Putting participation first: The use of the ICF-model in the assessment and instruction of L2 pronunciation

L2 pronunciation training should unequivocally be linked to complex daily life experiences (Derwing 2017). Each client comes from a different background, participates in a different environmental context and engages in different activities within those contexts (Threats 2008). This is a particularly challenging aspect in the L2 practice (Derwing 2017). The International Classification of Functioning, Disability and Health, also known as the ICF-Model (WHO 2001, 2013), offers a conceptual framework that acknowledges the intricate dimensions of human functioning and incorporates personal and contextual factors that can influence participation in daily live (Heerkens and de Beer 2007; Ma, Threats, and Worrall 2008). This paper provides an exploration of the application of this model to pronunciation and intelligibility difficulties in L2 learning. We apply the model to a specific L2 learner, Mahmout and demonstrate how its use allows for consideration of factors much broader than the phonological or phonetic challenges Mahmout faces. Mahmout must be able to generalize that what he has learned into functional communicative competences to improve his participation. The ICF-model (WHO 2001, 2013) is used globally in a broad array of healthcare professions, including Speech and Language Therapists (SLT’s). Yet, it is not a customary tool, nor probably an obvious one, used by L2-professionals (Blake and McLeod 2019). Of course, our goal is not to classify pronunciation problems of L2 learners as disabilities. The model proves a useful tool to view the individual L2 learner as a whole, and part of a larger system. It may allow L2 professionals to tailor their intervention to the individual’s needs and situation and will consequently be able to establish priorities in instruction to enable appropriate goal setting for each individual (Blake and McLeod 2019). It allows identification of influencing barriers or facilitating factors within the stagnation or improvement of pronunciation (Blake and McLeod 2019; Howe 2008)

Article Omission in Dutch Children with SLI: A Processing Approach

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Development and Diagnostic Accuracy of a Shortened Dutch Naming Test for People with Aphasia Using Item Response Theory

Objective The first objective was to assess the psychometric properties of the 92-item Dutch Naming Test (DNT-92), developed to assess word finding difficulties in people with aphasia, using Item Response Theory (IRT). The second objective was to select suitable items for a short version with a discriminative purpose. Method This study has a retrospective, psychometric research design, in which 510 DNT-92-forms of people with aphasia and 192 DNT-forms of healthy participants were used for analyses. An IRT analysis was performed and information on the item- and person parameters was obtained. Item selection for the short version was based on a combination of the discriminative ability of the items and their estimated theta or difficulty. Items with the highest information load, and a difficulty parameter in the range of overlap between the sample of people with aphasia and healthy participants were selected. Results A 2-PL IRT analysis showed best fit to the data. Assumptions of unidimensionality, local independence, and monotonicity were met. Items were removed incrementally, whilst checking sensitivity and specificity of the remaining short form. A selection of six items proved optimal in terms of sensitivity and specificity, with an area under the curve value of 0.85. Differences were found between participants younger than 70 and older. Conclusions The IRT assumptions for the DNT-92 were met, indicating that the test has good psychometric properties. A reduction of items to just six items proved possible, leading to a reliable six item short form with a discriminatory purpose

Feasibility of a communication program: improving communication between nurses and persons with aphasia in a peripheral hospital

Background: Difficulty in communicating (due to aphasia) can have serious consequences for patients in health care settings. Communication Partner Training is effective for improving communication between people with aphasia and health care professionals. Aim and Objective: This study aims to evaluate the feasibility of developing and introducing a Communication Program which focuses on improving communication between nurses and persons with aphasia in a peripheral hospital setting. Methods & Procedures: A mixed-methods feasibility study was conducted with a pre-test post-test design in the quantitative part and two focus group discussions in the qualitative part. Nurses received training for communicating with persons with aphasia. In the pre-test and post-test, nurses filled in a questionnaire for barriers and facilitators and a feasibility questionnaire. Nurses’ attitudes towards the Communication Program were further explored in two focus group discussions. Outcomes & Results: Forty six nurses took part in the training sessions. Most nurses were satisfied about the Communication Program (24/30) and intended to continue using it (25/30). Almost all nurses saw positive effects for patients with aphasia (27/30), such as an increase in the ability to communicate. However, nurses reported that using the program was time consuming and that they still often experienced frustration when communicating with persons with aphasia. Conclusions: Improving communication with persons with aphasia via the Communication Program seems feasible and valuable according to nurses. Nurses probably need more support during implementation of the Communication Program, mainly due to time barriers and the complexity of communicating with persons with aphasia. Further research should focus on revising the program, training health care professionals with different educational backgrounds, and assessing the implementation of this communication partner training in health care settings

Research, education and clinical practice: an example of a learning community in the field of Speech and Language Therapy

Description of the contributions of students participating in the Honours Programme of the Utrecht University of Applied Sciences in the development of a test for diagnosing word finding difficultie

How do healthcare professionals experience communication with people with aphasia and what content should Communication Partner Training entail?

Purpose: Aphasia after stroke has been shown to lead to communication difficulties between healthcare professionals (HCP) and people with aphasia. Clinical guidelines emphasize the importance of teaching HCP to use supportive conversative techniques through communication partner training (CPT). The aim of this study is to explore and describe the experiences of HCP in communicating with people with aphasia and their needs and wishes for the content in CPT. Materials and methods: The data were collected through qualitative semi-structured interviews with 17 HCP. HCP were recruited from two geriatric rehabilitation centres in the Netherlands and one academic hospital in Belgium. The interviews drew upon the qualitative research methodologies ethnography and phenomenology and were thematically analysed using the six steps of Braun & Clarke. Results: Three themes were derived from the interviews. HCP experienced that communication difficulties impede healthcare activities (theme 1) and reported the need to improve communication through organizational changes (theme 2), changing the roles of SLTs (theme 3) and increasing knowledge and skills of HCP (theme 4). Conclusions: According to HCP, communication difficulties challenge the provision of healthcare activities and lead to negative feelings in HCP. HCP suggest that communication can be improved by providing more time in the healthcare pathway of people with aphasia, adapting healthcare information to the needs of people with aphasia, commitment of physicians and managers, changing the roles of SLTs and improving knowledge and skills of HCP. Implications for rehabilitation Communication between healthcare professionals (HCP) and people with aphasia can be improved by training HCP to use supportive conversation techniques and tools. An important condition for successful implementation of communication partner trainings in healthcare centres is to identify the experiences of HCP with communication with people with aphasia and their needs and wishes for training content. This study shows that communication problems between HCP and people with aphasia impede diagnosis and therapy with considerable implications for healthcare quality. The suggestions that HCP have concerning the content of communication partner trainings can be placed under "education" and "implementation and post-training support." HCP describe specific roles for speech-and language therapists to fulfil after the training and suggest two main changes that should be made at an organizational level

Evaluating communication partner training in healthcare centres: Understanding the mechanisms of behaviour change

Background Communication between people with aphasia and their healthcare professionals (HCPs) can be greatly improved when HCPs are trained in using supportive conversation techniques and tools. Communication partner training (CPT) is an umbrella term that covers a range of interventions that train the conversation partners of people with aphasia. Several CPT interventions for HCPs have been developed and used to support HCPs to interact successfully with people with aphasia. Aims The objective of this study was to identify the mechanisms of change as a result of a Dutch CPT intervention, named CommuniCare, in order to evaluate and optimise the intervention. Methods & procedures A total of 254 HCPs from five different healthcare centres received CommuniCare. An explorative qualitative research design was chosen. Two interviews were conducted with 24 HCPs directly after and 4 months after receiving the training that was part of CommuniCare. Two conceptual frameworks were used to deductively code the interviews. HCPs’ perspectives were coded into a four-part sequence following CIMO logic: the self-reported use of supportive conversation techniques or tools pre-intervention (Context), the intervention elements (Intervention) that evoked certain mechanisms (Mechanisms), resulting in the self-reported use of supportive conversation techniques and tools post-intervention (Outcomes). The Capabilities Opportunities Motivation–Behaviour (COM-B) model was used to fill in the Mechanisms component. Outcomes & results Three themes were identified to describe the mechanisms of change that led to an increase in the use of supportive conversation techniques and tools. According to HCPs, (i) information, videos, e-learning modules, role-play, feedback during training and coaching on the job increased their psychological capabilities; (ii) information and role-play increased their automatic motivations; and (iii) information, videos and role-play increased their reflective motivations. Remaining findings show HCPs’ perspectives on various barriers to use supportive conversation techniques and tools. Conclusions & implications HCPs in this study identified elements in our CPT intervention that positively influenced their behaviour change. Of these, role-play and coaching on the job were particularly important. HCPs suggested this last element should be better implemented. Therefore, healthcare settings wishing to enhance HCPs’ communication skills should first consider enhancing HCPs’ opportunities for experiential learning. Second, healthcare settings should determine which HCPs are suitable to have a role as implementation support practitioners, to support their colleagues in the use of supportive conversation techniques and tools