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Dysphagia (impaired swallowing) is known to contribute to decreased quality of life, and increased length of hospital stay and mortality post-stroke. Despite the advancements in stroke treatment with the introduction of thrombolysis and endovascular clot retrieval (ECR), patients continue to present with high rates of dysphagia. Speech and language therapists and stroke teams should consider the presence of haemorrhagic transformation, success of reperfusion and presence of communication deficits as risk factors for dysphagia post-ECR and/or thrombolysis. Purpose: To establish incidence rates and patterns of dysphagia following the administration of reperfusion therapies in acute ischaemic stroke management. Method: A retrospective review of 193 patients admitted with acute ischaemic stroke to a quaternary stroke unit in Australia over a three year period was completed. Clinical information extracted included demographics, type (thrombolysis and/or endovascular clot retrieval) and success of reperfusion therapy, and the progression of dysphagia and related factors. Results: Over half of all patients treated with reperfusion therapies presented with dysphagia on initial assessment by speech-language pathology (SLP). The type of reperfusion therapy administered was not significantly correlated with the presence of dysphagia. Dysphagia on initial assessment was significantly correlated with the presence of aphasia on initial assessment, the presence of haemorrhagic transformation, and the success of reperfusion. Increased rates of enteral feeding were also found in this study compared to figures reported in literature. Conclusion: This study identified ongoing high rates of dysphagia amongst this patient population regardless of treatment type, demonstrating the need for ongoing SLP management post stroke. Further research is required in this area to develop an evidence-base for SLPs and the wider medical team and to inform clinical practice guidelines.

To investigate speech-language pathologists' (SLPs) perceptions and clinical experiences of dysphagia management following reperfusion therapies. A multi-staged mixed approach involving a two-phase cross-sectional design was used. Data generated during phase 1 (a purpose-built, online survey) guided the development of phase 2 (semi-structured interviews). Sixty-two SLPs participated in phase 1 and six SLPs participated in phase 2. SLPs in both phases reported perceived changes in dysphagia presentation according to the success of reperfusion therapy administered and had concerns regarding worsened dysphagia following unsuccessful procedures. Fluctuations in dysphagia were more frequently reported in the acute stage post-stroke. SLPs reported increased workload demands due to increased interhospital transfers between ECR/thrombolysis centres and referring facilities. The optimal timing for swallowing screening and assessment was not identified, with initial SLP involvement ranging from during the administration of thrombolysis to up to 24 hours post-reperfusion therapy. Preliminary evidence suggests that SLPs perceive that the presentation of post-stroke dysphagia is changing, with increasing fluctuations and complexities in the acute stage of post-stroke care, within the context of increasing use of reperfusion therapies. There is a critical need for research investigating the trajectory of dysphagia in the acute stage to inform dysphagia management within this patient population. [ABSTRACT FROM AUTHOR]

Aim: To identify management practices of Australian speech-language pathologists (SLPs) in the treatment of non-progressive dysarthria using a subsystem approach, and to explore SLPs' consideration and implementation of the theoretical underpinnings of non-progressive dysarthria management. Method: A 39-item online survey was distributed to Australian SLPs, with 80 responses suitable for data analysis. Results: Practices of SLPs were variable for the management of the speech subsystems. The Lee Silverman Voice Treatment (LSVT®) was the most commonly used manualised treatment program, and was employed by 63.77% of respondents. Almost all SLPs (>88%) provided strategies to improve functional communication. There was no clear preference for low tech alternative and augmentative communication (AAC) devices. Speech generating devices were the most commonly employed high tech device. Almost two-thirds of respondents used non-speech oral motor exercises (NSOMEs) in treatment. SLPs had varied frequencies and models of service delivery for intervention. SLPs valued interventions targeting the activity and participation domains of the ICF, however this was restricted by the treatment context and resources available. The majority of SLPs (92.06%) were aware of the principles of motor learning, however many were unsure regarding the specifics of implementation. Conclusion: There is a clear need for further research into the efficacy of treatment techniques to guide decision-making. [ABSTRACT FROM AUTHOR]

Purpose: To establish the clinical profiles of individuals with and without dysphagia following non-traumatic subarachnoid haemorrhage (SAH), and to further describe the clinical progression and outcome of dysphagia within the acute phase for those individuals with dysphagia. Method: Retrospective chart review of 250 patients consecutively admitted with non-traumatic SAH to a major, tertiary neurosurgery referral centre in Australia over a three-year period. Clinical information associated with usual clinical care was collected for the duration of the acute hospital admission. Characteristics of participants with dysphagia (n = 73/250) were further analysed to evaluate dysphagia progression and recovery. Result: Participants with dysphagia took 10.93 times longer to commence oral intake following admission than those without dysphagia (p < 0.01). Those with dysphagia took approximately 12.86 times longer to reach total oral feeding than those without dysphagia (p < 0.01). There was no statistically significant difference between groups for time to SLP referral (p = 0.549) or commencement of supplemental feeding (p = 0.256). Safe management of thin fluids occurred for >50% of participants by weeks 2 and 3 following admission, with 75.34% of participants with dysphagia resuming thin fluids by discharge. Safe management of full diet took slightly longer with 32.88% of participants resuming unmodified diet by week 3. By discharge, only 53.42% of participants resumed a full diet. Conclusion: The clinical progression and recovery of dysphagia within the acute phase following non-traumatic SAH can be protracted for some patients, necessitating ongoing speech-language pathology (SLP) input after discharge. The study findings will enhance SLP assessment processes, management focuses and guide prognostic decision making for this population. [ABSTRACT FROM AUTHOR]

Purpose: To explore Australian speech-language pathologists' use of non-speech oral motor exercises, and rationales for using/not using non-speech oral motor exercises in clinical practice. Methods: A total of 124 speech-language pathologists practising in Australia, working with paediatric and/or adult clients with speech sound difficulties, completed an online survey. Results: The majority of speech-language pathologists reported that they did not use non-speech oral motor exercises when working with paediatric or adult clients with speech sound difficulties. However, more than half of the speech-language pathologists working with adult clients who have dysarthria reported using non-speech oral motor exercises with this population. The most frequently reported rationale for using non-speech oral motor exercises in speech sound difficulty management was to improve awareness/placement of articulators. The majority of speech-language pathologists agreed there is no clear clinical or research evidence base to support non-speech oral motor exercise use with clients who have speech sound difficulties. Conclusions: This study provides an overview of Australian speech-language pathologists' reported use and perceptions of non-speech oral motor exercises' applicability and efficacy in treating paediatric and adult clients who have speech sound difficulties. The research findings provide speech-language pathologists with insight into how and why non-speech oral motor exercises are currently used, and adds to the knowledge base regarding Australian speech-language pathology practice of non-speech oral motor exercises in the treatment of speech sound difficulties. Non-speech oral motor exercises refer to oral motor activities which do not involve speech, but involve the manipulation or stimulation of oral structures including the lips, tongue, jaw, and soft palate. Non-speech oral motor exercises are intended to improve the function (e.g., movement, strength) of oral structures. The majority of speech-language pathologists agreed there is no clear clinical or research evidence base to support non-speech oral motor exercise use with clients who have speech sound disorders. Non-speech oral motor exercise use was most frequently reported in the treatment of dysarthria. Non-speech oral motor exercise use when targeting speech sound disorders is not widely endorsed in the literature. [ABSTRACT FROM AUTHOR]

• There is high variability in assessment practices for non-progressive dysarthria. • Informal measures of assessment are most commonly used. • A greater focus on impairment and intelligibility measures exists. This aim of this study was to identify assessment practices for non-progressive dysarthria used by Australian speech-language pathologists (SLPs) and to describe these practices within the framework of the World Health Organization's International Classification of Functioning Disability, and Health (ICF). A 23-item online survey was distributed to Australian SLPs, with 56 responses suitable for data analysis. The majority of SLPs prescribed 'high importance' to the assessment of impairment to speech function (96%, n = 54), activity limitations (91%, n = 51) and participation in society (91%, n = 51) in non-progressive dysarthria. However, reported assessment selection for non-progressive dysarthria focused largely on impairment and intelligibility, with assessments addressing participation restrictions being under-utilised. There was also a preference for informal assessment tools across all ICF domains. Over half (69%, n = 37) indicated that current assessment tools for non-progressive dysarthria generally do not meet their needs, with key issues being time-factors and inadequate sensitivity. There was variability in the use of outcome measures for non-progressive dysarthria, with workplace setting, time constraints and a perceived lack of relevance being the most commonly reported barriers to implementation. [ABSTRACT FROM AUTHOR]

Purpose: Dysphagia is common sequelae of chemical ingestion injury, resulting from damage to critical swallowing structures. From a speech-language pathology perspective, this study outlines the physiological deficits in 2 individuals with severe injury (1 woman, acid; 1 man, alkali) and the pattern of dysphagia rehabilitation and recovery. Method: A retrospective chart review of clinical and instrumental assessments was conducted to examine swallow characteristics and speech-language pathology management (compensatory and rehabilitation strategies) at multiple time points. Results: Chemical ingestion injury resulted in severe pharyngeal dysphagia for both participants, warranting speech-language pathology management. Dysphagia was characterized by poor base of tongue mobility and reduced laryngeal excursion. Decreased airway patency and protection, secondary to mucosal sloughing, widespread edema, and structural deficits necessitated tracheostomy. Recovery was complicated by physical alterations of pharyngeal and laryngeal structures (e.g., interarytenoid adhesions) and esophageal strictures. Participant 1 was discharged (Day 135) consuming a texture-modified diet; Participant 2 remained nil by mouth (Day 329). Conclusions: Dysphagia recovery subsequent to chemical ingestion is protracted and complex. Clinical outcomes may be improved through individualized and intensive rehabilitation by speech-language pathologists. [ABSTRACT FROM AUTHOR]

Purpose: To determine factors associated with chronic hoarseness in Australian group fitness instructors (GFIs). Method: A total of 361 GFIs (81 males, 280 females), aged between 18–67 years currently active in the Australian fitness industry, completed a 65-item self-completion questionnaire distributed via SurveyMonkey. Demographic, lifestyle and voice use variables thought to influence vocal health and voice production in the GFI population were examined using logistic regression analyses. GFIs' chronic hoarseness with response options "positive" and "negative" was considered as the outcome variable of interest. Result: Approximately 39% of the study participants reported having chronic hoarseness. Multivariable logistic regression modelling revealed a set of statistically significant factors associated with chronic hoarseness. These include: younger age, partial voice loss while instructing, partial voice loss after instructing and using vocal volume louder than normal speaking voice whilst instructing. Conclusion: This study has identified factors associated with the presentation of chronic hoarseness in the Australian GFI population. Prospective studies are required to validate the findings of this study in order to better understand predictive factors of chronic hoarseness among GFIs. [ABSTRACT FROM AUTHOR]

The aim of the study is to investigate dysphagia incidence and establish factors which may reliably predict dysphagia risk in individuals presenting with non-traumatic subarachnoid hemorrhage (SAH). A retrospective chart audit of 250 patients (151 females and 99 males) consecutively admitted with non-traumatic SAH to a major, tertiary neurosurgery referral center in Australia was conducted. Demographics, medical, and surgical information, along with speech-language pathology (SLP) assessment data were collected. Differences between dysphagic and non-dysphagic groups were evaluated using t tests, χ 2 , and Fisher's exact tests. Univariate and multivariate logistic regression analysis was performed to establish factors associated with dysphagia risk. A total of 31.6% of participants were identified with dysphagia during acute inpatient admission based on SLP, medical officer, and/or nursing staff reports. Individuals with dysphagia had significantly (p < 0.01) higher World Federation of Neurological Surgeons (WFNS) grading scores, were more likely to have an aneurysmal cause, were more likely to have secondary complications such as vasospasm, hydrocephalus, or new ischemia, were older, and had longer intubation and intensive care unit (ICU) periods than those without dysphagia. Dysphagia risk was significantly associated (p < 0.01) with age > 57.5 years, ICU length of stay > 7.5 days, length of intubation > 1.5 days, need for tracheostomy, vasospasm, and new stroke. Dysphagia is highly prevalent following non-traumatic SAH, and significantly associated with a number of factors. Established risk factors will improve current knowledge, promote early identification of dysphagia, and inform SLP referral criteria and management of this patient cohort.

Dysphagia assessment and rehabilitation practice is complex, and significant variability in speech-language pathology approaches has been documented internationally. The aim of this study was to evaluate swallowing-related assessment and rehabilitation practices of SLPs currently working in Australia. One hundred and fifty-four SLPs completed an online questionnaire administered via QuickSurveys from May to July 2015. Results were analysed descriptively. The majority of clinicians had accessed post-graduate training in dysphagia management and assessment (66.23%). Referral and screening were typically on an ad hoc basis (74.03%). Clinical swallow examination (CSE) and Videofluoroscopic Swallowing Study were used by 93.51 and 88.31% of respondents, respectively. CSE was the assessment that predominantly informed clinical decision-making (52.63%). Clinicians typically treated clients with dysphagia for 30 min per session (46.10%), with recommendations of repetition of exercises inconsistent across settings. Outcome measures were utilised by many (67.53%), which however were typically informal. Results indicate variable practice patterns for dysphagia assessment and management across Australia. This variability may reflect the heterogeneous nature of dysphagia and the varying needs of patients accessing different services.

Objectives: To determine the prevalence and nature of both acute and chronic voice problems experienced by group fitness instructors (GFIs) and gather information about the level of education currently being received by fitness professionals, the source of their education, and their opinion on mandatory voice training to highlight potential training needs., Study Design: Prospective self-completion questionnaire design., Methods: A total of 361 GFIs (81 males and 280 females), aged between 18 and 67 years currently active in the Australian fitness industry completed a self-report questionnaire distributed via SurveyMonkey., Results: The prevalence of self-reported acute and chronic voice symptoms was high at 78.95% and 70.91%, respectively. Partial voice loss and hoarseness while instructing was experienced most often (57.62%), followed by partial voice loss and hoarseness immediately after instructing (46.81%). Aphonia after teaching was less frequently reported (9.97%). Over 25% of the total cohort reported chronic voice symptoms of increased hoarseness (39.61%), difficulty with high notes (31.58%), strained voice (32.13%), and limited singing range (27.7%). Only 30% of GFIs reported having received any voice education, with even fewer respondents (10%) receiving any practical voice training, despite 98.06% agreeing that formal voice education should be covered as a standard topic in all official GFI training., Conclusions: The results of this study confirm that voice problems represent a significant occupational hazard for GFIs. Speech-language pathologists and other voice professionals should consider taking a proactive stance in understanding the vocal demands of the profession and engage in training for instructors to prevent both acute and chronic voice problems., (Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

The objective of this study is to determine dysphagia incidence for a consecutively admitted population of thermal burn injury patients and to determine admitting characteristics that can be used to reliably predict patients at risk of developing dysphagia after thermal burn. Four hundred thirty-eight patients with thermal burns, with or without inhalation injury, who were consecutively admitted to and received management at a state-wide burn center over a 2-year period (2007-2009) were included. All patients meeting the project's inclusion criteria underwent clinical swallowing assessment to determine the presence or absence of dysphagia. Dysphagia incidence was found to be 11.18% (n = 49) in the admitted population. Dysphagia severity at initial assessment was classified as severe for 40.82%, moderate for 30.61%, and mild for 28.57%. Statistical analysis revealed a core set of statistically significant parameters known within the first 24 hours postinjury that showed strong sensitivity and specificity for detection of dysphagia risk. These include, in isolation or in combination, with the consideration of increasing age, TBSA burnt ≥18%, head and neck burns, need for escharotomy, inhalation injury, need for intensive care admission, and need for mechanical ventilation. This is the first large, prospective cohort study to document dysphagia incidence within the thermal burn population and to validate key predictors for dysphagia risk in this population. These data will assist the allocation and planning of speech pathology services and provide an evidence-based pathway for ensuring early identification and management of patients at high risk of dysphagia after thermal burn injury.