During the simultaneous resection of vestibular schwannomas and cochlear implantation, acoustic nerve preservation is essential. A recent study highlighted the effectiveness of the Auditory Nerve Test System (ANTS) for evaluating cochlear nerve function following vestibular schwannoma resection and for determining its suitability for cochlear implantation. However, the use of this system for the continuous intraoperative monitoring of acoustic nerve preservation has only been documented in one case in the literature. We recently encountered three distinct clinical cases: a case of neurofibromatosis type 2, a medium-sized vestibular schwannoma with contralateral long-term idiopathic hearing loss, and a small vestibular schwannoma with bilateral mitochondrial hearing loss. In all cases, we successfully conducted continuous recordings of electrically evoked auditory brainstem responses during vestibular schwannoma resection. Subsequently, cochlear implantation was performed after tumor resection in all patients. Postoperatively, all three patients demonstrated successful hearing compensation. These findings suggest that the ANTS system is a reliable and effective tool for the continuous monitoring of acoustic nerve preservation during vestibular schwannoma surgery with ipsilateral cochlear implantation.
BACKGROUND:Consensus guidelines advocate multidisciplinary care to optimise recovery following laryngectomy. However, limited evidence exists regarding the nature of the patient recovery journey or their experience accessing rehabilitation services. AIMS:This study examined the services accessed by, and experiences of, individuals with a laryngectomy (IWL) in the first 12 months post-surgery. METHODS AND PROCEDURES:Patient journey mapping methodology was used to explore the healthcare journey and patient experience of 12 IWL across the first 12 months of rehabilitation. Demographics and detailed service data were collated from medical records and later reviewed for accuracy with each participant. Individual interviews were used to explore issues that influenced care experiences, and participants also provided experiential ratings relating to the emotional impact of each appointment (positive/negative/neutral) and the reason for the rating. Journeys were explored collectively as a group, then 3 detailed patient journeys are presented highlighting similarities and differences in participant experiences. OUTCOMES AND RESULTS:Participants attended a median (Mdn) of 7 medical visits (range = 4-14), 12 allied health visits (range = 4-45), saw 13 different professionals (range = 6-22), and travelled to 6 locations (range = 2-6) for healthcare. Factors adding to the complexity of the health care journeys included preparation for surgery, nature of surgery (primary versus salvage), access to trained specialists throughout phases of care, coordinating between services, travel and funding for consumables. Despite issues, participants largely rated experiences as positive (Mdn = 77; range = 37%-100% positive). Participant perspectives on issues impacting their healthcare journey formed 6 themes: (1) Preparation for laryngectomy surgery, (2) Recovery post-surgery (3) Access to skilled and coordinated services, (4) Approach of healthcare staff, (5) Communication difficulties impacting healthcare, and (6) Accessing laryngectomy resources and costs. CONCLUSIONS AND IMPLICATIONS:Following laryngectomy, a wide range of multidisciplinary services are accessed to support recovery and rehabilitation. Examining patient experiences through journey mapping has highlighted challenges that can influence the care pathway. Addressing issues that impact service access and patient experience will assist in enhancing laryngectomy care pathways and improve the patient experience. WHAT THIS PAPER ADDS:What is already known on the subject Current care pathways advocate specialist, multidisciplinary care for optimal recovery for individuals with a laryngectomy (IWL). Although existing laryngectomy guidelines specify that a range of specialist services are required, and detail what those services should entail, what this actually looks like and means for IWL as they live this path of recovery, remains largely unexplored. What this study adds to the existing knowledge This work expands the body of evidence in laryngectomy care by exploring the healthcare journeys of a cohort of IWL to better understand the extent of medical and allied health services required in the first 12-months post-surgery and the patients' experiences of that care. This work is the first to use journey mapping, a methodology that provides detailed insights gained from both quantitative and qualitative data to elucidate the patients' care experience. Understanding the patients lived experience, and any challenges faced, is essential information needed to continue to inform future care optimisation. What are the clinical implications of this study? The collective findings from this study highlight the potential challenges IWL can face accessing care in the post-acute phase. Participants attended a high number of medical and allied health visits, from a variety of professions and services, and faced several challenges including being prepared for their recovery, accessing skilled professionals, communication with healthcare staff, and costs of necessary consumables/equipment. Healthcare providers, including speech-language pathologists, must recognise and address these issues where possible, to optimise care and reduce patient burden.
BACKGROUND:Speech and voice disorders are frequently observed in individuals with acquired immunodeficiency syndrome (AIDS). However, the literature lacks detailed descriptions of how perceptual and acoustic characteristics manifest in the voice quality profiles of this population. AIM:To characterize the voice quality profile of older adults living with AIDS by describing the relationship between perceptual and acoustic voice measures. METHODS:The research group (RG) comprised 20 individuals with AIDS, aged 50-60 years, all presenting with lipodystrophy, metabolic conditions including dyslipidemia, and 2-9 years of antiretroviral therapy. The control group (CG) comprised 9 age-matched individuals with metabolic conditions, including dyslipidemia, but without AIDS or antiretroviral therapy. The corpus included semi-spontaneous speech samples and repetitions of three key sentences designed for the perceptual evaluation of voice quality settings (VQS) across the vocal tract, muscular tension, and phonatory domains. For the acoustic analysis, data were processed using a script in the Praat software, which automatically extracted measures of fundamental frequency (f0), intensity, spectral slope, and the long-term average spectrum (LTAS). A preliminary statistical analysis was performed to establish the basis for presenting the results. Among the sociophonetic factors examined, gender emerged as the most influential variable and was included in the multivariate statistical approach. RESULTS:The results indicated a significant prevalence of vocal tract VQS in the RG, including a retracted and lowered tongue body, pharyngeal constriction, and vocal tract hyperfunction, demonstrating strong discriminative power for classifying RG (98.7%) and CG (98.3%) samples. Acoustic measures showed a lower correlation factor (R2: 36.5%) for distinguishing the RG (77.4%) and CG (77.5%) samples. Regarding the relationship between acoustic measures and perceived voice qualities, f0 (particularly for females), LTAS (especially for males), and spectral slope were found to be relevant. CONCLUSIONS:Vocal tract and tension VQS, together with correlated spectral measures, were relevant in the RG. These findings may reflect the combined functional consequences of long-term antiretroviral therapy, opportunistic diseases, lipodystrophy, and associated metabolic alterations. The results highlight the need for further studies to support the future development of preventive, monitoring, and rehabilitative speech-language pathology strategies during the long-term follow-up of individuals living with AIDS. WHAT THIS PAPER ADDS:What is already known on this subject Research suggests a high prevalence of speech and voice disorders among patients with acquired immunodeficiency syndrome (AIDS). However, the relationship between perceived and acoustic voice quality in this population remains unexplored. What this study adds to existing knowledge Adjustments in vocal tract and tension-related voice quality, along with correlated spectral measures, were found to be significant in RG. These findings may relate to reported effects of lipodystrophy on the vocal tract and upper respiratory infections from opportunistic diseases. What are the clinical implications of this study? The findings of this study may be linked to the effects of lipodystrophy on the vocal tract in AIDS patients, as well as upper airway weakness due to opportunistic diseases. This underscores the need to develop therapeutic strategies for ongoing care in the AIDS population.
OBJECTIVE:Chronic nasopharyngitis is an under-recognized clinical condition, although the nasopharynx may serve as a source of persistent local and systemic symptoms. This study aimed to define diagnostic criteria for chronic nasopharyngitis and to prospectively evaluate changes in symptoms and endoscopic changes following nasopharyngeal abrasive therapy (EAT). METHODS:A multicenter prospective observational study. Patients with chronic nasopharyngitis treated between April 2022 and March 2025. Of 219 enrolled patients, 175 were included in the final analysis. EAT was administered weekly for two months using a transnasal or transoral cotton swab soaked in 1% zinc chloride. Nasopharyngeal endoscopic findings were prospectively graded using a three-point scoring system. Symptoms were assessed using a visual analog scale (VAS). RESULTS:Chronic nasopharyngitis was defined as persistent nasopharyngeal-related local or systemic symptoms lasting longer than one month, refractory to pharmacologic therapy, with endoscopic evidence of nasopharyngeal inflammation. The most common chief complaints were postnasal drip, general fatigue, and globus sensation. Median VAS scores for chief complaints decreased from 90 at baseline to 60 after one month and to 25 after two months. Improvements in endoscopic findings and symptoms were observed across local and systemic manifestations, including in patients with long COVID. Patients with severe nasopharyngitis demonstrated less pronounced symptom improvement. CONCLUSION:This multicenter prospective study proposes diagnostic criteria for chronic nasopharyngitis and shows that EAT was associated with improvement in symptoms and endoscopic inflammation. These findings suggest that targeted nasopharyngeal therapy may represent a clinically relevant approach for chronic nasopharyngitis, including cases with systemic symptoms, although controlled studies are required to establish its therapeutic efficacy.
BACKGROUND:Children with language disorders, including developmental language disorder (DLD), experience challenges with word learning. Common components of vocabulary interventions include presenting target words in a story, providing explicit teaching and using sign/gesture alongside speech. However, previous studies have not investigated the relative contribution of these components, in isolation or combination. AIM:To measure the effects of adding explicit teaching and/or augmentative signing to a story-based vocabulary intervention. METHODS:Eighteen participants, aged 7;09-15;02 years, took part in our within-participant design study. All had a language disorder; 14 with DLD, and four with an associated biomedical condition. They were taught 48 real verbs and adjectives, randomly assigned to one of four conditions, over an 8-week intervention period. In the reference condition, participants watched videos of a speech and language therapist (SLT) reading a story where target words were presented incidentally, four at a time. In the first experimental condition, the delivering SLT added explicit teaching to the reference intervention. This included: providing definitions, modelling words in sentences, requesting retrieval and employing a cueing hierarchy. The second experimental condition added augmentative signing to the reference intervention, whereby the SLT in the video signed the target words as they appeared in the story. The final experimental condition added both explicit teaching and signing. In all conditions, frequency of word presentations was controlled. Word sets were counterbalanced to minimise confounds. Outcome measures assessed vocabulary knowledge and use with: (1) a word definition task and (2) sentence generation. RESULTS:Participants showed stronger progress in all experimental conditions, compared to the reference condition. Bayesian models showed that adding both explicit teaching and augmentative signing in combination to the reference intervention did not lead to greater progress than adding just one of these components. Neither participants' age nor language ability were associated with intervention progress. DISCUSSION:Our results indicate that adding either explicit teaching or augmentative signing to story-based vocabulary intervention is similarly advantageous. Adding both does not confer additional advantage. Larger-scale studies are needed to explore differences between participants and experimental conditions. CONCLUSIONS/IMPLICATIONS:Our study highlights the importance of evaluating systematically the contribution of potential active ingredients within interventions. In particular, analysing how they work together and separately is important, as adding more ingredients does not necessarily improve effectiveness. Our results inform vocabulary teaching, indicating that staff should incorporate either augmentative signing or explicit teaching whenever possible to support the vocabulary learning of those with language disorders. WHAT THIS PAPER ADDS:What is already known on this subject Children with (developmental) language disorders experience difficulties with word learning, which can affect their education and social participation. Previous research indicates that story-based intervention, explicit teaching and, in some cases, augmentative signing can support vocabulary learning. However, many interventions combine multiple components, making it difficult to determine which specific components are active ingredients, responsible for progress. What this paper adds to existing knowledge This study systematically compared the effects of adding explicit teaching and/or augmentative signing to a story-based (implicit) vocabulary intervention for school-aged children with (D)LD. Our results indicate that adding explicit teaching and/or augmentative signing can lead to greater improvements in learning new verbs and adjectives than the implicit intervention alone. Combining explicit teaching and signing does not appear to lead to additional benefit. What are the potential or actual clinical implications of this work? SLTs and school staff working with children with (D)LD should prioritise incorporating either augmentative signing or explicit teaching strategies whenever feasible to support vocabulary development. Signing may be quicker to implement as this can be delivered alongside speech. Intervention choices could be tailored to children and staff's individual preferences and skills. Larger studies are required to explore differences between participants and experimental conditions.
PURPOSE:This study examined the test-retest and inter-rater reliability of non-clinician severity judgments using two brief rating tools-the 11-point Severity Scale (SEV) and the Visual Analog Scale (VAS)-and evaluated their concurrent validity with clinician-rated Stuttering Severity Instrument-4-Turkish version (SSI-4-TR) scores. METHOD:This observational cross-sectional study used speech samples from 15 adults who stutter as stimulus materials. Recordings were evaluated by two speech-language therapists (SLTs) and two independent groups of non-clinician raters (n = 26 per group). SLTs assessed stuttering severity using the SSI-4-TR. One non-clinician group rated severity using a VAS, whereas the other used SEV. All ratings were completed online across three sessions. To examine temporal stability, 30% of the samples were re-rated after a one-week interval. RESULTS:Both tools demonstrated excellent test-retest reliability, with intraclass correlation coefficients of 0.997 for the VAS and 0.987 for the SEV. Inter-rater reliability was moderate, with ICC values of 0.656 for the VAS and 0.573 for the SEV. Both scales showed strong positive correlations with SSI-4-TR scores, with correlation coefficients of 0.835 for the VAS and .814 for the SEV (p < 0.001). CONCLUSIONS:The findings indicate that the VAS and SEV demonstrated high test-retest reliability and moderate inter-rater reliability and showed strong associations with SSI-4-TR scores, supporting the use of brief perceptual rating scales as practical screening instruments in large-scale and time-limited clinical and research settings where rapid and resource-efficient assessment is required. WHAT THIS PAPER ADDS:What is already known on this subject Perceptual severity ratings are widely used to estimate stuttering severity in both clinical and research contexts. Likert-type scales have demonstrated acceptable reliability when applied by trained listeners, whereas the Visual Analog Scale (VAS) has shown strong psychometric performance in several perceptual domains such as voice and resonance assessment. However, empirical evidence regarding the reliability and validity of a single-item VAS for evaluating stuttering severity remains limited. In addition, it is not yet clear whether trained non-clinician raters can apply brief perceptual severity scales consistently, particularly when ratings are compared with standardized clinical measures such as the SSI-4. What this study adds to the existing knowledge This study provides novel psychometric evidence comparing an 11-point Likert-type severity scale (SEV) and a Visual Analog Scale (VAS) for rating stuttering severity using trained non-clinician raters. Both tools demonstrated excellent test-retest reliability, moderate inter-rater reliability, and strong concurrent validity with clinician-rated SSI-4-TR scores. The findings extend previous research by demonstrating that brief perceptual severity ratings can produce stable and clinically meaningful estimates when administered by trained but non-expert listeners. The study also contributes to the literature by directly comparing continuous and categorical response formats within the same experimental framework. What are the clinical implications of this study? The findings suggest that brief perceptual severity scales such as VAS and SEV may serve as practical adjunct tools for screening, monitoring change, and large-scale data collection in clinical and research settings where time and resources are limited. Trained non-clinician raters may provide consistent evaluations under controlled conditions, supporting their potential role in structured assessment contexts. However, perceptual ratings should not replace comprehensive clinical evaluation and may be most informative when used alongside standardized measures such as the SSI-4 or frequency-based indices to obtain a more complete representation of stuttering severity.
BACKGROUND:A positive family history is a significant risk factor for developmental stuttering. However, the reported rates of positive family histories are inconsistent across studies, making it difficult to synthesise the findings. AIM:This scoping review aimed to systematically map the literature on family histories of stuttering to clarify the reported stuttering proportions and identify methodological trends and gaps. METHOD & PROCEDURES:We conducted a literature search of PubMed, Web of Science, and PsycINFO on 4 February 2025. Two authors independently screened the records in two stages: first by title and abstract, and then by full text. OUTCOMES & RESULTS:We reviewed 19 studies that reported family histories of participants with developmental stuttering. Basic study characteristics such as sample size and country were extracted, and descriptive statistics, including family history rates, were calculated for quantitative data. A key finding was the wide variability in the reported proportion of individuals with a positive family history, ranging from 20.0% to 90.9%. This variability was strongly associated with inconsistencies in methodology, including the scope of relatives considered, the definition of stuttering within the family, and data collection methods. CONCLUSIONS & IMPLICATIONS:This review found that methodological variability appeared to be the primary factor contributing to the wide variation in reported rates in the research on family histories of stuttering. The findings suggest the need for rigorous research approaches to obtain a more comprehensive understanding of this phenomenon. WHAT THIS PAPER ADDS:What is already known on this subject A positive family history is widely recognized as a major risk factor for developmental stuttering, and genetic evidence suggests a strong heritable component. However, reported proportions of individuals with a family history of stuttering vary substantially across studies, making it difficult to synthesize the evidence and interpret findings consistently. What this study adds to the existing knowledge This scoping review systematically mapped 19 studies and revealed that reported rates of positive family history range widely from 20.0% to 90.9%. The review identifies key sources of methodological variability as primary contributors to this inconsistency. These findings highlight the need for greater clarification when defining and assessing family history in stuttering research. What are the potential clinical implications of this study? Clinicians and researchers may benefit from using clearer criteria and consistent reporting frameworks, which could support more accurate risk evaluation and better integration of genetic, epidemiological, and clinical evidence.
OBJECTIVE:To prospectively evaluate whether modifying DSL version 5-based hearing aid (HA) fittings by adjusting gain on HA fitting software so that measured functional gain (FG) approached a one-third gain (1/3G) target could provide appropriate fitting outcomes in patients with sensorineural hearing loss. METHODS:Twenty-four patients (48 ears) with bilateral sensorineural hearing loss underwent initial HA fitting using the DSL version 5 prescription formula. FG was measured at 250-4000 Hz, and HA gain was adjusted on HA fitting software so that FG approached the target 1/3 G. Speech discrimination scores at 65 and 80 dB SPL were evaluated after a two-week trial period using the 67-S Japanese monosyllable word list. Based on speech discrimination test results, ears were classified as well-fitting or non-well-fitting. FG values were compared between the two groups. RESULTS:Twenty-one patients (42 ears) completed the study. Thirty-one ears (73%) were classified as well-fitting. Although HA gain was adjusted toward the target 1/3 G, measured FG values at 250 and 500 Hz remained lower than the target values. In well-fitting ears, low-frequency FG values were lower than the target 1/3 G, whereas FG at 2000 Hz was close to the target value. In contrast, non-well-fitting ears showed low-frequency FG values closer to the target 1/3 G, whereas FG values at 2000 and 4000 Hz remained below the target values. CONCLUSIONS:Although HAs adjusted toward a 1/3 G target did not achieve the intended FG values, particularly at low frequencies, relatively favorable fitting outcomes were obtained in approximately three-quarters of the ears. In well-fitting ears, low-frequency FG remained below the target 1/3 G, whereas FG in the mid-frequency range around 2000 Hz was close to the target value. These findings provide a basis for future prospective studies to clarify how these FG characteristics should be applied to optimize HA adjustment.
OBJECTIVE:Tracheal reconstruction is typically performed in patients with defects caused by invasive thyroid carcinoma, tracheal cancer, or tracheal fistula. Various tracheal reconstructive techniques have been reported. However, there are few reports on the long-term outcomes of tracheal reconstruction. At our institution, soft tissue reconstruction was performed in patients with tracheal cartilage defects involving 20-40%, whereas rigid reconstruction was performed in those with 40-80% defects. This study analyzed mid- to long-term changes in tracheal volume after soft tissue and rigid reconstructions, as well as the volume changes of transplanted costal cartilage in rigid reconstructions. METHODS:Between April 2010 and March 2023, ten patients underwent tracheal reconstruction at Saitama Cancer Center (Saitama, Japan). Five patients with a 20-40% tracheal cartilage defect (Tr 1a) underwent soft tissue reconstruction, and five patients with a 40-80% tracheal cartilage defect (Tr 2b) underwent rigid reconstruction. The patients' medical records were retrospectively reviewed. Changes in reconstructed tracheal lumen volume and transplanted costal cartilage volume were analyzed. RESULTS:All ten patients successfully underwent two-stage reconstruction without major complications. Although the soft tissue reconstruction group exhibited variable changes in tracheal lumen volume, the volume generally increased over five years with no airway stenosis. In contrast, the rigid reconstruction group maintained stable tracheal lumen volumes, and costal cartilage grafts showed slight early resorption followed by stabilization. CONCLUSION:No cases of airway stenosis were observed in either the soft tissue or rigid reconstruction groups. For rigid reconstruction, the combination of costal cartilage and forearm flaps effectively maintained tracheal patency. Our preliminary findings suggest that costal cartilage may represent a suitable graft material for rigid tracheal reconstruction.
OBJECTIVE:To evaluate oncological and functional outcomes of frontolateral vertical partial laryngectomy (FLVPL) in carefully selected patients with cT3N0 glottic carcinoma. METHODS:We retrospectively reviewed consecutive patients with cT3N0 glottic carcinoma who underwent FLVPL as their primary treatment at a single institution between January 2014 and December 2024. Survival outcomes, including overall survival, disease-specific survival, disease-free survival, and laryngectomy-free survival, were analyzed using the Kaplan-Meier method. Postoperative functional outcomes were also assessed. RESULTS:Sixteen patients were included (median follow-up, 31 months). All tumors showed invasion of the paraglottic space without vocal cord fixation or invasion of the thyroid cartilage. There were five recurrences, two of which were local and required salvage total laryngectomy. The final laryngeal preservation rate was 87.5%. The 3-year overall, disease-specific, disease-free, and laryngectomy-free survival rates were 92.3%, 100%, 57.9%, and 73.9%, respectively. Oral intake resumed at a median of 5 days postoperatively, and all patients achieved oral feeding without long-term tube dependence. CONCLUSION:FLVPL provided favorable oncological control with excellent postoperative swallowing in selected patients with cT3N0 glottic carcinoma and no vocal cord fixation or invasion of the thyroid cartilage. This procedure may be a valuable larynx-preserving surgical option in carefully selected T3 cases.
BACKGROUND:Early language delay is a common presenting concern among toddlers with autism spectrum disorder (ASD) and developmental language disorder (DLD), creating challenges for clinical assessment and referral decisions. Although ASD and DLD differ in core social-communicative features, restricted/repetitive behaviours, and developmental mechanisms, language-focused assessment may provide complementary information about early communicative profiles. However, culturally adapted tools for assessing early language and communication in Mandarin-speaking toddlers remain limited. METHODS:A total of 213 children aged 24-36 months (ASD = 89, DLD = 60, TD = 64) were recruited from the Child Healthcare Department of a tertiary hospital between 2020 and 2022. Clinical diagnoses were established by multidisciplinary teams based on DSM-5 and CATALISE criteria. Caregivers completed the Diagnostic Receptive and Expressive Assessment of Mandarin-Infant & Toddler (DREAM-IT), which evaluates receptive and expressive language, cognitive play, and social communication. Receiver operating characteristic (ROC) curve analyses assessed discriminative validity across diagnostic groups, logistic regression examined the contribution of DREAM-IT domains to ASD-versus-DLD classification, and concurrent validity was evaluated against GDS, ABC, CARS, and ADOS-2. RESULTS:DREAM-IT showed strong diagnostic accuracy in distinguishing children with ASD or DLD from TD children (AUC = 0.84-0.998), but its ASD-versus-DLD discrimination was domain-specific and more limited. Receptive language provided the strongest ASD-versus-DLD discrimination (AUC = 0.81; sensitivity = 69.1%; specificity = 84.3%; optimal cutoff = 86.5), whereas expressive language, cognitive play, and social communication showed poor-to-limited standalone performance (AUC = 0.51-0.57). Logistic regression indicated that receptive language (OR = 1.10, p < 0.05) and expressive language (OR = 0.77, p = 0.015) independent contributed to ASD-versus-DLD discrimination, with an overall classification accuracy of 79.2%. DREAM-IT classifications demonstrated moderate-to-substantial agreement with established developmental and autism-related instruments, including GDS, ABC, CARS, and ADOS-2 (Cohen's κ = 0.62-0.82). Developmental age comparisons revealed domain-specific lags, with ASD characterized by greater receptive and social delays and DLD showing the largest lag in expressive language. CONCLUSIONS:The Mandarin DREAM-IT provides clinically useful information about early language and communication development in Mandarin-speaking toddlers with ASD and DLD and shows moderate-to-strong concurrent alignment with established developmental and autism-related measures. Its primary value lies in characterizing domain-specific developmental patterns and offering useful complementary information within a broader, multi-method diagnostic framework for Mandarin-speaking populations. WHAT THIS PAPER ADDS:What is already known on this subject Differentiating autism spectrum disorder (ASD) from developmental language disorder (DLD) in toddlers is clinically important but challenging. Both conditions may present with early language delay, while ASD is characterised by core social-communication difficulties and restricted or repetitive behaviours. Accurate interpretation therefore requires a multi-method assessment integrating language evaluation, developmental history, direct observation, and autism-specific measures. However, culturally and linguistically appropriate tools for characterising early language and communication in Mandarin-speaking toddlers remain limited. What this study adds to the existing knowledge This study evaluated the diagnostic accuracy and concurrent validity of the Mandarin DREAM-IT in 213 toddlers with ASD, DLD, or typical development. DREAMIT showed good-to-excellent accuracy in distinguishing children with ASD or DLD from typically developing children, but ASD-versus-DLD discrimination was more limited and domain-specific. Receptive language provided the clearest discriminatory signal, whereas expressive language, cognitive play, and social communication showed substantial overlap. DREAM-IT developmental age scores showed moderate correlations with corresponding GDS measures, and its descriptive rule-based patterns showed substantial agreement with autism-specific instruments. What are the potential or actual clinical implications of this study? DREAM-IT may provide useful caregiver-reported information about receptive language, expressive language, cognitive play, and social communication in Mandarin-speaking toddlers. Its main clinical value lies in characterising domain-specific developmental patterns and providing complementary information within a broader, multi-method assessment framework. It should not be used as a standalone instrument to diagnose ASD or DLD or to differentiate between them. Results should be interpreted alongside developmental history, direct clinical observation, developmental testing, and autism-specific measures.
BACKGROUND AND AIMS:Caregiver-mediated interventions are commonly used by Speech and Language Therapists to support early language development. Developmental Language Disorder (DLD) is associated with reduced quality of life throughout the lifespan. Understanding factors that predict intervention success is essential for developing appropriate, cost-effective therapy provision for the approximately 12% of preschool children who present with early markers for Developmental Language Disorder (DLD). This systematic review and meta-analysis examined the effectiveness of caregiver-mediated spoken language interventions for under-fives at risk of DLD, and factors influencing intervention effectiveness. METHODS:A systematic review following PRISMA guidelines was conducted. Five electronic databases were searched to identify experimental studies comparing caregiver-mediated spoken language interventions to control conditions in under-fives presenting with risk factors for DLD. Risk factors included prematurity, socioeconomic factors, caregiver language development concerns, and formal or informal language screening or assessment scores. Twenty-six experimental studies with 1407 child participants were included in qualitative synthesis. Meta-analysis was performed on nine Randomised Controlled Trials involving 947 children. RESULTS:Effectiveness was examined for outcomes including child language gains, child wellbeing, inclusion and attainment. Meta-analysis indicated a significant effect of caregiver-mediated spoken language interventions on language outcomes compared to treatment-as-usual, non-language intervention or waitlist control conditions. Non-language outcomes were evaluated via qualitative synthesis. Interventions significantly improved language development trajectories for under-fives presenting with risk factors or early markers for DLD. CONCLUSION AND IMPLICATIONS:This review contributes to the growing evidence base demonstrating that caregiver-mediated interventions can positively impact language development and wellbeing outcomes for children under five at risk of DLD. These findings support the implementation of caregiver-mediated environmental language interventions in clinical practice to maximise accessibility and cost-effectiveness while delivering optimal outcomes for vulnerable populations. WHAT THIS PAPER ADDS:What is already known on this subject Previous research on caregiver-mediated spoken language interventions has highlighted gaps in the evidence regarding the impact of risk factors, demographic characteristics, dosage and intervention components on child language outcomes. Developmental Language Disorder has relatively high population prevalence, estimated at 7%. Prevalence is associated with risk factors including low household socioeconomic status (SES), prematurity and late language emergence. In contrast to its prevalence, there is low public and professional awareness of DLD and a low diagnostic rate. Therefore, a strengthened evidence base and additional insights into the factors affecting success of family-based interventions is important in order to increase the effectiveness of service provision and care planning for this underserved population. Timely and effective intervention with young children presenting with early markers for DLD has the potential to offer lifelong improvement to their wellbeing, inclusion and attainment outcomes. Recent systematic reviews of the effectiveness of caregiver-mediated language interventions had differences in population age range and diagnostic inclusion criteria. What this paper adds to existing knowledge Our review examines the effectiveness of caregiver-mediated early spoken language interventions on child language, attainment and wellbeing, and on caregiver self-efficacy and adherence to language support strategies. Our population was children under five presenting with risk factors for Developmental Language Disorder, in the absence of other neurodevelopmental or genetic conditions such as intellectual disability or autism. This review adds depth and detail to the evidence base supporting the effectiveness of caregiver-mediated spoken language interventions in improving outcomes for this population of young children, and factors that influence their success. What are the potential or actual clinical implications of this work? The high prevalence of Developmental Language Disorder, estimated at around 7% of the population, and the strong association with risk factors including low SES, prematurity and late language emergence, coupled with the low awareness of DLD and low diagnostic rate, mean that a strengthened evidence base and additional insights into the factors affecting success of family-based interventions can increase the effectiveness of service provision and care planning for this population. Timely and effective intervention in this group of young children has the potential to improve wellbeing and attainment outcomes across the lifespan. This review contributes to our understanding of how to implement cost-effective, socially valid and maximally engaging partnership working with families of young children at risk for DLD.
BACKGROUND:The ability to converse with others enables us to participate in everyday life. People with neurogenic communication disorders (NCDs), such as aphasia or traumatic brain injury (TBI), often experience difficulties engaging in conversation. While Systemic Functional Linguistics (SFL) has been used to analyze conversations involving people with NCDs, its application to clinical assessment and intervention remains limited. AIMS:The primary aim of this paper is to make the case for Systemic Functional Linguistics as a clinically useful framework for understanding, assessing, and supporting conversation in people with neurogenic communication disorders. METHOD:We provide an overview of SFL and introduce an SFL-based framework, Discourse Structure Analysis. We review previous SFL-based studies of adult communication disorders and also describe the USeFuL Project, a multinational collaboration focused on developing SFL-based clinical tools. Finally, we present a worked clinical example illustrating how DSA can support detailed analysis of conversations involving people with and without aphasia. MAIN CONTRIBUTIONS:SFL-based frameworks can be used systematically to guide clinical decision-making when providing services to people with neurogenic communication disorders. By enabling detailed, coded analyzes of naturalistic conversations, these approaches reveal patterns of participation that are often missed in standard assessments. Moreover, SFL can inform the development of meaningful, measurable therapy goals and the development of individualized care plans. CONCLUSIONS:SFL offers a powerful, context-sensitive framework for analyzing and supporting communication in people with NCDs. By applying SFL in clinical contexts, clinicians can build more precise, functional, and person-centered interventions that enhance real-world communication. WHAT THIS PAPER ADDS:What is already known on this subject Systemic Functional Linguistics (SFL) is a theory of communication which examines how language users make choices to convey meaning in specific contexts. Over the past 30 years, researchers have used systemic functional linguistics (SFL)- based frameworks to study real-world conversations involving people with neurogenic communication disorders (NCDs). Researchers have investigated interactions that occur in a number of settings, focusing primarily on health care contexts. Two major themes are evident within this literature: control over how conversations play out tends to be exercised predominantly by people without communication disorders, and all participants in an interaction contribute to communicative success. What this study adds to existing knowledge We are the first group to argue for SFL-based studies that provide clinicians with conceptual frameworks and theory-informed tools they can use during all stages of clinical care including assessment, goal setting and treatment. As a first step in meeting this need, we offer an overview of discourse structure analysis (DSA, a form of SFL) and provide a worked example of how clinicians could use DSA when providing services to people with neurogenic communication disorders. Finally, we introduce the Using Systemic Functional Linguistics to Understand Neurogenic Communication Disorders (USeFuL) Project, a collaboration founded to pursue a clinical, SFL-based research agenda. What are the clinical implications of this study? People with NCDs want therapies that will improve communication abilities in the real world. Because SFL-based studies always focus on data gathered in everyday settings, this discipline could be used to develop highly functional and relevant assessments, goal setting procedures and treatments. The worked example provided in this paper illustrates some key ideas about how clinicians might go about applying DSA (a form of SFL) when working in conjunction with clients to develop and carrying out plans of care. Future studies by the USeFuL Project will build on current work and expand the SFL-informed tools and approaches available to clinicians.
BACKGROUND:Cognitive-communication disorders (CCDs) are common after acquired brain injury (ABI). People with CCD experience communication breakdowns, significantly impacting long-term social, familial, and vocational outcomes. Convers-ABI-lity, a web-based communication partner training intervention, was co-designed with key stakeholders, including people with ABI, their family members, speech pathologists, and other allied health professionals, to address communication breakdowns in everyday interactions. Implementing convers-ABI-lity in student speech pathology clinics may develop student skills and confidence when working with ABI clients, increase access to interventions, improve service delivery, and improve cost efficiency. However, students were not involved in the co-design of convers-ABI-lity, and limited research exists about students' understanding of CCD or how to treat this population. AIMS:To explore student speech pathologists' perspectives on their learning of CCD and first impressions of convers-ABI-lity as an overall programme, to understand how to support students using the intervention on future placements. METHODS AND PROCEDURES:Ten undergraduate and postgraduate Speech Pathology students from the University of Sydney who were at intermediate or entry-level clinical level participated in semi-structured, in-person qualitative interviews. Interviews focused on three key areas: knowledge and perceptions of CCD, a concurrent think-aloud protocol as students interacted with the convers-ABI-lity programme, and overall feedback on the intervention. Data were analysed using reflexive thematic analysis. OUTCOME AND RESULTS:Three themes were identified: (1) Varied learning experiences contribute to different understandings of CCD, ultimately impacting students' clinical confidence; (2) 'The actual program makes sense, I just don't think it really helps me figure out what I would do'; (3) Students need support to not feel 'thrown into' a clinical placement. CONCLUSIONS AND IMPLICATIONS:These findings highlight the need for greater clinical and academic support for students when implementing a CCD intervention. The implementation of digital health features and the structure of convers-ABI-lity, may effectively support student learning, however adaptations such as therapy demonstration, may further facilitate the use of convers-ABI-lity on placement. WHAT THIS PAPER ADDS:What is already known on this subject Cognitive-communication disorder is highly prevalent and typically the primary focus for intervention following an acquired brain injury. Intervention consists of communication partner training to facilitate everyday interactions for individuals with acquired brain injury. Current evidence-based interventions exist, including the new digital health programme convers-ABI-lity, however there is limited research regarding speech pathology students' perceptions of cognitive-communication disorder and their support needs when applying convers-ABI-lity in a clinical context. What does this study add to existing knowledge Findings from this study demonstrate how different learning experiences through academic units, clinical placements, independent research, or people with lived experience can influence students' understanding of cognitive-communication disorders and their confidence entering a clinical placement with a client with cognitive-communication disorder. Students described how using a digital health programme, such as convers-ABI-lity, helps facilitate their knowledge and preparation when entering placement; however, further supports through examples and observations are needed. What are the clinical applications of this work? Students commencing clinical placements with clients with cognitive-communication disorder need guidance regarding the nature of cognitive-communication disorder and explicit instruction on how to deliver a communication partner training intervention effectively. Greater exposure to cognitive-communication disorder interventions, such as using convers-ABI-lity during academic or clinical contexts, may facilitate the knowledge and learning needs for students.
BACKGROUND:The application of non-invasive brain stimulation in the rehabilitation of bilingual individuals with aphasia following a stroke is understudied. Recent studies show benefits of anodal cerebellar transcranial Direct Current Stimulation in bilinguals, while in monolinguals, repetitive Transcranial Magnetic Stimulation (rTMS) targeting the motor cortex of the lips seems to be effective in aphasia recovery. OBJECTIVE:We aimed to investigate the effects of inhibitory continuous theta burst rTMS stimulation targeting the right motor cortex of the lips during picture naming task in the second language of a French-English post-stroke bilingual individual. METHODS:We enrolled a single bilingual (PR) exhibiting chronic post-stroke aphasia in both her second language (L2), and first language (L1). In the present study PR engaged in naming tasks three times a week for six weeks, including 2-week baseline, 2-week intervention and 2-week follow-up. RESULTS:The results demonstrated a statistically significant improvement in naming accuracy in the second language of the patient, as evidenced by visual analysis in both cognate and non-cognate words, as well as, overall language accuracy. Visual analysis revealed a positive improvement in all variables, with the greatest improvements observed in phonology, overall accuracy, and pathological language switching. CONCLUSION:The stimulation of the motor cortex of the lips resulted in an improvement in naming accuracy in both the first and second language of the participant, despite the possible varying language recovery after stroke. This suggests the possible existence of shared representations of language in the brain, which is likely due to the similarities between the languages. Further studies are required to confirm the efficacy of non-invasive brain stimulation in bilingual individuals with aphasia for deeper understanding of the underlying mechanisms influencing these outcomes. WHAT THIS PAPER ADDS:What is already known on this subject The application of non-invasive brain stimulation in bilinguals with post-stroke aphasia is understudied. Studies have indicated that the cortical organization of each language in bilingual individuals may exhibit overlap particularly in the case of similar languages, leading to a pathological language switching following cerebral lesions. A study by Coemans et al. (2023) demonstrated the efficacy of cerebellar transcranial direct current stimulation in bilingual individuals. The objective of this study is to investigate the effects of transcranial magnetic stimulation during a naming task on the second language of a post-stroke bilingual aphasia individual and to gain insight into the cortical organisation of each language. What this study adds to existing knowledge The present study demonstrates the potential of inhibitory repetitive transcranial magnetic stimulation (rTMS) targeting the right motor cortex of the lips to enhance picture naming accuracy in both languages and reduce pathological language switching in bilingual individuals with aphasia. The results demonstrate that rTMS not only facilitates recovery in each language but also has a beneficial impact on the cognitive control mechanisms involved in language switching, particularly for cognate words. That suggests that rTMS impacts both the targeted motor areas and broader cognitive networks, thereby providing insights into the bilingual language recovery process and highlighting the benefits of rTMS in bilingual aphasia. What are the clinical implications of this study? The clinical implications of this study indicate that rTMS may serve as a valuable tool for enhancing naming abilities and, consequently, language abilities in bilingual patients, particularly when the two languages exhibit similarities. The results suggest that rTMS targeting the motor cortex of the lip has the potential to simultaneously address linguistic and cognitive aspects of bilingual aphasia by targeting the phonological pathway and brain regions involved in cognitive control and language selection. These findings may assist clinicians in the development of personalized rehabilitation strategies for bilingual individuals with post-stroke aphasia.
BACKGROUND:Spoken and written language are closely linked, and Speech and Language Therapists (SLTs) have expertise in the language skills that support both. However, unlike countries such as the US and Australia, UK SLTs lack clear guidance on their role in written language. This study explores the views of SLTs working with adults (aged 16+) and children to inform consideration of a UK position statement. AIMS:To examine UK SLTs' views on their role and scope of practice in written language assessment and intervention, and to ascertain whether a position statement is needed. METHODS AND PROCEDURES:In 2021, an online survey was completed by 511 SLTs across the UK. The survey explored SLTs' views on their role in written language, alongside their reported involvement in direct and indirect written language assessment and intervention. Quantitative data was analysed using R (R Core Team, 2024). OUTCOMES AND RESULTS:SLTs working with adults or across adults and children are more likely than those working solely with children to report having knowledge, skills, and a role in written language. Those already working in this area held a more positive view of their role. Most UK SLT respondents (89%) supported the development of a UK position statement. There was also strong support for greater emphasis on the links between language and literacy in university training. CONCLUSIONS AND IMPLICATIONS:SLTs working across the lifespan are more likely to engage in written language than those working only with children. Findings indicate a clear need for UK specific guidance on SLTs' role in written language. Addressing this will require enhanced pre-registration education and continuing professional development on the links between language and literacy. WHAT THE PAPER ADDS:What is already known on the subject Language is the foundation for reading (word reading and reading comprehension) and underpins spelling and writing skills. SLT training covers areas of language that are important for literacy development. Internationally, SLTs in countries such as the USA and Australia have clearer guidance and more established roles in supporting written language and literacy, whereas in the UK this guidance remains limited. What does this study add to existing knowledge The paper enhances our understanding of UK SLTs' views on their role in written language across the lifespan. It highlights differing views across those who work with adults and those who work with children, and their scope of practice within written language. The level of certainty around SLTs' role is influenced by whether they work on written language, resource allocation, and/or training. What are the potential clinical implications of this work? Key clinical implications include: greater clarity regarding the role and scope of practice of UK SLTs with written language across the lifespan; UK policy and guidance through, for example, a formal position statement; research into how current training institutions embed the links between language and literacy within their curricula; enhanced pre-registration training and continuing professional development opportunities for practising clinicians; and a strategic approach to supporting therapists working with children through interprofessional education and education-based placements.
INTRODUCTION:The Crosslinguistic Nonword Repetition Test (CL-NWR) was designed to accommodate the phonological diversity of human languages, providing a tool that may support the identification of Developmental Language Disorder (DLD) across different linguistic backgrounds. The test materials, including a PowerPoint game with recorded stimuli, administration guidelines, and scoring instructions, were available upon request. This study examines the uptake and application of the CL-NWR in clinical and research settings through a survey of individuals who have accessed the materials. The survey covered three main areas: (i) participant demographics; (ii) experience of using the CL-NWR task; and (iii) views on administration and scoring of the CL-NWR task. METHODS:We explored views of CL-NWR users through an online survey delivered through the Qualtrics platform and distributed to 156 individuals who had requested CL-NWR materials up to November 2024. Follow-up reminders were sent at one- and two-week intervals to maximise response rates. Response formats included yes/no, multiple choice, Likert scales and open-ended text responses. Survey data were analysed through descriptive statistics and content analysis of open-ended questions. RESULTS:A total of 109 respondents from 36 countries completed the survey, yielding a response rate of 70%. The test was most commonly used with multilingual children and those with suspected DLD. Notably, 92% of respondents indicated that the CL-NWR made a valuable contribution to their assessments. Qualitative responses highlighted its practical benefits as well as areas for refinement. CONCLUSION:The high response rate and overwhelmingly positive feedback suggest a high level of engagement and interest in the CL-NWR, particularly in multilingual populations. These findings will inform future developments of the CL-NWR test, ensuring its continued relevance and effectiveness in both clinical and research applications. The study also underscores the value of crosslinguistic tools in supporting equitable language assessment worldwide. WHAT THIS PAPER ADDS:What is already known on this subject Nonword repetition tasks are widely used to support the identification of Developmental Language Disorder across languages. The Crosslinguistic Nonword Repetition Test (CL-NWR) was developed as a language-neutral tool for multilingual populations, and a growing body of research has reported findings from diverse samples using the task. However, its uptake, usability, and application in clinical and research settings have not yet been systematically evaluated. What this study adds to existing knowledge This study provides the first large-scale evidence of global uptake and application of the CL-NWR across clinical and research contexts. Findings show high levels of use, particularly with multilingual children, and strong perceived value in assessment. The results highlight both the practical utility of the tool and areas for further development. What are the clinical implications of this study? The CL-NWR is a feasible and valuable tool for supporting language assessment, particularly in linguistically diverse populations. The identified need for clearer guidance on administration, scoring, and developmental norms has informed the provision of additional materials and access instructions, supporting more consistent and informed use in clinical and research practice.
BACKGROUND:Orofacial clefts are among the most common congenital anomalies worldwide, affecting approximately 1 in 700 live births. Despite surgical repair, most children require long-term speech therapy; parental perspectives on accessing and continuing this therapy remain poorly documented in Low resource contexts. OBJECTIVE:To explore the facilitators and barriers influencing access to and continuation of speech therapy for children with CP within the low resource context. METHODS:A qualitative descriptive design was employed. Semi-structured interviews were conducted with 32 caregivers (15 mothers, 17 fathers) of children with non-syndromic cleft palate (all post-palate repair) at a tertiary cleft care centre, (November 2023-July 2025). Purposive sampling ensured variation in child age, urban/rural residence, and therapy status. Sixteen interviews were conducted in-person (mean duration 20 min) and 16 by telephone (mean duration 18 min) by a single Speech-Language Pathologist interviewer. All interviews were conducted in Hindi. Data were analysed using Braun and Clarke's (2006) six-phase reflexive thematic analysis by two independent coders. Member-checking was conducted with six purposively selected participants to validate findings. RESULTS:Four themes were identified: (1) Information deficit as a barrier-28/32 (87.5%) caregivers reported inadequate guidance at diagnosis or post-surgery (mean importance 4.5 ± 0.8); (2) Structural, geographic, and financial barriers-20/32 (62.5%) reported challenges attending therapy (mean importance 3.8 ± 0.9), with a distinct urban/rural pattern; (3) Perceived therapy outcomes as a facilitator-all 32 participants discussed visible speech progress as the primary motivator for continuation (mean importance 4.7 ± 0.6); and (4) Social, emotional, and cultural impact-22/32 (68.8%) described stigma, psychosocial burden, and protective family support (mean importance 4.2 ± 0.7). CONCLUSION:Continuity of speech therapy is contingent on timely information, accessible care models, and empowered family engagement. Structured information at diagnosis, teletherapy, community rehabilitation worker models, and parent-implemented home programmes represent actionable, context-appropriate solutions. WHAT THIS STUDY ADDS:What is already known on this subject Existing research on cleft palate (CP) in low- and middle-income countries (LMICs), highlights significant barriers to speech therapy access, such as limited local SLP providers, financial constraints, long travel distances, and resource shortages. Studies document high unmet needs for rehabilitative care, delayed intervention, and caregiver concerns about speech outcomes, social impacts, and information gaps at diagnosis. Qualitative work from LMICs has explored general parental experiences, psychosocial challenges, and treatment pathways, but caregiver perspectives specifically on facilitators and barriers to initiating and continuing speech therapy remain limited. What this study adds to existing knowledge This qualitative study provides novel, in-depth insights from 32 LMICs caregivers on facilitators and barriers to accessing and continuing speech therapy for children with non-syndromic cleft palate in a high-burden LMIC setting. Using reflexive thematic analysis, it identifies four key themes: information deficits delaying early engagement; structural/geographic/financial barriers with urban-rural contrasts; perceived therapy benefits as the main continuation driver; and broader social/emotional/cultural impacts. It offers the first detailed, context-specific exploration of these issues from a tertiary centre perspective. What are the potential or actual clinical implications of this study? Findings underscore the need for improved information delivery at diagnosis to promote early SLP referral and engagement. Clinicians should address urban-rural disparities through targeted strategies, such as telepractice or community outreach for geographic/financial barriers. Emphasizing observable therapy benefits may enhance continuation rates. Recommendations include multidisciplinary training for non-specialists, culturally sensitive guidance, policy support for affordable SLP services, and community programs to reduce stigma and emotional burden-ultimately improving access, adherence, and outcomes in resource-constrained LMIC settings. PRACTITIONER POINTS:Information deficits at diagnosis are a major barrier to early speech therapy engagement for children with cleft palate in LMICs-clinicians should prioritize clear, timely education. Structural and geographic barriers differ markedly between urban and rural caregivers; telepractice and community outreach may improve access and continuation. Perceived positive therapy outcomes strongly facilitate ongoing attendance-emphasizing observable benefits can enhance adherence in resource-limited settings.
Botulinum neurotoxin type A (BoNT-A) is an effective treatment for facial nerve palsy sequelae; however, its use in patients with myasthenia gravis (MG) is generally contraindicated due to the risk of exacerbating neuromuscular blockade. We report a female in her 40 s with a 10-year history of generalized, seronegative MG who presented with facial tightness and mild synkinesis due to facial nerve palsy sequelae. As BoNT-A is contraindicated for MG patients in Japan, we obtained approval for off-label use from the Division of Patient Safety Management in our hospital. Under a predefined risk management protocol established to meet the approval conditions, a reduced dose of BoNT-A (3 units) was administered to the affected side. Safety measures included pre- and post-injection vital sign monitoring, frequent follow-ups, and advance information sharing with the on-call otolaryngologists. The patient experienced no respiratory failure or systemic MG exacerbation. At 2 months post-injection, objective grading (Sunnybrook Facial Grading System) and patient-reported outcomes (Facial Clinimetric Evaluation scale) demonstrated sustained improvement, particularly in facial tightness and psychological well-being. This case supports the cautious use of BoNT-A for facial palsy sequelae in patients with underlying MG when a predefined risk management protocol and low-dose strategy are employed.
