Publications by authors named "Kathryn Yorkston"

80 Publications

Predicting Communicative Participation in Adults Across Communication Disorders.

Am J Speech Lang Pathol 2021 Mar 3:1-13. Epub 2021 Mar 3.

Department of Rehabilitation Medicine, University of Washington, Seattle.

Purpose The purpose of this study was to explore the extent to which communicative participation differs across diagnoses and if there are common predictor variables for communicative participation across diagnoses. Method Survey data on self-report variables including communicative participation were collected from 141 community-dwelling adults with communication disorders due to Parkinson's disease, cerebrovascular accident, spasmodic dysphonia, or vocal fold immobility (VFI). Analysis of covariance was used to determine communicative participation differences between diagnoses, with age, sex, and hearing status as covariates. Sequential entry linear regression was used to examine associations between communicative participation and variables representing a range of psychosocial constructs across diagnoses. Results The VFI group had the least favorable communicative participation differing significantly from Parkinson's disease and spasmodic dysphonia groups. Self-rated speech/voice severity, self-rated effort, mental health, perceived social support, and resilience contributed to variance in communicative participation when pooled across diagnoses. The relationship between communicative participation and the variables of effort and resilience differed significantly when diagnosis was considered. Conclusions The findings suggest that communicative participation restrictions may vary across some diagnoses but not others. People with VFI appear to differ from other diagnosis groups in the extent of participation restrictions. Effort and resilience may play different roles in contributing to communicative participation in different disorders, but constructs such as social support, severity, and mental health appear to have consistent relationships with communicative participation across diagnoses. The findings can help clinicians identify psychosocial factors beyond the impairment that impact clients' communication in daily situations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1044/2020_AJSLP-20-00100DOI Listing
March 2021

Exploring the Psychosocial Impact of Botulinum Toxin Type A Injections for Individuals With Oromandibular Dystonia: A Qualitative Study of Patients' Experiences.

Am J Speech Lang Pathol 2021 Feb 25:1-15. Epub 2021 Feb 25.

Department of Rehabilitation Medicine, University of Washington, Seattle.

Purpose The purpose of this study was to explore the psychosocial impact of botulinum toxin (BoNT) injections for oromandibular dystonia (OMD) and to gain a better understanding of how participants judge the success of this treatment. Method Eight individuals with OMD and dysarthria participated in one face-to-face, semistructured interview. Interviews were audio-recorded and transcribed verbatim. Qualitative, phenomenological methods of coding, immersion, and emergence were used in the analysis of interview data. Results Two major themes and six subthemes emerged from the analysis of interview data. The first theme, , explored the participants' perspective of receiving BoNT injections and its psychosocial impact. The second theme, , explored the psychosocial impact of BoNT on speech production and participation. Conclusions Our results suggest that BoNT has a variable impact on domains related to quality of life, satisfaction with treatment, speech production, and communicative participation. This study adds novel information related to the psychosocial consequences of BoNT treatment in the management of OMD and builds on a literature that studies the consequences and experiences of living with OMD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1044/2020_AJSLP-20-00124DOI Listing
February 2021

Training students from rehabilitation professions on communicating with patients with communication disorders.

PM R 2021 Feb 20. Epub 2021 Feb 20.

Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.

Introduction: FRAME, a mnemonic referring to a program for helping healthcare providers adapt patient-provider communication when working with patients with communication disorders, improves the knowledge, confidence, and communication skills of medical students for working with this population. However, the impact of the FRAME program for preparing students from the rehabilitation disciplines to work with patients with communication disorders is unknown.

Objective: To examine the effects of the FRAME program on the knowledge, confidence, and communication skills of students in physical therapy (PT), occupational therapy (OT), and prosthetics and orthotics (P&O) in terms of how to communicate effectively with patients with communication disorders.

Design: An exploratory, quasi-experimental pretest-posttest design.

Setting: PT, OT, and P&O clinical education programs at the University of Washington's Department of Rehabilitation Medicine.

Participants: Twenty rehabilitation students (PT = 12; OT = 7; and P&O = 1) participated in the FRAME training.

Interventions: The FRAME program, delivered in a single, two-hour session teaches students communication skills to use with patients with various types of communication disorders.

Main Outcome Measures: A quiz of students' knowledge about communication disorders and a self-rating of confidence for interacting with this patient population were used. Speech-language pathology graduate clinicians rated students' use of communication strategies from each area of the FRAME training during interactions with standardized patients portraying aphasia and dysarthria. Student qualitative feedback were also collected.

Results: Students' knowledge, confidence, and use of communication strategies improved significantly following training. Greatest gains were observed in students' ability to familiarize themselves with how a patient communicates and establish a method of communication before proceeding with the interview. Qualitative feedback aligned with these findings.

Conclusions: The FRAME program increases the knowledge, confidence, and use of communication strategies in rehabilitation students in order to communicate more effectively with patients with communication disorders in their future careers. This article is protected by copyright. All rights reserved.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/pmrj.12580DOI Listing
February 2021

Beyond the Patient: A Mixed-Methods Inquiry Into Family Members' Involvement in the Treatment of Parkinson's Disease to Target Third-Party Disability.

Am J Speech Lang Pathol 2021 01 29;30(1):169-185. Epub 2020 Dec 29.

Department of Rehabilitation Medicine, University of Washington, Seattle.

Purpose Family members of people with Parkinson's disease (PD) may experience third-party disability, manifesting as difficulty managing communication breakdowns and changed relationships influenced by communication disorders. This study examined family involvement in therapy to address third-party disability from the perspective of family members of people with PD and speech-language pathologists (SLPs). Method A mixed-methods design was used with two phases of data collection. In Phase 1 qualitative interviews, nine family members shared their perspectives about their involvement in therapy. In Phase 2, a survey was developed from Phase 1 data to gather data from SLPs ( = 110) on their clinical practices involving family members. Results Family members and SLPs agreed that when family were involved in therapy, it was primarily to support therapy exercises for the person with PD. Many SLPs reported providing supportive activities for family members. However, qualitative data from family members suggested that the limited involvement they had in therapy did not sufficiently meet their unique needs resulting from communication changes with the person with PD and other related challenges. Constraints influencing family member involvement included insurance billing regulations, privacy laws for patients, and family members' availability. Conclusions While some families and SLPs reported efforts to specifically include families and address their needs in therapy, these practices were inconsistent and, from families' perspectives, insufficient to meet their own needs. Future research should consider family-centered approaches that involve family members in speech-language therapy to enhance their daily lives, along with persons with PD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1044/2020_AJSLP-20-00168DOI Listing
January 2021

Communicative Participation and Quality of Life in Pretreatment Oral and Oropharyngeal Head and Neck Cancer.

Otolaryngol Head Neck Surg 2021 Mar 15;164(3):616-623. Epub 2020 Sep 15.

Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington, USA.

Objective: To determine how communicative participation is affected in patients with oral and oropharyngeal head and neck cancers (HNCs) pretreatment and whether communication function predicts HNC-specific quality of life (QOL) before treatment, beyond known demographic, medical, psychosocial, and swallowing predictors.

Study Design: Cross-sectional study.

Setting: Tertiary care academic medical center.

Methods: Eighty-seven patients with primary oral (40.2%) or oropharyngeal (59.8%) HNC were recruited prior to treatment. T stage, tumor site, and p16 status were extracted from medical records. Demographic and patient-reported measures were obtained. Communicative participation was measured using the Communicative Participation Item Bank (CPIB) General short form. A hierarchical regression analysis included demographic, medical, psychosocial, and functional measures of swallowing and communication as predictors; the University of Washington Quality of Life (UW-QOL v4) composite score was the predicted variable.

Results: Median (SD) baseline CPIB scores were 71.0 (11.83); patients with oral cancers reported worse scores. A final sequential hierarchical regression model that included all variables explained 71% of variance in QOL scores. Tumor site, T stage, and p16 status accounted for 28% of variance ( < .001). Perceived depression predicted an additional 28% of the variance ( < .001). Swallowing and communicative participation together predicted an additional 12% of variance ( = .005). Tumor site, perceived depression, swallowing, and communication measures were unique predictors in the final model. Finally, communicative participation uniquely predicted QOL, above and beyond other predictors.

Conclusion: Pretreatment communication predicted QOL and was negatively affected in some oral and oropharyngeal patients with HNC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0194599820950718DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933052PMC
March 2021

The best possible start: A qualitative study on the experiences of parents of young children with or at risk for fetal alcohol spectrum disorders.

Res Dev Disabil 2020 Feb 26;97:103558. Epub 2019 Dec 26.

Seattle Children's Research Institute, 2001 8th Ave, Seattle, WA, 98121, USA. Electronic address:

Background: The developmental outcomes and life course trajectories of young children with or at-risk for fetal alcohol spectrum disorders (FASD) can be optimized when individual and family needs are identified early and met with family-centered early intervention (EI) services. However, little is known about access to and quality of EI services with this high-needs population.

Method: Twenty-five biological or adoptive parents of children with or at high risk for FASD, living in the greater area of Seattle, Washington participated in this qualitative study. Three focus groups were conducted using a semi-structured interview guide. Participants described their experience with EI, as well as other supports and challenges faced in their child's first three years of life. Interviews were audio recorded, transcribed verbatim and coded using phenomenological methods. Themes that were consistent across participant groups emerged from the data, as well as themes that showed differences among participant experiences.

Results: Common EI supports and needs between biological and adoptive parent groups were identified. In addition, perspectives and needs unique to each parent group were revealed. Themes were identified and organized into three categories: (1) child needs; (2) parent needs and priorities; and (3) EI capacity. When parents talked about their child's cognitive, physical, communication or adaptive development, they all discussed how EI was meeting those needs. In contrast, when parents expressed concern for their child's social-emotional development, a description of how EI was supporting these needs was missing from the conversation. Parents appreciated when EI providers were truthful, provided anticipatory guidance, and connected them with supports for their own social-emotional well-being. Yet there were unmet needs for respite care, and parents expressed that support for basic needs related to child or family survival was not consistently recognized as a top priority for families. This high-risk group of young children and their parents also encountered a multitude of transitions in their child's early years and later. Parents wanted more support navigating these transitions as they entered or moved through different systems of care.

Conclusions: Parents appreciated and endorsed the importance of EI with its provision of individualized, family-centered supports and resources. Examination of the gaps and unmet needs that are common and distinct underscore the importance of an FASD-informed approach to EI. Study findings provide insight into areas for which EI enhancements could be developed in order to tailor supports for the complex needs of this diverse population of children and parents.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ridd.2019.103558DOI Listing
February 2020

Experiences of Speaking With Noninvasive Positive Pressure Ventilation: A Qualitative Investigation.

Am J Speech Lang Pathol 2019 07 15;28(2S):784-792. Epub 2019 Jul 15.

Department of Rehabilitation Medicine, University of Washington, Seattle.

Purpose The aim of this study was to describe experiences of speaking with 2 forms of noninvasive positive pressure ventilation (NPPV)-mouthpiece NPPV (M-NPPV) and nasal bilevel positive airway pressure (BPAP)-in people with neuromuscular disorders who depend on NPPV for survival. Method Twelve participants (ages 22-68 years; 10 men, 2 women) with neuromuscular disorders (9 Duchenne muscular dystrophy, 1 Becker muscular dystrophy, 1 postpolio syndrome, and 1 spinal cord injury) took part in semistructured interviews about their speech. All subjects used M-NPPV during the day, and all but 1 used BPAP at night for their ventilation needs. Interviews were audio-recorded, transcribed, and verified. A qualitative descriptive phenomenological approach was used to code and develop themes. Results Three major themes emerged from the interview data: (a) M-NPPV aids speaking (by increasing loudness, utterance duration, clarity, and speaking endurance), (b) M-NPPV interferes with the flow of speaking (due to the need to pause to take a breath, problems with mouthpiece placement, and difficulty in using speech recognition software), and (c) nasal BPAP interferes with speaking (by causing abnormal nasal resonance, muffled speech, mask discomfort, and difficulty in coordinating speaking with ventilator-delivered inspirations). Conclusion These qualitative data from chronic NPPV users suggest that both M-NPPV and nasal BPAP may interfere with speaking but that speech is usually better and speaking is usually easier with M-NPPV. These findings can be explained primarily by the nature of the 2 ventilator delivery systems and their interfaces.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1044/2019_AJSLP-MSC18-18-0101DOI Listing
July 2019

The Consequences of Oromandibular Dystonia on Communicative Participation: A Qualitative Study of the Insider's Experiences.

Am J Speech Lang Pathol 2019 07 15;28(2S):771-783. Epub 2019 Jul 15.

Department of Rehabilitation Medicine, University of Washington, Seattle.

Purpose The purpose of this study was to obtain a self-reported account of the experience of living with oromandibular dystonia (OMD) to gain a better understanding of both the daily facilitators and barriers to communicative participation and the strategies used for adapting to life with OMD. Method Eight individuals with OMD and dysarthria participated in 1 face-to-face, semistructured interview. Interviews were audio-recorded and transcribed verbatim. Qualitative, phenomenological methods of coding, immersion, and emergence were used in the analysis of interview data. Results Three major themes and 7 subthemes emerged from the analysis of interview data. First, "speaking is different now" provided examples of how speech changes are manifested in various life situations. Second, "my roles have changed" addressed how OMD has impacted work, home, and social roles. Third, "I accept it and move on" involved finding strategies that help and adopting a different perspective. Conclusion We suggest that the management of OMD must take a more holistic approach by addressing consequences beyond the physical symptoms and be tailored to each individual based on his or her personal concerns and goals.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1044/2018_AJSLP-MSC18-18-0092DOI Listing
July 2019

Teaching Medical Students Skills for Effective Communication With Patients Who Have Communication Disorders.

Am J Speech Lang Pathol 2019 02;28(1):155-164

Department of Rehabilitation Medicine, University of Washington, Seattle.

Purpose Patients with communication impairments including speech, language, cognition, or hearing disorders face many barriers to communication in health care settings. These patients report loss of autonomy in health care decision making, are at increased risk for medical errors, and are less satisfied with health care than patients without communication disorders. Although medical students receive training in effective patient-provider communication, most of this training assumes patients have intact communication abilities. Medical students and other health care providers are often unprepared to meet the communication needs of patients with communication disorders in health care encounters. The purpose of this study was to assess the impact of a curriculum for training medical students to communicate effectively with patients who have a range of communication disorders. Method Twenty-six 2nd-year medical students volunteered for assessments before and after a required workshop in a class. This workshop included instruction about different types of communication disorders and communication strategies, followed by practice with standardized patients portraying different communication disorders. Outcome measures included a knowledge test, ratings of self-efficacy, and evaluation of students' skills when interviewing standardized patients portraying aphasia and dysarthria. Results Medical students demonstrated significant improvements in knowledge, self-efficacy, and use of recommended communication techniques. Conclusions The curriculum appeared effective in changing medical students' knowledge and skills for working with patients with communication disorders. Equipping medical students to meet the needs of patients with communication disorders is 1 key element for improving the quality of health care for this patient population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1044/2018_AJSLP-18-0130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6503863PMC
February 2019

Factors associated with disease self-efficacy in individuals aging with a disability.

Psychol Health Med 2019 12 29;24(10):1171-1181. Epub 2019 Apr 29.

Department of Rehabilitation Medicine, University of Washington , Seattle , WA , USA.

Self-management of a disability consists of treatment adherence, obtaining information about the disease and treatment options, caring for oneself, participating in decisions, and maintaining social relationships and emotional balance. Understanding and measuring an individual's beliefs about their ability to successfully self-manage and live well with a disability allows researchers and clinicians to better target interventions aimed at increasing disability management self-efficacy (DMSE). The purpose of this study was to examine the associations between demographic and clinical indicators, and self-efficacy for DMSE in individuals with chronic physical conditions. Adults (N = 815) with muscular dystrophy, multiple sclerosis, spinal cord injury, or post-polio syndrome completed a self-report mailed survey assessing DMSE, perceived social support, depression symptoms, resilience, fatigue, pain interference, satisfaction with participation in social roles, physical function, and demographics. A cross-sectional regression model was used to examine the associations between the clinical and demographic factors, and DMSE. The model explained 67% of the variance in DMSE. Satisfaction with participation in social roles, resilience, pain interference, social support, and fatigue were statistically significant. Better social functioning, more resilience, and less pain and fatigue were most strongly associated with DMSE. Interventions aimed at increasing DMSE should include strategies for improving social participation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13548506.2019.1612082DOI Listing
December 2019

Swallowing with Noninvasive Positive-Pressure Ventilation (NPPV) in Individuals with Muscular Dystrophy: A Qualitative Analysis.

Dysphagia 2020 02 11;35(1):32-41. Epub 2019 Mar 11.

Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.

The purpose of the study is to describe experiences of swallowing with two forms of noninvasive positive-pressure ventilation (NPPV): mouthpiece NPPV (M-NPPV) and nasal bilevel positive airway pressure (BPAP) in people with muscular dystrophy. Ten men (ages 22-42 years; M = 29.3; SD = 7.1) with muscular dystrophy (9 with Duchenne's; 1 with Becker's) completed the Eating Assessment Tool (EAT-10; Ann Otol Rhinol Laryngol 117(12):919-924 [33]) and took part in semi-structured interviews. The interviews were audio recorded, transcribed, and verified. Phenomenological qualitative research methods were used to code (Dedoose.com) and develop themes. All participants affirmed dysphagia symptoms via responses on the EAT-10 (M = 11.3; SD = 6.38; Range = 3-22) and reported eating and drinking with M-NPPV and, to a lesser extent, nasal BPAP. Analysis of interview data revealed three primary themes: (1) M-NPPV improves the eating/drinking experience: Most indicated that using M-NPPV reduced swallowing-related dyspnea. (2) NPPV affects breathing-swallowing coordination: Participants described challenges and compensations in coordinating swallowing with ventilator-delivered inspirations, and that the time needed to chew solid foods between ventilator breaths may lead to dyspnea and fatigue. (3) M-NPPV aids cough effectiveness: Participants described improved cough strength following large M-NPPV delivered inspirations (with or without breath stacking). Although breathing-swallowing coordination is challenging with NPPV, participants reported that eating and drinking is more comfortable than when not using it. Overall, eating and drinking with NPPV delivered via a mouthpiece is preferred and is likely safer for swallowing than with nasal BPAP. M-NPPV (but not nasal BPAP) is reported to improve cough effectiveness, an important pulmonary defense in this population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00455-019-09997-6DOI Listing
February 2020

The Relationship Between Non-Orthographic Language Abilities and Reading Performance in Chronic Aphasia: An Exploration of the Primary Systems Hypothesis.

J Speech Lang Hear Res 2018 12;61(12):3038-3054

Department of Speech & Hearing Sciences, University of Washington, Seattle.

Purpose: This study investigated the relationship between non-orthographic language abilities and reading in order to examine assumptions of the primary systems hypothesis and further our understanding of language processing poststroke.

Method: Performance on non-orthographic semantic, phonologic, and syntactic tasks, as well as oral reading and reading comprehension tasks, was assessed in 43 individuals with aphasia. Correlation and regression analyses were conducted to determine the relationship between these measures. In addition, analyses of variance examined differences within and between reading groups (within normal limits, phonological, deep, or global alexia).

Results: Results showed that non-orthographic language abilities were significantly related to reading abilities. Semantics was most predictive of regular and irregular word reading, whereas phonology was most predictive of pseudohomophone and nonword reading. Written word and paragraph comprehension were primarily supported by semantics, whereas written sentence comprehension was related to semantic, phonologic, and syntactic performance. Finally, severity of alexia was found to reflect severity of semantic and phonologic impairment.

Conclusions: Findings support the primary systems view of language by showing that non-orthographic language abilities and reading abilities are closely linked. This preliminary work requires replication and extension; however, current results highlight the importance of routine, integrated assessment and treatment of spoken and written language in aphasia.

Supplemental Material: https://doi.org/10.23641/asha.7403963.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1044/2018_JSLHR-L-18-0058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440304PMC
December 2018

Relationship between perceived social support and patient-reported communication outcomes across communication disorders: a systematic review.

Int J Lang Commun Disord 2018 11 24;53(6):1059-1077. Epub 2018 Jul 24.

Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.

Background: Beyond the severity of voice, speech and language impairments, one potential predictor of communication success across adult populations with communication disorders may be perceived social support: the expectation that others will provide support if needed. Despite the preponderance of intervention approaches that assume a positive relationship between perceived social support and patient-reported communication success, the evidence base for these relationships is limited.

Aims: The aim of this systematic review is to explore relationships between measures of perceived social support and patient-reported communication outcomes in adult populations with communication disorders.

Methods & Procedures: The PRISMA guidelines were followed in the conduct and reporting of this review. Electronic databases including PubMed, PsychINFO and CINAHL were systematically searched up to 19 May 2017. Additional data were obtained for two studies. All the included studies were appraised using the Critical Appraisal Skills Program (CASP) tools. Given the heterogeneous nature of the studies, data synthesis was narrative for the quantitative studies. A meta-ethnographic approach was used to synthesize qualitative data.

Outcomes & Results: Eight quantitative and four qualitative studies met eligibility criteria. All quantitative studies met eight of eight quality criteria. For the qualitative studies, one study met nine of nine quality criteria; the remaining three studies met three, seven and eight quality criteria. Of the eight included quantitative studies, six independent data sets were used. Results revealed no significant relationships between perceived social support and communication outcomes in three studies (two aphasia with one data set, one Parkinson's disease), while perceived social support was a weak, but significant predictor in two studies (one multiple sclerosis, one head and neck cancer). Three additional studies (two aphasia with one data set; one Parkinson's disease) found that relationships were initially weak, but strengthened over time to become moderate. Results from qualitative studies (one head and neck cancer, two aphasia, one multiple sclerosis) revealed that perceived social support acted as a facilitator, and absent or misguided support acted as a barrier to communication outcomes. Skilful, responsive family members were able to facilitate better quality of communicative interactions, whereas lack of social support, or negative attitudes and behaviours of other people, were barriers.

Conclusions & Implications: While perceived social support may affect communication outcomes in adults with communication disorders, current measures may not adequately capture these constructs. Results have implications for future research and interventions for speech and language therapists.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/1460-6984.12417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335018PMC
November 2018

Factors Associated With Communicative Participation in Amyotrophic Lateral Sclerosis.

J Speech Lang Hear Res 2017 06;60(6S):1791-1797

University of Washington, Seattle.

Purpose: People with amyotrophic lateral sclerosis frequently experience bulbar impairment and dysarthria that may restrict their ability to take part in everyday communication situations. The aim of this study is to examine selected variables that may contribute to restrictions in communicative participation.

Method: Community-dwelling participants with amyotrophic lateral sclerosis (N = 70) who reported communication changes but continued to use natural speech completed a survey, including the Communicative Participation Item Bank, demographics (age, sex, living situation, employment status, education, and time since diagnosis), and self- reported symptom-related variables (physical activity, emotional problems, fatigue, pain, speech severity, speech usage, and cognitive and communication skills). To identify predictors of restrictions in communicative participation, these variables were entered into a backward stepwise multiple linear regression analysis.

Results: Three variables (speech severity, swallowing severity, and speech usage) were included in the final model and accounted for 55% of the variability.

Conclusions: Better speech and swallowing skills and higher speech usage are associated with better communicative participation in this sample. Thus, when making clinical decisions regarding intervention, clinicians should continue their efforts to target speech and swallow abilities, while recognizing other variables that have the potential of restricting communicative participation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1044/2017_JSLHR-S-16-0206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5544405PMC
June 2017

The Nature of Error Consistency in Individuals With Acquired Apraxia of Speech and Aphasia.

Am J Speech Lang Pathol 2017 Jun;26(2S):611-630

Department of Speech and Hearing Sciences, University of Washington, SeattleVeterans Administration Puget Sound Health Care System, Seattle, WashingtonUniversity of Pretoria, Gauteng, South Africa.

Purpose: The primary characteristics used to define acquired apraxia of speech (AOS) have evolved to better reflect a disorder of motor planning/programming. However, there is debate regarding the feature of relatively consistent error location and type.

Method: Ten individuals with acquired AOS and aphasia and 11 individuals with aphasia without AOS participated in this study. In the context of a 2-group experimental design, error consistency was examined via 5 repetitions of 30 multisyllabic words. The influence of error rate, severity of impairment, and stimulus presentation condition (blocked vs. random) on error consistency was also explored, as well as between-groups differences in the types of errors produced.

Results: Groups performed similarly on consistency of error location; however, adults with AOS demonstrated greater variability of error type in a blocked presentation condition only. Stimulus presentation condition, error rate, and severity of impairment did not influence error consistency in either group. Groups differed in the production of phonetic errors (e.g., sound distortions) but not phonemic errors.

Conclusions: Overall, findings do not support relatively consistent errors as a differentiating characteristic of AOS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1044/2017_AJSLP-16-0080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576968PMC
June 2017

Internally Versus Externally Cued Speech in Parkinson's Disease and Cerebellar Disease.

Am J Speech Lang Pathol 2017 Jun;26(2S):583-595

Department of Speech and Hearing Sciences, University of Washington, Seattle.

Purpose: The purpose of this study was to examine the effects of an internally versus externally cued speech task on perceived understandability and naturalness in speakers with Parkinson's disease (PD) and cerebellar disease (CD).

Method: Sentences extracted from a covertly recorded conversation (internally cued) were compared to the same sentences read aloud (externally cued) by speakers with PD and a clinical comparison group of speakers with CD. Experienced listeners rated the speech samples using a visual analog scale for the perceptual dimensions of understandability and naturalness.

Results: Results suggest that experienced listeners rated the speech of participants with PD as significantly more natural and more understandable during the reading condition. Participants with CD were also rated as significantly more understandable during the reading condition, but ratings of naturalness did not differ between conversation and reading.

Conclusions: Speech tasks can have a pronounced impact on perceived speech patterns. For individuals with PD, both understandability and naturalness can improve during reading tasks versus conversational tasks. The speech benefits from reading may be attributed to several mechanisms, including possible improvement from an externally cued speech task. These findings have implications for speech task selection in evaluating individuals with dysarthria.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1044/2017_AJSLP-16-0109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576967PMC
June 2017

Speech Versus Speaking: The Experiences of People With Parkinson's Disease and Implications for Intervention.

Am J Speech Lang Pathol 2017 Jun;26(2S):561-568

Portland State University, ORNorthwest Clinic for Voice and Swallowing, Oregon Health & Sciences University, Portland.

Purpose: In this project, we explore the experiences of people who report speech changes associated with Parkinson's disease as they describe taking part in everyday communication situations and report impressions related to speech treatment.

Method: Twenty-four community-dwelling adults with Parkinson's disease took part in face-to-face, semistructured interviews. Qualitative research methods were used to code and develop themes related to the interviews.

Results: Two major themes emerged. The first, called "speaking," included several subthemes: thinking about speaking, weighing value versus effort, feelings associated with speaking, the environmental context of speaking, and the impact of Parkinson's disease on speaking. The second theme involved "treatment experiences" and included subthemes: choosing not to have treatment, the clinician, drills and exercise, and suggestions for change.

Conclusions: From the perspective of participants with Parkinson's disease, speaking is an activity requiring both physical and cognitive effort that takes place in a social context. Although many report positive experiences with speech treatment, some reported dissatisfaction with speech drills and exercises and a lack of focus on the social aspects of communication. Suggestions for improvement include increased focus on the cognitive demands of speaking and on the psychosocial aspects of communication.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1044/2017_AJSLP-16-0087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576965PMC
June 2017

Patient-Provider Communication Training for Dysarthria: Lessons Learned from Student Trainees.

Semin Speech Lang 2017 07 15;38(3):229-238. Epub 2017 Jun 15.

Department of Rehabilitation Medicine, University of Washington, Seattle, Washington.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0037-1602842DOI Listing
July 2017

Incorporating the Principles of Self-Management into Treatment of Dysarthria Associated with Parkinson's Disease.

Semin Speech Lang 2017 07 15;38(3):210-219. Epub 2017 Jun 15.

Department of Speech and Hearing Sciences, Northwest Clinic for Voice and Swallowing, Oregon Health and Sciences University, Portland State University, Portland, Oregon.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0037-1602840DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583887PMC
July 2017

Innovations in Dysarthria Management.

Authors:
Kathryn Yorkston

Semin Speech Lang 2017 07 15;38(3):159-160. Epub 2017 Jun 15.

Department of Rehabilitation Medicine, University of Washington, Seattle, Washington.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0037-1602834DOI Listing
July 2017

Assessing the Believability of Standardized Patients Trained to Portray Communication Disorders.

Am J Speech Lang Pathol 2017 Aug;26(3):791-805

Department of Rehabilitation Medicine, University of Washington, Seattle.

Purpose: The purpose of this study was to evaluate the believability of standardized patients portraying individuals with communication disorders as part of a larger study in which standardized patients help train medical and allied health students about communication disorders.

Method: Two women portrayed persons with aphasia, and 2 men depicted persons with dysarthria associated with Parkinson's disease. Two stakeholder groups rated believability. Speech-language pathologists rated believability of videos online. Persons with aphasia rated aphasia videos during in-person sessions with the researchers.

Results: Targeted believability was 80 or higher (0-100 scale; 0 = not at all believable, 100 = very believable). For speech-language pathologist raters, average ratings met the target for the portrayals of the aphasia characteristics of word-finding problems, agrammaticism, nonverbal communication, and overall portrayal but not for auditory comprehension problems. Targets for the portrayals were met for the dysarthria characteristics of reduced speech movements, reduced loudness, reduced intonation, flat affect, and overall portrayal but not for speech rate. Ratings for different standardized patients portraying the same case were not significantly different from each other on most characteristics. Ratings from persons with aphasia were highly variable.

Conclusion: Standardized patients who do not have communication disorders can portray disorder characteristics in a believable manner.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1044/2017_AJSLP-16-0068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5829793PMC
August 2017

Exploring the Relevance of Items in the Communicative Participation Item Bank (CPIB) for Individuals With Hearing Loss.

Am J Audiol 2017 Mar;26(1):27-37

Department of Rehabilitation Medicine, University of Washington, Seattle.

Purpose: The Communicative Participation Item Bank (CPIB) was developed to evaluate participation restrictions in communication situations for individuals with speech and language disorders. This study evaluated the potential relevance of CPIB items for individuals with hearing loss.

Method: Cognitive interviews were conducted with 17 adults with a range of treated and untreated hearing loss, who responded to 46 items. Interviews were continued until saturation was reached and prevalent trends emerged. A focus group was also conducted with 3 experienced audiologists to seek their views on the CPIB. Analysis of data included qualitative and quantitative approaches.

Results: The majority of the items were applicable to individuals with hearing loss; however, 12 items were identified as potentially not relevant. This was largely attributed to the items' focus on speech production rather than hearing. The results from the focus group were in agreement for a majority of items.

Conclusions: The next step in validating the CPIB for individuals with hearing loss is a psychometric analysis on a large sample. Possible outcomes could be that the CPIB is considered valid in its entirety or the creation of a new questionnaire or a hearing loss-specific short form with a subset of items is necessary.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1044/2016_AJA-16-0047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5597082PMC
March 2017

Validating the Communicative Participation Item Bank (CPIB) for use with people with aphasia: an analysis of Differential Item Function (DIF).

Aphasiology 2017 9;31(8):861-878. Epub 2016 Sep 9.

University of Washington, Department of Rehabilitation Medicine, Box 356490, Seattle, WA 98195, 206-543-3345.

Background: The term 'communicative participation' refers to participation in the communication aspects of life roles at home, at work, and in social and leisure situations. Participation in life roles is a key element in biopsychosocial frameworks of health such as the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF), and the Aphasia Framework for Outcomes Measurement (AFROM). The Communicative Participation Item Bank (CPIB) was developed as a patient-reported measure of communicative participation for adults. Initial validation focused on adults with motor speech or voice disorders. No prior studies have conducted quantitative validation analyses for the CPIB for persons with aphasia (PWA).

Aims: The primary purpose of this study was to begin validation of the CPIB for PWA by conducting an analysis of differential item functioning (DIF). A DIF analysis was used to identify whether item parameters of the CPIB differed between PWA and the populations used in prior CPIB calibration. Secondary analyses evaluated the level of assistance needed by PWA to complete the CPIB, relationships between the CPIB and a gold-standard patient-reported instrument for PWA - American Speech-Language-Hearing Association Quality of Communication Life Scale (ASHA-QCL), and relationships between PWA and family proxy report on the CPIB.

Methods And Procedures: This study included 110 PWA and 90 proxy raters. PWA completed a battery of patient-reported questionnaires in one face-to-face session. Speech-language pathologists (SLPs) provided communication support. Data on aphasia severity from the Western Aphasia Battery - Revised (WAB-R) and demographic data either existed from prior research or were collected during the session. Proxy raters completed a similar battery of self-report questionnaires.

Outcomes And Results: Results of the DIF analysis suggested statistically significant DIF on two of the 46 items in the CPIB, but the DIF had essentially no impact on CPIB scores. PWA with WAB-R Aphasia Quotient scores above 80 appeared comfortable reading the CPIB items, although required occasional assistance. Most participants who were unable to complete the CPIB had WAB-R Aphasia Quotient scores lower than 50. Correlation between the CPIB and ASHA-QCL was moderate; and correlation between PWA and proxy scores was low.

Conclusions: Most PWA were able to respond to CPIB items, although most required or requested support. Although these results are preliminary due to a small sample size, the data support that the CPIB may be valid for PWA. Caution is warranted regarding proxy report because of low correlation between PWA and proxy ratings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02687038.2016.1225274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6433404PMC
September 2016

Growing Older With a Physical Disability: A Special Application of the Successful Aging Paradigm.

J Gerontol B Psychol Sci Soc Sci 2017 Mar;72(2):290-299

Department of Rehabilitation Medicine, University of Washington, Seattle.

Objectives: In the United States, the average age of people living with early-acquired physical disabilities is increasing. This cohort is said to be aging with disability and represents a unique population among older adults. Given recent policy efforts designed to merge aging and disability services, it is critical that models of "successful aging" include and are relevant to this population. However, many current definitions of successful aging emphasize avoidance of disability and high levels of physical function as necessary to well-being.

Method: In 9 focus groups, we examined perspectives of "successful aging" in 49 middle-aged and older individuals living with spinal cord injury, multiple sclerosis, muscular dystrophy, or postpolio syndrome. Transcripts were analyzed using a structured qualitative coding approach and Dedoose indexing software.

Results: Participants ranged in age from 45 to 80 years (M = 62) and had lived with their disability diagnosis for an average of 21 years. Analysis revealed 4 primary themes of successful aging: resilience/adaptation, autonomy, social connectedness, and physical health (including access to general and specialty healthcare).

Discussion: Results highlight the need for a nuanced application of the "successful aging" paradigm in this population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/geronb/gbw122DOI Listing
March 2017

Variables Associated With Communicative Participation After Head and Neck Cancer.

JAMA Otolaryngol Head Neck Surg 2016 12;142(12):1145-1151

Department of Rehabilitation Medicine, University of Washington, Seattle.

Importance: For patients with head and neck cancer (HNC), communication difficulties often create substantial barriers in daily life, affecting a person's ability to return to work, establish or maintain relationships, or participate in everyday activities.

Objective: To examine variables significantly associated with communication in everyday activities, or communicative participation, in adult survivors of HNC.

Design, Setting, And Participants: In a cross-sectional study, from November 1, 2008, through March 18, 2011, participants completed questionnaires about specific experiences and symptoms associated with their health and communication. Seventeen variables were considered in association with communicative participation. Data were collected from adult survivors of HNC residing in a community. Participants completed questionnaires, in English, either online or using paper forms according to their preference. Participants were recruited through support groups, professional email lists, and professional contacts.

Main Outcomes And Measures: Communicative participation and predictor variables were measured using a variety of validated patient-report scales and demographic information. Multiple linear regression analysis was conducted with variables entered using a backward stepwise regression procedure. Variables with significant regression coefficients were retained in the model and reported as change in R2.

Results: One hundred ninety-seven adults (121 males and 76 females; mean age, 61.5 years) participated, all at least 6 months posttreatment of HNC with no additional medical conditions affecting speech. The final model contained 4 significant variables (R2 = 0.462): self-rated speech severity, cognitive function, laryngectomy status, and time since diagnosis. Better communicative participation was associated with less severe speech and cognitive problems; together, these 2 variables explained 42% of the variance in the model (self-rated speech severity, R2 = 0.227, and cognitive function, R2 = 0.193 [0.227 + 0.193 = 0.420 = 42%]). To a lesser extent, better communicative participation also was associated with not having undergone a total laryngectomy surgical procedure (R2 = 0.035) and longer time since diagnosis (R2 = 0.007); full model: R2 = 0.462, P < .001; regression coefficients [SE]: self-rated speech severity 0.551 [0.065], P < .001, R2 = 0.227; cognitive function 0.063 [0.011], P < .001, R2 = 0.193; laryngectomy status 0.285 [0.117], P = .02; and time since diagnosis 0.015 [0.006], P = .02.

Conclusions And Relevance: These results suggest that communicative participation in adults with HNC is associated with self-rated speech severity, cognitive function, whether or not a person has undergone total laryngectomy, and time since diagnosis. Clinicians can use these results to inform their practice in pretreatment counseling, patient education, and rehabilitation for survivors of HNC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamaoto.2016.1198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756625PMC
December 2016

Variables associated with communicative participation in Parkinson's disease and its relationship to measures of health-related quality-of-life.

Int J Speech Lang Pathol 2017 08 27;19(4):407-417. Epub 2016 Jun 27.

b Department of Rehabilitation Medicine , University of Washington , Seattle , WA , USA.

Purpose: Communication disorders associated with Parkinson's disease (PD) often lead to restricted participation in life roles, yet there is a limited understanding of influencing factors and few quantitative measurement tools available. This study aimed to identify variables associated with communicative participation in PD and to examine the relationship between the Communicative Participation Item Bank (CPIB) and existing health-related quality-of-life (HRQoL) measures.

Method: Self-report data from 378 participants with PD from the US and New Zealand were analysed. Data included responses to the CPIB, PD Questionnaire-8, sub-scales of the Global Health instrument from the Patient Reported Outcomes Measurement Information System (PROMIS) and additional self-report instruments.

Result: Greater perceived speech disorder, lower levels of speech usage, fatigue, cognitive and emotional problems and swallowing difficulties were associated with lower levels of communicative participation. Participants' age significantly influenced findings, interacting with country of residence, sex and speech usage. Scores on the CPIB were moderately correlated with HRQoL measures.

Conclusion: Communicative participation in PD is complex and influenced by both demographic and disease-based variables, necessitating a broader view of the communicative experiences of those with PD. Measurement of communicative participation as a separate construct to existing HRQoL measures is recommended.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/17549507.2016.1193900DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6190828PMC
August 2017

Addressing Communicative Participation in Treatment Planning for Adults: A Survey of U.S. Speech-Language Pathologists.

Am J Speech Lang Pathol 2016 08;25(3):355-70

Purpose: In speech-language pathology, there is increasing attention on participation-focused interventions to optimize participation in valued life roles. The purpose of this study was to investigate how speech-language pathologists (SLPs) in the United States address life participation in therapy programs, as well as their opinions regarding barriers and facilitators to participation-focused intervention.

Method: An online questionnaire presented case scenarios for aphasia, dysarthria, and laryngectomy to 66 SLPs who have worked with adults. SLPs were asked to write goals and describe therapy activities for the scenarios. The final section of the questionnaire was an open-ended question regarding barriers and facilitators to participation-focused intervention.

Results: Many SLPs addressed participation in their rationales for therapy; 50% of goals had a participation-focused rationale. However, the goals, activities, and outcomes measures typically focused more on impairment and skill performance. Only 8% of goals specifically referenced participation. Although many SLPs stated that participation-focused intervention is important, they identified many barriers to implementation including time and productivity constraints, limits of clinical settings, and documentation challenges.

Conclusions: There is potential for gaps between SLPs' participation-focused rationale for therapy and activities or outcomes measures that often do not include participation elements. SLPs are interested in participation-focused treatment resources.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1044/2015_AJSLP-15-0049DOI Listing
August 2016

The relationship between communicative participation and postlaryngectomy speech outcomes.

Head Neck 2016 04 29;38 Suppl 1:E1955-61. Epub 2015 Dec 29.

Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.

Background: The purpose of this study was to examine relationships between communicative participation and postlaryngectomy speech outcomes, including listener-rated speech intelligibility and acceptability, and patient-rated speech acceptability and voice handicap.

Methods: Thirty-six laryngectomized individuals completed the Communicative Participation Item Bank (CPIB) short form and the Voice Handicap Index-10 (VHI-10). They provided recordings from the Sentence Intelligibility Test (SIT) and a reading passage, and rated their own speech acceptability. Forty-eight inexperienced listeners transcribed the SIT sentences to derive intelligibility scores. Eighteen additional listeners judged the speech acceptability using the rating scales.

Results: Listeners judged tracheoesophageal speakers as significantly more intelligible and acceptable than electrolaryngeal speakers (p < .05). Speech acceptability was significantly more acceptable to speakers than listeners (p < .05). Weak, nonsignificant relationships were found between communicative participation and listener-rated outcomes. Stronger, significant relationships were found between communicative participation and self-rated speech acceptability and voice handicap (p < .05).

Conclusion: Patient-reported communication outcomes are complementary to listener-rated outcomes. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1955-E1961, 2016.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hed.24353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4844835PMC
April 2016

Everyday listeners' impressions of speech produced by individuals with adductor spasmodic dysphonia.

J Commun Disord 2015 Nov-Dec;58:1-13. Epub 2015 Jul 10.

Department of Speech-Language Pathology, School of Health & Medical Sciences, Seton Hall University, South Orange, NJ, United States.

Individuals with adductor spasmodic dysphonia (ADSD) have reported that unfamiliar communication partners appear to judge them as sneaky, nervous or not intelligent, apparently based on the quality of their speech; however, there is minimal research into the actual everyday perspective of listening to ADSD speech. The purpose of this study was to investigate the impressions of listeners hearing ADSD speech for the first time using a mixed-methods design. Everyday listeners were interviewed following sessions in which they made ratings of ADSD speech. A semi-structured interview approach was used and data were analyzed using thematic content analysis. Three major themes emerged: (1) everyday listeners make judgments about speakers with ADSD; (2) ADSD speech does not sound normal to everyday listeners; and (3) rating overall severity is difficult for everyday listeners. Participants described ADSD speech similarly to existing literature; however, some listeners inaccurately extrapolated speaker attributes based solely on speech samples. Listeners may draw erroneous conclusions about individuals with ADSD and these biases may affect the communicative success of these individuals. Results have implications for counseling individuals with ADSD, as well as the need for education and awareness about ADSD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcomdis.2015.07.001DOI Listing
September 2016

Describing Speech Usage in Daily Activities in Typical Adults.

J Voice 2016 Jan 11;30(1):42-52. Epub 2015 Apr 11.

Department of Rehabilitation Medicine, University of Washington, Seattle, Washington.

Objectives: "Speech usage" refers to what people want or need to do with their speech to meet communication demands in life roles. The purpose of this study was to contribute to validation of the Levels of Speech Usage scale by providing descriptive data from a sample of adults without communication disorders, comparing this scale to a published Occupational Voice Demands scale and examining predictors of speech usage levels.

Study Design: This is a survey design.

Methods: Adults aged ≥25 years without reported communication disorders were recruited nationally to complete an online questionnaire. The questionnaire included the Levels of Speech Usage scale, questions about relevant occupational and nonoccupational activities (eg, socializing, hobbies, childcare, and so forth), and demographic information. Participants were also categorized according to Koufman and Isaacson occupational voice demands scale.

Results: A total of 276 participants completed the questionnaires. People who worked for pay tended to report higher levels of speech usage than those who do not work for pay. Regression analyses showed employment to be the major contributor to speech usage; however, considerable variance left unaccounted for suggests that determinants of speech usage and the relationship between speech usage, employment, and other life activities are not yet fully defined.

Conclusions: The Levels of Speech Usage may be a viable instrument to systematically rate speech usage because it captures both occupational and nonoccupational speech demands. These data from a sample of typical adults may provide a reference to help in interpreting the impact of communication disorders on speech usage patterns.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvoice.2015.02.001DOI Listing
January 2016