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Introduction: Outcome measurement instruments (OMIs) are used to gauge the effects of treatment. In post‐stroke aphasia rehabilitation, benchmarks for meaningful change are needed to support the interpretation of patient outcomes. This study is part of a research programme to establish minimal important change (MIC) values (the smallest change above which patients perceive themselves as importantly changed) for core OMIs. As a first step in this process, the views of people with aphasia and clinicians were explored, and consensus was sought on a threshold for clinically meaningful change. Methods: Sequential mixed‐methods design was employed. Participants included people with post‐stroke aphasia and speech pathologists. People with aphasia were purposively sampled based on time post‐stroke, age and gender, whereas speech pathologists were sampled according to their work setting (hospital or community). Each participant attended a focus group followed by a consensus workshop with a survey component. Within the focus groups, experiences and methods for measuring meaningful change during aphasia recovery were explored. Qualitative data were transcribed and analysed using reflexive thematic analysis. In the consensus workshop, participants voted on thresholds for meaningful change in core outcome constructs of language, communication, emotional well‐being and quality of life, using a six‐point rating scale (much worse, slightly worse, no change, slightly improved, much improved and completely recovered). Consensus was defined a priori as 70% agreement. Voting results were reported using descriptive statistics. Results: Five people with aphasia (n = 4, > 6 months after stroke; n = 5, < 65 years; n = 3, males) and eight speech pathologists (n = 4, hospital setting; n = 4, community setting) participated in one of four focus groups (duration: 92–112 min). Four themes were identified describing meaningful change as follows: (1) different for every single person; (2) small continuous improvements; (3) measured by progress towards personally relevant goals; and (4) influenced by personal factors. 'Slightly improved' was agreed as the threshold of MIC on the anchor‐rating scale (75%–92%) within 6 months of stroke, whereas after 6 months there was a trend towards supporting 'much improved' (36%–66%). Conclusion: Our mixed‐methods research with people with aphasia and speech pathologists provides novel evidence to inform the definition of MIC in aphasia rehabilitation. Future research will aim to establish MIC values for core OMIs. Patient or Public Contribution: This work is the result of engagement between people with lived experience of post‐stroke aphasia, including people with aphasia, family members, clinicians and researchers. Engagement across the research cycle was sought to ensure that the research tasks were acceptable and easily understood by participants and that the outcomes of the study were relevant to the aphasia community. This engagement included the co‐development of a plain English summary of the results. Advisors were remunerated in accordance with Health Consumers Queensland guidelines. Interview guides for clinicians were piloted by speech pathologists working in aphasia rehabilitation. [ABSTRACT FROM AUTHOR]

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For people with post-stroke aphasia, "Will I get better?" is a question often asked, but one that is intellectually and emotionally demanding for speech pathologists to answer. Speech pathologists' formulation and delivery of aphasia prognoses is varied and there is limited evidence for optimising practice. We aimed to understand speech pathologists' clinical experiences, reasoning, and support needs in aphasia prognostication. Twenty-five Australian speech pathologists working with people with aphasia participated in individual, semi-structured interviews. Their age, level of experience, work setting, and location were maximally varied. Interview responses were analysed qualitatively using thematic analysis. Five themes were drawn from the interviews: (1) prognostic challenges are shared but not voiced; (2) truth is there's no quick fix; (3) recovery is more than words; (4) the power of words; and, (5) prognostic competence is implicit. Speech pathologists use implicit competencies to formulate and deliver aphasia prognoses. A patient-centred, holistic contextualisation of aphasia recovery may enable realistic, optimistic, and constructive conversations about prognosis. These conversations may have therapeutic potential if prognostic uncertainty, emotional adjustment, and conditional outcomes are carefully addressed. Future research should seek to understand the perceptions and preferences of people with aphasia and their significant others. Aphasia prognostication in clinical practice is complex and nuanced, thus increased clinical and research focus is warranted to ensure key stakeholder needs are met. Conversations about prognosis may be more meaningful to people with aphasia if recovery is conceptualised as encompassing impairment, activity, and participation outcomes. Given the implicit competencies required for prognostication, a structured approach to reflective practice and experience-based training may be beneficial. Conversations about prognosis may have therapeutic value, but further research is needed to explore this potential. [ABSTRACT FROM AUTHOR]

People diagnosed with COVID-19 who require hospitalization are primarily admitted secondary to shortness of breath because of hypoxia but also display difficulties with overall muscle weakness, which could impair gait, activities of daily living, speech, cognitive-linguistics, or swallowing. This article provides a clinical perspective of how a physical therapist, occupational therapist, and speech language pathologist in the US Public Health Service Commissioned Corps were deployed with an augmentation team and how they improved care at a hospital that was overwhelmed with patients diagnosed with COVID-19. The rehabilitation team completed 246 evaluation and treatment encounters in a 12-day period and began seeing patients within 24 hours on-site. After the rehabilitation team arrived, patients were noted to be more mobile, independent in activities of daily living, and able to tolerate the least restrictive diets without signs and symptoms of aspiration. As a result of rehabilitation services, safe discharges were expedited, length of stay was reduced, and the hospitals' inpatient admission capacity was maximized. The augmentation team learned the importance of including rehabilitation specialties for treating patients with COVID-19. Mobilizing rehabilitation specialties along with medical and nursing staff helps maximize the overall recovery, health, and outcomes for patients. Leadership that is responsible for the development and deployment of future medical teams in military, emergency response, and public health efforts should consider all therapy disciplines as an essential component for each team. [ABSTRACT FROM AUTHOR]

To date, little research has explored clinical assessment practices in the management of dysarthria. The aim of the present study was to explore the practices and perspectives of Australian speech-language pathologists (SLPs) regarding outcome measures (OMs) in the management of dysarthria, including barriers and enablers to their use. A focus group methodology was used to explore the practices and perspectives of 16 SLPs working with adults with dysarthria. The 4 focus groups were transcribed and analysed using qualitative content analysis with barriers and enablers to the use of OMs analysed according to the Theoretical Domains Framework. Seven categories were identified regarding SLPs' practices and perspectives on the use of OMs in dysarthria management. These were related to the importance of assessments, OMs currently and not currently being utilised, ideal assessment features, perspectives on the development of a core set of OMs in dysarthria management, and perceived enablers and barriers to the use of OMs. Each category had a number of constituent subcategories. Overarching the categories was the theme: the who, why, when, where, what and how of dysarthria outcome measurement. The use of OMs in dysarthria is influenced by a range of factors including: the clinical setting, patient factors, and where and when the patient is in their recovery journey. Variability in the assessments used suggests that formal measures may not meet current clinical needs. [ABSTRACT FROM AUTHOR]

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

Purpose: Traumatic brain injury (TBI) impacts millions of children each year, with those between birth and 4 years of age being 1 of the highest incidence groups. To address gaps in service provision specifically for children with mild TBI (mTBI), the Centers for Disease Control and Prevention (CDC) recently released guidelines for providers. Method: The goal of this commentary is to deliver viewpoints on the application of the CDC guidelines directly to speechlanguage pathology clinical practice, with special attention paid to assessment, symptom monitoring, and intervention using a family-centered approach to care for infants, toddlers, preschoolers, and early elementary students with mTBI. Results: In all pediatric practice settings, speech-language pathologists (SLPs) are a critical component of the care team for children who experience mTBI and should participate in symptom monitoring, assessment, intervention, education, and advocacy for this population. Conclusions: SLPs can use the CDC guidelines to advocate for their role in the care of young children with mTBI. In addition, SLPs can use the guidelines to create a framework for clinical care provision when working with young children with mTBI. Much work is needed to advance evidence-based practices for this population, and dissemination of current clinical practices could help to close this gap. [ABSTRACT FROM AUTHOR]

Highlights • Children's self-report on recovery from stuttering should not replace traditional criteria (expert rating and parental report). • Children's self-report needs to be added when considering the status of stuttering. • Future studies on recovery should add self-reports to improve the validity of the stuttering recovery rate estimates. • Clinicians are recommended to take into account children's self-report on stuttering status. Abstract Purpose The first purpose was to define the recovery rate in children who stutter in a clinical sample, adding self-report to validate recovery status. The second purpose was to explore whether children who were judged to be recovered showed subjective experiences that might be interpreted as coping behaviors used to control speech fluency. Methods In this longitudinal study, preschool-age children whose parents consulted a speech-language pathologist about stuttering were followed for 9 years. At follow-up, children's self-reports on stuttering were reported, as well as traditional criteria on recovery (parental and expert judgment). The Overall Assessment of the Speaker's Experience of Stuttering (OASES) was used to collect children's experiences with speaking. Results Eleven of the 15 children (73%) were judged by parents and clinicians to have recovered from stuttering. However, when considering children's self-reports, 9 children (60%) might be considered to have recovered. In addition, 3 children who were judged to be recovered reported experiences with speaking that were uncommon, even compared to children who continued to stutter. Conclusion In this exploratory study of a clinical population , the recovery rate in children that received treatment for stuttering appeared to be comparable to a non-clinical population. Considering self-reports can improve validity of assessing the "recovery rate". Moreover, recovery in children may not be effortless; instead, it may be the result of conscious or unconscious coping behavior. Future studies are recommended to consider self-reports to improve validity of recovery, and to document experiences with speaking to explore effortless, spontaneous fluency versus controlled fluency. [ABSTRACT FROM AUTHOR]

Postconcussion patients who have made progress through individual speech and language therapy may continue to experience cognitive-communication deficits, which include changes in word finding, executive function, reading comprehension, written expression, and social skills. In this article, the authors describe a pragmatic language group approach to maximize recovery from persisting cognitive-communication deficits in patients with postconcussion symptoms. Findings suggest that the inclusion of a pragmatic language group in concussion management benefits patient care, enabling participants to regain preconcussion functional communication skills and improve quality of life. Prior to enrollment in the pragmatic language group, participants completed a course of individual speech and language treatment ranging from 3 to 6 months. Following intervention, participants presented with varying degrees of impairment that continued to interfere with their communication function. The application of group therapy is within the scope of practice of speech-language pathology for a variety of communication deficits (e.g., aphasia, stuttering, autism spectrum disorder, Parkinson's disease, multiple sclerosis). Group treatment provides a forum for rehearsal of learned techniques while receiving feedback and support from peers and prepares patients to actualize strategies in social, professional, and community environments (Luterman, 2008; Tuckman, 1965). The authors demonstrate the positive effects of pragmatic language group treatment for postconcussion symptoms, which facilitate a favorable recovery. [ABSTRACT FROM AUTHOR]

Purpose: Maturation of neural processes for language may lag in some children who stutter (CWS), and event-related potentials (ERPs) distinguish CWS who have recovered from those who have persisted. The current study explores whether ERPs indexing semantic processing may distinguish children who will eventually persist in stuttering (CWSePersisted) from those who will recover from stuttering (CWS-eRecovered). Method: Fifty-six 5-year-old children with normal receptive language listened to naturally spoken sentences in a story context. ERP components elicited for semantic processing (N400, late positive component [LPC]) were compared for CWS-ePersisted, CWS-eRecovered, and children who do not stutter (CWNS). Results: The N400 elicited by semantic violations had a more focal scalp distribution (left lateralized and less anterior) in the CWS-eRecovered compared with CWSePersisted. Although the LPC elicited in CWS-eRecovered and CWNS did not differ, the LPC elicited in the CWSePersisted was smaller in amplitude compared with that in CWNS. Conclusions: ERPs elicited in 5-year-old CWS-eRecovered compared with CWS-ePersisted suggest that future recovery from stuttering may be associated with earlier maturation of semantic processes in the preschool years. Subtle differences in ERP indices offer a window into neural maturation processes for language and may help distinguish the course of stuttering development. [ABSTRACT FROM AUTHOR]

Purpose: Childhood stuttering is common but is often outgrown. Children whose stuttering persists experience significant life impacts, calling for a better understanding of what factors may underlie eventual recovery. In previous research, language ability has been shown to differentiate children who stutter (CWS) from children who do not stutter, yet there is an active debate in the field regarding what, if any, language measures may mark eventual recovery versus persistence. In this study, we examined whether growth in productive language performance may better predict the probability of recovery compared to static profiles taken from a single time point. Method: Productive syntax and vocabulary diversity growth rates were calculated for 50 CWS using random coefficient models. Logistic regression models were then used to determine whether growth rates uniquely predict likelihood of recovery, as well as if these rates were predictive over and above currently identified correlates of stuttering onset and recovery. Results: Different linguistic profiles emerged between children who went on to recover versus those who persisted. Children who had steeper productive syntactic growth, but not vocabulary diversity growth, were more likely to recover by study end. Moreover, this effect held after controlling for initial language ability at study onset as well as demographic covariates. Conclusions: Results are discussed in terms of how growth estimates can be incorporated in recommendations for fostering productive language skills among CWS. The need for additional research on language in early stuttering and recovery is suggested. [ABSTRACT FROM AUTHOR]

This second article of a two-part case study focuses on the experiences of a patient and his spouse (caregiver) when a neurological trauma occurs. It is the personal account when A.B. survived a vertebral artery aneurysm and hemorrhage resulting in a subarachnoid hemorrhage. It is also an in-depth post-trauma account from two speech-language pathologists' viewpoints (i.e., patient and spouse/caregiver). Present-day persistent difficulties, 5 years post-trauma, are also presented. Therapeutic strategies for managing working memory difficulties, attention issues, and word retrieval issues are given. The spouse's perspective on managing emotional and caregiver stressors and recommendations based on these personal experiences and the Caregiver Empowerment Scale are provided. Suggestions for patients with neurological trauma returning home are suggested to improve home and social integration. In addition, strategies for caregivers are suggested to reduce stress and improve quality of life. [ABSTRACT FROM AUTHOR]

Subarachnoid hemorrhages (SAHs) are a serious medical emergency, as 30% to 50% of all SAHs can result in death. Personal accounts and case studies are an important aspect of evidence-based practice. This first article of two presents a review of AB’s (patient) condition immediately following an SAH in the intensive care and immediately post discharge, that is, Days 1 through 22. An SAH shares many similarities with other neurological traumas such as a cerebral vascular accident, meningitis, and/or traumatic brain injury. Speech-language pathologists (SLPs) in medical settings have worked with patients and families with these types of disorders. Therefore, SLPs should be well equipped to assist with SAH issues from their existing knowledge and experiences. [ABSTRACT FROM AUTHOR]

Purpose: Dysphagia is common sequelae of chemical ingestion injury, resulting from damage to critical swallowing structures. From a speech-language pathology perspective, this study outlines the physiological deficits in 2 individuals with severe injury (1 woman, acid; 1 man, alkali) and the pattern of dysphagia rehabilitation and recovery. Method: A retrospective chart review of clinical and instrumental assessments was conducted to examine swallow characteristics and speech-language pathology management (compensatory and rehabilitation strategies) at multiple time points. Results: Chemical ingestion injury resulted in severe pharyngeal dysphagia for both participants, warranting speech-language pathology management. Dysphagia was characterized by poor base of tongue mobility and reduced laryngeal excursion. Decreased airway patency and protection, secondary to mucosal sloughing, widespread edema, and structural deficits necessitated tracheostomy. Recovery was complicated by physical alterations of pharyngeal and laryngeal structures (e.g., interarytenoid adhesions) and esophageal strictures. Participant 1 was discharged (Day 135) consuming a texture-modified diet; Participant 2 remained nil by mouth (Day 329). Conclusions: Dysphagia recovery subsequent to chemical ingestion is protracted and complex. Clinical outcomes may be improved through individualized and intensive rehabilitation by speech-language pathologists. [ABSTRACT FROM AUTHOR]

Objective: Awareness deficits are common after traumatic brain injury (TBI); however, relatively little is known of awareness deficits in the early stages post-injury. This study outlines the development of a new tool, 'The Insight Interview', designed to measure awareness across different domains (awareness of change, severity of deficits, current and future functional consequences) from 3 months post-TBI. Methods: Forty-three patients with at least a severe TBI, their nominated family member and treating clinician were all administered different versions of the Insight Interview during the patient's inpatient stay. Awareness was measured; (1) by calculating a discrepancy score between the patient's and their family informant's and/or clinician's ratings of the patient's abilities and (2) using interviewer-based ratings of the patients' responses to interview questions. Results: Awareness differed depending upon the domain being assessed, with patients demonstrating greatest awareness in the current functional consequences domain. Evidence for a distinction between awareness of current and future functional consequences of impairments was also seen. Discrepancy scores and interviewer-based ratings showed good concordance. Adequate reliability and validity was demonstrated. Conclusion: The Insight Interview is a useful and valid tool for measuring awareness in the acute stages following TBI and highlights that awareness depends on domain assessed. [ABSTRACT FROM AUTHOR]

The provision of information about cognitive-communication disorders (CCDs) following traumatic brain injury (TBI) is important given the impact these communication impairments can have on the rehabilitation of people with TBI. This study describes the results of an online survey which investigated the current practices of 74 Australian speech-language pathologists (SLPs) working with adults with TBI. Thirty-seven SLPs outlined their practices in information provision. SLPs reported they provide information to adults with TBI about CCDs, the impact of CCDs on participation in life activities, and rehabilitation from CCDs. In addition, SLPs identified barriers and facilitators to information provision. Barriers identified included time, impairments resulting from TBI, and personal characteristics of the client. Facilitators included family functioning and support and the multidisciplinary team. Findings of this research indicate a need for some changes in the format and content of information that SLPs provide to adults with TBI, to ensure they can achieve fundamental levels of health literacy and better health outcomes. [ABSTRACT FROM AUTHOR]

AAC supports in the ICU/Acute Care vary by patient presentation. Our 20+ years of bedside service delivery reveals trends in patient needs for AAC across the continuum of care. We detail three phases of AAC assessment and intervention and the role of SLP in the assessment/feature matching process. [ABSTRACT FROM AUTHOR]

Abstract: This post hoc study investigated coverbal gesture patterns in two persons with chronic Wernicke''s aphasia. They had both received therapy focusing on multimodal communication therapy, and their pre- and post-therapy verbal and gestural skills in face-to-face conversational interaction with their speech therapist were analysed by administering a partial barrier Referential Communication Task (RCT). The RCT sessions were reviewed in order to analyse: (a) participant coverbal gesture occurrence and types when in speaker role, (b) distribution of iconic gestures in the RCT communicative moves, (c) recognisable semantic content, and (d) the ways in which gestures were combined with empty or paraphasic speech. At post-therapy assessment only one participant showed improved communication skills in spite of his persistent language deficits. The improvement corresponded to changes on all gesturing measures, suggesting thereby that his communication relied more on gestural information. No measurable changes were observed for the non-responding participant—a finding indicating that the coverbal gesture measures used in this study might account for the different outcomes. These results point to the potential role of gestures in treatment aimed at fostering recovery from severe fluent aphasia. Moreover, this pattern of improvement runs contrary to a view of gestures used as a pure substitute for lexical items, in the communication of people with severe fluent aphasia. Learning outcomes: The readers will describe how to assess and interpret the patterns of coverbal gesturing in persons with fluent aphasia. They will also recognize the potential role of coverbal gestures in recovery from severe fluent aphasia. [Copyright &y& Elsevier]

The article describes a case of a speech-language pathologist (SPL) who is faced with an ethical dilemma concerning her job. The pathologist was sent by her employer on a course to be trained in Therapy X. She queries the use of such therapy as there is no research evidence to support it. Some ideas based on American Speech-Language-Hearing Association (ASHA) publications are presented to help clarify what is and is not appropriate practice.

Medulla blastomas are known to be invasive and rapidly growing tumors. This case study follows a boy’s journey for 3 years from when he was first diagnosed with medulla blastoma. The journey illustrates the complexities and challenges faced by individuals treated for brain tumors. A multifaceted view based on psychometric, cognitive-neuroscience, and humanistic approaches can be beneficial during the assessment and intervention of children with a similar diagnosis. The article also highlights how family and society both play an important role in an individual’s quality life. The boy’s journey is presented through the lens of a speech-language pathologist. [ABSTRACT FROM PUBLISHER]

A personal narrative is presented which explores the author's experience of playing the role of a caregiver for her husband, who is recovering from a stroke which resulted in aphasia.

The article reports on the position that the American Speech-Language Hearing Association, The Voice and Speech Trainers Association Inc. and the National Association of Teachers of Singing have developed for the management of singers with voice problems and disorders. A discussion of the results of a survey of the teaching practices and beliefs of vocal music teachers who treat voice disorders in singers is presented. In the article the authors attempt to develop a consensus regarding the optimal team which is needed to treat singers with vocal pathologies and attempt to offer a definition of the singing voice specialist.

Purpose: This response addresses comments made by Marcotte (2019) regarding our recent publication, "Preliminary Evidence That Growth in Productive Language Differentiates Childhood Stuttering Persistence and Recovery" (Leech, Bernstein Ratner, Brown, & Weber, 2017). Marcotte calls into question our finding that language growth is a valid predictor of recovery from stuttering because we did not account for treatment and family history. Conclusions: In response to her comments, we provide additional empirical analyses couched in a larger discussion of the difficulty of calibrating treatment and family history of stuttering. In short, we show that once treatment history and family history of stuttering are accounted for, the effect of language growth remains a significant predictor of stuttering persistence. [ABSTRACT FROM AUTHOR]