Uncertainty and Perceived Control as Predictors of Communicative Participation and Mental Health in Adults Who Stutter

Purpose: This study examined the role of uncertainty and perceived control in predicting the communicative participation and mental health of adults who stutter. Method: Two hundred sixty-nine adults who stutter completed measures of uncertainty about stuttering, perceived control of stuttering, communicative participation, and global mental health. In addition, participants self-reported on a variety of demographic and speech-related measures. Correlational analyses and hierarchical regression were performed to determine associations between variables of interest. Results: Uncertainty accounted for significant variance in communicative participation and global mental health after statistically controlling for the effects of demographic and speech-related variables. Perceived control accounted for significant variance in communicative participation over and above what was accounted for by demographic variables, speech-related variables, and uncertainty. Conclusions: The findings suggest that uncertainty about stuttering and perceived control of stuttering should be accounted for during assessment and intervention with adults who stutter. Interventions that specifically target uncertainty and perceived control may be useful in improving therapeutic outcomes for individuals who stutter.

Conducting a Community Engagement Studio to Adapt Enhanced Milieu Teaching

Purpose: Barriers to implementing evidence-based practices occur at various levels. Stakeholder input is required to identify challenges specific to clinical practice settings, client populations, and service delivery approaches. The purpose of this project was to solicit feedback from stakeholders on the telepractice service delivery and implementation strategies proposed for a future study of enhanced milieu teaching (EMT) in rural counties. Method: A Community Engagement Studio was conducted with 11 caregivers of children with language delays living in rural counties. Caregivers and the researchers discussed early intervention service delivery for children with language delays in rural Oregon and the proposed telepractice EMT procedures. Researchers gathered feedback on three intervention components: session frequency and schedule, implementation strategies to encourage caregivers' use of EMT, and performance feedback techniques to teach caregivers. Results: Findings from the Community Engagement Studio led to four primary modifications to the telepractice EMT study protocol. The principal investigator increased available days and times for intervention sessions and added text-message reminders for parents. A survey was also added for caregivers to identify their preferences for additional implementation strategies (e.g., tip sheets, checklist, e-mailed session summaries) and graphic representations of performance feedback (e.g., bar graph, radial graph, mountain climber infographic). Conclusion: Community Engagement Studios are a promising method for increasing community engagement in clinical research and soliciting stakeholder feedback on evidence-based intervention adaptations. Supplemental Material: https://doi.org/10.23641/asha.17774819

Toward Empowering Conversational Agency in Aphasia: Understanding Mechanisms of Topic Initiation in People With and Without Aphasia

Purpose: This study examined topic initiation (TI) in conversations involving people with aphasia (PWA), matched people without aphasia (M-PWoA), and speech-language pathologists who were their conversation partners (SLP-Ps). For each speaker type, we analyzed patterns of distribution of typical mechanisms of TI and patterns of simultaneous use of multiple TI mechanisms. Lastly, we examined associations between use of simultaneous TI mechanisms and communicative success. Method: Twenty PWA and 20 M-PWoA each participated in two conversations with SLP-Ps. Conversation samples were analyzed for TI locations and mechanisms, with results tallied for each speaker type following a published typology. A measure of communicative success was applied to TI utterances. Rank-order correlations were conducted to evaluate the patterns of distribution of the TI mechanisms between speaker types and the patterns of multiple mechanism usage between speaker types. Descriptive analysis was conducted to provide additional insight to the TI behaviors of each speaker type and to evaluate the relationship between multiple TI mechanisms and communicative success. Results: All speaker types used cohesion most often to achieve TI. PWA used an abrupt method of TI (noncoherent TI) more often than other speaker types. A single mechanism of TI was used most often by all speaker types, except for SLP-Ps when they were in conversations with PWA. In this case, SLP-Ps most often used two or more layered mechanisms of TI. SLP-Ps also used a highly salient TI mechanism with greater frequency when speaking with PWA than observed between other speaker types. When PWA layered mechanisms of TI, they appeared to be more likely to achieve better communicative success. Conclusions: Specific, teachable behaviors such as favoring certain TI mechanisms and using multiple TI mechanisms may improve communicative success during TI for PWA. Furthermore, findings suggest that SLP-Ps modify their TI behaviors when speaking to PWA. Supplemental Material: https://doi.org/10.23641/asha.17699423

Reading and Listening Comprehension in Individuals With Down Syndrome and Word Reading–Matched Typically Developing Children

Purpose: The purpose of this study was to explore the reading comprehension and listening comprehension performance of English-speaking children with Down syndrome (DS) compared with word reading–matched typically developing (TD) children. Method: Participants included 19 individuals with DS ( M age = 17;2 [years;months], range: 11;1–22;9) and 19 word reading–matched TD children ( M age = 7;2, range: 6;6–8;1). Participants completed three norm-referenced measures of reading comprehension and three norm-referenced measures of listening comprehension. Dependent variables were raw scores on each measure, with the exception of scaled scores on one reading comprehension measure. Results: Independent-samples t tests with Bonferroni-adjusted alpha levels of .008 revealed a significant between-groups difference for two of three reading comprehension measures. The mean raw scores were lower for the DS group than the TD group, with large effect sizes. Independent-samples t tests with Bonferroni-adjusted alpha levels of .008 revealed a significant between-groups difference for three of three listening comprehension measures. The mean raw scores on the three measures were lower for the DS group than the TD group, with large effect sizes. Conclusions: The DS group, despite being matched on word reading to the TD group, demonstrated reduced reading comprehension skills as compared with the TD group. Thus, as individuals with DS acquire word reading skills, it appears that they are unable to translate word reading success to achieve reading comprehension at the expected level (i.e., as indexed by typical readers). The between-groups differences in listening comprehension suggest that deficits in listening comprehension likely are a barrier to reading comprehension proficiency for children with DS. Listening comprehension may be a malleable factor that can be targeted to improve reading comprehension outcomes for individuals with DS.

Systematic Review and Meta-Analysis of Dysphagia and Associated Pneumonia in Patients With Stroke From India: A Call to Arms

Objectives: This study aimed to determine the prevalence of reported dysphagia and associated pneumonia risk among patients with stroke in India. Method: We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome of interest was dysphagia and pneumonia among patients with stroke in India. Two review authors independently assessed the quality of studies using the Newcastle–Ottawa Scale and extracted related data. Meta-analysis was performed for frequency of dysphagia, associated pneumonia, and its relative risk using a random-effects model. Statistical heterogeneity was computed using the I 2 index. Results: A total of 3,644 titles were screened, and only eight studies met our inclusion criteria. Based on data from these studies, we calculated the pooled prevalence of dysphagia (47.71%; 95% confidence interval [CI] [20.49%, 70.92%], p < .001) and pneumonia (20.43%; 95% CI [10.73%, 30.14%], p < .001) for patients with stroke in India. We found that the relative risks of pneumonia in patients with stroke and dysphagia versus those patients with stroke and no dysphagia was 9.41 (95% CI [5.60, 15.80], p < .001). Data on length of hospital stay and rates of mortality secondary to pneumonia are also presented. Conclusions: Despite the high incidence of dysphagia and associated pneumonia, the methodological quality of studies is fair and there is little research focused on epidemiological data. We call to arms to those SLPs working with patients with stroke in India to become proactive in both clinical practice and research domains. Supplemental Material https://doi.org/10.23641/asha.17701022

Intelligibility Across a Reading Passage: The Effect of Dysarthria and Cued Speaking Styles

Objective: Reading a passage out loud is a commonly used task in the perceptual assessment of dysarthria. The extent to which perceptual characteristics remain unchanged or stable over the time course of a passage is largely unknown. This study investigated crowdsourced visual analogue scale (VAS) judgments of intelligibility across a reading passage as a function of cued speaking styles commonly used in treatment to maximize intelligibility. Patients and Method: The Hunter passage was read aloud in habitual, slow, loud, and clear speaking styles by 16 speakers with Parkinson's disease (PD), 30 speakers with multiple sclerosis (MS), and 32 control speakers. VAS judgments of intelligibility from three fragments representing the beginning, middle, and end of the reading passage were obtained from 540 crowdsourced online listeners. Results: Overall passage intelligibility was reduced for the two clinical groups relative to the control group. All speaker groups exhibited intelligibility variation across the reading passage, with trends of increased intelligibility toward the end of the reading passage. For control speakers and speakers with PD, patterns of intelligibility variation across passage reading did not differ with speaking style. For the MS group, intelligibility variation across the passage was dependent on speaking style. Conclusions: The presence of intelligibility variation within a reading passage warrants careful selection of speech materials in research and clinical practice. Results further indicate that the crowdsourced VAS rating paradigm is useful to document intelligibility in a reading passage for different cued speaking styles commonly used in treatment for dysarthria.

Individuals Who Use Augmentative and Alternative Communication and Participate in Active Recreation: Perspectives From Adults With Developmental Disabilities and Acquired Conditions

Purpose: The aim of the study was to gather the perspectives and lived experiences of 10 adults who use augmentative and alternative communication (AAC) and participate in active recreation. Active recreational participation includes individual sports such as adaptive skiing, surfing, and cycling, as well as unified team sports such as soccer, bocce, and basketball. Method: This research involved a qualitative study with two separate asynchronous online focus groups each conducted over a 6-week span. The focus groups included literate individuals who use AAC and engage in active recreational pursuits across the United States. One focus group included five individuals with acquired conditions, and the other group included five individuals with developmental disabilities. Results: Thematic analysis of the data from both focus groups revealed five primary themes with corresponding subthemes: barriers (intrinsic and extrinsic), supports (intrinsic and extrinsic), benefits (intrinsic and extrinsic), communication (methods), and recommendations for communication partners and people who use AAC. Conclusions: This study provides important information to individuals who use AAC and their communication partners about the benefits of active recreation and the supports needed to make these experiences successful. As a result of this study, speech-language pathologists, related professionals, and caregivers will gain a better understanding of how they can support recreational participation for people who use AAC with a specific focus on enhancing communication and expanding social networks. Supplemental Material https://doi.org/10.23641/asha.17701043

Understanding Burden in Caregivers of Adults With Dysphagia: A Systematic Review

Introduction: A previous review suggested that dysphagia is negatively associated with burden in caregivers of community-dwelling older adults. Other literature suggests similar patterns of burden may be found across adult patient populations. The current study, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was conducted to determine the impact of dysphagia on caregivers of adults, regardless of etiology. Method: Five electronic databases were searched using terms based on a review by Namasivayam-MacDonald and Shune (2018) but included all adults rather than only older adults. Searches were limited to English-language empirical studies discussing caregiver burden, included caregivers of adult care recipients, had some care recipients with dysphagia, did not include palliative care, and published in a peer-reviewed journal. Results: The search yielded 1,112 unique abstracts, of which 17 were accepted. Across studies, caregiver burden was found to increase due to dysphagia in care recipients. Commonly reported dysphagia-related causes of burden included changes in meal preparation, disruption in lifestyle, effects on social life, lack of support, insertion of feeding tubes, and fear of aspiration. In general, dysphagia-related caregiver burden was a common experience across caregivers, regardless of patient population, caregiver age, and relationship between caregiver and care recipient. Meta-analyses suggest 71% of caregivers of adults with dysphagia experience some degree of burden. Conclusions: These findings support that dysphagia negatively impacts caregiver burden and suggests sources of burden that clinicians can address within dysphagia management to support caregivers. However, more research is needed to better delineate sources of burden, especially those specific to various dysphagia etiologies, to better meet the needs of our patients.

Informal Written Language Analysis Methods: Case Examples of Adults With Traumatic Brain Injury

Purpose: Written expression challenges following traumatic brain injury (TBI) in adults have received little clinical attention but can substantially affect quality of life and the success of reintegration efforts. Assessment tools and procedures are lacking despite the likelihood of post-TBI problems with microstructure (e.g., productivity, spelling accuracy) and macrostructure (e.g., topic adherence, organization) aspects of written language. The lack of standardized procedures forces reliance on informal methods to determine writing strengths and challenges. Method: A combination of assessment procedures allowed for evaluation of the productivity and efficiency, adherence to writing conventions (e.g., spelling, sentence structure, punctuation), and macrostructure organization (e.g., story grammar, topic adherence) of written narratives collected from five adults with TBI. Results: Use of multiple assessment methods revealed disparate writing challenges across the five case examples. The differing writing profiles underscore the necessity of evaluating multiple aspects of written narratives. Conclusions: The described analysis methods can help clinicians determine areas of strength and challenge in written work generated by adults with TBI. Examination of multiple aspects of writing is key to garnering a comprehensive appraisal of post-TBI writing.

Applying Implementation Science to Support Active Collaboration in Noninvasive Brain–Computer Interface Development and Translation for Augmentative and Alternative Communication

Purpose: The purpose of this article is to consider how, alongside engineering advancements, noninvasive brain–computer interface (BCI) for augmentative and alternative communication (AAC; BCI-AAC) developments can leverage implementation science to increase the clinical impact of this technology. We offer the Consolidated Framework for Implementation Research (CFIR) as a structure to help guide future BCI-AAC research. Specifically, we discuss CFIR primary domains that include intervention characteristics, the outer and inner settings, the individuals involved in the intervention, and the process of implementation, alongside pertinent subdomains including adaptability, cost, patient needs and recourses, implementation climate, other personal attributes, and the process of engaging. The authors support their view with current citations from both the AAC and BCI-AAC fields. Conclusions: The article aimed to provide thoughtful considerations for how future research may leverage the CFIR to support meaningful BCI-AAC translation for those with severe physical impairments. We believe that, although significant barriers to BCI-AAC development still exist, incorporating implementation research may be timely for the field of BCI-AAC and help account for diversity in end users, navigate implementation obstacles, and support a smooth and efficient translation of BCI-AAC technology. Moreover, the sooner clinicians, individuals who use AAC, their support networks, and engineers collectively improve BCI-AAC outcomes and the efficiency of translation, the sooner BCI-AAC may become an everyday tool in the AAC arsenal.