Narratives of Expert Speech-Language Pathologists: Defining Clinical Expertise and Supporting Knowledge Transfer

Clinical expertise is a component of evidence-based practice; however, relatively little attention has been paid to this phenomenon in the professional literature of speech-language pathology. This may have negative impacts on the training of pre-professional and novice speech-language pathologists. The purpose of this study was to examine professional narratives of expert Speech-Language Pathologists (SLPs) to consider applications for knowledge transfer between expert clinicians and novice clinicians. Collection of the professional narratives of 10 expert SLPs were obtained through in-depth interviews. Interviews were transcribed and coded for themes. Themes that impacted expertise in SLP included: training; work sites; individual and clinician traits; a holistic versus disorder-specific view; technical excellence; acknowledgment of and reflection upon mistakes; professional networking; peer and patient recognition; and, embracing the creative. Within the narratives, implications toward knowledge transfer for novice clinicians were evident. Narratives of expert SLPs may facilitate knowledge transfer of clinical expertise. Of the nine themes identified, seven were consistent with previous literature, and two were not. The themes provide an opportunity for further research and development, largely concerning knowledge transfer in clinical education

[Chapter 10] Selecting, Combining, and Bundling Different Therapy Approaches

[Book Description] Aphasia Rehabilitation: Clinical Challenges focuses on specific aphasia symptoms and clinical issues that present challenges for rehabilitation professionals. Contributed by experts in the field, each chapter presents a clinically relevant topic in detail while blending theoretical concepts with practical clinical applications. Part One provides in-depth coverage of complex aphasia symptoms and offers guidance for clinical implementation. Each topic is introduced with a review of contemporary literature followed by examples of problem-solving activities for treating patients with such symptoms. Part Two addresses clinical and service delivery issues that are at the forefront of modern clinical aphasiology and discusses how to implement them in daily clinical work. Key topics include evidence-based treatment, intensive treatment, and promoting patient motivation.https://nsuworks.nova.edu/hpd_facbooks/1007/thumbnail.jp

Utilising a systematic review-based approach to create a database of individual participant data for meta- and network meta-analyses: the RELEASE database of aphasia after stroke

Background Collation of aphasia research data across settings, countries and study designs using big data principles will support analyses across different language modalities, levels of impairment, and therapy interventions in this heterogeneous population. Big data approaches in aphasia research may support vital analyses, which are unachievable within individual trial datasets. However, we lack insight into the requirements for a systematically created database, the feasibility and challenges and potential utility of the type of data collated. Aim To report the development, preparation and establishment of an internationally agreed aphasia after stroke research database of individual participant data (IPD) to facilitate planned aphasia research analyses. Methods Data were collated by systematically identifying existing, eligible studies in any language (≥10 IPD, data on time since stroke, and language performance) and included sourcing from relevant aphasia research networks. We invited electronic contributions and also extracted IPD from the public domain. Data were assessed for completeness, validity of value-ranges within variables, and described according to pre-defined categories of demographic data, therapy descriptions, and language domain measurements. We cleaned, clarified, imputed and standardised relevant data in collaboration with the original study investigators. We presented participant, language, stroke, and therapy data characteristics of the final database using summary statistics. Results From 5256 screened records, 698 datasets were potentially eligible for inclusion; 174 datasets (5928 IPD) from 28 countries were included, 47/174 RCT datasets (1778 IPD) and 91/174 (2834 IPD) included a speech and language therapy (SLT) intervention. Participants’ median age was 63 years (interquartile range [53, 72]), 3407 (61.4%) were male and median recruitment time was 321 days (IQR 30, 1156) after stroke. IPD were available for aphasia severity or ability overall (n = 2699; 80 datasets), naming (n = 2886; 75 datasets), auditory comprehension (n = 2750; 71 datasets), functional communication (n = 1591; 29 datasets), reading (n = 770; 12 datasets) and writing (n = 724; 13 datasets). Information on SLT interventions were described by theoretical approach, therapy target, mode of delivery, setting and provider. Therapy regimen was described according to intensity (1882 IPD; 60 datasets), frequency (2057 IPD; 66 datasets), duration (1960 IPD; 64 datasets) and dosage (1978 IPD; 62 datasets). Discussion Our international IPD archive demonstrates the application of big data principles in the context of aphasia research; our rigorous methodology for data acquisition and cleaning can serve as a template for the establishment of similar databases in other research areas

Narrative Analysis

[Book Description] Qualitative research enriches the field of communication disorders because it has the potential to explore client experience and clinician expertise, so crucial in evidence-based practice, and complements the knowledge gained using quantitative methods. This book extends the foundational knowledge provided in Qualitative Research in Communication Disorders (2019) by going deeper into data analysis methods. Contributions from researchers worldwide will explain and illustrate, through case studies, various qualitative data analysis methods. Well established, commonly-used data analysis methods are included, as well as new and innovative methods emerging in other disciplines which have great applicability to speech and language therapy research. As well as describing and illustrating analysis methods, the book will describe how to achieve rigour in using the various methods of data analysis. There will also be discussion on ways in which qualitative analysis lends itself not only to research but also quality improvement and evaluations in clinical practice.https://nsuworks.nova.edu/hpd_facbooks/1005/thumbnail.jp

[Chapter 23] A Focus on Life Participation

[Book Description] The Handbook of Adult Language Disorders is the essential guide to the scientific and clinical tenets of aphasia study and treatment. It focuses on how language breaks down after focal brain damage, what patterns of impairment reveal about normal language, and how recovery can be optimally facilitated. It is unique in that it reviews studies from the major disciplines in which aphasia research is conducted—cognitive neuropsychology, linguistics, neurology, neuroimaging, and speech-language pathology—as they apply to each topic of language. For each language domain, there are chapters devoted to theory and models of the language task, the neural basis of the language task (focusing on recent neuroimaging studies) and clinical diagnosis and treatment of impairments in that domain. In addition, there is broad coverage of approaches to investigation and treatment from leading experts, with several authors specializing in two or more disciplines. This second edition focuses on characterizing the cognitive and neural processes that account for each variant of aphasia as a first step toward developing effective rehabilitation, given that aphasia is one of the most common and disabling consequences of stroke. The best and most authoritative handbook in the field, The Handbook of Adult Language Disorders is the definitive reference for clinicians and researchers working in the scientific investigation of aphasia.https://nsuworks.nova.edu/hpd_facbooks/1008/thumbnail.jp

Predictors of Poststroke Aphasia Recovery: A Systematic Review-Informed Individual Participant Data Meta-Analysis

Background and Purpose: The factors associated with recovery of language domains after stroke remain uncertain. We described recovery of overall-language-ability, auditory comprehension, naming, and functional-communication across participants’ age, sex, and aphasia chronicity in a large, multilingual, international aphasia dataset. Methods: Individual participant data meta-analysis of systematically sourced aphasia datasets described overall-language ability using the Western Aphasia Battery Aphasia-Quotient; auditory comprehension by Aachen Aphasia Test (AAT) Token Test; naming by Boston Naming Test and functional-communication by AAT Spontaneous-Speech Communication subscale. Multivariable analyses regressed absolute score-changes from baseline across language domains onto covariates identified a priori in randomized controlled trials and all study types. Change-from-baseline scores were presented as estimates of means and 95% CIs. Heterogeneity was described using relative variance. Risk of bias was considered at dataset and meta-analysis level. Results: Assessments at baseline (median=43.6 weeks poststroke; interquartile range [4–165.1]) and first-follow-up (median=10 weeks from baseline; interquartile range [3–26]) were available for n=943 on overall-language ability, n=1056 on auditory comprehension, n=791 on naming and n=974 on functional-communication. Younger age (\u3c55 years, +15.4 Western Aphasia Battery Aphasia-Quotient points [CI, 10.0–20.9], +6.1 correct on AAT Token Test [CI, 3.2–8.9]; +9.3 Boston Naming Test points [CI, 4.7–13.9]; +0.8 AAT Spontaneous-Speech Communication subscale points [CI, 0.5–1.0]) and enrollment \u3c1 month post-onset (+19.1 Western Aphasia Battery Aphasia-Quotient points [CI, 13.9–24.4]; +5.3 correct on AAT Token Test [CI, 1.7–8.8]; +11.1 Boston Naming Test points [CI, 5.7–16.5]; and +1.1 AAT Spontaneous-Speech Communication subscale point [CI, 0.7–1.4]) conferred the greatest absolute change-from-baseline across each language domain. Improvements in language scores from baseline diminished with increasing age and aphasia chronicity. Data exhibited no significant statistical heterogeneity. Risk-of-bias was low to moderate-low. Conclusions: Earlier intervention for poststroke aphasia was crucial to maximize language recovery across a range of language domains, although recovery continued to be observed to a lesser extent beyond 6 months poststroke

A Change of Art

This article is a section of a larger article titled Art in Clinical Practice

Dosage, Intensity, and Frequency of Language Therapy for Aphasia: A Systematic Review-Based, Individual Participant Data Network Meta-Analysis.

BACKGROUND AND PURPOSE: Optimizing speech and language therapy (SLT) regimens for maximal aphasia recovery is a clinical research priority. We examined associations between SLT intensity (hours/week), dosage (total hours), frequency (days/week), duration (weeks), delivery (face to face, computer supported, individual tailoring, and home practice), content, and language outcomes for people with aphasia. METHODS: Databases including MEDLINE and Embase were searched (inception to September 2015). Published, unpublished, and emerging trials including SLT and ≥10 individual participant data on aphasia, language outcomes, and time post-onset were selected. Patient-level data on stroke, language, SLT, and trial risk of bias were independently extracted. Outcome measurement scores were standardized. A statistical inferencing, one-stage, random effects, network meta-analysis approach filtered individual participant data into an optimal model examining SLT regimen for overall language, auditory comprehension, naming, and functional communication pre-post intervention gains, adjusting for a priori-defined covariates (age, sex, time poststroke, and baseline aphasia severity), reporting estimates of mean change scores (95% CI). RESULTS: Data from 959 individual participant data (25 trials) were included. Greatest gains in overall language and comprehension were associated with \u3e20 to 50 hours SLT dosage (18.37 [10.58-26.16] Western Aphasia Battery-Aphasia Quotient; 5.23 [1.51-8.95] Aachen Aphasia Test-Token Test). Greatest clinical overall language, functional communication, and comprehension gains were associated with 2 to 4 and 9+ SLT hours/week. Greatest clinical gains were associated with frequent SLT for overall language, functional communication (3-5+ days/week), and comprehension (4-5 days/week). Evidence of comprehension gains was absent for SLT ≤20 hours,/week, and ≤3 days/week. Mixed receptive-expressive therapy, functionally tailored, with prescribed home practice was associated with the greatest overall gains. Relative variance was CONCLUSIONS: Greatest language recovery was associated with frequent, functionally tailored, receptive-expressive SLT, with prescribed home practice at a greater intensity and duration than reports of usual clinical services internationally. These exploratory findings suggest critical therapeutic ranges, informing hypothesis-testing trials and tailoring of clinical services. Registration: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42018110947