Speech Pathology and Audiology - Collected Works

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Learning from students: facilitators' learning in interprofessional placements
(Taylor & Francis, 2018-05-10) Attrill, Stacie Lorraine; Brebner, Christine Mary; Marsh, Claire
Few studies have examined experiences and learning from the viewpoint of interprofessional facilitators of student placements, and limited research has investigated this learning enacted across traditional service boundaries or between health and education practitioners. This study aimed to address these gaps by exploring perceptions about the learning and experiences of Early Childhood Educators (ECEs) who facilitated placements in childcare settings for speech-language pathology students from a health professional background. Lave and Wenger’s theory of Legitimate Peripheral Participation was utilised to design and interpret this study. Seven ECEs from two childcare centres and four Centre Directors participated in focus groups and individual semi structured interviews respectively. Thematic analysis revealed five themes that described how the ECEs came to accept the students as legitimate members of their practice community, and how this subsequently facilitated the ECEs’ learning. The themes of power described in previous studies that explored status and hierarchical differences between facilitators and students from differing professions were not identified in this study. This absence of observed power differential, in addition to the embedded nature of the placement design, and the students’ participation in the ECEs’ everyday activities and routines contributed to the ECEs’ positive interprofessional learning.
International students in speech-language pathology clinical education placements: perceptions of experience and competency development
(Taylor & Francis, 2015-03-12) Attrill, Stacie Lorraine; Lincoln, Michelle; McAllister, Sue Margery
Purpose: This study aimed to describe perceptions of clinical placement experiences and competency development for international speech-language pathology students and to determine if these perceptions were different for domestic students. Method: Domestic and international students at two Australian universities participated in nine focus group interviews. Thematic analysis led to the identification of two themes shared by international and domestic students and several separate themes. Result: Shared themes identified the important influence of students’ relationships with clinical educators, unique opportunities and learning that occurs on placement. International student themes included concerns about their communication skills and the impact of these skills on client progress. They also explored their adjustment to unfamiliar placement settings and relationships, preferring structured placements to assist this adjustment. Domestic student themes explored the critical nature of competency attainment and assessment on placement, valuing placements that enabled them to achieve their goals. Conclusion: The findings of this study suggest that international students experience additional communication, cultural and contextual demands on clinical placement, which may increase their learning requirements. Clinical education practices must be responsive to the learning needs of diverse student populations. Strategies are suggested to assist all students to adjust to the professional and learning expectations of clinical education placements.
Predictors of professional placement outcome: cultural background, English speaking and international student status
(Springer, 2016-08-04) Attrill, Stacie Lorraine; McAllister, Sue Margery; Lincoln, Michelle
Placements provide opportunities for students to develop practice skills in professional settings. Learning in placements may be challenging for culturally and linguistically diverse (CALD) students, international students, or those without sufficient English proficiency for professional practice. This study investigated whether these factors, which are hypothesized to influence acculturation, predict poor placement outcome. Placement outcome data were collected for 854 students who completed 2747 placements. Placement outcome was categorized into ‘Pass’ or ‘At risk’ categories. Multilevel binomial regression analysis was used to determine whether being CALD, an international student, speaking ‘English as an additional language’, or a ‘Language other than English at home’ predicted placement outcome. In multiple multilevel analysis speaking English as an additional language and being an international student were significant predictors of ‘at risk’ placements, but other variables tested were not. Effect sizes were small indicating untested factors also influenced placement outcome. These results suggest that students’ English as an additional language or international student status influences success in placements. The extent of acculturation may explain the differences in placement outcome for the groups tested. This suggests that learning needs for placement may differ for students undertaking more acculturative adjustments. Further research is needed to understand this and to identify placement support strategies.
Teachers' phonological awareness assessment practices, self-reported knowledge and actual knowledge: the challenge of assessing what you may know less about
(Edith Cowan University, 2018) Carson, Karyn; Bayetto, Anne Elizabeth
This study investigates the relationship between early childhood (EC) and early years’ primary school (EYPS) teachers’ phonological awareness (PA) assessment practices, self-reported PA knowledge and actual PA knowledge. Method: A survey design was employed whereby 102 registered Australian EC and EYPS teachers responded to questions regarding PA assessment practices, selfreported PA knowledge and actual PA knowledge. Results: The results showed: a) more than 80% of teachers use PA assessments, with EYPS teachers conducting frequent assessments and EC teachers conducting rare-to-occasional assessments; b) overestimation of self-reported PA knowledge; c) low levels of actual PA knowledge; and d) high usage of observations and professional judgement as assessment methods despite limited own PA knowledge. Implications: Increasing EC and EYPS teachers’ knowledge of PA and improving their self-appraisal skills is critical for high-quality teacher PA assessment practices, and it illustrates the need for robust pre- and in-service teacher training.
IQ, non-cognitive and social-emotional parameters influencing education in speech- and languageimpaired children
(Cogent OA, 2017-07-31) Ullrich, Dieter; Ullrich, Katja; Marten, Magret
Speech-/language-impaired (SL)-children face problems in school and later life. The significance of “non-cognitive, social-emotional skills” (NCSES) in these children is often underestimated. Aim: Present study of affected SL-children was assessed to analyse the influence of NCSES for long-term school education. Methods: Nineteen severely SL-impaired children (7 girls, 12 boys) from a specialised kindergarten were followed; follow-up period: Up to 12 years; the different skills or parameters were known. Results: Fourteen children visited successfully a regular secondary school (RS), five children a "school focussing on learning problems" (SFL). SL-differences between the children attending RS and SFL were small; differences in “IQ” and “self-confidence” were significant, smaller differences were observed concerning “skills at crafts/construction” and "auditory-visual perception". Summary: Although the study group is small, results give evidence that beside SL- and "cognitive” skills "non-cognitive, social-emotional skills" are of major importance for long-term school education of SL-impaired children. These soft skills seem to be particularly important for “special need children” with SL-impairment.
Conversation Analysis of Repair in Interaction with Adults who Have Acquired HI
(Sonova., 2009-10) Lind, Christopher; Okell, Elise; Golab, Jenna
This chapter presents a summary of some recent re-search which has been undertaken to address the pat-terns of conversational behaviour in interaction involv-ing adults who have post-lingual hearing impairment (HI). The purpose behind this research is to develop a clinical assessment and intervention protocol for assist-ing HI adults and their conversation partners in reduc-ing the impact of conversation breakdown and its repair in everyday talk. Lind (this volume) lists various conversational be-haviours which arise in the conversation of HI adults and which have been identified by the authors as being mal-adaptive . Each of these behaviours may evolve to be a genuine target for intervention. However, at this point, the patterns of most of these behaviours as they are in-fluenced by one person’s HI are not yet well enough un-derstood nor are they yet clearly distinguished from the same behaviours as they occur in conversations not in-fluenced by HI. Until evidence of their patterns of occur-rence and their sequential consequences is established they cannot readily be translated into goals for assess-ment or intervention. Amongst these behaviours, conversation repair has been the most commonly identified therapy target, for two reasons. First, it is the only one of these behaviours that can be identified a priori as a problem for conversa-tional fluency. Repair is by its very nature the result of a breakdown in mutual understanding in the conversa-tion. Participants’ attempts to resolve the breakdown inhe immediate environment in which it occurred speaks to the importance to the talkers of re-instating mutual understanding. Second, there is now a growing body of research that identifies the patterns of repair as they may be influenced by post-lingual HI. The common se-quential behaviours in one particular type of repair were outlined briefly in Lind (this volume). Two additional ex-amples are provided here also. This series of projects from our recent research has been designed as the early stages in an attempt to ad-dress the foundation issues in conversation-based ther-apy; a model of therapy in which clinical tasks directly address conversation difficulties arising as a result of one participant having a post-lingual hearing impair-ment. The studies have been designed to address key questions about the clinical patterns of repair behaviour, including: • Can we reliably sample conversation repair? • Is repair behaviour consistent over time? • Is repair influenced by intervention? and • Does repair in conversationally-oriented clinical tasks mirror repair in conversation sampling?
Conversation Therapy: Interaction as Intervention
(Sonova., 2009-10) Lind, Christopher
This chapter presents an overview of the history, principles and clinical practice that might be labelled “Conversation Therapy” (henceforth, CT) in the context of aural rehabilitation (AR) for adults who have post-lingual hearing impairment (HI). Conversation is recog-nised as the major activity limitation/participation re-striction arising from HI and as such, the therapy, as out-lined in this chapter, is designed primarily to address the everyday conversation difficulties of adults who have HI. The focus on post-lingual HI implies that clients pres-ent with normal adult speech, language and conversa-tional abilities limited only by the reduction in ease of speech reception as a consequence of their HI. While the AR work outlined here is by no means limited to this population, it is designed with the view that the individ-ual had normal adult everyday spoken communication skills prior to the onset of their HI. The hallmarks of the clinical activities included in CT are: (a) their focus on interaction rather than on speech reception, (b) the incorporation of the full range of structural linguistic, interactional, environmental and interpersonal context cues, (c) the incorporation of units of speech (or more appropriately, “talk”) larger or longer than the syllable, word, phrase or sentence, (d) the use of tasks which can be designed with the client’s situation specific difficulties in mind and (e) the increased atten-tion paid to the role of the conversation partner in the resolution of conversational difficulties arising from the post-lingual HI. This chapter makes no claim that CT is a new ther-apy in AR, nor that it has been developed in a concerted or coordinated fashion. Rather, the term is applied retro-spectively, grouping certain existing therapy activities by their focus on conversational or interactional conse-quences of post-lingual HI, including therapies such as environmental and hearing tactics (Kaplan, Bally, & Garretson, 1985) as well as communication therapy (Er-ber, 1996, 2002; Erber, & Lind, 1994) and psychosocial intervention (Pedley, Giles, & Hogan, 2005).
Hearing handicap and quality of life: Reports by cochlear implantees and their frequent communication partners
(Speech Pathology Association of Australia Ltd., 2001-05) Williams, Natalie; Lind, Christopher; Russell, Alison; Swiderski, Nina
Questionnaires concerning communication, hearing handicap and quality of life were posted to all 55 adult cochlear implantees known to be resident in South Australia. Parallel questionnaires were included for completion by a chosen frequent communication partner. This interim analysis focuses on replies from 34/55 (61.8%) of recipients currently received on two scales included in the questionnnaire; the Hearing Handicap Inventory for the Elderly (HHIE - Ventry & Weinstein, 1982), and the SF-36 (Ware, Snow, Kosinski & Gandek, 1993). The main results indicate that: (a) implantees and their frequent communication partners substantially agree in their assessment of the hearing handicap remaining post-implantation, and (b) implantees’ ratings of aspects of quality of life are similar to those of the general population in South Australia. These results indicate both the complimentary and confirmatory nature of these two scales. Implications for assessment and intervention for this population are discussed in light of these findings.
Decision-making and outcomes of hearing help-seekers: A self-determination theory perspective
(Taylor & Francis Group, 2016-01-11) Ridgway, J; Hickson, L; Lind, Christopher
Objective: To explore the explanatory power of a self-determination theory (SDT) model of health behaviour change for hearing aid adoption decisions and fitting outcomes. Design: A quantitative approach was taken for this longitudinal cohort study. Participants completed questionnaires adapted from SDT that measured autonomous motivation, autonomy support, and perceived competence for hearing aids. Hearing aid fitting outcomes were obtained with the international outcomes inventory for hearing aids (IOI-HA). Sociodemographic and audiometric information was collected. Study sample: Participants were 216 adult first-time hearing help-seekers (125 hearing aid adopters, 91 non-adopters). Results: Regression models assessed the impact of autonomous motivation and autonomy support on hearing aid adoption and hearing aid fitting outcomes. Sociodemographic and audiometric factors were also taken into account. Autonomous motivation, but not autonomy support, was associated with increased hearing aid adoption. Autonomy support was associated with increased perceived competence for hearing aids, reduced activity limitation and increased hearing aid satisfaction. Autonomous motivation was positively associated with hearing aid satisfaction. Conclusion: The SDT model is potentially useful in understanding how hearing aid adoption decisions are made, and how hearing health behaviour is internalized and maintained over time. Autonomy supportive practitioners may improve outcomes by helping hearing aid adopters maintain internalized change.
Adults’ Perceptions of Their Tinnitus and a Tinnitus Information Service
(Australian Academic Press, 2010) Adams, Jennie; Verrier, Emily; Walsh, Megan; Lind, Christopher
The South Australian Government funds Tinnitus SA to provide advice and information to South Australians to assist in their understanding of tinni-tus and their decision making about tinnitus-related service provision. This qualitative study aimed to identify key motivations for adults seeking tinnitus advice, determine how those services are perceived, and provide insight into the help-seeking behaviour of those who experience tinni-tus. Participants in this study were recruited from Tinnitus SA’s attendance lists for their community information sessions held in 2008 and 2009. Of the 60 people contacted, 13 adults agreed to particpate in the semistructured interviews. Interviews, lasting approximately 45 minutes focused on interviewees’ perceptions of their tinnitus prior to attending the Tinnitus SA information session, their response to the information session itself, and their perceptions and actions following the information session. Grounded theory was used as the guiding method-ology for analysis of the transcribed interview data. The themes that emerged during analysis of the interviews fell into two broad descriptive categories: Empowerment through information and education; and If you can’t cure me I’ll cope. Together these categories led to the overarching theme of participants’ responses: ‘I don’t need help, but I’d like more information’. Further analy-sis revealed that the Tinnitus SA community sessions were the primary source of information for the majority of these participants and there was a high level of satisfaction with these sessions by contrast to other information sources.
Attendees’ Perceptions of, Motivation for and Outcomes, Following an Adult Group Aural Rehabilitation Program
(Australian Academic Press, 2010-11) Golder, Fleur; Walsh, Erin; Buchanan, Angus; Lind, Christopher
The aim of this grounded theory (GT) study was to gain insight into adult participants’ perceptions of a group aural rehabilitation (AR) program. The partici-pant group for this in-depth interview-based study were 8 female and 2 male adults with acquired hearing losses who had completed an introductory group AR course conducted by South Australian organisation Hearing Solutions (now Guide Dogs of South Australia and Northern Territory Hearing Services) in the prior 12 months. Semistructured interviews were carried out and analysed using GT methodology. The core category (Empowerment through improved self-image) describes the overall main benefit the partici-pants reported from attending the course. Six descriptive categories were found that underpinned the core category: Improved understanding of communication strategies, Improved social relation-ships, Course satisfaction, Personal validation from social interaction, Decreased emotional isolation, and Improved self-confidence. An additional three descriptive categories were discovered that related to factors that motivated people to attend the course: Motivation for change, Hearing difficulties, and Negative self-perceptions of hearing loss. The current study provides a model for understanding how these factors may interrelate, and highlights the importance of motivation and group interaction in obtaining positive outcomes in AR
Self-Reported Hearing Handicap and Mental Health in Australia: Some Preliminary Findings
(Australian Academic Press, 2010-11) Veale, Holly; Gill, Laura; Ng, Swee Guan; Lind, Christopher; Bond, Malcolm James
It has long been suggested that the consequences of adult hearing impairment (HI) include stress, anxiety and depression, yet relatively little formal assessment of mental health status amongst adult Australians who have acquired HI has been reported. This questionnaire- based study investigated the self-reported hearing handicap and mental health characteristics of a sample of 375 Australian adults with HI who were members of Better Hearing Australia (BHA) in six Australian states/territories. Participants completed two mental health questionnaires; the Kessler Psychological Distress Scale-10 (K-10; Kessler, Andrews, Colpe, & Hiripi, 2002) and the Depression- Anxiety-Stress Scale (DASS; Lovibond & Lovibond, 1995) as well as the short version of the Hearing Handicap Inventory for Adults — Screening Version (HHIA-S; Newman, Weinstein, Jacobson, & Hug, 1990). No difference was found in the prevalence of psychological distress amongst participants compared to that of the Australian adult population. It was noted, however, that increased severity of self-reported hearing handicap was associated with higher levels of self-perceived psychological distress. In turn, high or very high levels of psychological distress measured on the K-10 were correlated with depressive states more than with stress or anxiety ratings on the DASS. The results highlighted the need to incorporate a combination of questionnaire-based measures in evaluating self-reported mental health and hearing handicap.
Conversation Repair and Acquired Hearing Impairment: A Preliminary Quantitative Clinical Study
(Australian Academic Press, 2004-04) Lind, Christopher; Hickson, L
This report provides a quantitative summary of the initial findings in a series of investigations into the validity and reliability of repair behaviour recorded in free conversation in clinical settings between adults who have acquired hearing impairments (HIs) and their frequent communication partners (FCPs). Seven adults who have severe or greater acquired HIs (and who had subsequently been either fitted with hearing aids or undergone cochlear implanta-tion) were audio-recorded undertaking a 20-minute free conversation in a quiet clinical setting with their chosen FCP. Transcriptions of the conversations were analysed for the occurrence of repair sequences following the Conversation Analysis (CA) model. A total of 735 completed repair sequences were identi-fied across the seven conversations, the majority occurring within the same turn as the trouble source. No difference was noted in the frequency with which all but one trajectory was initiated by either the HI or FCP participants. Repairs initiated by the HI participant and repaired by the FCP in response to a trouble source in a previous turn by the FCP occurred significantly more often than the same sequence initiated by the FCPs. The results empha-sise the usefulness of framing repair activity arising from acquired HI in the broader conversational act of repairing and the CA model.
Auditory-visual speech perception: The effect of visual acuity in older people
(Australian Academic Press, 2004-03) Hickson, Louise; Hollins, Manda; Lind, Christopher; Worrall, Linda; Lovie-Kitchin, Jan E
This study aimed to investigate the benefit gained by older people in auditory-visual speech perception compared to auditory-only perception and to investigate the correlation between visual acuity and benefit gained. A total of 77 community-based older people participated in the study. Pure-tone audiometry showed that 36% had normal hearing, 40% had a mild hearing loss and the remainder (23%) had a moderate or greater loss. Objective easurements of corrected distance and near visual acuities were obtained using the Bailey-Lovie logMAR distance and near visual acuity tests. According to the criteria used in the present study, 34% had some distance vision impairment and 9% had some near vision impairment. The benefit gained in auditory-visual speech perception was determined by comparing auditory-only and auditory-visual performance on the Bamford-Kowal-Bench Australian Version Speech reading Test. An average visual benefit of 28.8% was achieved by the participants, and, for the vast majority of participants (86%), the benefit gained was statistically significant. A significant correlation was not found between either distance or near visual acuity and benefit gained in auditory-visual speech perception. The implications of these findings are that it is important for audiologists to recommend the use of lipreading to older clients, irrespective of their visual impairment, as the majority will gain significant benefit from the use of visual cues.
Aphasia Rehabilitation Service Delivery in a Stroke Rehabilitation Unit in Australia: A Clinical Audit of Speech Pathology Practices
(Nova Southeastern University, 2016-04) Rej, Laleh; Doeltgen, Sebastian; Rodriguez, A; van Steenbrugge, Willem
Purpose: To investigate service delivery of aphasia rehabilitation in a metropolitan rehabilitation hospital by speech pathologists and assess adherence to both the National Stroke Foundation (NSF) Clinical Guidelines and the Australasian Rehabilitation Outcomes Centre (AROC) database of benchmarks. Method: A retrospective audit of 34 discharged patients was conducted within a dedicated stroke rehabilitation unit from March 2012 to July 2013 in Australia. Discharge reports, Functional Independence Measure (FIM) scores and clinical time statistics derived from the organization’s electronic database were studied and compared with NSF’s Clinical Guidelines for best practice recommendations and AROC benchmarks. Results: Patients with aphasia were admitted to inpatient rehabilitation at an average of 21 days post stroke, 2 days beyond the AROC benchmark for inpatient rehabilitation. The mean length of stay of patients with aphasia was 60 days, significantly longer than the average AROC benchmark of 32.8 days. Patients received an average of 4.25 hours of speech pathology therapy per week, more than twice the minimum amount of therapy time recommended by the NSF Guidelines. Conclusion: The current clinical audit is the first known speech pathology audit investigating adherence to stroke and aphasia rehabilitation guidelines set forth by the NSF clinical guidelines and AROC benchmarks in Australia. By comparing current care with advocated best practice, strengths were identified in service delivery, as well as priority areas for quality improvement.
Swallowing Neurorehabilitation: From the Research Laboratory to Routine Clinical Application
(Elsevier, 2012-01-27) Doeltgen, Sebastian; Huckabee, Maggie-Lee
The recent application of neurostimulation techniques to enhance the understanding of swallowing neural plasticity has expanded the focus of rehabilitation research from manipulation of swallowing biomechanics to manipulation of underlying neural systems. Neuromodulatory strategies that promote the brain's ability to reorganize its neural connections have been shown to hold promising potential to aid the recovery of impaired swallowing function. These techniques include those applied to the brain through the intact skull, such as transcranial magnetic stimulation or transcranial direct current stimulation, or those applied to the sensorimotor system in the periphery, such as neuromuscular electrical stimulation. Recent research has demonstrated that each of these techniques, either by themselves or in combination with these and other treatments, can, under certain circumstances, modify the excitability of motor representations of muscles involved in swallowing. In some studies, experimentally induced plastic changes have been shown to have functional relevance for swallowing biomechanics. However, the transition of novel, neuromodulatory brain stimulation techniques from the research laboratory to routine clinical practice is accompanied by a number of ethical, organizational, and clinical implications that impact professions concerned with the treatment of swallowing rehabilitation. In this article, we provide a brief overview of the neuromodulatory strategies that may hold potential to aid the recovery of swallowing function, and raise a number of issues that we believe the clinical professions involved in the rehabilitation of swallowing disorders must confront as these novel brain stimulation techniques emerge into clinical practice.
Supervising international students in clinical placements: perceptions of experiences and factors influencing competency development
(BioMed Central, 2016) Attrill, Stacie Lorraine; Lincoln, M; McAllister, Sue Margery
Background Health professional education programs attract students from around the world and clinical supervisors frequently report that international students find learning in clinical placement contexts particularly challenging. In existing literature clinical supervisors, who support international students on placement have identified concerns about their communication and interactions within clinical environments. However, clinical supervisors’ perspectives about their experiences with international students on placement and the strategies they utilise to facilitate international student learning have not been described. As a result we have little insight into the nature of these concerns and what clinical supervisors do to support international students’ competency development. Methods Five focus group interviews were conducted with twenty Speech-Language Pathology clinical supervisors, recruited from 2 Australian universities. Interview data were analysed thematically. Themes identified were interpreted using cognitive load and sociocultural learning theories to enhance understanding of the findings. Results Four themes were identified: ‘Complex teaching and learning relationships’, ‘Conceptions of students as learners’; Student communication skills for professional practice’, and ‘Positive mutual learning relationships’. Conclusions Findings indicated that clinical supervisors felt positive about supporting international students in clinical placements and experienced mutual learning benefits. However, they also identified factors inherent to international students and the placement environment that added to workload, and made facilitating student learning complex. Clinical supervisors described strategies they used to support international students’ cultural adjustment and learning, but communication skills were reported to be difficult to facilitate within the constraints of placements. Future research should address the urgent need to develop and test strategies for improving international students’ learning in clinical settings.
Redefining ‘Chinese’ L1 in SLP: Considerations for the assessment of Chinese bilingual/bidialectal language skills
(Taylor & Francis, 2015-12-04) Han, Weifang; Brebner, Christine Mary; McAllister, Sue Margery
Purpose: Language assessment of bilingual/bidialectal children can be complex. This is particularly true for speakers from China, who are likely to be bilingual and bidialectal at the same time. There has been, however, a lack of understanding of the diversity of Chinese languages as well as data on bidialectal children’s L1 syntactic development and the development of L1 bidialectal children’s L2 acquisition. Method: This paper provides information on the complexity of the language system for people from China. It will present illustrative examples of the expressive language outputs of bilingual and bidialectal children from the perspective of bilingual, bidialectal linguists and speech-language pathologists. Then it will outline why appropriate assessment tools and practices for identification of language impairment in bilingual Chinese children need to be developed. Result: Considerations include that Chinese bilingual children may differ in L2 performance because of lack of exposure in the target language or because of their varied L1 dialectal backgrounds, but not necessarily because of language impairment. Conclusion: When evaluating morphosyntactic performance of bilingual children, a series of reliable threshold indicators for possible language impairment is urgently needed for SLPs to facilitate accurate diagnosis of language impairment.
Implications of Variability in Clinical Bedside Swallowing Assessment Practices by Speech Language Pathologists
(Springer, 2016-07-12) McAllister, Sue Margery; Kruger, Samantha; Doeltgen, Sebastian; Tyler-Boltrek, Emma
Speech language pathology (SLP) clinical bedside swallowing assessments (CBSA) are a cornerstone of quality care for patients in acute hospitals who have dysphagia. The CBSA informs clinical diagnosis and decisions regarding further instrumental assessment, and is used to develop a management plan and monitor progress. However, self-report and retrospective research shows that SLPs are highly variable in their use of assessment components considered by experts to be important for quality CBSA, casting doubt on the validity and reliability of CBSA. This prospective study describes the components included by SLPs when designing a standardised evidence based dysphagia assessment protocol for acute care patients and observed patterns of component use. The findings confirm that SLPs use the CBSA for multiple purposes beyond diagnosis of aspiration risk and dysphagia presence/severity. They are highly variable in their use of certain components, but also demonstrate consistent use of a core set. It is apparent that SLPs prioritise the application of clinical reasoning to tailor their CBSA to the patient over following a highly structured item-based protocol. The variability in component use likely reflects a complex clinical reasoning process that draws on a wide variety of information combined with expert knowledge as is also observed in many other medical specialties. Rather than promoting the standardisation of CBSA protocols that constrain SLP practice to strict item-based assessment protocols, consideration should be given to promoting the value and facilitating the clinical reasoning process that supports the utility of the CBSA for diagnosis, patient centred management and treatment planning.
A survey of thickened fluid prescribing and monitoring practices of Australian health professionals.
(John Wiley & Sons, 2014) Murray, Jo; Miller, Michelle Deanne; Doeltgen, Sebastian; Scholten, Ingrid Maria
RATIONALE, AIMS AND OBJECTIVES: This study aimed to describe (1) how thickened fluids are supplied to clients with dysphagia; (2) how clients' consumption of thickened fluids and hydration status is monitored; and (3) the impact of institutional factors on thickened fluid intake and hydration in Australian health care settings. METHODS: Speech pathologists, dietitians and nurses working in Australian health care settings were asked to voluntarily participate in an online survey that was advertised through their respective professional associations. The questions required a self-report of their practice with respect to thickened fluids. RESULTS: Few health care facilities (17%) monitored thickened fluid consumption routinely even though, in the opinion of 51% the respondents, clients on thickened fluids at their facility do not drink enough. Palatability of the thickened fluid products and patients' dependence on others for drinking were thought to have a major impact on fluid intake. Respondents also highlighted institutional factors such as inadequate assistance from staff and inconsistent systems for monitoring fluid intake and signs of dehydration. The most common way to address inadequate intake was for nurses to 'push fluids' (87%). Free water protocols were used only 14% of the time and setting small oral fluid targets throughout the day was the least common strategy (11%). CONCLUSIONS: There is a need for Australian health care facilities to educate all clinical staff about the risks of dehydration and develop clinical pathways for clients with dysphagia, which include routine monitoring of oral fluid consumption and dehydration and timely intervention.

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