Oral Care in Acute Stroke

Purpose: Stroke impacts independent activities, particularly personal care such as oral hygiene. Existing guidelines lack details about how to provide effective oral care. This study explores the frequency of oral care based on staff adherence to oral care policies. Method: As part of a quality improvement initiative, we conducted a retrospective chart review of 30 consecutive stroke admissions to an acute care hospital. Patients with primary intracerebral hemorrhage or ischemic stroke were eligible. Sources of information included a decision support database and an electronic chart review. Data collection included length of hospitalization, stroke type, presence of infections, oral mechanism exam, dysphagia evaluations, and daily personal care provision by nursing staff (e.g., oral care and bathing). Results: Twenty-seven patients met the inclusion criteria. They had a mean age of 74 years, and 52% were men. Most had supratentorial stroke (86%) with comparable frequencies of right (48%) and left (52%) hemisphere lesions. In over half of the cases, provision of oral care was not documented at any point during the patients' hospitalization ( Mdn = 128 hr). Pericare and bathing were about twice and 4 times more frequent than oral care, respectively. Conclusions: Oral care after stroke is challenging. Existing oral care recommendations from stroke guidelines lack sufficient detail and warrant reconsideration for optimal and routine implementation particularly in acute settings. Education around oral care and associated protocols are necessary to advance oral care practices and improve stroke recovery.

Do Mothers and Fathers of Egyptian Stuttering Children View Stuttering Differently?

Purpose: Limited research has shown that knowing or interacting with a person who stutters facilitates more positive attitudes toward stuttering. This is true when the stuttering person is a close friend or a family member. The study sought to determine if Egyptian mothers held different stuttering attitudes than fathers as joint parents of children who stuttered. Method: Public Opinion Survey of Human Attributes–Stuttering results of 25 mothers and 25 fathers of the same children who stuttered were compared. Also, children's severity scores were correlated with their parents' attitudes. Results: There were no significant differences between mothers' and fathers' stuttering attitudes; however, an unexpected trend for more positive attitudes of fathers was observed. Weak relationships between children's stuttering severity and their parents' attitudes existed, with slightly higher correlations for the fathers. Conclusion: Nonsignificant trends for slightly more positive attitudes for fathers than mothers should be explored in larger sample sizes in order to answer the question “Should information provided for parents of children who stutter be different or differently presented to mothers versus fathers?”

The Love and Science of Reading: A Promising Instructional Approach for Adolescent Multilingual Learners

Purpose: Adolescent multilingual learners are at high risk for reading difficulties as evidenced by persistent achievement gaps. This article calls for a paradigm shift and aims to elucidate what constitutes promising second-language literacy instruction for multilingual adolescents, comprising effective literacy practices grounded in research, combined with an emphasis on individual learners and their sociocultural development. Cast in ecological systems and functionalist perspectives, this article provides a model for language and literacy instruction that is grounded in basic tenets of reading science within a sociocultural context. We outline strategies that focus on language as a basis for reading development followed by examples of authentic learning experiences designed to motivate students and nurture their love of reading. Conclusions: A solution to existing achievement gaps may be a promising approach that emphasizes both the science and love of reading, which entails targeted instruction rooted in the research evidence integrated into engaging and meaningful learning experiences, central to which is the acknowledgement of multilingual learners as individuals. The authors call for an intentional focus on accelerating the development of language through frequent use of and a genuine love for both the science of reading and the science of teaching reading.

Tele-Ethics in Communication Disorders: Asking the Right Questions, Finding the Right Answers

Purpose: A hypothetical case is used to illustrate legal and ethical issues involving the decision to replace the traditional in-person service delivery model with telepractice in schools beyond the context of the initial COVID-19 health emergency. In this clinical focus article, the reader follows Maria, the lead speech-language pathologist (SLP) in the district, as she determines the feasibility of continuing telepractice in her district now that students and clinicians are returning to schools. First, she considers the support needed to implement this service delivery model within the school setting given the anticipated changes to the rules and regulations governing lawful and ethical provision of telepractice after the health emergency ends. Next, she decides if telepractice is warranted in the district by considering the rationales behind the requests. Faced with balancing school, student, and clinician needs, Maria uses an ethical decision-making model to determine if requests for telepractice, tied to health safety concerns and potentially influenced by implicit bias, reflect legal, ethical, and/or moral issues driven by fear or unconscious discriminatory motives. Conclusions: The health emergency gave SLPs working in schools the unique opportunity to experience the benefits and utility of telepractice. Following the return to schools, continuation of telepractice services will require support and training of SLPs. Many factors must be considered including equivalency of services, technology, and protection of privacy as they relate to the changes to the laws and regulations governing telepractice after the health emergency allowances end. Of primary importance is the selection of telepractice to address student needs, not to avoid specific schools because of their characteristics or location. An ethical decision-making model can be used as a framework to guide service delivery model decisions that balance the needs of the student, the clinician, and the district.

Tutorial for Abstract Semantic Associative Network Training (AbSANT): Theoretical Rationale, Step-by-Step Protocol, and Material Resources

Purpose: The availability of evidence-based therapies for abstract words is limited. Abstract Semantic Associative Network Training (AbSANT) is theoretically motivated and has been shown to not only improve directly trained abstract words, such as the word emergency in the category hospital, but also promote generalization to related concrete words, such as the word doctor . Method: This tutorial provides step-by-step instructions, including cueing strategies, and material resources for conducting AbSANT. Importantly, this tutorial also explains the theoretical motivation behind AbSANT, as well as information regarding the population, dose, and environment characteristics of effective trials, to help clinicians make informed decisions regarding the applicability of this approach and to guide decision-making throughout the steps of therapy. Conclusions: AbSANT is an effective, theoretically based treatment for abstract words. This tutorial provides all of the resources needed to conduct AbSANT with clients with aphasia. Supplemental Material https://doi.org/10.23641/asha.17776211

Speech as a Biomarker: Opportunities, Interpretability, and Challenges

Purpose: Over the past decade, the signal processing and machine learning literature has demonstrated notable advancements in automated speech processing with the use of artificial intelligence for medical assessment and monitoring (e.g., depression, dementia, and Parkinson's disease, among others). Meanwhile, the clinical speech literature has identified several interpretable, theoretically motivated measures that are sensitive to abnormalities in the cognitive, linguistic, affective, motoric, and anatomical domains. Both fields have, thus, independently demonstrated the potential for speech to serve as an informative biomarker for detecting different psychiatric and physiological conditions. However, despite these parallel advancements, automated speech biomarkers have not been integrated into routine clinical practice to date. Conclusions: In this article, we present opportunities and challenges for adoption of speech as a biomarker in clinical practice and research. Toward clinical acceptance and adoption of speech-based digital biomarkers, we argue for the importance of several factors such as robustness, specificity, diversity, and physiological interpretability of speech analytics in clinical applications.

The Case for Addressing Emotional Resilience in Graduate Student Training

Purpose: The purpose of this study was to review the evidence for addressing emotional resilience in the training of graduate students in communication sciences and disorders (CSD). As helping professionals, speech-language pathologists and audiologists face unique emotional challenges that can lead to burnout, compassion fatigue, and eventually possible career changes. At the same time, we also know that graduate students across the country, in all disciplines, are in the throes of a mental health crisis. Graduate students in CSD are, therefore, in need of targeted instruction on how to foster emotional resilience both to manage the stressors of graduate school and to ensure professional wellness and career longevity. Conclusions: While there is currently limited research evidence on how to effectively target emotional resilience for graduate students in CSD, existing research and guidance from studies in CSD and other helping professions can provide a framework to follow. The recent mental health challenges facing our nation, and graduate students more specifically, should be seen as both a call to action and an opportunity to elevate the depth of training provided beyond core knowledge and skills to include education on wellness, self-care, and emotional resilience to develop career-long habits.

Strategies for Teachers to Support Children Who Stutter: Perspectives of Speech-Language Pathologists

Purpose: This study assessed how speech-language pathologists (SLPs) believe teachers can best support school-age children who stutter (CWS) in the classroom. Method: An online survey adapted from the Personal Appraisal of Support for Stuttering–Parent was given to 122 SLPs licensed in the State of Oklahoma. The median age of the participants was 43 years (interquartile range [IQR] = 16), and the average number of CWS the participants reported treating was 14 (IQR = 14). The participants rated the helpfulness of supports teachers can use as they interact with CWS (e.g., “Tell the child to slow down”). The participants rated 41 items on a 1–5 Likert scale, with 1 indicating unhelpful and 5 indicating very helpful , followed by a “not sure” category. Results: The three items rated most helpful were for teachers to collaborate with the child's SLP, to be patient when the child talks, and to know how to react when the child stutters. The three items rated least helpful were for teachers to be bothered by the child's stuttering, to laugh at the child because of the child's stuttering, and to use a fast rate of speech. The two items with the greatest response variability were for teachers to tell the child to think about what to say before speaking and to tell the child what to do when stuttering. The variability suggests inconsistency in the SLPs' beliefs about the helpfulness of those actions. Conclusion: Findings from this study contribute to the literature on supporting CWS and the development of educational materials for classroom teachers.

Facilitators and Barriers to Implementing the International Dysphagia Diet Standardisation Initiative in Care Facilities in Upstate New York

Introduction: Dysphagia is a swallowing disorder that can result in aspiration, asphyxiation, or other complications. One method of facilitating safer swallowing is modification of the diet and fluids of individuals living with dysphagia. The International Dysphagia Diet Standardisation Initiative (IDDSI) is a globally standardized framework for texture modification. Its implementation has been recommended in the United States, but adoption is not yet universal. This study investigated implementation issues by surveying health care professionals in health care facilities in rural, Upstate New York. Method: A questionnaire created through the SurveyMonkey platform was distributed to health care facilities within a predetermined geographical area in Upstate New York. The survey consisted of 22 questions and utilized a mixed-methods design. Results: Forty-six participants from 10 individual professions and nine types of facilities completed the study. Twenty texture modification labels and 10 fluid modification labels were described. Analysis of qualitative data yielded three main barriers to implementation: funding, education, and communication. Within each barrier, awareness and resources were recurrent themes. Discussion: The variety of modification labels in comparison with the sample size demonstrates a lack of standardization of texture modification processes across facilities. While nearly half the respondents had not heard of IDDSI prior to the survey, 89% agreed that a standardized dysphagia diet would improve patient health and safety. This demonstrated a willingness to adopt IDDSI and indicated that staff attitudes may not be a barrier to its implementation. Participants felt that training was needed for successful implementation and expressed concern about the lack of availability of financial resources. Supplemental Material: https://doi.org/10.23641/asha.17270861

Effects of Cued and Uncued Swallowing in Patients With Dementia

Purpose: Parameters such as bolus location at swallow onset (BLSO), stage transition duration (STD), pharyngeal transition duration (PTD), pharyngeal response duration (PRD), and pharyngeal phase duration (PPD) often vary between cued and uncued swallowing conditions. Research has demonstrated that cued swallows may offer functional benefits that mitigate pathophysiological processes. However, there are limited data assessing differences between cued and uncued swallows in disordered populations, such as dementia. The purpose of this study was to evaluate if cued swallowing alters swallowing biomechanics in patients living with dementia. Method: Through a retrospective analysis of videofluoroscopic swallow studies (VFSS), 105 swallows from 26 participants living with dementia ( M age = 81 years; 14 women) were analyzed in duplicate by blinded raters using the Analysis of Swallowing Physiology, Events, Kinematics, and Timing method. Only VFSS with at least one cued and one uncued swallow were included in the analysis. Chi-square tests were used to explore differences in BLSO. Repeated-measures analyses of variance (ANOVAs) were used to explore differences in STD, PTD, PRD, and PPD. Results: Results revealed no significant differences in BLSO between cued and uncued swallows for patients living with dementia ( p = .934). Repeated-measures ANOVAs revealed no significant differences between the two types of swallows for STD ( p = .995), PTD ( p = .864), PRD ( p = .807), or PPD ( p = .660). Conclusions: This study suggests that there may be limited benefit to providing cued swallows to individuals living with dementia. Further research should investigate if this is due to impaired cognition and/or changes in motor control to volitionally complete the cued swallow.