Advances in Communication and Swallowing

COVID-19 accelerated telepractice implementation in speech and language therapy (SLT) in Ireland.

This study documents the service delivery changes that took place in the SLT profession in Ireland during the public health crisis.

An online survey of speech and language therapists (SLTs) in Ireland was conducted from June-September 2020 to investigate their perceptions of telepractice. Data were analysed using descriptive and inferential statistics and frequency distribution.

173 SLT responses were analysed. Over half of the participants worked in urban locations. Respondents’ years of experience varied from less than four years to over 20 years. Slightly over half the participants reported using telepractice, with 85% starting to use telepractice in the six months prior to the survey. Telepractice uptake was not influenced by participants’ professional experience or geographical location (p > 0.05). Almost all participants who used telepractice were trained informally (92%). Telepractice was most commonly used with school-aged children with developmental language and speech sound disorders. Respondents perceived that telepractice was not suitable for all individuals who need SLT, including those with complex needs. Clinicians reported that telepractice facilitated access to therapy for clients and opportunities to see clients in their own environments. Technology barriers were the biggest hurdle to telepractice use.

Uptake of telepractice by the SLT profession in Ireland was widespread during COVID-19, highlighting the profession’s flexibility and innovation. Respondents indicated they are likely to continue to use telepractice as a complementary service delivery model post-COVID due to the distinct benefits for clinicians and clients.

There is a mismatch between languages spoken by speech and language therapists (SLTs) and their clients. Consequently, SLTs are required to collaborate with interpreters to provide equitable services to multilingual clients.

This systematized review aimed to identify the barriers and facilitators to SLT and interpreter collaboration within the paediatric population.

A systematic and comprehensive search of literature was conducted. Selected literature underwent quality assessment and thematic analysis resulting in a narrative synthesis of included literature.

Fifteen research studies were identified to be included in the review. Five themes were identified: (1) Frequency of interpreter and paediatric SLT collaboration; (2) training of SLTs and interpreters for speech therapy paediatric practice; (3) type of interpreters used during speech and language therapy paediatric sessions; (4) paediatric SLTs’ confidence when collaborating with interpreters; and, (5) policy influencing SLT and interpreter collaboration during management of paediatric clients.

The review revealed limited direct research on the barriers and facilitators to SLT interpreter collaboration in the multilingual paediatric setting. Findings indicate that: (1) many SLTs consider their training in working with interpreters to be inadequate; (2) there is a lack of available professional interpreters and the use of family members as interpreters is common with paediatric clients. Further research is required to explore the specifics of training provided to interpreters and the factors that contribute to the lack of availability of professional interpreters for paediatric clients.

Few studies have documented the utility of side-lying in dysphagia management. We report on a patient who benefitted from the side-lying posture for safe and efficient oral intake.

The patient underwent resections of the left tongue base, the left lateral pharyngeal wall, and a left marginal mandibulectomy for oropharyngeal cancer. The Videofluoroscopic Swallowing Study (VFSS) on Postoperative Day (POD) 10 confirmed significant pyriform sinus residue and post-swallow aspiration. Techniques including bolus modification, the 45-degree reclining position, head rotation to the left, and the Mendelsohn maneuver did not prevent post-swallow aspiration of severe pyriform sinus residue. Instead of the 45-degree reclining position, when fed in the side-lying posture with head rotation to the left and the Mendelsohn maneuver, residue clearance was improved on the second VFSS on POD 34. The patient started taking gelatin jelly and continued swallowing exercises in side-lying with head rotation to the left and the Mendelsohn maneuver. With the same techniques, aspiration was not observed in the third VFSS on POD 50. We upgraded the patient’s diet to a pureed diet two months after surgery. The patient resumed taking a regular diet sitting upright by four months after the operations with no aspiration pneumonia.

The use of side-lying posture, when combined with other techniques, has compensated for the unilateral pharyngeal dysmotility after cancer resection. This preliminary finding suggests that side-lying posture may be an option as a transitional compensatory technique for safe and effective swallowing until the patient returns to full oral intake.

Clinical practice guidelines (CPGs) can act as a bridge between clinical research and everyday practice. CPGs have been generated to inform Fiberoptic Endoscopic Evaluation of Swallowing (FEES), but their quality is unclear.

This study aims to systematically evaluate the quality of FEES CPGs to identify their suitability for use in clinical practice.

A systematic review of the literature was conducted. A comprehensive search of four academic databases (Medline, Embase, CINAHL, Web of Science) and other sources was completed. Three independent researchers used the Appraisal of Guidelines for Research and Evaluation-II (AGREE-II) instrument to appraise the quality of included CPGs. CPGs were rated over 23 items across six domains. Intraclass correlation coefficients established agreement across raters.

Four FEES CPGs were included. Individual CPG scores ranged from 0% to 89% across AGREE-II domains. Median domain scores were “Scope and Purpose” 66%; “Stakeholder Involvement” 47%; “Rigour of Development” 29%; “Clarity of Presentation” 60%; “Applicability” 13% and “Editorial Independence” 0%. None of the CPGs included sufficient detail regarding their development methodology and supporting evidence. No CPG was recommended to guide practice in their current state. Only 1 CPG was recommended for use, upon appropriate modifications.

CPGs are highly influential tools that play a vital role in guiding clinical practice. Study findings highlight a scarcity of high-quality FEES CPGs to inform dysphagia practice. Superior FEES CPGs are required to ensure individuals with dysphagia are benefiting from high-quality research emerging internationally.