Dr Liz Spencer

Background: Spoken discourse impairments post-traumatic brain injury (TBI) are well-documented and heterogeneous in nature. These impairments have chronic implications for adults in terms of employment, socializing and community involvement. Intervention delivered by a speech¿language pathologist (SLP) is recommended for adults with discourse impairments post-TBI, with an emphasis on context-sensitive treatment. The developing evidence base indicates a wide array of treatment components for SLPs to evaluate and implement within their clinical practice. However, there is limited insight into how SLPs are currently treating discourse impairments and the rationales informing clinical practice. Aims: To explore the under-researched area of clinical practice for spoken discourse interventions with adults post-TBI, including treatment components and clinician rationales, and to contribute towards a shared knowledge base. Methods & Procedures: Participants were recruited via purposeful sampling strategies. Six SLPs participated from Australia, the United Kingdom (UK) and the United States (US). Semi-structured interviews were conducted via Zoom. Interviews were manually transcribed, coded and analysed via a qualitative content analysis approach. Outcomes & Results: :Participants described discourse treatment practices across various settings and TBI recovery stages. Results indicated that SLPs used numerous treatment activities, resources and outcome measures. Intervention approaches primarily targeted social communication skills, strategy development/utilization and insight-building. Clinical practice conformed to available guidelines where possible, reflected best practice and incorporated components of the research literature. Participants reported using individualized treatment activities aimed at addressing client-specific factors and rationales prioritized tailored, context-sensitive and goal-directed treatment. Conclusions & Implications: This study provided insight into a previously under-researched area. It highlighted a wide range of treatment activities and factors informing current SLPs' treatment of spoken discourse impairment post-TBI. Overall, clinical practice and rationales discussed in this study were aligned with best practice and emphasized a contextualized, individualized approach to discourse treatment across service settings and stages of recovery. Participants identified areas requiring further support, including access to training, resources and research, and the challenge of finding suitable outcome measures. Further investigation into discourse management post-TBI, from initial assessment to outcome measurement, may help inform clinical decision-making and the transfer of research to practice. WHAT THIS PAPER ADDS: What is already known on the subject Spoken discourse impairments occur in dialogic and monologic productions post-TBI. Interventions targeting both genres are detailed within the research literature; however, studies exploring clinical practice and decision-making for discourse interventions post-TBI are limited. What this paper adds to existing knowledge This study provides new insight into the current treatment targets, activities, resources and outcome measures employed by clinicians supporting adults with discourse impairment post-TBI. It details the factors that influence clinical decision-making for this caseload and identifies an emphasis on client priorities and the value of clinician experience. What are the potential or actual clinical implications of this work? This study identifies the broad and complex considerations required to deliver context-sensitive discourse intervention post-TBI. It indicates the need for an in-depth review from assessment to treatment outcomes to better understand and support this area of practice and to direct future research. This study also highlighted the role of clinician experience in discourse intervention and the value of sharing...

The aim of this review was to critically synthesize barriers and facilitators to the use of AAC systems by children with autism spectrum disorder (ASD) and their communication partners. Qualitative data related to barriers and facilitators were synthesized from 42 studies located using a systematic search. A diverse range of studies was examined in order to identify the span of barriers and facilitators reported in the literature. Included studies comprised quasi-experimental, non-experimental, and qualitative study designs. The full range of unaided, low-tech aided, and high-tech aided AAC systems were reported across the included studies. The critical synthesis identified 5 themes to which barriers and facilitators are related: (a) Intervention Services and Service Providers, (b) AAC Systems and Technologies (c), Communication Partners of Children with ASD, (d) Parents of Children with ASD, and (e) Children with ASD. The findings suggest that barriers and facilitators to the use of AAC vary across individuals, AAC modalities, and environments. By identifying barriers and facilitators to the use of AAC experienced by children with ASD and their communication partners, service providers might be better equipped to support these children and their communication partners. Clinical implications and future research directions are discussed.

Background: There has been limited empirical speech¿language pathology (SLP) study of language and cognitive communication during post-traumatic amnesia (PTA) and the early stages after TBI. The purpose of the current research was to explore the potential means and utility of assessing cognitive communication during PTA and the post-acute recovery period. Method: This research used a longitudinal mixed methods design to describe language and cognitive communication assessment and recovery profiles of three patients with TBI. Cognitive communication was assessed with repeated standardised and non-standardised methods during PTA (rated with Westmead PTA Scale) and at follow-up 3¿months after PTA emergence. Results: All participants demonstrated a profile of language and cognitive communication strengths and weaknesses during PTA and the post-acute period, also evident at follow-up. Improvement occurred gradually throughout PTA, although with individual fluctuation across test occasions. There was no marked change in communication function immediately before and after PTA emergence, indicating that cognitive communication ability and those functions measured on the Westmead PTA Scale (memory and orientation) did not recover at the same rate. Conclusion: It was feasible to assess language and cognitive communication throughout PTA and the post-acute period, and early assessment results were relevant to the patient's ongoing communicative function. It is suggested that early and repeated SLP assessment may contribute to the prediction of persisting cognitive communication issues.

Background: Linguistic discourse analysis is an assessment method widely applied within aphasia research literature to examine impairments as they affect the language of daily function¿discourse. Although this literature suggests that clinical applications do occur, it also identifies barriers that may inhibit the translation of research to practice. Aims: This study aimed to identify the frequency of use and methods of linguistic discourse analysis application by speech pathologists when assessing their clients with aphasia. Methods & Procedures: A survey was distributed electronically to speech pathologists in five English-speaking countries using the online survey management tool Survey Monkey®. Clinical applications of linguistic discourse analysis were examined using descriptive statistics and cross-tabulation analyses. Outcomes & Results: Of 123 valid survey results, 106 clinicians reported use of linguistic discourse analysis to assess language in aphasia. Respondents collected language elicited in conversational contexts and expositional discourse samples most often, and subjected these samples to a range of linguistic measures. Most clinicians applied a judgement-based method of analysis based on clinical observation. Clinicians reported positive attitudes towards the use of linguistic discourse analysis, but were limited from widespread use by barriers such as a lack of available clinical time. Conclusions: Results revealed that speech pathologists defined and therefore implemented linguistic discourse analysis in a variety of ways. The methods used to elicit, prepare and analyse discourse varied among respondents. Further investigation is warranted to examine the effectiveness of clinical discourse analysis applications and to support the translation of evidence-based research methods to clinical practice.

BACKGROUND: There is minimal speech pathology literature on communication presentation during post-traumatic amnesia (PTA) and the early recovery period after traumatic brain injury. While a body of research reports on other cognitive and behavioural functions during PTA, language and/or cognitive communication are not routinely the primary focus of current research literature. OBJECTIVE: This critical synthesis provides an overview of research to date on communication during PTA to inform speech pathology assessment practice and to assist with information provision to the multidisciplinary team and family members. METHODS: A search was conducted of studies reporting on language, cognition, and cognitive communication during the acute, inpatient and early recovery period after TBI. These were examined for relevance to speech pathology practice during PTA and acute confusional state. RESULTS: Historic and recent literature has described types of language and communication impairment during PTA and early recovery after TBI. Recently, aspects of communication impairment during PTA have been found relevant for outcome prediction. Few studies were found originating from speech pathology on communication during PTA. CONCLUSIONS: Communication disruption forms a key feature of PTA. Existing literature indicates that speech pathology monitoring of communication during PTA may be of benefit as part of multidisciplinary team management during early recovery.

Decline in linguistic function has been associated with decline in cognitive function in previous research. This research investigated the informativeness of written language samples of Australian men from the Health in Men's Study (HIMS) aged from 76 to 93 years using the Computerised Propositional Idea Density Rater (CPIDR 5.1). In total, 60 255 words in 1147 comments were analysed using a linear-mixed model for statistical analysis. Results indicated no relationship with education level (p = 0.79). Participants for whom English was not their first learnt language showed Propositional Idea Density (PD) scores slightly lower (0.018 per 1 word). Mean PD per 1 word for those for whom English was their first language for comments below 60 words was 0.494 and above 60 words 0.526. Text length was found to have an effect (p = <0.0001). The mean PD was higher than previously reported for men and lower than previously reported for a similar cohort for Australian women.

Speech sound disorders reportedly co-occur in young children who stutter at a substantial rate. Despite this, there is a paucity of scientific research available to support a treatment approach when these disorders co-exist. Similarly, little is known about how clinicians are currently working with this caseload given that best practice for the treatment of both disorders in isolation has evolved in recent years. This study used a qualitative approach to explore current clinical management and rationales when working with children who have co-occurring stuttering and speech sound disorder. Thirteen participant SLPs engaged in semi-structured telephone interviews. Interview data were analysed based on principles derived from grounded theory. Several themes were identified including multi-faceted assessment, workplace challenges, weighing-up the evidence, and direct intervention. The core theme, clinical reasoning, highlighted the participants' main concern, that not enough is known about this caseload on which to base decisions about intervention. There was consensus that little is available in the research literature to guide decisions relating to service delivery. These findings highlight the need for further research to provide evidence-based guidelines for clinical practice with this caseload. © 2013 The Speech Pathology Association of Australia Limited.