‘There’s this big fear around palliative care because it’s connected to death and dying’: A qualitative exploration of the perspectives of undergraduate students on the role of the speech and language therapist in palliative care

Background: Speech and language therapy in palliative care is a developing discipline of clinical practice. Research literature has highlighted that undergraduate palliative care education in speech and language therapy is inconsistent and inadequate. However, limited research has been carried out to date in relation to student speech and language therapists and palliative care. Aim: To explore the role of speech and language therapists in palliative care from the perspective of speech and language therapy students in Ireland. Design: A qualitative descriptive research study was conducted, involving focus group interviews. Setting/participants: Purposive sampling was used to recruit 12 student speech and language therapists from one university site for this study. Undergraduate second, third and fourth year students were eligible for inclusion. Results: This study revealed that undergraduate student speech and language therapists collectively agree that there is a role for speech and language therapy in palliative care. Although students acknowledged that speech and language therapists can make a positive difference to patients’ lives, and academic lectures were positively received, insufficient exposure to palliative care has resulted in fear, uncertainty and a lack of confidence amongst student speech and language therapists. Conclusions: A greater emphasis on palliative care is needed in undergraduate speech and language therapy education to ensure confidence and competency development. An exploration of student speech and language therapists’ experiences in a specialist palliative care unit would be advantageous to determine the appropriateness of this setting for clinical placements.

The Effectiveness of Transcranial Magnetic Stimulation (TMS) Paradigms as Treatment Options for Recovery of Language Deficits in Chronic Poststroke Aphasia

Background. In an effort to boost aphasia recovery, modern rehabilitation, in addition to speech and language therapy (SALT), is increasingly incorporating noninvasive methods of brain stimulation. The present study is aimed at investigating the effectiveness of two paradigms of neuronavigated repetitive transcranial magnetic stimulation (rTMS): (i) 1 Hz rTMS and (ii) continuous theta burst stimulation (cTBS) each as a standalone treatment for chronic aphasia poststroke. Methods. A single subject experimental design (SSED) trial was carried out in which six people with aphasia (PWA) were recruited, following a single left hemispheric stroke more than six months prior to the study. Three individuals were treated with 1 Hz rTMS, and the remaining three were treated with cTBS. In all cases, TMS was applied over the right pars triangularis (pTr). Language assessment, with standardized and functional measures, and cognitive evaluations were carried out at four time points: twice prior to treatment (baseline), one day immediately posttreatment, and at follow-up two months after treatment was terminated. Quality of life (QoL) was also assessed at baseline and two months posttreatment. In addition, one of the participants with severe global aphasia was followed up again one and two years posttherapy. Results. For all participants, both rTMS paradigms (1 Hz rTMS and cTBS) generated trends towards improvement in several language skills (i.e., verbal receptive language, expressive language, and naming and reading) one day after treatment and/or two months after therapy. Rated QoL remained stable in three individuals, but for the other three, the communication scores of the QoL were reduced, while two of them also showed a decline in the psychological scores. The participant that was treated with cTBS and followed for up to two years showed that the significant improvement she had initially exhibited in comprehension and reading skills two months after TMS (1st follow-up) was sustained for at least up to two years. Conclusion. From the current findings, it is suggested that inhibitory TMS over the right pTr has the potential to drive neuroplastic changes as a standalone treatment that facilitates language recovery in poststroke aphasia.

Telepractice in service delivery: A survey of perspectives and practices of speech and language therapists in Ireland during COVID-19

BACKGROUND: COVID-19 accelerated telepractice implementation in speech and language therapy (SLT) in Ireland. OBJECTIVE: This study documents the service delivery changes that took place in the SLT profession in Ireland during the public health crisis. METHODS: An online survey of speech and language therapists (SLTs) in Ireland was conducted from June-September 2020 to investigate their perceptions of telepractice. Data were analysed using descriptive and inferential statistics and frequency distribution. RESULTS: 173 SLT responses were analysed. Over half of the participants worked in urban locations. Respondents’ years of experience varied from less than four years to over 20 years. Slightly over half the participants reported using telepractice, with 85% starting to use telepractice in the six months prior to the survey. Telepractice uptake was not influenced by participants’ professional experience or geographical location (p > 0.05). Almost all participants who used telepractice were trained informally (92%,). Telepractice was most commonly used with school-aged children with developmental language and speech sound disorders. Respondents perceived that telepractice was not suitable for all individuals who need SLT, including those with complex needs. Clinicians reported that telepractice facilitated access to therapy for clients and opportunities to see clients in their own environments. Technology barriers were the biggest hurdle to telepractice use. CONCLUSIONS: Uptake of telepractice by the SLT profession in Ireland was widespread during COVID-19, highlighting the profession’s flexibility and innovation. Respondents indicated they are likely to continue to use telepractice as a complementary service delivery model post-COVID due to the distinct benefits for clinicians and clients.

On the Benefits of Speech-Language Therapy for Individuals Born With Cleft Palate: A Systematic Review and Meta-Analysis of Individual Participant Data

Purpose: Cleft lip and/or palate (CLP) is a common birth defect, and after reconstructive surgery, about 50% of children at 5 years of age have speech deviations and are referred to speech-language therapy (SLT). The peer-reviewed evidence for the benefit of SLT has been uncertain. Our objective was to systematically review and meta-analytically summarize the benefit of SLT for individuals born with CLP. Method: A systematic search was conducted (last search on February 19, 2021) on studies evaluating SLT with pre and post measures on speech production, language ability, intelligibility, and/or patient-reported outcomes. We sought individual participant data (IPD) and evaluated on an individual level if the outcome measure had improved to a clinically relevant degree during SLT and if the outcome measure was on a level with peers or not after SLT. Meta-analyses and meta-regressions were applied to synthesize IPD across studies. Results: Thirty-four eligible studies were found. Nineteen studies provided IPD ( n = 343) for the main analysis on speech production. The synthesized information suggests that, during SLT, speech production improved to a clinically relevant degree for many individuals (95% CI [61%, 87%]) and that speech production was on a level with peers for some individuals after SLT (95% CI [10%, 34%]). Conclusions: The main strength of this meta-analysis is that we evaluated on an individual level pre- and post-intervention data based on considerations of clinical relevance. This approach allowed us to conclude that many individuals benefit from SLT and that further work on evaluating SLT in this patient group is meaningful. Supplemental Material https://doi.org/10.23641/asha.17700992

Association Between Timing of Speech and Language Therapy Initiation and Outcomes Among Post-Extubation Dysphagia Patients: A Multicenter Retrospective Cohort Study

Background: Post-extubation dysphagia (PED) is recognized as a common complication in the intensive care unit (ICU). Speech and language therapy (SLT) can potentially help improve PED; however, the impact of the timing of SLT initiation on persistent PED has not been well investigated. This study aimed to examine the timing of SLT initiation and its effect on patient outcomes after extubation in the ICU.Methods: We conducted this multicenter, retrospective, cohort study, collecting data from eight ICUs in Japan from patients treated between 2017 and 2020. Patients aged ≥ 20 years with orotracheal intubation and mechanical ventilation for longer than 48 hours, and those who received SLT due to PED, defined as patients with modified water swallowing test scores of 3 or lower, were included. The primary outcome was dysphagia at hospital discharge, defined as functional oral intake scale score <5 or death after extubation. Secondary outcomes included dysphagia or death at the seventh, 14th, or 28th day after extubation, aspiration pneumonia, and in-hospital mortality. Associations between the timing of SLT initiation and outcomes were determined using multivariable logistic regression. Results: Two hundred and seventy-two patients met the study inclusion criteria. Of them, 82 (30.1%) patients exhibited dysphagia or death at hospital discharge, and their time spans from extubation to SLT initiation was 1.0 days. The primary outcome revealed that every day of delay in SLT initiation post-extubation was associated with dysphagia or death at hospital discharge (adjusted odds ratio (AOR), 1.09; 95% CI, 1.02 to 1.18). Similarly, secondary outcomes showed associations between this per day delay in SLT initiation and dysphagia or death at the seventh day (AOR, 1.28; 95% CI, 1.05 to 1.55), 14th day (AOR, 1.34; 95% CI, 1.13 to 1.58), or 28th day (AOR, 1.21; 95% CI, 1.07 to 1.36) after extubation and occurrence of aspiration pneumonia (AOR, 1.09; 95% CI, 1.02 to 1.17), while per day delay in post-extubation SLT initiation did not affect in-hospital mortality (AOR, 1.04; 95% CI, 0.97 to 1.12). Conclusions: Delayed initiation of SLT in PED patients was associated with persistent dysphagia or death. Early initiation of SLT may prevent this complication post-extubation.

A Bilingual Child Diagnosed With Autism Spectrum Disorder (ASD)

Silvia and Antonio Juarez described their 4-year-old son Emanuel as often happy. Emanuel came from a bilingual home and spoke both Spanish and English. His favorite activities were reading and playing with his iPad over-and-over again. Reading was a favorite pasttime and something that the Juarez's felt he did well. While he was described as “loving to engage people,” it was not clear that his efforts were successful nor was it clear that they were reciprocated. Briefly observing Emanuel's interaction with his parents, it was noted Emanuel used echolalic phrases and engaged in repetitive and restricted behaviors, toe walking, and finger flicking. These behaviors were noted to be unusual and warranted further evaluation. The Juarez's primary concern was regarding Emanuel's “talking and being able to hold a conversation.” Through speech and language therapy, the family expected that Emanuel's communication skills would improve, and he would be able to participate in conversations and talk in sentences.

Factors associated with suicide ideation of healthcare university students

ABSTRACT Objectives: to analyze the factors associated with suicidal ideation in students from healthcare graduation courses. Methods: quantitative, cross-sectional study, with 251 students from the courses of radiology, speech-language therapy, medicine, nutrition, health service management, and nursing, from a federal higher education institution in the Southeast of Brazil. Data were collected from August to October 2019, using an electronic questionnaire. Results: the prevalence of suicidal ideation among participants was 26.33%. In the final logistic regression model, only depressive symptoms were associated with suicidal ideation. Having symptoms of depression increased the chances of suicidal ideation 2.6 times. Conclusion: the high prevalence of suicidal ideation and its associated factors constitutes a situational diagnosis that demands the elaboration of public and institutional policies, focused on the promotion and attention to the mental health of the students.

Protocol for Escitalopram and Language Intervention for Subacute Aphasia (ELISA): A randomized, double blind, placebo-controlled trial

In this forthcoming multicenter, prospective, randomized, double-blind placebo-controlled trial, we will investigate the augmentative effects of a selective serotonin reuptake inhibitor, escitalopram, on language therapy in individuals with post-stroke aphasia. We hypothesize that, when combined with language therapy, daily escitalopram will result in greater improvement than placebo in an untrained picture naming task (Philadelphia Naming Test short form) administered one week after the end of language therapy. We also will examine whether escitalopram’s effect on language is independent of its effect on depression, varies with lesion location, or is associated with increased functional connectivity within the left hemisphere. Finally, we will examine whether individuals with BDNF met alleles show reduced response to treatment and reduced changes in connectivity. We expect to enroll 88 participants over four years. Participants are given escitalopram or placebo within one week of their stroke for 90 days and receive fifteen 45-minute computer-delivered sessions of language treatment beginning 60 days from the start of drug therapy. Patients then complete a comprehensive assessment of language at one, five, and twenty weeks after the last language therapy session. ELISA is the first randomized, controlled trial evaluating the effect of a selective serotonin reuptake inhibitor on the improvement of language in people with aphasia undergoing language treatment during the acute to subacute post-stroke period. Trial registration: The trial is registered with ClinicalTrials.gov NCT03843463.