Family Perceptions of Facilitators and Inhibitors of Effective School-Based Dysphagia Management

from Language, Speech, and Hearing Services in Schools

Abstract:Purpose: This qualitative study focused on the perceptions of family members of children with dysphagia by asking what the family-identified factors are that facilitate or inhibit effective school-based management of pediatric dysphagia. Method: Semistructured interviews of 7 family members of 6 children with dysphagia, ages 2 through 11 years, were conducted. Collective case study and cross-case analyses were conducted. The findings were confirmed through triangulation, respondent validation, and member checking. Results: Interviewees identified 5 facilitating factors that enhance school-based dysphagia programs: (a) setting, (b) therapist and/or program, (c) capitalizing on positive child characteristics, (d) home-school interactions, and (e) external supports. Four factors that inhibit effectiveness also emerged: (a) setting, (b) therapist and/or program, (c) limiting child characteristics, and (d) home-school interactions. Conclusion: Practitioners may consider addressing the factors that were identified as facilitators of effective programs. More research is needed concerning (a) factors promoting effective parent-professional relationships, (b) methods for increasing professional preparation in pediatric dysphagia, and (c) the efficacy of school-based pediatric dysphagia management programs. [ABSTRACT FROM AUTHOR]

Legal and Financial Issues Associated With Providing Services in Schools to Children With Swallowing and Feeding Disorders

from Language, Speech, and Hearing Services in Schools

Abstract:Purpose: This review of federal statutes and regulations, state and federal administrative and case law, and policy documents is designed to provide information regarding the treatment of children with swallowing and feeding disorders in the law for the purpose of identifying best practice procedures for school personnel serving children with swallowing and feeding disorders. Method: A narrative review of federal statutes and regulations, state and federal administrative and case law, and policy documents was conducted. The review identified prevailing and emerging policies related to serving children with swallowing and feeding issues in schools. In addition, federal standards regarding funding were reviewed for relevance to serving children with dysphagia. Implications: Statutes, regulations, and case law establish the rights of students with health impairments, including swallowing and feeding disorders, to receive such related services as are necessary to attend school safely. Recent administrative hearings have addressed dysphagia, identifying the importance of ensuring the child’s feeding safety through diet and services. School districts can receive reimbursement for services that are provided to children with dysphagia through Medicaid when said services are provided in accordance with each state’s Medicaid requirements. [ABSTRACT FROM AUTHOR]

Managing Dysphagia in the Schools

from Language, Speech, and Hearing Services in Schools

Abstract:Purpose: This epilogue summarizes the contribution of the articles in the clinical forum, “Managing Dysphagia in the Schools” and discusses future trends in pediatric dysphagia and the need for clinical practice and research. Method: The contribution of each of the 10 articles that make up the forum is summarized briefly. Conclusion: This clinical forum provides a discussion of numerous issues that need to be considered by clinicians working with children who exhibit swallowing and feeding problems and their families in school settings. Current and future challenges exist for clinicians, children, and families dealing with dysphagia. Discussion of current issues and strategies for successful treatment outcomes are provided. [ABSTRACT FROM AUTHOR]

Much mouth much tongue: Chinese metonymies and metaphors of verbal behaviour

from Cognitive Linguistics

Abstract:This paper explores metonymical and metaphorical expressions of verbal behaviour in Chinese. While metonymy features prominently in some of these expressions and metaphor in others, the entire dataset can be best viewed as spanning the metonymy-metaphor-continuum. That is, we observe a gradation of conceptual distance between the source and target which corresponds to the gradation of figurativity. Specifically, roughly half of the expressions we encounter are based on the ORGAN OF SPEECH ARTICULATION FOR SPEECH metonymy and can be considered as clustering around the metonymic pole. The other half can be seen as tending towards the metaphoric pole, as they are largely motivated by conceptual metaphors: (a) VERBAL BEHAVIOUR IS PHYSICAL ACTION, (b) SPEECH IS CONTAINER, (c) ARGUMENT IS WAR (or WORDS ARE WEAPONS) and (d) WORDS ARE FOOD. The interaction between metonymy and metaphor is an important cognitive strategy in the conceptualisation of verbal behaviour. The findings (i) evidence the gradient predictability of idiom meanings based on semantic compositionality, (ii) confirm the hypothesis of a bodily and experiential basis of cognition, (iii) suggest the existence of culture-specific models in the utilization of basic experiences, and (iv) point to the role of emotion in the metaphorisation of verbal behaviour as a socio-emotional domain. [ABSTRACT FROM AUTHOR]

Noun Phrase Elaboration in Children’s Spoken Stories

from Language, Speech, and Hearing Services in Schools

Abstract:Purpose: One feature of literate language, noun phrase elaboration, was examined in the oral fictional narratives of school-aged children. Method: Two narratives were elicited from 5-, 8- and 11-year-old children, 1 in response to a picture sequence and 1 in response to a single picture. Noun phrases were categorized into 4 types. Results: Simple designating noun phrases were produced by all children at age 5, simple descriptive noun phrases by all children at age 8, and noun phrases with postmodification by all children at age 11. All noun phrase types were produced by more children in object than in subject position and in the single picture than in the picture sequence context. Conclusion: There are important developmental changes in noun phrase elaboration in the elementary school years as children learn to manage narrative contexts. Even within picture tasks, variations in visual depiction can affect the use of elaborated noun phrases (ENPs), with more descriptive language more likely to occur in narratives based on a single picture fantasy context than on a realistic picture sequence context. Performance expectations for types of ENPs within these contexts are provided. These findings will be useful to school clinicians in evaluating and working on narrative language within the elementary school period. [ABSTRACT FROM AUTHOR]

Schoolchildren With Dysphagia Associated With Medically Complex Conditions

from Language, Speech, and Hearing Services in Schools

Abstract:Purpose: This article reviews population trends and general characteristics of children with dysphagia in schools, provides an overview of dysphagia teams and the roles of the speech-language pathologist (SLP) in school and hospital settings, and describes assessment and treatment of swallowing and feeding problems in children with complex medical histories. Method: A review of the literature of swallowing and feeding problems in young children and population trends for children who are at risk for dysphagia was completed. Two case studies are presented to illustrate the complexities that are common to this population and to provide practical information to maximize the health and education outcomes of children with dysphagia. Results: SLPs in schools are increasingly evaluating and treating children with dysphagia associated with medically complex conditions. There is a rising incidence in preterm births and the survival of medically fragile children, suggesting that a greater number of children will be at risk for dysphagia in the future. Limited evidence is available to support most therapeutic interventions. Conclusion: School-based SLPs are uniquely positioned to identify swallowing and feeding problems, evaluate and treat children with dysphagia, participate on dysphagia teams in the school setting, and interact with the medical team. [ABSTRACT FROM AUTHOR]

Subjects in the hands of speakers: An experimental study of syntactic subject and speech-gesture integration

from Cognitive Linguistics

Abstract:Work by Russell Tomlin has shown that there is a close relationship between the syntactic subject of an utterance and the entity the speaker’s attention is focused on while the utterance is being formulated, for descriptions of a simple event (Tomlin 1985, 1995, 1997). The experiment presented in this paper demonstrates that the same effect can be obtained for a more complex event, and that attention also impacts the spontaneous hand gestures produced along with speech. The paper shows that both syntactic subject and the information contained in gesture can be manipulated by changing which entity a speaker is focused on during utterance formulation. This pattern suggests that changes in conceptualization give rise to changes in both speech and gesture. [ABSTRACT FROM AUTHOR]

Training and Self-Reported Confidence for Dysphagia Management Among Speech-Language Pathologists in the Schools

from Language, Speech, and Hearing Services in Schools

ABSTRACT: Purpose: The number of children requiring dysphagia management in the schools is increasing. This article reports survey findings relative to speech-language pathologists’ (SLPs’) training and self-rated confidence to treat children with swallowing and feeding disorders in the schools. Method: Surveys were completed by 222 SLPs representing Virginia and its contiguous states. Queries on dysphagia training targeted formal education, on-the-job experiences, and current caseload information. In addition, participants self-rated their confidence to treat dysphagia. Results: Statistically significant relationships between training and self-confidence levels were demonstrated. Specifically, participation in continuing education and currency of educational activities revealed significant and moderately strong correlations to self-reported confidence to treat children with dysphagia in the school setting. Conclusion: Findings support continuing education as a correlate to self-reported confidence to treat dysphagia in the school setting among SLPs in Virginia and its contiguous states. Further research is merited to ascertain if these findings reflect national trends. Quantifiable, costeffective, and evidenced-based dysphagia training, consultancy, and management models are needed if school-based SLPs are to meet the increasing challenges of their diverse caseloads. [ABSTRACT FROM AUTHOR]

Transition From Tube to Oral Feeding in the School Setting

from Language, Speech, and Hearing Services in Schools

Abstract:Purpose: A school-based treatment program for tube-fed children with medically complex conditions and food refusal was implemented to facilitate the children’s transition to oral feeding and advance their eating skills. Method: The program combined educational and therapeutic goals. It was implemented in a regional public school for children with hearing impairments. A team approach was used. Collaboration with the student’s families, medical care providers, personal assistants, and classroom staff was maintained. Results: Detailed case reviews are provided for 2 of the children who completed the program at age 8;1 (years;months) and 7;8 after 29 and 26 months of treatment, respectively. At the end of the program, tube feeding was discontinued; the children were feeding themselves and taking medications orally. One child was using mature eating skills to eat an unrestricted diet; the other was eating a modified diet consisting of a full nutrient drink and limited smooth and lightly textured solids. Conclusion: Successful transition to oral feeding and advancement of developmental eating skills were accomplished in a school setting for long-term tube-fed children with medically complex conditions. The program included collaboration with family and medical personnel as well as integrated therapeutic and educational goals. [ABSTRACT FROM AUTHOR]

Using Motor Learning Approaches for Treating Swallowing and Feeding Disorders: A Review

from Language, Speech, and Hearing Services in Schools

Abstract:Purpose: This article discusses children’s development of mature swallowing and feeding as a process of skill acquisition and considers the applicability of motor learning concepts for advancing these capabilities in school-aged children. Method: The motor learning literature was reviewed, with concentration on (a) concepts that are relevant for the acquisition of skill and (b) structuring practice experiences to optimize learning. Results: The discussion includes (a) swallowing physiology with a focus on motor task components, (b) normal development of eating skills, (c) factors that may slow or disrupt normal development, (d) motor learning concepts found to influence learning efficiency and performance adequacy, (e) applications to the assessment and treatment of pediatric swallowing and feeding disorders, and (f ) an illustrative case history. Conclusion: Deficiencies in swallowing and feeding may encompass eating, saliva control, swallowing during oral hygiene, and swallowing medications. Motor learning literature provides a rich foundation of evidence-based theory and educational strategies for the development and remediation of motor-based skills such as swallowing and feeding. [ABSTRACT FROM AUTHOR]

Long Term Communication Support For Stroke Survivors Totally Inadequate

from Medical News Today.com

According to new figures from The Stroke Association, a staggering nine out of ten (88 per cent) of stroke survivors in England are left unsupported and isolated in the community.

A new paradigm to inform inter-professional learning for integrating speech and language provision into secondary schools: a socio-cultural activity theory approach

from Child Language Teaching and Therapy

The paper presents a new way of understanding and investigating inter-professional learning across agencies for children and young people with speech, language and communication needs (SLCN) in schools in England. It considers specifically speech and language therapy staff and school staff learning to work together and working to learn together in secondary mainstream provision. Concepts and analysis of learning to work collaboratively are orientated by socio-cultural activity theory. In addition, evidence of learning for risk-taking and resilience are presented which are not readily analysed by the theory. The paper argues for considering collaborative working as organizational learning predicated on collective, rather than individual, engagement.

Change for children with language and communication needs: creating sustainable integrated services

from Child Language Teaching and Therapy

This paper takes a `whole system’ view of the opportunities and challenges presented to those working to achieve better outcomes for children. Collaboration will be considered from a multi-layered perspective, taking into account practitioner, operational, strategic and national levels of collaboration and the factors which have been identified to be of relevance to outcomes. Policy and legislation will be summarized as applied to the delivery of effective services for children with speech, language and communication needs. The paper will then explore models which are emerging or in development within the new structures resulting from the policy agenda over the past decade. The aim is to provide examples and discussion of novel systems. Consequently the paper does not present retrospective data in terms of evaluation of models as this will require a longitudinal approach as the new structures unfold.

Measures for rating social participation in people with aphasia: a systematic review

from Clinical Rehabilitation

Background: Re-establishing participation in social life is an important aim of rehabilitation, but instruments to measure participation in people with aphasia are rare.

Aims: To identify and describe measures of social participation that may be specifically useful when measuring participation in people with aphasia.

Methods and procedures: A systematic review of the literature concerning participation instruments was conducted. Then six speech and language therapists evaluated the suitability of selected participation measures for use in people with aphasia and a systematic literature review concerning the feasibility, internal consistency, validity, reliability and responsiveness of the measures selected by the therapists was carried out.

Results: In total 12 instruments measuring aspects of participation were found: seven measured actual performance and five measured actual performance combined with experienced problems. Two were considered unsuitable for people with aphasia, leaving 10. Six speech and language therapists working with people with aphasia scored the 10 selected instruments, and two instruments were judged as possibly suitable for use in people with aphasia: the Community Integration Questionnaire (CIQ) and the Nottingham Extended Activities of Daily Living (NEADL). However, the Community Integration Questionnaire is much closer to the concept of participation. The literature review concerning the psychometric properties of the Community Integration Questionnaire revealed that very little is known about the use of this instrument in people with aphasia.

Conclusion: The Community Integration Questionnaire is possibly suitable for use in people with aphasia when measuring participation, but data on its psychometric properties in people with aphasia are absent.

Other ways of seeing; other ways of being: imagination as a tool for developing multiprofessional practice for children with communication needs

from Child Language Teaching and Therapy

The purpose of this discussion paper is to explore ways in which professionals working in multi-professional settings can develop their understanding of the different perspectives and knowledge bases of team members in order to build new working practices together. The importance of exploring professional identity in professional development programmes for new teams is emphasized. The authors draw on their own experience of leading professional development to suggest the use of imagination as a key tool that can enable professionals to develop new ways of understanding the perspectives of others and to forge new identities for themselves in multi-professional teams. On foundations of mutual understanding professionals can begin to develop effective multi-professional working to meet the needs of children with communication difficulties.