Bernice Mathisen

A Systematic Review and Meta-analysis of Measurements of Tongue and Hand Strength and Endurance Using the Iowa Oral Performance Instrument (IOPI)

The purpose of this systematic review was to examine the evidence for the use of the Iowa Oral Performance Instrument (IOPI) to measure strength and endurance of the tongue and hand in healthy populations and those with medical conditions. A systematic search of the scientific literature published since 1991 yielded 38 studies that addressed this purpose. The IOPI was used primarily for tongue strength (38 studies) and endurance (15 studies) measurement; relatively few studies measured hand strength (9 studies) or endurance (6 studies). The majority of the studies identified used the IOPI as an evaluation tool, although four used it as an intervention tool. Half the studies were conducted in healthy people, primarily adults. Most of the other participants had disorders with dysphagia, primarily Parkinson’s disease or head or neck cancer. Age and gender, as well as a number of medical conditions, influence the values of tongue and hand strength. There is sufficient evidence to support the use of the IOPI as a suitable tool for measuring tongue strength and endurance and as an assessment tool for intervention studies, and there is growing support for its use to assess hand strength and endurance in healthy and clinical populations.

Reliability of Measurements of Tongue and Hand Strength and Endurance Using the Iowa Oral Performance Instrument with Healthy Adults

The purpose of this study was to investigate the reliability of tongue and handgrip strength and endurance measurements in healthy adults using the Iowa Oral Performance Instrument. Fifty-one healthy participants (21 males, 30 females; age range = 19–57 years) were tested on four occasions 1 week apart to determine test–retest reliability. The primary outcome measures were isometric tongue and handgrip strength (best of three trials) and sustained isometric endurance. Small increases (changes in group mean) in both anterior (1.7 %) and posterior (2.5 %) tongue strength and handgrip strength (5 %) between weeks 1 and 2 were observed with no change in subsequent weeks, suggesting that there is only a small learning effect for these measurements. The within-subject variation (mean-typical error expressed as a coefficient of variation [CV]) indicated higher than desirable initial variation for anterior (CV 10.8 %) and posterior (CV 11.8 %) tongue strength and handgrip strength (CV 15.2 %) but this was reduced in weeks 2–4. Intraclass correlation coefficients (ICC) indicated acceptable and improved reliability for both anterior (ICC 0.77–0.90) and posterior (ICC 0.79–0.86) tongue strength and handgrip strength (ICC 0.69–0.91) after week 1. Additional exploratory analyses were conducted with a subset of data to determine whether two values within 5 kPa (tongue) or 15 kPa (handgrip) provide superior strength reliability. Neither tongue nor hand endurance measurements were sufficiently reliable. These findings suggest that tongue and handgrip strength values demonstrate acceptable reliability, especially if familiarization is provided. Further investigation is needed to reduce sources of variability in tongue endurance measurements.

Incorporating speech-language pathology within Australian neonatal intensive care units

Working in neonatal intensive care units (NICU) is considered to be advanced practice for speech‐language pathologists (SLPs) requiring post‐graduate specialised education and ongoing clinical mentoring, not easily accessible within some countries such as Australia. This review investigated whether there was evidence to support SLPs as core NICU team members, rather than fleeting therapists. The review found that the roles and responsibilities of SLPs in NICUs included assessment and intervention of preterm infant communication, feeding and swallowing using a family‐centred approach. This approach was respectful of the cultural and linguistic diversity of the parents and the particular expertise of other NICU team members. Whilst there has been a significant and promising increase in research with regard to SLP involvement with preterm infants (especially around feeding and swallowing assessment and specific treatments), the need for high‐quality well‐designed research is essential.

The role of speech-language pathologists in adult palliative care

Abstract Purpose: Given minimal studies describing the role and practice of speech-language pathologists (SLPs) in adult palliative care, the aim of this review was to compile a database of research literature, examine the potential research gaps and to consider material that specifically discussed the need for and/or use of procedures and protocols for SLPs working in palliative care that would support the development of SLP palliative care guidelines. Method: A scoping review was conducted utilising Arksey and O’Malley’s framework with the goal of exploring any key concepts and approaches utilised by SLPs in adult palliative care, plus any literature and/or recommendations regarding SLP practice in adult palliative care settings. Result: Over 1200 articles were initially identified. Of the 1200 articles, 13 academic papers were considered relevant as they recommended, or at least suggested, the need for speech-language pathology therapy guidelines to be implemented within adult palliative care settings. Conclusion: The main focus of these articles was on ethical considerations and clinical recommendations for SLPs. Recommendations arising from this scoping review include providing goals to support current practising SLP clinicians and developing clinical guidelines to manage swallowing and/or communication needs of people receiving palliative care.

Religion, Spirituality and Speech-Language Pathology: A Viewpoint for Ensuring Patient-Centred Holistic Care

Abstract This paper presents a viewpoint concerning the largely neglected clinical relevance of spirituality and religious belief in speech-language pathology (SLP) assessments, interventions and outcomes across the lifespan. An overview of the refereed SLP literature is presented with regard to religion and spirituality. It was found that while there is increasing research with regard to spirituality, health and well-being, there is very little specific to SLP. What is available and clinically relevant, generally relates to holistic care and/or cultural and linguistic diversity. Amidst the health care literature, however, there is a growing number of recommended instruments (for religious/spiritual screening) sensitive to intercultural and interfaith issues that are currently available to medical, nursing, allied health and chaplaincy practitioners. These instruments can also be of value to SLPs to ensure holistic assessments and interventions. It would seem timely for SLPs (and other allied health practitioners) to consider including spiritual screenings/assessments as part of their clinical practice so as to ensure appropriate holistic care. This would also mean undertaking research and including relevant education within tertiary institutions and professional development programs.

Using tongue-strengthening exercise programs in dysphagia intervention

Abstract Purpose: The purpose of this article was to review the literature with regard to use of tongue-strengthening exercise in the management of swallowing disorders (dysphagia) such as those with cerebrovascular accident (stroke) or head and neck cancer. Methods: A database of articles published from 1984 to June 2010 was compiled from MEDLINE, CINAHL, and PubMed using combinations of the following key words: exercise, exercise therapy, swallowing, dysphagia, stroke, cerebrovascular disorder, tongue strength, tongue-strength exercise, lingual strength, age, intensity, head and neck cancer, and swallowing rehabilitation. References listed in identified publications as well as abstracts were examined. Studies that satisfied the following selection criteria were included: (1) individuals had a diagnosis of dysphagia after stroke or head and neck cancer; (2) effects of tongue-strength exercises were examined; and (3) the design of the studies was either randomized control trial (RCT), prospective cohort intervention study, or case study. Results: Analysis of candidate studies showed that tongue-strengthening exercise is applicable to dysphagia intervention in general. However, the optimum dose, frequency, and duration of the exercise required to rehabilitate tongue function has yet to be established. Conclusion: Tongue-strengthening exercise has the potential to be a simple yet effective therapeutic tool to add to the options for swallowing rehabilitation in adults.

Global Citizenship and Higher Education: A Scoping Review of the Empirical Evidence

Student attainment of capabilities associated with global citizenship remains a priority for higher education institutions. We report on a scoping review of empirical studies to explore how global citizenship is understood and enacted in higher education. The 29 included studies span the arts, psychology and social sciences, professional degrees, purpose-designed global citizenship courses, and community development, service, and educational travel programs. Notwithstanding considerable diversity in study aims, methodology, and how global citizenship was described, we were able to discern an overarching framework to describe the theoretical contributions to global citizenship education. Our findings contribute to building conceptual clarity both for educators charged with developing curricula and for higher education researchers seeking to explore and evaluate the outcomes of global citizenship education.

Speech–language pathology in paediatric palliative care: A scoping review of role and practice

Abstract Purpose: Attempts have been made within the literature to clarify the role and scope of speech–language pathologists (SLPs) within paediatric palliative care (PPC). As SLP literature regarding adult/geriatric populations is gaining traction, it is fitting to investigate the role of SLPs in the management of infants and children in end-of-life care. Method: Arksey and O’Malley’s (2005) scoping review method was utilised for searching multiple databases. Two database searches were undertaken. The first located literature in which SLP PPC intervention is specifically addressed. The second search utilised internationally recognised SLP scope of practice areas. Manual searching of reference lists was also utilised. Result: Themes identified included management of communication, feeding, upper-airway and oral health as well as the role of SLPs within a multidisciplinary PPC team. Conclusion: There is acknowledgement that SLPs have a role in PPC. However, there is little information identifying SLP involvement in the diagnosis and management of swallowing, cognition/communication, oral hygiene and upper airway issues. The available literature predominantly relies on limited adult palliative care research and does not address age-specific management approaches across the paediatric life-stage. Given an absence of SLP PPC guidelines, further research is warranted to explicitly define SLP scope of practice within this population.