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.

Circumstances and outcomes of falls in hospital for adults with communication disability secondary to stroke: A qualitative synthesis

BACKGROUND: Falls are a significant patient safety concern in hospital. Adult patients with stroke, and those with communication disability, are at an increased risk of falls during their hospital admission compared to patients without stroke or communication disability. OBJECTIVE: The aim of this review is to determine the circumstances and outcomes of falls in hospitalised patients with communication disability following stroke. METHOD: A qualitative synthesis of 16 papers according to the Generic Reference Model of patient safety. This is a secondary analysis of studies in a systematic review of the association between communication disability after stroke and falls in hospitalised patients. RESULTS: In studies including participants with communication disability, falls commonly occurred at the patient bedside, during the day, and in transfers. However, no studies provided individual or group specifically detailing the circumstances and outcomes of falls of the included participants with communication disability. CONCLUSION: Research to date provides scant evidence on the circumstances and outcomes of falls in hospital patients with communication disability after stroke. This review performs a useful function in highlighting a glaring gap in the literature and the urgent need to enrich hospital falls prevention research that includes patients with communication disability following stroke. Findings of this review are discussed in relation to providing a framework for analysis of for future research.

Retention in rural speech and language therapy: The impact of rural tertiary education in Australia

BACKGROUND: Recruitment and retention of skilled health workers into rural areas is a major challenge to achieving equity in health between rural and urban populations. OBJECTIVE: This study explored the impact of rurally-based tertiary education in promoting the recruitment and retention of speech and language therapists (SLTs) in non-metropolitan areas and intention to remain in the profession. METHODS: Participants in this cohort study were 133 graduates from a rurally-based speech and language therapy course in Australia who completed the course between 1998 and 2018. Data were collected via an online survey. Data were analysed using inferential statistics, ArcGIS mapping software and content analysis in NVivo. RESULTS: 65.0% of the graduates practiced in rural or remote areas with just 21.1% practicing in major cities. Most participants’ ideal work location was in a rural area. Benefits of rural practice included seeing a mixed caseload, living near family, work/life balance and loving their location. Challenges of rural practice included limited opportunities for specialist caseloads and career progression. In total, 93.2% of the rural graduates intended to remain in the speech and language therapy profession for the next 5 years. CONCLUSIONS: This study indicates that SLTs who are trained in rural areas with a focus on servicing rural populations are highly likely to enter and remain in rural practice, consistent with the rural pipeline model.

The enablers and barriers to facilitating the development of reflective practice skills of third level allied health professional students through technology: A scoping review

BACKGROUND: The ability to reflect on one’s own performance, attitudes, and knowledge is an essential attribute of a competent allied health professional (AHP). Traditionally, reflective practice skills have been fostered during clinical placements via dyadic or narrative means (e.g. face-to-face supervision, journal writing, and observational assessment). However, with the onset of the Covid-19 pandemic, students face reduced opportunities for traditional clinical learning experiences, and embraced telepractice, simulation-based learning and other technology-based learning opportunities. OBJECTIVE: Research is limited regarding the use of digital technologies to facilitate the development of students’ reflective practice skills, therefore the best ways to facilitate this novel learning are not fully known and students may be disadvantaged as a result. As such, a scoping review was conducted to identify studies addressing the enablers and barriers to facilitating reflective practice skills of third level healthcare students, including speech and language therapy students, through technological means. METHODS: Five electronic databases were searched for studies published between 2016 to 2020. Identified records were imported into Covidence and titles and abstracts were screened by two independent reviewers. Data charting and critical analysis was completed by both authors independently. RESULTS: Six studies were ultimately included in data charting. These were of heterogeneous design and mixed quality. Four themes and a range of subthemes were identified regarding enablers and barriers to the facilitation of reflective practice via technological means. CONCLUSIONS: This research has provided critical information which may support the future use of technology in facilitating reflective practice among students. Competency in reflective practice is crucial to the professional development of students, yet Covid-19 and resultant restrictions present challenges to implementing the processes traditionally involved in developing such skills. This research highlights potential avenues for future developments in higher education which may overcome these barriers and augment the professional development of students.

Supporting speech and language therapy students in uncertain times

The COVID-19 pandemic has impacted significantly on the provision of speech and language therapy education. In this commentary, we consider the impact of unprecedented uncertainty and disruption on the student experience. Changes made within both university and practice-based learning environments have resulted in the continuation of high-quality learning experiences enabling students to continue or complete their programmes. However, studying in uncertain times has been destabilising for students having the potential to impact on the more nuanced aspects of clinical and professional development (e.g., self-efficacy, confidence, and professional identity formation). We reflect on collaborative efforts to support students with navigating uncertainty and change and to facilitate their ongoing personal, professional and clinical development in a holistic way. There is a need for empirical research into the experiences of student speech and language therapists who have studied or are continuing to study in the context of COVID-19. Such research will help inform university and practice-based educators as well as SLT managers about the ongoing needs of this population. Dealing with uncertainty should be considered within university-based curriculum development as well as induction and supervisory systems within the workplace.

Prevalence, aetiology, and impact of paediatric feeding disorders in preterm infants admitted to a neonatal intensive care unit in Cyprus

BACKGROUND: Advancements in neonatal care have resulted in increased survival for preterm infants, with associated risk for paediatric feeding disorders (PFDs), the prevalence of which is relatively unexplored. Risk factors for developing PFDs in this population must be identified. OBJECTIVE: The aim of this study was to determine the epidemiology and risk factors for PFDs in preterm infants with Extremely Low Birth Weight (ELBW); Very Low Birth Weight (VLBW) and Low Birth weight (LBW) in the only neonatal intensive care unit (NICU) in Cyprus. METHODS: This study comprised 2 phases: Phase 1, a retrospective 2-year file audit, informing methodology for Phase 2, a prospective epidemiological study. Profiles of 1027 preterm infants were obtained in Phase 1. In Phase 2, clinical assessment data on 458 preterm infants (N = 224) were analyzed. RESULTS: The prevalence of PFDs was 36.5%. All preterm infants with ELBW and 69%with VLBW exhibited PFDs. Risk factors were birth weight (BW), gestational age (GA), bronchopulmonary dysplasia (BPD), neurological disorders, structural anomalies, and congenital heart disease (CHD). CONCLUSIONS: This unique epidemiological data for one country will inform NICU service provision and direct international research on PFDs in neonates.

Frameworks used in cluttering treatments: Past, present, and future

BACKGROUND: This integrative review is of two literatures on cluttering treatments. It integrates into those two reviews a third literature to show an alternative way for cluttering to be treated in the future. OBJECTIVE: The aim is to encourage professionals involved in treating those who clutter to reflect on how conceptual frameworks can affect their treatment choices. METHODS: Works from three literatures on interventions are examined. Literatures covering two historic periods of cluttering treatments are compared to one another and to a third literature that offers an alternative framework for working with those who clutter. RESULTS: Treatment approaches to cluttering have almost universally focused on remediating impairments associated with the disorder. This impairment focus flows from a medical model –a model that views cluttering as a disease, located in the person, in need of remediation. An alternative framework, called the social model, one that focuses on the social conditions surrounding cluttering, is reviewed for its applicability to cluttering therapy. CONCLUSIONS: The medical model, used by authors since cluttering first appeared in the literature, carries within it assumptions about the selection and sequencing of clinical goals aimed at reducing cluttering symptoms. The social model alternative would likely shift the focus to working on ways for promoting the life participation of those who clutter. The applicability of social model practices to the treatment of cluttering is explored and encouraged.

Characterization of dysphagia following anterior cervical spine surgery

BACKGROUND: Post-operative dysphagia is one of the most common complications of anterior cervical spine surgery (ACSS). OBJECTIVE: Examine post-operative structural and physiologic swallowing changes in patients with dysphagia following ACSS as compared with healthy age and gender matched controls. METHODS: Videofluoroscopic swallow studies of adults with dysphagia after ACSS were retrospectively reviewed. Seventy-five patients were divided into early (≤2 months) and late (> 2 months) post-surgical groups. Modified Barium Swallow Impairment Profile (MBSImP), Penetration-Aspiration Scale (PAS) scores, and pharyngeal wall thickness (PWT) metrics were compared. RESULTS: Significant differences were identified for all parameters between the control and early post-operative group. MBSImP Pharyngeal Total (PT) scores were greater in the early group (Interquartile Range (IQR) = 9–14, median = 12) versus controls (4–7, 5, P < 0.001) and late group (0.75–7.25, 2, P < 0.001). The early group had significantly higher maximum PAS scores (IQR = 3–8, median = 7) than both the control group (1–2, 1, P < 0.001) and late post-operative group (1–1.25, 1, P < 0.001). PWT was significantly greater in the early (IQR = 11.12–17.33 mm, median = 14.32 mm) and late groups (5.31–13.01, 9.15 mm) than controls (3.81–5.41, 4.68 mm, P < 0.001). CONCLUSION: Dysphagic complaints can persist more than two months following ACSS, but often do not correlate with validated physiologic swallowing dysfunction on VFSS. Future studies should focus on applications of newer technology to elucidate relevant deficits.