Aerosol generating procedures, dysphagia assessment and COVID‐19: A rapid review

In response to members’ significant concerns and their request for an examination of the evidence relating to oropharyngeal dysphagia assessment, aerosol‐generating procedures (AGPs) and associated risk of COVID‐19 infection, the Royal College of Speech and Language Therapists (RCSLT) established a COVID‐19 Advisory Group (see the appendix). The group aimed to review the evidence underpinning the current healthcare policies in relation to AGPs, dysphagia assessment, and risk of transmission of and infection with COVID‐19 in response to urgent clinical information needs

A systematic scoping review of speech and language therapists’ public health practice for early language development

Background: There have been calls for speech and language therapists (SLTs) to work within a public-health framework to support language development. Innovative practice is reported, but the range of services remains unknown. Furthermore, the potential impact of public health practice in speech and language therapy on early child development is also currently unknown. A new method in SLT research, systematic scoping reviews enable greater breadth of focus than traditional systematic reviews when identifying innovative practice. Aim: To report scope and critically appraise evidence of family-focused health-promotion practice for early language development in this area. Methods & Procedures: Using the Cochrane Public Health Group scoping review framework, data from reports of health-promotion practice with families of children aged 0-3 years were extracted and critically appraised on service delivery, information, reach and evaluation. Main contribution: Group-based service delivery was the most popular form of service delivery. There were limited reports on the information given in services and on their reach. Questionnaires were the most popular reported evaluation method. Quality of evaluations was poor due to lack of replicability and experimental control in the studies reported. Conclusions & Implications: This method of systematic review has highlighted the scope of health-promotion practice in speech and language therapy and also demonstrated the lack of evidence for its effectiveness on child language development. It is argued that systematic scoping reviews are valuable for scoping innovative practice in areas where either there is a lack of robust evidence or there is a high level of heterogeneity in practice or evaluation. To support clinician appraisal of available evidence, recommendations are given for development of questionnaire appraisal and for categorization of evidence levels on summary databases

Identification of phonological processes in preschool children's single-word productions

Speech and language therapists (SLTs) often refer to phonological data norms as part of their assessment protocols in evaluating the communication skills of the pre-school child. There is a variety of norms available and although broadly similar, differences are embedded within their definitions of mastery of the adult target system. Presence of velar fronting, stopping of affricates and [s] reduction in the dataset was found to mirror previous research. However, there was a lower than expected incidence by age groups of palato-alveolar fronting, stopping of fricatives and obstruent cluster reduction

Consensus-building on developing dysphagia competence: A North West of England perspective

© 2017 Royal College of Speech and Language Therapists. Background: Dysphagia has been an increasing area of practice for speech and language therapists (SLTs) for over 20 years, and throughout that period there has been debate about how practical skills in dysphagia can best be developed. The implementation of the new Royal College of Speech and Language Therapists (RCSLT) framework was considered from a regional perspective seeking to establish consensus across different speech and language therapy settings. Aim: To explore practical solutions to the development of dysphagia competency in new graduates whilst acknowledging the wide variation in staffing and clinical dysphagia experience across the geographical and clinical landscape in the North West of England. Methods & Procedures: A four-phase study involved a literature search; interviews with experts in the field of dysphagia; a survey to identify current practice; and a two-round Delphi process. Outcomes & Results: Five themes emerged for dysphagia competency development: development of practical skills; supervision; clinical excellence networks; workforce planning; and postgraduate formal training. Challenges, and solutions to these, were identified through the phases of the study. A model for dysphagia competency development relevant to the North West context was achieved by consensus. Conclusions & Implications: There are many practical ways of developing dysphagia competency. The themes and model generated provide constructive support to services in adopting the most appropriate methods for their own settings

Discriminating disorder from difference using dynamic assessment with bilingual children

The DAPPLE (Dynamic Assessment of Preschoolers’ Proficiency in Learning English) is currently being developed in response to a clinical need. Children exposed to English as an additional language may be referred to speech and language therapy because their proficiency in English is not the same as their monolingual peers. Some, but not all, of these children are likely to have a core language learning difficulty. Clinicians need to be able to distinguish disorder from difference due to a child’s language learning context. The assessment used a test–teach–test format to examine children’s ability to learn vocabulary, sentence structure and phonology. The assessment, which takes less than 60 minutes to administer, was given to 26 children who were bilingual: 12 currently on a speech and language therapy caseload and 14 children matched for age and socio-economic status who had never been referred to speech and language therapy. The DAPPLE data clearly discriminated the two groups. The caseload group required a greater amount of prompting to identify targeted words in the receptive vocabulary assessment and performed less well in the post-teaching expressive component. For sentence structure, the caseload group required more cues to acquire the targeted clause elements in the teaching phase. The caseload group made more phoneme errors at the initial and final assessments than the controls, and the type of errors made differed. Teaching resulted in greater positive change in percent phonemes correct for the caseload participants. Qualitative analyses of individual children’s performance on the DAPPLE suggested that it has the potential to discriminate core language deficits from difference due to a bilingual language learning context. Future directions for development of the test are considered

How much exposure to English is necessary for a bilingual toddler to perform like a monolingual peer in language tests?

Background Bilingual children are under-referred due to an ostensible expectation that they lag behind their monolingual peers in their English acquisition. The recommendations of the Royal College of Speech and Language Therapists (RCSLT) state that bilingual children should be assessed in both the languages known by the children. However, despite these recommendations, a majority of speech and language professionals report that they assess bilingual children only in English as bilingual children come from a wide array of language backgrounds and standardized language measures are not available for the majority of these. Moreover, even when such measures do exist, they are not tailored for bilingual children. Aims It was asked whether a cut-off exists in the proportion of exposure to English at which one should expect a bilingual toddler to perform as well as a monolingual on a test standardized for monolingual English-speaking children. Methods & Procedures Thirty-five bilingual 2;6-year-olds exposed to British English plus an additional language and 36 British monolingual toddlers were assessed on the auditory component of the Preschool Language Scale, British Picture Vocabulary Scale and an object-naming measure. All parents completed the Oxford Communicative Development Inventory (Oxford CDI) and an exposure questionnaire that assessed the proportion of English in the language input. Where the CDI existed in the bilingual's additional language, these data were also collected. Outcomes & Results Hierarchical regression analyses found the proportion of exposure to English to be the main predictor of the performance of bilingual toddlers. Bilingual toddlers who received 60% exposure to English or more performed like their monolingual peers on all measures. K-means cluster analyses and Levene variance tests confirmed the estimated English exposure cut-off at 60% for all language measures. Finally, for one additional language for which we had multiple participants, additional language CDI production scores were significantly inversely related to the amount of exposure to English. Conclusions & Implications Typically developing 2;6-year-olds who are bilingual in English and an additional language and who hear English 60% of the time or more, perform equivalently to their typically developing monolingual peers