The latest medical research on Audiology

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Development and Utility of an International Classification of Functioning, Disability and Health Code Set for Younger-Old Adults With Fall Risk: Implications for Audiologists.

Am J Audiology

Falling is a multifactorial condition that can cause severe injury and even death in older adults. Early identification of fall risk factors, as the first step of preventive health care, can assist in reducing the negative and often debilitating effects of falls in older adults. By using the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework to develop an ICF code set to identify fall risk factors in older adults, health care practitioners could obtain health information in a multidimensional way.

This study describes the final phase of a comprehensive, three-phase, mixed-methods sequential study. For this third phase, a pre-post group design that focused on the audiologist's perceptions of the clinical utility of a newly developed ICF code set was employed. The questionnaire that was used for this purpose consisted of two distinct sections: clinical application and clinical utility (viz., appropriateness, accessibility, practicability, acceptability, and professional utility). Thirty practicing audiologists participated in the study. Data were analyzed for each of the two sections of the questionnaire.

Results related to clinical application indicated that regardless of the audiologists' experience in routine fall risk assessment or fall risk factor identification, the use of the developed ICF code set increased their ability to correctly identify relevant clinical aspects. Results related to clinical utility showed high scores across all five measure components, with the highest clinical utility component being acceptability, closely followed by appropriateness and professional utility, and the lowest being accessibility.

Several clinical implications have emerged from this study, including the usefulness of the ICF code set to identify and document fall risk factors in older adults, the code set's ability to guide audiologists to determine individualized assessment needs either by themselves or by other health care disciplines, and that the code set could be used by audiologists regardless of their experience in vestibular assessments.

Development of a holistic communication score (HoCoS) in patients treated for oral or oropharyngeal cancer: Preliminary validation.

Int J Lang

In head and neck cancer, many tools exist to measure speech impairment, but few evaluate the impact on communication abilities. Some self-administered questionnaires are available to assess general activity limitations including communication. Others are not validated in oncology. These different tools result in scores that does not provide an accurate measure of the communication limitations perceived by the patients.

To develop a holistic score measuring the functional impact of speech disorders on communication in patients treated for oral or oropharyngeal cancer, in two steps: its construction and its validation.

Patients treated for oral/oropharyngeal cancer filled six self-questionnaires: two about communicative dynamics (ECVB and DIP), two assessing speech function (PHI and CHI) and two relating to quality of life (EORTC QLQ-C30 and EORTC QLQ-H&N35). A total of 174 items were initially collected. A dimensionality reduction methodology was then applied. Face validity analysis led to eliminate non-relevant items by surveying a panel of nine experts from communication-related disciplines (linguistics, medicine, speech pathology, computer science). Construct validity analysis led to eliminate redundant and insufficiently variable items. Finally, the holistic communication score was elaborated by principal component factor and validated using cross-validation and latent profile analysis.

A total of 25 patients filled the questionnaires (median age = 67 years, EIQ = 12; 15 men, 10 women; oral cavity = 14, oropharynx = 10, two locations = 1). After face validity analysis, 44 items were retained (κ > 0.80). Four additional items were excluded because of a very high correlation (r > 0.90) with other items presenting a better dispersion. A total of 40 items were finally included in the factor analysis. A post-analysis score prediction was performed (mean = 100; SD = 10). A total of 24 items are finally retained for the construction of the holistic communication score (HoCoS): 19 items from questionnaires assessing communicative dynamics (13 from the ECVB and six from the DIP), four items from a perceived speech impairment questionnaire (PHI) and one from a quality-of-life questionnaire (EORTC QLQ-H&N35). The reliability is good (five-fold cross-validation: rs = 0.91) and the complementary latent profile analysis shows a good validity of the HoCoS, clustering subjects by level of communication performance.

What is already known on the subject Because of their anatomical location, head and neck cancer degrades the speech abilities. Few tools currently allow the assessment of the impact of the speech disorder on communication abilities. In ENT oncology, self-administered questionnaires are available to assess activity limitations and participation restrictions (International Classification of Functioning (ICF)-WHO). Other tools from the field of neurology allow an evaluation of communication dynamics. But these different tools, constructed by items, give global additive or averaged scores. This implies an identical weighting of each item, resulting in global scores that are not very representative of the communication limitations really perceived by the patients. What this paper adds to existing knowledge A new global holistic score allowing a measurement of the impact of speech impairment on communication after treatment of oral or oropharyngeal cancer has been developed. The methodology of its construction allows a better reflection of the symptomatological, pragmatic and psychosocial elements leading to a degradation of communication abilities. What are the potential or actual clinical implications of this work? The developed HoCoS score fills the gap in the absence of this type of tool in head and neck oncology. It may allow a better understanding of the factors involved in the functional and psychosocial limitations of these patients, and better customize their follow-up.

Stability of language difficulties among a clinical sample of preschoolers.

Int J Lang

Some data call into question the persistence of developmental language disorders (DLDs) identified during the preschool period. For this reason, speech-language pathologists (SLPs) often reassess children. However, it is unclear if the instability of the profiles documented in community sample studies is present in children referred to specialized clinics. Given the scarcity of SLP resources, is re-evaluating the language skills of these children a good use of clinical time?

To examine the stability of the findings from two SLP assessments in a sample of Canadian preschool children referred to a tertiary clinic between the ages of 2 and 6 years. It was hypothesized that children under the age of 4 years at first assessment and children with less severe initial deficits would show less stability of DLD diagnosis.

The clinical files of children referred to an early childhood psychiatric clinic in Canada were reviewed. For 149 children with two SLPs assessment reports, persistence of language deficits was documented and tested with McNemar's statistics. Differences between preschoolers under the age of 4 versus 4 years and over, as well as between mildly and severely impaired children, were examined.

High level of agreement (94%) and McNemar's test (p = 0.180) supported the stability of initial diagnosis. The stability for children assessed before the age of 4 (n = 64) was 100%, and was significantly different from older children's (n = 85) stability of 89% (Fisher's exact test, p = 0.01; bilateral). The stability for children with mild impairments (n = 18) was 78%, which was significantly lower than the stability (97%) in children with severe impairments (n = 114) (Fisher's exact test, p = 0.007; bilateral).

What is already known on this subject? Previous research that has demonstrated important instability in the classification of language impairment before 4 years of age gathered data mainly by screening the general population or was not based on a comprehensive clinical assessment. What this paper adds to existing knowledge? This study investigated the classification stability of DLD between two comprehensive SLP assessments in a clinical sample of Canadian preschoolers. The results indicate great stability of language status assessed before 4 years old in this population, suggesting that severity of impairments may trump the age factor in this group. What are the potential or actual clinical implications of this work? In the case of children referred to a specialized clinic, clinicians and policymakers should be aware that DLD diagnosis made before 4 years of age remains stable during preschool age, and that a best practice with this population would be to abandon unnecessary testing in favour of early intervention.

The oral language and emergent literacy skills of preschoolers: Early childhood teachers' self-reported role, knowledge and confidence.

Int J Lang

Early childhood teachers (ECTs) play a significant role in equipping children with oral language and emergent literacy skills ahead of school entry. They are well positioned to play a vital role in ensuring preschool children receive a high-quality preschool curriculum to prepare them for later literacy learning.

The purpose of this study was to explore early career ECTs' views and confidence regarding their role in providing preschoolers with oral language and emergent literacy support and to examine their perceptions of their preservice preparation.

Nine Australian early career ECTs were recruited via purposive sampling for an in-depth, semi-structured interview. Data were analysed using an inductive thematic analysis approach.

Participants attached strong significance to their role in facilitating children's oral language growth and emergent literacy skills and reported a range of practices to support children's learning. However, they rarely referred to using established language facilitation strategies or using dialogic book reading prompts. Further, emergent literacy concepts such as phonological awareness and print awareness were not routinely described as features of participants' classroom activities. Participants did not consistently make a clear conceptual distinction between the constructs of oral language and emergent literacy and often used these terms interchangeably. Notably, participants indicated that they did not feel confident in their ability to identify preschool children who were not meeting developmental language milestones and reported that they felt poorly equipped to do so by their preservice training.

What is already known on this subject? High-quality learning experiences in preschool are important for maximising preschoolers' oral language and emergent literacy growth. Early childhood teachers can play an important role in facilitating this development and preparing children for later literacy learning. What this paper adds to existing knowledge? The study findings provide insight into ECTs' perceptions of their role and support in developing children's oral language and emergent literacy skills. The results indicated ECTs did not feel confident with their knowledge of children's language milestones or identifying children with language difficulties. Participants reported that their preservice training left them underprepared in the area of oral language. What are the potential or actual clinical implications of this work? ECTs demonstrated a strong willingness to support preschoolers' oral language and emergent literacy skills. However, their self-reported knowledge gaps and low confidence may have implications for the early detection of children who are not reaching language developmental milestones in a timely way.

Black Children With Developmental Disabilities Receive Less Augmentative and Alternative Communication Intervention Than Their White Peers: Preliminary Evidence of Racial Disparities From a Secondary Data Analysis.

Speech Language Path

Ensuring equitable access to augmentative and alternative communication (AAC) intervention services for children with complex communication needs (CCN) is crucial. Evidence suggests that racial disparities exist in access to communication interventions, disadvantaging Black children. However, no research has investigated specifically the evidence for racial disparities in AAC services for children with developmental disabilities and CCN.

The current study applied post hoc data analysis methods within a preexisting, open-access data set to explore preliminary evidence of racial disparities in AAC intervention. Amount of AAC intervention was compared for Black versus white 1 preschool students at study initiation (M age = 3;8 [years;months]) and 2 years later at study completion (M age = 5;10).

Black preschool students were reported to receive significantly less AAC intervention per week as compared to their white peers, both at study initiation and 2 years later. By study end, 75% of the Black children were receiving less than 60 min of AAC intervention per week, an inadequate amount to achieve meaningful gains given their significant disabilities.

It is unclear what mechanisms may contribute to the observed disparities; however, it is critical that concrete steps are taken by individual speech-language pathologists, school districts, preservice preparation programs, and researchers to identify inequities in AAC services and take actions to rectify them. Future research is essential to investigate the potential factors contributing to inequalities and determine effective interventions to address them.

Clinical Guidelines for Eliciting Discourse Using the RHDBank Protocol.

Speech Language Path

Examining discourse after right hemisphere brain damage (RHD) can provide invaluable clinical data and insight into functional communication capabilities. Yet, clinicians preparing to enter the field may have limited experience eliciting and analyzing discourse for therapeutic purposes. The purpose of this work is to present a practical guide for the clinical use of the RHDBank protocol.

Following a brief overview of the RHDBank protocol, elicitation guidelines and protocol administration considerations are offered. Measures that should be considered when analyzing RHDBank-elicited discourse are summarized. The RHDBank protocol is positioned as an accessible resource for discourse elicitation in the clinical setting, and examples for the clinical use of the protocol are provided.

Discourse production can be a key source of information regarding communication ability following RHD. The RHDBank provides a structured and scripted approach to the clinical elicitation of language and consideration of discourse production. Its immediate clinical utility will assist developing clinicians with the acquisition of a clinically relevant elicitation approach and more comprehensive view of the RHD communication impairments. Application of the protocol can aid in collective knowledge advancement that will promote a better understanding of RHD language production as a clinical entity with an array of possible characteristics.

Assessing Shared Reading in Families at Risk: Does Quantity Predict Quality?

Speech Language Path

Quantity and quality of early at-home reading shape literacy outcomes. At-home reading frequency is a common outcome measure in interventions. This single measure may not fully capture the quality of early reading interactions, such as parent and child references to print, an important contributor to language and literacy outcomes. This study aims to evaluate if and how reported reading frequency and duration are associated with parent and child print referencing, controlling for perceived parenting self-efficacy, developmental knowledge, and child sex.

This study is a secondary analysis of baseline data from a treatment study with parents (N = 30) and children (1;1-2;3 [years;months]) from underresourced households. Parents reported weekly reading episode frequency and duration (in minutes). We coded parent-child book-sharing interactions to quantify use of print references.

Negative binomial regression modeling suggested that parents who reported more weekly reading episodes tended to use more print references during interactions. However, reported reading time in minutes was not significantly associated with parents' print referencing. Parents' print references were also associated with perceived self-efficacy, developmental knowledge, and child sex. In our sample, parents used more print references with male children. Neither reading frequency nor reading time was associated with increased print referencing from children.

Duration of reading did not positively predict children's use of print references. However, weekly reading frequency positively predicted parents' use of print references. Parent perceived self-efficacy and knowledge may predict early interaction quality similarly to quantity of reading.

Which Videofluoroscopy Parameters Are Susceptible to the Influence of Differences in Barium Product and Concentration?

Speech Language Path

Prior studies suggest there may be differences in videofluoroscopic measures of swallowing across different barium concentrations. Whether different barium products of identical concentration result in similar swallowing physiology remains unknown. This is important, as barium intended for videofluoroscopy (i.e., Bracco Varibar) is not available globally. Our aim was to identify differences in healthy swallowing across five different barium stimuli.

Twenty healthy adults (10 women), aged 22-54 years, underwent videofluoroscopy including comfortable sips of thin liquid barium: two sips of 20% weight-to-volume (w/v) barium prepared with E-Z-HD powder, and two sips each of 20%w/v and 40%w/v barium prepared with Liquid Polibar Plus and E-Z-Paque powder. Recordings were analyzed according to the Analysis of Swallowing Physiology: Events, Kinematics and Timing Method. Measures of timing, kinematics and residue were obtained. Chi-square, Friedman's, and Wilcoxon signed-ranks test were used to identify differences across stimuli.

Significant differences were seen across barium stimuli for upper esophageal sphincter (UES) opening duration, UES diameter, pharyngeal area at maximum constriction, and residue. In all cases, smaller values were seen with the 20%w/v E-Z-HD stimulus; however, this stimulus had questionable opacity for visualization. Patterns of residue severity were not explained by barium concentration.

This study confirms that some measures of swallowing are influenced by barium product and/or concentration. Measures are not necessarily similar across different barium products at the same concentration. This study illustrates the importance of using standard and appropriate stimuli in videofluoroscopy, and for clinicians to report not only the product but also the concentration of stimuli used.

Estimating Early Language Input in Deaf and Hard of Hearing Children With the Language Access Profile Tool.

Speech Language Path

The purpose of this study was to describe the Language Access Profile Tool (LAPT) and its psychometric properties with the aim of evaluating its suitability as an alternative to the deaf or hard of hearing (DHH) Language Exposure Assessment Tool (D-LEAT) in clinical practice with DHH children age 12 years and younger.

We administered both the LAPT and D-LEAT to the caregivers of 105 DHH children 12 years old and younger from across the United States, 40% of whom were interviewed again after a delay of at least 1 month. Each interview resulted in a child-specific estimate of their cumulative experience with language input, expressed as a proportion divided across eight categories.

Participants in the sample reported experience with all eight input categories, but four categories were common and four were rare. Estimates for all input categories were consistent at both initial and follow-up interviews. Estimates for each input category were also strongly correlated with the corresponding estimates from the D-LEAT, although correlations for the rare categories should be interpreted cautiously.

The LAPT demonstrates sufficient test-retest reliability and convergent validity to be a useful and more user-friendly alternative to the D-LEAT. We provide recommendations for how the LAPT and the D-LEAT can be best used in their current form.

Intervention Research to Increase Pediatric Hearing Device Use: A Scoping Review.

Am J Audiology

This study is a scoping review examining interventions to increase hearing device use for children.

Online databases were used to identify peer-reviewed journal articles published prior to November 1, 2021, yielding 1,288 after duplications were removed. Four articles met the inclusion criteria after articles were screened by title name and abstract and subsequent full-text screening of six articles. A qualitative analysis was conducted to identify features of the intervention studies related to the participants, design, intervention, key findings, and limitations.

The included studies were published between 1982 and 2021, and in all four studies, the children used hearing aids. All four of the studies used a longitudinal design to address hearing aid use problems, with the timeframe ranging from approximately 1 month to 6 months and had variable success in increasing use time. None of the studies included a protocol, such as counseling skills, for addressing internal challenges that interfere with hearing aid use.

Review of the limited research in this area found variable effectiveness for the interventions studied. There is an urgent need for research in this area to inform clinical practice and provide evidence-based interventions to address malleable factors that interfere with audibility for children who use hearing devices.

Phonological processing skills in children with speech sound disorder: A multiple case study approach.

Int J Lang

Children with speech sound disorder (SSD) are at increased risk of reading difficulties due to poor phonological processing skills. However, the extent to which children with SSD demonstrate weaknesses on specific or all phonological processing tasks is not well understood.

To examine the phonological processing abilities of a clinically identified sample of children with SSD, with and without reading difficulties. To determine the extent to which the proportion of children with concomitant SSD and reading difficulties exhibited weaknesses in specific areas of phonological processing, or a more general phonological deficit.

Data were obtained from 157 school-aged children (Mage = 77 months, SD = 7.01) in receipt of school-based speech therapy. Approximately 25% of the sample was identified as poor readers, based on a standardized measure of word decoding. We compared the proportion of children who scored at or below 1 SD below the mean, or the bottom 16th percentile, on measures of phonological awareness, rapid automatized naming and verbal short-term memory among those identified as poor readers and good readers.

Children with SSD demonstrated a range of phonological processing difficulties, particularly on the measure of verbal short-term memory. No specific skill differentiated groups of children with SSD with and without reading difficulties; however, those classified as poor readers on the word-decoding measure exhibited more widespread difficulties, even after controlling for language ability.

What is already known on the subject Children with SSD are at heightened risk of reading difficulties, particularly if their SSD persists into school age. However, not all children with SSD experience reading problems. Research aimed at determining which children are at the highest risk is mixed as to how best to identify which children with SSD are most likely to experience reading difficulties. What this paper adds to existing knowledge The study used a multiple case study approach to determine if performance on phonological processing skills might differentiate children with SSD who were poor readers from those who were good readers. As a group, children with SSD exhibited poor verbal short-term memory but relatively intact rapid automatized naming skills. No one phonological processing skill differentiated children who were poor readers from good readers. However, children with reading difficulties appeared to experience more general difficulties across phonological processing tasks, even after controlling for language abilities. What are the potential or actual clinical implications of this work? A single deficit (i.e., speech sound production) is not sufficient data to make a complete diagnosis or treatment decisions. Multiple sources of data, including several aspects of phonological processing, should be obtained to understand reading risk in children with SSD.

Healthcare Professionals' Perceptions of Stabilized Edible Foam with Adults with Severe Dysphagia; an exploratory study: Use of stabilized edible foam with adults with dysphagia: Use of stabilized edible foam with adults with dysphagia.

Int J Lang

Improving the quality of life for individuals with severe dysphagia is a priority when considering new areas of dysphagia management, especially if this increases opportunities to participate in social activities associated with eating and drinking. Edible foam is widely researched and available in the food industry; however, the use of edible foam within the field of dysphagia remains unexplored. Despite no research published on effectiveness and safety, a commercial product currently on the market is widely distributed across both Europe and the UK, including 28 NHS Trusts, suggesting that it is increasingly being used in clinical practice.

To explore the perceptions and experiences of healthcare professionals on the use of stabilized edible foam (SEF) with adults with severe dysphagia in order to inform areas for future research in this novel dysphagia intervention.

Healthcare professionals were recruited using purposeful sampling and snowballing technique. A total of 56 healthcare professionals were initially approached, of which 10 completed the semi-structured interviews. Interview questions were developed from a topic guide and a pilot questionnaire.

Thematic analysis was used to identify three themes: potential impact, consideration of risk and perceived experiences. Overarching each of these themes was the element of the unknown.

What is already known on the subject The use of SEF with individuals with swallowing problems is a relatively novel area of dysphagia intervention in the UK. There are currently no published studies on its effectiveness and safety profile. What this paper adds to existing knowledge This study provides valuable preliminary work into the area of SEF and adults with severe dysphagia, capturing the experience and perceptions of healthcare professions who have an awareness of SEF. What are the potential or actual clinical implications of this work? Increasing clinicians and researcher's awareness of this novel area of dysphagia management.