Effects and mechanisms of an allied health research position in a Queensland regional and rural health service: a descriptive case study

The aim of the present case study is to illustrate the outcomes of a dedicated allied health (AH) research position within a large Queensland regional and rural health service. The secondary aim of the case study is to describe the enabling and hindering mechanisms to the success of the role. Semistructured interviews were conducted with the Executive Director of Allied Health and the current AH research fellow incumbent within the health service. A focus group was also undertaken with six stakeholders (e.g. clinicians, team leaders) who had engaged with the research position. Outcomes of the AH research fellow included clinical and service improvements, enhanced research culture and staff up-skilling, development of research infrastructure and the formation of strategic research collaborations. Despite being a sole position in a geographically expansive health service with constrained resources, key enabling mechanisms to the success of the role were identified, including strong advocacy and regular communication with the Executive. In conclusion, the case study highlights the potential value of an AH research position in building research capacity within a large non-metropolitan health service. Factors to facilitate ongoing success could include additional research and administrative funding, as well as increased use of technology and team-based research. What is known about the topic?: Dedicated research positions embedded within health care settings are a well cited strategy to increase research capacity building of allied health professionals (AHPs). However the majority of these positions are within metropolitan health settings and unique challenges exist for these roles in regional and rural areas. Few studies have described the impact of dedicated AH research positions within regional health centres or the factors which facilitate or hinder their role. What does this paper add?: Dedicated research positions within a non-metropolitan Australian health service may have a positive impact on AH clinical services, research culture, staff upskilling, research infrastructure and research collaborations. Key enabling mechanisms to support the role may include advocacy from higher level management, strong networks and communication channels. Additional research and administrative funding, the use of technology and team based research may enhance sustainability of such roles. What are the implications for practitioners?: AH research positions have potential value in building research capacity within a large non-metropolitan health service. Health managers and researchers should be aware of the unique challenges to these roles and consider mechanisms that may best enhance and sustain outcomes of the positions including: the development of infrastructure (i.e. technology, website of resources), networks, and communication strategies (i.e. regular meetings with leadership and promotion internally)

The short- and long-term effectiveness of the LSVT® for dysarthria following TBI and stroke

Objectives: To examine the effectiveness of Lee Silverman Voice Treatment (LSVT (R)) for the treatment of 10 individuals with dysarthria following TBI and stroke

Effectiveness of Lee Silverman Voice Treatment (LSVT) on hypernasality in non-progressive dysarthria; the need for further research

Hypernasality is a common feature of non-progressive dysarthria. However, limited research has investigated the effectiveness of treatments for this impairment. Preliminary research has revealed positive effects on nasalance when using increased loudness in certain non-progressive dysarthric speakers. However, the long-term effects of loud speech on nasalance as part of a structured intervention such as Lee Silverman Voice Treatment (LSVT) are yet to be investigated in this population.The study aimed to investigate the short- and long-term effects of LSVT on hypernasality (perceptual ratings and degree of nasalance) in non-progressive dysarthria; and secondly, to evaluate the effects of traditional dysarthria therapy on these same measures, in comparison with the effects of LSVT.Ten non-progressive dysarthric speakers with varying levels of hypernasality (taken from a larger research study) were randomly allocated to receive LSVT((R)) (n = 5) or individually tailored traditional dysarthria therapy (n = 5). Both treatments were administered four times weekly for 4 weeks (that is, 16 x 1-hour sessions). Participants were assessed twice before treatment, twice immediately post-treatment, and twice at follow-up 6 months post-treatment using a perceptual rating task performed by two independent speech pathologists, and the Nasometer. Changes to individual mean nasalance scores were compared against clinically significant criterion and perceptual ratings were analysed descriptively.Three out of five participants demonstrated reductions in perceived hypernasality immediately following LSVT, but these changes were maintained at follow-up for only one participant. Two of these three participants demonstrated a corresponding reduction in mean nasalance. Limited changes in perceived hypernasality and nasalance scores were found following traditional dysarthria therapy, with only one participant exhibiting reduced nasalance at follow-up.Due to the small sample size in the present research and variability between participants, further exploration into the effects of LSVT on nasality with a larger population with different dysarthria types is essential

A comparison of the effects of the Lee Silverman voice treatment and traditional therapy on intelligibility, perceptual speech features, and everyday communication in nonprogressive dysarthria

The current study aimed to compare the effects of the Lee Silverman Voice Treatment (LSVT®) with traditional dysarthria therapy (TRAD) on speech intelligibility, perceptual speech features, and everyday communication in nonprogressive dysarthria. Twenty-six participants with nonprogressive dysarthria were randomly allocated to receive either LSVT (n = 13) or TRAD (n = 13), with both treatments being provided during 16 hourly sessions over 4 weeks. An ABAA experimental design was used with participants being assessed on perceptual and self-report measures prior to treatment, immediately post treatment, and 6 months posttreatment (follow-up). A limited number of significant differences between the two treatments were identified. Differences included a slower speaking rate (words per minute) and reports of an increase in conversation initiation with strangers at follow-up in the LSVT group and reduced slurring of speech at follow-up in the TRAD group. Although certain improvements to intelligibility, rate, and loudness were found exclusively after LSVT, a comparable pattern of long-term improvements in participation and well-being as determined by the AusTOMs (the Australian version of the Therapy Outcome Measures), was demonstrated in participants after both treatments. The study demonstrated that the LSVT as a treatment option for individuals with nonprogressive dysarthria resulted in comparable effects to intensive TRAD. Because of the relatively small participant numbers and subjective nature of variables, it was suggested that the LSVT be trialed on an individual basis in this population until further research is undertaken. The positive effects of LSVT on dysarthric speakers and the importance of applying motor learning principles in dysarthria management are highlighted. Copyrigh

Changes to articulation following LSVT (R) and traditional dysarthria therapy in non-progressive dysarthria

The present study aimed to evaluate the effects of the Lee Silverman Voice Treatment (LSVT (R)) on acoustic and perceptual measures of articulation in non-progressive dysarthria in comparison to traditional dysarthria therapy. The study involved 26 individuals with non-progressive dysarthria who were randomly allocated to receive either LSVT (R) or traditional dysarthria therapy (TRAD), both of which were administered for 16 hourly sessions over 4 weeks. Participants' speech samples were collected over a total of six testing sessions during three assessment phases: (1) prior to treatment, (2) immediately post-treatment, and (3) 6 months post-treatment (FU). Speech samples were analysed perceptually to determine articulatory precision and intelligibility as well as acoustically using vowel space (and vowel formant measures) and first moment differences. Results revealed short and long-term significant increases in vowel space area following LSVT (R). Significantly increased intelligibility was also found at FU in the LSVT (R) group. No significant differences between groups for any variables were found. The study reveals that LSVT (R) may be a suitable treatment option for improving vowel articulation and subsequent intelligibility in some individuals with non-progressive dysarthria

The effectiveness and feasibility of TREAT (Tailoring Research Evidence and Theory) journal clubs in allied health: a randomised controlled trial

Abstract Background Journal clubs (JC) may increase clinicians’ evidence-based practice (EBP) skills and facilitate evidence uptake in clinical practice, however there is a lack of research into their effectiveness in allied health. We investigated the effectiveness of a structured JC that is Tailored According to Research Evidence And Theory (TREAT) in improving EBP skills and practice compared to a standard JC format for allied health professionals. Concurrently, we explored the feasibility of implementing TREAT JCs in a healthcare setting, by evaluating participating clinicians’ perceptions and satisfaction. Methods We conducted an explanatory mixed methods study involving a cluster randomised controlled trial with a nested focus group for the intervention participants. Nine JCs with 126 allied health participants were randomly allocated to receive either the TREAT or standard JC format for 1 h/month for 6 months. We conducted pre-post measures of EBP skills and attitudes using the EBP questionnaire and Assessing Competence in Evidence-Based Medicine tool and a tailored satisfaction and practice change questionnaire. Post-intervention, we also conducted a focus group with TREAT participants to explore their perceptions of the format. Results There were no significant differences between JC formats in EBP skills, knowledge or attitudes or influence on clinical practice, with participants maintaining intermediate level skills across time points. Participants reported significantly greater satisfaction with the organisation of the TREAT format. Participants in both groups reported positive changes to clinical practice. Perceived outcomes to the TREAT format and facilitating mechanisms were identified including the use of an academic facilitator, group appraisal approach and consistent appraisal tools which assisted skill development and engagement. Conclusions It is feasible to implement an evidence-based JC for allied health clinicians. While clinicians were more satisfied with the TREAT format, it did not significantly improve their EBP skills, attitudes, knowledge and/or practice, when compared to the standard format. The use of an academic facilitator, group based critical appraisal, and the consistent use of appraisal tools were perceived as useful components of the JC format. A structured JC may maintain EBP skills in allied health clinicians and facilitate engagement, however additional training may be required to further enhance EBP skills. Trial registration ACTRN12616000811404 Retrospectively registered 21 June 2016

Dynamic assessment of articulation during lingual fatigue in myasthenia gravis

The present study aimed to investigate how induced lingual fatigue affected lingual strength, articulatory kinematics, and perceptual speech features in CS, a 51-year-old female with active myasthenia gravis (MG), and three age and gender matched control participants, Lingual fatigue was elicited via a series of endurance tasks using a tongue pressure bulb. Following each endurance task, the participants performed a speech task containing the phonemes /k/, /t/, and /j/ that was recorded with an electromagnetic articulograph, followed by a lingual strength assessment using a tongue pressure bulb. Participants repeated this schedule over five phases and kinematic and strength changes during each phase were compared to baseline measurements. All of CSs significant kinematic changes occurred during the final fatigue phase compared to 27.3% of the control group's kinematic changes occurring during this phase, suggesting the kinematic changes associated with fatigue were not accelerated in CS. The endurance tasks also elicited different kinematic effects for CSs anterior and posterior tongue segments. While CS exhibited mostly similar kinematic and perceptual changes to the control group, some of CS's perceptual transcriptions for /k/ and kinematic changes were not replicated, indicating that some different perceptual and physiological consequences to CS's speech were elicited by the endurance tasks

Is more intensive better? Client and service provider outcomes for intensive versus standard therapy schedules for functional voice disorders

Background. Functional dysphonias are commonly associated with reduced treatment attendance leading to variable treatment outcomes. Preliminary research has proposed that intensive treatment may improve client adherence and outcomes; however, further research into the application of intensive models in functional dysphonia in comparison with standard intensity models is warranted. Aims. The present study evaluated the impact of intensive and standard treatments on functional, well-being, and service outcome measures in clients with functional dysphonia. Methods. Participants with a functional dysphonia were randomly allocated to one of two treatment groups: (1) intensive treatment (n = 7) or (2) standard treatment (n = 9). Participants completed the voice handicap index (VHI) and the Australian therapy outcome measures voice assessment (conducted by a blinded assessor) before and after treatment and 4 weeks after treatment. Satisfaction questionnaires were completed after treatment and data pertaining to attendance and duration of intervention were collected throughout treatment. In addition to a vocal hygiene education session, all participants received a total of 8 hours of treatment; intensive treatment consisted of four 1-hour treatment sessions per week over 2 weeks, whereas the standard group received one 1-hour treatment session per week over 8 weeks. Results. High satisfaction and statistically significant improvements on the VHI ratings were found after treatment in the intensive group. Significantly greater attendance rates were found in the intensive group. Intensive treatment is a potentially viable service delivery option for functional dysphonia and warrants further larger scale investigation