Search

Current service models in childhood rehabilitation promote the active participation of parents/caregivers in their children’s therapies. The existing literature provides a limited understanding of the tasks and responsibilities parents undertake in their children’s therapies, especially over telepractice. This study describes the tasks undertaken by parents in their children’s speech therapy delivered virtually during the COVID-19 pandemic. A qualitative descriptive study was conducted with parents and speech-language pathologists, using open-ended interviews. Interviews were analyzed using a combination qualitative content analysis and thematic analysis. Parents performed many tasks to enable telepractice. These tasks happened before (e.g., setting up both physical and virtual space for therapy), during (e.g., managing child’s behavior), and after the virtual therapy session (e.g., carrying out home practice). While parents were willing to perform these tasks in order to help their children, some expressed the toll that it can take on them. Compared to what is known from in-person visits, some of these tasks were novel and unique to telepractice. We recommend that clinicians and parents collaboratively decide on tasks and responsibilities to avoid burdening parents, and that they weigh the costs associated with performing these tasks against the benefits of teletherapy.IMPLICATIONS FOR REHABILITATIONParents perform many tasks to support their children’s therapies, both during and outside of therapy sessionsTherapies delivered virtually require parents to assume additional tasks to support their childrenFor services to be Family-Centered, tasks and responsibilities need to be decided collaboratively between parents and clinicians Parents perform many tasks to support their children’s therapies, both during and outside of therapy sessions Therapies delivered virtually require parents to assume additional tasks to support their children For services to be Family-Centered, tasks and responsibilities need to be decided collaboratively between parents and clinicians

Purpose of Review Telemedicine use in dermatology, termed “teledermatology”, offers a cost-effective model to improve healthcare efficiency and access. Only a minority of dermatology practices has integrated teledermatology into their practice prior to COVID-19. A thorough understanding of the barriers and facilitators may promote teledermatology adoption. Implementation science frameworks offer theoretically driven ways to assess factors affecting teledermatology implementation. This review uses a comprehensive implementation science framework to summarize barriers and facilitators of teledermatology implementation and appraises the quality of existing research. Recent Findings Technological characteristics of teledermatology (e.g., user-friendliness) and factors within the outer setting (e.g., reimbursement and legal considerations) were the most commonly reported barriers. No existing studies use a comprehensive implementation framework to identify factors influencing teledermatology implementation. Many included studies have a risk of bias in at least two of the five study quality indices evaluated. Summary This systematic review is the first study to summarize the existing teledermatology implementation literature into well-defined constructs from a comprehensive implementation science framework. Findings suggest future studies would benefit from the use of an implementation framework to reduce study bias, improve result comprehensiveness, facilitate comparisons across studies, and produce evidence-based resolutions to implementation barriers. Tools, resources, and recommendations to facilitate the use of an implementation framework in future studies are provided. Supplementary Information The online version contains supplementary material available at 10.1007/s13671-020-00323-0.

Background: There has been a significant uptake in the use of telepractice during the coronavirus SARS-CoV-2 (COVID-19) pandemic. This study explored the experiences of speech and language therapists, assistants and parents with telepractice during the COVID-19 pandemic. Aims: The aims of the study were to (a) identify factors that influenced success of telepractice, and (b) describe clinicians’ and parents’ preferences for the future mode of service delivery for preschoolers with communication disorders. Methods & Procedures: The study was conducted in partnership with one publicly funded program in Ontario, Canada that offered services to preschoolers with speech, language, and communication needs at no cost. Speech and language therapists (N = 13), assistants (N = 3) and parents (N = 13) shared their experiences and perspectives during semi-structured videoconference interviews. Outcomes & Results: Factors that influenced the success of telepractice were reported in three categories: the setting (i.e., where and how telepractice was being delivered); the nature of telepractice (i.e., the services that were provided via telepractice); and the individuals (i.e., who was involved in telepractice). These factors were reported to interact with each other. As needs for each child and family are unique, parents and clinicians reported a preference for a hybrid and flexible service delivery model in the future. Conclusions & Implications: The themes identified in this study can be used by clinicians and managers to consider factors that influence the success of telepractice for children and families What this paper adds: What is already known on the subject? Studies conducted before the COVID-19 pandemic showed that telepractice was an effective and acceptable service approach. However, some clinicians and parents reported wanting to resume in-person visits. The provision of telepractice services to families with children with communication disorders increased significantly during COVID-19. What this paper adds to existing knowledge? Parents and clinicians shared factors that influenced the success of telepractice during semi-structured interviews. Factors were identified in three categories: the setting (i.e., where and how telepractice was being delivered); the nature of telepractice (i.e., the services that were provided via telepractice); and the individuals (i.e., who were involved in telepractice). As each child's and family's needs are unique, parents and clinicians reported a preference for a hybrid and flexible service delivery model in the future. What are the potential or actual clinical implications of this work? SLTs and SLT managers can use the factors identified to discuss with parents and decide whether telepractice may be well suited to the needs of each child and family.

BACKGROUND The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) is an international initiative that offers standardized and validated tools to guide the appraisal of patient-reported outcome measures in healthcare. AIMS To explore the use of a new set of tools from the COSMIN to appraise studies on one outcome measure available to speech and language therapists (SLTs). METHODS & PROCEDURES We used the COSMIN tools to appraise seven studies and a user manual that reported the measurement properties of the Focus on the Outcomes of Children Under Six (FOCUS), a validated measure of pre-schoolers' communicative participation that is used in various contexts around the world. OUTCOMES & RESULTS Using COSMIN guidelines, the FOCUS was categorized as a 'category A' tool because there was a sufficient level of evidence to support its content validity and internal consistency. According to the COSMIN guidelines, this means that the FOCUS can be recommended for use. The quality of evidence supporting measurement properties of the FOCUS received a rating of 'moderate', meaning users can have moderate confidence in its measurement properties. Since these ratings from the COSMIN tools may be unclear to users of the FOCUS, we have provided more specific recommendations. CONCLUSIONS & IMPLICATIONS The COSMIN tools offer detailed standards to support the appraisal of outcome measures available to SLTs. However, several limitations were observed, and recommendations to support the application of the COSMIN tools are provided. What this paper adds What is already known on the subject Collecting outcome data is essential to ensure speech and language therapy is effective. Until the development of COSMIN there was a lack of standards in the way the measurement properties of outcome measure instruments were appraised. What this paper adds to existing knowledge This paper used the FOCUS, a measure of pre-schoolers' communicative participation outcomes in speech and language therapy, as a case example to illustrate the applications of the COSMIN tools. In doing so, the strengths and limitations of the current COSMIN tools in appraising the quality of outcome measure instruments are emphasized. What are the potential or actual clinical implications of this work? The COSMIN tools offer a step-by-step, standardized approach to appraise various measurement properties in outcome instruments. Due to existing limitations of the COSMIN tools, appraisal should provide clear and specific recommendations so users of outcome measures (e.g., SLTs, researchers) can identify the appropriate uses of each instrument.

Background To improve the uptake of research into practice, knowledge translation frameworks recommend tailoring implementation strategies to address practice barriers. This study reports our experience pairing the Theoretical Domains Framework with information from multiple stakeholder groups to co-develop practice-informed strategies for improving the implementation of an evidence-based outcome measurement tool across a large community health system for preschoolers with communication impairments. Methods Concept mapping was used to identify strategies for improving implementation of the Focus on the Outcomes of Communication Under Six (FOCUS) in Ontario Canada’s Preschool Speech and Language Program. This work was done in five stages. First, we interviewed 37 speech-language pathologists (clinicians) who identified 90 unique strategies to resolve practice barriers to FOCUS implementation. Second, clinicians (n = 34), policy-makers (n = 3), and members of the FOCUS research team (n = 6) sorted and rated the strategies by importance and feasibility. Third, stakeholders’ sorting data were analyzed to generate a two-dimensional concept map. Based on the rating data from stakeholders, we prioritized a list of strategies that were rated as highly important and highly feasible, and summarized the practice barriers addressed by each of the prioritized strategies. Fourth, we validated these findings with stakeholders via an online survey. Fifth, the mechanisms of action of the prioritized list of strategies were considered based on available evidence from the Theoretical Domains Framework and associated behavior change literature. Results Stakeholders categorized the 90 unique implementation strategies into a six-cluster concept map. Based on stakeholders’ ratings, a list of 14 implementation strategies were prioritized. These implementation strategies were reported to resolve barriers within the environmental context and resources and beliefs about consequences domains of the Theoretical Domains Framework. All but one of the prioritized strategies have a demonstrated link in resolving existing barriers according to the behavioral change literature. Conclusions Our study contributes to a growing literature that demonstrates the process of tailoring implementation strategies to specific barriers. Practical drawbacks and benefits of using concept mapping as a way to engage stakeholders in implementation research are discussed.

© 2017 Federation of European Neuroscience Societies and John Wiley & Sons Ltd. Processing of auditory information in the cortex continues to develop into later childhood and adolescence. Recent research has indicated that intraclass correlation (ICC) is the best method for capturing maturation in auditory event-related potentials (AEPs) of school-age children. However, the sensitivity of the ICC approach in discerning AEP changes in children has not been consistently demonstrated and positive results have not been replicated. We attempted this replication and further explored whether AEP maturation estimated using the ICC approach predicts cognitive and linguistic abilities in addition to chronological age. We measured AEPs in response to simple tones in groups of 7-, 8-, 9- and 10-year olds with typical development (N = 67) and used ICC to estimate the age equivalent of each child's AEP (AEP-age). Results indicated that ICC differentiated 7- to 8-year-old children from 9- to 10-year-old children and that AEP-age predicted both chronological age and significant, unique variance in language ability, but not in nonverbal IQ. Our findings support the view that auditory organization in children reflects both general developmental maturation and more specific development of language skills, and support the future use of AEP-age to identify and understand individual differences in brain maturation in typically developing and clinical populations.

Early childhood is a period of tremendous growth in both language ability and brain maturation. To understand the dynamic interplay between neural activity and spoken language development, we used resting-state EEG recordings to explore the relation between alpha oscillations (7–10 Hz) and oral language ability in 4- to 6-year-old children with typical development (N=41). Three properties of alpha oscillations were investigated: a) alpha power using spectral analysis, b) flexibility of the alpha frequency quantified via the oscillation’s moment-to-moment fluctuations, and c) scaling behavior of the alpha oscillator investigated via the long-range temporal correlation in the alpha-amplitude time course. All three properties of the alpha oscillator correlated with children’s oral language abilities. Higher language scores were correlated with lower alpha power, greater flexibility of the alpha frequency, and longer temporal correlations in the alpha-amplitude time course. Our findings demonstrate a cognitive role of several properties of the alpha oscillator that has largely been overlooked in the literature. Graphical Abstract

© 2014 Elsevier Ltd. All rights reserved. Clinical anecdotes suggest that children with autism spectrum disorder (ASD) often show an atypical language profile in which expressive language exceeds receptive language competency. However, the few studies to directly explore this language profile have yielded inconsistent findings. This meta-analysis examined 74 studies that reported the receptive and expressive language performances of children and youth with ASD. Four potential predictors (age, language domain, source of language data, method of ASD diagnosis) were separately analyzed for their contribution to the relative receptive and expressive language impairment in ASD. Contrary to popular belief, the current meta-analyses found no evidence that an expressive advantage is common in ASD. Overall, children and youth with ASD showed equally impaired receptive and expressive language skills, both falling roughly 1.5 SD below peers with typical development. No discrepancies were found in receptive and expressive language across developmental stages, cognitive abilities, vocabulary, global language skills, caregiver report measures, clinician-administered measures, mixed method measures, or method of ASD diagnosis. Although some individual children with ASD may have an expressive-better-than-receptive language profile, this profile is not common enough to be a useful marker of ASD.

Purpose Immature auditory processing has been proposed to underlie language impairments in children with developmental language disorder (DLD; also known as specific language impairment ). Using newly available normative auditory evoked potential (AEP) waveforms, we estimated AEP maturity in individual children with DLD and explored whether this maturational index was related to their language abilities. Method AEPs were elicited by 225 trials of a 490-Hz pure tone. Using intraclass correlation and our previously established normative AEP waveforms of 7- to 10-year-old children with typical development, we estimated the age equivalent of the AEPs (AEP–age) from 21 children with DLD. The relation between AEP maturity and language was explored through regression analysis. Results AEP–age predicted 31% of the variance in the language abilities of children with DLD. The AEP–age of children with mild DLD was similar to their chronological age, whereas children with moderate–severe DLD showed, on average, a 1.3-year delay in their neural responses. AEP–age predicted receptive, but not expressive, language performance. Conclusion Maturation in auditory neural responses is a significant predictor of language ability, particularly in children with moderate–severe DLD.

Background Few studies have compared patient and anatomic characteristics across the broad scope of oral and maxillofacial disease seen in dental clinics. The authors conducted a study to make these comparisons by surveying a large sample of histologically diagnosed oral and maxillofacial lesions in a US adult population. Methods A total of 51,781 specimens biopsied from 51,781 adult patients were received by an oral pathology service over 13 years (2001-2015) and analyzed. A description of patients’ sex and age at diagnosis, as well as the anatomic site of biopsy was given for diagnoses of 10 oral disease types, including malignant neoplasm, benign neoplasm, infectious, reactive, potentially malignant, developmental, healthy tissue, immune dysfunction, physical trauma, and other. Results The authors reported reactive lesions were the most prevalent disease type found in the sample (74.9%). Malignant diagnoses comprised 1.97% of all biopsies. The 3 most prevalent diagnoses in this study included benign keratosis, chronic apical periodontitis, and radicular cyst. Different anatomic sites, patient age groups, and sexes show different distributions of disease. Conclusions Certain disease types and diagnoses were found to have a higher prevalence by sex, among particular age groups, and in certain anatomic sites. Practical Implications This information provides clinicians with a detailed and broad scope of the variety of oral and maxillofacial lesions processed at an oral pathology service and may assist practitioners in forming clinical impressions and differential diagnoses.