Tough problems in stuttering disorders

Dr Susan Block, Senior Lecturer, School of Human Communication Sciences, La Trobe University

Speech pathologists working with people who stutter face many barriers to effective and desirable service delivery. Service options such as the number of sessions available to clients, mandated by managers (often with no background in speech pathology) restrict the application of evidence-based best practice; lack of understanding of the implications or severity of stuttering may limit funding allocation; lack of flexibility in service delivery may restrict ongoing access to treatment etc. However, equally concerning and representing a very significant problem for the profession is the fact that adults who stutter, who are unable to access treatment, are increasingly turning to non-evidence-based treatments provided by people who stutter (who have had no theoretical background in stuttering or its treatment). These issues will be discussed.

Exploring the intergroup dynamics of disordered communication using Leximancer text analytics technology

Ms J. Cretchley and Dr A. Smith, School of Psychology, the University of Queensland

In the work described here, Leximancer text analytic software was used to search for evidence of communication disorder by comparing the conversational styles of participants. The program uses a complex systems approach to analyse unstructured and qualitative data. Word frequency and co-occurrence information are used to explore semantic and relational aspects of natural language texts. Leximancer provides valid and efficient relational content analyses of diverse text documents. Further, the technology can offer insights into the dynamics underlying real-life interactions.

The software was used to analyse 9 transcripts of 25-35 minute conversations between people with a DSM-III-R diagnosis of chronic schizophrenia (PwS) and their conversational partners (4 family carers and 5 case worker carers). Key themes and concepts confirmed that there are differences between the communication styles of PwS and carers. Within the PwS sample, two distinct communication profiles emerged. Members of the first tended towards minimal responses, therefore carers did much of the work in managing the conversations. Members of the second profile dominated the discourse, and carers were more reactive in their behaviour. There were also clear differences in the conversational strategies employed by family versus professional carers. The interactional complexities in these conversations were well-illuminated by the graphical representations offered by Leximancer.

Tough Problems in Aphasia Rehabilitation: A Personal Reflection

Cindy Gallois PhD FASSA,Deputy Executive Dean and Director of Research Faculty of Social and Behavioural Sciences Professor of Psychology

Recent literature suggests that intensive language rehabilitation over a fairly extended period (several months or longer) is more effective in producing language recovery in adult aphasia than less intensive or shorter periods of formal rehabilitation. Nevertheless, it is extremely common for patients to receive far less treatment than this, partly because of resource constraints in the health sector and partly because of motivational and social issues for patients and their families. This situation is made more complex by the wide range of individual differences in language loss and recovery in aphasia, and by the expectations for recovery of patients, carers, speech pathologists, and other health professionals. In this presentation, I reflect on resource and motivational issues in terms of the experience my partner and I had during his recovery of language after a stroke, over a period that ultimately spanned six years. Our own backgrounds gave us some insight into motivational and resource issues. In addition, our backgrounds permitted a much longer and more intensive rehabilitation process than is usual, which was crucial in his recovery.

Optimising Speech Perception in Cochlear Implant Recipients

Belinda A. Henry, School of Health and Rehabilitation Sciences, The University of Queensland

Cochlear implant technology has advanced significantly over time, and current devices enable high levels of speech recognition in quiet listening environments for many adults and children with severe to profound hearing impairment. However, despite these advances, wide variability in performance among individuals remains. In addition, speech recognition is highly susceptible to the effects of competing background noise, reducing the effectiveness of these devices in real-life environments. Programming parameters can be adjusted on an individual basis with the aim of optimising performance, however this is time-consuming in the clinical setting and particularly challenging in children. Identifying the perceptual factors related to speech recognition may lead to improved speech processor design and assist in parameter optimisation. A novel technique of directly measuring the ability of cochlear implant listeners to resolve spectral peaks in the acoustic signal which is predictive of speech recognition in both quiet and competing backgrounds will be discussed. This research has implications for improving the transmission of speech cues with cochlear implants, and has potential clinical applications in optimising and predicting speech recognition for individuals. Current directions and challenges in optimizing performance will be explored.

Tough Problems in Rehabilitation of Adults with Hearing Impairment

Louise Hickson PhD, Professor and Co-Director, Communication Disability Centre, School of Health and Rehabilitation Sciences, The University of Queensland.

Hearing impairment is the most prevalent communication disorder in adults occurring in 10% of the general population over 18 years of age, and in 60% of people over the age of 60. Evidence about the improvements associated with the rehabilitation of adults with hearing impairment is strong, particularly for the efficacy of hearing aid fitting which is the most common form of rehabilitation. Hearing aids improve speech perception in a range of listening environments, reduce communication difficulties and improve quality of life. However, despite major advances in hearing aid technology in the last 15 years and excellent results in the laboratory environment, this approach is still unsuccessful for the vast majority of people with hearing impairment. Only approximately 20% of people seek rehabilitation for hearing impairment. Of those who do accept hearing aid fitting, between 10 and 30% discontinue use of the devices within a year. Funding support from the new HEARing Cooperative Research Centre will allow us to investigate barriers and facilitators to successful rehabilitation of adults with hearing impairment and an outline of the project plan will be presented.

Tough problems in management of speech pathology service delivery for human communication disorders: Private and public health

Fiona Hinchliffe PhD, Co-director Speech Pathology, Mater Health Services, South Brisbane

This paper will address the challenges of securing and sustaining speech pathology services in the health environment for adults and children with communication disorders. The Mater Health Services speech pathology department provides specialist care for people across the life-span within a corporation that encompasses a unique collocation of seven public and private hospitals. Allocation of speech pathology services for communication disorders competes with prioritised allocations for dysphagia management. Communication assessment and treatment, particularly for complex conditions, is costly in an environment where funding arrangements favour evidence of high activity and short length of stay. Business cases for increased staff and equipment funding compete with applications promoting risk reduction outcomes. Specialised services for communication disorders deemed not to be health related, such as fluency, remain unfunded in the public domain. Management strategies in relation to these issues will be explored.

Acquired language impairments: Tough problems for research and clinical practice

Lyndsey Nickels, Associate Professor & NHMRC Senior Research Fellow, Macquarie Centre for Cognitive Science (MACCS), Macquarie University, Sydney

I will address the problems that face those involved in the field of acquired language disorders and will particularly focus on the clinical/research interface. These problems focus around the development and application of evidence-based practice. One major issue is raised by the fact that impairment-focused treatment often results in improvements to only the items that have been treated. Thus, there is the requirement to ensure that items are functionally relevant for the communicative needs of people with language impairment. However, current databases neither provide us with the relevant information, nor are easily accessible for clinicians. Similarly, there is a need to ensure that improvements at one level of impairment (e.g. comprehension and/or production of single words) result in real and meaningful change at other communicative levels (e.g. discourse, conversation). However, here the tools for measuring such change require refinement in order to provide tools that are reliable, consistent and can be employed quickly in the clinical setting. The second major issue to be discussed involves the clinical use of methods that enable the efficacy of treatment to be established. Such methods, while widely accepted in research circles, are used surprisingly little in the clinical arena.

Tough problems in paediatric speech and language disorders

Dr Wendy Pearce, Head of Speech Pathology Unit, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University.

Speech pathologists working with children who have speech and language disorders face many tough problems as they strive to achieve effective outcomes for this group. The problems cut across a range of parameters including efficacy at the client interface, efficacy of service delivery systems, implementation of research, and education for the next and current generations of speech pathologists. The toughest problems we have centre around how ready we are to facilitate “mandated speech pathology services for all children with speech and/or language disorders” and “improved access to speech pathology services in rural and remote Australia” as requested by Speech Pathology Australia in its election policy for 2007. Paediatric speech pathologists also face tough problems in their readiness to embrace new therapy approaches and technological advances. A range of issues in relation to these themes will be raised to promote exploration of the tough problems for paediatric speech and language disorders.

Tough problems in the management of motor speech disorders: Future directions

Deborah Theodoros PhD, Associate Professor and Head, Division of Speech Pathology, The University of Queensland

Motor speech disorders such as dysarthria and apraxia of speech collectively represent approximately 50% of all neurogenic communication disorders. These speech disorders may range from mildly indistinct speech to a complete loss of speech intelligibility and an inability to communicate in everyday life. Based on current treatment protocols, progress towards everyday communication for many individuals is steady but slow, while for others, rehabilitation may need to assist the individual to learn strategies to enable him/her to adapt to life with disordered speech. This paper will address the difficult clinical and research issues relating to the management of motor speech disorders such as the need for effective and efficient treatment techniques/programs, sensitive treatment outcome measures, and alternative service delivery models responsive to changing social and demographic factors. Current research in treatment efficacy for dysarthria and the development of telerehabilitation applications for the assessment and treatment of motor speech disorders remotely will be presented.

The Use of Voice Acoustic Measures to Monitor the Progression and Treatment of CNS Disorders

Adam Vogel, Clinical Scientist, CogState Ltd. Melbourne

A critical unmet need for clinical research is to improve early detection of central nervous system disorders by developing tools to assist with earlier diagnosis. Specific biomarkers such as voice acoustics may be useful at the onset of neurodegeneration, the onset of disease, and/or to mark disease progression. Two experimental designs will be discussed in the context of biomarker development. The first study examines the relationship between dopamine depletion, symptom severity rating scales and voice acoustic profiles in patients with Parkinsons Disease. The second study looks at new methods for collecting and analyzing voice acoustic data in the context of a clinical depression study. Implications and limitations of this burgeoning field are discussed.