An overview of dysphagia rehabilitation for stroke patients

ABSTRACT Background: Dysphagia is characterized by difficulty in the swallowing pattern at any stage of this neuromuscular process. It is a frequent symptom after stroke. Objective: This study aimed to investigate the most commonly used phonoaudiological interventions as therapy for the treatment of swallowing disorders in patients with dysphagia after stroke. Methods: We performed a review of studies indexed in MEDLINE-PubMed, LILACS, Cochrane, and Clinical trials.gov focusing on speech-language interventions for adult dysphagic patients after stroke between January 2008 and January 2021. Results: Thirty-six articles of clinical trials were selected. Eleven different types of therapies have been studied. Studies on the efficacy of therapeutic interventions for the rehabilitation of adult patients with dysphagia after stroke are still scarce. Most techniques are combined with conventional therapy, so the effectiveness of the other techniques alone cannot be assessed. Conclusions: Therapeutic interventions should be selected in accordance with the possibilities and limitations of the patients, and especially with the findings of the clinical evaluation and with its objective.

Use of a language intervention to reduce vaccine hesitancy

Vaccine hesitancy is a major global challenge facing COVID-19 immunization programs. Its main source is low public trust in the safety and effectiveness of the vaccine. In a preregistered experimental study, we investigated how using a foreign language when communicating COVID-19 vaccine information influences vaccine acceptance. Hong Kong Chinese residents (N = 611) received COVID-19 vaccine information either in their native Chinese or in English. English increased trust in the safety and effectiveness of the vaccine and, as a result, reduced vaccine hesitancy. This indicates that language can impact vaccine attitudes and demonstrate the potential of language interventions for a low cost, actionable strategy to curtail vaccine hesitancy amongst bilingual populations. Language interventions could contribute towards achieving the United Nations Sustainable Development Goal of health and well-being.

Motivating Adolescents to Participate in Literacy Intervention: A Case Example From Telepractice

Purpose: Motivation declines as children reach adolescence. Poor motivation inhibits participation and engagement in language-based interventions. The purpose of this tutorial is to demonstrate how intervention can be designed to increase client motivation to participate while improving language-based literacy skills. Method: Motivation and behavior change techniques based on self-determination theory are presented, as are examples of how to integrate these techniques into contextualized language intervention with adolescent clients. Conclusion: Incorporating motivation and behavior change techniques into contextualized language interventions with adolescents promotes self-determination and motivation through satisfaction of their need for autonomy, relatedness, and competence while simultaneously addressing language-based literacy deficits.

Supporting Adjective Learning by Children with DLD: Enhancing Metalinguistic Approaches

Background: Adjectives are essential for communication, conceptual development, and academic success. However, they are semantically and syntactically complex and can be particularly challenging for children with Developmental Language Disorder. Surprisingly, language interventions have not typically focused on this important word class.Aims: 1) To provide a supportive and accessible primer on adjectives for practitioners; 2) to explore how the SHAPE CODINGTM system can be adapted to support adjective learning in DLD; and 3) to provide practical recommendations on how to support adjective learning in clinical practice and education.Methods/procedure: We synthesise linguistic and psychological research on adjective semantics, clinical insights into DLD, and pedagogical practice supporting this population.Main contribution: We address the lack of specific training in the nature and acquisition of adjectives for SLTs by providing an accessible primer. We provide an innovative, detailed, and practical guide to adapting an established metalinguistic intervention to support adjective learning. Conclusions/Implications: Without targeted support for adjective learning, the communicative potential of children with DLD is compromised. Our guide can be used across a range of therapeutic and educational contexts to enable SLTs and teaching staff to improve their understanding and practice in this area and, ultimately, to develop robust, effective interventions for children with DLD.

Communication Bridge™-2 (CB2): A NIH Stage 2 randomized control trial of a speech-language intervention for communication impairments in individuals with mild to moderate primary progressive aphasia

Background : Primary Progressive Aphasia (PPA) is a clinical dementia syndrome. Impairments in language (speaking, reading, writing, and understanding) are the primary and persistent symptoms. These impairments progress insidiously and devastate communication confidence, participation, and quality of life for persons living with PPA. Currently, there are no effective disease modifying treatments for PPA. Speech-language interventions hold promise for mitigating communication challenges and language symptoms. However, evidence regarding their efficacy in PPA is of low quality and there are currently no rigorous randomized control trials. Method : Communication Bridge™-2 (CB2) is a Stage 2, superiority, single-blind, randomized, parallel group, active-control, behavioral clinical trial delivered virtually within a telehealth service delivery model to individuals with PPA. Ninety carefully characterized participants with clinically confirmed PPA will be randomized to one of two speech-language intervention arms: 1) Communication Bridge™ a dyadic intervention based in communication participation therapy models that incorporates salient training stimuli or 2) the control intervention a non-dyadic intervention based in impairment therapy models addressing word retrieval and language production that incorporates fixed stimuli. The superiority of Communication Bridge™ over the Control arm will be evaluated using primary outcomes of communication confidence and participation. Other outcomes include accuracy for trained words and scripts. Participants complete two therapy blocks over a 12-month period. Outcomes will be measured at baseline, at each therapy block, and at 12-months post enrollment. Discussion : The CB2 trial will supply Level 2 evidence regarding the efficacy of the Communication Bridge™ intervention delivered in a telehealth service delivery model for individuals with mild to moderate PPA. An important by-product of the CB2 trial is that these data can be used to evaluate the efficacy of speech-language interventions delivered in both trial arms for persons with PPA. The impact of these data should not be overlooked as they will yield important insights examining why interventions work and for whom, which will advance effectiveness trials for speech-language interventions in PPA. Trial Registration: The CB2 trial was registered prospectively with ClinicalTrials.gov (NCT03371706) on December 13, 2017. Registered at https://clinicaltrials.gov/ct2/show/NCT03371706

Morphology and Syntax in Arabic-Speaking Adolescents Who Are Deaf and Hard of Hearing

Purpose Diagnoses, assessments, and treatments, as well as social and language interventions, can be effective in identifying and interpreting specific linguistic features that present special challenges to the language abilities of individuals who are deaf and hard of hearing (DHH). This article reports on a study analyzing complex sentences and morphosyntactic error production by Arabic-speaking adolescents who are hearing and DHH. Method A total of 124 adolescents participated, all native speakers of Arabic in Grades 6–10 (63 hearing and 61 DHH). The participants were asked to provide an oral narrative about a dangerous experience. Results Both groups produced a low mean percentage of complex sentences out of the total number of clauses. However, adolescents who are DHH produced significantly fewer complex sentences and more morphosyntactic errors when compared with their hearing peers. The most common errors produced by both groups were clause errors including omission of subject or predicate and errors in word order. Determiner errors were produced significantly more often by adolescents who are DHH. Conclusions To our knowledge, this study is one of the first to investigate morphosyntactic aspects of complex sentences and morphosyntactic errors produced by Arabic-speaking adolescents who are hearing and DHH. This study therefore has significance for further research on language development among Arabic speakers and on definitions of vulnerable linguistic aspects in DHH.

Consensus on Terminology for Describing Child Language Interventions: A Delphi Study

Purpose Language intervention for children with language disorder may be effective; however, lack of detailed and consistent terminology for describing language interventions poses barriers for advancement within the field. This study aimed to develop consensus from speech-language pathologists (SLPs) in Australia on a taxonomy with terminology for describing language interventions for school-aged children and investigate SLPs' application of taxonomy terminology when describing child language interventions. Method A taxonomy with terms for describing interventions was developed with reference to contemporary literature and presented to clinicians and researchers with expertise in child language disorders in a three-round Delphi study. We asked Delphi participants to indicate agreement with the taxonomy or propose changes. Application of the taxonomy was investigated by asking participants to use taxonomy terminology to describe interventions presented in two case studies. Results The taxonomy consists of five aspects across which interventions may be described: modality/domain, purpose, delivery, form, and teaching techniques. Consensus on the taxonomy was established in both Round 1 (55 participants) and Round 2 (43 participants), with 100% of SLPs strongly agreeing or agreeing with the overall structure of the taxonomy and at least 87.3% of SLPs strongly agreeing or agreeing with each aspect. In Round 3 (32 participants), consensus was reached on 45/54 taxonomy categories (4/12 of the components) for Case Study 1 and 45/54 taxonomy categories (7/12 of the components) for Case Study 2. Conclusions Consensus on a taxonomy with terminology for describing language interventions represents a significant advancement in the field of child language intervention. Future actions may be needed to facilitate consistent application of taxonomy terms. Supplemental Material https://doi.org/10.23641/asha.16435290

Brain-Derived Neurotrophic Factor Polymorphism and Aphasia after Stroke

Stroke is one of the most deliberating causes of mortality and disability worldwide. Studies have implicated Val66Met polymorphism of the brain-derived neurotrophic factor (BDNF) gene as a genetic factor influencing stroke recovery. Still, the role of BDNF polymorphism in poststroke aphasia is relatively unclear. This review assesses the recent evidence on the association between the BDNF polymorphism and aphasia recovery in poststroke patients. The article highlights BNDF polymorphism characteristics, speech and language interventions delivered, and the influence of BNDF polymorphism on poststroke aphasia recovery. We conducted a literature search through PubMed and Google Scholar with the following terms: “brain derived-neurotrophic factor” and “aphasia” for original articles from January 2000 until June 2020. Out of 69 search results, a detailed selection process produced a total of 3 articles that met the eligibility criteria. All three studies included Val66Met polymorphism as the studied human BDNF gene. One of the studies demonstrated insufficient evidence to conclude that BDNF polymorphism plays a role in poststroke aphasia recovery. The remaining two studies have shown that Met allele genotype (either single or double nucleotides) was associated with poor aphasia recovery, in either acute or chronic stroke. Carriers of the Val66Met polymorphism of BDNF gave a poorer response to aphasia intervention and presented with more severe aphasia.