper adds to existing knowledge: This study presents a unique and effective approach for cognitive decline assessment through analysing speech data. The study provides valuable insights into the importance of context and semantic memory in accurately detecting the potential in dementia and demonstrates the applicability of deep learning models for this purpose. The findings of this study have important clinical implications and can inform future research and development in the field of dementia detection and care. What are the potential or actual clinical implications of this work?: The proposed approach for cognitive decline assessment using speech data and deep learning models has significant clinical implications. It has the potential to improve the accuracy and efficiency of dementia diagnosis, leading to earlier detection and more effective treatments, which can improve patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

Background: The use of telepractice in aphasia research and therapy is increasing in frequency. Teleassessment in aphasia has been demonstrated to be reliable. However, neuropsychological and clinical language comprehension assessments are not always readily translatable to an online environment and people with severe language comprehension or cognitive impairments have sometimes been considered to be unsuitable for teleassessment. Aim: This project aimed to produce a battery of language comprehension teleassessments at the single word, sentence and discourse level suitable for individuals with moderate‐severe language comprehension impairments. Methods: Assessment development prioritised response consistency and clinical flexibility during testing. Teleassessments were delivered in PowerPoint over Zoom using screen sharing and remote control functions. The assessments were evaluated in 14 people with aphasia and 9 neurotypical control participants. Modifiable assessment templates are available here: https://osf.io/r6wfm/. Main Contributions: People with aphasia were able to engage in language comprehension teleassessment with limited carer support. Only one assessment could not be completed for technical reasons. Statistical analysis revealed above chance performance in 141/151 completed assessments. Conclusions: People with aphasia, including people with moderate‐severe comprehension impairments, are able to engage with teleassessment. Successful teleassessment can be supported by retaining clinical flexibility and maintaining consistent task demands. WHAT THIS PAPER ADDS: What is already known on the subject: Teleassessment for aphasia is reliable but assessment of auditory comprehension is difficult to adapt to the online environment. There has been limited evaluation of the ability of people with severe aphasia to engage in auditory comprehension teleassessment. What this paper adds to existing knowledge: Auditory comprehension assessment can be adapted for videoconferencing administration while maintaining clinical flexibility to support people with severe aphasia. What are the potential or actual clinical implications of this work?: Teleassessment is time and cost effective and can be designed to support inclusion of severely impaired individuals. [ABSTRACT FROM AUTHOR]

Background: Increasing research capacity and capability for the speech and language therapy (SLT) profession is a key national strategic driver, with many speech and language therapists (SLTs) aspiring to a clinical academic (CA) career. There are known benefits but also acknowledged challenges with this career path, including limited funding opportunities and a poorly established career trajectory. Aims: To present models, frameworks and support structures that can be used by aspiring SLT CAs to chart research knowledge and skills, and plan career development. Organisational models are also presented to facilitate SLT CA career development and research capacity‐building. Methods & Procedures: A narrative review was conducted using a literature search of published peer‐reviewed journals across four electronic databases: Medline, CINAHL, AMED and Embase, with additional search for grey literature through internet searches. Search results were screened against eligibility criteria by two researchers, with full‐text articles retrieved and reviewed by four researchers independently. Results & Discussion: The database search and grey literature search combined identified 610 records. Full‐text screening of 66 records resulted in 19 articles or grey literature sources being included within the narrative review. Main Contribution: This paper details models, frameworks and support structures pertinent to SLTs that can be used at an individual and organizational level to assist CA skill development and career paths. Conclusion & Implications: The national climate is looking positive for aspiring SLT CAs. The time is now to take the initiative and use the support structures available to show our CA value and develop the necessary skills outlined within these resources to fulfil our ambitions. WHAT THIS PAPER ADDS: What is already known on the subject: Interest in CA careers within the SLT profession is increasing. Whilst there are known benefits to embedding research within clinical practice, barriers exist including the strategic and operational steps individuals can take to make the career path a reality. What this study adds: This narrative review has searched the literature for CA models, frameworks and support structures created for nurses, midwives and allied health professionals. These tools are presented and discussed, with special consideration and focus to the SLT profession. What are the clinical implications of this work?: This paper will provide SLTs with the tools to support their personal CA career development as well as advocate for CA roles within their teams and organisations. Organisational models are also presented to support SLT managers to foster a CA path for workforce development. [ABSTRACT FROM AUTHOR]

Background: Vocal fold nodules (VFNs) are the main cause of paediatric dysphonia. Voice therapy is recommended as the preferable treatment option for VFNs in children. Aim: The aim of this systematic review is to provide an overview of the existing literature concerning the effects of voice therapy in children with VFNs. Methods & Procedures: This systematic literature review was developed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) guidelines. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via PubMed) and Embase were searched and the grey literature was checked. The search strategy was based on three concepts: VFNs, voice therapy and children. Two examiners independently determined article eligibility and extracted all relevant data from the included studies. The methodological quality of the included study was assessed using the QualSyst tool. Main contributions: By identifying, evaluating and summarizing the results of all relevant studies about voice therapy in paediatric VFNs, this systematic review makes the available evidence more accessible to voice therapists, otolaryngologists and other relevant stakeholders. Conclusions & Implications: 24 studies were included in this systematic review. Eight studies (8/24) reported a significant improvement for at least one outcome parameter after voice therapy. However, five papers (5/24) could not demonstrate significant changes after voice therapy. All studies that did not test for significance (11/24) found improvements for one or more outcome parameters. The overall quality of the included studies is adequate (55%). In sum, there is some evidence that voice therapy is effective in children with VFNs, but further well‐designed research, especially randomized controlled trials, is necessary to confirm these results. WHAT THIS PAPER ADDS: What is already known on the subject: Voice therapy is preferable in children with VFNs because of the phonotraumatic nature of the nodules and the associated high recurrence rate after phonosurgery. Most voice therapists in clinical practice offer an eclectic voice therapy programme, consisting of direct and indirect voice therapy techniques. What this study adds to existing knowledge: This systematic review provides a clear overview of the available evidence concerning the effects of voice therapy in paediatric VFNs. There is some evidence that voice therapy is an effective treatment option in children with VFNs, but well‐designed research is scarce on this subject. What are the potential or actual clinical implications of this work?: This review shows that effectiveness studies with strong designs are very scarce in children with VFNs. Clinicians should be aware that few therapy techniques have been thoroughly investigated in this population. However, this review may guide voice therapists when creating a treatment plan for a child with VFNs because it identifies, evaluates and summarizes the results of all relevant individual studies about voice therapy in paediatric VFNs. Voice therapy seems to be effective in treating paediatric patients with VFNs, given the fact that a considerable number of included studies report significant improvements after voice therapy. Both direct and indirect therapy approaches appear to have a positive effect on the phonation of children with VFNs. [ABSTRACT FROM AUTHOR]

Background: Eating, drinking and swallowing (EDS) difficulties are important to identify early. Awareness of EDS changes starts with those living with dementia or their family carers. However, little is known about early identification from the perspective of people with dementia. Aim: The aim of this study was to understand the experience of EDS by people living with dementia in their own home. Methods: Published evidence pertaining to EDS difficulties in dementia was used to inform an online semi‐structured interview guide. Four people living with dementia and a third‐sector Empowerment Lead were invited to become co‐researchers. People living with dementia and their carers were invited to be interviewed. We enquired about their past and present experiences, and future expected changes in EDS, information needs, opinions on early problem identification, and lifestyle modifications following onset of EDS difficulty. Narrative concepts of heroes and villains in their 'stories' were identified. Responses were subjected to framework analysis informed by narrative enquiry. Results: Seven people living with dementia and five family carers were interviewed. The overarching theme was a 'missed connection' between EDS difficulty and dementia. Where EDS difficulties were identified, 'compensatory changes' and a need for 'access to information' were noted. Conclusions: The connection between potential EDS difficulties and a dementia diagnosis may not be made, even though EDS changes were recognised by people living with dementia and their family carers. This may be explained by behaviours that mask problems or allow individuals to cope or compensate. Reduced awareness may also be due to inadequate access to information and lack of specialist services. If the connection between dementia and EDS difficulty is missed it could further delay access to support services. WHAT THIS PAPER ADDS: What is already known on the subject: The prevalence of dementia is increasing and is expected to affect 9% of the population by 2040. EDS difficulties are common in people living with dementia and predispose to poorer outcomes. Better awareness of EDS changes early in the disease process of dementia or at preclinical stages can identify individuals at risk and allow for intervention prior to advanced EDS difficulties developing. What this paper adds to existing knowledge: This paper reports the perspective of people living with dementia and family carers and provides insights into experiences of EDS and the challenges faced and identifies commonalities. The connection between potential EDS difficulties and dementia is missed despite various changes reported by both people living with dementia and their family carers, who tend to make compensatory lifestyle changes without support. What are the potential or actual clinical implications of this work?: Lack of awareness of the connection between potential EDS difficulties and dementia may arise due to inadequate access to information to support people living with dementia and their family carers. Access to such information is needed and the quality assurance of information from reputable sources is important to people living with dementia. There is a need for greater service user awareness of signs of EDS difficulty and how to access specialist services. [ABSTRACT FROM AUTHOR]

Background: Aims: To investigate the developmental trajectory of the rate and perceptual assessment of oral diadochokinesis (DDK) in typically developing children compared with adults. Also to examine the characteristics of DDK productions in children with speech sound disorders (SSD) and the relationship between DDK production and percentage of consonants correct (PCC). Methods & Procedures: Participants were 316 typically developing children and 90 children with SSD from 3 to 9 years old, as well as 20 adults with normal speech. The mono‐, bi‐ and trisyllabic nonsense strings containing Korean tense consonants and the vowel [a] were used for DDK tasks. The number of iterations per s was measured as the DDK rate for each stimulus. The perceptual assessment of DDK productions was also performed for regularity, accuracy and rate. Outcomes & Results: The DDK rates increased throughout childhood, but the oldest children, 9‐year‐olds in the current study, did not achieve adult‐like rates for all mono‐ and trisyllabic strings. Children with SSD also did not show significant differences from typically developing children when the DDK productions were analysed using only accurate tokens. The PCC of children with SSD showed higher correlations with regularity, accuracy and rate of perceptual ratings than the timed DDK rate. Conclusions & Implications: This study highlighted the fact that the comprehensive evaluation of DDK productions may provide even more useful information about children's oral motor skills. WHAT THIS PAPER ADDS: What is already known on the subject: Rates of DDK reflect the motor skills of the articulatory systems independently of phonological skills; therefore, the tasks are widely used in the diagnostic evaluations of speech disorders in both children and adult populations. However, a substantial number of studies have questioned the validity and usefulness of DDK rates for evaluating speech abilities. Also, the literature suggested that the measure of DDK rate alone does not provide a clear and useful indication of children's oral motor skills. DDK tasks should be analysed in terms of accuracy and consistency as well as rate. What this paper adds to the existing knowledge: The literature reporting normative DDK performance has mainly been based on English speakers. As different consonants have different temporal characteristics, the linguistic and segmental features of DDK tasks can impact the DDK rate. This study established a norm for DDK rate for Korean‐speaking children and investigated the developmental trajectory of DDK performance in typically developing children compared with adults. This study suggested that the comprehensive evaluation of DDK productions may provide even more useful information about children's oral motor skills by examining the characteristics of DDK productions in children with SSD. What are the potential or actual clinical implications of this work?: This study provided normative data of young Korean‐speaking children aged 3–9 years. Normative data in children under 5 years of age are valuable given that the majority of children referred for speech difficulty assessments are between 3 and 5 years of age, but only a few studies have provided the normative data in young children. This study showed that many children could not complete DDK tasks correctly and provided additional support for the notion that other aspects of DDK performance, including accuracy and regularity, may yield more useful diagnostic indications than timed DDK rates alone. [ABSTRACT FROM AUTHOR]

Background: Acute and late toxicities in patients treated with (chemo)radiotherapy for head and neck cancer (HNC) is common and can negatively impact quality of life and performance. Performance status instruments measure the functional ability to perform daily life activities and are important tools in the oncologic population. Aims: Since Dutch performance status scales for the HNC population are lacking, we conducted this study to translate the Performance Status Scale for Head and Neck Cancer Patients (PSS‐HN) into Dutch (D‐PSS‐HN) and to validate this version. Methods & Procedures: The D‐PSS‐HN was translated into Dutch according to the internationally described cross‐cultural adaptation process. It was administered to HNC patients and together with the Functional Oral Intake Scale completed by a speech and language pathologist at five different time points during the first 5 weeks of (chemo)radiotherapy. Patients were asked each time to complete the Functional Assessment of Cancer Therapy and the Swallowing Quality of Life Questionnaire. Pearson correlation coefficients were used to calculate convergent and discriminant validity and the evolution of D‐PSS‐HN scores was assessed by means of linear mixed models. Outcomes & Results: A total of 35 patients were recruited and > 98% of the clinician‐rated scales were completed. Convergent and discriminant validity were demonstrated, with all correlations rs between 0.467 and 0.819, and between 0.132 and 0.256, respectively. The subscales of the D‐PSS‐HN are sensitive to detect changes through time. Conclusion & Implications: The D‐PSS‐HN is a valid and reliable instrument to assess performance status in patients with HNC treated with (chemo)radiotherapy. It is a useful tool to measure HNC patients' current diet level and functional abilities to perform daily life activities. WHAT THIS PAPER ADDS: What is already known on the subject: Acute and late toxicities in patients treated with (chemo)radiotherapy for HNC are common and can negatively impact quality of life and performance. Performance status instruments measure the functional ability to perform daily life activities and are important tools in the oncologic population. However, Dutch performance status scales for the HNC population are lacking. Therefore, we translated the Performance Status Scale for Head and Neck Cancer Patients (PSS‐HN) into Dutch (D‐PSS‐HN) and validated this version. What this paper adds to existing knowledge: We translated the PSS‐HN and demonstrated its convergent and discriminant validity. The subscales of the D‐PSS‐HN are sensitive to detect changes through time. What are the potential or actual clinical implications of this work?: The D‐PSS‐HN is a useful tool to measure HNC patients' functional abilities to perform daily life activities. The tool can easily be used in clinical settings: since data collection duration is very short, this facilitates clinical (and research‐related) implementation of the scale. Patients' individual needs could be identified by using the D‐PSS‐HN, resulting in more appropriate approaches and (early) referrals if needed. Interdisciplinary communication could be facilitated. [ABSTRACT FROM AUTHOR]

Background: Verbal fluency tests (VFT) are highly sensitive to cognitive deficits. Usually, the score on VFT is based on the number of correct words produced, yet it alone gives little information regarding underlying test performance. The implementation of different strategies (cluster and switching) to perform efficiently during the tasks provide more valuable information. However, normative data for clustering and switching strategies are scarce. Moreover, scoring criteria adapted to Colombian Spanish are missing. Aims: (1) To describe the Colombian adaptation of the scoring system guidelines for clustering and switching strategies in VFT; (2) to determine its reliability; and (3) to provide normative data for Colombian children and adolescents aged 6–17 years. Methods & Procedures: A total of 691 children and adolescents from Colombia completed phonological (/f/, /a/, /s/, /m/, /r/ and /p/) and semantic (animals and fruits) VFT, and five scores were calculated: total score (TS), number of clusters (NC), cluster size (CS), mean cluster size (MCS) and number of switches (NS). The intraclass correlation coefficient was used for interrater reliability. Hierarchical multiple regressions were conducted to investigate which strategies were associated with VFT TS. Multiple regressions were conducted for each strategy, including as predictors age, age2, sex, mean parents' education (MPE), MPE2 and type of school, to generate normative data. Outcomes & Results: Reliability indexes were excellent. Age was associated with VFT TS, but weakly compared with strategies. For both VFT TS, NS was the strongest variable, followed by CS and NC. Regarding norms, age was the strongest predictor for all measures, while age2 was relevant for NC (/f/ phoneme) and NS (/m/ phoneme). Participants with higher MPE obtained more NC, and NS, and larger CS in several phonemes and categories. Children and adolescents from private school generated more NC, NS and larger CS in /s/ phoneme. Conclusions & Implications: This study provides new scoring guidelines and normative data for clustering and switching strategies for Colombian children and adolescents between 6 and 17 years old. Clinical neuropsychologists should include these measures as part of their everyday practice. WHAT THIS PAPER ADDS: What is already known on the subject: VFT are widely used within the paediatric population due to its sensitivity to brain injury. Its score is based on the number of correct words produced; however, TS alone gives little information regarding underlying test performance. Several normative data for VFT TS in the paediatric population exist, but normative data for clustering and switching strategies are scarce. What this paper adds to existing knowledge: The present study is the first to describe the Colombian adaptation of the scoring guidelines for clustering and switching strategies, and provided normative data for these strategies for children and adolescents between 6 and 17 years old. What are the potential or actual clinical implications of this work?: Knowing VFT's performance, including strategy development and use in healthy children and adolescents, may be useful for clinical settings. We encourage clinicians to include not only TS, but also a careful analysis of strategies that may be more informative of the underlying cognitive processes failure than TS. [ABSTRACT FROM AUTHOR]

Background: Reading comprehension is frequently impaired in persons with aphasia (PWA). For goal‐setting and outcome measurement, speech and language therapists (SLTs) need to determine an individual's perspective of their reading difficulties and everyday reading activities. The Comprehensive Assessment of Reading in Aphasia (CARA) reading questionnaire provides a person‐centred tool to find out the individual perception of reading functions, reading‐related emotions and reading activities in PWA. It was developed and evaluated in English. So far, there is no equivalent instrument in German. Aims: To translate and adapt the CARA reading questionnaire into German language and culture, to evaluate its practicability and acceptance, and to provide the first psychometric properties of the German version. Methods & Procedures: Based on translation and adaptation guidelines, we conducted two forward translations that were merged and then adapted. A back translation was prepared and compared with the original version. It was found to be semantically equivalent by one of the authors of the original version. We performed pilot testing with 12 PWA, and the pilot version was adapted according to the comments of these participants. We then collected data on self‐reported perception of reading and on psychometric properties of the translated and adapted German version. A total of 22 German‐speaking PWA completed the questionnaire at least five times during an intervention study. We analysed retest reliability with Spearman correlation, internal consistency with Cronbach's alpha, internal responsiveness with the standardized response mean, as well as the relationship between outcomes of the questionnaire and text comprehension measures using repeated measures correlations. Outcomes & Results: Our data suggest good practicability and acceptance of the German version of the CARA reading questionnaire as well as appropriate validity, reliability and sensitivity to measure therapy‐induced change. We found moderate correlations between outcomes of the questionnaire and text‐level reading speed. Conclusions & Implications: The German version of the CARA reading questionnaire could be helpful in intervention planning and goal‐setting with German‐speaking PWA. By using the questionnaire, SLTs can find out about a person's individual perception of reading difficulties as well as individually relevant reading activities. The questionnaire provides a tool to measure change and is therefore valuable to demonstrate self‐reported individual progress. As reading speed seems to be an indicator of personal perception of reading difficulty, it is important to consider reading speed in reading interventions and in reading comprehension assessments. WHAT THIS PAPER ADDS: What is already known on the subject: Reading comprehension is frequently impaired in PWA. Reading preferences, the perception of difficulties and the impact on everyday life reading activities are specific to the individual and thus need to be known for goal‐setting, intervention planning and monitoring of change. As part of a comprehensive assessment of reading, Morris et al. developed a person‐centred English language questionnaire for this purpose. So far, there is no equivalent tool in German. What this paper adds to the existing knowledge: In this study, we translated and adapted the questionnaire to German language and culture, and analysed its validity and reliability with German‐speaking PWA. We demonstrated that the German version is accessible for German‐speaking PWA, and that it has appropriate validity, reliability and sensitivity to measure self‐reported change. Outcomes of the questionnaire correlate with text level reading speed. What are the potential or actual clinical implications of this work?: The German version of the questionnaire could be a valuable self‐reported outcome measure to assess individual perceptions of reading and to measure progress (as perceived by an individual) as a consequence of recovery or intervention in either clinical or research settings. As reading speed might be an indicator of everyday life reading as perceived by an individual, it should be considered in reading assessments and interventions. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic necessitated that speech–language therapists (SLTs) make a radical change to provide services to their clients safely via telepractice. For many practitioners, telepractice was an unfamiliar mode of practice that had to be implemented under emergency conditions. Limited literature on SLTs' experiences of implementing telepractice in the Global South during this time is available. Aims: To explore the experiences of South African SLTs (N = 45) who implemented telepractice services during the COVID‐19 pandemic. Methods & Procedures: SLTs across the country were invited via professional bodies to participate in an online qualitative survey distributed in 2021. Data were analysed using thematic analysis principles. Outcomes & Results: We describe participants' reports of their current telepractices, discuss their perspectives on accessibility to telepractice for SLTs, clients and caregivers, and working with specific diagnoses, and consider the support needs of SLTs to enhance telepractice services. Most participants work in private practice or school settings with primarily paediatric caseloads. They reported telepractice as a positive experience and felt it was effective, although they judged that some clients were not well served by telepractice. SLTs felt underprepared for the rapid switch to telepractice and the flexibility required, especially given the limited availability of guidelines given the pandemic crisis. Greater preparation is required for telepractice sessions and more attention needs to be paid to supporting caregiver involvement online. Conclusions & Implications: Telepractice involves various barriers and facilitators, many of which seem common across Global North and South contexts. Support is required to enhance current telepractices in terms of computer literacy, technical education, different telepractice methods and caregiver coaching. Our findings have the potential to enable the development of support, training and guidelines to improve SLTs' confidence in providing telepractice whilst delivering quality services in an accessible and safe manner. WHAT THIS PAPER ADDS: What is already known on the subject: Many SLTs had to transition quickly to telepractice service provision during COVID‐19, with limited existing guidelines and support. Although there is some literature available on SLTs' experiences of implementing telepractice in the Global North, perspectives from the Global South during this time are limited. It is important to understand experiences, barriers and facilitators to telepractice provision to provide tailored support to practitioners. What this paper adds to existing knowledge: Telepractice provides a viable alternative to in‐person therapy for specific clients and contexts. Telepractice presents both benefits and barriers for effective clinical practice across Global North and South contexts. Greater preparation is required for telepractice sessions and more attention needs to be paid to enhancing caregiver involvement online, especially since many practitioners are likely to continue offering telepractice services post‐pandemic. What are the potential or actual clinical implications of this work?: Clinicians felt underprepared for the rapid switch from service delivery mode to telepractice. Greater support, training and guidelines for students and practitioners are required to enhance current practices and ensure practitioners are equipped to provide effective telepractice in the future. In particular, support should cover technological aspects, caregiver coaching and online assessment options, especially for paediatric clients. [ABSTRACT FROM AUTHOR]

Background: At the beginning of the 21st century, international adoptions of children with cleft lip and/or palate increased dramatically in Sweden. Many children arrived partially or totally unoperated, despite being at an age when palatoplasty has usually been performed. To date, the speech development of internationally adopted (IA) children has been described up to age 7–8 years, but later development remains unstudied. Aims: To investigate speech development between ages 5 and 10 years in children born with cleft lip and palate (CLP) adopted from China and to compare them with non‐adopted (NA) children with CLP. A secondary aim was to compare the frequencies of secondary palatal surgery and number of visits to a speech and language pathologist (SLP) between the groups. Methods & Procedures: In a longitudinal study, 23 IA children from China were included and matched with 23 NA children born in Sweden. Experienced SLPs blindly reassessed audio recordings from routine follow‐ups at ages 5 and 10 years. Velopharyngeal function (VPF) was assessed with the composite score for velopharyngeal competence (VPC‐Sum) for single words and rated on a three‐point scale (VPC‐Rate) in sentence repetition. Target sounds in words and sentences were phonetically transcribed. Per cent correct consonants (PCC) were calculated at word and sentence levels. For in‐depth analyses, articulation errors were divided into cleft speech characteristics (CSCs), developmental speech characteristics (DSCs) and s‐errors. Information on secondary palatal surgery and number of visits to an SLP was collected. Outcomes & Results: VPF differed significantly between the groups at both ages when assessed with VPC‐Sum, but not with VPC‐Rate. Regardless of the method for assessing VPF, a similar proportion in both groups had incompetent VPF but fewer IA than NA children had competent VPF at both ages. IA children had lower PCC at both ages at both word and sentence levels. More IA children had CSCs, DSCs and s‐errors at age 5 years, and CSCs and s‐errors at age 10. The development of PCC was significant in both groups between ages 5 and 10 years. The proportion of children receiving secondary palatal surgery did not differ significantly between the groups, nor did number of SLP visits. Conclusions & Implications: CSCs were more persistent in IA children than in NA children at age 10 years. Interventions should target both cleft and DSCs, be comprehensive and continue past the pre‐school years. WHAT THIS PAPER ADDS: What is already known on this subject: At the beginning of the 21st century, IA children with cleft lip and/or palate arrived in Sweden partially or totally unoperated, despite being at an age when palatoplasty has usually been performed. Studies up to age 7–8 years show that adopted children, compared with NA peers, have poorer articulation skills, demonstrate both cleft‐related and developmental articulation errors, and are more likely to have velopharyngeal incompetence. Several studies also report that adopted children more often require secondary palatal surgery due to fistulas, dehiscence or velopharyngeal incompetence compared with NA peers. What this paper adds to existing knowledge: This longitudinal study provides additional knowledge based on longer follow‐ups than previous studies. It shows that the proportion of children assessed to have incompetent VPF was similar among IA and NA children. It was no significant difference between the groups regarding the proportion that received secondary palatal surgery. However, fewer IA children were assessed to have a competent VPF. Developmental articulation errors have ceased in most IA and all NA children at age 10 years, but significantly more adopted children than NA children still have cleft‐related articulation errors. What are the potential or actual clinical implications of this work?: Speech and language therapy should target both cleft‐related and developmental articulation errors. When needed, treatment must be initiated early, comprehensive, and continued past the pre‐school years, not least for adopted children. [ABSTRACT FROM AUTHOR]

Background: Extensive variation in the terminology used for paediatric diagnoses across the speech and language therapy research literature is an internationally recognized problem. Little is known, however, about how and how often diagnoses are given in a clinical context. In the UK, speech and language therapists (SLTs) identify and support children who have speech and language needs. To understand and address clinically rooted terminological issues that may directly impact clients and families, there is a need for exploration of how the diagnostic process is operationalized in practice. Aim: To identify, from the perspective of SLTs, areas that present as enabling and obstructive factors to conducting diagnosis in clinical practice. Methods & Procedures: Taking a phenomenological approach, 22 paediatric SLTs were interviewed using a semi‐structured format. Thematic analysis revealed a number of factors that were either classified as 'enabling' or 'obstructive' to their diagnostic processes. Outcomes & Results: Participants were often hesitant to provide a diagnosis to families and universally reported the need for targeted guidance, which accounts for the demands of current clinical practice, to guide their diagnostic process. Four enabling factors were identified from participant data: (1) working to a medical model, (2) the availability of collegiate support, (3) recognizing the benefits of diagnosis,, and (4) relating to the needs of the family. Seven themes portrayed obstructive factors in practice: (1) the complex presentation of clients, (2) the risk of giving a 'wrong' diagnosis, (3) participants' uncertainty about diagnostic criteria, (4) insufficient training, (5) service models, (6) concerns about stigma and (7) not having enough clinical time. The obstructive factors created dilemmas for participants and resulted in hesitancy to give a diagnosis, potentially contributing to delays in diagnosis experienced by families as reported in previous literature. Conclusions & Implications: Of paramountcy to SLTs were the individual needs and preferences of their clients. Practical barriers and areas of uncertainty increased hesitance to diagnose, which may inadvertently preclude families from accessing resources. Recommendations include more widely accessible training in diagnostic practice, guidelines to support clinical decision‐making, and a greater understanding of client preferences with regard to terminology and its potential relationship with social stigma. What This Paper Adds: What is already known on the subject: Inconsistency in terminology for paediatric language diagnoses has been broadly discussed, mostly in reference to variation within research literature. The Royal College of Speech and Language Therapists' (RCSLT) position statement on developmental language disorder (DLD) and language disorder made recommendations for SLTs to use these terms in clinical practice. There is some evidence that SLTs face challenges in operationalizing diagnostic criteria in practice, particularly given financial and resource constraints. What this paper adds to existing knowledge: SLTs disclosed several issues that either supported or were obstructive to the practice of diagnosing paediatric clients and delivering this information to families. Whilst most SLTs faced constraints related to the practicalities and demands of clinical practice, a number also held reservations about the impact of a lifelong diagnosis for young clients. These issues resulted in considerable avoidance of formal diagnostic terminology, in favour of description or informal terminology. What are the potential or actual clinical implications of this work?: If diagnoses are not given, or if SLTs are using informal diagnostic terms as an alternative strategy, clients and families may experience reduced opportunities to yield benefits associated with a diagnosis. Clinical guidance that specifically addresses the prioritization of time and provides directives for clinical action in instances of uncertainty may support SLTs to feel confident in giving diagnoses. [ABSTRACT FROM AUTHOR]

Background: Many amateur singers enjoy singing in choirs. They are likely to lack the training and expertise of professional singers and this may have an impact on their vocal health. Aims: To assess the experiences of amateur singers, their use of warm‐up and cool‐down sessions, their vocal health, their sources of help and advice and their reactions to receiving a diagnosis and treatment. Methods and Procedures: A questionnaire was sent to amateur choir singers. Quantitative data on their use of warm‐up and cool‐down activities were collected and the singers rated how frequently they experienced adverse voice symptoms after singing. Qualitative data were collected from singers who had sought advice about their voice and from those who had received a diagnosis and treatment. Outcome and Results: Most choirs used warm‐up sessions but few used cool‐down. Singers who participated in choir warm‐ups experienced significantly less vocal symptoms. Individual warm‐ups were ineffective. Singers who had previously had a diagnosis continued to have significantly higher symptom scores. A quarter of the singers who had neither sought help nor had a diagnosis had high scores. Singers appeared uncertain about who to consult for help. Those who saw a speech and language therapist were much more likely to receive a diagnosis and treatment either by the therapist or by referral to an ear, nose and throat specialist. Those receiving treatment were mainly positive about it and likely to complete a course of therapy. Conclusions and Implications: Warm‐up sessions performed by choirs are helpful in avoiding voice symptoms and are recommended. The presence of singers who are unaware of potential damage to their voices is a concern. A simple rating system, as used in this research, may act to alert them to the dangers. Choir leaders could be more active in advising singers and refer them to professionals where necessary. Speech and language therapists appear more sensitive to their problems and could be a first point of contact. WHAT THIS PAPER ADDS: What is already known on this subject: Poor vocal health may occur in amateur singers and lead to voice disorders which will reduce the demonstrated benefits of regular singing. They may be less aware than professional singers of potential hazards and may not know how to sing in a way that ensures good vocal health. There has been less research on the extent of voice problems in amateurs or of the actions they may take to resolve the vocal difficulties they encounter. What this paper adds to the existing knowledge: This survey demonstrates that choir warm‐ups were effective in helping to avoid common symptoms associated with voice problems. A large minority of singers who had not sought help for voice problems had high symptom scores on our assessment. Singers frequently turned to a singing teacher for help. Those who consulted a speech and language therapist were much more likely to be referred for further investigation and treatment. What are the potential or actual clinical implications of this work?: We present a simple subjective measure of symptom severity which succeeds in distinguishing between singers who warm up their voices and those who do not and between singers who have received a past diagnosis and those who have not. There are a number of indications in this research that amateur singers are unsure if they need help and are uncertain who can offer it. In these circumstances the use of a simple measure of the severity of vocal abuse may be useful. [ABSTRACT FROM AUTHOR]

Background: People with aphasia (PWA) can experience functional numeracy difficulties, that is, problems understanding or using numbers in everyday life, which can have numerous negative impacts on their daily lives. There is growing interest in designing functional numeracy interventions for PWA; however, there are limited suitable assessments available to monitor the impact of these interventions. Existing functional numeracy assessments lack breadth and are not designed to be accessible for PWA, potentially confounding their performance. Additionally, they do not include real‐life demands, such as time pressure, which may affect their ecological validity. Thus, there is a crucial need for a new assessment to facilitate further research of PWA's functional numeracy. Aims: To develop, validate and pilot a wide‐ranging, aphasia‐friendly functional numeracy assessment to investigate how functional numeracy is impacted by aphasia severity and time pressure demands, and to explore predictors of PWA's functional numeracy. Methods & Procedures: To develop the Functional Numeracy Assessment (FNA), 38 items inspired by the General Health Numeracy Test (GHNT) and Excellence Gateway were adapted for suitability for PWA and entered in a computerized psychometric‐style test. The final 23 items (FNA23) were selected based on 213 neurotypical controls' performance, and controlled for difficulty, response modality and required numeracy skills. Aphasia‐friendly adaptations of the GHNT and Subjective Numeracy Scale were used to examine the FNA23's concurrent validity. Internal consistency reliability and interrater reliability (for spoken responses) were also examined. A novel Time Pressure Task was created by slight adaptation of seven FNA23 questions to explore the effects of time pressure on functional numeracy performance. A total of 20 PWA and 102 controls completed all measures on an online testing platform. Outcomes & Results: The FNA23 demonstrated acceptable internal consistency reliability (KR‐20 = 0.81) and perfect interrater reliability (for spoken responses). FNA23 and GHNT scores were positively associated, suggesting satisfactory concurrent validity. PWA demonstrated poorer functional numeracy than controls and took longer to complete assessments, indicating that aphasia impacts functional numeracy. Time pressure did not significantly impact performance. PWA demonstrated a wide range of functional numeracy abilities, with some performing similarly to controls. Conclusions & Implications: The FNA23 is a wide‐ranging, valid and reliable assessment which, with further development, will be a useful tool to identify and monitor PWA's functional numeracy difficulties in research and clinical practice. Considering PWA's widespread functional numeracy difficulties evidenced by this study, all PWA would likely benefit from routine evaluation for functional numeracy difficulties as part of their neurorehabilitation journeys. WHAT THIS PAPER ADDS: What is already known on this subject: Few studies have investigated functional numeracy difficulties in PWA. No published functional numeracy assessments exist that have been specifically designed to be accessible for PWA. What this paper adds to existing knowledge: The newly developed FNA23 is a valid and reliable tool to extensively assess PWA's functional numeracy. This study confirmed previous findings of widespread functional numeracy difficulties in PWA that are related to their aphasia severity. What are the potential or actual clinical implications of this work?: The FNA23 can be used to assess PWA's functional numeracy to inform areas of strengths and difficulties to target in intervention, and to monitor progress towards achieving intervention objectives. All PWA should be routinely evaluated for functional numeracy difficulties. [ABSTRACT FROM AUTHOR]

Background: Despite accumulated evidence that language development depends on basic cognitive processes, the balance in contributions of verbal and non‐verbal cognitive skills to language abilities is still underexplored. Little is known about which cognitive measures best predict the degree of severity in children with language disorder (LD). Aims: To examine the association between verbal and non‐verbal cognitive abilities with language abilities in typically developing and language impaired 8‐year‐old children, as well as which cognitive abilities are most effective in distinguishing LD severity levels. Methods & Procedures: Children (N = 509) from the Language‐8 Study, which oversampled probable cases of children with LD from a population‐based cohort in Norway, were assessed at 8 years. Language skills were assessed using the Norwegian Clinical Evaluation of Language Fundamentals—4 (CELF‐4). Children's verbal and non‐verbal cognitive abilities were assessed via standardized cognitive measures. An exploratory factor analysis (EFA) was first conducted to uncover the underlying factor structure of the cognitive variables. Using a hierarchical multiple regression analysis, we then examined to what extent the non‐verbal cognition factor explained language abilities above and beyond verbal cognition factors. Lastly, multinomial logistic regression was used to examine which cognitive measures best predicted the degree of severity in the children with LD. Outcomes & Results: The EFA resulted in three factors (Verbal Cognition, Processing Speed and Memory, and Non‐Verbal Cognition). The hierarchical multiple regression analysis revealed that all three cognitive factors contributed significantly to individual variation in language abilities. Non‐Verbal Cognition explained 5.4% variance in language abilities above and beyond that accounted for by Verbal Cognition and Processing Speed and Memory. Results from the multinomial logistic regression analysis indicated that cognitive subtests, including Familiar Sequences, WASI Vocabulary and WASI Similarities, not only distinguished LD from typically developing children, but were also efficient in distinguishing severity of LD symptoms. Conclusions & Implications: This study confirms concurrent links between language and non‐verbal cognitive skills above and beyond the contribution of verbal cognitive skills. The results provide further evidence that children with LD experience both language and cognitive problems in mid‐childhood. Our findings suggest implications for LD intervention and diagnosis. The findings support the importance of measuring both verbal and non‐verbal cognitive skills when making an LD diagnosis, and point to the potential of targeting underlying cognitive skills as one strategy to support language abilities. WHAT THIS PAPER ADDS: What is already known on the subject: Language development is dependent on basic cognitive processes. These include both verbal and non‐verbal cognitive abilities. Children with LD often experience both language and cognitive problems. There is evidence that performance on cognitive tests may be associated with the degree of severity of LD. What this paper adds to existing knowledge: The current results from a large population‐based cohort establish that a number of verbal and non‐verbal cognitive abilities are tightly linked to variation in language abilities and the degree of severity of LD. Our study confirms concurrent links between language and non‐verbal cognitive abilities above and beyond the contribution of verbal cognitive abilities. We also identify specific verbal and non‐verbal cognitive tests that distinguish between typical children and children with LD, as well as LD severity. What are the potential or actual clinical implications of this work?: Our findings support the importance of measuring both verbal and non‐verbal cognitive skills when making an LD diagnosis. Our findings also point to the potential of targeting underlying cognitive skills as one strategy to support language abilities. We suggest that future intervention studies focus on the impact of non‐verbal cognitive skills on language development in children with LD. [ABSTRACT FROM AUTHOR]

Background: The Montreal Children's Hospital Feeding Scale (MCH‐FS) allows paediatricians and other health care professionals to identify feeding difficulties among children. Aim: To translate and adapt the MCH‐FS into Italian, and to evaluate the validity and reliability of this Italian version of the Montreal Children's Hospital Feeding Scale (I‐MCH‐FS). Methods & Procedures: A total of 150 children with special healthcare needs were admitted to the Rare Disease Unit of the Paediatrics Department at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy, between March 2021 and March 2022 (74 males; mean age = 3.85 ± 1.96 years; median age = 4 years; age range = 6 months–6 years and 11 months) and 150 healthy participants (83 males; mean age = 3.5 ± 1.98 years; median age = 3 years; age range = 6 months–6 years and 11 months) were included in the study, which was approved by the local ethics committee. The original version of the MCH‐FS was translated and cross‐cultural adapted through five stages: (1) initial translation, (2) synthesis of the translations, (3) back translation, (4) expert committee and (5) test of the prefinal version. Test–retest reliability and internal consistency were assessed using Pearson r, Spearman r and Cronbach's alpha, respectively. Construct validity was established by comparing data obtained from patients with those of healthy participants using the Mann–Whitney U‐test. Outcomes & Results: A Pearson r of 0.98, a Spearman r of 0.95 and Cronbach's alpha value of 0.86 were obtained. In the clinical group, 40.6% children were classified as having feeding disorders (n = 61), while in the normative group 4.7% were diagnosed with feeding problems (n = 7). Mean total score of the clinical group was significatively different from the normative's. Conclusions & Implications: The I‐MCH‐FS is a valid and reliable one‐page, quick screening tool used to identify feeding disorders among children with special needs in outpatient paediatric setting. WHAT THIS PAPER ADDS: What is already known on the subject: The MCH‐FS is a valid and reliable parent‐report measure aimed at discriminating between children presenting or not feeding disorders. What this paper adds to existing knowledge: This paper presents the translation and cross‐cultural adaptation of the scale into the Italian language. What are the potential or actual clinical implications of this work?: The Italian version of the MCH‐FS can be used in the special healthcare needs population. [ABSTRACT FROM AUTHOR]

Background: Speech–language pathologists often multitask in order to be efficient with their commonly large caseloads. In stuttering assessment, multitasking often involves collecting multiple measures simultaneously. Aims: The present study sought to determine reliability when collecting multiple measures simultaneously versus individually. Methods & Procedures: Over two time periods, 50 graduate students viewed videos of four persons who stutter (PWS) and counted the number of stuttered syllables and total number of syllables uttered, and rated speech naturalness. Students were randomly assigned to one of two groups: the simultaneous group, in which all measures were gathered during one viewing; and the individual group, in which one measure was gathered per viewing. Relative and absolute intra‐ and inter‐rater reliability values were calculated for each measure. Outcomes & Results: The following results were notable: better intra‐rater relative reliability for the number of stuttered syllables for the individual group (intraclass correlation coefficient (ICC) = 0.839) compared with the simultaneous group (ICC = 0.350), smaller intra‐rater standard error of measurement (SEM) (i.e., better absolute reliability) for the number of stuttered syllables for the individual group (7.40) versus the simultaneous group (15.67), and better inter‐rater absolute reliability for the total number of syllables for the individual group (88.29) compared with the simultaneous group (125.05). Absolute reliability was unacceptable for all measures across both groups. Conclusions & Implications: These findings show that judges are likely to be more reliable when identifying stuttered syllables in isolation than when simultaneously collecting them with total syllables spoken and naturalness data. Results are discussed in terms of narrowing the reliability gap between data collection methods for stuttered syllables, improving overall reliability of stuttering measurements, and a procedural change when implementing widely used stuttering assessment protocols. WHAT THIS PAPER ADDS: What is already known on the subject: The reliability of stuttering judgments has been found to be unacceptable across a number of studies, including those examining the reliability of the most popular stuttering assessment tool, the Stuttering Severity Instrument (4th edition). The SSI‐4, and other assessment applications, involve collecting multiple measures simultaneously. It has been suggested, but not examined, that collecting measures simultaneously, which occurs in the most popular stuttering assessment protocols, may result in substantially inferior reliability when compared to collecting measures individually. What this paper adds to existing knowledge: The present study has multiple novel findings. First, relative and absolute intra‐rater reliability were substantially better when stuttered syllables data were collected individually compared to when the same data were collected simultaneously with total number of syllables and speech naturalness data. Second, inter‐rater absolute reliability for total number of syllables was also substantially better when collected individually. Third, intra‐rater and inter‐rater reliability were similar when speech naturalness ratings were given individually compared to when they were given while simultaneously counting stuttered and fluent syllables. What are the potential or actual clinical implications of this work?: Clinicians can be more reliable when identifying stuttered syllables individually compared to when they judge stuttering along with other clinical measures of stuttering. In addition, when clinicians and researchers use current popular protocols for assessing stuttering that recommend simultaneous data collection, including the SSI‐4, they should instead consider collecting stuttering event counts individually. This procedural change will lead to more reliable data and stronger clinical decision making. [ABSTRACT FROM AUTHOR]

Background: Bilingualism is widespread and being bilingual is more common than being monolingual. The lifelong practice bilinguals receive from managing two languages seems to lead to a cognitive benefit. Conversely, bilingualism seems to affect language ability negatively due to less use of each known language. Aims: This systematic review aims to summarize the results of the studies on the effect of bilingualism on executive functioning assessed by verbal fluency tasks. The verbal fluency task is a neuropsychological measure of lexical retrieval efficiency and executive functioning. Methods: The review was conducted according to the PRISMA statement through searches in the scientific databases PsycINFO, PsycARTICLES, MEDLINE, PubMed, Web of Science and SCOPUS. Studies included in this review had at least one bilingual and monolingual group, participants over 18 years and one verbal fluency task. Studies that considered bimodal bilingual, second language learners, trilingual or multilingual people, and clinical populations were excluded. A total of 38 studies were included in the systematic review. Main Contribution: Quantitative analysis of performance did not show significant differences between monolinguals and bilinguals. Qualitative results are mixed, and no definitive conclusions can be drawn about a bilingual advantage or disadvantage in the verbal fluency tasks. Conclusions: Normative data based on the monolingual population are not appropriate to test a bilingual population. It is necessary to take precautions in using this task, especially in clinical practice. WHAT THIS PAPER ADDS: What is already known on the subject: Bilingualism seems to lead to a cognitive benefit due to constantly monitoring the known languages to select the most suitable one for each interactional context and to affect language ability negatively due to less use of each known language but also to language ability negatively. What this paper adds to the existing knowledge: This systematic review summarizes the results of the studies on the effect of bilingualism on executive functioning assessed by verbal fluency tasks, a neuropsychological measure of lexical retrieval efficiency and executive functioning. What are the potential or actual clinical implications of this work?: Normative data based on the monolingual population are not appropriate to test a bilingual population. It is necessary to take precautions in using this task, especially in clinical practice. [ABSTRACT FROM AUTHOR]

Background: The risks of developmental language disorder (DLD) for both educational progress and socio‐emotional development are well documented, but little is known about how children and young people with DLD experience and describe their language and communication. The need to complement experimental and quantitative studies with qualitative perspectives of the lived experience of individuals with DLD for speech and language therapists (SLT) practice has recently been foregrounded. Aims: To understand further the experiences of young people with DLD focusing on language and communication in a school context, and thereby contribute to the improvement of the communicative situation in school for this group. The study is guided by the following research question: How do young people diagnosed with DLD describe their experiences of language and communication in school? Methods & Procedures: The study is based on data generated from qualitative semi‐structured interviews with 23 participants diagnosed with DLD (age 13–19 years old) living in Sweden. All participants attended mainstream schools. To enable data to be collected during COVID‐19 restrictions, all interviews were conducted using Zoom. Reflexive thematic analysis was used to analyse the data. Outcomes & Results: Four main themes related to experiences of language and communication in school were constructed from the interviews: (1) feelings of inadequacy and comparisons with others; (2) feelings of being misjudged and misunderstood; (3) the importance of feeling safe and comfortable; and (4) the significance of the social and communicative context. The results bear witness of difficult and challenging aspects related to language and communication in school, including educational, social and emotional dimensions. An important outcome of this study is how young people diagnosed with DLD describe their language and communication functioning to be dependent on both individual characteristics and abilities, as well as situational, contextual and social factors. Conclusions & Implications: The results from this study show that young people with DLD can have persisting problems related to language and communication in school, including educational, social and emotional dimensions. SLT services may therefore be needed throughout the school years to ensure that students with DLD receive adequate support. In addition, support that goes beyond language abilities and targets social, contextual and emotional aspects should be considered. WHAT THIS PAPER ADDS: What is already known on this subject: Children and young people have unique knowledge about their language and communication which is instrumental for designing interventions and support strategies. Qualitative analyses of interview data have been able to identify both risk factors and protective strategies in relation to the well‐being of individuals with DLD. Despite this, children and young people with DLD are rarely heard in research or clinical discussions. What this paper adds to existing knowledge: In this study we listen to the voices of young people with DLD as they describe their experiences of language and communication in school. The participants describe a condition that makes them struggle to keep up with peers and puts them at risk of being misjudged by teachers, but also give examples of situations where negative consequences are hardly felt. What are the potential or actual clinical implications of this work?: DLD is a complex and dynamic disorder where contextual and social factors interact with individual abilities in creating the end result. The results of the study indicate that DLD can cause persisting problems related to language and communication in school, with impact on educational, social and emotional dimensions. To counteract these effects, SLT services may be needed throughout the school years, and support that goes beyond language abilities must be considered. [ABSTRACT FROM AUTHOR]

Background: A wealth of evidence supports the important role high‐quality parent–child interactions play in children's early language acquisition. However, the impact on later language outcomes remains unclear. Aims: To examine the associations between responsive parental behaviours across the early years and child language outcomes at age 7 years with families from an Australian longitudinal cohort study (N = 1148, 50% female). Methods & Procedures: At child ages 12, 24 and 36 months, parents completed a self‐report measure of responsive parental behaviours. Child language was directly assessed at age 7 using the Clinical Evaluation of Language Fundamentals, 4th edition (CELF‐4), Australian Standardisation. Linear regression was used to examine associations between responsive parental behaviours from 12 to 36 months (consistently high, inconsistent and consistently low responsive parental behaviours at the three time points) and language scores at age 7 years. Adjusted models were run, including the following potential confounders: child sex; birth weight; birth order; maternal education; socio‐economic disadvantage; non‐English‐speaking background; family history of speech–language problems; mother's vocabulary score; maternal mental health score; and mother's age at birth of child. A final adjusted model was run, including the potential confounder variables as well as adjusting for children's earlier language skills. Outcomes & Results: Linear regression results showed children with parents who rated high on responsive parental behaviours at all three time points had higher mean language scores at age 7 than children whose parents reported low responsive parental behaviours across early childhood. This association attenuated after adjusting for earlier child language skills. Conclusions & Implications: Findings support the consistent use of responsive parental behaviours across the very early years of childhood to support long‐term language outcomes. Findings also suggest that models of surveillance and support which monitor and assist families at multiple time‐points over the early years are likely to be most effective for preventing ongoing language difficulties. WHAT THIS PAPER ADDS: What is already known on this subject: There is extensive evidence consistently demonstrating the important contribution of aspects of parent–child interaction, specifically responsive parental behaviours, to children's language development. What this paper adds to the existing knowledge: Understanding the cumulative benefit of responsive parent–child interactions across the very early years may help to inform preventive interventions and service delivery models for supporting young children's language development. This study demonstrates in a large, population‐based cohort the contribution of consistency of responsive parental behaviours during infancy and toddlerhood to school‐age language outcomes, accounting for other child, family and environmental factors. Capturing regular parent behaviours via self‐report during the early years may be a more efficient and less costly method than parent–child interaction observations to monitor the home language‐learning environment during routine developmental checks. What are the potential or actual clinical implications of this work?: Findings support the need for surveillance of children and families in the early years, ensuring that intervention occurs when families need it most, that is, support is responsive to changing needs and that nuanced advice and support strategies are provided to activate positive developmental cascades. Capturing both parent behaviours and child language may assist clinicians to identify those families who may benefit from parent–child interaction intervention. [ABSTRACT FROM AUTHOR]

Background: Despite increasing knowledge of social communication skills of autistic peole, the interrelatedness of different skills such as non‐linguistic comprehension, social inference and empathizing skills is not much known about. A better understanding of the complex interplay between different domains of social communication helps us to develop assessment protocols for individuals with social communication difficulties. Aims: To compare the performances of autistic young adults, young adults with autistic traits identified in childhood and control young adults in social communication tasks measuring non‐linguistic comprehension, social inference and empathizing skills. In addition, to examine associations between the different social communication measures. Methods & Procedures: Autistic young adults (n = 34), young adults with autistic traits (n = 19) and control young adults (n = 36) completed the extra‐ and paralinguistic scales of the Assessment Battery for Communication (ABaCo), the Faux Pas Recognition Test, Social–Pragmatic Questions (SoPra) and the Empathy Quotient (EQ). Outcomes & Results: Group differences were found in the performance in the ABaCo, SoPra and EQ scores. Compared with the control young adults, autistic young adults scored lower. The performance of the young adults in the autistic traits group fell in between the other two groups. There were no group differences in the Faux Pas Recognition Test. The variability within the groups was large in all measurements. In the control group, there was a significant correlation between EQ and SoPra scores and between the Faux Pas and SoPra scores. In the autistic group, a significant correlation was found between Faux Pas and SoPra scores. Also, other patterns were observed but these were not statistically significant. Conclusions & Implications: The young adults with autistic traits fell in between the control and autistic young adults, highlighting the presence of the continuum in the terms of features of social communication. The results support other current research that suggests that theory of mind and other social communication skills may not be universally or widely impaired in all autistic individuals without cognitive deficits. Although all tasks examined social communication skills, only a small number of significant correlations were found between test scores. This highlights that clinical conclusions about a person's social communication should be based on the outcomes of different types of methods measuring different aspects of social communication. It is clear that the interrelatedness of different social communication skills needs further research. What This Paper Adds: What is already known on this subject: For successful communication, the ability to infer others' emotions, intentions and mental states is crucial. Autistic people have difficulty with many aspects of social communication. However, the associations between different aspects of social communication need to be better understood. What this paper adds to existing knowledge: The unique contribution of this study is to compare the performance of autistic people not only with that of a control group but also with people with childhood autistic traits. This provides an understanding of the interrelatedness of different social communication skills in people with varying degrees of autistic traits. This study used four assessment methods focusing on three different social communication elements (non‐linguistic comprehension, social inference and empathizing skills). These elements have complex relationships to one another, some being closely overlapping, some more distally related and some reflect more complex multifactorial elements. This study shows that although groups differ from each other in most of the assessments, the performance of different groups overlapped showing that many autistic young adults can perform well in non‐linguistic and social inference tasks in structured assessment contexts. What are the potential or actual clinical implications of this work?: Our findings suggest that in the assessment of social communication, self‐reports and clinical assessments can be used effectively together. They can complement each other, pointing out the strengths and weaknesses of a person, leading to more personalized therapeutic interventions. [ABSTRACT FROM AUTHOR]

Background: A number of practice barriers (e.g., time constraints, patient comorbidities and competing demands) exist as regards the evidence‐based assessment of adult language within the acute hospital setting. There is need for an evidence‐based, diagnostically validated, adaptable, comprehensive and efficient aphasia assessment. The Brisbane Evidence Based Language Test (EBLT) was developed to meet this need for a clinically appropriate and diagnostically robust assessment measure. Since the release of the EBLT, there has been no detailed investigation into speech and language therapists' (SLT) use and perceptions of the assessment. To inform future research and improvements to the EBLT, a better understanding of current language assessment practices, use and thoughts on the EBLT are required. Aims: To investigate SLTs' current language assessment practices; and to explore the current usage and future directions of the Brisbane EBLT. Methods & Procedures: A convergent parallel mixed‐methods study design with an electronic survey was utilized. The survey consisted of 16 multiple‐choice, multiple‐answer and free‐text questions that explored respondents' perceptions of current language assessment measures, ideal language assessment features, Brisbane EBLT use, positives and negatives, and future directions for the EBLT. The survey was developed on Qualtrics and disseminated via email, social media and professional networks. Snowball sampling was used. Study inclusion criteria required participants to be qualified SLTs with clinical experience working with patients with aphasia. Quantitative data were analysed via descriptive and correlative statistics, and qualitative data were analysed via content analysis. Outcomes & Results: The survey was completed by 115 SLTs from Australia, New Zealand, the United States, the UK, Canada, France, Lebanon and Belgium. Many respondents identified that a range of assessments is required to meet SLT clinical needs in the assessment of aphasia. Key desirable assessment features reported were: comprehensive, efficient, evidence‐based, responsive and flexible. The EBLT was the most frequently used standardized measure reported by respondents (used by 78.63%). The EBLT reportedly has many positive features; however, respondents indicated dislike of the form layout, scoring and responsiveness. The majority of respondents indicated that the development of additional EBLT tests (94.29%) and additional cut‐off scores (95.15%) would benefit their clinical practice. Conclusions & Implications: The study findings indicate that SLT assessment of language is complex and multifaceted. While the EBLT is reportedly used widely by SLTs, respondents identified areas for further research which would optimize the test's usability within their practice, to ultimately improve patient outcomes. WHAT THIS PAPER ADDS: What is already known on the subject: Previous studies have explored existing SLT adult language assessment practices within acute settings; however, the most recent comprehensive study was completed in 2010. In 2020, the development, diagnostic validation, intra‐ and interrater reliability of the Brisbane EBLT were published. As of yet there has not been an investigation into clinician use and perspectives of the assessment since its release. What this paper adds to existing knowledge: This study provides contemporary data about international aphasia assessment practices, as well as descriptive and qualitative information on the current use of the Brisbane EBLT, and the positives, negatives, and future directions for the assessment measure. What are the potential or actual clinical implications of this work?: The study suggests that no one language assessment currently satisfies all SLTs' assessment needs. It additionally implies that a large proportion of SLTs believe that it is best practice to use multiple language assessment measures and select these based on the patient's presentation and context. Further research is required to aid the development of additional EBLT test versions and cut‐off scores to improve SLT adult language assessment practices. [ABSTRACT FROM AUTHOR]

Background: Discourse analysis has recently received much attention in the aphasia literature. Even if post‐stroke language recovery occurs throughout the longitudinal continuum of recovery, very few studies have documented discourse changes from the hyperacute to the chronic phases of recovery. Aims: To document a multilevel analysis of discourse changes from the hyperacute phase to the chronic phase of post‐stroke recovery using a series of single cases study designs. Methods & Procedures: Four people with mild to moderate post‐stroke aphasia underwent four assessments (hyperacute: 0–24 h; acute: 24–72 h; subacute: 7–14 days; and chronic: 6–12 months post‐onset). Three discourse tasks were performed at each time point: a picture description, a personal narrative and a story retelling. Multilevel changes in terms of macro‐ and microstructural aspects were analysed. The results of each discourse task were combined for each time point. Individual effect sizes were computed to evaluate the relative strength of changes in an early and a late recovery time frame. Outcomes & Results: Macrostructural results revealed improvements throughout the recovery continuum in terms of coherence and thematic efficiency. Also, the microstructural results demonstrated linguistic output improvement for three out of four participants. Namely, lexical diversity and the number of correct information units/min showed a greater gain in the early compared with the late recovery phase. Conclusions & Implications: This study highlights the importance of investigating all discourse processing levels as the longitudinal changes in discourse operate differently at each phase of recovery. Overall results support future longitudinal discourse investigation in people with post‐stroke aphasia. What This Paper Adds: What is already known on the subject: Multi‐level discourse analysis allows for in‐depth analysis of underlying discourse processes. To date, very little is known on the longitudinal discourse changes from aphasia onset through to the chronic stage of recovery. This study documents multi‐level discourse features in four people with mild to moderate aphasia in the hyperacute, acute, subacute and chronic stage of post‐stroke aphasia recovery. What this paper adds to existing knowledge: The study found that most discourse variables demonstrated improvement throughout time. Macrostructural variables of coherence and thematic units improved throughout the continuum whereas microstructural variables demonstrated greater gains in the early compared to the late period of recovery. What are the potential or actual clinical implications of this work?: This study suggests that multilevel discourse analysis will allow a better understanding of post‐stroke aphasia recovery, although more research is needed to determine the clinical utility of these findings. Future research may wish to investigate longitudinal discourse recovery in a larger sample of people with aphasia with heterogenous aphasia profiles and severities. [ABSTRACT FROM AUTHOR]

Background: Written reflective practice (WRP) is a teaching tool used across speech–language therapy (SLT) clinical education programmes. The process aims to support the development of reflective skills required for the workplace (e.g., problem‐solving and self‐evaluation). Aims: This cross‐sectional and repeated‐measures study design investigated students' demonstration of breadth of WRP across the clinical education programme. Methods & Procedures: The participants were 77 undergraduate SLT students in their first, second or final professional year of the clinical programme. Participants wrote critical reflections following an interaction with a client/s as part of their clinical education experiences. Formative feedback was provided after each written reflection (WR). In total four WRs per participant were coded for breadth of WRP using a modification of Plack et al.'s coding schema from 2005. This was completed for each of the four time points across the academic year for each professional year. Outcomes & Results: There was a statistically significant association between time (i.e., professional year of the programme) and likelihood of demonstration of breadth of reflection for the lower level reflective element of 'attend' and higher level reflective element of 're‐evaluate'. A positive trend between time and likelihood of demonstration of breadth of reflection was seen for the lower level element of 'reflection‐for‐action'. Final‐professional‐year students exhibited significant enhancements in the higher level elements (e.g., 'premise') compared with first‐ and second‐professional‐year students. Conclusions & Implications: This group of SLT students exhibited significant change in breadth of WRP across the degree programme. This finding has positive implications for facilitating WRP with students and using the current coding framework in clinical programmes. What this paper adds: What is already known on this subject: WRP is one form of reflective practice (RP) used in SLT, allied health, medical and nursing clinical education programmes. Researchers have suggested that RP skills develop over time for students. Previously, studies examining WRP have focused on one off assessment of skill or over a timeframe of 6–10 weeks. Here, we examine SLT students' WRP skills across the degree programme. What this paper adds to existing knowledge: SLT students exhibited significant positive change in breadth of WRP across the degree programme as their clinical experience increased. Our results provide quantitative information in support of using RP as a learning tool throughout clinical education programmes for SLT. What are the potential or actual clinical implications of this work?: This study offers support for educators of SLT students; for example, how educators can assess WRP, and how educators can foster SLT student skill development with formative feedback and reflective questioning. This study also offers support for student SLT, for example, describing how WRP can be part of their individualized learning approach and provide a purposeful examination of self and clinical skill development. [ABSTRACT FROM AUTHOR]

Background and Objectives: In Italy, approximately 650 individuals receive a diagnosis of primary progressive aphasia (PPA) every year. Unfortunately, the frequency with which patients are referred to speech‐language services is suboptimal, likely due to skepticism regarding the value of speech‐language therapy in the context of neurodegeneration. Materials and Methods: We conducted a virtual survey of speech and language therapists (SLTs) across Italy, to collect information about the assessment, intervention and management of patients with PPA. To ensure that as many SLTs as possible received the survey, the Italian Federation of SLTs (Federazione Logopedisti Italiani, FLI) aided in disseminating the survey. Results: In total, 336 respondents participated in the online survey, 140 of whom had previous experience with PPA patients. Respondents indicated having seen a total of 428 PPA patients in the previous 24 months (three patients on average, range: 0–40). SLTs who reported never working with PPA identified underdiagnoses, low referral rates and the rarity of the clinical syndrome as major reasons for their lack of experience with PPA. SLTs with experience working with PPA indicated that patients may not have accessed services because of service dysfunction and geographical barriers. Respondents reported using informal interviews during assessments and tests developed for post‐stroke aphasia, while impairment‐based/restitutive interventions were utilised most often. Conclusion: Findings may serve to inform health policy organisations regarding the current shortcomings and needed recommendations for improving the care of individuals with PPA in Italy. Improving awareness of the utility of rehabilitation among SLTs and other clinical service providers may serve to facilitate access to intervention, which in turn will serve to better support individuals living with PPA. What This Paper Adds: What is already known on the subject: Speech and language therapists (SLTs) play a crucial role in the assessment, diagnosis and treatment of people with primary progressive aphasia (PPA). However, the frequency with which individuals with PPA are referred for speech and language services is suboptimal due to skepticism regarding the value of speech and language therapy in the context of neurodegeneration, the scarcity of SLTs with expertise in the treatment of PPA and the lack of awareness of the SLT role amongst referrers. What this paper adds to existing knowledge: In recognition of the lack of published information on the provision of speech and language therapy services and clinicians' approaches to the assessment and treatment of individuals with PPA in Italy, we conducted an online survey to evaluate the current referral patterns for speech and language therapy services and to examine the current barriers to access these services for individuals with PPA in Italy. What are the potential or actual clinical implications of this work?: The data presented here support that SLTs view treatment as useful for individuals with PPA and other professional figures and may serve to improve access to intervention, which in turn will serve to better support individuals living with PPA. The results highlight the need to inform health policy organisations about current gaps and aid in developing recommendations for improving the care of individuals with PPA, in order to understand how SLTs can best support individuals with PPA and their families. [ABSTRACT FROM AUTHOR]

Background: Children with Down syndrome have speech and language difficulties that are disproportionate to their overall intellectual ability and relative strengths in the use of gesture. Shared book reading between parents and their children provides an effective context in which language development can be facilitated. However, children with Down syndrome often take a passive role in shared book reading and the use of key word signing (KWS) as a shared book reading technique has never been investigated. Aims: This study aimed to compare children with Down syndrome's participation and use of KWS across two methods of shared book reading – one in which a book had key‐word sign prompts embedded (signed condition) and the other in which a book was read as normal (unsigned condition). Measures of child and parent communicative behaviour were taken in each condition to establish if differences emerged. Methods & Procedures: A total of 36 children with Down syndrome (aged between 18 and 61 months) and their mothers took part in the study. Parent–child dyads were videoed at home reading two books, one in a signed and one in an unsigned condition. Child measures included total number of signs produced in each condition and levels of attention and initiation as measured by the Pivotal Behaviour Rating Scale. Parent measures included total number of utterances, mean length of utterance (MLU) in morphemes and vocabulary diversity (VOCD). Parental measures were transcribed using the Codes for Human Analysis Transcripts (CHAT) software and analysed by the Computerised Language Analysis software (CLAN). Contrasts in outcomes between the signed and unsigned conditions were estimated using Poisson and linear mixed‐effects models, determined by the type of data. Outcomes & Results: Results showed that children attempted to sign significantly more in the signed than unsigned condition, as well as showing significant increases in their levels of attention and initiation. There was also a significant increase in the total number of utterances used by parents in the signed versus unsigned condition and a decrease in MLU. VOCD was similar in both conditions. Conclusions & Implications: This study shows that the simple act of embedding key word signs into commercially available books, during shared book reading between parents and young children with Down syndrome, positively affects children's participation (initiation and attention) and use of KWS. The use of KWS as a core shared book reading technique may therefore be a fruitful avenue to facilitate growth in the language abilities of young children with Down syndrome. What this paper adds: What is already known on this subject: Most children with Down syndrome have significant speech and language difficulties, with relative strengths in the use of gesture. Shared book reading is an activity reported to positively affect language. However, children with Down syndrome are reported to take a passive role in shared book reading and are therefore more dependent on their parents to use techniques that facilitate their levels of participation, in order to maximise potential benefits. To the best of our knowledge, the communicative effects of embedding key word signing (KWS) in shared book reading have never been examined with children with Down syndrome. What this paper adds to existing knowledge: This is the first study to investigate the communicative impact of parents embedding KWS in a shared book reading activity with their young children with Down syndrome. Our findings show that this relatively simple manipulation resulted in Increase in children's sign attempts.Increase in children's overall participation in shared book reading (indicated by levels of attention and initiation).Increase in the number of utterances produced by parents (primarily as a result of repetitions).Decrease in parental mean length of utterance. These findings suggest that embedding KWS in shared book reading is likely to facilitate increased language abilities in this cohort. What are the potential or actual clinical implications of this work?: Shared book reading is part of the daily routine for many parents and their children with Down syndrome. Integrating KWS is a relatively simple adaptation to this activity which is likely to enhance children's language skills. Therapists can encourage parents to do this at home to support work carried out at school and in a clinical setting. [ABSTRACT FROM AUTHOR]

Background: Evidence‐based recommendations for a core outcome set (COS; minimum set of outcomes) for aphasia treatment research have been developed (the Research Outcome Measurement in Aphasia—ROMA, COS). Five recommended core outcome constructs: communication, language, quality of life, emotional well‐being and patient‐reported satisfaction/impact of treatment, were identified through three international consensus studies. Constructs were paired with outcome measurement instruments (OMIs) during an international consensus meeting (ROMA‐1). Before the current study (ROMA‐2), agreement had not been reached on OMIs for the constructs of communication or patient‐reported satisfaction/impact of treatment. Aim: To establish consensus on a communication OMI for inclusion in the ROMA COS. Methods & Procedures: Research methods were based on recommendations from the Core Outcome Measures in Effectiveness Trials (COMET) Initiative. Participants with expertise in design and conduct of aphasia trials, measurement instrument development/testing and/or communication outcome measurement were recruited through an open call. Before the consensus meeting, participants agreed on a definition of communication, identified appropriate OMIs, extracted their measurement properties and established criteria for their quality assessment. During the consensus meeting they short‐listed OMIs and participants without conflicts of interest voted on the two most highly ranked instruments. Consensus was defined a priori as agreement by ≥ 70% of participants. Outcomes & Results: In total, 40 researchers from nine countries participated in ROMA‐2 (including four facilitators and three‐panel members who participated in pre‐meeting activities only). A total of 20 OMIs were identified and evaluated. Eight short‐listed communication measures were further evaluated for their measurement properties and ranked. Participants in the consensus meeting (n = 33) who did not have conflicts of interest (n = 29) voted on the top two ranked OMIs: The Scenario Test (TST) and the Communication Activities of Daily Living—3 (CADL‐3). TST received 72% (n = 21) of 'yes' votes and the CADL‐3 received 28% (n = 8) of 'yes' votes. Conclusions & Implications: Consensus was achieved that TST was the preferred communication OMI for inclusion in the ROMA COS. It is currently available in the original Dutch version and has been adapted into English, German and Greek. Further consideration must be given to the best way to measure communication in people with mild aphasia. Development of a patient‐reported measure for satisfaction with/impact of treatment and multilingual versions of all OMIs of the COS is still required. Implementation of the ROMA COS would improve research outcome measurement and the quality, relevance, transparency, replicability and efficiency of aphasia treatment research. WHAT THIS PAPER ADDS: What is already known on this subject: International consensus has been reached on five core constructs to be routinely measured in aphasia treatment studies. International consensus has also been established for OMIs for the three constructs of language, quality of life and emotional well‐being. Before this study, OMIs for the constructs of communication and patient‐reported satisfaction/impact of treatment were not established. What this paper adds to existing knowledge: We gained international consensus on an OMI for the construct of communication. TST is recommended for inclusion in the ROMA COS for routine use in aphasia treatment research. What are the potential or actual clinical implications of this work?: The ROMA COS recommends OMIs for a minimum set of outcomes for adults with post‐stroke aphasia within phases I–IV aphasia treatment research. Although not intended for clinical use, clinicians may employ the instruments of the ROMA COS, considering the quality of their measurement properties. The systematic inclusion of a measure of communication, such as TST, in clinical practice could ultimately support the implementation of research evidence and best practices. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic and subsequent measures to reduce transmission risk has led to unprecedented digital transformation across health, education and social care services. This includes UK paediatric speech and language therapy (SLT), which sits at the crossroads of these services. Given the rapid onset of this pandemic‐induced digital transition, there is now a need to capture, reflect and learn from the SLT profession so that benefits can be sustained, and barriers addressed. Aims: To survey the impact of COVID‐19 remote working on UK paediatric SLTs' digital views and experiences using the Capability, Opportunity, Motivation and Behaviour (COM‐B) model. Methods & Procedures: An online survey was conducted from May to October 2020. Respondents were asked to rate their use of technology in service delivery before and during the pandemic, to select factors facilitating digital practice, and to provide open‐response aspirations for the future role of technology in paediatric SLT which were analysed thematically using the COM‐B behaviour change model. Outcomes & Results: A total of 424 UK paediatric SLTs responded to the survey. Findings indicate a marked increase in clinicians' perception of their frequency, convenience and confidence with digital practice during COVID‐19 compared with before the pandemic. Respondents identified that specialist training (27%), funding for workplace devices (22%) and supportive leadership (19%) were most likely to facilitate sustained digital practice. Clinicians hoped for a blended approach going forward with technology enhancing existing best practice. Further prominent themes included digital accessibility for all and maintaining the increased opportunity for multidisciplinary working that videoconferencing has afforded. More service‐specific aspirations were bespoke technological solutions as well as parents/carers being able to engage remotely with school‐based provisions. Conclusions & Implications: During COVID‐19, paediatric SLTs' recognition and acceptance of how technology can augment practice has accelerated, with particular value being placed on inclusivity, choice, training, resources, leadership and indication of effectiveness. These are important considerations to help guide the profession towards the long‐term digital enhancement of SLT services. WHAT THIS PAPER ADDS: What is already known on the subject: The COVID‐19 pandemic led to an unprecedented interest in the use of technology across SLT practice. Studies are emerging nationally and internationally to identify the digital priorities of the SLT workforce, the areas of digital SLT provision that are thriving or lacking, and the evidence to guide clinical practice and service development. What this study adds to existing knowledge: This is the first UK‐wide COVID‐19 survey solely focusing on the digital practice of paediatric SLTs. The findings provide critical insights into SLT perception of how practice has been impacted in the early stages of the COVID‐19 pandemic, including digital trends that are service, condition and demographic specific. Tools and channels required to support sustained beneficial change are also discussed. What are the potential or actual clinical implications of this work?: This paper demonstrates the potential for digital solutions to enhance SLT practice, as long as implementation is guided by clinicians' experiences and perspectives. The findings lay groundwork for service development work, such as the creation of training packages, updating of clinical guidelines and care pathways, and development of processes to ensure equitable allocation of evidence‐based resources. [ABSTRACT FROM AUTHOR]

Background: Research is beginning to shed light on the practices employed by speech‐language therapists (SLTs) for the management of acquired dysarthria. However, studies that explore SLTs' satisfaction with the effectiveness of current therapies and their interest in new treatment methods for this population have not been carried out. One potential new method is neuromuscular electrical stimulation (NMES): the pool of evidence for its use in rehabilitation is increasing, yet it has not been widely explored for use with dysarthria. Aim: To extend the understanding of acquired dysarthria management practices employed by SLTs across the globe and determine their satisfaction with current therapy options. To explore their interest in using NMES with this population. Methods and Procedures: A cross‐sectional international online survey was developed and disseminated to SLTs working with adults with acquired dysarthria through international professional associations. The survey collected information on demographic characteristics, dysarthria management practices, satisfaction with treatment effectiveness and interest in and knowledge of NMES. Survey responses were analysed using descriptive and inferential statistics, and quantitative content analysis. Outcomes and Results: A total of 211 SLTs (North America, 48.8%; Europe, 36%; Asia, 8.1%; Oceania, 5.7%; Africa, 0.9%; South America, 0.5%) completed the survey in full. Management practices varied considerably. There was a clear preference for informal assessments, mainly oral‐motor examinations, focusing on body functions and structures. The majority of respondents rejected the use of non‐speech oral motor exercises as a clinical or carryover exercise. Variable satisfaction with current speech subsystem treatments was noted; however, overall, there was a general dissatisfaction. Whilst a strong interest in the use of NMES for dysarthria was evidenced, it was noted that most SLTs lacked fundamental knowledge of NMES principles and application. Conclusion: SLTs' management practices and satisfaction with acquired dysarthria treatments differed substantially. Investigations of the potential use of NMES for dysarthria treatment are of interest. WHAT THIS PAPER ADDS: What is already known on the subject: Recent country‐specific surveys have explored speech‐language therapists' (SLTs') assessment and intervention practices for acquired dysarthria. These studies indicate that although clinical management for this speech disorder mainly involves informal assessment tools and impairment‐focused treatment, communication beyond the impairment, such as the activity and participation domains, is also frequently assessed and treated. What this paper adds to existing knowledge: The majority of SLTs are dissatisfied with the overall benefits of current acquired dysarthria treatment. Phonatory, respiration and speech rate therapies are perceived to be more effective than prosody, articulation and resonance treatments. Despite a general lack of theoretical knowledge, most SLTs are interested in neuromuscular electrical stimulation treatment for acquired dysarthria. What are the potential or actual clinical implications of this work?: New, evidence‐based treatments are needed for SLTs to be confident in the effectiveness of their acquired dysarthria treatment. [ABSTRACT FROM AUTHOR]

Background: When parents bring their child to appointments and then adhere to agreed speech and language therapy (SLT) recommendations, there is the potential to increase the intensity of the intervention, support generalization and improve outcomes. In SLT, however, little is known about factors that may promote attendance or adherence. Studies in other clinical areas such in medicine, psychology and physiotherapy have identified risk factors for non‐attendance or non‐adherence that are multifactorial and variable dependent on, for example, population and intervention. Aims: To identify rates of non‐attendance and non‐adherence, and to identify parent or child factors associated with parent involvement in intervention for children under 5 years of age receiving SLT. Methods: Parents completed questionnaires at two time points assessing the domains of parents' beliefs (problem perceptions, self‐efficacy), personal circumstances (socio‐demographics, family functioning), treatment experience and child factors. Predictors of parent attendance and adherence were identified through multiple regression analyses. Non‐attendance rates were identified via local health records and non‐adherence ascertained using a specific parent‐reported measure within the treatment experience domain. Results: Participants (N = 199) were predominantly mothers, and were ethnically and socio‐economically diverse, speaking a wide range of languages. Their children presented with a range of speech, language communication needs (SLCN). The rate of non‐attendance was 25% and the main predictors of non‐attendance were maternal age, education level and two factors within the parent beliefs domain. This model explained 40% of the variance in attendance. The rate of non‐adherence in this cohort was 26% with parental rating of the importance of a recommendation and self‐efficacy beliefs predicting adherence; this explained 56% of the variance in adherence to SLT recommendations at home. Conclusions & Implications: Our research has provided preliminary evidence of the influence of parents' beliefs, personal circumstances and treatment experiences on their involvement in their child's therapy. Speech and language therapists should consider factors impacting attendance and adherence to treatment and explore parental perceptions of their child's SLCN before embarking on an intervention, a foundation for collaborative practice. A possible limitation of this study is that the levels of attrition in our sample led to generally high measured rates of participation, which should be considered in future studies. Future research should explore adherence in treatments with varying doses, with different types of SLCN or interventions and in different settings. WHAT THIS PAPER ADDS: What is already known on the subject: It is acknowledged that parent involvement in their child's therapy, such as attending and adhering to recommendations, is important but little is known about the rates of involvement and what factors may be associated with attendance and adherence in SLT. Qualitative research has explored parental involvement suggesting that beliefs about an intervention may be pertinent. Extensive research in other clinical areas suggest multiple and varied factors are influential and further exploration of particular populations and interventions is necessary. What this paper adds to the existing knowledge: This study identified rates of parental non‐attendance and non‐adherence in a cohort of predominantly mothers of children under the age of 5 years. It is the first study to measure parent adherence in SLT and identify factors that are associated parental adherence to SLT recommendations. It adds to the small body of SLT specific research in understanding risk factors for non‐attendance. What are the potential or actual clinical implications of this work?: This study highlights the need for a speech and language therapist to consider and explore parents' perspectives of their child's SLCN as a part of achieving collaboration with a parent in order to achieve the best outcomes. It provides a foundation for further systematic research into parent involvement with the ultimate aim of enhancing outcomes for children with SLCN. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease (PD) can affect social interaction and communication as well as motor and cognitive processes. Speech is affected in PD, as is the control of voluntary eye movements which are thought to play an important role in 'turn taking' in conversation. Aims: This study aimed to measure eye movements during spoken conversation in PD to assess whether differences in patterns of eye gaze are linked to disrupted turn taking and impaired communication efficiency. Methods & Procedure: Eleven participants with mild PD and 14 controls completed a two‐player guessing game. During each 3 min game turn, one of the players had to guess the names of as many objects as possible based only on the other player's description. Eye movements were recorded simultaneously in both participants using mobile eye trackers along with speech onset and offset times. Outcomes & Results: When people with PD played the role of describer, the other player guessed fewer objects compared to when controls described objects. When guessing objects, people with PD performed just as well as controls. Analysis of eye fixations showed that people with PD made longer periods of fixation on the other player's face relative to controls and a lower number of such 'gaze on face' periods. Conclusions & Implications: A combination of oculomotor, cognitive and speech abnormalities may disrupt communication in PD. Better public awareness of oculomotor, speech and other deficits in the condition could improve social connectedness in people with Parkinson's. WHAT THIS PAPER ADDS: What is already known on this subject?: Parkinson's disease is known to affect the control of voluntary eye movements. Direction of eye gaze is important in spoken conversation as a cue to turn‐taking, but no studies have examined whether eye movements are different during communication in people with Parkinson's. What this paper adds to existing knowledge?: People with Parkinson's showed longer periods of eye fixation during conversations compared to controls. Delays and overlaps between speech turns were also affected in patients. What are the clinical implications of this work?: Better knowledge of the effect of the disease on eye gaze control amongst clinicians may help improve communication and social connectedness for patients in the future. [ABSTRACT FROM AUTHOR]