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In this podcast we interview Amy Connery, one of the authors of a paper that aims to build stakeholder consensus on the core components of intervention for adults who stutter, and to establish a guiding framework for the design and development of evidence-based interventions for adults who stutter.

The paper is:
Obtaining consensus on core components of stuttering intervention for adults: An e-Delphi Survey with key stakeholders
Amy Connery, J. Scott Yaruss, Holly Lomheim, Torrey M. Loucks, Rose Galvin, Arlene McCurtin
First published: 24 November 2021
Access the paper here:
https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12680

NOTES:

For RCSLT members, access this paper by navigating to the IJLCD website from our A-Z journals list here. Also, if you would like further information on the research terms used in the podcast, or many other aspects of research design, please navigate to the 'Sage Research Methods' collection from the Research Methods page of the RCSLT website'.

The interview is conducted by Jacques Strauss, freelance producer, on behalf of The Royal College of Speech and Language Therapists.

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ijlcd - stuttering intervention for adults

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rcslt - royal college of speech and language therapists

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‎RCSLT - Royal College of Speech and Language Therapists: IJLCD - Stuttering intervention for adults on Apple Podcasts

# data[].attributes.attachment_link.description
In this podcast we interview Amy Connery, one of the authors of a paper that aims to build stakeholder consensus on the core components of intervention for adults who stutter, and to establish a guiding framework for the design and development of evidence-based interventions for adults who stutter....

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4 min read

Many stroke survivors have trouble talking as a result of the damage to the brain. There are many reasons why an adult might suddenly have trouble talking, and it's important to know which one is causing the communication breakdown to provide the right therapy.

In the hospital, a speech-language pathologist (SLP) performs an assessment to diagnose the problem in stroke patients who are having trouble communicating. They may have one or more of the four types of acquired communication disorders that are common after a stroke that impact speech, language, or cognition.

Aphasia - a Language Disorder

Someone who's had a stroke may be left with aphasia, which is the inability to produce or to comprehend language (or both). Approximately 1/3 of stroke survivors have aphasia.

Aphasia affects different people in different ways. Someone with aphasia may be unable to do some or all of the following:

Understand what other people say

Use the right words to express a thought

Read

Write

Use gestures

Draw pictures

Use numbers or do math

Aphasia varies in severity. Someone with a mild form called usually just has trouble finding certain words during conversation. Someone whose language abilities are severely impaired, however, is said to have . Most aphasia is a type called non-fluent, or Broca's aphasia. Some people have a very different type of aphasia known as fluent or Wernicke's aphasia.

Aphasia has nothing to do with intelligence. A person with aphasia is just as smart after the brain injury as before. He or she usually has coherent thoughts and meaningful ideas to share, but has trouble getting the words out.

If you know someone with aphasia, read "What is Aphasia?" to find out how you can help.

Acquired Apraxia of Speech

Someone who's had a stroke may also have apraxia of speech, which is an impaired ability to control the muscles used to form words. This makes it hard to initiate and sequence the sounds that make up speech.

Someone with apraxia of speech has trouble coordinating movements of the tongue, lips, and/or jaw. You may see groping movements in the mouth as the person tries to speak.

Someone with this type of impairment may speak slowly and haltingly, if at all. They may have trouble starting to talk, making multiple attempts to articulate a word.

Errors are often inconsistent. The person may be able to say something once, then not be able to say it again, or it might come out differently next time.

According to the American Speech-Language-Hearing Association, apraxia of speech often occurs together with other communication disorders, such as aphasia. The exact number of people with apraxia of speech, however, is poorly understood since diagnosis can be difficult.

If you know someone with apraxia of speech, read "What is Apraxia?" to find out how you can help.

Dysarthria - Slurred Speech

Someone who's had a stroke may also have dysarthria. This is difficulty speaking clearly because of weakness, slowness, or lack of coordination in the muscles of the mouth, face, voice, and lungs.

There are several types of dysarthria. The area of the nervous system that's damaged determines the type of dysarthria the person has.

Many stroke survivors have a mild dysarthria that sounds like mumbling or a bit nasal because half of their face is paralyzed. Those who have cerebellar strokes will have more trouble with timing, sounding like they're drunk when they haven't had a drop.

If you know someone with dysarthria of speech, read "What is Dysarthria?" to find out how you can help.

Cognitive-Communication Disorders

Stroke survivors may be left with a cognitive disorder that affects how they communicate. This is referred to as a cognitive-communication disorder.

It's not a single condition, but rather a group of disorders that result when communication is impaired because of problems with cognition. This makes it different from primary speech and language deficits.

A cognitive-communication disorder results from impaired functioning of one or more cognitive processes, including the following:

Attention

Memory

Perception

Insight and judgment

Organization

Orientation

Processing speed

Problem solving

Reasoning

Executive functioning

Metacognition.

A person with a cognitive-communication disorder may have difficulty paying attention to a conversation, staying on topic, remembering information, responding accurately, understanding jokes or metaphors, or following directions.

Cognitive-communication disorders vary in severity. Someone with a mild deficit may simply have difficulty concentrating in a loud environment, while someone with a more severe impairment may be unable to communicate at all.

Thirty-five to 44 percent of stroke survivors find themselves with cognitive impairments about three months after their strokes. About a third of these people experience impairments for a long time.

Stroke is just one cause. A cognitive-communication disorder can also result from a traumatic brain injury, a brain infection, a brain tumor, or a degenerative disease such as multiple sclerosis, Parkinson's disease, Alzheimer's disease, or some other form of dementia.

Cognitive-communication disorders can occur alone or in combination with other conditions, such as dysarthria, apraxia, and aphasia.

If you know someone with a cognitive communication disorder, read "What's a Cognitive-Communication Disorder?" to find out how you can help.

Communication Problems after Stroke

If you have one of these communication disorders, or if you are a professional who works with people with these disorders, you'll want to bookmark our " What Is " series of articles full of information on the definitions, causes, symptoms, treatments, and tips to share with others.

We make apps to help with communication problems after stroke. Try our App Finder to find out which apps might work for you and then download the free versions to try them out.

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Trouble Talking: Diagnosing communication problems after a stroke

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Communication problems after stroke can benefit from speech therapy. Do you know if someone has aphasia, apraxia, dysarthria, or cog-comm issues?

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5 min read

Stroke can be a frightening word to hear if you find out that you or someone you know has experienced one. But what is a stroke exactly?

Stroke is a medical term that describes an event inside the brain in which there is a sudden loss of function, also known as a brain attack or cerebrovascular attack (CVA). It is not uncommon and it can affect anyone at any age. Stroke is the fifth leading cause of death and the leading cause of adult disability in the United States according to the Centers for Disease Control - affecting nearly 800,000 people per year.

A stroke occurs when a part of the brain is deprived of the oxygen it needs to function properly. Like the rest of our body, the brain depends on a network of blood vessels to carry oxygen and nutrients to the cells. When those vessels become blocked or damaged and oxygen can no longer reach its destination, a person suffers a stroke.

The Types of Stroke

Ischemic stroke

The brain can be deprived of oxygen in one of two ways during a stroke. One way is for a clot to travel into a blood vessel and become lodged, forming a blockage. This is called an ischemic stroke. This is the most common type of stroke by far: approximately 85% of strokes are ischemic.

Hemorrhagic stroke

Another way is for a blood vessel to burst or leak, causing swelling that puts pressure on a specific site in the brain. This is called a hemorrhagic stroke. Other names you might hear include aneurysm or bleed. A hemorrhagic stroke can happen in the brain ( intracerebral hemorrhage) or between the brain and the tissue that covers it ( subarachnoid hemorrhage).

Transient ischemic attack

If blood flow is only interrupted for a short time, a person may experience a transient ischemic attack (TIA) or a mini-stroke. Since the lack of oxygen is only temporary in a TIA, the brain does not suffer permanent damage as it does in an ischemic or hemorrhagic stroke, although it still requires medical care. In fact, experiencing a TIA puts a person at a 10x greater risk of experiencing a major stroke later on than someone who has not.

What Happens During a Stroke

When oxygen deprivation occurs due to a stroke, the brain becomes damaged as the affected brain cells die. When brain cells are impaired or killed, the function of the part of they body they control is compromised - making those body parts weak, paralyzed, or uncoordinated.

Because of the way the brain is organized, damage to one side of the brain affects the opposite side of the body (e.g., a stroke affecting the right side of the brain may impair the use of the left arm).

The onset of stroke symptoms is important to recognize and could help save someone's life. Remember the acronym F.A.S.T. to recognize the sudden and serious signs of a stroke that include: Face drooping to one side, Arm weakness or numbness, Speech difficulty, and T ime to call 9-1-1.

Doctors will use a neurological and physical examination in addition to images of the brain (from a CT scan or an MRI) and blood work to confirm a diagnosis of a stroke. Depending upon the type of stroke and how much time has passed, some treatment options include medications, surgery, or a combination of the two to remove a clot or relieve the pressure caused by a bleed.

A stroke survivor will experience an array of effects on their mind and body after a stroke, depending on where, how much, and how long the brain was affected. These can include physical, cognitive, and communication challenges that vary widely from person to person.

Areas of Impairment Following a Stroke

Language and Communication:

Difficulty coordinating the muscles of speech production to articulate words, called apraxia of speech

Weakness of speech muscles and slurred speech, called dysarthria

Challenges with producing and understanding speech and language, called aphasia

Impaired ability to follow and maintain conversation and other cognitive-communication disorders

Trouble reading, writing, or using numbers

Physical:

Paralysis or weakness on one side of the body, called hemiplegia or hemiparesis

Mobility problems that may require the use of a wheelchair, walker, or cane

Vision difficulty

Fatigue

Trouble with activities of daily living (e.g. dressing, grooming)

Swallowing and eating difficulties, called dysphagia

Bladder and bowel problems such as incontinence

Cognitive:

Disorientation

Memory difficulty

Challenges with problem solving tasks

Emotional instability

Problems with attention, including visual neglect

Learn more about strokes in the book Healing the Broken Brain: Leading Experts Answer 100 Questions about Stroke Recovery.

Recovering from a Stroke

Some people recover very quickly, while others have more lasting disabilities. Overcoming the effects of a stroke is not an easy task for most. Long-term treatment of a stroke can require ongoing medical management, rehabilitation services from therapists, and emotional support from family and friends.

For many stroke survivors with physical, cognitive, and/or communication impairments, recovery can be a frustrating task. But with the help of rehab professionals, many stroke survivors will regain crucial physical and cognitive skills that allow them to increase their independence by participating in and enjoying daily activities.

Read about the 5 factors you can control in stroke recovery.

The rehab professionals most likely to work with a stroke survivor include a physical therapist (PT), occupational therapist (OT), and speech-language pathologist (SLP). Each professional will help the patient and their caregivers set achievable goals in the areas of learning to use their body, improving cognitive abilities, and enhancing communication skills.

Therapy may include a combination of restorative exercises and strategies to compensate, including learning to use assistive devices. Education and counseling are also important parts of the recovery process. Every stroke survivor is different and will do best with a customized treatment plan created collaboratively with their doctors, family, and therapists.

Speech therapy apps can give you extra practice at home to get better faster. Find out which apps might help you and try them for FREE.

Preventing a Stroke

Approximately 80% of strokes are preventable according to the National Stroke Association. Certain risk factors have been identified that can increase a person's risk for stroke; some are preventable and some, like genetics, are not. While you can't change your age, gender, or ethnicity, you can reduce your risk of a major stroke with the following healthy lifestyle choices:

Eating a healthy diet

Maintaining a healthy weight

Regulating blood pressure

Preventing or managing diabetes

Getting enough exercise

Not smoking

Limiting alcohol use

For more helpful information about stroke, please visit our Stroke resource page and watch this video:

At Tactus Therapy, we understand stroke and the unique communication challenges of stroke survivors. Find out more about the therapy tools, resources, and benefits we offer for families looking for help.

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What is a Stroke? Info on Strokes, Recovery & Prevention

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A stroke is both a deadly and disabling event, but what is a stroke exactly? Find out what causes it, the types, how people recover, and how to prevent one.

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By the end of this CAL you will be able to:

Describe the general purpose and component parts of the Mental State Examination (MSE), specifically patients' speech and thought.

Evaluate patients' speech and thought in their mental state and use appropriate terminology to describe abnormalities.

Acknowledgments:

Thank you to Neelom Sharma, Alexandra Pittock, Meroe Grove, Maia Forrester and Mercedes Smith for their major contributions to the content of this module.

Introduction Part 1 of 11

Before we get started, let's quickly recap on the last session, which was about the domains of appearance and behaviour:

Speech and Thought Part 2 of 11

Is it all coming back to you?

Great! Let's move on then to learning about the next two domains of the MSE:
Speech and Thought.

How a person speaks can be abnormal in a number of mental disorders and should be observed and commented upon. This should be described in terms of...

the 'latencies' - the time between you asking a question and the patient replying

the 'volume' - both how loudly one speaks and the number of words one uses

the 'rate' - how fast one gets the words out

the 'rhythm' - the regularity of phrasing within sentences

the 'intonation' - the amount of inflection, or cadence (the 'lilt') in the voice

the 'prosody' - the extent to which one uses emphasis to convey meaning that grammar alone cannot

Thought Form Part 5 of 11

Thought form deals with the 'mechanics' of the patient's thoughts i.e. how the patient is thinking. This is of diagnostic use as in many psychiatric disorders, thinking 'slips' to a less sophisticated level as a consequence of the illness.

This results in disorders of thought form, where the ability to express ideas cogently and coherently is compromised or lost completely. The stream of goal-directed thought is disrupted by irrelevancies to the extent that the goal gets lost.

The first thing to note, therefore, is how easy is it for you to follow what the person is saying...

Do you have a sense of where they are going with their thoughts?

Do they go off on a lot of tangents?

Do they seem to be including too much information?

Do they eventually get to the 'goal' or not?

Do their thoughts seem to jump from one 'connection' to another really quickly?

Are these break-points logical or is it hard to see the connections?

Images from: Marwick K, Birrel S. The psychotic patient. In: Crash Course: Psychiatry. 4th edition. Elsevier Ltd; 2015. p. 65-75.

Overvalued Ideas Part 8 of 11

An overvalued idea is a plausible belief that a patient becomes pre-occupied with to an unreasonable extent. The key feature is that the pursuit of this idea cause considerable distress to the patient or those living around them.

They are distinguished from delusions by the lack of gross abnormality in reasoning; these patients can often give fairly logical reasons for their beliefs.

They differ from obsessions in that they are not seen as recurrent intrusions.

Questions Part 10 of 11

Now watch this video and write your own record of the patient's speech and thought. Then, click the button at the end to compare your answer.

Summary Part 11 of 11

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Mental State Examination 2 - Speech and Thought

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By the end of this CAL you will be able to: Describe the general purpose and component parts of the Mental State Examination (MSE), specifically patients' speech and thought. Evaluate patients' speech and thought in their mental state and use appropriate terminology to describe abnormalities.

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DON'T FORGET TO CHECK THE SLIDES ON MOODLE

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DON'T FORGET TO CHECK THE SLIDES ON MOODLE

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Dysarthria can result from congenital conditions, or it can be acquired at any age as the result of a neurologic injury, disease, or disorder. The scope of this page is limited to acquired dysarthria in adults.

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Communication Confidence Rating Scale for Aphasia

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Characteristics: Slow, laborious speech, limited vocabulary, difficulty forming complete sentences, and relatively preserved comprehension.

Damage Area: Broca's area in the left frontal lobe.

Examples: A person might say "Walk dog" instead of "I will walk the dog."

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Aphasia is a language disorder caused by damage to specific areas of the brain, typically the left hemisphere, which is responsible for language and communication. It affects a person's ability to speak, understand speech, read, and write. Aphasia can result from stroke, head injury, brain tumour, or other neurological conditions.

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Characteristics: Fluent but nonsensical speech, difficulty understanding spoken and written language, and use of incorrect or made-up words.

Damage Area: Wernicke's area in the left temporal lobe.

Examples: A person might say "I want to bliff the gorple" instead of "I want to watch the movie."

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Characteristics: Severe impairment in both expressive and receptive language skills, limited speech production, and poor comprehension.

Damage Area: Extensive damage to the left hemisphere.

Examples: Limited to single words or short phrases, often repetitive and not meaningful.

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Characteristics: Difficulty in finding words, especially nouns and verbs, while speech and comprehension are relatively intact.

Damage Area: Various locations in the left hemisphere.

Examples: A person might say "It's a... you know... the thing you use to write."

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Characteristics: Good comprehension and fluent speech, but difficulty repeating words or phrases and making phonological errors.

Damage Area: Arcuate fasciculus connecting Broca's and Wernicke's areas.

Examples: A person might say "repiblication" instead of "replication."

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Western Aphasia Battery (WAB)

Positives: Provides a comprehensive profile of language abilities, helps differentiate between types of aphasia, and quantifies severity.

Negatives: Time-consuming, may not capture subtle language deficits, and requires training to administer.

Boston Diagnostic Aphasia Examination (BDAE)

Positives: Detailed analysis of language skills, identifies specific language impairments, and guides treatment planning.

Negatives: Lengthy administration time, complex scoring, and may be challenging for patients with severe impairments.

Aphasia Diagnostic Profiles (ADP)

Positives: Offers a quick screening option, assesses functional communication, and provides intervention guidelines.

Negatives: Less comprehensive than other tests, might not detect mild aphasia, and can be less detailed in diagnosis.

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Spontaneous Speech Analysis

Positives: Reflects real-life communication abilities, easy to perform, and can be tailored to individual needs.

Negatives: Subjective, lacks standardized measures, and may miss specific language deficits.

Conversational Analysis

Positives: Provides insight into pragmatic language use, identifies functional communication strategies, and observes interaction skills.

Negatives: Requires skilled observation, subjective interpretation, and may not cover all language domains.

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Caregiver Reports

Positives: Offers insight into daily communication abilities, captures real-life challenges, and involves significant others in the assessment process.

Negatives: Subject to bias, may not be detailed, and depends on the caregiver's observation skills.

Functional Communication Tasks

Positives: Assesses practical language use, highlights functional communication strengths and weaknesses, and aligns with everyday activities.

Negatives: Variable results based on task difficulty, may not be standardised, and can be influenced by non-language factors (e.g., motivation).

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PALPA subtests
CAT