Home practice is an integral component of the therapeutic process for children with speech and language difficulties, facilitating effective collaborative practice between parents and speech and language therapists (SLTs) and increasing the dosage of intervention received. However, numerous challenges have been documented. Understanding how home practice is currently perceived by parents and SLTs may help address these challenges, enhance home practice approaches and strategies, and subsequently optimise therapy outcomes for children. This study aimed to gather views of parents and speech and language therapists on home practice, including how home practice is currently being implemented, its benefits and challenges, and how it could be improved. A mixed-methods, cross-sectional, anonymous, online survey was developed and distributed to parents and SLTs via social media. Data were analysed using descriptive statistics and content analysis. A total of 117 responses were received with a relatively balanced representation between parents (43%) and SLTs (57%). Survey findings suggest that home practice is a valued and common practice within SLT intervention, across countries and settings, that supports a positive parent-SLT alliance. Specific factors to ensure high-quality home practice were identified by participants, in addition to a range of challenges that can frequently impede the benefits of home practice being reaped and warrant attention. Home practice may be currently underutilised and not consistently nurtured to support effective collaborative working with families. Technological solutions may offer a valuable aid to improve how home practice is construed, provided, monitored, evaluated, and enhanced.

Team collaboration is an essential component of augmentative and alternative communication (AAC) services that directly impacts outcomes for students in special schools. Given the central role of the Special Education Teacher (SET) in the AAC team, there is a need to explore and understand SETs' perceptions to support effective team collaboration. This study explored the perceptions of SETs on team working and collaboration in AAC service delivery in Ireland during a period of significant systemic change. A qualitative interview approach was utilised to explore the perceptions of five SETs working with students who use AAC in special education settings in Ireland. The dataset was analysed through the process of reflexive thematic analysis and identified four themes. Participants valued team collaboration but perceived it as inconsistent or non-existent in current practice. The impact of recent service changes on collaboration was highlighted, with all participants recognising a need for enhanced collaboration. Facilitators to collaboration identified included child centredness, shared goals, role clarity, sharing of knowledge and resources, and effective working relationships.

Emerging communicators are those who are at an early stage of communication because of their age or developmental level. For these communicators, the pathway to communication and participation may be unclear at the initial assessment. In this chapter, two cases will be outlined demonstrating how early communicators may present at initial assessment, how AAC may support communication skill development, and illustrate two contrasting potential pathways as the clinical picture evolves through diagnostic intervention. Assessment tools, and intervention techniques utilised will be discussed. The chapter illustrates that AAC may be an important tool for emerging communicators to facilitate communication skill development and should be introduced as early as possible.

Recommending the most appropriate augmentative and alternative communication (AAC) supports can profoundly influence the outcomes achieved, but given the rate of developments in AAC options, navigating the range of possibilities can be challenging. This chapter presents a model of clinical decision making in AAC and illustrates application of that model using a clinical case. The model is based on a recent study of decision-making practices in making AAC recommendations for children and young people. The I-ASC study focused on the identification of attributes and characteristics that professionals, family members, and those who use communication aids considered important during the communication aid recommendation process. Findings from that study suggest that decisions made in real clinical contexts vary from decisions individuals make based on hypothetical choices removed from the clinical environment. In both contexts, a range of contextual factors beyond the child had a considerable impact on decisions made, including professional knowledge, referral criteria, and service structure. Furthermore, although in their survey responses professionals recognised the central importance of language and communication abilities to decision making, in real-time decision making, the impact of physical access features of specific devices appeared more prominent. Finally, the study findings suggest that family involvement in decision making is often suboptimal, with inadequate focus given to consensus building across all involved in making decisions. This chapter concludes with a summary of the evidence-based tools derived from the I-ASC study (https://iasc.mmu.ac.uk/) that can support effective and collaborative decision making.

Practice education is a core component of speech and language therapy education. COVID-19 led to the abrupt disruption of student placements and the rapid adoption of technology-supported solutions to ensure the continuity of clinical learning, including telepractice and simulation-based learning. Technology brings many opportunities. For example, simulation-based learning allows students to engage with rare clinical presentations or practise skills before meeting clients. However, the sudden shift to technology solutions meant that many practice educators and students were learning through trial and error as they engaged with the technology. Furthermore, telepractice requires additional skill learning and competency development for both students and educators. This study aimed to evaluate the experience of students and educators involved in practice education during the pandemic and identify how technology-enabled practice education can be effectively supported in the future. Using a six-step co-design approach, we considered the extant literature and evaluated the benefits and challenges of using technology-enabled practice education during the pandemic. Through an iterative co-design process, we synthesised the learning to develop a framework to support technology-enabled practice education and an online toolkit resource to support students engaging with technology-enabled practice education.

This adapted case report presents Seán, whose journey with augmentative and alternative communication (AAC) started in the early preschool years and evolved and changed over the course of his childhood and adolescence. It presents insights from Seán himself, from his mother Gillian and from the speech and language therapist who was involved in Seán's early engagement with AAC. Key themes emerging from these perspectives are the importance of families in supporting all aspects of communication and the critical role of recognising that AAC systems adapt and evolve as individuals face new challenges, acquire new skills, and enter new environments.

Little is known about what features of AAC systems are regarded by AAC professionals as more suitable for children with different characteristics. A survey was conducted in which participants rated the suitability of hypothetical AAC systems on a Likert scale from 1 (very unsuitable) to 7 (very suitable) alongside a discrete choice experiment. The survey was administered online to 155 AAC professionals in the United Kingdom of Great Britain and Northern Ireland. Statistical modeling was used to estimate how suitable 274 hypothetical AAC systems were for each of 36 child vignettes. The proportion of AAC systems rated at least 5 out of 7 for suitability varied from 51.1% to 98.5% for different child vignettes. Only 12 out of 36 child vignettes had any AAC systems rated at least 6 out of 7 for suitability. The features of the most suitable AAC system depended on the characteristics of the child vignette. The results show that, while every child vignette had several systems that had a good suitability rating, there were variations, that could potentially lead to inequalities in provision.

BACKGROUND Those supporting children and young people who use augmentative and alternative communication (AAC) contribute to ongoing complex decision-making about communication aid selection and support. Little is known about how these decisions are made in practice and how attributes of the communication aid are described or considered. AIMS To understand how communication aid attributes were described by those involved in AAC recommendations and support for children and young people, and how these attributes were described as impacting on AAC use. METHODS & PROCEDURES A secondary qualitative analysis was completed of interview and focus group data from 91 participants involved in the support of 22 children and young people. Attributes of communication aids described by participants were extracted as themes and this paper reports a descriptive summary of the identified software (non-hardware) attributes. MAIN CONTRIBUTION Decisions were described in terms of comparisons between commercially available pre-existing vocabulary packages. Attributes related to vocabulary, graphic representation, consistency and intuitiveness of design, and ease of editing were identified. Developmental staging of vocabularies, core and fringe vocabulary, and vocabulary personalization were attributes that were described as being explicitly considered in decisions. The potential impact of graphic symbol choice did not seem to be considered strongly. The physical and social environment was described as the predominant factor driving the choice of a number of attributes. CONCLUSIONS & IMPLICATIONS Specific attributes that appear to be established in decision-making in these data have limited empirical research literature. Terms used in the literature to describe communication aid attributes were not observed in these data. Practice-based evidence does not appear to be supported by the available research literature and these findings highlight several areas where empirical research is needed in order to provide a robust basis for practice. WHAT THIS PAPER ADDS What is already known on the subject Communication aid attributes are viewed as a key consideration by practitioners and family members in AAC decision-making; however, there are few empirical studies investigating language and communication attributes of communication aids. It is important to understand how those involved in AAC recommendations and support view communication aid attributes and the impact different attributes have. What this paper adds to existing knowledge This study provides a picture of how communication aids are described by practitioners and family members involved in AAC support of children and young people. A range of attributes is identified from the analysis of these qualitative data as well as information about how participants perceive these attributes as informing decisions. What are the potential or actual clinical implications of this work? This study provides a basis on which practitioners and others involved in AAC support for children and young people can review and reflect on their own practice and so improve the outcomes of AAC decisions. The study provides a list of attributes that appear to be considered in practice and so also provides a resource for researchers looking to ensure there is a strong empirical basis for AAC decisions.

The special edition of the Journal of Pediatric Rehabilitation Medicine on Cerebral Palsy (CP) this year is focusing on ONE of the major overarching goals in Pediatric Rehabilitation Medicine (PRM), which is to prevent complications from the known natural history of CP, especially those that impact function. We are using a lifespan lens to take an in-depth comprehensive perspective on the management of hip health and reduction of pathology throughout the life for those with CP. Stable comfortable hips are foundational for mobility and important for sitting. For all of us, sitting is one of our most essential positions for function and participation: we eat, we socialize, we learn and most of us do our work from a seated position. It is important to maintain an optimal sitting posture to allow for meaningful participation. Hip pathology can cause significant pain in individuals, and this necessitates an aggressive approach to early prevention of morbidity. In addition to decreasing costly surgical procedures, we want to encourage the use of clinical guidelines that have been proven successful in many countries. In this issue we have assembled an eclectic group to discuss various approaches to the hip. We also present the management guidelines that have been proven useful. Australian authors present the impact of 10 years post guideline development. The Cerebral Palsy Research Network team

Active engagement in interactions is crucial for the development of identity, social competence, and cognitive abilities. For children with severe speech impairment (SSI) who have little or no intelligible speech, active participation in conversations is challenging and can be critical for their social inclusion and participation. The present study investigated the conversational patterns emerging from interactions between children with SSI who use aided communication and typically speaking conversation partners (CPs) and explored whether active participation was different in interactions with different numbers of partners (dyadic versus multi-person interactions). An unusually large multilingual dataset was used (N = 85 conversations). This allowed us to systematically investigate discourse analysis measures indicating participation: the distribution of conversational control (initiations versus responses versus recodes) and summoning power (obliges versus comments). The findings suggest that (i) conversations were characterized by asymmetrical conversational patterns with CPs assuming most of the conversational control and (ii) multi-person interactions were noticeably more symmetric compared to dyadic, as children’s active participation in multi-person interactions was significantly increased. Clinical implications and best practice recommendations are discussed.

BACKGROUND: COVID-19 accelerated telepractice implementation in speech and language therapy (SLT) in Ireland. OBJECTIVE: This study documents the service delivery changes that took place in the SLT profession in Ireland during the public health crisis. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

In this study, we aimed to identify processes that enabled the involvement of a person with complex speech and motor disorders and the parent of a young person with these disorders as co-researchers in a U.K. research project. Semi-structured individual and focus group interviews explored participants' experiences and perceptions of public involvement (PI). Sixteen participants were recruited, with representation from (a) the interdisciplinary project team; (b) academics engaged in discrete project activities; (c) individuals providing organizational and operational project support; and (d) the project's two advisory groups. Data were analyzed using Framework Analysis. Five themes were generated: (a) the challenge of defining the co-researcher role; (b) power relations in PI; (c) resources used to enable PI; (d) perceived benefits of PI; and (e) facilitators of successful PI. Our findings provide new evidence about how inclusive research teams can support people with complex speech and motor disorders to contribute meaningfully to co-produced research.

ObjectivesAlthough literature exists on using qualitative methods to generate potential attributes for a discrete choice experiment (DCE), there is little on selecting which attributes to include. We present a case study in which a best-worst scaling case 1 (BWS-1) survey was used to guide attribute selection for a DCE. The case study’s context was the decision making of professionals around the choice of augmentative and alternative communication (AAC) systems for children with limited natural speech.MethodsBWS-1 survey attributes were generated from literature reviews and focus groups. DCE attributes were selected from BWS-1 attributes. The selection criteria were: include mostly important attributes; create coherent descriptions of children and AAC systems; address the project’s research aims; have an appropriate respondent burden. Attributes’ importance was judged using BWS-1 relative importance scores.ResultsThe BWS-1 survey included 19 child and 18 AAC device/system attributes and was administered to N = 93 AAC professionals. Four child and five device/system attributes were selected for the DCE, administered to N = 155 AAC professionals.ConclusionsIn this case study BWS-1 results were useful in DCE attribute selection. Four recommendations are made for future studies: define selection criteria for DCE attributes a priori; consider the impact participant’s perspective will have on BWS-1 and DCE results; clearly define key terminology at the start of the study and refine it as the study progresses to reflect interim findings; BWS will be useful when there is little existing stated preference work on a topic and/or qualitative work is difficult.

Background: Symbol communication aids are used by children with little or no intelligible speech as an Augmentative and Alternative Communication strategy. Graphic symbols are used to help support understanding of language and used in symbol communication aids to support expressive communication. The decision making related to the selection of a symbol communication aid for a child is poorly understood and little is known about what language and communication attributes are considered in this selection.Aim: To identify from the literature the language or communication attributes of graphic symbol communication aids that currently influence AAC practice.Method and Procedure: A search strategy was developed and searches were performed on a range of electronic databases for papers published since 1970. Quality appraisal was carried out using the CCAT tool and papers rated as weak were not included in the review.Results: Eleven studies were included in the review reporting data from 66 participants. Weaknesses were identified in most studies that would limit the validity of the results for application to practice. Included studies investigated aspects of vocabulary organization and design, the process of vocabulary selection, and the choice of the symbol system and encoding method. Two studies also evaluated innovative communication aid attributes.Conclusions: Information from studies reported in the research literature provides a sparse source of information about symbol communication aids from which clinicians, children or family members may make informed decisions.Implications for RehabilitationThis review is the first to systematically appraise the literature to answer the question what evidence exists to inform clinical decision making in relation to the language or communication attributes of graphic symbol based communication aids? The review establishes that there is a paucity of evidence from studies and that these decisions must thus be based on other information and factors.The review does establish a small number of language or communication attributes of symbol communication aids, but no synthesis of the results of these studies was possible. This review thus suggests that vocabulary design and organization, symbol system and encoding method, and the choice of vocabulary selection method are attributes that clinicians may carefully review in order to inform decisions.Clinicians encountering symbol vocabulary packages claiming to be 'evidence based' should query the nature of this evidence.The rehabilitation research community should debate and develop appropriate research designs that will facilitate future robust studies investigating the effect of specific language or communication attributes of communication aids.

Background This project [Identifying Appropriate Symbol Communication (I-ASC)] explored UK decision-making practices related to communication aid recommendations for children and young people who are non-speaking. Research evidence related to communication aid decision-making is limited. The research aims were to increase understanding of influencers on the decision-making process in recommending electronic communication aids, and to develop guidance tools to support decision-making. An additional, post hoc aim was to evaluate the public involvement contribution to the I-ASC project. The research focused on the identification of attributes and characteristics that professionals, family members and those who use communication aids considered important in the recommendation process. Findings informed the development of guidance resources. The evaluation of public involvement focused on what could be learned from a nationally funded project with involvement from public contributors typically regarded as hard to include. Methodology For the clinical decision-making component, the methodological investigation adopted a three-tier approach with three systematic reviews, a qualitative exploration of stakeholder perspectives through focus groups and interviews, and a quantitative investigation surveying professionals’ perspectives. The public involvement evaluation adopted a mixed-methods approach. A total of 354 participants contributed to the decision-making data set, including professionals, family members, and children, young people and adults who use communication aids; 22 participants contributed to the public involvement evaluation. The literature review process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Thematic analysis and framework approach supported the analysis of qualitative data. Two stated preference surveys, a best–worst scaling and a discrete choice experiment, allowed the relative importance of factors in decision-making to be determined. Analysis was grounded in random utility theory. Public involvement Two public involvement co-researchers, an adult using a symbol communication aid and a parent of a communication aid user, were core members of the research team. The I-ASC public involvement resulted in an additional award to evaluate the impact of public involvement across the project. Results Factors influencing decision-making are not always under the control of the decision-makers, for example professional knowledge, referral criteria and service structure. Findings suggest that real clinical decisions contrast with hypothetical decisions. Survey responses indicated that children’s physical characteristics are less important than their language, communication and learning abilities; however, during real-time decision-making, the opposite appeared to be true, with access needs featuring most prominently. In contrast to professionals’ decisions, users and family members prioritise differing aesthetic attributes of communication aids. Time allocated to system learning remains underspecified. The research informed the development of decision-making guidance tools ( https://iasc.mmu.ac.uk/ ; accessed 8 June 2020). A public involvement evaluation suggests that successful public involvement of individuals with disabilities requires significant resources that include staff time, training and personal support ( https://iasc.mmu.ac.uk/publicinvolvement ; accessed 8 June 2020). Future work Further research is needed in the areas of language assessment, communication aid attributes, types of decision-making episodes and service user perspectives. These data highlight the need for mechanisms that enable public involvement co-researchers to be paid for their contributions to research bid preparation. Limitations Individuals who benefit from communication aids are a heterogeneous group. We cannot guarantee that this study has captured all relevant components of decision-making. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research ; Vol. 8, No. 45. See the NIHR Journals Library website for further project information.