International Journal of Speech-Language Pathology

This study investigates the phonological acquisition of 19 monolingual English children and 21 English?French bilingual children at 18 and 36 months. It contributes to the understanding of age-related changes to phonological complexity and to differences due to bilingual language development. In addition, preliminary normative data is presented for English children and English?French bilingual children. Five measures were targeted to represent a range of indices of phonological development: the phonological mean length of utterance (pMLU) of the adult target, the pMLU produced by the child, the proportion of whole-word proximity (PWP), proportion of consonants correct (PCC), and proportion of whole words correct (PWC). The measures of children's productions showed improvements from 18 to 36 months; however, the rate of change varied across the measures, with PWP improving faster, then PCC, and finally PWC. The results indicated that bilingual children can keep pace with their monolingual peers at both 18 months and 36 months of age, at least in their dominant language. Based on these findings, discrepancies with monolingual phonological development that one might observe in a bilingual child's non-dominant language could be explained by reduced exposure to the language rather than a general slower acquisition of phonology.

This longitudinal investigation examined the temporal and spectral characteristics of the high front vowels /i/ and /I/ as produced by nine monolingual US English children from 21-33 months. Vowel overlap was quantified in two-dimensional (F1, F2) and three-dimensional (F1, F2, duration) space using Spectral Overlap Assessment Measure (SOAM). These findings were compared with the results from Support Vector Machine (SVM) vowel classification, vowel duration ratios, and measures of effect size, to determine whether a spectral/temporal trading effect existed in the early vowel productions of young children. Children between the ages of 21 and 33 months are highly variable in the way they use spectral and temporal parameters to distinguish between these two adjacent vowels. However, findings pointed to the existence of a spectral/temporal trading effect when spectral overlap values are relatively high (>60%) at 21 and 24 months of age.

Language impairments are reported in multiple sclerosis (MS). To date, the majority of studies have evaluated language differences between relapsing-remitting (RR) and chronic progressive (CP) clinical courses. Neurologists have distinguished two progressive courses of MS: primary progressive (PP) MS and secondary progressive (SP) MS. Recent evidence suggests that cognitive performance profiles may provide a means of differentiating between the clinical courses of RR, SP, and PPMS. With this in mind, a deviation of language profiles between sub-types is predicted. The purpose of this study is to profile the language abilities of five participants with PPMS. Five participants with PPMS participated in this investigation. The participants were assessed using the Neurosensory Center Comprehensive Examination for Aphasia (NCCEA), the Boston Naming Test (BNT), and the Test of Language Competence-Expanded (TLC-E). Data analysis consisted of (a) comparison of the total scores achieved by the PPMS participants and a group of 26 age-matched controls on the NCCEA, BNT, and TLC-E, and (b) case studies to individually profile the language abilities of the five participants with PPMS. Comparison of the NCCEA, BNT, and TLC-E total scores of the participants with PPMS and the control group did not indicate significant differences between the two groups. Case-by-case analysis revealed deficits in meta-linguistic abilities in two participants. The results provide preliminary evidence to suggest that, although patients with PPMS may have preserved general language abilities, some individuals may present with mild impairments in high-level linguistic abilities.

Children with Attention Deficit Hyperactivity Disorder (ADHD) commonly experience significant pragmatic language deficits which put them at risk of developing emotional and social difficulties. This study aimed to examine the pragmatic language exhibited in a peer-to-peer interaction between the children with ADHD and their playmates following a pilot play-based intervention. Participants were children (aged 5-11 years) diagnosed as having ADHD (n = 14) and their self-selected typically-developing playmate. Pragmatic language was measured using the Pragmatic Protocol (PP) and the Structured Multidimensional Assessment Profiles (S-MAPs). Children's structural language was also screened and compared against their pragmatic language skills pre-post play-based intervention. The pragmatic language of children with ADHD improved significantly from pre-post intervention as measured by both the PP and S-MAPs. Both children with and without structural language difficulties improved significantly from pre- to post-intervention using S-MAPs; only children with structural language difficulties improved significantly using PP. The findings support the notion that pragmatic skills may improve following a play-based intervention that is characterized by didactic social interaction. As pragmatic language is a complex construct, it is proposed that clinicians and researchers reconsider the working definition of pragmatic language and the operationalization thereof in assessments.

The timely release of the World Report on Disability serves as a challenge to members of the health professions to review and renew their response to inequity of access and provision of services to children and adults with a disability. This paper responds to the lead article by Wylie, McAllister, Davidson, and Marshall, and provides commentary on two of the recommendations of the World Report on Disability in the context of a novel inter-professional service for Aboriginal and Torres Strait Islander children with communication and learning needs. Speech-language pathology and occupational therapy students reported on their learning within a model of service delivery based on partnership with an Aboriginal and Torres Strait Islander school community and inter-professional collaboration. Lessons learned have the potential to inform future services for under-served populations and to impact on capacity building through health professionals gaining experiential knowledge and understanding of an urban Aboriginal and Torres Strait Islander community.

The use of standardized language assessment tools with Australian Indigenous children has been criticized for language and cultural reasons; however, this has not been tested in an urban context. The aim of the study was to explore the language performance of a small sample of urban Aboriginal pre-schoolers on a standardized language tool compared with a conversational sample. Fifteen participants (drawn from a birth cohort study of over 150 Aboriginal infants born at a metropolitan hospital) completed the Clinical Evaluation of Language Fundamentals-Preschool Edition, Second Edition (CELF-P2) and generated a 30-minute conversational language sample. Descriptive data are reported, and five case studies are explored in detail to compare results of the CELF-P2 and the language sample analysis. Grammatical features of Aboriginal English are also investigated. There was a diverse range of responses to standardized assessment and language sampling, with some samples reflective of CELF-P2 results. Two or more grammatical features of Aboriginal English were identified in 13 of the language samples. The results suggest the CELF-P2 is an appropriate tool to use to assess the language development of the children in the study when used in conjunction with analysis of language samples obtained using culturally appropriate methods.

This study investigated the phonological awareness and early spelling skills of 10 Australian Aboriginal and 10 non-Aboriginal children in their first year of schooling at urban schools. Phonological awareness was assessed using a standardized test (the Queensland University Inventory of Literacy), and children completed a standard spelling task that required them to generate spelling attempts in response to 12 line drawings of familiar animals. Spelling was analysed using the Spelling Scoring Sensitivity procedure. All children performed within the normal range for scores on the QUIL. However, as a group, Aboriginal children performed more poorly than their non-Aboriginal peers. Statistically significant differences were found on the subtests non-word spelling, non-word reading, and phoneme segmentation. Both formal scoring and informal observations were used to examine the spelling skills of participants. Possible explanations of the differences between groups are discussed in terms of health and cultural factors, and implications for the education of Aboriginal children are suggested.

Abstract The study aimed to evaluate the phonological profiles of Chinese-English bilingual children in primary grades relative to those of English monolinguals, and to compare these profiles with speech-language pathologists' (SLPs') ratings of children's speech in terms of accent or developmental level. Participants were 29 Chinese-English bilinguals and 25 English-monolingual children. Speech samples were collected using the Goldman-Fristoe Test of Articulation-2, either a Cantonese or Mandarin phonology test, and three sentences in a delayed repetition task. In addition, 10 SLPs rated each of the randomized sentences on either an accent or developmental level scale. Bilingual children with identified accents had significantly lower standard scores than monolingual children on the GFTA-2, but on the Chinese phonological assessments the same children showed age-expected speech. The differences in the bilingual children's scores on phonology tests in English vs Chinese highlight the need for phonological assessment in both languages. The SLP listener results further suggest that perceptual judgement may be a useful complement in phonological assessment of bilingual children but not a replacement for more formal testing.

The present study quantified the amount of accent in English vowels produced by native adult Turkish speakers. Vowels that are present in both Turkish and English (close vowels) were compared with those that are present only in English (distant vowels). The first two formant frequencies (F1 and F2) were obtained from the 11 English monophthong vowels (/i, i, e, ε, æ, Λ, u, [Formula: see text], o, [Formula: see text], [Formula: see text]/) produced by 20 Turkish-accented English (TE) (10 males and 10 females) bilinguals and 20 native American English (AE) speakers. Euclidean distance (ED) was used to measure the separation between the corresponding TE and AE vowels. Perceptual experiment was also carried out to assess the amount of accent in the English produced by Turkish speakers as perceived by native monolingual English speakers. F1 and F2 values revealed that TE speakers generally were able to produce close and distant vowels comparably, with considerable amount of deviation from AE speakers. ED values for close and distant vowels were not significantly different. The amount of perceived accent indicated the precision of vowel production and was found to directly correlate with the acoustic findings.

This paper reports results and implications of two related studies which investigated (a) access of residents and speech-language pathologists (SLPs) of rural Australia to information and communication technologies (ICT) and (b) their attitudes towards the use of ICT for delivery of speech-language pathology services. Both studies used mail out questionnaires, followed by interviews with a subset of those who completed the questionnaires. Data were obtained from 43 questionnaires from rural residents and 10 interviews with a subset of those residents, and from questionnaires returned by 49 SLPs and 4 interviews with a subset of those SLPs. Results show a mismatch between rural residents' and SLPs' access to and attitudes towards use of ICT for speech-language pathology service delivery. Rural residents had better access and more positive attitudes to the use of ICT for speech-language pathology service delivery than expected by SLPs. The results of this study have important implications for education and professional development of SLPs and for research into the use of ICT for telespeech-language pathology.

There is a growing body of research that indicates that a person with a communication disability communicates and participates more effectively given a communicatively accessible environment. If this research is to be translated into practice then one needs to determine who will take on the role of creating communicatively accessible environments. This research adopted a qualitative methodology to explore the perceptions of speech-language pathologists about working to create communicatively accessible healthcare settings. Fifteen speech-language pathologists in three focus groups participated in this research. The focus group discussions were transcribed and analysed thematically. Thematic analysis indicated that speech-language pathologists believe there are four main benefits in creating communicatively accessible healthcare environments. These are Benefits for all people: Access for all, Benefits for healthcare administrators, Benefits for those wanting to improve communication with patients, and Benefits to the capacity to provide communicatively accessible environments. However, they believe these benefits can only be achieved if; The communication resources are available, Skilled, knowledgeable and supportive healthcare providers are available; and Systems are in place to support a whole-of-hospital approach. This research supports the development of a new role to improve the communicative accessibility of healthcare settings.

The aim of this study was to explore the expectations, awareness, and experiences of parents in their efforts to access evidence-based speech-language pathology (SLP) services for their children with autism spectrum disorders (ASD). Four focus groups were conducted with 20 parents of pre school aged children with ASD and transcripts were analysed using thematic analysis. Two themes emerged to account for the participants' expectations, awareness, and experiences. The two themes, "Speech-language pathology: More than just a business", and "Parents and power", represented the complex interaction between factors including the parents' access to information, their involvement in the therapy process, and their sense of empowerment. The parents in this study expressed a strong desire for evidence-based practice (EBP) to be employed. However, the parents had different views on how EBP should be achieved. The findings of this study demonstrate the importance of involving parents in therapeutic relationships as partners in the decision-making process. This means providing parents with comprehensive information, including research evidence to support the clinical decisions that need to be made, and respecting parents' preferences in the therapy process.

Speech impairment (speech sound disorder) is a high prevalence condition that responds well to early intervention provided by speech-language pathologists (SLPs). However, not all children in Australia are able to access necessary speech-language pathology services. The aim of this research was to investigate Australian parents' experiences of accessing and engaging in speech-language pathology services for their children with speech impairment. Two studies were conducted to achieve this aim. In Study 1, questionnaires were completed by 109 parents of pre-school children who had been identified with concerns about their speech. Only a third (n = 34, 31.2%) of the parents had previously accessed speech-language pathology services for assessment of their children's speech and just 29 of these (26.6% of the entire sample) reported their children had received intervention. Two thirds (n = 68, 62.4%) of the parents had not sought speech-language pathology services and half of these (n = 35, 32.1% of the entire sample) reported that "services were not needed". There was a small number of parents (n = 7, 6.4%) who had attempted to access services but had been unsuccessful. Parents identified teachers, family, friends, and doctors as important sources of information about their children's speech. In Study 2, interviews were conducted with 13 of the parents to discuss their experiences of speech impairment and service delivery in greater depth. Parents expected that others would make them aware of their child's speech impairment and that they should be able to access speech-language pathology services when required. Consequently, there is a need to raise awareness about speech impairment and speech-language pathology services to ensure appropriate identification, referral, and service provision for children at risk.

Abstract Over the past decade, there has been increased interest in identifying autism and autism spectrum disorder (ASD) in toddlers. Although there is a strong rationale for identifying ASD early and delivering effective intervention, a recent report in the journal Pediatrics raises important questions about the scientific evidence currently available supporting early intervention. In addition, the British National Health Service (NHS) has not adopted universal screening for autism, even though the American (US) Academy of Pediatrics endorsed a recommendation that all toddlers be screened for ASD by the age of 24 months (in 2007). The goal of this initiative is to identify and, where indicated, provide early intervention for autism and ASD. Although it is inarguable that this is a worthwhile and laudable goal, the systematic study of this goal is confounded by the inherent difficulty in reliably identifying autism in 24-month-old toddlers. It is challenging to demonstrate intervention effects in the absence of randomly assigned control groups in an increasingly heterogeneous ASD population. The purpose of this paper is to examine the current literature on early identification and early intervention in autism and ASD and to provide a framework for examining these issues.

This study involved an acoustic and perceptual analysis of the speech produced by a 31-year-old female following total glossectomy. Speech samples were collected on three occasions within the first 3 months following glossectomy. Vowel articulation was examined acoustically as a function of vowel space and the Euclidean distance separating corner vowels. Perceptual analyses involved presentation of the participant's CV productions to 30 healthy adult listeners who made forced-choice identifications of consonant type. Acoustic analysis revealed improvements in vowel space area and an increase in the Euclidean distances. The perceptual results revealed a statistically significant deterioration in consonants over the 3-month period with anterior sounds being perceived more correctly than medial and posterior sounds. The current study highlights the variable nature of speech following glossectomy, with greater improvements in vowel articulation compared to consonant articulation during the earliest stages of surgical recovery.

This paper discusses the implementation and evaluation of an interaction-focused intervention single case study for a couple where one partner has aphasia. Drawing on conversation analytic research, naturally occurring conversations of the couple at home pre- and post-intervention were collected and analysed. Analysis of the speaker with aphasia's topic initiating turns in the pre-intervention conversation showed that in each case a feature of the attempt was that the speaker had difficulty in getting the topic initiation accepted and established. Drawing on conversation analytic work on topic initiations in normal conversation, intervention focused on training the couple to co-produce these topic initiating turns of the speaker with aphasia in a collaborative and step-by-step manner. Post-intervention, there was evidence that the couple were now using this new method, albeit in a slightly different way to that worked on in the intervention sessions. Drawing on work into adaptation by speakers with aphasia and their conversation partners, these results are discussed in terms of a process of mutual adaptation by the couple.

This study investigated the development of Polish #sC clusters (word-initial /s/+ consonant clusters) in typically-developing children and in children with phonological disorders. Data from 49 Polish-speaking children were analysed in terms of correct and incorrect productions, possible groupings according to the sonority index and the continuancy of the second member of the cluster. While a great deal of variability occurred both within and across children, a number of general findings are indicative of the roles of language-specific vs language-universal factors. For correctness of productions, sonority distance between the members of the cluster did not affect accuracy. In contrast, for the reduction of the targets, the continuancy of the second member played a significant role. Results give support to language-specific patterns in correctness of realizations but follow the universal patterns in reduction.

Early-identified severe/profound hearing loss (HL) following universal newborn hearing screening (UNHS) has been associated with improved speech and language outcomes. However, speech outcome reports have typically been based on broad measures of speech intelligibility and/or singleton consonant accuracy, with little known about production of consonant clusters. Using a prospective design, the range and accuracy of consonant clusters produced by a homogenous cohort of 12 children early-identified with severe/profound HL aged 3- and 4-years were examined. All children demonstrated bilateral aided thresholds within a range of 15-25 dB HL across all frequencies, were optimally amplified with cochlear implants (11/12) or hearing aids (1/12), and attended auditory-verbal (AV) early intervention. Standardized speech and language assessments were administered. Consonant clusters were strategically sampled in single-word and conversational speech contexts. All standard scores for speech, receptive, and expressive language were within normal limits. All children produced consonant clusters commensurate with expectations for typically-developing hearing peers at 3- and 4- years-of-age. Children's production of phonetically complex morphophonemes (final consonant clusters marking grammatical morphemes) was also in keeping with developmental expectations. Factors which contributed to these encouraging outcomes require further investigation.

The objective of this study is to evaluate language outcome in pre-term children, considering multiple factors. The hypothesis is that early communicative capacity (pre-verbal communicative utterances) is affected mainly by biological (prematurity, birth weight, and gender) and social factors (maternal education), while more advanced linguistic abilities (i.e., combinatorial and syntactic abilities) are mostly influenced by previously acquired communicative abilities. Eighteen monolingual Italian pre-term children (birth weight between 750 and 1600 grams, gestational age <37 weeks; 13 males and five females) were compared with a control group of 18 age-matched full-term children (8 males, 10 females). The longitudinal design comprised motor and cognitive assessment at 14 and 36 months, and communicative evaluation by direct observation at 14, 24, 30, and 36 months, and by indirect observation at 24 and 30 months. The main results evidenced were delayed development in pre-term compared to full-term children, particularly after 24 months of age; intra-individual differences in the pre-term group; and a strong effect of prematurity on communicative ability at 14 and 24 months; however, more advanced communicative developmental stages were influenced both by prematurity and by previously acquired linguistic skills.

The study reported evaluated an assessment of phonology for 2-year-olds to establish normative data and determine if early identification of children with speech difficulties is possible. The study evaluated 62 2-year-old children on the Toddler Phonology Test (TPT). Children produced 32 words, spontaneously or in imitation. Ten of the children were assessed three times, on the third occasion, when they had reached 3 years, on another phonological assessment. The data indicated that older children performed better than younger children on quantitative measures. Girls and boys performed equally well. Their phonetic repertoires were missing some fricatives and all affricates, as well as /r/. Consistently used error patterns identified included cluster reduction, final consonant deletion, stopping, fronting, weak syllable, deletion, gliding and deaffrication. Correlation analyses indicated that performance at the first assessment on the TPT indicated performance on subsequent assessments. While quantitative data was not a reliable predictive indicator of speech disorder, qualitative analysis of error types was predictive, with children who made many atypical errors at 2 years being diagnosed as phonologically disordered at 3 years. The findings provide initial evidence that direct formal assessment of 2-year-old phonology is possible.

Previous research has indicated that in Parkinson's disease (PD) some motor speech characteristics are changed by levodopa administration, while others are not. In advanced PD, the time course of these changes and the correlations with motor performance have not been sufficiently investigated. The purpose was to investigate the sequential changes of respiratory, articulatory, and phonatory speech characteristics across a levodopa drug cycle, using spirometry, acoustic, and motor speech analysis. Seven patients with advanced PD were included. All patients were evaluated sequentually at 15 minute intervals before and following levodopa intake. Data were analysed using repeated measures ANOVA and non-parametric analysis. Significant changes were found in motor function, vital capacity, and standard deviation of the diadochokinetic period. A trend was present for shimmer and frequency of the first formant. Significant inter-individual differences in the sequential changes were demonstrated for nearly all evaluated parameters. The conclusion is that, in advanced PD, the evaluation of speech characteristics at one moment after levodopa administration is not representative of an entire drug cycle and that an individualized evaluation of an entire drug cycle is warranted before initiation of a speech-language pathology program.

This study looked at performance on the conversational discourse checklist of the Protocole Montréal d'évaluation de la communication (D-MEC) in 195 adults with TBI of all severity hospitalized in a Level 1 Trauma Centre. To explore validity, results were compared to findings on tests of memory, mental flexibility, confrontation naming, semantic and letter category naming, verbal reasoning, and to scores on the Montreal Cognitive Assessment. The relationship to outcome as measured with the Disability Rating Scale (DRS), the Extended Glasgow Outcome Scale (GOS-E), length of stay, and discharge destinations was also determined. Patients with severe TBI performed significantly worse than mild and moderate groups (χ(2)KW2df = 24.435, p = .0001). The total D-MEC score correlated significantly with all cognitive and language measures (p < .05). It also had a significant moderate correlation with the DRS total score (r = -.6090, p < .0001) and the GOS-E score (r = .539, p < .0001), indicating that better performance on conversational discourse was associated with a lower disability rating and better global outcome. Finally, the total D-MEC score was significantly different between the discharge destination groups (F(3,90) = 20.19, p < .0001). Thus, early identification of conversational discourse impairment in acute care post-TBI was possible with the D-MEC and could allow for early intervention in speech-language pathology.

Effective communication between patients who have had a stroke and their healthcare providers is vital. However, this may be difficult if patients have communication related impairments as a result of the stroke and/or have age related impairments that impact on their ability to communicate. This study sought to identify how many patients admitted into two acute hospital stroke units had a hearing, vision, speech, language and/or cognitive communicative impairment regardless of the cause. A total of 69 patients participated in this study. The majority (88%) of patients had one or more mild or more severe communication related impairments, 69% of patients had two or more communication related impairments and 39% of patients had three or more communication related impairments. The most common type of impairment was hearing impairment, followed by near vision impairment. That a high number of patients in acute hospital stroke units have communication related impairments suggests that many patients in acute stroke units may experience difficulty communicating their healthcare needs with healthcare providers and that alternative ways to support patients with communication related impairments in acute stroke units need to be available.

Abstract The aim of the investigation was to examine the changes in phonation and related quality-of-life in the acute and sub-acute stages of recovery post-cervical spinal cord injury (CSCI). A prospective examination of phonation was conducted using perceptual and instrumental measures of respiratory and laryngeal functioning alongside a quality-of-life rating scale. Change was present across measures for both cases at each time point. Overall, a general pattern of recovery was seen, although some areas deteriorated between 6-12 months. Severity of impairments, extent of change, and impact on quality-of-life differed between the cases. Measures varied in sensitivity to change in function. Phonation can be impaired following both complete and incomplete CSCI, with type and severity of impairment/s undergoing change throughout the acute and sub-acute period post-injury. Spontaneous physiological recovery does not necessarily result in improved phonation and/ or quality-of-life. Potential exists for targeted speech-language therapy in this population, throughout recovery, to best capitalize on the physical changes that are occurring and to maximize functional application of skills to improve quality- of-life. Further research is warranted to examine this recovery period on a larger scale.

Intrathecal chemotherapy (ITC) is the treatment option for acute lymphoblastic leukaemia (ALL). Neurocognitive deficits have been described following ITC, but language status post-treatment is yet to be clarified. This study examined the language skills of nine children following ITC for ALL (mean age 7;8 years and 3;2 years post-diagnosis at baseline measurement) and nine age- and sex-matched controls, at baseline then 2 years later, using a battery of tests assessing general language skills. An assessment of cognitively-demanding high level language skills was undertaken on a sub-group of the children (n =12). Statistical analysis revealed no significant difference between children treated with ITC and controls when comparing change in performance scores from baseline measurement to 2 years post-baseline measurement. Descriptive analysis of three of the ALL participants in the Intermediate Stage survivorship at language re-assessment indicated no clinically-significant change in performance over 2 years for all measures except receptive language skills, which improved over the time for two of the children. As language skills continue to develop into late adolescence, the need for the monitoring of language abilities of children treated at a young age with ITC as they enter the Intermediate and Late Stages of survivorship is discussed.

Purpose: Undiagnosed motor and behavioural problems have been reported for children with childhood apraxia of speech (CAS). This study aims to understand the extent of these problems by determining the profile of and relationships between speech/non-speech oral, manual and overall body motor functions and adaptive behaviours in CAS. Method: Eighteen children (five girls and 13 boys) with CAS, 4 years 4 months to 10 years 6 months old, participated in this study. The assessments used were the Verbal Motor Production Assessment for Children (VMPAC), Bruininks-Oseretsky Test of Motor Proficiency (BOT-2) and Adaptive Behaviour Assessment System (ABAS-II). Result: Median result of speech/non-speech oral motor function was between -1 and -2 SD of the mean VMPAC norms. For BOT-2 and ABAS-II, the median result was between the mean and -1 SD of test norms. However, on an individual level, many children had co-occurring difficulties (below -1 SD of the mean) in overall and manual motor functions and in adaptive behaviour, despite few correlations between sub-tests. Conclusion: In addition to the impaired speech motor output, children displayed heterogeneous motor problems suggesting the presence of a global motor deficit. The complex relationship between motor functions and behaviour may partly explain the undiagnosed developmental difficulties in CAS.

Abstract The World Health Organization's World Report on Disability underscores the need to identify and address barriers that limit people with disabilities from having access to services. Wylie, McAllister, Davidson, and Marshall (2013) consider the impact of that report on people with communication disabilities (PWCD). Over the past 5 years, the authors have worked together in Ghana to address the needs of PWCD. With only about 10 university-trained speech-language pathologists (SLPs) in Ghana, the barriers to PWCD receiving services are quite high. The authors are working together and with others to establish the first speech-language pathology program in Ghana. The authors also work to identify ways to share with PWCD and their families knowledge and skills on how to improve the communicative function of PWCD. In doing so, the authors have learned valuable lessons about the role of an SLP, especially when considering under-served PWCD, lessons that are applicable to both Majority and Minority World countries. This commentary describes the authors' work over the past 5 years, and describes initiatives that have had some measure of success in reducing barriers to access to information and services needed by PWCD and their caregivers and communities.

Inequity in service provision for Indigenous Australians with communication disability is an issue requiring urgent attention. In the lead article, Wylie, McAllister, Davidson, and Marshall (2013) note that, even in the relatively affluent Minority World, including Australia, equity in service provision for people with communication disability has not been achieved. In remote communities in the Northern Territory (NT) almost all residents speak a language other than English as their primary language. However, there are no speech-language pathologists (SLPs) in the NT who speak an Indigenous language or who share their cultural background. Specific data on the prevalence of communication disability in this population are unavailable due to a range of factors. The disability data that are available, for example, demonstrating the high level of conductive hearing loss, indicates that the risk of communication disability in this population is particularly high. Change is urgently needed to address current inequities in both availability of, and access to, culturally responsive services for Indigenous people with communication disability. Such change must engage Indigenous people in a collaborative process that recognizes their expertise in identifying both their needs and the most effective form of response to these needs.

Psychological well-being is essential to overall health; however, there is a paucity of research on how to address psychological well-being in stroke survivors with aphasia. This study describes the current beliefs, attitudes and practices of Australian speech-language pathologists in addressing psychological well-being in people with aphasia after stroke. A 26-item web-based survey consisting of open and closed questions was distributed to Australian speech-language pathologists through four electronic databases. Australian speech-language pathologists (n = 111) utilized counselling and clinical approaches to address psychological well-being in people with post-stroke aphasia. The majority of speech-language pathologists did not feel comfortable with addressing psychological well-being in people with aphasia and sought support from other health professionals in this practice. Self-perception of being under-skilled was the main barrier identified to adequate practice in this domain, followed by inadequate time, inadequate staffing and people with aphasia declining referral to counselling. The main facilitators reported by speech-language pathologists to address psychological well-being included personal interest, personal and professional experience and availability of counselling health professionals for people with aphasia. There were small-to-medium statistically significant correlations between speech-language pathologists reporting additional training in counselling and perceived knowledge of, confidence in and satisfaction with managing psychological well-being in people with aphasia. This study identifies factors requiring attention in order to enable speech-language pathologists to facilitate improved psychological well-being in people with aphasia.

Abstract The current paper is a response to the Wiley, McAllister, Davidson, and Marshall lead article regarding the application of the World Report on Disability (WRD) to people with communication disorders. The current paper directly addresses recommendation 5 (improvement of human resource capacity) and indirectly addresses recommendations 7, 8, and 9 (related to improving local knowledge and data on communicative disabilities) indirectly. The paper describes Malaysia's initiatives in the early 1990s, in developing its local professional capacity to provide services for people with communication disorders (PWCD). It charts the history of development of a local undergraduate entry-level degree program for speech-language pathology (SLP) from the point of conceptualization to full execution. The article provides glimpses to the processes and challenges faced by Universiti Kebangsaan Malaysia as the pioneer university in the South East Asia region to undertake the training and education of the SLP profession and highlights relevant issues faced by newly introduced professions in a country where resources and practice traditions were previously unavailable. It underscores the important role played by government institutions and an international professional network in driving forward-looking policies to implement and sustain the program.

This prospective, single-blinded study investigated the validity and reliability of cervical auscultation (CA) under two conditions; (1) CA-only, using isolated swallow-sound clips, and (2) CSE + CA, using extra clinical swallow examination (CSE) information such as patient case history, oromotor assessment, and the same swallow-sound clips as condition one. The two CA conditions were compared against a fibre-optic endoscopic evaluation of swallowing (FEES) reference test. Each CA condition consisted of 18 swallows samples compiled from 12 adult patients consecutively referred to the FEES clinic. Patients' swallow sounds were simultaneously recorded during FEES via a Littmann E3200 electronic stethoscope. These 18 swallow samples were sent to 13 experienced dysphagia clinicians recruited from the UK and Australia who were blinded to the FEES results. Samples were rated in terms of (1) if dysphagic, (2) if the patient was safe on consistency trialled, and (3) dysphagia severity. Sensitivity measures ranged from 83-95%, specificity measures from 50-92% across the conditions. Intra-rater agreement ranged from 69-97% total agreement. Inter-rater reliability for dysphagia severity showed substantial agreement (rs = 0.68 and 0.74). Results show good rater reliability for CA-trained speech-language pathologists. Sensitivity and specificity for both CA conditions in this study are comparable to and often better than other well-established CSE components.

Telephone interviews and postal surveys may be a resource-efficient way of assessing health-related quality-of-life post-stroke, if they produce data equivalent to face-to-face interviews. This study explored whether telephone interviews and postal surveys of the Stroke and Aphasia Quality of Life Scale (SAQOL-39g) yielded similar results to face-to-face interviews. Participants included people with aphasia and comprised two groups: group one (n =22) were 3-6 months post-stroke; group two (n =26) were ≥1 year post-stroke. They completed either a face-to-face and a telephone interview or a face-to-face interview and a postal survey of the SAQOL-39g. Response rates were higher for group two (87%) than for group one (72-77%). There were no significant differences between respondents and non-respondents on demographics, co-morbidities, stroke severity, or communication impairment. Concordance between face-to-face and telephone administrations (.90-.98) was excellent; and very good-excellent between face-to-face and postal administrations (.84-.96), although scores in postal administrations were lower (significant for psychosocial domain and overall SAQOL-39g in group two). These findings suggest that the SAQOL-39g yields similar results in different modes of administration. Researchers and clinicians may employ alternative modes, particularly in the longer term post-stroke, in order to reduce costs or facilitate clients with access difficulties.

This article addresses the issue of whether difficulties with reading and writing in a second language learner stem from developmental dyslexia or from issues associated with second language acquisition. In line with a phonological explanatory model of dyslexia, phonological processing and reading (decoding at both word and text levels) were tested, using data from 10 Spanish-Swedish speaking adolescents whose teachers had identified them as possibly having dyslectic difficulties, and a matched comparison group of 10 Spanish-Swedish speaking adolescents with no reading difficulties. Unlike previous studies, this analysis takes into account results from both languages and uses a matched bilingual comparison group as the norm. Based on these results, a bilingual dyslexia continuum is proposed as an analytical tool to be used for the assessment of developmental dyslexia from a bilingual perspective. The systematized continuum offers various degrees of difficulty -from high indications of dyslexia to no indications of dyslexia-and the positioning along this continuum by the target group participants of this study provides examples of both over- and under-identification of dyslexia. Overall, a greater number of participants in the target group were under-identified rather than over-identified by the schools. An important insight of this study is that the positioning of bilingual participants on the continuum would have been different if the analysis had taken only one of the two languages into account. Furthermore, possible effects from differences between Spanish and Swedish orthographies and syllable structure were observed, as, in general, the participants read more accurately in Spanish. The present data also suggest that decoding processing might vary more in second-language learners with dyslexia compared to monolingual individuals with dyslexia.

The study aimed to investigate (i) whether adolescents with Specific Language Impairment (SLI) and Autism plus Language Impairment (ALI) experience word-formation difficulties, and (ii) whether these two groups present with a similar language phenotype. The study investigated four groups using a 2 (language status) ×2 (autism status) design; adolescents with SLI (n = 14), ALI (n = 16), Autism Language-Typical (ALT; n = 14), and language matched controls (n = 17), with all groups presenting with typical non-verbal skills. Mean age was 14;10. Comprehension of conventional Noun-Noun lexical compounds (e.g., snowman), synthetic compounds (SCs, e.g., cat chaser), and novel root compounds (RCs, e.g., sheep socks), was assessed using a forced-choice picture selection task. The SLI and ALI participants frequently mis-parsed the SCs, interpreting the first noun as the agent. Those with poorer vocabularies and non-word repetition had greater difficulties. Reaction time (RT) profiles were flatter in the ASD groups, with similar RTs across different compounds. Language difficulties in the SLI and ALI groups extend to word-formation processes; for example, comprehension of SCs. This may reflect difficulties making analogies with stored lexical items. Overall the results support the hypothesis of a phenotypic overlap between SLI and ALI.

This study investigated whether measures of percentage syllables stuttered (%SS) and stuttering severity ratings with a 9-point scale differ when made from audiovisual compared with audio-only recordings. Four experienced speech-language pathologists measured %SS and assigned stuttering severity ratings to 10-minute audiovisual and audio-only recordings of 36 adults. There was a mean 18% increase in %SS scores when samples were presented in audiovisual compared with audio-only mode. This result was consistent across both higher and lower %SS scores and was found to be directly attributable to counts of stuttered syllables rather than the total number of syllables. There was no significant difference between stuttering severity ratings made from the two modes. In clinical trials research, when using %SS as the primary outcome measure, audiovisual samples would be preferred as long as clear, good quality, front-on images can be easily captured. Alternatively, stuttering severity ratings may be a more valid measure to use as they correlate well with %SS and values are not influenced by the presentation mode.

Purpose: The current study aimed to investigate what Australian speech-language pathologists frequently include in their bedside assessments in adult dysphagia, what factors influence these bedside assessments and whether they are consistent with the current evidence base. Method: These aims were achieved via an online questionnaire and a series of semi-structured interviews. In the questionnaire, respondents were asked to rate how frequently they utilized bedside assessment components on a scale of five ranging from never to always. Result: One hundred and forty practicing speech-language pathologists completed the online questionnaire in full. Eight interviews were then conducted. Respondents reported utilizing predominantly motor elements of their oro-motor examination with very few sensory elements being frequently utilized. Five main themes arose from the interviews including the influence of the individual patient and participant, the current evidence base, the participants' clinical practice and the participants' workplace. Conclusion: The findings from this research have implications for current clinical and education practices, in particular the impact of education and training and caseload demands on current practice.

It is commonly assumed that boys have poorer language skills than girls, but this assumption is largely based on studies with small, clinical samples or focusing on expressive language skills. This study examines the relationship between gender and receptive vocabulary, literacy, and non-verbal performance at 5 years through to adulthood. The participants were a UK birth cohort of 11,349 children born in one week in March 1970. Logistic regression models were employed to examine the association of gender with language and literacy at 5 and 34 years. Non-verbal abilities were comparable at 5 years, but there were significant differences for both receptive vocabulary and reading, favouring the boys and the girls, respectively. Boys but not girls who had parents who were poor readers were more likely to be not reading at 5 years. Gender was not associated with adulthood literacy. Boys may have a slight advantage over girls in terms of their receptive vocabulary, raising questions about the skills tested and the characteristics of clinical populations. The findings are discussed in terms of the nature of the way that children are assessed and the assumptions underpinning clinical practice.

This paper describes the results of a survey that explored the experiences of carers when accessing rehabilitative services alongside their family member with a moderate-severe TBI. The 184 carers who completed these surveys reflected retrospectively on the care they received. The results of this study indicated that 61% of the carer respondents recollected accessing inpatient rehabilitation following their acute care. However, following inpatient discharge only 33% of carers reported receiving ongoing services. One quarter of carers stated they received inadequate information while transitioning through their healthcare journey and fewer than 20% of carers recollected receiving any formal support service. The results of this study showed that as carers transitioned through the healthcare journey with their family member with TBI, health services progressively declined. As this occurred, carers' satisfaction with services reduced, while their responsibilities for caring increased. This trend is concerning given the needs of carers have been shown to change over time and increase if not addressed. This paper describes both carer experience following TBI in Australia and encourages clinicians to advocate for carers needs when planning and providing rehabilitation services.

This study uses a qualitative approach to examine common techniques used by speech-language pathologists (SLPs) to manage fatigue in communication intervention following traumatic brain injury (TBI). Thirteen SLPs from New Zealand hospital and rehabilitation services completed semi-structured interviews in which they discussed their current management strategies. A number of management-related themes recurred throughout the interviews, highlighting the basis of fatigue-management-focused (FMF) communication intervention. The four fatigue-related themes were: intervention structure, client and family strategies, monitoring by both the client and therapist, and lifestyle and daily activities. From these four themes, a model of current SLP practice was developed for clients with TBI. This model will provide the basis for future studies evaluating the effectiveness of FMF communication intervention.

Young children's speech is compared to (a) adult-to-adult (A-A) normal speech, and (b) adult-to-adult (A-A) slow speech, and (c) adult-to-child (A-C) speech by measuring durations and variability of each segment in consonant-vowel-consonant CVC (CVC consonant-vowel-consonant) words. The results demonstrate that child speech is more similar to A-C speech than A-A slow speech in that it exhibits a large portion of long vowel duration in a word. However, child speech but differs from A-C speech by more noticeable lengthening of consonants. In addition, child speech exhibits an inconsistent timing relationship across segments within a word whereas durational variation in consonants and vowels was correlated in A-A speech and A-C speech. The results suggest that temporal patterns of young children are quite different from those of adults, and provide some evidence for lack of motor control capability and great variance in articulatory coordination.

Community participation by people with lifelong disability is not a new concept. Yet, within the field of disability there is ongoing debate about the barriers to participation and how these can be solved. At a practical level, participation remains an issue that is often misunderstood by many who seek to promote the integration of adults with lifelong disability into the community. Community presence alone does not denote participation or integration. Furthermore, the role of the speech-language pathologist is rarely, if ever, discussed in the research into participation by people with lifelong disability. In this paper a brief overview is given of the barriers and solutions to participation by people with lifelong disability, including those with complex communication needs who use or require augmentative and alternative communication (AAC). Two innovative solutions, the Change Laboratory and Second Life™, are discussed. These may be useful for the speech-language pathologist to consider when seeking additional ways to support community participation by adults with lifelong disability.

This paper investigates the continuum of care experienced by adults and their significant others following a moderate to severe traumatic brain injury (TBI) in Victoria, Australia. Clinical care guidelines exist defining best practice in TBI rehabilitation, but little is currently known about the experiences of those who sustain a TBI, their needs and the barriers they encounter when attempting to access services. This paper presents the journeys of 202 Victorians admitted for acute care following a moderate to severe TBI over 4 years. Results of this study indicate very few participants report receiving services in line with recommendations made in clinical care guidelines. In addition reported access to services was noted to vary according to allocated healthcare funding (i.e., compensable vs. private vs. public). Clinicians' consideration of healthcare consumers' experiences are essential if services provided are to match consumers' needs.

There is widespread concern that individuals with dysphagia as a result of stroke do not drink enough fluids when they are prescribed thickened liquids. This paper details a retrospective audit of thickened liquid consumption of 69 individuals with dysphagia following stroke in acute and rehabilitation hospitals in Adelaide, South Australia. Hospitalized individuals with dysphagia following stroke drank a mean of 781 ml (SD = 507 ml) of prescribed thickened liquids per day, significantly less in the acute setting (M = 519 ml, SD = 305 ml) than in the rehabilitation setting (M = 1274 ml, SD = 442 ml) (t(67) = -8.34, p < .001). This daily intake of thickened liquids was lower than recommended standards of fluid intake for hospitalized adults. Fluid intake could be increased with definitive protocols for the provision and monitoring of consumption of thickened liquids, by offering more fluid via food or free water protocols or by routine use of non-oral supplementary routes. Future research into the effectiveness of such recommendations needs to evaluate not only the impact on fluid intake but also on health outcomes.

Abstract This study examined Australian speech-language pathologists' (SLPs) use of evidence-based practice (E(3)BP) when treating adults with functional voice disorders (FVDs). It was hypothesized that SLPs would report using the available evidence to care for their clients but may be limited by time and skills. Fifty-eight SLPs completed a 26-item survey. A combination of indirect and direct voice therapy was most frequently reported, with hum and nasal consonants, pitch extension, elimination of glottal attack, and diaphragmatic breathing being the most frequently used techniques. In the absence of higher levels of evidence, 98% of respondents reported they relied on clinical experience to guide their clinical decision-making. Despite a lack of research evidence supporting this decision, SLPs also reported simultaneously using a combination of direct voice therapies to cater to the needs of their individual clients. Barriers to EBP were lack of time, specialty training and high quality evidence. To improve SLPs' management of adults with FVDs, it is suggested that SLPs need both greater access to voice training and to use practice-based evidence by actively collecting and reporting clinical data.