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Purpose This article discusses the complexities of caring for individuals with dementia with an interdisciplinary team approach. The overlap and potential conflict between speech-language pathologists (SLPs) and occupational therapists (OTs) are addressed. SLPs and OTs have potentially similar roles when caring for people with dementia, so it can be difficult to decipher whose job it is to implement similar therapy techniques. However, there are ways health care professionals can prepare themselves to work collaboratively and potentially avoid conflict among team members, such as overstepping their professional boundaries and scopes of practice. This article discusses three beneficial techniques for interprofessional collaboration: acquiring sufficient knowledge about the scopes of practice of both SLPs and OTs, developing effective communication skills, and identifying the intentions of each therapeutic technique. Conclusions There is no straightforward or universal answer to the question “Whose job is it?” when considering SLPs and OTs in caring for people with dementia. Deciding whether an SLP or an OT should implement certain aspects of therapy depends on the roles of each professional and how they can benefit the patient. Interdisciplinary team members must work together to identify how their roles interact and overlap. SLPs and OTs must have a solid knowledge base about each other's scopes of practice, develop effective communication skills, and be able to identify the intentions of their therapy. Developing these skills allows SLPs and OTs to work harmoniously in interprofessional teams.

Dysphagia management is complex and requires balancing individuals’ preferences, quality of life, and medical consequences. Ethical challenges are not uncommon given the complexity of dysphagia. Professionals must engage in ethical reflection and shared decision-making when managing dysphagia. Recognizing one’s own presuppositions and beliefs may be fundamental to ensuring an ethical approach. The goal of this article is to apply principles of ethics using hypothetical case studies of dysphagia. To this end, we will describe the challenges of working with the disorder of dysphagia, the influence of culture on decision-making about eating and feeding, the importance of information disclosure and respect for individuals’ refusal of recommendations, and the interplay of ethical reflection, evidence, and clinical judgment when making complex dysphagia management decisions. These concepts should be kept in mind ensure compassionate and competent care of the person with eating, drinking or swallowing problems and their family caregivers.

Traditional point-based grading is failing students entering a competency-based workforce: Employers require concrete skills and knowledge, not "high" grades. In the specifications approach, learning outcomes are explicitly linked to the grading system. The basic components of the approach include: clear alignment of learning outcomes to certification standards, bundled sequences of assessments tied to basic and advanced competency/learning outcomes, pass/fail grading with no partial credit, opportunities to revise unacceptable work, and detailed expectations of performance on assessments. This article describes the specifications approach and provides examples highlighting how to (a) align course learning objectives with a grading system, (b) implement a pass/fail approach even for complex assessment, (c) define specifications, (d) create and sequence bundles of assessments, and (e) provide instructor support through feedback and tokens.

PURPOSE: Dysphagia prevalence in younger community dwelling adults and across nations is sparse. We investigated the prevalence of swallowing problems in an unselected cohort of people aged 18-65 years. METHODS: The EAT-10 Assessment Tool was converted into an anonymized online survey. Invitations were emailed to author contacts and onwards dispersal encouraged. Analysis was performed using non-parametric test for group comparison (Mann-Whitney U) and Spearman’s rho correlation. RESULTS: From March 2014 to October 2017: 2,054 responses (32 reported ages outside of 18-65 or undeclared) from Africa, Asia, Australasia/Oceania, Europe, and North and South America. Responses: 1,648 female, 364 male, (10 reported as both), median age 34, (range 18-65, mean 37.12, SD 12.40) years. Total EAT-10 scores: median 0 (range 0-36, mean 1.57, SD 3.49). EAT-10 score ≥3 (337) median 5 (range 3-36, mean 7.02 SD 5.91). Median age 36 (range 19-65, mean 37.81, SD 13.21) years. Declared sex was not statistically significantly associated with non-pathological vs. pathological EAT-10 score (p=.665). Female scores (median 0.00, mean 1.56, SD 3.338) were significantly higher than for males (median 0.00, mean 1.62, SD 4.161): U (Nfemale=1648, Nmale=364) = 275420.000, z=-2.677, p=.007. Age and EAT-10 score were not associated: females rs=-0.043, p=.079, N=1648, males rs=-0.003, p=.952, N=364. Considerable impact on people: “I take ages to eat a main course … This is embarrassing and I often leave food even though I am still hungry.” (no diagnosis, EAT-10=17). CONCLUSION: Concerns regarding swallowing exist in people undiagnosed with dysphagia, who may feel uncomfortable seeking professional help. Dysphagia may be under reported resulting in a hidden population. Subtle changes are currently seen as subtle markers of COVID-19. Further work is required to ensure that what is an essentially normal swallow does not become medicalized.

Interprofessional, collaborative health care is the ideal standard in geriatrics. Students’ interprofessional practice skills are limited in typical siloed education. An experiential, team-based geriatrics course was designed to improve health professions (HP) students’ perceived knowledge, skills, and attitudes about interprofessional practice. Students (n=209) from dentistry, medicine, nursing, nutrition, occupational therapy, pharmacy, physician assistant, social work, and speech-language pathology were assigned to interprofessional (IP) and medical-student only teams. The Interprofessional Collaborative Competency Attainment Survey-Revised (ICCAS-R) was administered pre- and post-course, along with program evaluations. Seventy percent of students completed both pre- and post-surveys. ICCAS-R scores were analyzed comparing the impact of training for medical students (n=78) on IP teams and remaining HP students (n=58). Students rated themselves as improved on all six ICCAS-R subscales (paired t-tests, p < 0.05). Sixty-nine percent rated themselves as better able to collaborate interprofessionally. A competitive team-based learning exercise using gamification was rated as the most authentic skill-building interprofessional activity. Experiential learning where students worked with the same team helped to build interprofessional and teamwork skills. Findings will be used to improve authenticity of the clinical and teamwork content, increase the use of gamification as a teaching technique, and refine students’ practice of IP teamwork competencies.

Speech-language pathologists working with adults in medical settings are likely to encounter patients with a diagnosis of diabetes mellitus on a regular basis (NCD Risk Factor Collaboration, 2016). The current literature supports an association between diabetes and mild cognitive impairment (Moreira, Soldera, Cury, Meireles, & Kupfer, 2015; Vincent & Hall, 2015). Mild impairments in executive functioning are of particular relevance in this population. Even within the range of normal cognitive abilities, reduced executive functioning can negatively impact patients’ self-management of their diabetes (and potentially adherence to therapy programs and strategies) and therefore their overall health. Mild cognitive deficits in this population are therefore clinically relevant and may warrant intervention (Vincent & Hall, 2015). Diabetic complications may also impact digestion, indirectly impacting patients’ intake and tolerance of food and drink (Borgnakke, Anderson, Shannon, & Jivanescu, 2015; Gatopoulou, Papanas, & Maltezos, 2012; Hüppe et al., 1992; Sandberg, Sundberg, Fjellstrom, & Wikblad, 2000).

Evidence-based practice (EBP) has become a hallmark of modern medicine. Diving into the literature is an essential part of clinical decision-making. The management of rare disorders and disease almost always prompts a search, but the answers to important clinical questions can be challenging and rarely straightforward. The majority of us have endured the “EBP Class” of our academic careers, drilling the hierarchy of research evidence and whether strict inclusion/exclusion criteria were considered, etc. We frequently see our medical colleagues turn to high powered trials and meta-analyses, but such works are few and far between. Single-subject design, case studies, case series, and reviews of such cannot be discredited, especially within a profession that is relatively new in the broad scheme of medicine. The following case study details a clinician’s process through the identification, appraisal, and application of relevant literature in the management of a rare disorder: Lance-Adams syndrome. Proposed assessment considerations are intended to help the reader’s approach to diagnosis and intervention.

Speech–language pathologists (SLPs), and really their patients, are often faced with challenging clinical decisions to be made. Patients may decline interventions recommended by the SLP and are often inappropriately labeled “noncompliant.” The inappropriateness of this label extends beyond the negative charge; the patient's right to refuse is, in fact, protected by law. Anecdotal exchanges, social media platforms, and American Speech-Language-Hearing Association forums have recently revealed that many SLPs are struggling with the patient's right to decline. Many are not comfortable with the informed consent process and what entails patients' capacity to make their own medical decisions. Here, we discuss the basics of clinical decision-making ethics with intent to minimize the clinician's discomfort with the right to refuse those thickened liquids and eliminate the practice of defensive medicine.

BACKGROUND Eating, drinking, and feeding are individual acts signaling our values, our identity, our cultural alignment, and care giving. Humans need oxygen, a system to transport oxygen, and fuel (food and drink), but only with the last of these do we choose what, where and with whom. Swallowing difficulties (dysphagia) affect nine million adults in the United States. Health care providers report more discomfort with dysphagia decisions than other clinical interventions. Feeding is a unique form of clinical care because providers live in both worlds: eating, drinking and feeding as fundamentally and culturally part of 1) human experience and 2) clinical process. AIM To explore health care providers’ personal and professional attitudes to eating, drinking, and feeding focusing on the incongruities between the two perspectives. METHODS Two focus groups occurred with speech-language pathologists (total n=15) from rehabilitation settings and two groups with non-SLP front line providers (total n=15) from an urban health care network. Participants considered: 1) eating/drinking/feeding as a) a human experience, and b) a biomechanical task in dysphagia care, and 2) why health care providers may deviate from practice guidelines. Dialogue was audio recorded, transcribed and studied using Thematic Analysis. RESULTS A list of 33 codes gave rise to 8 themes: we eat and drink for health and life; meanings of food and feeding; nutrition/hydration versus food/drink; reasons for practice patterns; professional collaboration; patient control; economic concerns; improving things. Participants voiced concern that a) patients lose control over a highly meaningful life process, and b) health care providers do not recognize their role in this problem. Participants expressed inner turmoil with feeding interventions/decisions. BIOETHICAL SIGNIFICANCE Dysphagia intervention uniquely challenges and distresses people making decisions. Health care providers aim to do good but the definition o

Variability has long been known to be a primary feature of the disorder of stuttering (Bloodstein & Bernstein Ratner, 2008; Costello & Ingham, 1984; Yaruss, 1997a, 1997b). Many factors that affect variability have been investigated (Brown, 1937; Johnson & Brown, 1935; Quarrington, Conway, & Siegel, 1962) yet the typical range of variability experienced by speakers remains unknown. This study will examine the speech of six adult speakers in three spontaneous speaking situations and two reading tasks. The frequency, duration, and types of stuttered events that occur on the tasks will be compared within and between speakers. The focus will be on describing variability in stuttering frequency and duration within speakers and attempting to detect consistent patterns between speakers.

This is the first study to examine dysphagia assessment practices of UK/Ireland speech and language therapists. The aims were to (1) examine practice patterns across clinicians, (2) determine levels of consistency in practice, and (3) compare practices of clinicians in the UK/Ireland with those previously reported of clinicians in the United States. A questionnaire, developed for earlier U.S. research, was adapted following a pilot study. The resulting email survey was completed by 296 speech and language therapists working with dysphagic adults. Respondents were asked to rate how frequently they use 31 components of a clinical dysphagia examination. Consistency was determined by calculating the percentage of respondents who agreed on frequency of use. Low frequency of use was reported for four components: trials with compensatory techniques, obtain patient’s drug history, assessment of speech articulation/intelligibility, and screening/assessment of mental abilities. Variability among clinicians was high, with inconsistency observed for 6/31 components (19%) and high consistency for only 10/31 (32%). Results were compared with data from the earlier U.S. study. Notable differences in practice were observed for five components: cervical auscultation, trials with compensatory techniques, gag reflex, assessment of sensory function, and screening/assessment of mental abilities. Inconsistency among UK/Ireland clinicians was higher than in the comparator U.S. study. The clinical implications of these findings are discussed.