Development of the Mandarin speech banana

Abstract

Purpose: For Indo-European languages, “speech banana” is widely used to verify the benefits of hearing aids and cochlear implants. As a standardised “Mandarin speech banana” is not available, clinicians in China typically use a non-Mandarin speech banana. However, as Chinese is logographic and tonal, using a non-Mandarin speech banana is inappropriate. This paper was designed to develop the Mandarin speech banana according to the Mandarin phonetic properties.

Method: In the first experiment, 14 participants read aloud the standard Mandarin initials and finals. For each pronounced sound, its formants were measured. The boundary of all formants formed the formant graph (intensity versus frequency). In the second experiment, 20 participants listened to a list of pre-recorded initials and finals that had been filtered with different bandwidths. The minimum bandwidth to recognise a target sound defined its location on the formant graph.

Result: The Mandarin speech banana was generated with recognisable initials and finals on the formant graph. Tone affected the shape of the formant graph, especially at low frequencies.

Conclusion: Clinicians can use the new M andarin speech banana to counsel patients about what sounds are inaudible to them. Speech training can be implemented based on the unheard sounds in the speech banana.     

Factors affecting speech pathologists’ implementation of stroke management guidelines: a thematic analysis

Abstract

Purpose: Although clinical practice guidelines can facilitate evidence-based practice and improve the health outcomes of stroke patients, they continue to be underutilised. There is limited research into the reasons for this, especially in speech pathology. This study provides the first in-depth, qualitative examination of the barriers and facilitators that speech pathologists perceive and experience when implementing guidelines. Methods: A maximum variation sample of eight speech pathologists participated in a semi-structured interview concerning the implementation of the National Stroke Foundation's Clinical Guidelines for Stroke Management 2010. Interviews were transcribed, thematically analysed and member checked before overall themes were identified. Results: Three main themes and ten subthemes were identified. The first main theme, making implementation explicit, reflected the necessity of accessing and understanding guideline recommendations, and focussing specifically on implementation in context. In the second theme, demand versus ability to change, the size of changes required was compared with available resources and collaboration. The final theme, Speech pathologist motivation to implement guidelines, demonstrated the influence of individual perception of the guidelines and personal commitment to improved practice. Conclusions: Factors affecting implementation are complex, and are not exclusively barriers or facilitators. Some potential implementation strategies are suggested. Further research is recommended.

• Implications for Rehabilitation

• In most Western nations, stroke remains the single greatest cause of disability, including communication and swallowing disabilities.

• Although adherence to stroke clinical practice guidelines improves stroke patient outcomes, guidelines continue to be underutilised, and the reasons for this are not well understood.

• This is the first in-depth qualitative study identifying the complex barriers and facilitators to guideline implementation as experienced by speech pathologists in stroke care.

• Suggested implementation strategies include local monitoring of guideline implementation (e.g. team meetings, audits), increasing collaboration on implementation projects (e.g. managerial involvement, networking), and seeking speech pathologist input into guideline development.

     

“Ode to confidence”: Poetry groups for dysarthria in multiple sclerosis

Abstract

Purpose: Approximately 40–50% of people with multiple sclerosis (MS) have dysarthria impacting confidence in communication. This study explored how people with MS experienced a novel therapeutic approach combining dysarthria therapy with poetry in a group format.

Method: Participants were recruited through MSWA (formerly known as the Multiple Sclerosis Society of Western Australia), a leading service provider for people living with all neurological conditions in Western Australia. They attended eight weekly sessions led by a speech pathologist and a professional poet. The study was co-designed and qualitative, using observational field notes recorded during sessions and semi-structured in-depth interviews with participants after programme completion. The results from an informal, unstandardised rating scale of communication confidence, along with standardised voice and speech measures, were used to facilitate discussion about confidence in the interviews.

Result: Nine participants with MS completed the group programme. Analysis of the qualitative data revealed participants’ positive views regarding the pairing of speech pathology and poetry. Thematic analysis identified four core themes: living with MS and its “series of griefs”; belonging to a group – “meeting with a purpose”; the power of poetry; and poetry as a medium for speech pathology.

Conclusion: Poetry in combination with dysarthria therapy represents a novel, interprofessional approach for improving communication confidence in individuals with MS.     

Facilitating speech in the patient with a tracheostomy

A tracheostomy tube decreases the ability of the patient to communicate effectively. The ability to speak provides an important improvement in the quality of life for a patient with a tracheostomy. In mechanically ventilated patients, speech can be provided by the use of a talking tracheostomy tube, using a cuff-down technique with a speaking valve, and using a cuff-down technique without a speaking valve. Speech can be facilitated in patients with a tracheostomy tube who are breathing spontaneously by use of a talking tracheostomy tube, by using a cuff-down technique with finger occlusion of the proximal tracheostomy tube, and with the use of a cuff-down technique with a speaking valve. Teamwork between the patient and the patient care team (respiratory therapist, speech-language pathologist, nurse, and physician) can result in effective restoration of speech in many patients with a long-term tracheostomy.     

An acoustic feature-based similarity scoring system for speech rehabilitation assistance

The purpose of this study is to develop a tool to assist speech therapy and rehabilitation, which focused on automatic scoring based on the comparison of the patient’s speech with another normal speech on several aspects including pitch, vowel, voiced–unvoiced segments, strident fricative and sound intensity. The pitch estimation employed the use of cepstrum-based algorithm for its robustness; the vowel classification used multilayer perceptron (MLP) to classify vowel from pitch and formants; and the strident fricative detection was based on the major peak spectral intensity, location and the pitch existence in the segment. In order to evaluate the performance of the system, this study analyzed eight patient’s speech recordings (four males, four females; 4–58-years-old), which had been recorded in previous study in cooperation with Taipei Veterans General Hospital and Taoyuan General Hospital. The experiment result on pitch algorithm showed that the cepstrum method had 5.3% of gross pitch error from a total of 2086 frames. On the vowel classification algorithm, MLP method provided 93% accuracy (men), 87% (women) and 84% (children). In total, the overall results showed that 156 tool’s grading results (81%) were consistent compared to 192 audio and visual observations done by four experienced respondents.

• Implication for Rehabilitation

• Difficulties in communication may limit the ability of a person to transfer and exchange information.

• The fact that speech is one of the primary means of communication has encouraged the needs of speech diagnosis and rehabilitation.

• The advances of technology in computer-assisted speech therapy (CAST) improve the quality, time efficiency of the diagnosis and treatment of the disorders.

• The present study attempted to develop tool to assist speech therapy and rehabilitation, which provided simple interface to let the assessment be done even by the patient himself without the need of particular knowledge of speech processing while at the same time, also provided further deep analysis of the speech, which can be useful for the speech therapist.

     

Parent–child interaction in motor speech therapy

Purpose: This study measures the reliability and sensitivity of a modified Parent–Child Interaction Observation scale (PCIOs) used to monitor the quality of parent–child interaction. The scale is part of a home-training program employed with direct motor speech intervention for children with speech sound disorders.

Method: Eighty-four preschool age children with speech sound disorders were provided either high- (2×/week/10 weeks) or low-intensity (1×/week/10 weeks) motor speech intervention. Clinicians completed the PCIOs at the beginning, middle, and end of treatment. Inter-rater reliability (Kappa scores) was determined by an independent speech-language pathologist who assessed videotaped sessions at the midpoint of the treatment block. Intervention sensitivity of the scale was evaluated using a Friedman test for each item and then followed up with Wilcoxon pairwise comparisons where appropriate.

Results: We obtained fair-to-good inter-rater reliability (Kappa?=?0.33–0.64) for the PCIOs using only video-based scoring. Child-related items were more strongly influenced by differences in treatment intensity than parent-related items, where a greater number of sessions positively influenced parent learning of treatment skills and child behaviors.

Conclusion: The adapted PCIOs is reliable and sensitive to monitor the quality of parent–child interactions in a 10-week block of motor speech intervention with adjunct home therapy.

• Implications for rehabilitation

• Parent-centered therapy is considered a cost effective method of speech and language service delivery. However, parent-centered models may be difficult to implement for treatments such as developmental motor speech interventions that require a high degree of skill and training.

• For children with speech sound disorders and motor speech difficulties, a translated and adapted version of the parent–child observation scale was found to be sufficiently reliable and sensitive to assess changes in the quality of the parent–child interactions during intervention.

• In developmental motor speech interventions, high-intensity treatment (2×/week/10 weeks) facilitates greater changes in the parent–child interactions than low intensity treatment (1×/week/10 weeks).

• On one hand, parents may need to attend more than five sessions with the clinician to learn how to observe and address their child’s speech difficulties. On the other hand, children with speech sound disorders may need more than 10 sessions to adapt to structured play settings even when activities and therapy materials are age-appropriate.

     

Music therapy applied to complex blast injury in interdisciplinary care: a case report

Purpose: Music therapy has a long history of treating the physiological, psychological, and neurological injuries of war. Recently, there has been an increase in the use of music therapy and other creative arts therapies in the care of combat injured service members returning to the United States from Iraq and Afghanistan, especially those with complex blast-related injuries. This case report describes the role of music therapy in the interdisciplinary rehabilitation of a severely injured service member.

Methods: Music therapy was provided as stand-alone treatment and in co-treatment with speech language pathology, physical therapy, and occupational therapy. The report is based on clinical notes, self-reports by the patient and his wife, and interviews with rehabilitation team members.

Results: In collaboration with other treatment disciplines, music therapy contributed to improvements in range of motion, functional use of bilateral upper extremities, strength endurance, breath support, articulation, task-attention, compensatory strategies, social integration, quality of life, and overall motivation in the recovery process. The inclusion of music therapy in rehabilitation was highly valued by the patient, his family, and the treatment team.

Conclusions: Music therapy has optimized the rehabilitation of a service member through assisting the recovery process on a continuum from clinic to community.

• Implications for Rehabilitation

• Music therapy in stand-alone sessions and in co-treatment with traditional disciplines can enhance treatment outcomes in functional domains of motor, speech, cognition, social integration, and quality of life for military populations.

• Music therapists can help ease discomfort and difficulty associated with rehabilitation activities, thereby enhancing patient motivation and participation in interdisciplinary care.

• Music therapy assists treatment processes from clinic to community, making it highly valued by the patient, family, and interdisciplinary team members in military healthcare.

• Music therapy provides a platform to prevent social isolation by promoting community integration through music performance.

     

How the Integration of Pathology in the Gross Anatomy Laboratory Affects Medical Students

Problem: The main objective of this project was to integrate pathologists into the gross anatomy laboratory setting to increase the exposure that early medical students receive to pathologists as clinicians. Intervention: Pathologists visited the gross anatomy laboratory 3 times throughout the 15-week course to assist medical students in determining the cause of death of the cadaver being dissected. Context: This intervention was implemented with 1st-semester medical students for 2 consecutive years (a total of 100 dissection teams consisting of 4 students in each team). Outcome: A quantitative content analysis was performed on the students' end of the course assignments to determine whether the students learned a greater percentage of pathologic information by having interactions with pathologists in the gross lab and to identify trends in the way medical students diagnosed their “first patient” (i.e., the cadaver). The students who had interactions with pathologists in the laboratory had significantly more pathology in their narrative than the students who did not receive pathologist interaction. They were also more likely to conclude that the cadaver they dissected actually died from a cause other than the one listed on the death certificate (18.3%; n = 15) compared to the students who had no pathologist interaction (1.8%; n = 2). A postintervention survey indicated that 65% of students felt that interaction with pathologists helped them understand the clinical application of gross anatomy, more than 40% become more interested in pathology, and 74% would have liked to have had more pathologist interaction. Lessons Learned: This intervention demonstrated a way to increase pathologist interaction within the undergraduate medical curriculum and enhance the educational environment of the gross anatomy laboratory.     

Pulmonary rehabilitation for mechanically ventilated patients.

Pulmonary rehabilitation for the mechanically ventilated patient is a complex process requiring the teamwork of many disciplines. The physician, pulmonary CNS, respiratory therapist, physical therapist, occupational therapist, dietician, speech pathologist, social worker, and chaplain all work together in a coordinated effort. Daily assessment of patient changes and tolerance to therapy is necessary to progress the patient to a relatively independent state. When communication among the team members is effective, few problems go unnoticed. The primary goal of pulmonary rehabilitation is to return patients to their highest functional capacity to enhance their independence and personal ego strength, whether on or off a ventilator, part or all of the time. If chronic mechanical ventilation is the reality, pulmonary rehabilitation must promote a quality lifestyle of independence and autonomy.     

Delivering high quality hip fracture rehabilitation: the perspective of occupational and physical therapy practitioners

Aim: The majority of post-acute hip fracture rehabilitation in the US is delivered in skilled nursing facilities (SNFs). Currently, there are limited guidelines that equip occupational and physical therapy practitioners with a summary of what constitutes evidence-based high quality rehabilitation. Thus, this study aimed to identify rehabilitation practitioners’ perspectives on the practices that constitute high quality hip fracture rehabilitation.

Methods: Focus groups were conducted with 99 occupational and physical therapy practitioners working in SNFs in southern California. Purposive sampling of facilities was conducted to capture variation in key characteristics known to impact care delivery for this patient population (e.g., financial resources, staffing, and patient case-mix). Questions aimed to elicit practitioners’ perspectives on high quality hip fracture rehabilitation practices. Each session was audio-recorded and transcribed. Data were systematically analyzed using a modified grounded theory approach.

Results: Seven themes emerged: objectives of care; first 72?h; positioning, pain, and precautions; use of standardized assessments; episode of care practices; facilitating insight into progress; and interdisciplinary collaboration.

Conclusions: Clinical guidelines are critical tools to facilitate clinical decision-making and achieve desired patient outcomes. The findings of this study highlight the practitioners’ perspective on what constitutes high quality hip fracture rehabilitation. This work provides critical information to advance the development of stakeholder-driven rehabilitation clinical guidelines. Future research is needed to verify the findings from other stakeholders (e.g., patients), ensure the alignment of our findings with current evidence, and develop measures for evaluating their delivery and relationship to desired outcomes.

• Implications for Rehabilitation

• This study highlights occupational and physiotherapy therapy practitioners’ perspectives on the cumulative best practices that reflect high quality care, which should be delivered during hip fracture rehabilitation.

• While this study was limited to two professions within the broader interdisciplinary team, consistently occupational and physiotherapy therapy practitioners situated their role and practices within the team, emphasizing that high quality care was driven by collaboration among all members of the team as well as the patient and caregivers.

• Future research needs to evaluate the (a) frequency at which these practices are delivered and the relationship to patient-centered outcomes, and (b) perspectives of rehabilitation practitioners working in other PAC settings, patients, caregivers, as well as the other members of the interdisciplinary PAC team.

     

Role of the speech-language pathologist in palliative hospice care

In reviewing the literature, there are few articles describing the role of the speech-language pathologist in hospice. Communication impairments can impact upon the hospice team's ability to provide symptom control and supportive psychosocial care, and diminish the patient's ability to guide the decision making process and maintain social closeness with family. Swallowing difficulties may result in discomfort for patients and concern from caregivers. Patient care provided by the speech-language pathologist can align with the framework of the World Health Organization's components of palliative care. Four primary roles of the speech-language pathologist in hospice can be described. (1) To provide consultation to patients, families, and members of the hospice team in the areas of communication, cognition, and swallowing function; (2) To develop strategies in the area of communication skills in order to support the patient's role in decision making, to maintain social closeness, and to assist the client in fulfillment of end-of-life goals; (3) To assist in optimizing function related to dysphagia symptoms in order to improve patient comfort and eating satisfaction, and promote positive feeding interactions for family members and (4) To communicate with members of the interdisciplinary hospice team, to provide and receive input related to overall patient care. Further development of the speech-language pathologist as a participating member of the hospice interdisciplinary team would support the overall goal of providing quality care for patients and families served by hospice.     

Waiting for speech-language pathology services: A randomised controlled trial comparing therapy,advice and device

Abstract

Purpose: To compare children’s speech, language and early literacy outcomes, and caregivers' empowerment and satisfaction following provision of 12 sessions of direct intervention (therapy), or face-to-face advice or a purpose-built website (device) while waiting for therapy.

Method: A four-stage randomised controlled trial was undertaken involving three- to six-year-old children referred to speech-language pathology waiting lists at two Australian community health centres over eight months (n?=?222). Stage 1 (screening): 149 were eligible to participate. Stage 2 (pre-assessment): 117 were assessed. Stage 3 (intervention): 110 were randomised to advice (33), device (39) or therapy (38). Stage 4 (post-assessment): 101 were re-assessed by a speech-language pathologist blinded to the intervention condition.

Result: After controlling for baseline levels, children’s speech (percentage of consonants correct) was significantly higher in the therapy group compared to the advice and device conditions. Caregivers' satisfaction was also significantly higher in the therapy condition compared to the device condition. There were no significant differences between the three conditions for children’s intelligibility, language and early literacy or caregivers' empowerment.

Conclusion: Therapy resulted in significantly higher speech outcomes than the advice and device conditions and was associated with significantly greater caregiver satisfaction. Provision of a website containing evidence-based material or a single session of advice may be a viable alternative while children wait for therapy targeting intelligibility, language and early literacy, and to empower caregivers.     

A collaborative approach to supporting communication in the assessment of decision-making capacity

Purpose: This paper explores the clinical implications of acquired communication disorders in decisional capacity. Discipline-specific contributions are discussed in a multidisciplinary context, with a specific focus on the role of speech and language pathologists (SLPs). Method: Key rehabilitation issues in determining decisional capacity are identified. The impact of communication impairment on capacity is discussed in light of the research literature relating to supportive communication and collaborative practice that respects human rights. Results: Guidelines are presented for professionals involved in the assessment of the decisional capacity of individuals with communication disorders of neurological origin. They guide an assessor through: assessing cognition, language and speech; determining preferred communication domains; and practical strategies and considerations for maximising communication. Conclusion: There is a dearth of guidelines available that deal with augmenting and supporting communication of individuals with acquired communication disorders of neurological origin when it comes to assessing legal decision-making capacity. Capacity assessment is a multidisciplinary realm, and the involvement of SLPs is key to maximising the decision-making capacity of these individuals.

• Implications for rehabilitation

• All clinicians have an obligation to maximise client autonomy and participation in decision-making.

• Assessments of capacity should involve a general cognitive ability assessment, followed by a decision-specific assessment tool or question set for the decision facing the patient.

• The involvement of speech and language pathologists (SLPs) is key to assess and facilitate capacity determinations in instances of cognitive-communication disorder.

• Impairments in different aspects of auditory comprehension require different accommodations.

     

The cognitive competence of speakers with acquired dysarthria: Judgements by doctors and speech and language therapists

Background.?Studies have shown that listeners make negative attributions towards people with communication impairments. This appears to be the case for healthcare professionals as well as non-professional listeners.

Aims.?This study extends this line of research to speakers with acquired dysarthria. These clients often complain that listeners treat them differently after the onset of their speech impairment. The study examines judgements of the cognitive status of speakers with acquired dysarthria made by health care professionals.

Methods and procedures.?Doctors, speech and language therapists and speech and language therapy students viewed videos of speakers with acquired dysarthria and of controls matched for age and gender who had acquired neurological deficits that did not affect their speech. Listeners judged whether speakers could carry out a number of everyday tasks. All the tasks were known to be within the speakers' competence.

Outcomes and results.?Doctors were significantly less confident of the competence of speakers with dysarthria than of the controls. No difference was found for speech and language therapists or speech and language therapy students.

Conclusions Although caution is required in generalizing these results to other speakers, the results lend some support to the complaints of clients with acquired dysarthria that their speech leads others, in this case doctors, to misjudge their cognitive competence.     

The values underlying team decision-making in work rehabilitation for musculoskeletal disorders

Purpose.?This paper presents the results of a qualitative study on the values underlying the decision-making process of an interdisciplinary team working in a work rehabilitation facility of a Québec teaching hospital.

Methods.?In order to document the values underlying the decision-making process, a single case observational study was conducted. Interdisciplinary team weekly discussions on ongoing cases of 22 workers absent from work due to musculoskeletal disorders were videotaped. All discourses were transcribed and analyzed following an inductive and iterative approach. The values identified were validated by feedback from team members.

Results.?Ten common decision values emerged from the data: (1) team unity and credibility, (2) collaboration with stakeholders, (3) worker's internal motivation, (4) worker's adherence to the program, (5) worker's reactivation, (6) single message, (7) reassurance, (8) graded intervention, (9) pain management and (10) return to work as a therapy. The analysis of these values led to the design of a model describing interrelations between them.

Conclusions.?This study throws light on some mechanisms underlying the decisions made by the team and determining its action. This improves understanding of the actions taken by an interdisciplinary team in work rehabilitation and may facilitate knowledge transfer in the training of other teams.