Health expectations : an international journal of public participation in health care and health policyLucy Rodgers, Nicola Botting, Ros Herman
BACKGROUND: Integrating the perspectives of people with lived experience is integral to developing new healthcare interventions. However, individuals from under-represented communities may face additional barriers to taking part in such patient and public involvement (PPI) activities. Within paediatric speech and language therapy (SLT), under-represented communities might include families from lower SES backgrounds and/or families where the majority language for that country is not spoken. Excluding families from under-represented communities poses the risk of new interventions not being acceptable to them, thus exacerbating pre-existing healthcare inequalities. OBJECTIVE: The aim of this study was to optimise the prospective acceptability of a new paediatric speech and language therapy intervention with parents from under-represented backgrounds, in the hope of optimising future accessibility to families from diverse communities. METHODS: An individualised PPI approach was taken, consisting of two semi structured interviews informed by the Theoretical Framework of Acceptability (TFA). Six parent partners from non-majority language and/or lower SES backgrounds were recruited through a local charity. In the first interview, parent partners were shown a video of the intervention and identified key areas for increasing acceptability. Refinements were made to the intervention by the project steering group in an online meeting. These refinements were the topic of the second interview, where the impact on prospective acceptability was explored. RESULTS: Following the first round of interviews, areas for improvement included consideration of access to/co-ordination with wider services, and the financial and practical implications for parents accessing the intervention. Most of the intervention refinements and solutions to potential barriers came directly from the parent partners themselves, rather than the steering group. In the second round of interviews, parent partners rated the intervention's prospective acceptability between 4/5 (acceptable) and 5/5 (very acceptable). CONCLUSION: By working with parent partners from under-represented communities, the research team was able to enhance the prospective acceptability of a new paediatric speech and language therapy intervention. Many refinements related to the wider healthcare and support system, rather than to the content of the intervention itself. This reinforces the importance of exploring and addressing wider contextual barriers within the intervention development process. PATIENT OR PUBLIC CONTRIBUTION: The methods for this project were co-designed with a project steering group consisting of 3 Speech and Language Therapists (one with specialist EDI expertise), a bi/multilingual education support worker, a specialist early years teacher, a parent of a child with developmental language disorder (DLD) and an adult with DLD. The steering group also assisted with identifying potential intervention refinements. The parent partners were responsible for identifying areas where acceptability could be increased and addressing the prospective acceptability of the intervention refinements.
INTRODUCTION: Poststroke aphasia is a common disabling complication following stroke, severely affecting patients' communication abilities and quality of life. Currently, various non-pharmacological therapies (eg, speech and language therapy, transcranial magnetic stimulation, computer-assisted therapy, etc) have been applied in clinical practice and show potential. However, the relative effectiveness and superiority among these interventions remain unclear. This study aims to systematically compare the effectiveness of different non-pharmacological therapies in improving language function in poststroke aphasia through a network meta-analysis and to rank their efficacy, thereby providing the best evidence for clinical decision-making. METHODS AND ANALYSIS: The protocol will be reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The subsequent completed systematic review and network meta-analysis will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for network meta-analyses (an extension of the PRISMA 2020 statement) guidelines. We will systematically search PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science and China National Knowledge Infrastructure for randomised controlled trials on non-pharmacological therapies for poststroke aphasia published from inception to March 2026. Two researchers will independently conduct literature screening, data extraction and risk of bias (RoB) assessment using the Cochrane RoB tool. The primary outcome is overall language function; secondary outcomes include specific language domains and quality of life. We will employ a frequentist framework for network meta-analysis using random-effects models. The node-splitting model will assess inconsistency, and surface under the cumulative ranking curve will evaluate treatment ranking probabilities. ETHICS AND DISSEMINATION: As this review will use only published aggregated data, ethical approval is not required. Findings will be disseminated through a peer-reviewed publication and presentations at relevant conferences. PROSPERO REGISTRATION NUMBER: CRD420261297981.
Frontiers in neurologyJoan K-Y Ma, Mari Viviers, Louise Edwards
BACKGROUND: Vocal fold motion impairment (VFMI) is a common laryngeal disorder in infants and young children and may impact respiration, phonation and swallowing. Flexible nasendoscopy (FNE) is the current gold standard for assessment; however, its invasive nature may limit its use for routine screening. Recent studies reported good sensitivity and specificity of laryngeal ultrasound (LUS), a minimally invasive alternative compared to FNE. However, its application by Speech and Language Therapists (SLTs) in the paediatric population remains underexplored. OBJECTIVES/HYPOTHESIS: This study aimed to evaluate the feasibility of a novel SLT-led LUS protocol for infants and young children and to examine the reliability of defined laryngeal measurements. METHODS: In this mixed-methods feasibility study, eleven participants (nine children aged 3- and 4-years-old and two 2-month-old infants) underwent an SLT-led LUS protocol incorporating quiet breathing and functional tasks. Completion and visualisation rates were analysed as an indicator of feasibility. Laryngeal landmarks were identified and laryngeal measurements were quantified in selected static images by two raters. Inter- and intra-rater reliability were evaluated using intraclass correlation coefficients (ICC). Inductive thematic analysis of the LUS operator's field notes was used to identify experiences of conducting the protocol and areas for future refinement. RESULTS: The protocol demonstrated high feasibility, with good completion and visualisation rates. Differences were noted across tasks, with a higher visualisation rate in quiet breathing and swallowing than in phonation. Inductive thematic analysis of the LUS operator's experience highlighted areas for future refinement of the protocol. Quantitative analysis showed excellent reliability between raters across laryngeal measures, with moderate to excellent confidence intervals. CONCLUSION: This feasibility study provides initial evidence for an SLT-led LUS protocol to assess paediatric laryngeal function. LUS may enhance clinical pathways by enabling non-invasive screening and monitoring, while also serving as a research tool for phonation and swallowing. Further studies with larger and more diverse samples, including those with VFMI, are needed to establish clinical utility and generalisability.
Medical science monitor : international medical journal of experimental and clinical researchMałgorzata Buksińska, Piotr H Skarżyński, Elżbieta Gos, Danuta Raj-Koziak, Małgorzata Fludra
BACKGROUND Loss of smell can impair quality of life. Olfactory disorders are often caused by viral infections, including SARS-CoV-2. The aim of the study was to evaluate the effectiveness of a structured, multidisciplinary rehabilitation program, including pharmacological treatment and speech therapy-guided olfactory training, in patients with post-COVID olfactory disorders. MATERIAL AND METHODS A total of 75 patients (15 men, 60 women) were allocated to a study group (n=50) or control group (n=25) using a systematic assignment method. Both groups received the same pharmacological treatment (intranasal corticosteroids and topical vitamin A), saline nasal irrigation, and elements of speech therapy-guided olfactory training. In addition, the study group performed classical olfactory training using 4 odorants twice daily. Olfactory function was assessed using the Sniffin' Sticks Test (SST). RESULTS For the total SST score, the mean change before and after intervention in the study group was 7.9 points (P<0.001). In the control group, the mean change was 2.8 points (P=0.006). CONCLUSIONS Classical olfactory training was associated with greater improvement in post-COVID olfactory disorders compared with pharmacological treatment supplemented with speech therapy-guided olfactory training alone. The observed effects may be related to the combined use of intranasal corticosteroids, topical vitamin A, and saline nasal irrigation; however, the individual contribution of these interventions cannot be determined. The potential contribution of a multidisciplinary approach involving a physician, speech therapist, and psychologist remains to be established.
BMC health services researchSusann May, Felix Muehlensiepen, Laura Plotho, Helmut Ritschl, Robert Darkow
BACKGROUND: Although evidence-based recommendations for aphasia rehabilitation exist, guideline-based speech and language therapy is still not consistently implemented in routine care. Previous studies have described barriers to therapy participation from the perspective of people with aphasia, but less is known about how these barriers develop along the patient journey, especially in outpatient care. This study explored systemic and individual barriers to the uptake of speech and language therapy in aphasia care and identified implications for improving services. METHODS: An exploratory qualitative study was conducted in the German-speaking healthcare context using two online focus group discussions. A multiperspectival sample was recruited, including people with aphasia, relatives, speech and language therapists, and other healthcare stakeholders. Data were collected with a semi-structured topic guide addressing barriers to guideline-based therapy use, challenges along the patient journey, and possible solutions. Audio recordings were transcribed verbatim, anonymized, and analyzed in German using Kuckartz's structured qualitative content analysis. RESULTS: The analysis identified six main categories of factors influencing the provision of guideline-recommended speech and language therapy: societal and systemic conditions; access to care; the patient journey and continuity of care; relatives and the social environment; psychosocial factors; and therapy provision and interdisciplinary care; proposed solutions and areas for improvement are reported separately. Findings indicated that the provision of guideline-recommended speech and language therapy is strongly shaped by structural barriers within the healthcare system, particularly in the outpatient sector. Fragmented care pathways, limited coordination, bureaucratic and financial obstacles, and insufficiently accessible or specialized services hindered the implementation of guideline-based care. The transition from inpatient treatment to self-organized outpatient follow-up emerged as a particularly vulnerable stage. Relatives often compensated for deficits in formal care structures by taking on organizational, communicative, and emotional responsibilities. However, this informal compensation also created inequalities, as access to ongoing care partly depended on privately available support. Participants further highlighted shortcomings in interdisciplinary and psychosocial care and emphasized the need for earlier information, structured care pathways, improved coordination, and stronger implementation of evidence-based recommendations. CONCLUSIONS: The provision of guideline-recommended speech and language therapy in aphasia appears to be shaped largely by structural and organizational barriers rather than by individual factors alone. Improving aphasia care will require coordinated action across the healthcare system, especially in outpatient care, including communication-accessible pathways, stronger continuity between sectors, better access to specialized and interdisciplinary services, and less reliance on informal support from patients and families. TRIAL REGISTRATION: This exploratory qualitative study was not prospectively registered.
JMIR formative researchTooba Haris, Harshvi Shah, Jose F Florez-Arango
BACKGROUND: As the global population ages, Parkinson disease (PD) has emerged as the second most prevalent neurodegenerative condition after Alzheimer disease. People with PD often experience speech problems, including reduced volume, monotone pitch, breathiness, and word slurring. Interventions such as speech therapy through mobile apps provide reassurance and easier access to care for patients having this neurodegenerative condition. Mobile apps offer patients with PD greater access to care and the reassurance of being able to manage their condition at home. However, we do not know the quality of these apps. A systematic evaluation of these mobile apps is necessary to ensure their effectiveness and suitability for use by patients with PD. OBJECTIVE: This study aimed to evaluate the quality of existing free apps that support speech therapy for people with PD. METHODS: This study took place at Weill Cornell Medicine in New York, New York. It was conducted between January 2024 and July 2025. We conducted a systematic application search to identify apps available on the Apple App Store for speech therapy targeting people with PD and then performed an evaluation using the Mobile App Rating Scale framework with 4 raters. We only included freely available apps. We calculated interrater reliability and found median and mean ratings and SD for Mobile App Rating Scale dimensions. RESULTS: From 33 candidate apps, we included 3 apps in our evaluation. Functionality scored high for all 3 apps, with ratings above 4.5. However, engagement scored the lowest in all the apps. Interrater reliability agreement varied for all sections. Voicibel had the highest agreement of 0.83 for engagement. Aesthetics had the lowest agreement in all 3 apps, with agreements at 0.33 or below. CONCLUSIONS: All 3 apps offer targeted exercises and are targeted for the patient. Mobile apps hold promise for increasing the accessibility of speech therapy for patients with PD and provide promising support for managing speech difficulties in PD. Evaluating these apps is essential to determine their quality in supporting these patients. Future research with speech therapy apps should evaluate clinical efficacy through randomized controlled trials.
The South African journal of communication disorders = Die Suid-Afrikaanse tydskrif vir KommunikasieafwykingsLucie B L Graca, Renate Strehlau, Jacqueline K Bezuidenhout
BACKGROUND: Speech and language skills are essential for effective communication. Speech and language delays may have far-reaching consequences on a child's development; their early identification and intervention are paramount to a child reaching their full potential. OBJECTIVES: To describe the referral process, clinical characteristics, risk factors and outcomes of paediatric referrals to a Speech Therapy and Audiology (STA) department at a district-level hospital in Gauteng, South Africa. METHOD: A retrospective record review was conducted on paediatric outpatient referrals to the STA department between the 01 January 2021 and 30 June 2022. Descriptive statistical analysis was performed on the categorical data. Associations between receptive and expressive language delays and the presence of maternal comorbidities or a bilingual household were analysed using the Chi-squared test and Fisher's exact test. RESULTS: A total of 150 referrals were reviewed, with speech delay being the most common reason for referral (38%). Children under 2 years old accounted for 42% of the referrals. Of the children seen by the speech therapists and audiologists, 58 (49.2%) defaulted on follow-up appointments, and three (2.5%) were identified as having hearing loss. Twenty-eight children (23.7%) were referred for neurodevelopmental assessments, of whom 52% received a diagnosis of autism spectrum disorder (ASD). The mean age of ASD diagnosis was 49.54 months (standard deviation 11.47). CONCLUSION: Understanding the clinical profile and outcomes of children referred to a STA department at a district-level hospital provides valuable insight into the vital role of the speech therapists and audiologists in early identification and intervention of children with speech and language delay.Contribution: The STA departments at South African district hospitals are well-positioned for early identification and intervention, particularly for neurodevelopmental conditions, including ASD.
Journal of fluency disordersMarta Wesierska, Susanne Cook, Joanna Szymczakowska, Christine Tournier-Badré, Katarzyna Węsierska
Cluttering is a comparatively rare speech and language disorder. This lower prevalence has also been observed in textbooks for the academic curriculum (Tetnowski & Douglas, 2011), and fewer opportunities within higher education curricula to learn about this disorder (Tetnowski, 2009). The present study aimed to examine the extent to which cluttering is represented in SLT curricula, as well as students' knowledge of cluttering and their perceived readiness and confidence to diagnose and treat individuals who clutter. Additionally, the study aimed to compare these findings across countries. A total of 343 students and 31 course coordinators participated in this study. Data was collected in four countries: UK, Germany, Poland, and France. Students completed online surveys containing yes/no, multiple choice and open-ended questions. Their responses were analysed in the context of input from their course coordinators. The results indicated a limited number of teaching hours dedicated to cluttering, as reported by both SLT students and course coordinators. Many respondents did not feel prepared to diagnose and/or treat cluttering; however, they perceived the necessity to learn more about the topic. The findings of this exploratory study contribute to current knowledge about the extent to which cluttering is addressed in the higher education curriculum for future SLTs. Ultimately, these findings may lead to recommendations for curriculum development and promote greater knowledge and awareness of cluttering within the field of speech-language therapy.
CoDASAna Carolina Bucci, Camila Goulart, Aline Mara de Oliveira
Speech Motor Delay (SMD) is characterized by difficulties in motor execution, resulting in unintelligible speech, with changes in articulatory precision, stability, voice, and prosody, as well as reduced articulatory dissociation and excessive movements for age. The objective of this study was to describe, through four longitudinal case studies, the performance of Brazilian children with SMD submitted to the Rapid Syllable Transition Treatment (ReST), verifying acquisition, retention, and generalization. Four monolingual children, aged five to eight years and diagnosed with SMD, participated. The intervention was conducted via synchronous telepractice, twice a week, over six weeks. Probes of trained and untrained pseudowords, sentences, real words, and control items were applied at different stages of therapy. The results showed progressive improvement in all evaluated aspects. Significant gains were observed in phoneme accuracy, lexical stress, and coarticulation, confirming acquisition, retention, and generalization. It is concluded that ReST is effective for children with SMD, including when applied through telepractice, representing a promising evidence-based therapeutic alternative grounded in motor learning principles and supported by linguistically controlled stimuli selection.
BACKGROUND: Oropharyngeal dysphagia is a common and disabling consequence of stroke. Transcranial direct current stimulation (tDCS) has shown potential in promoting swallowing recovery, although evidence remains limited. OBJECTIVE: To determine whether bilateral anodal tDCS combined with intensive speech-language therapy (SLT) improves swallowing outcomes compared with sham stimulation in patients with post-stroke dysphagia. Exploratory analyses examined the influence of treatment phase, sex, lesion site, and baseline severity. METHODS: This multicenter, randomized, double-blind, sham-controlled trial enrolled patients with supratentorial or infratentorial ischemic stroke and oropharyngeal dysphagia. Participants received either bilateral anodal tDCS or sham stimulation (1.5 mA, 20 min/day, 5 days/week for 2 weeks) combined with intensive SLT over 6 weeks. Swallowing outcomes were assessed at baseline, 2 weeks, and 6 weeks using the Dysphagia Outcome and Severity Scale (DOSS, primary outcome), Penetration-Aspiration Scale (PAS), Mann Assessment of Swallowing Ability (MASA), and Swallowing Quality of Life questionnaire (SWAL-QoL). RESULTS: Forty-six patients (24 active, 22 sham) completed the protocol. Both groups showed significant improvement across all outcomes (p < 0.001), with no significant difference between active and sham stimulation. The DOSS was the most sensitive measure, showing sustained improvement over time. Exploratory analyses indicated greater MASA gains with active tDCS in infratentorial strokes (p = 0.04). Correlation analyses showed that greater baseline dysphagia severity was associated with larger functional gains. CONCLUSIONS: Intensive SLT was associated with meaningful recovery in post-stroke dysphagia, regardless of stimulation condition. Exploratory findings suggest that bilateral tDCS may confer additional benefit in selected lesion subgroups.
Children born with cleft palate, with or without cleft lip (CP ± L), are at high risk for speech and resonance disorders that can significantly impact communication and quality of life. Causes of cleft-related speech disorders include velopharyngeal insufficiency, malocclusion, dental anomalies, and airway obstruction. Accurate differential diagnosis is critical, as mismanagement can result in unnecessary surgery or ineffective therapy. Nonetheless, many children do not receive specialist evaluation or targeted intervention. Optimal outcomes require coordinated multidisciplinary care, with speech-language pathologists (SLPs) playing a central role in the assessment and treatment of feeding, articulation, resonance, and velopharyngeal function. However, a global shortage of trained SLPs has created major barriers to care, particularly in low- and middle-income countries, where geographic, financial, and infrastructure constraints further limit access. This article reviews the effects of CP ± L on speech, the essential contributions of SLPs, and the systemic challenges restricting service delivery, and proposes practical strategies for optimizing outcomes in resource-constrained settings. Service gaps are driven by workforce shortages, excessive caseloads, training deficits in cleft-specific care, and poor integration of speech services into healthcare systems. Promising strategies to mitigate these barriers include expanding cleft-specific training within university curricula and continuing education, implementing mentorship and "train-the-trainer" programs, and adopting task-shifting models that equip paraprofessionals, teachers, and caregivers to support therapy under SLP supervision. Telehealth provides opportunities for remote assessment, therapy, and professional supervision, whereas group therapy and structured parent-led home practice extend the impact of limited sessions. Standardized protocols for assessment and outcome reporting are essential for quality improvement and international data comparability. Policy initiatives that prioritize funding, workforce development, and integration of speech services into national health frameworks are critical for ensuring equitable, sustainable access to care. By adopting innovative, evidence-based approaches, including telehealth, mentorship, and parental involvement, healthcare providers can expand cleft speech services worldwide and improve long-term communication outcomes for children affected by CP ± L.
Medical sciences (Basel, Switzerland)Carmela De Domenico, Margherita La Fauci, Noemi Mancuso, Mariarita Caputo, Marcella Di Cara, Adriana Piccolo, Alessia Fulgenzi, Daniele Borzelli, Caterina Impa…
BACKGROUND/OBJECTIVES: Digital technologies are increasingly explored as complementary tools in speech and language therapy for children with neurodevelopmental disorders. However, evidence on virtual reality-based interventions for children with developmental language disorder (DLD) remains limited. This study aimed to evaluate the effects of a Virtual Reality Rehabilitation System (VRRS)-based language intervention combined with standard speech therapy in preschool children with DLD. Secondary objectives included assessing the feasibility, usability, and safety of the VRRS-integrated intervention. METHODS: A randomized controlled pilot study was conducted in preschool children diagnosed with DLD. Participants were allocated to an experimental group receiving VRRS-based language intervention integrated with conventional therapy or to a control group receiving standard speech therapy alone. Both groups attended two 60 min sessions per week for six months. Clinical language outcomes were assessed at baseline (T0) and post-intervention (T1). Feasibility was evaluated through adherence and retention rates, usability through a therapist-completed questionnaire, and safety through monitoring of adverse events during sessions. RESULTS: All participants in the experimental group completed the intervention (100% retention). No adverse events were observed. Therapists reported good usability of the VRRS system, highlighting ease of exercise customization, intuitive monitoring of progress, and good integration into routine therapy. CONCLUSIONS: VRRS-based activities integrated into conventional speech therapy appear feasible, safe, and well accepted in preschool children with DLD. Further controlled studies with larger samples are needed to confirm these findings. TRIAL REGISTRATION: ClinicalTrials.gov (NCT07438639).
Post-stroke aphasia is a debilitating condition affecting approximately one-third of stroke survivors, profoundly impairing communication, social participation, and quality of life. While speech-language therapy (SLT) remains the standard of care, pharmacological agents such as Cerebrolysin may enhance recovery through neuroprotection and neuroplasticity. We report the case of a 38-year-old female lawyer who developed acute Wernicke's aphasia and right-sided hemiparesis following an ischemic stroke. Despite timely thrombolysis and mechanical thrombectomy, she experienced significant neurological deficits. Early multidisciplinary rehabilitation, combined with a 10-day course of Cerebrolysin, memantine, and sertraline, was associated with substantial improvements in language, motor function, and independence over a three-month period. This case highlights the potential synergistic effect of Cerebrolysin in a young patient with early reperfusion and intensive rehabilitation, including pharmacotherapy and SLT, especially in settings where optimal post-stroke rehabilitation resources may be limited.
JPMA. The Journal of the Pakistan Medical AssociationRamma Inam, Saleh Shah, Muhammad Sana Ullah, Tahreem Tariq, Hira Ashraf
The study was conducted to evaluate the effects of Ayres sensory integration therapy versus conservative treatment in autism spectrum disorder. In a prospective randomised controlled trial, we assessed pre- and post-intervention scores of both the intervention group (A) that took ASI and the control group (B) that received conservative treatment-only behaviour therapy, speech therapy, and educational activities of children with Autism Spectrum Disorder (ASD) -using sensory profile from Jan 2024 to July 2024. Thirty diagnosed ASD cases, age range 2-8 years, were randomly enrolled in both groups (n=15/group) at the RICCER Institute of Faisalabad. The intervention group (A) was noted to be significantly better in mean change as compared with the control group (B). Independent and paired t-test results showed significant relationship between ASI intervention group (A) and sensory integration dysfunction, while non-significant relationship between sensory integration dysfunction and conservative group (B) treatment (p> 0.05). Ayres Sensory Integration, an Occupational Therapy Approach, was significantly effective in developing socialisation, self-care, and aim accomplishment in comparison to conservative treatment in ASD.
International journal of language & communication disordersAnna Volkmer, Rosemary Townsend, Bethany Anthony, Sharon M Antonucci, Petronilla Battista, Sandrine Basaglia-Pappas, Jeanne Gallée, Stephanie Grasso, Maya L He…
INTRODUCTION: Globally, there is a lack of awareness of rare dementias such as those led by language decline (the primary progressive aphasias, PPA). The main treatment for PPA is speech and language therapy, yet many people are unaware of the benefits and are often not referred on by other health care professionals. Delays in diagnosis can exacerbate a delay in accessing resources such as speech and language therapy which can assist in maintenance of communication and independence. Some people affected by PPA are able to seek out information independently and navigate their own way to these services, but others experience substantial challenges in accessing support. This study was born out of discussions with people affected by PPA who identified an urgent need to raise awareness of PPA and the benefits of speech and language therapy. The aim of the project was to co-develop a PPA awareness campaign and, through feedback, understand the impact of a co-produced and delivered awareness campaign on awareness and knowledge of PPA and the role of the speech and language therapy. METHODS: This study was informed by the People with Aphasia and Other Layperson Involvement (PAOLI) framework for guiding patient and public involvement (PPI) in aphasia research. Key components of the PPA awareness campaign were co-developed at a World Café event with 30 people affected by PPA. Consequently, engagement data were collected from social media posts during the 10-week campaign, and registration and attendance at the co-planned webinars. A feedback survey was collected from attendees after the event, and a micro-costing analysis conducted to understand the costs. RESULTS: The 10-week PPA awareness campaign focused on raising awareness of the role of speech and language therapy for PPA and a bespoke logo was developed that was shared across seven participating countries internationally. Attendees reported increased knowledge of the role of speech and language therapists and valued hearing the voices of people affected by PPA throughout the campaign. Webinar events were well attended across the participating countries with an average of 300 attendees, ranging from 233 in Greece to 369 in the UK. The cost of developing the awareness campaign was calculated at £26.20 per webinar attendee in the UK. DISCUSSION: The PPA awareness campaign was conceived by people affected by PPA and aimed to increase awareness that speech and language therapy can support people affected by the condition. The awareness campaign developed iteratively and concluded with an awareness day event spanning seven-countries internationally which are all now permanently accessible as resources on the International Speech and Language Therapist / Pathologist PPA network (International SLT/P PPA network) website. Future campaigns will take a more focused approach by targeting more specific audiences such as trainee doctors. The co-development blueprint for the PPA awareness campaigns provides actionable, field-tested recommendations for planning future health awareness initiatives. WHAT THIS PAPER ADDS: What is already known on the subject Primary Progressive Aphasia (PPA) is a rare language led dementia for which speech and language therapy is the main treatment. At present, people affected by PPA report a lack of information available about speech and language therapy. This can perpetuate feelings of loneliness and social isolation. What this paper adds to the existing knowledge This paper provides the key components of a co-developed PPA awareness campaign and describes a collaboration across organisations and countries to deliver the first year of the PPA awareness campaign. Future PPA awareness campaigns will build on this, by targeting specific audiences and aiming to increase knowledge and awareness of the role of the speech and language therapist. What are the clinical implications of this study? Increasing awareness of PPA and the role of the speech and language therapist has been identified by people with lived experience in the UK, as the core care pathway for people with PPA and their families. The PPA awareness campaign has made this information available to people affected by PPA and health care professionals. This includes a set of recommendations for the development of future similar awareness campaigns beyond PPA.
International journal of language & communication disordersSione Twilt, Karin Neijenhuis, Rick de Graaff, Jan Ten Thije
BACKGROUND: Collaboration with parents is essential in speech and language therapy to achieve therapeutic goals for children. However, linguistic and cultural differences can complicate communication and collaboration with multilingual parents. This study offers insight into the perspectives, experiences, and needs of multilingual parents who share little or no common language with the Speech and Language Therapist (SLT) supporting their child. AIMS: This study aims to provide an in-depth understanding of the perspectives of multilingual parents on the perceived communication and collaboration with SLTs. METHODS: Individual in-depth interviews were conducted with 12 multilingual parents whose children were involved in SLT. The oral interviews were supported by a visual and tactile method, the Yucel method, which had not previously been applied in this context. The data were analysed using reflexive thematic analysis. RESULTS: Reflexive thematic analysis revealed six key themes: 1) Language barriers affect the equity within parent-SLT partnerships, 2) Inclusive communication in speech and language therapy is not self-evident, 3) Child-centred communication simplifies the complexity of the message, 4) There is a discrepancy between the desire and the possibilities for collaboration in therapy, 5) Contextual factors influence the interaction between parents and SLTs and 6) Empowerment of multilingual children and their parents enhances through speech and language therapy CONCLUSION: This study provides a unique view into the perspectives of multilingual parents regarding communication and collaboration with SLTs. The identified themes underscore the importance of increasing awareness of the complex multilingual interactions between SLTs, parents, and children. The findings highlight the vulnerable position of parents and advocate for the conscious and appropriate use of inclusive communication strategies in SLT practice. Furthermore, the study emphasizes that the impact of SLT extends beyond child empowerment, contributing to the broader support and inclusion of multilingual families. WHAT THIS PAPER ADDS: What is already known on this subject Speech and language therapists (SLTs) often face challenges when collaborating with multilingual parents due to linguistic and cultural differences. While some previous studies have explored parental perspectives on partnership with SLTs, little research has focused specifically on multilingual parents and their views on communication and partnership in speech and language therapy. What this study adds to existing knowledge This study offers a unique perspective of parents who share little or no common language with the SLTs supporting their children. It provides insight into the experiences, needs, and viewpoints of multilingual parents, a group often underrepresented in research. The findings emphasise the importance of raising awareness among SLTs of inclusive communication and collaboration with multilingual parents. What are the clinical implications of this study? This study underscores the importance of increasing awareness of the complex multilingual interactions between SLTs, parents, and children. It highlights the vulnerable position of parents and advocates for the adequate and conscious use of inclusive communication strategies when language barriers are significant. Moreover, speech and language therapy hold substantial value for multilingual families, contributing to their communicative self-efficacy. KEY POINTS: There is a discrepancy between parents' willingness to act as partners and the actual opportunities to collaborate in an equitable way in the absence of a shared language. Despite language differences, parents report increased empowerment in their family's communicative participation through speech and language therapy, underscoring its broader value. The use of complementary visual and tactile methods, such as Yucel, enables a more inclusive approach in both research and practice by facilitating access to parental perspectives that might otherwise remain underexplored.
International journal of language & communication disordersJill Titterington, Sarah Rudd, Helen Stringer, Emma Pagnamenta, Tomos Robinson, Sam Harding
BACKGROUND: Speech Sound Disorder (SSD) reduces speech intelligibility, affecting a child's ability to make themselves understood. If SSD is not resolved in the early years it will negatively impact children's education and general well-being. Effective and efficient speech and language therapy is known to resolve SSD and mitigate these risks. Intervention for SSD is often provided in inadequate dosages to be effective or efficient. Quantitative dosage is an overarching term for the different aspects of intensity of intervention which may impact outcomes. Existing literature on quantitative dosage indicates that more intensive therapy approaches for SSD appear to be more effective and efficient than less intensive delivery. A scoping review of current research in this area will serve to clarify evidence-based knowledge and understanding about quantitative dosage, how it works, and how different components potentially interact to contribute to outcomes for children with phonological impairment (PI) (a sub-type of SSD), informing future service developments and research. AIMS: This scoping review investigates quantitative dosage elements in interventions for 3-8-year-olds with PI within speech and language therapy-led contexts to identify preliminary evidence and inform reflections for practice and future research. It is registered on the Open Science Framework (OSF) registry (https://osf.io/b3as4/). METHODS: The review followed the Population, Concept, Context framework (Joanna Briggs Institute) and is reported in line with PRISMA guidance for Scoping Reviews. Key information sources were searched, including MEDLINE, CINAHL, PsycInfo, EMBASE. Grey literature searching included the COSMIN, PROSPERO, FigShare and Open Science Framework, Google scholar (advanced search), and SpeechBite. Data extraction included intervention approach, quantitative dosage of intervention delivery, outcome measurement tools, and context. The PAGER framework was used for analysis and synthesis of the identified patterns. MAIN CONTRIBUTION: Seventy-six papers were extracted for the synthesis. Only four studies specifically investigated the impact of quantitative dosage on outcomes. Three patterns developed across the 76 papers: quantitative dosage is an active ingredient; issues reporting quantitative dosage; characteristics of the evidence base and are discussed in relation to advances in the field, gaps, evidence for practice and research recommendations. Preliminary evidence for practice highlights that aspects of quantitative dosage make an important contribution to effective and efficient intervention for children with SSD. However, rigour and consistency in reporting quantitative dosage should be improved to support translation of evidence to practice and replication of research. The importance of using benchmarked study designs and appropriate methodologies to support robust research to better-inform evidence-based practice is highlighted. CONCLUSIONS/IMPLICATIONS: This scoping review provides preliminary evidence for quantitative dosage in children with PI. The findings are promising, (with evidence of some stronger research designs for example, randomised controlled trials, multiple baseline SCEDs with multiple participants, and replication of findings). However, further robust research, reporting all aspects of quantitative dosage and considering the potential costs and benefits of more efficient, evidence-based quantitative dosages is urgently needed. WHAT THIS STUDY ADDS: What is already known on this subject General findings about quantitative dosage for children with SSD show that reporting on dosage is often absent. When dosage is reported it is often under specified or different aspects of dosage are conflated. Reporting standards for dosage need to be agreed. Further research is required about the specific levels of quantitative dosage optimally required before children with SSD are discharged. Previous reviews have mainly extracted evidence about session numbers, session frequency, session length, and dose of practise items per session, across subtypes of SSD. What this study adds to the existing knowledge This paper specifically considers how all aspects of quantitative dosage are reported on and explored in the literature with a focus on children with phonological impairment (PI). A novel approach following the PAGER framework synthesized the data extracted from the papers to identify Patterns and relate these to clinical practice and research. The key patterns that emerged in this scoping review were: quantitative dosage is an active ingredient; issues reporting quantitative dosage; and characteristics of the evidence base. Advances, Gaps, Evidence for practice and Research Recommendations (the AGER of PAGER) are reported for each Pattern. What are the clinical implications of this study? For children with PI, intervention delivered two to four times weekly is likely to be more cost- and clinically effective than once weekly. More sessions delivered over time with a higher dose of production trials per session are likely to be more effective and efficient than fewer sessions delivered with a lower dose (although an upper threshold may exist). Potentially, more timely intervention is more effective over the longer term, than less timely intervention. Further high-quality research is needed because study design, reporting of quantitative dosage, and exploring the cost benefits of more efficient dosages are weaknesses in current literature.
International journal of language & communication disordersPhilippa Clay, Suzanne Beeke, Lucie Hogger, Ida Brix, Emma Massé, Hannah Hunt, Lynn Dangerfield, Steven Bloch
BACKGROUND: Communication Partner Training (CPT) has an established evidence base in aphasia, dementia and traumatic brain injury. It has been shown to improve the skills, attitudes and knowledge of the communication partner, and improve communicative participation and confidence of the person with communication difficulties. CPT therefore holds potential value for people living with Parkinson's and their everyday conversation partners who report significant impact of communication changes on their day-to-day lives. However, the CPT evidence base is less well established in this population. People living with Parkinson's and their communication partners report wanting support with everyday communication. They also describe online intervention as acceptable. AIMS: The primary aim was to evaluate the feasibility and acceptability of a novel CPT intervention, Better Conversations with Parkinson's (BCP), when delivered via telehealth in an NHS setting. Feasibility was explored in terms of completion of BCP intervention and assessment data when delivered via telehealth, and the ability to recruit and retain participants in an NHS trial. Acceptability was investigated for: (1) dyads completing the therapy (people with a diagnosis of Parkinson's and their communication partners) and (2) the speech and language therapist (SLT) delivering it. METHODS AND PROCEDURES: This feasibility study recruited dyads comprising a person living with Parkinson's and a familiar communication partner. Participants were involved for 6 weeks of direct BCP intervention, delivered remotely by one SLT, and completed pre- and post-intervention measures. Descriptive statistics were used to report on recruitment, attendance, and attrition. Feasibility was further explored using logs and a focus group with study recruiters. Acceptability was evaluated using participant interviews, analysed using reflexive thematic analysis, and the SLT's reflective diary and interview feedback, which were analysed using qualitative content analysis. RESULTS AND OUTCOMES: Seven dyads were recruited to the study, with an overall recruitment rate of 10%. Participants completed all therapy sessions and data collection for all outcome measures was achieved. Qualitative themes reflected a high degree of acceptability from dyads concerning their own agency, the therapeutic alliance, methods used, and expectations/beliefs. The acceptability for the SLT delivering the therapy was also high. CONCLUSIONS AND IMPLICATIONS: The results indicated the BCP programme was feasible in terms of online delivery within an NHS setting, and acceptable for clients and the SLT. These results pave the way for a large-scale study that will evaluate the effectiveness of a BCP programme. WHAT THIS PAPER ADDS: What is already known on the subject Despite an identified need for treatments beyond the impairment level, communication partner training (CPT) for people living with Parkinson's lacks evidence for acceptability or feasibility. What this study adds to the existing knowledge This study suggests that CPT for people living with Parkinson's is feasible to deliver via telehealth and acceptable to people living with Parkinson's, their communication partners, and SLTs. What are the clinical implications of this work? UK NHS speech and language therapy services could feasibly run online CPT programmes for people living with Parkinson's. Further work is required to move toward a full-scale trial of CPT for people living with Parkinson's and to establish whether such programmes may be most effectively run alongside impairment-based approaches or independently.
International journal of language & communication disordersDespina Laparidou, Sophie Willis, Louise Howe, Aparna Ramachandran
BACKGROUND: Demand for children's speech and language therapy (SLT) services has surged globally, exacerbated by the COVID-19 pandemic and workforce shortages. In England, waiting lists remain extensive, with over 66 000 children awaiting intervention in early 2025. Delayed access to SLT services is linked to poorer academic, social, and health outcomes. Innovative approaches are urgently needed to address these challenges. Embedding SLT student placements within schools offers a potential solution, simultaneously enhancing service capacity and providing authentic learning experiences. International evidence, such as the Broken Hill model in Australia, supports this approach, particularly for rural and remote communities. AIMS: This rapid scoping review aimed to identify success factors, barriers, and enablers of school-based SLT placement models, and to assess their potential for scalability and sustainability. The review sought to inform policy and practice by synthesising evidence on supervision models and implementation strategies. METHODS: Following PRISMA-ScR guidelines and Arksey & O'Malley's framework, a comprehensive search was conducted across eight databases (e.g., Web of Science, ERIC, CINAHL, Medline) and supplemented by grey literature searches. Inclusion criteria focused on SLT student placements in schools, particularly in underserved areas. Fourteen studies published between 2011 and 2024 were included, predominantly from Australia (57%), with others from the USA and UK. Data were extracted and synthesised narratively around barriers, facilitators, and model characteristics. MAIN CONTRIBUTION: Findings indicate that school-based SLT placements can increase service capacity, improve student confidence and employability, and foster interprofessional collaboration. Successful models share key principles: Integration into policy frameworks, dedicated funding, strong cross-sector partnerships, cultural responsiveness, and structured supervision. Barriers include insufficient funding, infrastructure limitations in rural areas, student preparedness, and challenges with technology during remote delivery. Facilitators include early stakeholder engagement, flexible supervision approaches, and orientation training. Evidence suggests that positive placement experiences may influence graduates' willingness to work in underserved areas, addressing workforce shortages. CONCLUSIONS: School-based SLT placements represent a promising strategy to alleviate service pressures and enhance workforce development. Greater alignment with health and education policy, sustainable funding, and approaches tailored to diverse contexts may support successful implementation. Scaling effective models could reduce waiting lists, improve equitable access to SLT services, and provide high-quality experiential learning for future practitioners. WHAT THIS PAPER ADDS: What is already known on this subject School-based SLT placements have been implemented internationally, particularly in rural and underserved areas, to address workforce shortages and improve access to services. Evidence suggests these models can enhance student learning and service capacity, but there is limited synthesis of success factors, barriers, and scalability in the UK context. What this study adds to the existing knowledge This review identifies key principles for successful school-based SLT placements, including integration into policy frameworks, dedicated funding, cross-sector partnerships, and cultural responsiveness. It highlights barriers such as infrastructure limitations and student preparedness, and demonstrates that positive placement experiences may influence future workforce distribution. These findings provide an evidence-informed foundation for scaling models to reduce waiting lists and improve equitable access. What are the clinical implications of this study? Embedding SLT student placements in schools can increase service capacity, reduce waiting times, and support early intervention for children with speech and language needs. Structured supervision and orientation, alongside policy alignment and appropriate funding, may support sustainability and workforce readiness across diverse clinical contexts.
International journal of language & communication disordersPatricia McCabe, Donna C Thomas, Jessica Xue Ming Choo, Rob Heard, Denise Ng
BACKGROUND: In recent years there has been a significant increase in the number and quality of childhood apraxia of speech (CAS) treatment research published. Much of this research has focussed on establishing treatment efficacy and identifying treatment components. A smaller subset of the literature has looked at treatment intensity, such as comparing therapy delivered twice per week with four times per week, however this literature has not been compared across interventions. AIMS: This systematic review and meta-analysis examines cumulative intervention intensity and its components (dose per session, dose frequency, intervention duration-number of weeks) and reported treatment effects to understand whether there is a relationship between dose and effect in specific treatments or overall. METHODS: A systematic search and review was registered with Prospero (CRD420251107259). Twelve electronic databases were searched supplemented by handsearching references lists. Included studies were coded for CAS diagnosis confidence, methodological quality, dose characteristics, and treatment outcomes. Standard mean difference (SMD), an effect size metric equivalent to Cohen's d, was calculated for 25 included papers and weighted Pearson's correlations performed to identify relationships between dose characteristics and treatment outcomes. MAIN CONTRIBUTION: This paper is the first to (1) create omnibus standard effect sizes across diverse interventions and (2) show the relationship between intensity and treatment outcome in children with CAS. The omnibus SMD across studies with three or more participants for treated items was 1.22 (confidence interval 0.76-1.67), a large effect, and for generalisation items was 0.66 (confidence interval 0.46-0.85) which is a moderate effect. These results show that CAS treatment works in well-controlled studies when delivered at least twice per week for at least 45 min per session. The relationship between intensity variables and generalisation SMD was less clear with weeks of therapy being moderately correlated (r = 0.39) and none of the other variables showing any relationship with study SMD. These results should be interpreted carefully as there was significant missing data and limited range in some variables. Researchers need to include more standard intensity information in reporting their results. CONCLUSIONS: Treatment for CAS is effective and leads to moderate generalisation; more weeks of therapy leads to stronger gains than fewer weeks of therapy. WHAT THIS PAPER ADDS: What is already known on this subject CAS is a neurological-based motor speech disorder that originates in childhood for which there are a number of effective treatments. For this population, high intensity treatment is recommended-over 100 production trials per session, 2-5 sessions per week, across an extended period. In studies which directly compare intensity of variables, more therapy (e.g. 20 sessions) results in greater improvement than less therapy (e.g. 10 sessions). There are no previous meta-analyses of intensity variables-dose, dose frequency, treatment duration, or cumulative intervention intensity in CAS What this study adds to the existing knowledge This study compiles data from 25 studies with a low risk of bias and high CAS diagnostic confidence in a meta-analysis of the dose effects of CAS treatment. The meta-analysis shows that CAS treatment in general works. Most studies had 2-4 sessions per week across 3-12 weeks. Within this narrow band of intensity, a significant correlation was shown between the number of weeks of therapy and outcome. There is no significant evidence for CAS therapy less frequently than twice per week at this time. Eight different treatments demonstrated efficacy for improving speech outcomes in children with CAS. What are the clinical implications of this study? Provided they are delivered at least twice per week for at least 12 sessions, with greater improvements when treatment extends over more weeks, selection of any of the included treatments should result in improved speech where the child being treated is similar to children in the research. The following treatments were shown to be effective for CAS: Integral stimulation treatments including Dynamic Temporal and Tactile Cueing, Kaufman-Speech to Language Protocol, Motor Speech Treatment Protocol, Nuffield Dyspraxia Programme-3rd Edition, Rapid Syllable Transition Treatment, Speech Motor Chaining and Ultrasound Biofeedback alone and the combination of Speech Motor Chaining with Ultrasound Biofeedback. PRACTITIONER POINTS: Therapy must be sufficiently frequent and sustained: Evidence shows that CAS treatment is effective when therapy is provided at least twice per week, over a minimum of 12 sessions, for 45 min per session with total weeks of therapy being the only intensity variable consistently associated with treatment outcomes. Dose matters, both within and across sessions: Clinicians should prioritise the number of production trials and ensure adequate cumulative intervention intensity. Sessions with low active practice time or insufficient trials are unlikely to produce meaningful change. Eight treatments are effective for CAS: Integral Stimulation including Dynamic Temporal and Tactile Cueing (DTTC), Kaufman Speech to Language Program (K-SLP), Motor Speech Treatment Protocol (MSTP), Nuffield Dyspraxia Programme (3rd ed; NDP3), Rapid Syllable Transition Treatment (ReST), Speech Motor Chaining (SMC), Ultrasound Biofeedback, and SMC + Ultrasound Biofeedback combined. Clinicians should consider the client's speech needs and overall profile when selecting from the treatments that have demonstrated effectiveness.
International journal of language & communication disordersVictoria Johnstone-Cooke, Marion Rutherford, Ainuska Sheripkanova, Rachel Hutcheson, Ann Hodson
BACKGROUND AND AIMS: Caregiver-mediated interventions are commonly used by Speech and Language Therapists to support early language development. Developmental Language Disorder (DLD) is associated with reduced quality of life throughout the lifespan. Understanding factors that predict intervention success is essential for developing appropriate, cost-effective therapy provision for the approximately 12% of preschool children who present with early markers for Developmental Language Disorder (DLD). This systematic review and meta-analysis examined the effectiveness of caregiver-mediated spoken language interventions for under-fives at risk of DLD, and factors influencing intervention effectiveness. METHODS: A systematic review following PRISMA guidelines was conducted. Five electronic databases were searched to identify experimental studies comparing caregiver-mediated spoken language interventions to control conditions in under-fives presenting with risk factors for DLD. Risk factors included prematurity, socioeconomic factors, caregiver language development concerns, and formal or informal language screening or assessment scores. Twenty-six experimental studies with 1407 child participants were included in qualitative synthesis. Meta-analysis was performed on nine Randomised Controlled Trials involving 947 children. RESULTS: Effectiveness was examined for outcomes including child language gains, child wellbeing, inclusion and attainment. Meta-analysis indicated a significant effect of caregiver-mediated spoken language interventions on language outcomes compared to treatment-as-usual, non-language intervention or waitlist control conditions. Non-language outcomes were evaluated via qualitative synthesis. Interventions significantly improved language development trajectories for under-fives presenting with risk factors or early markers for DLD. CONCLUSION AND IMPLICATIONS: This review contributes to the growing evidence base demonstrating that caregiver-mediated interventions can positively impact language development and wellbeing outcomes for children under five at risk of DLD. These findings support the implementation of caregiver-mediated environmental language interventions in clinical practice to maximise accessibility and cost-effectiveness while delivering optimal outcomes for vulnerable populations. WHAT THIS PAPER ADDS: What is already known on this subject Previous research on caregiver-mediated spoken language interventions has highlighted gaps in the evidence regarding the impact of risk factors, demographic characteristics, dosage and intervention components on child language outcomes. Developmental Language Disorder has relatively high population prevalence, estimated at 7%. Prevalence is associated with risk factors including low household socioeconomic status (SES), prematurity and late language emergence. In contrast to its prevalence, there is low public and professional awareness of DLD and a low diagnostic rate. Therefore, a strengthened evidence base and additional insights into the factors affecting success of family-based interventions is important in order to increase the effectiveness of service provision and care planning for this underserved population. Timely and effective intervention with young children presenting with early markers for DLD has the potential to offer lifelong improvement to their wellbeing, inclusion and attainment outcomes. Recent systematic reviews of the effectiveness of caregiver-mediated language interventions had differences in population age range and diagnostic inclusion criteria. What this paper adds to existing knowledge Our review examines the effectiveness of caregiver-mediated early spoken language interventions on child language, attainment and wellbeing, and on caregiver self-efficacy and adherence to language support strategies. Our population was children under five presenting with risk factors for Developmental Language Disorder, in the absence of other neurodevelopmental or genetic conditions such as intellectual disability or autism. This review adds depth and detail to the evidence base supporting the effectiveness of caregiver-mediated spoken language interventions in improving outcomes for this population of young children, and factors that influence their success. What are the potential or actual clinical implications of this work? The high prevalence of Developmental Language Disorder, estimated at around 7% of the population, and the strong association with risk factors including low SES, prematurity and late language emergence, coupled with the low awareness of DLD and low diagnostic rate, mean that a strengthened evidence base and additional insights into the factors affecting success of family-based interventions can increase the effectiveness of service provision and care planning for this population. Timely and effective intervention in this group of young children has the potential to improve wellbeing and attainment outcomes across the lifespan. This review contributes to our understanding of how to implement cost-effective, socially valid and maximally engaging partnership working with families of young children at risk for DLD.
International journal of language & communication disordersK Bunning, S Buell, L Flannery, E Manzi, N Grove
BACKGROUND: All communication involves the expression and the reception of information, both of which are considered by speech and language therapists (SLTs) when assessing and planning intervention for language difficulties. Comprehension, or understanding, has to be inferred, whereas expressive behaviours are directly observable. Possibly because of the level of inference, views and assessments of a person's understanding often vary: between different practitioners, professionals, family members and carers. The aim of the research was to examine how and why such different perspectives occur and how they are managed. There were three research questions: (1) How is understanding conceptualised and addressed from the perspectives of: (a) SLT practitioners and (b) SLT educators? (2) Are discrepant views on a person's understanding recognised and encountered in SLT practice? and (3) if so, how are such differences explained and navigated in practice? METHODS: The research design used a survey methodology involving two bespoke online questionnaires aimed at: (i) SLT practitioners; and (ii) SLT educators. Purposive convenience samples were recruited via UK-based pre-registration programmes in Speech and Language Therapy and the Clinical Excellence Networks (CENs) of the Royal College of Speech and Language Therapists (RCSLT). The online questionnaires included demographic information followed by a mixture of closed and free-field questions exploring conceptualisation and assessment of understanding. Descriptive statistics were applied to closed question responses, and summative content analysis to the free-field responses. RESULTS: A total of 80 completed questionnaires were returned: (i) SLT practitioners = 77; (ii) SLT educators = 3. Understanding was defined in different ways. Approaches to assessment focused on vocabulary and semantics, language processing, and responses to different communicative modalities. Differing views on a person's understanding were recognised to be a common issue encountered by SLTs, which were mainly associated with parents, partners and family members rather than fellow professionals. CONCLUSIONS: SLTs seem to vary in the ways they conceptualise and address the question of understanding in their practice, and the findings confirm anecdotal suggestions that differences of opinion with other professionals, family members and carers are relatively common. Receptive communication, therefore, emerges as a contested field, which has implications for how successfully and thoroughly SLTs are able to plan and deliver effective interventions. Further clarification is needed regarding the relevant information and guidance provided in pre-registration training. Implementation science may provide some useful guidance as to the marrying of theory and research evidence. WHAT THIS PAPER ADDS: What is already known on the subject Language involves both expression and comprehension, the one process being observable whereas the other is inferred. Various models of understanding are proposed, which speech and language therapists can apply in their therapeutic practice, but we know little about which they choose and why. Furthermore, there is anecdotal report of disagreements occurring between assessments made by the speech and language therapist and those of other professionals, family members and caregivers.What this paper adds to the existing knowledge The current study is the first reported survey into how understanding is conceptualised and operationalised in the practice of speech and language therapists in the UK. The findings revealed the different ways that understanding was defined with assessment approaches generally focusing on components within the architecture of language and communication. It appears that differing views on a person's understanding are often encountered by speech and language therapists.What are the potential or clinical implications of this work? This survey suggests that more work needs to be done to establish a unified theory of understanding to underpin speech and language therapy practice: one that combines social cognitive processes and psycholinguistic processes.
International journal of language & communication disordersAndrea Hanratty, Claire Mills
BACKGROUND: Speech language therapists (SLTs) are recognised as key members of the multidisciplinary team in adult critical care and have more recently been assessing and managing swallowing with adults on high-flow nasal oxygen (HFNO). HFNO is a non-invasive respiratory support that delivers a stable fraction of inspired oxygen ranging from 0.21 to 1.0 with flow rates of 15-60 litres per min. Despite HFNO being used routinely in critical care and SLTs postulating an effect of HFNO on oropharyngeal swallowing, there is limited evidence and consensus of potential effects in the literature. Subsequently, there are no clear guidelines or practice patterns for managing dysphagia in this patient cohort. There is limited understanding of how SLTs are interpreting and applying the available literature to their practice patterns. AIM: The aim of this qualitative study was to explore international SLTs' practice approaches and opinions when assessing and managing oropharyngeal swallowing in adults on HFNO. METHODS & PROCEDURES: Participants were SLTs with at least two years of experience working in critical care. Three online focus groups consisting of 18 participants from six countries were conducted. The participants were asked about their current practices, opinions, considerations, and perceptions of challenges and opportunities when assessing and managing adults on HFNO. Inductive content analysis was used to analyse the data. OUTCOMES & RESULTS: Six content categories were identified; 'consider the patient individually and holistically', 'types of assessment procedures', 'impact of HFNO on oropharyngeal swallowing', 'considerations when assessing adults on HFNO', 'current knowledge and practice landscape', and 'collaboration and communication'. A further 15 subcategories were derived. CONCLUSION: This research has identified concerns amongst SLTs that there is a lack of evidence to guide assessment and management of dysphagia in patients receiving HFNO. Research efforts should focus on clarifying how different flow rates impact swallowing function. This would help establish best-practice approaches for screening, assessing, and managing swallowing in patients receiving HFNO. WHAT THIS PAPER ADDS: What is already known on this subject High-flow nasal oxygen (HFNO) is being used more frequently to treat critically-ill adults, however the impact of HFNO on oropharyngeal swallowing has not been fully established. Speech and language therapists (SLTs) are now routinely integrated into the multidisciplinary team in critical care and assess adults on HFNO. To the authors knowledge, no study has previously explored in-depth the perspectives of critical care SLTs who assess and manage oropharyngeal swallowing in adults on HFNO. What this paper adds to the existing knowledge This is the first qualitative study exploring international SLTs opinions and practices when assessing and managing oropharyngeal swallowing in adults on HFNO. This study provides valuable insights into how oropharyngeal swallowing is currently being assessed and managed internationally by SLTs and provides guidance on future research in this area. What are the potential or actual clinical implications of this work? Findings from this study demonstrate variability in clinical practice and highlights uncertainty regarding assessment and management in this patient population. Some participants emphasised the value of instrumental assessment in supporting clinical decision making. This study identified that there are currently no standardised protocols or guidelines for the screening and comprehensive assessment for adults on HFNO. Further research is needed to guide the development of such protocols and guidelines to enable best practice.
International journal of language & communication disordersBader Alhejji, Stuart Cunningham, Samantha Dorney, Rebecca Palmer
BACKGROUND: Although speech and language therapy (SLT) is central to post-stroke aphasia rehabilitation, global SLT provision often falls short of recommended dosages. In response, interest has grown in technology-based interventions, including therapy software, virtual reality (VR) and artificial intelligence (AI) tools. However, current evidence for the effectiveness of technology is fragmented, and no recent review offers a comprehensive synthesis across these three modalities. AIM: This review examined the range of technologies used in aphasia assessment and therapy and summarised their effectiveness across different intervention targets. The two research questions were: (1) What types of technology have been investigated for assessing and treating people with aphasia (PWA)? (2) How effective is the use of technology in the assessment and treatment of PWA? METHODS: A systematic search of four databases (PubMed, PsycINFO, Web of Science and Scopus) covering the period 2013 to May 2026 identified 67 included studies, of which 14 were randomised controlled trials. Studies reporting quantitative outcomes, were peer-reviewed, and focused on technology-based intervention for PWA were eligible. Quality was appraised using the NICE checklist. The GRADE framework was applied to evaluate certainty of evidence for each intervention target. Findings were then synthesised narratively due to heterogeneity across study designs, and outcome measures. RESULTS: Three technology types were identified: computerised speech and language therapy (CSLT) (38 studies), VR (17 studies) and AI (13 studies). AI was used predominantly for aphasia assessment and classification. The strongest and most consistent evidence related to word-finding, where high certainty of evidence was supported by multiple RCTs delivering therapy at or above the recommended 20-h threshold. For language production and comprehension, functional communication, and reading, outcomes were more variable, reflecting moderate certainty of evidence, and inconsistent dose adherence. Writing interventions received a low certainty rating, reflecting small samples, limited blinding and task-specific rather than generalised gains. Across domains, higher-dose studies were consistently associated with better outcomes, which may suggest that technology functions primarily as a tool to enable high-intensity practice rather than as an independently effective treatment ingredient. CONCLUSION: CSLT, VR and AI tools show promise as adjuncts to face-to-face SLT for aphasia assessment and rehabilitation. Word-finding interventions delivered at recommended doses have the strongest evidence base. Some studies did not use technology to support the recommended therapy dose. For other intervention targets, larger, higher-dose trials are needed. Future research should also examine whether integrating different technology types could offer additional clinical benefit. WHAT THIS PAPER ADDS: What is already known about the subject Previous systematic reviews have demonstrated the emerging role of technology in aphasia rehabilitation, with earlier work focusing primarily on computer-based therapy or AI technologies. However, these reviews were either narrow in scope (targeted specific technology type), or outdated. What this study adds to the existing knowledge This review provides an updated, cross-technology synthesis encompassing AI, virtual reality, and computerised speech-and-language therapy. It outlines how these tools were applied within the studies in the literature. The review also identifies persistent limitations in therapy dosage across studies, underscoring the need for future higher-dose trials to confirm the certainty of evidence across different intervention targets. What are the clinical implications of this study? The growing evidence for computerised speech and language therapy, virtual reality, and artificial intelligence tools continues to support their role as adjuncts to face to face SLT, particularly for language assessment and targeted word-finding interventions. These technologies may extend therapy provision beyond clinical hours, enable therapeutic doses of practice to be achieved, and improve consistency in assessment procedures.
International journal of language & communication disordersSuvashis Dash, Priyam Arora, Archana Sinha, Akshya Dhiman, Raj Kumar Manas, Raja Tiwari, Shashank Chauhan, Sujata Sarabhai
BACKGROUND: Orofacial clefts are among the most common congenital anomalies worldwide, affecting approximately 1 in 700 live births. Despite surgical repair, most children require long-term speech therapy; parental perspectives on accessing and continuing this therapy remain poorly documented in Low resource contexts. OBJECTIVE: To explore the facilitators and barriers influencing access to and continuation of speech therapy for children with CP within the low resource context. METHODS: A qualitative descriptive design was employed. Semi-structured interviews were conducted with 32 caregivers (15 mothers, 17 fathers) of children with non-syndromic cleft palate (all post-palate repair) at a tertiary cleft care centre, (November 2023-July 2025). Purposive sampling ensured variation in child age, urban/rural residence, and therapy status. Sixteen interviews were conducted in-person (mean duration 20 min) and 16 by telephone (mean duration 18 min) by a single Speech-Language Pathologist interviewer. All interviews were conducted in Hindi. Data were analysed using Braun and Clarke's (2006) six-phase reflexive thematic analysis by two independent coders. Member-checking was conducted with six purposively selected participants to validate findings. RESULTS: Four themes were identified: (1) Information deficit as a barrier-28/32 (87.5%) caregivers reported inadequate guidance at diagnosis or post-surgery (mean importance 4.5 ± 0.8); (2) Structural, geographic, and financial barriers-20/32 (62.5%) reported challenges attending therapy (mean importance 3.8 ± 0.9), with a distinct urban/rural pattern; (3) Perceived therapy outcomes as a facilitator-all 32 participants discussed visible speech progress as the primary motivator for continuation (mean importance 4.7 ± 0.6); and (4) Social, emotional, and cultural impact-22/32 (68.8%) described stigma, psychosocial burden, and protective family support (mean importance 4.2 ± 0.7). CONCLUSION: Continuity of speech therapy is contingent on timely information, accessible care models, and empowered family engagement. Structured information at diagnosis, teletherapy, community rehabilitation worker models, and parent-implemented home programmes represent actionable, context-appropriate solutions. WHAT THIS STUDY ADDS: What is already known on this subject Existing research on cleft palate (CP) in low- and middle-income countries (LMICs), highlights significant barriers to speech therapy access, such as limited local SLP providers, financial constraints, long travel distances, and resource shortages. Studies document high unmet needs for rehabilitative care, delayed intervention, and caregiver concerns about speech outcomes, social impacts, and information gaps at diagnosis. Qualitative work from LMICs has explored general parental experiences, psychosocial challenges, and treatment pathways, but caregiver perspectives specifically on facilitators and barriers to initiating and continuing speech therapy remain limited. What this study adds to existing knowledge This qualitative study provides novel, in-depth insights from 32 LMICs caregivers on facilitators and barriers to accessing and continuing speech therapy for children with non-syndromic cleft palate in a high-burden LMIC setting. Using reflexive thematic analysis, it identifies four key themes: information deficits delaying early engagement; structural/geographic/financial barriers with urban-rural contrasts; perceived therapy benefits as the main continuation driver; and broader social/emotional/cultural impacts. It offers the first detailed, context-specific exploration of these issues from a tertiary centre perspective. What are the potential or actual clinical implications of this study? Findings underscore the need for improved information delivery at diagnosis to promote early SLP referral and engagement. Clinicians should address urban-rural disparities through targeted strategies, such as telepractice or community outreach for geographic/financial barriers. Emphasizing observable therapy benefits may enhance continuation rates. Recommendations include multidisciplinary training for non-specialists, culturally sensitive guidance, policy support for affordable SLP services, and community programs to reduce stigma and emotional burden-ultimately improving access, adherence, and outcomes in resource-constrained LMIC settings. PRACTITIONER POINTS: Information deficits at diagnosis are a major barrier to early speech therapy engagement for children with cleft palate in LMICs-clinicians should prioritize clear, timely education. Structural and geographic barriers differ markedly between urban and rural caregivers; telepractice and community outreach may improve access and continuation. Perceived positive therapy outcomes strongly facilitate ongoing attendance-emphasizing observable benefits can enhance adherence in resource-limited settings.
International journal of language & communication disordersDaichi Iimura, Takuma Yamamoto, Osamu Ishida
PURPOSE: This systematic review and meta-analysis evaluated the fluency- enhancing effect of DAF alone in individuals with developmental stuttering. METHODS: Following PRISMA 2020 guidelines, we searched multiple databases for studies published between 2000 and 2024. Eligible studies examined DAF conditions applied to speech tasks with stuttering-related outcomes. Meta-analyses were conducted using a random-effects model, with subgroup analyses by disfluency type, delay time, speech task, stuttering severity, and participant age. RESULTS: Of the 194 records screened, eight studies involving a total of 98 participants in total met the inclusion criteria, and five studies involving 61 participants were eligible for quantitative synthesis. Each study included 8-20 participants ranging from school-age children to adults. Most participants were male, and stuttering severity ranged from mild to severe. DAF conditions were evaluated using oral reading and spontaneous speech/monologue tasks. Meta-analysis revealed no significant overall benefit of DAF compared with normal auditory feedback (NAF; mean difference = -1.46, 95% CI [-4.83, 1.91]). CONCLUSION: DAF alone does not consistently reduce disfluencies; however, specific populations and conditions may derive greater benefits from it. Larger, well-controlled studies are needed to clarify its therapeutic potential and clinical applications. WHAT THIS PAPER ADDS: What is already known on this subject Delayed auditory feedback (DAF) has been reported to improve fluency in people who stutter and is used in several assistive devices. However, its independent effect remains unclear because DAF is often combined with other altered auditory feedback conditions. What this study adds to existing knowledge This systematic review and meta-analysis evaluated the exclusive effect of DAF on stuttering. The results indicate that DAF alone does not consistently reduce disfluency compared with NAF, although certain conditions (e.g., shorter delays or reading tasks) may show greater benefits. What are the potential or actual clinical implications of this work? Clinicians should interpret the fluency-enhancing effects of DAF cautiously when used alone. Further well-controlled studies are needed to determine which individuals and speech contexts may benefit most from DAF-based interventions.
International journal of language & communication disordersFien Allemeersch, Kristiane Van Lierde, Cassandra Alighieri, Kim Bettens, Tara Mouton, Greet Hens, Nick Verhaeghe
PURPOSE: This paper aims to provide speech and language pathologists and researchers with practical, educational guidance on designing health economic evaluations (HEEs) to assess the cost-effectiveness of high-intensity speech intervention (HISI) for children with cleft palate with or without cleft lip (CP±L). METHOD: Key methodological considerations for designing HEEs of HISI for children with CP±L were identified by drawing on established frameworks. The foundational framework by Drummond et al. (2015) and the CHEERS reporting standards served as guiding structures for organizing and synthesizing principles relevant to conducting rigorous and transparent HEEs. Based on this conceptual synthesis, this paper provides practical recommendations to support researchers in implementing high-quality HEEs in the context of HISI for children with CP±L. CONCLUSIONS: Despite growing interest in HISI, rigorous evidence on its cost-effectiveness is still lacking. Well-designed HEEs are needed to inform policymakers about the efficient allocation of healthcare resources. Clear evidence on cost-effectiveness is essential to ensure that implementation and reimbursement decisions are based on interventions that are both clinically effective and economically justified. WHAT THIS PAPER ADDS: What is already known on this subject High-intensity speech intervention (HISI) is increasingly used in the management of speech sound errors in children with cleft palate with or without cleft lip (CP±L), with growing evidence supporting its clinical effectiveness. However, despite rising healthcare costs and pressure on effective service delivery, evidence on the cost-effectiveness of HISI remains limited. Health economic evaluations (HEEs) are well established in health research but are underutilised in speech and language therapy, and existing studies often show considerable methodological variability and limited transparency in reporting. What this study adds to existing knowledge This paper provides structured, practical guidance for designing rigorous HEEs of HISI for children with CP±L. Drawing on established frameworks and the CHEERS reporting standards, it synthesises key methodological considerations tailored to speech and language therapy research. The study clarifies how HEEs can be systematically integrated into intervention research in this field and offers concrete recommendations to improve methodological quality, transparency, and comparability of future economic evaluations of speech interventions for children with CP±L. What are the clinical implications of this study? By supporting the design of high-quality HEEs, this paper enables speech and language pathologists and researchers to generate evidence on the economic value of HISI. Such evidence can inform service planning and reimbursement decisions, supporting efficient allocation of resources in cleft care. Ultimately, improved economic evidence may facilitate wider, equitable implementation of effective interventions while ensuring sustainability of speech and language therapy services for children with CP±L.
International journal of language & communication disordersHarun Ayas, Müge Müzeyyen Çiyiltepe
BACKGROUND AND AIMS: Access to Speech and Language Therapy (SLT) is often described in terms of whether a service exists. However, formal recognition alone does not ensure that individuals can obtain timely, affordable, coordinated, and sustainable care across the life course. The use of the rights-based Availability, Accessibility, Acceptability, and Quality (AAAQ) framework remains limited in comparative policy research on SLT access. England (UK), Sweden, Australia, and the United States were purposively selected to capture contrasting arrangements in statutory coordination, financial protection, payer structure, and telehealth codification. The objective of this study was to compare how Türkiye and these four settings translate formal SLT entitlement into operational access conditions across the AAAQ dimensions. METHODS AND PROCEDURES: A comparative policy analysis was conducted using a structured document-mapping approach. Primary evidence sources comprised official legislation, statutory instruments, regulations, ministry and agency guidance, reimbursement and coding rules, official standards, and selected official implementation materials. Searches were conducted between 1 June and 20 September 2025, with update verification through 27 November 2025. Twenty-four eligible evidence sources were included. Data were extracted using a standardized form and analysed through directed qualitative content analysis with AAAQ as the deductive framework. Findings were subsequently synthesized across three cross-cutting policy axes: life-course continuity, the education-health interface, and telerehabilitation implementation. OUTCOMES AND RESULTS: All five settings recognized SLT as a health benefit, an education entitlement, or both, but differed markedly in how entitlement was translated into implementable access conditions. England (UK) showed the strongest statutory continuity for children and young people through the SEND framework. Official patient-facing and regional sources from Sweden indicated comparatively transparent outpatient fee and high-cost protection arrangements. Australia and the United States illustrated how reimbursement codification and documentation rules can support administrative traceability and tele-enabled delivery. In Türkiye, the main issue was not the absence of normative entitlement, but the extent to which access remained sensitive to dispersed reimbursement definitions, administrative interpretation, less explicit cross-sector procedures, and limited codification of tele-SLT within the reviewed reimbursement architecture. CONCLUSIONS AND IMPLICATIONS: Access to SLT should be understood not simply as service presence, but as a system-design issue shaped by financing, documentation, coordination, and quality-governance arrangements. For Türkiye, policy development may depend less on further recognition of SLT-related need and more on strengthening implementation architecture through clearer reimbursement itemization, more explicit education-health coordination, and tele-SLT coding linked to documentation and reporting standards. More broadly, the findings suggest that equitable and sustainable SLT access requires attention to how entitlement is operationalized across the life course. WHAT THIS PAPER ADDS: What is already known on the subject Access to speech and language therapy is often discussed in terms of service availability or formal entitlement. However, less is known about how entitlement is translated into practical access conditions across health and education systems, particularly from a comparative rights-based perspective. What this paper adds to the existing knowledge Using the Availability, Accessibility, Acceptability and Quality (AAAQ) framework, this study shows that differences in SLT access across Türkiye and four comparator settings lie not simply in whether services are formally recognized, but in how entitlement is operationalized through financing, documentation, cross-sector coordination and telehealth arrangements. Three system-level mechanisms emerged as particularly important: life-course continuity, the education-health interface and the operationalization of tele-SLT through reimbursement and reporting arrangements. What are the potential or clinical implications of this work? For SLT practice, service planning and policy, improving access requires attention to implementation architecture as well as formal entitlement. Clearer reimbursement and documentation rules, stronger education-health coordination and explicit tele-SLT coding may support more predictable, traceable and equitable access across the life course.
International journal of language & communication disordersKatherine Pritchard, Vesna Stojanovik, Jill Titterington, Emma Pagnamenta
BACKGROUND: Speech sound disorder (SSD) is broadly defined as difficulty producing speech sounds in childhood. It can have a lasting impact on academic outcomes and well-being, making effective early intervention vital. Speech and language therapists (SLTs) consider parental involvement-particularly supporting their child with home practice-as essential to a child's progress. Relationships between SLTs and parents are known to facilitate this engagement. However, there is a significant gap in the literature regarding parents' perspectives, and little is known about what parents perceive to be most effective in supporting home practice. Understanding these perspectives is crucial for designing interventions that are both feasible and meaningful for families. AIM: To explore the perspectives of parents of children with SSD aged ≤5;11, about their experiences with speech and language therapy intervention sessions and home practice. METHODS AND PROCEDURES: This study used qualitative methodology. Nine parents, recruited via social media, professional networks and a university clinic, participated in focus groups or 1:1 interviews. A group of children, aged 4-6, who had lived experience of SSD, speech and language therapy and home practice were consulted to design the topic guide and inform data analysis. Discussions were recorded, transcribed verbatim and analysed using Reflexive Thematic Analysis. OUTCOMES AND RESULTS: Four main themes were constructed as follows: (1) Building positive therapeutic relationships is fundamental to families' experiences and creates the foundation for successful home practice. (2) SLTs need to employ a wide range of skills and knowledge, including a multi-modal approach to empower parents and develop their capability. (3) Clear communication is key for shared power, understanding of roles, active involvement and effective home practice. (4) Factors outside an individual's control can impact parents' attitudes towards, and engagement with, home practice. CONCLUSIONS AND IMPLICATIONS: We conclude that relationships between SLTs and parents, and the skills required to build these, underpin parental motivation to engage in home practice. To maximise parental capability, SLTs ensure that parents understand not only what to do but why they are doing it, utilising a variety of methods. Whilst some barriers for home practice are out of the SLT's control, using all opportunities to develop the motivation and capability of the parents is required. To achieve this, service delivery models may need to be reconsidered. WHAT THIS PAPER ADDS: What is already known on this subject SSD that persists into school years can have lasting implications for a child's academic outcomes and well-being. Effective and efficient early intervention is essential. SLTs and parents agree that working together, including parental delivery of home practice, is important for a child's progress. Little is known about how parents experience and perceive what SLTs do within intervention sessions to ensure parents feel confident and capable of delivering effective home practice. What this paper adds to existing knowledge This is the first study to explore parents' perceptions and experiences of what SLTs do within direct intervention sessions for young children with SSD and how this supports parents to become implementors of intervention for their child at home. Findings suggest that parents benefit from SLTs using a range of teaching and coaching approaches, including clear instructions and active involvement, to ensure parents feel confident and capable at home. Relationships between the parent, SLT and the child are highly valued by parents, and are fundamental for parental engagement with home practice. What are the potential or actual clinical implications of this work? SLTs prioritising building effective relationships with parents and children can support parental motivation for home practice. SLTs can work with parents to increase opportunities for home practice by building it into their daily lives, including working with other family members. To maximise parental capability, it is important to ensure that parents understand not only what to do but why they are doing it, utilising a variety of methods. To achieve this, service delivery models may need to be reconsidered.
International journal of language & communication disordersSusanna Williams, Freyja Bell, Sarah Northcott, Suzanne Beeke
BACKGROUND: Wernicke's aphasia is a challenging communication disability to live with, characterised by fluent speech, impaired auditory comprehension and reduced self-monitoring. There is little literature addressing functional therapy approaches. For example, there is limited evidence for communication partner training (CPT) for this client group, despite research on its effectiveness more generally. It is not known how speech and language therapists (SLTs) understand and apply this limited and disparate evidence to their practice. AIMS: To explore how SLTs assess and treat people with Wernicke's aphasia (PwWA), specifically how SLTs engage with PwWA; work with the multi-disciplinary team to support PwWA; support significant others of PwWA, including through the provision of CPT. METHODS: In this qualitative interview study, SLTs were recruited through social media and professional newsletters. Interviews via videoconferencing followed a topic guide and were transcribed and analysed using Framework Analysis. Fifteen SLTs participated, with 1.5-34 years of experience, working in England and Wales across a range of inpatient and community settings. RESULTS: SLTs described a range of issues when working with PwWA. Building a therapeutic alliance was considered important, but could take longer than in other types of aphasia. Informal assessment was required for many PwWA, with published language assessments deemed unsuitable by many. It was perceived that available outcome measures did not capture change. SLTs took differing views on which theoretical models they should use to guide impairment-based therapy. Treatment choices were sometimes driven by trial and error. SLTs offered CPT throughout the stroke pathway, reporting it to be clinically useful; however, there was uncertainty around which communication strategies to recommend. Many SLTs viewed working with PwWA negatively. They wanted to help but felt unsure about how to do so, and commented that the evidence base for treatment was limited. SLTs worked most closely with occupational therapists to manage Wernicke's aphasia. SLTs expressed concerns around the quality of decision-making capacity assessments completed by other members of the multidisciplinary team and access to psychological support for PwWA. CONCLUSION: SLTs want evidence to guide their practice when working with Wernicke's aphasia. Further research is needed to inform CPT and outcome measures for PwWA. CPT should be supported by empirical research into interactions involving PwWA. There needs to be improved access to mental health support and high-quality decision-making capacity assessment for PwWA. WHAT THIS PAPER ADDS: What is already known on this subject Impairment-based treatments for Wernicke's aphasia from varied theoretical perspectives are reported in the literature. There is little literature reporting on functional approaches and communication partner training for Wernicke's aphasia. It is not known how practising speech and language therapists (SLTs) assess and treat people with Wernicke's aphasia (PwWA). What this paper adds to existing knowledge SLTs found PwWA difficult to work with; they wanted to help but felt unsure about what to offer. SLTs are offering communication partner training for Wernicke's aphasia throughout the stroke pathway; however, they expressed differing opinions on which communication strategies to recommend. What are the potential or actual clinical implications of this work? SLTs would like more research evidence to guide them when managing Wernicke's aphasia. There is a need for assessments, treatments, outcome measures and psychological support that meet the unique needs of PwWA.
International journal of language & communication disordersCarol Moxam, Claire d'Urban-Jackson, Lauren Ackerman
BACKGROUND: Spoken and written language are closely linked, and Speech and Language Therapists (SLTs) have expertise in the language skills that support both. However, unlike countries such as the US and Australia, UK SLTs lack clear guidance on their role in written language. This study explores the views of SLTs working with adults (aged 16+) and children to inform consideration of a UK position statement. AIMS: To examine UK SLTs' views on their role and scope of practice in written language assessment and intervention, and to ascertain whether a position statement is needed. METHODS AND PROCEDURES: In 2021, an online survey was completed by 511 SLTs across the UK. The survey explored SLTs' views on their role in written language, alongside their reported involvement in direct and indirect written language assessment and intervention. Quantitative data was analysed using R (R Core Team, 2024). OUTCOMES AND RESULTS: SLTs working with adults or across adults and children are more likely than those working solely with children to report having knowledge, skills, and a role in written language. Those already working in this area held a more positive view of their role. Most UK SLT respondents (89%) supported the development of a UK position statement. There was also strong support for greater emphasis on the links between language and literacy in university training. CONCLUSIONS AND IMPLICATIONS: SLTs working across the lifespan are more likely to engage in written language than those working only with children. Findings indicate a clear need for UK specific guidance on SLTs' role in written language. Addressing this will require enhanced pre-registration education and continuing professional development on the links between language and literacy. WHAT THE PAPER ADDS: What is already known on the subject Language is the foundation for reading (word reading and reading comprehension) and underpins spelling and writing skills. SLT training covers areas of language that are important for literacy development. Internationally, SLTs in countries such as the USA and Australia have clearer guidance and more established roles in supporting written language and literacy, whereas in the UK this guidance remains limited. What does this study add to existing knowledge The paper enhances our understanding of UK SLTs' views on their role in written language across the lifespan. It highlights differing views across those who work with adults and those who work with children, and their scope of practice within written language. The level of certainty around SLTs' role is influenced by whether they work on written language, resource allocation, and/or training. What are the potential clinical implications of this work? Key clinical implications include: greater clarity regarding the role and scope of practice of UK SLTs with written language across the lifespan; UK policy and guidance through, for example, a formal position statement; research into how current training institutions embed the links between language and literacy within their curricula; enhanced pre-registration training and continuing professional development opportunities for practising clinicians; and a strategic approach to supporting therapists working with children through interprofessional education and education-based placements.
International journal of language & communication disordersGino Hipolito, Rachel Batchelor, Victoria Joffe, Kate Nation, Cathy Creswell
BACKGROUND: Selective mutism (SM), an anxiety disorder often beginning in early childhood, can impair communication, social interaction, and educational progress. When left untreated, problems may persist into adulthood and impact longer term mental health. Although effective interventions exist, many children with SM are unable to access support services, in part due to the lack of suitable training for professionals in SM, the absence of national guidelines, and unclear professional responsibilities which together create gaps in provision. AIM: To survey UK therapists working in the National Health Service (NHS), Local Authorities or Health and Social Care (HSC) services who support preschool and primary school-aged children (3-12 years) with SM to identify the training therapists have received, their perceived training needs, the professions providing interventions, and the nature of the interventions delivered. METHODS: A 32-item online survey was distributed via professional organisations and specialist networks, charity forums, and social media using snowball sampling. Results were analysed using descriptive statistics and free text quotes depicting therapists' opinions or experiences were used to triangulate the quantitative data. RESULTS: Of 244 responses, 201 met eligibility criteria. Most respondents were speech and language therapists (81%), followed by clinical psychologists (11%), educational psychologists (5%) and other professions (3%). Just over half (59%) had received some form of SM training, but only 15% received training during their professional qualification. The majority (85%) expressed the need for additional training in SM to do their jobs particularly in the areas of delivering intervention, addressing co-occurring conditions and working within multidisciplinary teams. Three quarters of the sample (75%) had provided intervention for children with SM, predominantly within schools, involving parents/carers (95%) and teaching staff (96%). Intervention complexity and number of components increased with child age; the most common components across ages were exposure, rapport building, transfer of control and psychoeducation. However, there was extensive variability in the dosage of the interventions provided. CONCLUSIONS AND IMPLICATIONS: This exploratory survey with a non-representative sample suggested that the intervention components used, the people involved, and where the intervention occurred generally reflected the available evidence base. However, even in this sample who are more likely to have an interest in SM, there are still gaps in professional training and variability in service provision for children with SM. To promote consistent, evidence-based care, we recommend development of national cross-profession guidelines and quality standards for professional training and clinical management of children with SM. WHAT THIS PAPER ADDS: What is already known on the subject Effective interventions for selective mutism (SM) exist, but many children cannot access appropriate support. Inadequate professional training, absence of national guidelines, and unclear responsibilities across professions have been identified as key barriers to provision. What this paper adds to the existing knowledge This first UK-wide exploratory survey of therapists highlights that SM training is rarely included in professional qualification courses, leaving most practitioners seeking additional training post-qualification. Intervention components used by the sample of therapists reflected the current evidence base and increased in complexity with age; there was wide variation in dosage and delivery. The findings provide new evidence on which professions deliver SM interventions in a sample of UK therapists and the training gaps they experience. What are the potential implications of this study? There is a pressing need to embed SM training into professional qualification programmes and to provide accessible cross-professional specialist training post-qualification. Developing cross-profession guidelines and quality standards will help ensure consistency, accountability and equitable delivery of evidence-based interventions for children with SM across the UK.
International journal of language & communication disordersGemma Moya-Galé, Julia Hunter, Alireza Goudarzi, Edwin Maas, Leire Escalada-Cebadero
BACKGROUND/OBJECTIVES: Motor speech impairments, such as hypokinetic dysarthria, are highly prevalent among individuals with Parkinson's disease (PD). These voice and speech deficits may significantly impact speech intelligibility, leading many individuals with PD to withdraw socially. Digital platforms may provide a feasible way to address motor speech impairments in this population while also fostering patients' self-management skills through independent home-based practice. The objective of this preliminary one-group pre-post treatment study is to provide a qualitative examination of participants' experience and satisfaction using a custom-developed web-based application to improve speech intelligibility using noise-augmented automatic speech recognition feedback. METHODS: Four individuals with PD completed one month (= 16 sessions) of a novel intensive speech treatment program through a web-based application with weekly online support from a speech-language pathologist. At post-treatment, participants completed individual interviews to document their user experience with the digital platform and a brief satisfaction survey. Interviews were analysed qualitatively following an experiential orientation and reflexive thematic analysis. RESULTS: Overall, participants were satisfied with their experience using the app. Four themes were generated from the data set: (1) From external feedback to metacognitive awareness, (2) two worlds colliding, (3) beyond voice and speech gains: Psychosocial benefits of noise-augmented automatic speech recognition, and (4) reconciling the demands of a digital interface with the motor and non-motor symptoms of Parkinson's disease. CONCLUSIONS: Qualitative data yields preliminary support for the use of a digital speech web-based application that provides noise-augmented automatic speech recognition feedback to improve intelligibility in individuals with PD. Results support further testing of this protocol with a larger cohort of participants in a controlled environment. WHAT THIS PAPER ADDS: What is already known on this subject Motor speech impairments, such as hypokinetic dysarthria, are highly prevalent among individuals with Parkinson's disease (PD). These voice and speech deficits may significantly impact speech intelligibility, leading many individuals with PD to withdraw socially. Digital platforms may provide a feasible way to address motor speech impairments in this population while also fostering patients' self-management skills through independent home-based practice. Digital tools for speech rehabilitation in this population are emerging in the field. However, no digital tool has explored the role of automatic speech recognition (ASR) in noise as a treatment method. Hence, user experience for this novel and naturalistic method warrants further investigation. What this study adds to the existing knowledge The objective of this one-group pre-post treatment study is to provide a qualitative examination of participants' experience and satisfaction using a custom-developed web-based application to improve speech intelligibility using noise-augmented ASR feedback. To the authors' knowledge, this is the first study to describe this novel approach, powered by artificial intelligence, and provide a qualitative examination of this naturalistic method targeting intelligibility. This information will guide future iterations of this web-based technology and provide preliminary insights into how noise-augmented ASR feedback can contribute to patient management. What are the clinical implications of this study? Patient-led digital technologies leveraging ASR in noise hold promise for clinical practice. For the participants with dysarthria secondary to PD in our study, a novel speech treatment that targets intelligibility through noise-augmented ASR feedback was deemed useful and promising to improve not only their voice and speech but also to increase their awareness of how dysarthria impacts their voice in noisy conditions. Additionally, some participants reported increases in confidence and motivation to communicate, which underscores a promising psychosocial impact of this approach.