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Objectives: Although much is known about discourse impairment, little is known about discourse recovery after severe traumatic brain injury (TBI). This paper explores discourse recovery across the critical first year, controlling for pre-injury, injury and post-injury variables. Design and methods: An inception cohort comprising 57 participants with severe TBI was examined at 3, 6, 9 and 12 months post-injury and compared to a cross-section of matched healthy control participants. A narrative discourse task was analyzed with main concept analysis (MCA). A mixed linear model approach was used to track recovery controlling for pre-injury, injury and post-injury variables. Results: An upward trajectory of recovery was observed, with peak periods of improvement between 3-6 and 9-12 months and all time points were significantly below controls. Years of education and PTA duration were significant covariates in the recovery model. Presence of aphasia also influenced the recovery model. Conclusions: Individuals with TBI typically improve over the first year, however many will continue to have discourse deficits at 12 months. Years of education, PTA duration and aphasia should be considered when planning services. The 3-6- and 9-12-month periods may offer optimal periods for discourse recovery and increased supports may be beneficial between 6-9 months. [ABSTRACT FROM AUTHOR]

This article explores how ethics can facilitate "recipes" for successful treatment outcomes for people at the end of life. Conversations between a speech-language pathologist, dietitian, and two members of the Speech Pathology Australia Ethics Board delve into how client circumstances, professional philosophies, and ethical approaches may influence recommended treatment options for an individual. Our goal is to highlight the importance of listening to the "other" when decision-making around end of life nutrition and hydration options is necessary. A complex scenario of a client with advanced head and neck cancer is used as a stimulus for this conversation. [ABSTRACT FROM AUTHOR]

Background: There is limited research on communicative recovery during the early stages after a severe traumatic brain injury (TBI) in adults. Methods and procedures: In the current study 43 people with severe TBI described a simple procedure at 3 and 6 months post injury and this was compared to the description provided by 37 healthy speakers. Linguistic productivity and the presence of macrostructural discourse elements were analysed. Main outcomes and results: No change occurred in productivity in the TBI group between the two time points. There was increased use of relevant information (macrostructure) over time for the TBI group, reflecting improvement. People with TBI differed from controls in speech rate and in two out of three macrostructural categories at both time points, indicating difficulties even after 12 weeks of recovery. Conclusions: Overall, the quality, rather than the quantity of discourse was disordered for participants with TBI. Findings indicate that procedural discourse is sensitive to discourse deficits of people with TBI and can be used to map recovery during the sub-acute phase. [ABSTRACT FROM AUTHOR]

Purpose: (i) To systematically review longitudinal and prognostic studies relating to the trajectory of cognitive-communication recovery after TBI and (ii) to provide recommendations to strengthen future research. Method: Thirteen health literature databases were accessed up until July 2014. Main measures: Articles were screened systematically against pre-determined inclusion and exclusion criteria. Quality reviews were performed on the selected articles using a modified Downs & Black Rating Scale. Two independent reviewers performed the reviews. Result: Sixteen longitudinal and prognostic articles met the inclusion criteria. There was evidence of either maintenance or improvement of cognitive-communication skills during the first 3 years post-injury. However, the studies did not provide detailed recovery trajectories, by failing to evaluate numerous data points over time. No studies evaluated recovery beyond 3 years post-injury. Injury severity, lesion location, brain volume loss and conversation skills may predict specific cognitive-communication outcomes. There was high variability in study characteristics and measures. Conclusion: There is currently scarce evidence regarding cognitive-communication recovery and prognosis. People with TBI may recover or maintain pre-morbid cognitive-communication skills during the early rehabilitation stage. Further research detailing the recovery trajectory with a view to evaluating predictive factors is strongly indicated. Guidelines for future research are provided. [ABSTRACT FROM AUTHOR]

Speech-language pathologists working with adults across the continuum of care from acute sub-acute hospitals to in home community services and nursing homes frequently encounter people diagnosed with dementia. Patients with dementia and their families often face challenging decisions about current and future management plans and goals of care. Speech pathologists must also address ethical challenges in providing care for such patients. This article discusses how speech-language pathologists may contribute to "doing good" to enable quality end-of-life care for people with advanced dementia through their communication and dysphagia expertise. Case studies illustrate the potential role of speech language pathologists in improving the quality of end-of-life care for people with advanced dementia. [ABSTRACT FROM AUTHOR]

In this paper Belinda Kenny and Susan Block, members of the Speech Pathology Australia Ethics Board, reflect upon the challenges and opportunities facing speech pathologists as they make decisions about client interactions and intervention. Such challenges can be particularly stressful when clinicians attempt to evaluate, interpret and maintain best practice and emerging evidence, and balance the demands of everyday clinical practice. [ABSTRACT FROM AUTHOR]

In this paper, Suze Leitão, Chair of the Speech Pathology Australia Ethics Board, reflects on emerging ethical and professional issues and discusses some of the Speech Pathology Australia documents that can act as a resource for members of the profession. Members of the Board were asked to respond to the question: “What do you consider to be emerging ethical and professional issues in your workplace?” This article discusses some of the key themes that emerged and reflects on the need to be pro-active in our professional lives. [ABSTRACT FROM AUTHOR]

In this paper Belinda Kenny and Susan Block, members of the Speech Pathology Australia Ethics Board, reflect upon the challenges and opportunities facing speech pathologists as they make decisions about client interactions and intervention. Such challenges can be particularly stressful when clinicians attempt to evaluate, interpret and maintain best practice and emerging evidence, and balance the demands of everyday clinical practice. [ABSTRACT FROM AUTHOR]

Ethics are an integral factor in effective clinical decision-making. While codes of ethics do not provide a recipe for resolving ethical dilemmas, knowledge and open discussion of bioethical principles may facilitate ethical practice in the speech pathology profession. This paper focuses upon some of the ethical issues that may confront speech pathologists in contemporary health care practice and aims to facilitate discussion of ethical practice in the speech pathology profession. [ABSTRACT FROM AUTHOR]