Rachel Wenke

The short- and long-term effectiveness of the LSVT®for dysarthria following TBI and stroke

Objectives: To examine the effectiveness of Lee Silverman Voice Treatment (LSVT®) for the treatment of 10 individuals with dysarthria following TBI and stroke. Research design: ABAA experimental research design. Methods: Participants received 4 weeks of the standard LSVT® programme. To measure the effects of intervention, participants were assessed using perceptual and acoustic speech measures and everyday communication outcome measures prior to, immediately post and 6 months post-treatment. Results: Following treatment, participants demonstrated statistically and clinically significant improvements to several acoustic and perceptual parameters. This included increased vocal loudness in sustained phonation and connected speech, increased vocal frequency range and improved word and sentence intelligibility. Improved ratings of communication initiation and participation and well-being were also found on the AusTOMs and items on participant questionnaires post-LSVT®. The majority of treatment effects were maintained 6 months following treatment. Conclusions: LSVT® has the potential to be a viable treatment option for individuals with dysarthria featuring respiratory-phonatory impairments following TBI and stroke.

Feasibility and cost analysis of implementing high intensity aphasia clinics within a sub-acute setting.

Abstract The current study explored the clinical feasibility and costs of embedding three different intensive service delivery models for aphasia treatment (computer, group therapy, and therapy with a speech pathology therapy assistant) within three sub-acute facilities. The study employed a two cohort comparison design, with the first cohort (n = 22) receiving the standard service of treatment currently offered. This treatment was delivered by a speech-language pathologist and involved on average 3 hours of treatment/week over 8 weeks. Participants in the second cohort (n = 31) received one of the three intensive treatment models providing up to 9 hours of therapy/week for 11 weeks. Organizational data was collected throughout treatment, with participant, caregiver, and clinician satisfaction with the intensive models also being measured. Participants completed the spoken language production sub-tests and the Disability Questionnaire of the Comprehensive Aphasia Test (CAT) pre- and post-treatment. All intensive models yielded high participant attendance, satisfaction, and significant improvements to the CAT sub-tests. The pro-rata cost of providing treatment per hour per client for the computer and group therapy models was found to be ˜ 30% cheaper compared to the standard service. The outcomes support the potential feasibility of embedding the different models into sub-acute facilities to enhance client access to intensive treatment for aphasia.

Effectiveness of Lee Silverman Voice Treatment (LSVT)® on hypernasality in non-progressive dysarthria: the need for further research

BACKGROUND Hypernasality is a common feature of non-progressive dysarthria. However, limited research has investigated the effectiveness of treatments for this impairment. Preliminary research has revealed positive effects on nasalance when using increased loudness in certain non-progressive dysarthric speakers. However, the long-term effects of loud speech on nasalance as part of a structured intervention such as Lee Silverman Voice Treatment (LSVT) are yet to be investigated in this population. AIMS The study aimed to investigate the short- and long-term effects of LSVT on hypernasality (perceptual ratings and degree of nasalance) in non-progressive dysarthria; and secondly, to evaluate the effects of traditional dysarthria therapy on these same measures, in comparison with the effects of LSVT. METHODS & PROCEDURES Ten non-progressive dysarthric speakers with varying levels of hypernasality (taken from a larger research study) were randomly allocated to receive LSVT((R)) (n = 5) or individually tailored traditional dysarthria therapy (n = 5). Both treatments were administered four times weekly for 4 weeks (that is, 16 x 1-hour sessions). Participants were assessed twice before treatment, twice immediately post-treatment, and twice at follow-up 6 months post-treatment using a perceptual rating task performed by two independent speech pathologists, and the Nasometer. Changes to individual mean nasalance scores were compared against clinically significant criterion and perceptual ratings were analysed descriptively. OUTCOMES & RESULTS Three out of five participants demonstrated reductions in perceived hypernasality immediately following LSVT, but these changes were maintained at follow-up for only one participant. Two of these three participants demonstrated a corresponding reduction in mean nasalance. Limited changes in perceived hypernasality and nasalance scores were found following traditional dysarthria therapy, with only one participant exhibiting reduced nasalance at follow-up. CONCLUSIONS & IMPLICATIONS Due to the small sample size in the present research and variability between participants, further exploration into the effects of LSVT on nasality with a larger population with different dysarthria types is essential.

The role and impact of research positions within health care settings in allied health: a systematic review.

BackgroundEmbedding dedicated research positions within healthcare settings is a potential strategy to build allied health research capacity, with different health care organisations investing in such positions. The aim of this review was to gather evidence regarding the nature of the role of the research position in allied health professional (AHP) healthcare settings and the impact that these positions have on building research capacity.MethodsA systematic review was undertaken searching eight databases (Medline CINAHL, Cochrane, OTSeeker, Speechbite, PEDro, Web of Science, and Proquest) using English language restrictions. Both authors independently screened abstracts, reviewed full-text articles, extracted data and performed quality assessments using the Mixed Methods Appraisal Tool. Studies were included that reported the evaluation and/or components of the role of a dedicated research position with AHPs in any healthcare setting. A thematic analysis approach was used to synthesise findings.ResultsA total of 360 abstracts were initially screened, with 58 full text articles being reviewed. Eight unique studies were included in the thematic analysis clarifying either the nature of role of the research position (n = 7) or impact of the position (n = 4). Studies included mixed methods (n = 3), descriptive case study (n = 4), and observational (n = 1) designs. The majority of studies reported the research positions to provide academic support to individual clinicians and their teams, while developing their own research projects. Other studies reported support for research capacity building at a service and organisational level. Positive changes from these research positions was reported via increased individual research skills and participation and research outputs, improvements in research culture, attitudes and team and organisational level skills.ConclusionEmerging evidence suggests that research positions embedded within healthcare settings can influence individual and team based research skills and research participation of AHPs. Future research is needed to further investigate the sustainability of changes arisen from research positions and what mechanisms of the positions have the greatest impact. Healthcare managers should consider how to support potential components of the research position roles identified in the literature, as well consider evaluating their impact on research capacity, cultural and attitudinal changes of AHP staff in addition to traditional research metrics.

Allied health research positions: a qualitative evaluation of their impact

BackgroundResearch positions embedded within healthcare settings have been identified as an enabler to allied health professional (AHP) research capacity; however, there is currently limited research formally evaluating their impact. In 2008, a Health Practitioner industrial agreement funded a research capacity building initiative within Queensland Health, Australia, which included 15 new allied health research positions. The present project used a qualitative and realist approach to explore the impact of these research positions, as well as the mechanisms which facilitated or hindered their success within their respective organisations.MethodsForty-four AHP employees from six governmental health services in Queensland, Australia, participated in the study. Individual interviews were undertaken, with individuals in research positions (n = 8) and their reporting line managers (n = 8). Four stakeholder focus groups were also conducted with clinicians, team leaders and professional heads who had engaged with the research positions.ResultsNine key outcomes of the research positions were identified across individual, team/service and organisational/community levels. These outcomes included clinician skill development, increased research activity, clinical and service changes, increased research outputs and collaborations, enhanced research and workplace culture, improved profile of allied health, development of research infrastructure, and professional development of individuals in the research positions. Different mechanisms that influenced these outcomes were identified. These mechanisms were grouped by those related to the (1) research position itself, (2) organisational factors and (3) implementation factors.ConclusionsThe present findings highlight the potential value of the research positions for individuals, teams and clinical services across different governmental healthcare services, and demonstrate the impact of the roles on building the internal and external profile of allied health. Results build upon the emerging evidence base for allied health research positions and have important implications for a number of stakeholders (i.e. individuals in the research positions, AHPs and their managers, university partners and state-wide executives). Key recommendations are provided for all stakeholders to enhance the ongoing impact of these roles and the potential advocacy for additional positions and resources to support them.

A cross sectional observational study of research activity of allied health teams: is there a link with self-reported success, motivators and barriers to undertaking research?

BackgroundTeam-based approaches to research capacity building (RCB) may be an efficient means to promote allied health research participation and activity. In order to tailor such interventions, a clearer understanding of current patterns of research participation within allied health teams is needed. Different self-report measures exist which evaluate a team’s research capacity and participation, as well as associated barriers and motivators. However, it remains unclear how such measures are associated with a team’s actual research activity (e.g., journal publications, funding received). In response, this observational study aimed to identify the research activity, self-reported success, and motivations and barriers to undertaking research of eight allied health professional (AHP) teams and to explore whether any relationships exist between the self-reported measures and actual research activity within each team.MethodsA total of 95 AHPs from eight teams completed the research capacity and culture survey to evaluate team success, barriers and motivators to undertaking research, and an audit of research activity from January 2013 to August 2014 was undertaken within each team. Kendell’s correlation coefficients were used to determine the association between research activity (i.e., number of journal publications, ethically approved projects and funding received) and the self-reported measures.ResultsSeven out of eight teams rated their teams as having average success in research and demonstrated some form of research activity including at least two ethically approved projects. Research activity varied between teams, with funding received ranging from

Clinicians’ perceptions of delivering new models of high intensity aphasia treatment

0 to over

Communication and well-being outcomes of a hybrid service delivery model of intensive impairment-based treatment for aphasia in the hospital setting: a pilot study

100,000, and half the teams not producing any journal publications. Team motivators demonstrated a stronger association with research activity compared to barriers, with the motivator “enhancing team credibility” being significantly associated with funding received. No significant association between self-reported research success and actual research activity was identified.ConclusionsPreliminary findings suggest that self-report measures of research success may not always correspond to actual research activity, and a combination of both these measures may be useful when planning RCB interventions. Variation in activity between teams and organisations should also be considered when tailoring RCB interventions. Reinforcing intrinsically motivating rewards of research may also be useful in promoting research participation for some teams.

Speech-Language Pathologist Interventions for Communication in Moderate–Severe Dementia: A Systematic Review

ABSTRACT Background: While evidence suggests that intensive aphasia therapy is associated with positive patient outcomes, speech language pathologists continue to report delivering therapy at low intensity schedules. Investigation of the barriers and enablers of delivering intensive therapy in hospital settings is needed to help address this evidence–practice gap. Aims: To explore clinicians’ perceptions of delivering high intensity aphasia treatment through three different service models and their recommendations for future directions in implementing high intensity aphasia clinics in a public health setting. Methods & Procedures: A sequential mixed methods design was employed. Thirteen speech language pathologists who provided intensive aphasia therapy to 31 patients across three facilities as part of a larger study consented to participate. Participants contributed to a log of barriers and facilitators while delivering treatment and completed a questionnaire in the last week of treatment. Findings were used to inform the question guide for a focus group interview conducted with nine of the clinicians post-treatment. Outcomes & Results: Most clinicians found the increased intensity of treatment more difficult to deliver than standard treatment, and reported barriers included patient fatigue, patient personal factors, locating resources, scheduling and coordination issues, and clinician workload and potential burn-out. Emotional challenges were less expected and were potentially intensified by the frequency of contact with patients. Despite this, clinicians remained dedicated, and were motivated by patient progress, peer support and the opportunity to prove the worth of speech language pathology. They were positive about the perceived benefits of patient confidence, clinician development, teamwork, and the relationships that formed between patients, carers and clinicians. Conclusions: Clinicians agreed that delivering the treatment brought great rewards and benefits, but also challenges. Communicating the benefits and finding ways to address the barriers identified by the participants of this study may be instrumental in assisting future implementation of high intensity models of aphasia treatment in existing services.

Strategies for research engagement of clinicians in allied health (STRETCH): a mixed methods research protocol

Abstract Purpose: This pilot study aimed to evaluate the effects of an intensive hybrid service delivery model (i.e., combining face-to-face individual, computer and group therapy) on communication and well-being for people with aphasia (PWA) in the hospital setting. Materials and methods: The study explored two different intensities of the hybrid model, 4 h/week (Hybrid-4) and 8 h/week (Hybrid-8) both for 8 weeks. Participants ranging from 1 month to 5 years post-onset were allocated using matched-pair randomisation to receive either Hybrid-4 (n = 5) or Hybrid-8 (n = 4) and assessed using a comprehensive language battery by a blinded assessor, as well as selected activity, participation and well-being measures before, immediately after and 4-week post-treatment. Results: All participants in Hybrid-4 and three out of four participants in Hybrid-8 demonstrated clinically significant improvement to measures of language impairment immediately post-treatment, with the majority also demonstrating maintenance effects 4-week post-treatment. Clinically significant improvements to activity, participation and well-being measures were also observed across participants in both groups. Conclusions: Findings support the potential benefit of employing an intensive hybrid service model and suggest that both 4 and 8 h per week of impairment-based treatment for 8 weeks may result in improvements in communication and well-being for some PWA across different stages of recovery. Implications for rehabilitation The present findings help bridge the gap between what evidence suggests is effective intensity of rehabilitation for aphasia and what can be practically delivered in real-world hospital settings. Findings support the potential clinical value of employing a hybrid service model (using computer, group and individual therapy) to deliver intensive rehabilitation to people with aphasia in the hospital setting, and suggest that clinically significant improvements to communication and well-being can result when the model is delivered at either 4 or 8 h per week. The current study highlights that people with aphasia in the early stages of aphasia recovery can potentially benefit from intensive impairment-based hybrid models of intervention.