Search

Background: Written reflective practice (WRP) is a teaching tool used across speech–language therapy (SLT) clinical education programmes. The process aims to support the development of reflective skills required for the workplace (e.g., problem‐solving and self‐evaluation). Aims: This cross‐sectional and repeated‐measures study design investigated students' demonstration of breadth of WRP across the clinical education programme. Methods & Procedures: The participants were 77 undergraduate SLT students in their first, second or final professional year of the clinical programme. Participants wrote critical reflections following an interaction with a client/s as part of their clinical education experiences. Formative feedback was provided after each written reflection (WR). In total four WRs per participant were coded for breadth of WRP using a modification of Plack et al.'s coding schema from 2005. This was completed for each of the four time points across the academic year for each professional year. Outcomes & Results: There was a statistically significant association between time (i.e., professional year of the programme) and likelihood of demonstration of breadth of reflection for the lower level reflective element of 'attend' and higher level reflective element of 're‐evaluate'. A positive trend between time and likelihood of demonstration of breadth of reflection was seen for the lower level element of 'reflection‐for‐action'. Final‐professional‐year students exhibited significant enhancements in the higher level elements (e.g., 'premise') compared with first‐ and second‐professional‐year students. Conclusions & Implications: This group of SLT students exhibited significant change in breadth of WRP across the degree programme. This finding has positive implications for facilitating WRP with students and using the current coding framework in clinical programmes. What this paper adds: What is already known on this subject: WRP is one form of reflective practice (RP) used in SLT, allied health, medical and nursing clinical education programmes. Researchers have suggested that RP skills develop over time for students. Previously, studies examining WRP have focused on one off assessment of skill or over a timeframe of 6–10 weeks. Here, we examine SLT students' WRP skills across the degree programme. What this paper adds to existing knowledge: SLT students exhibited significant positive change in breadth of WRP across the degree programme as their clinical experience increased. Our results provide quantitative information in support of using RP as a learning tool throughout clinical education programmes for SLT. What are the potential or actual clinical implications of this work?: This study offers support for educators of SLT students; for example, how educators can assess WRP, and how educators can foster SLT student skill development with formative feedback and reflective questioning. This study also offers support for student SLT, for example, describing how WRP can be part of their individualized learning approach and provide a purposeful examination of self and clinical skill development. [ABSTRACT FROM AUTHOR]

Background: Online knowledge translation (KT) approaches are becoming increasingly prevalent within healthcare due to their accessibility and facilitation of international support networks. Online platforms enable timely and far‐reaching dissemination of current evidence and best‐practice recommendations. Although there is potential to improve the uptake of rehabilitation guidelines, it is essential to consider the acceptability of online approaches to healthcare professionals to ensure their successful integration within everyday clinical settings. Aims: To establish the prospective acceptability of a theoretically informed online intervention for speech pathologists, Aphasia Nexus: Connecting Evidence to Practice, that aims to facilitate the implementation of aphasia best practice. Methods & Procedures: A mixed‐methods multinational electronic survey based on the Theoretical Framework of Acceptability (TFA) completed by aphasia researchers and clinicians. Outcomes & Results: A total of 43 participants completed the survey with 91% (n = 39) indicating that they would use Aphasia Nexus. Understanding the intervention and how it works (intervention coherence as per the TFA) was the key factor influencing the likelihood of integration within everyday clinical practice. Participants identified potential areas where the intervention could influence service change and also recommended further design and content changes to improve the intervention. Conclusions & Implications: Aphasia Nexus is an acceptable platform for further feasibility testing in the form of a pilot trial within an Australian‐based health service. The study progresses the theory of TFA as it was a valuable framework facilitating the identification of prominent factors influencing acceptability. The study also informs further intervention refinements in preparation for the next stage of research. WHAT THIS PAPER ADDS: What is already known on the subject: Online strategies have the potential to enhance KT and promote the uptake of rehabilitation guidelines. An online intervention, however, can only be effective if implemented well. For this reason, it is essential to establish the acceptability of online interventions to the intended recipients and therefore increase the likelihood of successful implementation. What this paper adds to existing knowledge: This study used a theoretically based framework to establish the acceptability of an online implementation intervention, Aphasia Nexus, to multinational aphasia clinicians and researchers. It demonstrated the value in identifying the prominent factors influencing acceptability to inform further intervention refinements and warrant continuing research. What are the potential or actual clinical implications of this work?: Speech pathologists should use online platforms to drive the implementation of best practice on an international scale. It is important for clinicians to have an in‐depth understanding of online interventions and how they work to enhance their successful uptake into routine clinical practice. Aphasia Nexus is an acceptable online platform for implementing best practice in aphasia. [ABSTRACT FROM AUTHOR]

Background: Previous studies have explored the size and word type composition (nouns, predicates, etc.) of expressive vocabularies of preschool children with Down syndrome, both spoken and signed. Separately, overall preferences for modality of expression have also been explored. Aims: To extend previous findings by describing the relationships between expressive vocabulary size and both word type and modality of expression in the preschool period including changes to modality preference over time. Methods & Procedures: Mothers of 35 children with Down syndrome, aged 36–66 months and attending the same early intervention programme, completed a version – with both spoken word and sign options – of the New Zealand MacArthur‐Bates Communicative Development Inventory (CDI): Words and Sentences. Most mothers completed the CDI on multiple occasions across the duration of the study. Completions (n = 114) were analysed cross‐sectionally and longitudinally in terms of (1) word type relative to vocabulary size, (2) modality of expression relative to word type and vocabulary size, and (3) individual trajectories in vocabulary size and modality of expression. Outcomes & Results: (1) Word type relative to vocabulary size was similar to previous studies with a greater proportion of the SOCIAL words being present in the children's vocabularies throughout, followed by NOUNS, PREDICATES and CLOSED class words, with proportions converging as vocabulary sizes increase. (2) An initial spoken word preference for SOCIAL and CLOSED class words and sign preference for NOUNS and PREDICATES was found, with more spoken words in larger vocabularies overall. (3) Individual trajectories were highly variable and also revealed temporary points of regression in overall expressive vocabulary size in some children. Children who shifted from reliance on sign to predominantly spoken word expression did so at different ages and at different vocabulary sizes. At school entry, while most of the children used both modalities, some children continued to rely on sign for most vocabulary items whereas others used only spoken words. Conclusions & Implications: An appreciation of both the general trends and potential for individual variation in vocabulary structure, modality of expression and change over time will better position clinicians and education specialists to provide individually tailored support to both preschool and school‐aged children with Down syndrome. What this study adds: What is already known on this subject: Preschool children with Down syndrome have been shown to demonstrate developmental patterns in overall conceptual vocabulary size and word type development broadly similar to typical development. The use of signed vocabulary has also been explored, but independently from word type development and with less attention to individual trajectories in either vocabulary size development or modality preferences throughout the preschool period than is necessary for clinical use. What this paper adds to existing knowledge: This study found interactions between word type and modality of expression in relation to vocabulary size as well as a few temporary vocabulary size regressions similar to those found in much younger typically developing children. An initial spoken word preference for social and closed class words, and sign preference for nouns and predicates, was followed by a general trend towards spoken words for all word types as vocabulary (with some fluctuations) increased over time. Children demonstrated considerable individual variation in size of vocabulary and age at which they pivoted from a signed to a spoken word preference. Moreover, while most children used both modalities at school entry, a few retained a sign‐only vocabulary and others had moved fully onto spoken word‐only expression. What are the potential or actual clinical implications of this work?: An understanding of both the general trends and individual variation in vocabulary structure and modality of expression development will better position clinicians and educational specialists to provide individually tailored support to children with Down syndrome. [ABSTRACT FROM AUTHOR]

Background: The involvement of speech and language therapists (SLTs) within paediatric palliative care (PPC) settings has been recognized within the extant literature. However, there is little understanding of SLT's specific roles and practices when working with this vulnerable cohort of children and their families. As part of a larger body of work to develop consensus‐based recommendations for SLTs working in PPC, it is important to investigate demographic and caseload characteristics. Aims: This exploratory study aimed to gather previously undocumented international demographic data pertaining to SLT service provision, caseload and training in PPC. Additionally, it sought to ascertain the current treatment and assessment approaches of SLTs, and if variations exist in beliefs and practices. Methods & Procedures: An anonymous cross‐sectional survey was designed and reported according to the Checklist for Reporting Results of Internet E‐Surveys (CHERRIES). The online survey consisted of 40 items spanning four domains: (1) demographic information, (2) caseload information, (3) service provision and (4) training and education. SLTs from Australia, Canada, New Zealand, the UK, Ireland and the United States were recruited using a purposive snowball sampling approach. Descriptive analysis of closed‐ended survey responses and content analysis of open‐ended responses are presented. Outcomes & Results: A total of 52 respondents completed the survey. SLTs worked in a variety of PPC settings, with patients of varying age and disease groups. Over 50% of participants reported working in PPC for ≤ 4 years. Genetic disorders (34%), oncology (27%) and neurological conditions (21%) made up a significant portion of respondents' caseloads. Reported treatments and assessment approaches used by SLTs are not unique to a PPC population. Barriers and enablers for practice were identified. A portion of participants did not feel trained and prepared to assess (19.2%) or treat (15.4%) PPC clients. Conclusions & Implications: This study confirms that SLTs internationally have a role in the management of communication and swallowing impairments in a PPC context. However, whether current training and resources adequately support SLTs in this role remains questionable. This paper helps to provide SLTs, administrators, professional associations and tertiary institutions with foundational data to help inform workforce planning, advocacy efforts and training priorities. What this paper addsWhat is already known on the subjectThe published multidisciplinary literature has identified that SLTs have a role in PPC. However, there has been no targeted research investigating the professional characteristics of clinicians in this context, nor any detailed information regarding associated clinician beliefs or management approaches.What this paper adds to existing knowledgeThis study is a snapshot of attributes, practice patterns and beliefs of SLTs who work with a PPC population. It highlights SLT perspectives of education and training, as well as meta‐perceptions of themselves within the multidisciplinary team.What are the potential or actual clinical implications of this work?Data presented in this paper will help to enable SLTs, organizations and associations to augment service provision and determine future professional development priorities within the field of PPC. [ABSTRACT FROM AUTHOR]

Background: Tracheostomy management is considered an area of advanced practice for speech–language therapists (SLTs) internationally. Infrequent exposure and limited access to specialist SLTs are barriers to competency development. Aims: To evaluate the benefits of postgraduate tracheostomy education programme for SLTs working with children and adults. Methods & Procedures: A total of 35 SLTs participated in the programme, which included a 1‐day tracheostomy simulation‐based workshop. Before the workshop, SLTs took an online knowledge quiz and then completed a theory package. The workshop consisted of part‐task skill learning and simulated scenarios. Scenarios were video recorded for delayed independent appraisal of participant performance. Manual skills were judged as (1) completed successfully, (2) completed inadequately/needed assistance or (3) lost opportunity. Core non‐medical skills required when managing a crisis situation and overall performance were scored using an adapted Ottawa Global Rating Scale (GRS). Feedback from participants was collected and self‐perceived confidence rated prior, immediately post and 4 months post‐workshop. Outcomes & Results: SLTs successfully performed 94% of manual tasks. Most SLTs (29 of 35) scored > 5 of 7 on all elements of the adapted Ottawa GRS. Workshop feedback was positive with significant increases in confidence ratings post‐workshop and maintained at 4 months. Conclusions & Implications: Postgraduate tracheostomy education, using a flipped‐classroom approach and low‐ and high‐fidelity simulation, is an effective way to increase knowledge, confidence and manual skill performance in SLTs across patient populations. Simulation is a well‐received method of learning. [ABSTRACT FROM AUTHOR]

Background: The involvement of speech and language therapists (SLTs) within paediatric palliative care (PPC) settings has been recognized within the extant literature. However, there is little understanding of SLT's specific roles and practices when working with this vulnerable cohort of children and their families. As part of a larger body of work to develop consensus-based recommendations for SLTs working in PPC, it is important to investigate demographic and caseload characteristics. Aims: This exploratory study aimed to gather previously undocumented international demographic data pertaining to SLT service provision, caseload and training in PPC. Additionally, it sought to ascertain the current treatment and assessment approaches of SLTs, and if variations exist in beliefs and practices. Methods & Procedures: An anonymous cross-sectional survey was designed and reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). The online survey consisted of 40 items spanning four domains: (1) demographic information; (2) caseload information; (3) service provision; and (4) training and education. SLTs from Australia, Canada, New Zealand, the UK, Ireland and the United States were recruited using a purposive snowball sampling approach. Descriptive analysis of closed-ended survey responses and content analysis of open-ended responses are presented. Outcomes & Results: A total of 52 respondents completed the survey. SLTs worked in a variety of PPC settings, with patients of varying age and disease groups. Over 50% of participants reported working in PPC for [less than or equal to] 4 years. Genetic disorders (34%), oncology (27%) and neurological conditions (21%) made up a significant portion of respondents' caseloads. Reported treatments and assessment approaches used by SLTs are not unique to a PPC population. Barriers and enablers for practice were identified. A portion of participants did not feel trained and prepared to assess (19.2%) or treat (15.4%) PPC clients. Conclusions & Implications: This study confirms that SLTs internationally have a role in the management of communication and swallowing impairments in a PPC context. However, whether current training and resources adequately support SLTs in this role remains questionable. This paper helps to provide SLTs, administrators, professional associations and tertiary institutions with foundational data to help inform workforce planning, advocacy efforts and training priorities.

Abstract: Background: Engagement is commonly considered important in stroke rehabilitation, with some arguing it is essential for positive patient outcomes. An emerging body of research indicates the practitioner influences engagement through their ways of relating, communicating and working with the patient. People experiencing communication disability may face particular challenges with engagement as a practitioner's communication and interactional patterns may limit their ability to engage. Aims: To understand how rehabilitation practitioners worked to engage people experiencing communication disability throughout the course of rehabilitation. Methods & Procedures: A qualitative study using the Voice Centred Relational Approach. Longitudinal observational and interview data were gathered from 28 practitioners and three people experiencing communication disability in inpatient and community stroke rehabilitation services. Data were analyzed using the Listening Guide. Outcomes & Results: Engagement was a relational practice on the part of the rehabilitation practitioner. It was underpinned by a relational philosophy and characterized by three core processes: embedding relational work throughout rehabilitation; getting to know the patient and working in ways valued by the patient; and communicating using relational dialogue and supported conversation. Practitioners wove these together with their technical, disciplinary‐based work and rehabilitation tasks. Conclusions & Implications: Patient engagement was constructed through relationships and strongly influenced by the practitioners’ way of thinking about and enacting practice, challenging the idea that engagement is solely an intrinsic patient state and behaviour. The findings raise questions about which aspects of rehabilitation work and communication are most valuable when working to engage people experiencing communication disability. Viewing engagement as a relational practice and understanding the different ways this is enacted may support practitioners to reflect on their understandings of engagement, their patient's engagement, their ways of working, and the frames and philosophies that surround and influence their practice. [ABSTRACT FROM AUTHOR]

Background Preliminary studies of inter-professional education (IPE) among student speech-language therapists (SLTs) and student teachers suggest that workshop-based applications are beneficial in preparing participants for elements of collaborative practice. Situating IPE within the students' professional practice placements may provide another useful avenue to develop attitudes, knowledge and skills for inter-professional collaboration. Research examining the impact of different approaches to IPE is required to advance our understanding of effective design and evaluation of such initiatives. Aims To understand how student SLTs and student teachers develop competency for collaborative practice when co-working during professional practice placements to support children's speech and literacy development. Methods & Procedures A case study design was used to monitor the impact of the IPE. Student SLTs ( n = 4) were paired with student teachers ( n = 4) to participate in shared professional practice placements in junior school classrooms. An inductive thematic analysis of interviews conducted with participants after the IPE was employed to explore the development of competencies in collaborative practice. Change in inter-disciplinary knowledge and perceptions over the IPE was evaluated via survey to further explore the development of collaborative competencies. Outcomes & Results Integration of qualitative and quantitative findings suggested that participants began to develop four broad areas of collaborative competency: understanding of professional roles and expertise, communication skills to support shared decision-making, inter-dependency in supporting children's learning, and flexibility to implement alternative instructional practices. Interview analysis also revealed factors related to the facilitators and learning contexts that supported and/or limited the collaboration between participants. Conclusions & Implications Shared placement experiences between student SLTs and student teachers may be an effective method for building participants' competencies in multiple aspects of collaborative practice. Active facilitation by both SLT and classroom teacher supervisors alongside careful consideration of learning contexts (e.g., classroom structure) will help to ensure that learning is maximized for prospective professionals. [ABSTRACT FROM AUTHOR]