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Background: Dysphagia impacts negatively on quality of life, however there is little in-depth qualitative research on these impacts from the perspective of people with dysphagia. Aims: To examine the lived experiences and views of people with lifelong or ongoing dysphagia on the impacts of dysphagia and its interventions on quality of life, and barriers and facilitators to improved quality of life related to mealtimes. Methods & Procedures: Nine adults with lifelong or acquired chronic dysphagia engaged in in-depth interviews and a mealtime observation. The observations were recorded and scored using the Dysphagia Disorders Survey (DDS). Interviews were recorded, transcribed and de-identified before content thematic and narrative analysis, and verification of researcher interpretations. Outcomes & Results: Participants presented with mild to severe dysphagia as assessed by the DDS. They viewed that dysphagia and its interventions reduced their quality of life and that they had 'paid a high price' in terms of having reduced physical safety, reduced choice and control, poor mealtime experiences, and poor social engagement. As part of their management of dysphagia, participants identified several barriers to and facilitators for improved quality of life including: being involved in the design of their meals, being adaptable, having ownership of swallowing difficulties, managing the perceptions of others and resisting changes to oral intake. Conclusions & Implications: This research improves understanding of the primary concerns of people with dysphagia about their mealtime experiences and factors impacting on their quality of life. Clinicians working with people with dysphagia need to consider how self-determination, autonomy and freedom of choice could be improved through involvement in food design of texture-modified foods. It is important that future research considers the views of health professionals on how these findings could impact on policy and practice particularly in ways to address the barriers and enhance facilitators to improved quality of life for people with dysphagia.

Background: People with communication disability following stroke are at risk of falls during inpatient rehabilitation. However, they are often excluded from hospital falls research, and little is known about the circumstances or outcomes of their falls to inform risk management strategies. Aims: To examine hospital medical records and incident reports relating to falls of patients with communication disability following stroke for content codes, categories and themes relating to communication. Methods & Procedures: This medical record chart review examined data on 72 patients and 265 falls. A content thematic analysis was used to identify how patient communication is characterized in relation to falls, and their prevention and management strategies. Outcomes & Results: The data reflected that staff viewed patients having difficulty following simple instructions as contributing to falls. Gaining the attention of staff and communicating basic needs were also considered to be contributing factors for falls. Patients were often described as experiencing a fall when taking a risk or attempting to address an unmet basic need. Furthermore, written notes for patients with more severe communication disability reflected that the patient's communication impairments prevented staff from establishing the circumstances of some falls and complicated the assessment for injury following a fall. Conclusions & Implications: The medical records and incident reports of patients with communication disability following stroke reveal that hospital staff recognize the impact of communication disability as potential risk factors for falls for this group. It was difficult for staff to report the circumstances of the fall for patients with severe communication disability. Despite the recognition of communication as a potential contributing factor, few medical record entries documented strategies related to communication interventions to improve patients' ability to understand instructions, gain attention or communicate basic needs.

Purpose: To systematically review the research relating to views and experiences of people with disability eating out in cafés, restaurants, and other settings; and identify factors that impede or enhance accessibility of eating out experiences, inform future inclusive research, and guide policy development. Materials and Methods: This study involved systematic search and review procedures with qualitative metasynthesis of the barriers to and facilitators for participation and inclusion in eating/dining-out activities. In total, 36 studies were included. Results: Most studies reviewed related to people with physical or sensory disability eating out, with few studies examining the dining experiences of adults with intellectual or developmental disability, swallowing disability, or communication disability. People with disability encountered negative attitudes and problems with physical and communicative access to the venue. Staff lacked knowledge of disability. Improvements in the design of dining spaces, consultation with the disability community, and staff training are needed. Conclusion: People with disability may need support for inclusion in eating out activities, as they encounter a range of barriers to eating out. Further research within and across both a wide range of populations with disability and eating out settings could guide policy and practice and help develop training for hospitality staff. IMPLICATIONS FOR REHABILITATION: Some people with disability require support for increased self-determination and self-advocacy to access eating out experiences satisfactorily. Goals and strategies to increase access and participation in eating out activities for people with disability should include attention to the environment and hospitality venues and to staff training. Rehabilitation professionals have a role in training hospitality staff about disability access and inclusion in eating out activities. To enhance community inclusion and participation, rehabilitation professionals could focus more on the skills and strategies needed for people with disability to participate in eating out activities. Rehabilitation professionals could implement a range of facilitators that might strengthen participation in eating out activities for people with disability. [ABSTRACT FROM AUTHOR]

Background: A recent literature review identified that past research has described the impacts of dysphagia on quality of life; but there is limited research on these impacts from the perspective of people with dysphagia, their supporters and allied health professionals. Recent qualitative research has provided details about these perspectives, but researchers have also called for verification of these findings with a larger group of participants. Aims: To expand upon the findings of the prior qualitative research on the views of people with dysphagia, supporters of people with dysphagia, and allied health professionals on the impacts of dysphagia and texture‐modified food on quality of life. Methods & Procedures: An online survey of adults with dysphagia (n = 30), supporters of people with dysphagia (n = 4) and allied health professionals (n = 18) was conducted between November 2021 and February 2022. Categorical questions were analysed descriptively and open‐ended questions were analysed for content categories of meaning. Outcomes & Results: Participants with dysphagia reported that dysphagia and texture‐modified foods had a greater impact on their physical health than on their choice and control or social engagement. Supporters and allied health professionals viewed that dysphagia impacted the physical health and their choice and control of people with dysphagia. Across groups, participants considered that mealtime enjoyment, participation, and inclusion were influenced by the control the person had over their meals, the accessibility of the mealtime environment, and the attitudes of others. Conclusions & Implications: Dysphagia and its interventions negatively impact quality of life for people with dysphagia. People with dysphagia were the most affected by the physical impacts of dysphagia. Their perspectives contrasted with those of supporters and allied health professionals in some domains, highlighting the need for people with dysphagia to be included in research. Future research exploring how these perspectives are integrated into person‐centred dysphagia management is warranted. WHAT THIS PAPER ADDS: What is already known on the subject: Recent qualitative research has provided insights into the impacts of dysphagia on quality of life from the perspective of people with dysphagia, supporters of people with dysphagia, and allied health professionals. However, the small scale of these studies means that further research is needed with a larger group of people with dysphagia, supporters of people with dysphagia, and allied health professionals. What this paper adds to existing knowledge: This paper verifies and extends upon the findings of prior qualitive research on the views of people with dysphagia, supporters of people with dysphagia, and allied health professionals on the impacts of dysphagia and its interventions on quality of life, participation, and inclusion. What are the potential or actual clinical implications of this work?: This research shows the importance of supporters of people with dysphagia and allied health professionals discussing mealtime quality of life with the person with dysphagia so that their perspectives are considered in the mealtime decision‐making process. Furthermore, people with dysphagia should be able to specify strategies they want to trial to enhance their mealtime participation and inclusion. [ABSTRACT FROM AUTHOR]

Background: Falls are a common safety incident in people with stroke. Studies report that between 14% and 65% of people with stroke fall at least once during their hospital admission. Risk factors for falls in people with stroke have been reported to include neglect, balance and dependence for activities of daily living. Communication disability has been identified as a risk factor for patient safety incidents in hospital that has not been closely examined as a potential risk factor for falls in people with stroke. Aim: To determine the association between communication disability secondary to stroke and falls in people with stroke in hospital. Methods & Procedures: Systematic searches of five electronic databases were conducted in June 2019 using the key concepts of 'falls' and 'stroke' (PROSPERO CRD 42019137199). Included studies provided comparative data of falls in patients with stroke with and without communication disability. The methodological quality of the studies was examined using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Both a narrative synthesis and a meta-analysis were completed. Main Contribution: A total of 15 studies met the criteria for inclusion and 11 were included in a meta-analysis. Three studies found people with communication disability had an increased rate of falls in hospital. However, a meta-analysis showed no significant association between a non-specific classification of communication disability and an increased risk of falls. There was some indication from individual studies that higher risk of falls may be associated with severe communication disability, but there were insufficient data reported on the severity of the communication disability to draw robust conclusions. Conclusion & Implications: The results of this systematic review suggest that a generic classification of communication disability following stroke is not a risk factor for falls. However, further research that is inclusive of this population and considers severity of communication disability more specifically is required.

Background: Social media can support people with communication disability to access information, social participation and support. However, little is known about the experiences of people with traumatic brain injury (TBI) who use social media to determine their needs in relation to social media use. Aims: To determine the views and experiences of adults with TBI and cognitive-communication disability on using social media, specifically: (1) the nature of their social media experience; (2) barriers and facilitators to successful use; and (3) strategies that enabled their use of social media. Methods & Procedures: Thirteen adults (seven men, six women) with TBI and cognitive-communication disability were interviewed about their social media experiences, and a content thematic analysis was conducted. Outcomes & Results: Participants used several social media platforms including Facebook, Twitter, Instagram and virtual gaming worlds. All but one participant used social media several times each day and all used social media for social connection. Five major themes emerged from the data: (1) getting started in social media for participation and inclusion; (2) drivers to continued use of social media; (3) manner of using social media; (4) navigating social media; and (5) an evolving sense of social media mastery. In using platforms in a variety of ways, some participants developed an evolving sense of social media mastery. Participants applied caution in using social media, tended to learn through a process of trial and error, and lacked structured supports from family, friends or health professionals. They also reported several challenges that influenced their ability to use social media, but found support from peers in using the social media platforms. This information could be used to inform interventions supporting the use of social media for people with TBI and directions for future research. Conclusions & Implications: Social media offers adults with TBI several opportunities to communicate and for some to develop and strengthen social relationships. However, some adults with TBI also reported the need for more information about how to use social media. Their stories suggested a need to develop a sense of purpose in relation to using social media, and ultimately more routine and purposeful use to develop a sense of social media mastery. Further research is needed to examine the social media data and networks of people with TBI, to verify and expand upon the reported findings, and to inform roles that family, friends and health professionals may play in supporting rehabilitation goals for people with TBI.

Background: The aim of this review was to explore the legal, ethical, and rights issues surrounding use of the Australian My Health Record (MyHR) by people with communication disability. Method: We undertook a narrative review of the legislation and research affecting the implementation of MyHR in populations with communication disability. Results: Use of MyHR by people with communication disability will require careful consideration in relation to (a) capacity and consent; (b) roles of nominated or authorised representatives in the system; and (c) the way decisions are made in relation to the use of MyHR, including supported decision-making for people with intellectual disability. Conclusion: Legal and ethical issues in the use of MyHR by people with communication disability centre on legal rights and equal access. These issues must be addressed if people with communication disability are to have full access to their legal rights and access in exercising personal choice and control in the use of MyHR.

Although 3D food printing is expected to enable the creation of visually appealing pureed food for people with disability and dysphagia, little is known about the user experience in engaging with 3D food printing or the feasibility of use with populations who need texture-modified foods. The aim of this study was to explore the feasibility and usability of using domestic-scale 3D food printer as an assistive technology to print pureed food into attractive food shapes for people with dysphagia. In total, 16 participants engaged in the unfamiliar, novel process of using a domestic-scale 3D food printer (choosing, printing, tasting), designed for printing pureed food, and discussed their impressions in focus group or individual interviews. Overall, results demonstrated that informed experts who were novice users perceived the 3D food printing process to be fun but time consuming, and that 3D food printers might not yet be suitable for people with dysphagia or their supporters. Slow response time, lack of user feedback, scant detail on the appropriate recipes for the pureed food to create a successful print, and small font on the user panel interface were perceived as barriers to accessibility for people with disability and older people. Participants expected more interactive elements and feedback from the device, particularly in relation to resolving printer or user errors. This study will inform future usability trials and food safety research into 3D printed foods for people with disability and dysphagia. 3D food printers potentially have a role as an assistive technology in the preparation of texture-modified foods for people with disability and dysphagia. To increase feasibility, 3D food printers should be co-designed with people with disability and their supporters and health professionals working in the field of dysphagia and rehabilitation. Experts struggled to be able to print 3D pureed shapes owing to relatively low usability of the 3D food printer tested with problems using the interface and resolving problems in the print. 3D food printing is a fun and novel activity and may help to engage people with disability and dysphagia in making choices around the shape of the food to be printed. [ABSTRACT FROM AUTHOR]

Background: Augmented reality (AR) technologies may provide immersive visual supports that foster active user engagement in activities. However, there is little research examining the use of AR as a visual support to guide its use in research or therapy settings. Aims: To investigate the development and use of AR for delivering visual supports in an immersive environment, using the Microsoft® HoloLens2® and Microsoft® Dynamics 365 Guides® software. Method: In a duo-ethnography, two speech-language pathologists who were novice users of the HoloLens2®, examined the affordances of the device for potential use in future research with people with neurodevelopmental disability. In a proof-of-concept study, an AR application was designed by the first author and used by two researchers in a duo-ethnography. The first and second author tested the AR guide and reflected on opportunities and barriers to further use of AR technology, specifically the HoloLens2®, to support people with disability to participate and be included in meaningful activities. Results: The guide created provided situated visual instructions, video models, and holographic symbols to direct the second author in making of a cup of tea. While a moderate level of technological literacy was needed to establish and install a guide, effective use could be established with minimal training. Discussion & conclusions: AR guides offer a situated and integrated means of providing visual support to people with disabilities. This proof-of-concept study justifies further testing and evaluation of AR as an assistive technology for people with neurodevelopmental disability. Emerging immersive Augmented Reality technology provides new opportunities to create integrated visual supports that function within the user's environment to enable active participation in activities and interactions. Visual supports integrated with the user's environment may better support people with disability to actively engage and attend to objects and to their communication partners. While new and emerging technologies like Augmented Reality are largely untested for disability support, they offer opportunities to enable participation in independent activities. [ABSTRACT FROM AUTHOR]

To understand the views of people with dysphagia and their supporters on the feasibility of using 3D food printing to improve the visual appeal of texture-modified foods and their mealtime experiences. Nine people with dysphagia and four of their supporters engaged in a virtual 3D food printing experience and interview over Zoom© about their impressions and usability of the printer and potential for it to improve their mealtime experiences. The in-depth interviews were analysed using thematic analysis and usability heuristics. Four content themes in the interviews impacted on the feasibility of 3D food printing. They related to the practicality, design acceptability, population suitability, and cost of 3D food printing. Usability heuristic analysis revealed that print quality, user control, error prevention, and handling of food consistencies would impact on use. Perceived low efficiency and increased time required to create food shapes meant participants were cautious in their overall impressions of the role of the device. After an immersive virtual experience with a 3D food printer, people with dysphagia and their supporters identified a wide range of usability issues that would need to be addressed prior to implementation and in the future design of user-friendly 3D food printers for people with dysphagia. Future research should include people with dysphagia and their supporters in 3D food printer design and implementation trials. 3D food printing may provide people with dysphagia who require texture-modified food a way to produce visually appealing texture-modified food if usability issues are addressed. 3D food printing could improve participation in meal preparation if the person with dysphagia chooses the food and the shape and size of the printed food shape. [ABSTRACT FROM AUTHOR]

Virtual reality (VR) lends itself to communication rehabilitation by creating safe, replicable, and authentic simulated environments in which users learn and practice communication skills. The aim of this research was to obtain the views of health professionals and technology specialists on the design characteristics and usability of a prototype VR application for communication rehabilitation. Nine professionals from different health and technology disciplines participated in an online focus group or individual online interview to evaluate the application and use of the VR prototype. Data sources were analysed using a content thematic analysis. Four main themes relating to VR design and implementation in rehabilitation were identified: (i) designing rehabilitation-focused virtual worlds; (ii) understanding and using VR hardware; (iii) making room for VR in rehabilitation and training; and (iv) implementing VR will not replace the health professional's role. Health professionals and technology specialists engaged in co-design while evaluating the VR prototype. They identified software features requiring careful consideration to ensure improved usability, client safety, and success in communication rehabilitation outcomes. Continuing inclusive co-design, engaging health professionals, clients with communication disability, and their families will be essential to creating useable VR applications and integrating these successfully into rehabilitation. Health and technology professionals, along with clients, are integral to the co-design of new VR technology applications. Design of VR applications needs to consider the client's communication, physical, cognitive, sensory, psychosocial, and emotional needs for greater usability of these programs. Realism and authenticity of interactions, characters, and environments are considered important factors to allow users to be fully immersed in virtual simulations to enhance rehabilitation. [ABSTRACT FROM AUTHOR]

Dysphagia in people with lifelong disabilities places a substantial burden on people with lifelong developmental disabilities, their carers, health and disability service, and society as a whole. Dysphagia in this population can be associated with respiratory illness, impaired nutrition, increased support needs, emergency hospital admissions with increased length of stay, readmission, and premature death. Research into better ways to prevent premature death in this population, including by choking, is an international priority. There is a wealth of information, guidance, resources, and training available on dysphagia management; fact sheets on modified foods, fluids, equipment, and tube feeds; yet to date this has been based upon "expert opinion," and there have been no studies investigating the impact of training on changing direct support workers' behaviours with regard to safety at mealtimes. Similarly, to date there are no reports of research naming dysphagia as a safety issue for residents with developmental disabilities in community settings. Therefore, there is little information available on the range of relevant factors contributing to dysphagia-related safety incidents. Such information is needed to inform policy, practice, and training to enhance the protection of adults with lifelong disabilities and dysphagia from preventable dysphagia-related respiratory illness or death, and to inform development of "resident safety frameworks" that reflect the "patient safety frameworks" pertaining to health care practices. This article calls for further research to properly understand the full range of factors influencing mealtime safety in people with lifelong disabilities and dysphagia. Improved documentation, practice systems, and services taking account of these factors could help paid and unpaid service providers as well as health services increase protection and reduce risk for people with dysphagia living in the community.