The effect of three practice conditions on the consistency of chronic dysarthric speech

This study investigated whether it is possible for people with chronic dysarthria to adjust their articulation in three practice conditions. A speaker dependent, speech recognition system was used to compare participants' practice attempts with a model of a word made from previous recordings to give a recognition score. This score was used to indicate changes in production of practice words with different conditions. The three conditions were reading of written target words, visual feedback, and an auditory model followed by visual feedback. For eight participants with dysarthria, the ability to alter speech production was shown, together with a differential effect of the three conditions. Copying an auditory target gave significantly better recognition scores than just repeating the word. Visual feedback was no more effective than repetition alone. For four control participants, visual feedback did produce significantly better recognition scores than just repetition of written words, and the presence of an auditory model was Significantly more effective than visual feedback. Possible reasons for differences between conditions are discussed

Where are we now with aphasia after stroke?

Objective: To provide a brief review of research literature relating to the current state of knowledge regarding speech and language therapy for people with aphasia and place these research findings within the context of outcome data of non-selected patients receiving usual therapy in the UK. Methods: Part 1 presents a literature search aimed at exploring up-to-date information related to the nature and evolution of aphasia, the impact of therapy and the changing nature of therapy. This provides the context of what may be achieved in rehabilitation. Part 2 examines of the impact of speech and language therapy on 1664 prospective patients receiving therapy for aphasia after stroke by 3 different types of service provision was collected and statistically analysed. The Therapy Outcome Measure was used to identify change in impairment, activity, participation and well-being at the beginning and end of therapy. Results: The findings from the non-selected group of patients supports the conclusions of the reported randomised control trials in that speech and language therapy for post stroke aphasia is associated with gains in one or more of the domains of the International Classification of Functioning

The impact of stroke: are people with aphasia different to those without?

Purpose. Stroke rehabilitation programmes aim to improve functional outcomes and quality of life. This study explored long-term outcomes in a cohort of people admitted to two acute stroke units with stroke. Comparisons were drawn between people with aphasia (PWA) and people without aphasia. Methods. People admitted to hospital with a first stroke were assessed at 2-weeks, 3-months and 6-months post-stroke. Measures included: the Barthel Index for Activities of Daily Living (ADL), the Frenchay Aphasia Screening Test, the General Health Questionnaire-12 for emotional well-being and the Stroke and Aphasia Quality of Life Scale-39g. Extended ADL and social support were also measured at 3 and 6 months, with the Frenchay Activities Index and the Social Support Survey, respectively. Results. Of 126 eligible participants, 96(76%) took part and 87(69%) were able to self-report. Self-report data are reported here. Although outcomes improved significantly across time, at 6 months people continued to experience substantial functional limitations (16% aphasic; 32% dependent on basic ADL); participation limitations (79% ≤30 on the FAI); high psychological distress (45%) and compromised quality of life (54% ≤4 on the SAQOL-39g). Levels of social support remained relatively stable. Though at 3-months post-stroke PWA were significantly more likely to experience high psychological distress (93% versus 50% for those without), across time, there were no significant differences between PWA and those without on psychological distress and also ADL and social support. There were, however, significant differences on extended ADL (F(1,68) = 7.80, p < 0.01) and quality of life (F(1,69) = 6.30, p < 0.05). Conclusion. PWA participated in fewer activities and reported worse quality of life after stroke than people without aphasia, even when their physical abilities, well-being and social support were comparable. Implications for clinical practice and future research are discussed

N<i>e</i>XOS – the design, development and evaluation of a rehabilitation system for the lower limbs

Recent years have seen the development of a number of automated and semi-automated systems to support for physiotherapy and rehabilitation. These deploy a range of technologies from highly complex purpose built systems to approaches based around the use of industrial robots operating either individually or in combination for applications ranging from stroke to mobility enhancement. The NeXOS project set out to investigate an approach to the rehabilitation of the lower limbs in a way which brought together expertise in engineering design and mechatronics with specilists in rehabilitation and physiotherapy. The resulting system has resulted in a prototype of a system which is capable in operating in a number of modes from fully independent to providing direct support to a physiotherapist during manipulation of the limb. Designed around a low cost approach for an implementation ultimately capable of use in a patients home using web-baased strategies for communication with their support team, the prototype NeXOS system has validated the adoption of an integrated approach to its development. The paper considers this design and development process and provides the results from the initial tests with physiotherapists to establish the operational basis for clinical implementation

How do health and social care professionals in England and Wales assess mental capacity? A literature review

PURPOSE: To review evidence describing how health and social care professionals in England and Wales assess mental capacity, in order to identify ways to improve practice. METHODS: A systematised literature review was completed. Electronic databases of published medical, health and social care research and gray literature were searched. Journal articles and research reports published between 2007 and 2018 were included if they met predefined eligibility criteria. Evidence from included studies was synthesized using thematic analysis. RESULTS: 20 studies of variable methodological quality were included. The studies described assessments carried out by a range of multidisciplinary professionals working with different groups of service users in diverse care contexts. Four main themes were identified: preparation for assessment; capacity assessment processes; supported decision-making; interventions to facilitate or improve practice. There was a lack of detailed information describing how professionals provided information to service users and tested their decision-making abilities. Practice reported in studies varied in terms of its conformity to legal requirements. CONCLUSIONS: This review synthesized evidence about mental capacity assessment methods and quality in England and Wales and analyzed it to suggest ways in which practice might be improved. Implications for rehabilitation: Mental capacity assessment practice in England and Wales varies and is not always consistent with legal requirements, risking inconsistent and inaccurate judgements about capacity and exposure to legal action. Interventions have been developed to help professionals to engage in supported decision-making, and improve their mental capacity assessments and documentation in line with legal standards. These interventions include training and practical resources, such as assessment flowcharts, checklists and documentation aids. Such interventions would benefit from robust evaluation before they are implemented more widely

Outcome measurement in speech and language therapy: a digital journey

Background Evidencing the impact of speech and language therapy interventions is challenging. The UK’s professional body for speech and language therapists (SLTs) is supporting a consistent approach to outcome measurement and analysis using Therapy Outcome Measures (TOMs). Objective To develop a digital solution for collecting TOMs data, evaluate the impact of therapeutic interventions and explore contributing factors to outcome variation across clinical areas. \ud Method Agile methodology was applied to software development. Organisations were recruited to provide data. Criteria were identified to exemplify outcome variability. Results A digital tool was developed. 21 organisations provided data on 16 356 individuals. Improvement in at least one domain of TOMs occurred in 77.1% of instances. Data for two clinical areas exemplify the tool’s effectiveness in highlighting the impact of speech and language therapy. Conclusion This established outcomes data set can be used to evaluate the impact of speech and language therapy, and explore variation in outcomes

Mapping the contribution of Allied Health Professions to the wider public health workforce : a rapid review of evidence-based interventions

Objectives: The objective was to identify a selection of the best examples of the public health contributions by Allied Health Professionals (AHPs) in order to encourage a wider awareness and participation from that workforce to public health practice. Study design: A mapping exercise was used to identify evidence-based interventions that could lead to health improvements across a population. Methods: A rapid review was undertaken to identify evidence, followed by a survey of Allied Health Profession (AHP) practitioners and an expert panel consensus method to select the examples of AHP public health interventions. Results: Nine evidence-based interventions are identified and selected as examples of current AHP good practice. These examples represent a contribution to public health and include screening interventions, secondary prevention and risk management. Conclusions: This study contributes to a strategy for AHPs in public health by appraising the effectiveness and impact of some exemplar AHP practices that contribute to health improvement. There is a need for AHPs to measure the impact of their interventions and to demonstrate evidence of outcomes at population level. Keywords: allied health professions; Applied Health Professionals; evidence-based practice; health improvement; public health; rapid revie

Psychometric properties of the Stroke and Aphasia Quality of Life Scale (SAQOL-39) in a generic stroke population

Background: We previously developed the Stroke and Aphasia Quality of Life scale (SAQOL-39) and tested it with people with chronic aphasia. A scale allowing comparisons of quality of life between people with versus without aphasia post-stroke would be of value to clinicians. Objectives: To evaluate the psychometrics of the SAQOL-39 in a generic stroke sample. Should this process result in a generic-stroke version of the scale (SAQOL-39g), a further aim is to compare the latter and the SAQOL-39 as tested in chronic aphasia. Design and subjects: Repeated measures psychometric study, evaluating internal consistency, test—retest reliability, construct validity and responsiveness to change. People admitted to hospital with a first stroke were assessed two weeks, three months and six months post stroke. Measures: SAQOL-39, National Institutes of Health Stroke Scale, Barthel, Frenchay Aphasia Screening Test, General Health Questionnaire-12 and Frenchay Activities Index. Results: Of 126 eligible participants, 96 (76%) participated and 87 (69%) were able to self-report and are presented here. Testing the SAQOL-39 in generic stroke resulted in the SAQOL-39g, which has the same items as the SAQOL-39 but three domains: physical, psychosocial, communication. The SAQOL-39g showed good internal consistency (α = 0.95 overall score, 0.92—0.95 domains), test—retest reliability (interclass correlation (ICC) = 0.96 overall, 0.92—0.98 domains), convergent (r = 0.36—0.70 overall, 0.47—0.78 domains) and discriminant validity (r = 0.26 overall, 0.03—0.40 domains). It differentiated people by stroke severity and visual analogue scale (VAS)-defined quality of life. Moderate changes (d = 0.35—0.49; standardized response mean (SRM) = 0.29—0.53) from two weeks to six months supported responsiveness. Conclusions: The SAQOL-39g demonstrated good reliability, validity and responsiveness to change. It can be used to evaluate quality of life in people with and without aphasia post stroke

An exploration of mental capacity assessment within acute hospital and intermediate care settings in England: a focus group study

© 2016 Informa UK Limited, trading as Taylor & Francis Group. Purpose: To explore approaches to the assessment of mental capacity within acute hospital and intermediate care settings in England. Methods: Two focus group interviews were conducted with multidisciplinary staff (n = 13) within a large hospital trust. Data were analysed using a Framework approach. Results: Three main themes were identified: (i) the assessment process; (ii) staff experience of assessment; (iii) assessing capacity for patients with communication difficulties. Staff identified the main patient groups, patient decisions and professionals involved in capacity assessment. They described using both formal and informal approaches to assess capacity and specific methods to identify and support the needs of patients with communication difficulties during the assessment process. Most staff reported finding capacity assessment challenging, due to time pressures, a perceived lack of knowledge or skills and encountering practice that is not consistent with legal requirements. Staff stated a need for initiatives to facilitate and improve practice. Conclusions: These findings provide confirmatory evidence that mental capacity assessment is complex and challenging and that staff would benefit from additional support and resources to aid their practice. It provides new evidence about the methods used by staff to assess capacity, particularly for patients with communication difficulties. Implications for Rehabilitation This study contributes to our understanding of how staff assess capacity in hospital and intermediate care settings. Mental capacity assessment is a complex activity and many staff reported finding it challenging. Patients with communication difficulties need additional support during capacity assessments but may not always receive this. Current practice needs to be improved and staff need support and resources to achieve this

The state of the art in non-pharmacological interventions for developmental stuttering. Part 2: qualitative evidence synthesis of views and experiences.

BACKGROUND: A range of interventions have been developed to treat stuttering in recent years. The effectiveness of these interventions has largely been assessed in studies focusing on the impact of specific types of therapy on patient outcomes. Relatively little is known about the factors that influence how the delivery and impact of different types of intervention may be experienced from the perspective of both people who deliver as well as those who receive interventions. AIMS: To synthesize the available evidence in relation to factors that might enhance or mitigate against successful outcomes following interventions for stuttering by identifying and synthesizing relevant qualitative research that explored the experiences of people delivering and receiving interventions that aim to improve fluency. METHODS & PROCEDURES: We carried out a systematic review including research that had used in-depth interviews and focus groups and conducted a substantive qualitative analysis of the data collected. Included study populations were either adults or children affected by a diagnosed stutter and/or providers of therapy for stuttering. An iterative approach was used to search for published qualitative evidence in relevant databases from 1990 to 2014. Retrieved citations were sifted for relevance and the data from articles that met the inclusion criteria were extracted. Each included paper was assessed for quality and a thematic analysis and synthesis of findings was carried out. MAIN CONTRIBUTION: Synthesized qualitative evidence highlights the changing experiences for people who stutter both historically and, for individuals, over the life course. Barriers and facilitators to the implementation of interventions for stuttering are encountered at the individual, intervention, interpersonal and social levels. Interventions may be particularly pertinent at certain transition points in the life course. Attention to emotional as well as practical aspects of stuttering is valued by people receiving therapy. The client-therapist relationship and support from others are also key factors in achieving successful outcomes. CONCLUSIONS & IMPLICATIONS: A synthesis of qualitative findings from published papers has added to the effectiveness data reported in an accompanying paper in understanding how stuttering impacts on people across the life course. Evidence suggests that a client-centred and individually tailored approach enhances the likelihood of successful intervention outcomes through attention to emotional, situational and practical needs