Common Practices of Australian Speech-Language Pathologists in the Management of Paediatric Vocal Health

Speech-Language Pathology Session IBConference Theme: Care of the Professional VoiceObjective: This study aimed to determine the common approaches taken by Australian speech language pathologists (SLPs) in the management of paediatric voice caseloads. Methods & Results: Forty-eight Australian SLPs with a current paediatric voice caseload completed an online questionnaire containing 38-items related to assessment, treatment and discharge procedures used in managing a paediatric voice caseload. Paediatric voice comprised between 1-100% of the respondents’ caseloads (M = 8.27%, SD = 17.71). Eight respondents (16.6%) considered themselves to be a voice specialist. Perceptual ratings of voice disorders were used more frequently than instrumental assessment tools throughout the management process. Respondents considered instrumental assessment by an Ear Nose and Throat (ENT) specialist to be important however reported barriers related to ENT service constraints (e.g., ENT availability and long waiting lists) and the associated cost to the client. A range of direct and indirect voice therapy approaches (often in combination) were employed by the respondents, usually determined by client specific factors. Respondents reported that it was more common for patients to be formally discharged (M= 42.32%; SD=41.1) than to self-discharge (M=24.71%; SD=31.78). The most commonly used outcome measures were clinician judgement, pre/post voice recording comparison, and review of results from a follow-up ENT assessment. Quality of life scales were rarely used as outcome measures. The majority of clinicians (56.25%, n = 27/48) indicated that they did not feel confident when managing children with voice disorders, and would welcome further training in the area. Conclusion: This investigation captured current practice of Australian SLPs managing paediatric voice caseloads. This data allows for comparison with management approaches in other countries. The findings highlight a need for further training in this area, particularly to enhance translation of recent research evidence into clinical practice.published_or_final_versio

Communication changes following non-glottic head and neck cancer management: The perspectives of survivors and carers

Purpose. Head and neck cancer (HNC) survivors may experience functional changes to their voice, speech and hearing following curative chemoradiotherapy. However, few studies have explored the impact of living with such changes from the perspective of the HNC survivor and their carer. The current study employed a person-centred approach to explore the lived experience of communication changes following chemoradiotherapy treatment for HNC from the perspective of survivors and carers. Method. Participants included 14 survivors with non-glottic HNC and nine carers. All participants took part in in-depth interviews where they were encouraged to describe their experiences of living with and adjusting to communication changes following treatment. Interviews were analysed as a single data set. Result. Four themes emerged including: (1) impairments in communication sub-systems; (2) the challenges of communicating in everyday life; (3) broad ranging effects of communication changes; and (4) adaptations as a result of communication changes. Conclusion. These data confirm that communication changes following chemoradiotherapy have potentially negative psychosocial impacts on both the HNC survivor and their carer. Clinicians should consider the impact of communication changes on the life of the HNC survivor and their carer and provide adequate and timely education and management to address the needs of this population

Speech-language pathology services in Australian and New Zealand pediatric burn units and chemical ingestion injury

To date, little is known regarding the extent and nature of involvement of speech-language pathology (SLP) services within pediatric burn settings. The aim of this clinical service study was to investigate the role of SLP services within burn teams across Australia and New Zealand. Eleven pediatric burn units were identified as members of the Australian and New Zealand Burn Association Bi National Burns Registry. Representatives from both burn units and SLP departments at each setting were sent a link to a purpose-built online questionnaire. Seven responses from eight centers were received, with paired responses (burn units and SLP departments) being obtained from six centers. Pediatric burn units and SLP departments were found to differ in perceptions of SLP involvement in burn care. No burn units reported utilization of a protocol for referral to SLP. Dysphagia, followed by orofacial contracture management was the most frequently reported areas of SLP involvement, and multidisciplinary contribution within these areas was recognized. A majority (71%) of SLP departments reported involvement with chemical ingestion injury; however, referral rates were low. This study confirms that SLP services are utilized within Australian and New Zealand pediatric burn units, and SLPs are involved with pediatric patients with chemical ingestion injuries. However, potential exists for increased SLP input. There is also evident needed for established guidelines surrounding referrals and greater education regarding the role of SLPs within pediatric burn care

Interferon β-1a in relapsing multiple sclerosis: four-year extension of the European IFNβ-1a Dose-C omparison Study

Background: Multiple sclerosis (MS) is a chronic disease requiring long-term monitoring of treatment. Objective: To assess the four-year clinical efficacy of intramuscular (IM) IFNb-1a in patients with relapsing MS from the European IFNb-1a Dose-C omparison Study. Methods: Patients who completed 36 months of treatment (Part 1) of the European IFNb-1a Dose-C omparison Study were given the option to continue double-blind treatment with IFNb-1a 30 mcg or 60 mcg IM once weekly (Part 2). Analyses of 48-month data were performed on sustained disability progression, relapses, and neutralizing antibody (NA b) formation. Results: O f 608/802 subjects who completed 36 months of treatment, 493 subjects continued treatment and 446 completed 48 months of treatment and follow-up. IFNb-1a 30 mcg and 60 mcg IM once weekly were equally effective for up to 48 months. There were no significant differences between doses over 48 months on any of the clinical endpoints, including rate of disability progression, cumulative percentage of patients who progressed (48 and 43, respectively), and annual relapse rates; relapses tended to decrease over 48 months. The incidence of patients who were positive for NAbs at any time during the study was low in both treatment groups. Conclusion: C ompared with 60-mcg IM IFNb-1a once weekly, a dose of 30 mcg IM IFNb-1a once weekly maintains the same clinical efficacy over four years

Altered Dendritic Morphology of Purkinje cells in Dyt1 ΔGAG Knock-In and Purkinje Cell-Specific Dyt1 Conditional Knockout Mice

BACKGROUND: DYT1 early-onset generalized dystonia is a neurological movement disorder characterized by involuntary muscle contractions. It is caused by a trinucleotide deletion of a GAG (ΔGAG) in the DYT1 (TOR1A) gene encoding torsinA; the mouse homolog of this gene is Dyt1 (Tor1a). Although structural and functional alterations in the cerebellum have been reported in DYT1 dystonia, neuronal morphology has not been examined in vivo. METHODOLOGY/PRINCIPAL FINDINGS: In this study, we examined the morphology of the cerebellum in Dyt1 ΔGAG knock-in (KI) mice. Golgi staining of the cerebellum revealed a reduction in the length of primary dendrites and a decrease in the number of spines on the distal dendrites of Purkinje cells. To determine if this phenomenon was cell autonomous and mediated by a loss of torsinA function in Purkinje cells, we created a knockout of the Dyt1 gene only in Purkinje cells of mice. We found the Purkinje-cell specific Dyt1 conditional knockout (Dyt1 pKO) mice have similar alterations in Purkinje cell morphology, with shortened primary dendrites and decreased spines on the distal dendrites. CONCLUSION/SIGNIFICANCE: These results suggest that the torsinA is important for the proper development of the cerebellum and a loss of this function in the Purkinje cells results in an alteration in dendritic structure

A new MRI rating scale for progressive supranuclear palsy and multiple system atrophy: validity and reliability

AIM To evaluate a standardised MRI acquisition protocol and a new image rating scale for disease severity in patients with progressive supranuclear palsy (PSP) and multiple systems atrophy (MSA) in a large multicentre study. METHODS The MRI protocol consisted of two-dimensional sagittal and axial T1, axial PD, and axial and coronal T2 weighted acquisitions. The 32 item ordinal scale evaluated abnormalities within the basal ganglia and posterior fossa, blind to diagnosis. Among 760 patients in the study population (PSP = 362, MSA = 398), 627 had per protocol images (PSP = 297, MSA = 330). Intra-rater (n = 60) and inter-rater (n = 555) reliability were assessed through Cohen's statistic, and scale structure through principal component analysis (PCA) (n = 441). Internal consistency and reliability were checked. Discriminant and predictive validity of extracted factors and total scores were tested for disease severity as per clinical diagnosis. RESULTS Intra-rater and inter-rater reliability were acceptable for 25 (78%) of the items scored (≥ 0.41). PCA revealed four meaningful clusters of covarying parameters (factor (F) F1: brainstem and cerebellum; F2: midbrain; F3: putamen; F4: other basal ganglia) with good to excellent internal consistency (Cronbach α 0.75-0.93) and moderate to excellent reliability (intraclass coefficient: F1: 0.92; F2: 0.79; F3: 0.71; F4: 0.49). The total score significantly discriminated for disease severity or diagnosis; factorial scores differentially discriminated for disease severity according to diagnosis (PSP: F1-F2; MSA: F2-F3). The total score was significantly related to survival in PSP (p<0.0007) or MSA (p<0.0005), indicating good predictive validity. CONCLUSIONS The scale is suitable for use in the context of multicentre studies and can reliably and consistently measure MRI abnormalities in PSP and MSA. Clinical Trial Registration Number The study protocol was filed in the open clinical trial registry (http://www.clinicaltrials.gov) with ID No NCT00211224

Plasma–liquid interactions: a review and roadmap

Plasma–liquid interactions represent a growing interdisciplinary area of research involving plasma science, fluid dynamics, heat and mass transfer, photolysis, multiphase chemistry and aerosol science. This review provides an assessment of the state-of-the-art of this multidisciplinary area and identifies the key research challenges. The developments in diagnostics, modeling and further extensions of cross section and reaction rate databases that are necessary to address these challenges are discussed. The review focusses on non-equilibrium plasmas

Post-disaster social recovery: disaster governance lessons learnt from Tropical Cyclone Yasi

Post-disaster social recovery remains the least understood of the disaster phases despite increased risks of extreme events leading to disasters due to climate change. This paper contributes to advance this knowledge by focusing on the disaster recovery process of the Australian coastal town of Cardwell which was affected by category 4/5 Tropical Cyclone Yasi in 2011. Drawing on empirical data collected through semi-structured interviews with Cardwell residents post-Yasi, it examines issues related to social recovery in the first year of the disaster and 2 years later. Key findings discuss the role played by community members, volunteers and state actors in Cardwell’s post-disaster social recovery, especially with respect to how current disaster risk management trends based on self-reliance and shared responsibility unfolded in the recovery phase. Lessons learnt concerning disaster recovery governance are then extracted to inform policy implementation for disaster risk management to support social recovery and enhance disaster resilience in the light of climate change

Exploring Australian speech-language pathologists' use and perceptions of non-speech oral motor exercises

To explore Australian speech-language pathologists' use of non-speech oral motor exercises, and rationales for using/not using non-speech oral motor exercises in clinical practice.A total of 124 speech-language pathologists practising in Australia, working with paediatric and/or adult clients with speech sound difficulties, completed an online survey.The majority of speech-language pathologists reported that they did not use non-speech oral motor exercises when working with paediatric or adult clients with speech sound difficulties. However, more than half of the speech-language pathologists working with adult clients who have dysarthria reported using non-speech oral motor exercises with this population. The most frequently reported rationale for using non-speech oral motor exercises in speech sound difficulty management was to improve awareness/placement of articulators. The majority of speech-language pathologists agreed there is no clear clinical or research evidence base to support non-speech oral motor exercise use with clients who have speech sound difficulties.This study provides an overview of Australian speech-language pathologists' reported use and perceptions of non-speech oral motor exercises' applicability and efficacy in treating paediatric and adult clients who have speech sound difficulties. The research findings provide speech-language pathologists with insight into how and why non-speech oral motor exercises are currently used, and adds to the knowledge base regarding Australian speech-language pathology practice of non-speech oral motor exercises in the treatment of speech sound difficulties. Implications for Rehabilitation Non-speech oral motor exercises refer to oral motor activities which do not involve speech, but involve the manipulation or stimulation of oral structures including the lips, tongue, jaw, and soft palate. Non-speech oral motor exercises are intended to improve the function (e.g., movement, strength) of oral structures. The majority of speech-language pathologists agreed there is no clear clinical or research evidence base to support non-speech oral motor exercise use with clients who have speech sound disorders. Non-speech oral motor exercise use was most frequently reported in the treatment of dysarthria. Non-speech oral motor exercise use when targeting speech sound disorders is not widely endorsed in the literature