Dysphagia training for speech-language pathologists: implications for clinical practice

There are competency standards available in countries with established speech-language pathology services to guide basic dysphagia training with ongoing workplace mentoring for advanced skills development. Such training processes, however, are not as well established in countries where speech-language pathology training and practice is relatively new, such as Malaysia. The current study examines the extent of dysphagia training and workplace support available to speech-language pathologists (SLPs) in Malaysia and Queensland, Australia, and explores clinicians’ perceptions of the training and support provided, and of their knowledge, skills, and confidence. Using a matched cohort cross-sectional design, a purpose-built survey was administered to 30 SLPs working in Malaysian government hospitals and 30 SLPs working in Queensland Health settings in Australia. Malaysian clinicians were found to have received significantly less university training, less mentoring in the workplace, and were lacking key infrastructure needed to support professional development in dysphagia management. Over 90% of Queensland clinicians were confident and felt they had adequate skills in dysphagia management; in contrast, significantly lower levels of knowledge, skills, and confidence were observed in the Malaysian cohort. The findings identify a need for improved university training and increased opportunities for workplace mentoring, training, and support for Malaysian SLPs

The benefits of a 5-day dysphagia intensive placement

Finding practical dysphagia opportunities for students pre-qualification is challenging. Discussions with clinicians led to the development of a new placement model. The placement was just five days and had an accompanying workbook. The current study aimed to evaluate the benefits of the placement. Data were analysed from 40 students who attended an adult dysphagia placement and 13 who attended a paediatric dysphagia placement. Measures included a pre and post self-rating questionnaire, qualitative feedback from clinical educators and students and a pre and post measure of knowledge using concept maps. Student self-rating data indicated gains in experience, awareness, knowledge, clinical skills, competence, confidence and interest in dysphagia. Clinical educators and students also reported a range of benefits from this placement. Students who undertook a placement that focused on adult dysphagia significantly increased their knowledge of adult dysphagia, but this did not generalize to paediatric dysphagia. Despite reporting that they felt they had gained in knowledge of dysphagia, the students who did a paediatric dysphagia placement did not significantly increase their knowledge of dysphagia. The study raises a number of important considerations when designing placements including length, timing, intensity, how best to encourage generalization of knowledge, and how best to measure learning

Speech and language therapy/pathology: Perspectives on a gendered profession

Background: The Speech and Language Therapy/Pathology (SLT/SLP) profession is characterised by extreme ‘occupational sex segregation’, a term used to refer to persistently male or female-dominated professions. Men make up only 2.5% of all SLTs in the UK, and similar imbalance is found in other countries. Despite calls to increase diversity in the allied health professions more generally, research into the reasons for occupational sex segregation and gender as a potential key factor remains scarce. Aims: This study aims to explore the potential role of gender/ gendered discourses in people’s decision to pursue a career in SLT/SLP. It seeks to illustrate how gendered assumptions/ expectations/ discourses continue to construct SLT as a ‘gendered’ profession, and to make some recommendations in this area for SLT recruitment and practice. Methods & Procedure: The study adopted a qualitative design which elicited research participants’ views, knowledge and experiences (in their own words) in relation to the research questions. Data collection involved two iterative phases: preliminary data phase – which involved semi-structured interviews with newly qualified SLT graduates and practising SLTs, and completion of questionnaires by undergraduate SLTs – and main/ focus group phase. In the focus group phase, reported in this paper, six focus groups in total were held with SLTs, teachers of speech and language therapy, and careers advisors in London, UK. The data were analysed qualitatively using grounded theory principles, thematic analysis, and discourse analysis. Outcomes & Results: The findings extend our knowledge and understanding of gender as a parameter of people’s motivations and perceptions, which can influence their choice of career (e.g. as regards, pay and flexibility). The findings also show that discourses around women as carers, nurturers, and communicators constitute key ways through which the SLT profession continues to be constructed as ‘women’s work’. The topic of structural gender inequalities in the profession was also discussed in the data. Some recommendations for change, with implications for SLT recruitment and practice, were made by the participants themselves. Conclusions & Implications: Gender imbalance in SLT needs to be researched further, in order to help address inequalities, re-evaluate professional practices, and develop service delivery in the profession. This area also needs to be researched via analysis that goes beyond gender distribution in numerical terms, to consider the complex perceptions or discourses around gender and work. Cross-disciplinary and comparative perspectives in future research would also be fruitful

Communication rehabilitation in sub-Saharan Africa: A workforce profile of speech and language therapists.

BACKGROUND: There is an urgent global need to strengthen rehabilitation services for people with disabilities. In sub-Saharan Africa, rehabilitation services for people with communication disabilities continue to be underdeveloped. A first step in strengthening services for people with a communication disabilities is to understand the composition and conditions of the current workforce. OBJECTIVES: This research describes a sample of the speech and language therapists (SLTs) working in SSA (excluding South Africa). This study explores the characteristics of this workforce, including their demographics, education, experience and geographical stability. METHOD: A mixed-methods survey was used to collect data from SLTs within Anglophone countries of SSA. Completed surveys were received from 33 respondents working in 44 jobs across nine countries. Analysis included descriptive and non-parametric inferential statistics. This study reports on a subset of descriptive and quantitative data from the wider survey. RESULTS: A background profile of SLTs across the region is presented. Results indicated that the workforce of SLTs comprised a mix of local and international SLTs, with university-level education. Local SLTs were educated both within and outside of Africa, with more recent graduates trained in Africa. These data reflected the local emergence of speech and language therapy training in SSA. CONCLUSION: This sample comprised a mix of African and international SLTs, with indications of growing localisation of the workforce. Workforce localisation offers potential advantages of linguistic diversity and stability. Challenges including workforce support and developing culturally and contextually relevant SLT practices are discussed

Service delivery and intervention intensity for phonology-based speech sound disorders

Background: When planning evidence-based intervention services for children with phonology-based speech sound disorders (SSD), speech and language therapists (SLTs) need to integrate research evidence regarding service delivery and intervention intensity within their clinical practice. However, relatively little is known about the optimal intensity of phonological interventions and whether SLTs’ services align with the research evidence.Aims: The aims are twofold. First, to review external evidence (i.e., empirical research evidence external to day-today clinical practice) regarding service delivery and intervention intensity for phonological interventions. Second,to investigate SLTs’ clinical practice with children with phonology-based SSD in Australia, focusing on service delivery and intensity. By considering these complementary sources of evidence, SLTs and researchers will be better placed to understand the state of the external evidence regarding the delivery of phonological interventions and appreciate the challenges facing SLTs in providing evidence-based services.Methods & Procedures: Two studies are presented. The first is a review of phonological intervention research published between 1979 and 2016. Details regarding service delivery and intervention intensity were extractedfrom the 199 papers that met inclusion criteria identified through a systematic search. The second study was an online survey of 288 SLTs working in Australia, focused on the service delivery and intensity of intervention provided in clinical practice.Main Contributions: There is a gap between the external evidence regarding service delivery and intervention intensity and the internal evidence from clinical practice. Most published intervention research has reported toprovide intervention two to three times per week in individual sessions delivered by an SLT in a university clinic, in sessions lasting 30–60 min comprising 100 production trials. SLTs reported providing services at intensities below that found in the literature. Further, they reported workplace, client and clinician factors that influenced the intensity of intervention they were able to provide to children with phonology-based SSD.Conclusions & Implications: Insufficient detail in the reporting of intervention intensity within published research coupled with service delivery constraints may affect the implementation of empirical evidence into everyday clinical practice. Research investigating innovative solutions to service delivery challenges is needed to provide SLTs with evidence that is relevant and feasible for clinical practice

Long-term functional outcomes and the patient perspective following altered fractionation with concomitant boost for oropharyngeal cancer

With no long-term data available in published research to date, this study presents details of the swallowing outcomes as well as barriers to and facilitators of oral intake and weight maintenance at 2 years after altered fractionation radiotherapy with concomitant boost (AFRT-CB). Twelve patients with T1-T3 oropharyngeal cancer who received AFRT-CB were assessed at baseline, 6 months, and 2 years post-treatment for levels of dysphagia and salivary toxicity, food and fluid tolerance, functional swallowing outcomes, patient-reported function, and weight. At 2 years, participants were also interviewed to explore barriers and facilitators of oral intake. Outcomes were significantly worse at 2 years when compared to baseline for late toxicity, functional swallowing, and patient-rated physical aspects of swallowing. Most patients (83%) tolerated a full diet pretreatment, but the rate fell to 42% (remainder tolerated soft diets) at 2 years. Multiple barriers to oral intake that impacted on activity and participation levels were identified. Participants lost 11 kg from baseline to 2 years, which was not regained between 6 months and 2 years. Global, social, and emotional domains of patient-reported function returned to pretreatment levels. At 2 years post AFRT-CB, worsening salivary and dysphagia toxicity, declining functional swallowing, and multiple reported ongoing barriers to oral intake had a negative impact on participants' activity and participation levels relating to eating. These ongoing deficits contributed to significant deterioration in physical swallowing functioning determined by the MDADI. In contrast, patients perceived their broader functioning had improved at 2 years, suggesting long-term adjustment to ongoing swallowing deficits

Ageing with bilingualism: benefits and challenges

Much of the world’s population speaks more than one language, and there has been a great deal of media attention given to the potential benefits of bilingualism. In this paper we provide a critical overview of the literature on bilingualism as it relates to older adults. We address whether there is indeed a cognitive advantage from speaking more than one language, and whether it can help preserve cognitive and linguistic function as we age, and potentially reduce the impact of dementia. We also focus on the patterns of language impairment after stroke (aphasia) in bilingual speakers and the issues relating to clinical management of bilingual aphasia

Physiological characteristics of dysphagia following thermal burn injury

The study aim was to document the acute physiological characteristics of swallowing impairment following thermal burn injury. A series of 19 participants admitted to a specialised burn centre with thermal burn injury were identified with suspected aspiration risk by a clinical swallow examination (CSE) conducted by a speech-language pathologist and referred to the study. Once medically stable, each then underwent more detailed assessment using both a CSE and fiberoptic evaluation of swallowing (FEES). FEES confirmed six individuals (32%) had no aspiration risk and were excluded from further analyses. Of the remaining 13, CSE confirmed that two had specific oral-phase deficits due to orofacial scarring and contractures, and all 13 had generalised oromotor weakness. FEES revealed numerous pharyngeal-phase deficits, with the major findings evident in greater than 50% being impaired secretion management, laryngotracheal edema, delayed swallow initiation, impaired sensation, inadequate movement of structures within the hypopharynx and larynx, and diffuse pharyngeal residue. Penetration and/or aspiration occurred in 83% (n = 10/12) of thin fluids trials, with a lack of response to the penetration/aspiration noted in 50% (n = 6/12 penetration aspiration events) of the cases. Most events occurred post swallow. Findings support the fact that individuals with dysphagia post thermal burn present with multiple risk factors for aspiration that appear predominantly related to generalised weakness and inefficiency and further impacted by edema and sensory impairments. Generalised oromotor weakness and orofacial contractures (when present) impact oral-stage swallow function. This study has identified a range of factors that may contribute to both oral- and pharyngeal-stage dysfunction in this clinical population and has highlighted the importance of using a combination of clinical and instrumental assessments to fully understand the influence of burn injury on oral intake and swallowing

A prospective investigation of swallowing, nutrition, and patient-rated functional impact following altered fractionation radiotherapy with concomitant boost for oropharyngeal cancer

Altered fractionation radiotherapy for head and neck cancer has been associated with improved locoregional control, overall survival, and heightened toxicity compared with conventional treatment. Swallowing, nutrition, and patient-perceived function for altered fractionation radiotherapy with concomitant boost (AFRT-CB) for T1–T3 oropharyngeal squamous cell carcinoma (SCC) have not been previously reported. Fourteen consecutive patients treated with AFRT-CB for oropharyngeal SCC were recruited from November 2006 to August 2009 in a tertiary hospital in Brisbane, Australia. Swallowing, nutrition, and patient-perceived functional impact assessments were conducted pretreatment, at 4–6 weeks post-treatment, and at 6 months post-treatment. Deterioration from pretreatment to 4–6 weeks post-treatment in swallowing, nutrition, and functional impact was evident, likely due to the heightened toxicity associated with AFRT-CB. There was significant improvement at 6 months post-treatment in functional swallowing, nutritional status, patient-perceived swallowing, and overall function, consistent with recovery from acute toxicity. However, weight and patient perception of physical function and side effects remained significantly worse than pretreatment scores. The ongoing deficits related to weight and patient-perceived outcomes at 6 months revealed that this treatment has a long-term impact on function possibly related to the chronic effects of AFRT-CB