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Purpose: The intervention of thickened liquids (TL) is commonly used to reduce aspiration in people with dysphagia. Speech-language pathologists (SLPs) have traditionally believed it is an effective intervention. Recent articles highlight limited evidence, poor acceptance, and a variety of unintended consequences. This study explores if current debates have been reflected in SLP practices and perspectives., Method: An e-survey was developed. Participants were recruited via professional associations in Australia, New Zealand, Ireland, the United Kingdom, and the United States. Descriptive and inferential statistics were used to explore the data. Principal component analysis was used to summarize SLP practices and perspectives., Results: The 370 respondents represented mainly experienced, confident, hospital-based clinicians. While 20% of respondents frequently recommend TL, 61% believe it to be a burdensome treatment. "Best treatment" and "It works" beliefs continue to underpin decision making. Those who recommend TL most often are most influenced by penetration, coughing, and their own clinical experience. They are more likely to believe TL is evidence based and effective, reduces aspiration, and improves hydration. Person-centeredness is important among all respondents, although significant numbers would implement TL against patient wishes. Improvements in aspiration status and quality of life rank highly as reasons to discontinue TL., Conclusions: The results of this study suggest that fewer respondents are regularly using TL. Divergent groups are evident with those frequently employing and believing in the efficacy of TL and those who do not. While current debates are influencing practice, there clearly remains a significant number of SLPs continuing to recommend TL. This study's findings highlight both alterations and preservations in the discipline's approach to TL and calls for SLPs to reframe our thinking regarding this intervention as well as consider alternative options in this treatment space., Supplemental Material: https://doi.org/10.23641/asha.24317110.

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 (1) align course learning objectives with a grading system, (2) implement a pass/fail approach even for complex assessment, (3) define specifications, (4) create and sequence bundles of assessments, and (5) provide instructor support through feedback and tokens., Competing Interests: None declared., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

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., Competing Interests: None declared, (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Purpose: This study surveyed didactic and clinical education in fluency disorders at undergraduate and graduate institutions in the United States that provide education in speech-language pathology to determine whether a previously observed reduction in requirements has continued since prior surveys (Yaruss, 1999; Yaruss & Quesal, 2002)., Method: The study involved a detailed questionnaire that was sent to 282 communication science and disorders departments. Questions examined didactic and clinical education, as well as faculty knowledge about fluency disorders., Results: Comparisons with prior surveys revealed several findings, including (a) on average, programs have increased academic coursework and incorporated more practical sessions and competency-based testing in the classroom; (b) the number of faculty who possess extensive clinical experience with fluency disorders has decreased; and (c) although an increase in clinical requirements in fluency disorders was detected, the number of programs providing minimal education about fluency disorders remains high., Conclusion: Given an expanding scope of practice, many programs have continued to try to provide adequate education about fluency disorders. Still, direct clinical experiences are limited, and faculty expertise in this area has continued to decrease. To raise students' confidence and competence in fluency disorders, efforts beyond graduate work-or systemic changes in the profession-may be necessary.

Purpose: Speech-language pathologists routinely assess physical tension during evaluation of those who stutter. If speakers experience tension that is not visible to clinicians, then judgments of severity may be inaccurate. This study addressed this potential discrepancy by comparing judgments of tension by people who stutter and expert clinicians to determine if clinicians could accurately identify the speakers' experience of physical tension., Method: Ten adults who stutter were audio-video recorded in two speaking samples. Two board-certified specialists in fluency evaluated the samples using the Stuttering Severity Instrument-4 and a checklist adapted for this study. Speakers rated their tension using the same forms, and then discussed their experiences in a qualitative interview so that themes related to physical tension could be identified., Results: The degree of tension reported by speakers was higher than that observed by specialists. Tension in parts of the body that were less visible to the observer (chest, abdomen, throat) was reported more by speakers than by specialists. The thematic analysis revealed that speakers' experience of tension changes over time and that these changes may be related to speakers' acceptance of stuttering., Conclusion: The lack of agreement between speaker and specialist perceptions of tension suggests that using self-reports is a necessary component for supporting the accurate diagnosis of tension in stuttering., (© 2018 S. Karger AG, Basel.)

Hersh (2010) raises important issues regarding the ending of the therapeutic relationship. In this paper, we will explore this concept in relation to speech-language pathology (SLP) and palliative care. Palliative care aims to affirm life and minimize the complications of life limiting disease. Speech-language pathologists (SLPs) work with people with progressive and life limiting disease as rehabilitation experts but often work independently of specialist palliative care teams. Rehabilitation may seem incongruent with palliation but SLPs have a vital role in the empowerment of patients with communication difficulties and symptom reduction through specialist dysphagia management and communication therapy. This is vital in the last months and weeks of life. Starting and closing episodes of care remains a challenging area for therapists. SLP membership of palliative care multidisciplinary teams is limited and there may be a lack of understanding between professionals regarding the SLP role. In this paper we will use case studies and the palliative care literature to define a role for rehabilitation and the transition from supportive to palliative rehabilitation and closing episodes of care.

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.

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' 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. [ABSTRACT FROM AUTHOR]