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There is a lot of studies done about children’s learning to read but not a lot about themselves reading aloud. The purpose of this study was to see if reading aloud to an animal can increase the reading motivation in children with reading difficulties. The study had 2 participating children with reading difficulties and 3 participating parents who were recruited by a speech and language pathologist who works at Lära med djur, the association where the reading intervention took place. The method was a single subject design (A-B-A) where each child constituted as their own control. The study was divided into three different phases. During the baseline (A), the child read aloud in the home environment. During the intervention (B), the child read aloud to an animal on five occasions. During the follow-up (A), the child read at home again. All readings were videotaped. The parents were interviewed three times, one time in each of the phases. The children showed some change in the areas of active reading time, the correct number of words read and the number of interruptions during reading. The interviews with the parents showed that the intervention with animals seemed to have had a positive effect on foremost one of the childrens’ motivation for reading. Both parent couples said that they chose to let their child continue to read at Lära med djur atthe end of the study. Overall, the resultsshowed that reading with animals can have a certain effect on the child's reading, but further studies are required in this area.

Background: We require high-quality information on the current burden, the types of therapy and resources available, methods of delivery, care pathways and long-term outcomes for people with aphasia.

Aim: To document and inform international delivery of post-stroke aphasia treatment, to optimise recovery and reintegration of people with aphasia.

Methods & Procedures: Multi-centre, prospective, non-randomised, open study, employing blinded outcome assessment, where appropriate, including people with post-stroke aphasia, able to attend for 30 minutes during the initial language assessment, at first contact with a speech and language therapist for assessment of aphasia at participating sites. There is no study-mandated intervention. Assessments will occur at baseline (first contact with a speech and language therapist for aphasia assessment), discharge from Speech and Language Therapy (SLT), 6 and 12-months post-stroke. Our primary outcome is changed from baseline in the Amsterdam Nijmegen Everyday Language Test (ANELT/Scenario Test for participants with severe verbal impairments) at 12-months post-stroke. Secondary outcomes at 6 and 12 months include the Therapy Outcome Measure (TOMS), Subjective Index of Physical and Social Outcome (SIPSO), Aphasia Severity Rating Scale (ASRS), Western Aphasia Battery Aphasia Quotient (WAB-AQ), stroke and aphasia quality of life scale (SAQoL-39), European Quality of Life Scale (EQ-5D), lesion description, General Health Questionnaire (GHQ-12), resource use, and satisfaction with therapy provision and success. We will collect demography, clinical data, and therapy content. Routine neuroimaging and medication administration records will be accessed where possible; imaging will be pseudonymised and transferred to a central reading centre. Data will be collected in a central registry. We will describe demography, stroke and aphasia profiles and therapies available. International individual participant data (IPD) meta-analyses will examine treatment responder rates based on minimal detectable change & clinically important changes from baseline for primary and secondary outcomes at 6 and 12 months. Multivariable meta-analyses will examine associations between demography, therapy, medication use and outcomes, considering service characteristics. Where feasible, costs associated with treatment will be reported. Where available, we will detail brain lesion size and site, and examine correlations with SLT and language outcome at 12 months.

Conclusion: International differences in care, resource utilisation and outcomes will highlight avenues for further aphasia research, promote knowledge sharing and optimise aphasia rehabilitation delivery. IPD meta-analyses will enhance and expand understanding, identifying cost-effective and promising approaches to optimise rehabilitation to benefit people with aphasia.

Purpose: Since the beginning of 2020, teachers all over the world have had to switch over to virtual teaching because of the COVID-19 pandemic. This change of teaching mode has unknown consequences on the vocal health of teachers. Therefore, the purpose of this study is to investigate teachers’ self-reported voice problems during virtual teaching compared to face-to-face teaching and how they are associated to perceived risk factors in the work environment. Method: Participants included 141 teachers in high schools and higher education in Sweden who responded to an internet-based survey. Information was collected about participants’ self-reported voice handicap using a translated version of the Voice Handicap Index-10 (VHI-10; Rosen et al., 2004). Information about self-reported VTD (Vocal Tract Discomfort) symptoms and dysphonia was collected in regard to both modes of teaching (virtual vs. face-to-face). The survey also included questions on risk factors related to vocal health. Results: Self-reported voice handicap and VTD symptoms were slightly lower during periods of virtual teaching compared to periods of face-to-face teaching. There was a lower frequency of dysphonia symptoms during virtual teaching compared to face-to-face teaching, however the difference was not statistically significant. In addition, 34% of teachers reported experiencing more voice problems when teaching face-to-face while 15% reported more voice problems when teaching virtually. The most reported VTD symptoms during both virtual and face to face teaching were having a dry and a tight throat. The dysphonia symptoms with the highest reported frequency were a tense voice and hoarseness in both modes of teaching. Risk factors associated with higher prevalence of voice symptoms and/or higher levels of voice handicap during virtual teaching were air quality and straining the voice while lecturing. In addition, experiencing more voice problems while teaching virtually was associated with feeling more stressed during virtual teaching. Conclusion: The results showed a slight decrease in voice symptoms and voice handicap during virtual teaching compared to face-to-face teaching. Although multifactorial, results suggest that a potential positive effect may be attributed to better air quality in the work environment and more favourable acoustic conditions preventing teachers from straining their voice.

Stuttering is one of the most well-known speech disorders, but the underlying neurological mechanisms are debated. In addition to genetic factors, there are also major non-genetic contributions. It is here proposed that infection with group A beta-hemolytic streptococcus (GAS) was a major underlying cause of stuttering until the mid-1900s when penicillin was introduced in 1943. The main mechanism proposed is an autoimmune reaction from tonsillitis, targeting specific molecules, for example within the basal ganglia. It is here also proposed that GAS infections may have continued to cause stuttering to some extent, to the present date, though more rarely. If so, early diagnosis of such cases would be of importance. Childhood cases with sudden onset of stuttering after throat infection may be particularly important to assess for possible GAS infection. The support for this hypothesis primarily comes from three lines of argument. First, medical record data from the 1930s strongly indicates that there was one type of medical event in particular that preceded the onset of childhood stuttering with unexpected frequency: diseases related to GAS throat infections. In particular, this included tonsillitis and scarlet fever, but also rheumatic fever. Rheumatic fever is a childhood autoimmune sequela of GAS infection, which was a relatively widespread medical problem until the early 1960s. Second, available reports of changes of the childhood prevalence of stuttering indicate striking parallels between stuttering and the incidence of rheumatic fever, with: (1) decline from the early 1900s; (2) marked decline from the introduction of penicillin in the mid 1940s; and (3) reaching a more stable level in the 1960s. The correlations between the data for stuttering and rheumatic fever after the introduction of penicillin are very high, at about 0.95. Third, there are established biological mechanisms linking GAS tonsillitis to immunological effects on the brain. Also, a small number of more recent case reports have provided further support for the hypothesis linking stuttering to GAS infection. Overall, it is proposed that the available data provides strong evidence for the hypothesis that GAS infection was a major cause of stuttering until the mid-1900s, interacting with genetic predisposition.

Stuttering is a disorder characterized by intermittent loss of volitional control of speech movements. This hypothesis and theory article focuses on the proposal that stuttering may be related to an impairment of the energy supply to neurons. Findings from electroencephalography (EEG), brain imaging, genetics, and biochemistry are reviewed: (1) Analyses of the EEG spectra at rest have repeatedly reported reduced power in the beta band, which is compatible with indications of reduced metabolism. (2) Studies of the absolute level of regional cerebral blood flow (rCBF) show conflicting findings, with two studies reporting reduced rCBF in the frontal lobe, and two studies, based on a different method, reporting no group differences. This contradiction has not yet been resolved. (3) The pattern of reduction in the studies reporting reduced rCBF corresponds to the regional pattern of the glycolytic index (GI; Vaishnavi et al., 2010). High regional GI indicates high reliance on non-oxidative metabolism, i.e., glycolysis. (4) Variants of the gene ARNT2 have been associated with stuttering. This gene is primarily expressed in the brain, with a pattern roughly corresponding to the pattern of regional GI. A central function of the ARNT2 protein is to act as one part of a sensor system indicating low levels of oxygen in brain tissue and to activate appropriate responses, including activation of glycolysis. (5) It has been established that genes related to the functions of the lysosomes are implicated in some cases of stuttering. It is possible that these gene variants result in a reduced peak rate of energy supply to neurons. (6) Lastly, there are indications of interactions between the metabolic system and the dopamine system: for example, it is known that acute hypoxia results in an elevated tonic level of dopamine in the synapses. Will mild chronic limitations of energy supply also result in elevated levels of dopamine? The indications of such interaction effects suggest that the metabolic theory of stuttering should be explored in parallel with the exploration of the dopaminergic theory.

The last decades of research have gradually elucidated the complex functions of the dopamine system in the vertebrate brain. The multiple roles of dopamine in motor function, learning, attention, motivation, and the emotions have been difficult to reconcile. A broad and detailed understanding of the physiology of cerebral dopamine is of importance in understanding a range of human disorders. One of the core functions of dopamine involves the basal ganglia and the learning and execution of automatized sequences of movements. Speech is one of the most complex and highly automatized sequential motor behaviors, though the exact roles that the basal ganglia and dopamine play in speech have been difficult to determine. Stuttering is a speech disorder that has been hypothesized to be related to the functions of the basal ganglia and dopamine. The aim of this review was to provide an overview of the current understanding of the cerebral dopamine system, in particular the mechanisms related to motor learning and the execution of movement sequences. The primary aim was not to review research on speech and stuttering, but to provide a platform of neurophysiological mechanisms, which may be utilized for further research and theoretical development on speech, speech disorders, and other behavioral disorders. Stuttering and speech are discussed here only briefly. The review indicates that a primary mechanism for the automatization of movement sequences is the merging of isolated movements into chunks that can be executed as units. In turn, chunks can be utilized hierarchically, as building blocks of longer chunks. It is likely that these mechanisms apply also to speech, so that frequent syllables and words are produced as motor chunks. It is further indicated that the main learning principle for sequence learning is reinforcement learning, with the phasic release of dopamine as the primary teaching signal indicating successful sequences. It is proposed that the dynamics of the dopamine system constitute the main neural basis underlying the situational variability of stuttering.

One third of stroke survivors are estimated to suffer from aphasia. Likewise, one third of stroke survivors are reported to experience depression. People with aphasia and especially those with severe aphasia are frequently excluded from stroke research. The aim of this study was to examine the participation of people with aphasia in studies of post-stroke depression by reviewing the inclusion and exclusion criteria. We also aimed to explore the reasons given for excluding people with aphasia from research. Another intention was to compare our results to a previous systematic review published 2007, to examine if there have been any changes regarding inclusion or exclusion of people with aphasia in research about post-stroke depression over the last five years. A systematic literature search, covering three databases, was performed during September 2021, generating 3752 articles. After screening, 91 studies were included in the review. The results revealed that in some studies, both inclusion and exclusion of people with aphasia was adopted. According to this, inclusion and exclusion criteria have been scrutinized and presented separately. The analysis revealed that according to inclusion criteria, people with aphasia were included in five studies. People with aphasia were totally or partially excluded in 63 studies (69%), based on the exclusion criteria. In 25 studies there was no mention of people with aphasia either in the inclusion or exclusion criteria. The result shows that people with aphasia are excluded from research about post-stroke depression to a high extent. In recent years, the knowledge about suitable adjustments and approaches to be able to include people with aphasia in research has been enhanced. It is important that researchers acquire and make practical use of such advances in their research. To be able to generalize the post-stroke depression research results to the entire population of stroke survivors, people with aphasia must not be systematically excluded, since they constitute a large part of the population in question.

Writing impairments are common as part of aphasia. To make qualified decisions regarding what intervention to provide, speech and language pathologists need easy access to the current knowledge base. The purpose of this study was to identify, describe and rate the level of evidence for interventions targeting writing impairments following aphasia. A systematic literature search procedure in six databases was performed during May 2020, which generated 1937 results. Based on criteria concerning inclusion and exclusion 26 articles were included in the review. 16 interventions were identified and their purpose, underlying theory, participants, execution and resulting effects were described. The methodological quality of the reviewed articles was assessed using validated rating scales and each identified intervention had their level of evidence graded according to GRADE (SBU, 2017). All of the reviewed articles were single- or multiple subject design studies, which resulted in an insufficient level of evidence. Improved writing abilities were noted for each intervention and most were deemed suitable for Swedish clinical conditions. The insufficient level of evidence accentuated the need for more research concerning interventions for acquired writing impairments.

The language ability starts to develop before birth and the language and speech environment of toddlers has been found to be of significant importance for the further development of language acquisition. Earlier studies have shown that female caregivers talk more with toddlers compared with male caregivers. This study is a part of the ongoing research project “Words make a difference”, Karolinska Institutet. The purpose was to investigate caregiver gender differences amongst Swedish caregivers regarding the number of adult words in the environment around toddlers. Another purpose was to contribute in validating the Language ENvironment Analysis (LENA) in Swedish. The software LENA V3.1.0 analyzes the language environment and provides information about the number of adult words, child utterances and conversational turns. Estimated adult words can separate female adult words from male adult words. The authors also wanted to see if the LENA-result correlated with the child’s expressive vocabulary which was measured with the parent formulary CDI. Thirteen toddlers in the age of 12 - 30 months conducted an all-day recording with LENA. Random samples of the participants were chosen in order to validate the LENA-method. A total of 60 minutes of recordings was transcribed by the authors. The hypothesis that women talk more with toddlers was confirmed in this study, although the gender differences were less than in previous research. Male adult words showed a correlation with conversational turns. The result showed no significant correlation between expressive vocabulary and conversational turns. The human transcriptions were expected to conform with the LENA software especially regarding the number of adult words. The result showed that the conformity was high regarding the child utterances but somewhat lower regarding the adult words. In summary the study confirms the earlier research that female caregivers talk more to their toddlers compared with male caregivers, but the difference was not as large as shown in earlier research. Additional research about gender differences regarding adult talk and child directed speech is necessary to confirm this result. The result of the validation of LENA showed high conformity in a good audio environment. The LENA-method can be used as a useful tool to measure the listening and language environment in Sweden both in clinical and research contexts.

Bakgrund och syfte: Barns språkförmåga börjar utvecklas redan innan födseln och tal- och språkmiljön som omger barnet har visat sig vara viktig för hur hens språk kommer utvecklas. Från tidigare studier har det framkommit att kvinnor talar mer med små barn gällande antal ord jämfört med manliga vårdnadshavare. Denna studie var en del av det pågående projektet “Ord gör skillnad”, Karolinska Institutet. Syftet var att undersöka skillnaderna mellan manliga och kvinnliga vårdnadshavare gällande antal ord i närheten av yngre barn. Hypotesen byggd på tidigare studier var att kvinnor skulle tala betydligt mer med sina barn än vad män skulle göra. Ett annat syfte vara att undersöka om LENA-resultatet korrelerade med barnets expressiva ordförråd. Hypotesen var att barn som hade ett större expressivt ordförråd hade fler turtagningsmöjligheter i verbal kommunikation med sina vårdnadshavare. Studien var också ett steg i processen att validera LENA-metoden (Language ENvironment Analysis) på svenska, med fokus på vuxenord och barnyttranden. Metod: 13 deltagande familjer med barn i åldrarna 12-30 månader genomförde en heldagsinspelning med LENA-metoden. Mjukvaran LENA V3.1.0 analyserar barns tal- och språkmiljö och kan ge information om antal vuxenord, barnyttranden och turtagningar. Estimerat antal talade vuxenord kan även separeras i ord från kvinnlig respektive manlig röst. Barnets expressiva ordförråd mättes med föräldraformuläret SE-CDI. För att validera LENA-metoden valdes stickprov ut från inspelningarna. Totalt 60 minuters inspelning från fyra deltagare (15 minuter per deltagare) transkriberades av testledarna för att sedan jämföras med LENA-beräkningen. Resultat: Kvinnliga vårdnadshavare använde fler antal ord än manliga vårdnadshavare. Dock var könsskillnaderna mindre än vad som tidigare påvisats. Det fanns ett samband mellan större andel ord från män och fler turtagningar. Resultatet visade dock ingen statistiskt signifikant korrelation mellan expressivt ordförråd och antal turtagningar. Gällande validering förväntades bedömarnas transkriptioner stämma överens med LENA-resultatet, särskilt beträffande estimerat antal vuxenord. Interbedömarreliabiliteten mellan de tre  bedömarna bedömdes hög. Överensstämmelsen mellan testledarna och LENA:s estimeringar blev hög gällande barnyttranden och något lägre för vuxenord. Sammanfattningsvis stärker studiens resultat tidigare forskning att kvinnor talar mer i närheten av små barn jämfört med män, även om könsskillnaderna inte blev lika stora i aktuell studie. Mer forskning beträffande könsskillnader och barnriktat tal behövs för att belägga om resultatet har en extern validitet. Gällande validering hade LENA en hög överensstämmelse med mänskliga transkriptioner vid de inspelningar där ljudmiljön var god, vilket innebär att LENA kan vara ett bra verktyg för att kartlägga svenska barns tal- och språkmiljö både kliniskt och i forskningssammanhang.

Feeding difficulties in children can be present already from birth or appear later during the child's upbringing. In typically developed children between the ages of 2 and 7, it is estimated that feeding difficulties occur in 25% – 45%. Until recently, there has been a lack of reliable Swedish instruments to quantify and assess feeding difficulties in children. In a systematic review, a group of researchers compared different parent forms and finally highlighted the BPFAS, Behavioral Pediatric Feeding Assessment Scale, as the best instrument based on content and psychometric quality. In the spring of 2022, BPFAS was translated into Swedish. To evaluate the form, a survey was conducted on a small number of patients with diagnosed feeding difficulties. However, for the Swedish version to be clinically useful, normative data on Swedish children without feeding difficulties are needed. In this pilot study, which is part of a larger study the aim is to investigate whether an online survey is a suitable way to collect normative data for Swedish BPFAS. A web-based survey, with BPFAS questions, was created in which 154 guardians with children between 1–5 years participated. The guardians were asked to participate either via the child's preschool, child health services or via social media. The result showed that BPFAS as a data collection tool and measurement instrument works well and the results are comparable to previous studies. However, continued research is needed because most of the participants were highly educated, which cannot be classified as representative for the whole of Sweden.

Individuals with laryngectomy must find a new way of generating voice after the larynx has been removed. In Sweden, the two most common options for this new form of alaryngeal voicing are electrolaryngeal (EL) speech and tracheoesophageal (TE) speech. Only a small amount of research has been conducted on how listeners perceive the speech of individuals with laryngectomy depending on the mode of speech (i.e., EL or TE) and the mode of presentation (i.e., audio only or audiovisual). The current study is one of few examples that aim to fill this gap in the literature. The study aims to examine how Swedish listeners perceive different alaryngeal speech modes (i.e., EL and TE) in both audio only and audiovisual conditions regarding the attributes intelligibility, prosody, speech rate, and listener effort, which were used as dependent variables. The design used for this study was 2´2 repeated measures MANOVA. The data was collected through an online survey, which was answered by 64 individuals. Four different surveys were created to present a randomized order between mode of presentation and mode of speech. One speaker per speech mode was included. The surveys were evenly distributed to the listeners through four links which consisted of 23 questions. Overall, results suggest that TE-speech was rated more favorably than EL-speech in both audio only and audiovisual presentation (mode of speech: p = .000, partial eta squared = .62). The difference between audio only and audiovisual presentation was not as distinct although a preference for the audiovisual presentation could be seen (mode of presentation: p = .00, partial eta squared = .25). Furthermore, no interaction effect between mode of presentation and mode of speech was observed, F(4) = 2.138, p = .09. The effect of mode of speech was statistically significant on all the individual dependent variables whereas the effect of mode of presentation only was statistically significant for intelligibility and listener effort. For those variables, the effect size for mode of presentation was larger than the effect size for mode of speech. However, the results should not be generalized to the larger population due to limitations that are described in the discussion. In addition, the current study provides suggestions for future studies.

Objective and aim: Adults use child-directed-speech in their interaction with infants,w hich has been confirmed to have positive effects on their language learning. This study was a part of the Words make a difference project at Karolinska Institutet (KI). Within this project, a new intervention model has been developed for caregivers of children with a hearing impairment, called the Prevention Education Program forParents (PEPP). The purpose of the present study was to investigate whether caregiver’s use of child-directed speech differed between a structured play situation and in home environment. The aim was also to evaluate the PEPP model's methods of analysis; video and LENA-recording, concerning measurement of child-directed speech in a structured play situation. Data from the present study were also collected as reference data for the Words make a difference. Methods: The study involved four families with typically hearing infants aged 0-7months and their caregivers. Data collection was undertaken using PEPP's evaluation methods in a short, structured play situation and a full day recording in a home environment. Results and conlusion: In some cases, the care-givers’ use of child-directed speech differed between the structured play situation and the full-day recording in the home environment. The two data collection methods (audio recording and video recording) during the structured play situation were in good agreement regarding the use of child directed speech. The conclusion is that the PEPP model is a functional method for examining the spoken language environment of infants.

Bakgrund och syfte: Barnriktat tal (BRT) används av vuxna i samspel med små barn och har visat sig innebära positiva effekter för språkinlärningen. Denna studie var en del av Ord gör skillnad- projektet på Karolinska Institutet (KI) där en ny interventionsmodell för föräldrar till barn med hörselnedsättning utvecklas: Prevention Education Program for Parents (PEPP). Den aktuella studiens syfte var att undersöka spädbarns talspråksmiljö och om föräldrars användning av BRT skiljer sig mellan en strukturerad leksituation och i hemmiljö. Syftet var också att utvärdera PEPP- modellens bedömningsmetoder; LENA-inspelning och videoinspelning. Metod: I studien deltog fyra normalhörande spädbarn i åldrarna 0-7 månader och deras mammor. Datainsamlingen gjordes med hjälp av PEPP:s bedömningsmetoder dels under en kort strukturerad leksituation dels genom en heldagsinspelning i hemmiljö. BRT analyserades utifrån fem språkspecifika särdrag; segmentell fonologi, prosodi, syntax, ordförråd och pragmatik. Resultat och slutsatser: Användning av BRT skiljde sig i enstaka fall mellan den strukturerade leksituationen och heldagsinspelningen i hemmiljö. De två bedömningsmetoderna stämde väl överens med avseende på användningen av BRT under den strukturerade leksituationen. Slutsatsen är att PEPP-modellens bedömningsmetoder är användbara vid undersökning av talspråksmiljön hos spädbarn i åldrarna 0-7 mån gällande BRT och kan med fördel användas i föräldrahandledning. Resultaten från den här studien kan komma att användas för metodutveckling av PEPP- modellen och även som referensdata till Ord gör skillnad- projektet. 

I Sverige insjuknar omkring 25 000 personer i stroke årligen. Av de 25 000 beräknas cirka 20 – 40 % få afasi till följd av stroken. De kommunikativa svårigheter som afasi medför kan påverka informationsutbytet mellan person med afasi (PMA) och vårdpersonal. Syftet med föreliggande studie var att undersöka hur arbetsterapeuter upplever att arbeta med PMA. Vidare var syftet att undersöka hur arbetsterapeuter anpassar sin kommunikation utefter de kommunikationssvårigheter PMA har. Fyra arbetsterapeuter verksamma inom olika strokevårdenheter i Stockholm rekryterades som deltagare. Materialinsamlingen utfördes genom semistrukturerade intervjuer där materialet analyserades genom en kvalitativ innehållsanalys. I resultatet framkom att besök med PMA beskrevs vara mer komplexa och tidskrävande på grund av de kommunikativa svårigheterna. Svårigheterna vid kommunikation med PMA orsakade känslor av osäkerhet, frustration och otillräcklighet. Arbetsterapeuterna använde alternativa kommunikationsstrategier för att underlätta kommunikationen med PMA. Trots att vissa kommunikationsstrategier användes, visar föreliggande studies resultat att vidare fortbildning om hur kommunikationen kan underlättas för PMA behövs. Vidare och mer omfattande forskning om hur arbetsterapeuter verksamma inom strokesjukvården upplever arbete med PMA är motiverat.

Bakgrund: Kongenital cytomegalovirusinfektion, kCMV-infektion har en prevalens på 0,5–2,0 % och är den vanligaste orsaken till förvärvad, progressiv hörselnedsättning. Infektionen kan också medföra en rad andra komplikationer som exempelvis ADHD, autismspektrumtillstånd och språkstörning. Syfte: Syftet med studien var att undersöka vad föräldrar till barn med kCMV-infektion har för upplevelse av svensk sjukvård gällande diagnosbesked, informationsflöde och kunskap om diagnosen. Metod: Datainsamling skedde genom en fokusgruppsintervju med tre deltagare och en individuell semistrukturerad intervju med en deltagare. Analysmetoden som användes var kvalitativ innehållsanalys med konventionell ansats. Resultat: Vid analysen identifierades fyra separata teman; “Information från sjukvården”, “Diagnosbesked”, “Upplevelse av sjukvården” och “Förbättringsförslag till sjukvården”. Slutsats: Resultaten tyder på att det finns en önskan från föräldrar att få information om kCMV-infektion i preventivt syfte, exempelvis vid rutinbesök hos barnmorska under graviditet. Dessutom indikerar resultaten att föräldrar till barn med kCMV-infektion önskar ökad kunskap och mer fokus på diagnosen från sjukvårdens sida, snarare än att huvudsakligen fokusera på de efterföljande funktionsnedsättningarna. 

Background: Changes in the everyday life and health of the significant others (SOs) of people living with stroke sequalae have been widely investigated. However, information regarding the frequency of the changes in daily life and the variables most associated with these perceived life changes is limited.

Aims: To examine the extent to which SOs of persons with aphasia (PWAs) experience changes in everyday life and health after the stroke event and how they evaluate these changes and to identify which variables are associated with these perceived life changes.

Methods & Procedures: A study-specific questionnaire about perceived changes in everyday life and health was completed by 173 SOs of PWAs living in Sweden (response rate 67.8%). The items concerned the SO’s working and financial situation, leisure time and social life, relationship with the PWA, household work and responsibility, and health and quality of life.

Outcomes & Results: The everyday life and health of the SOs were greatly affected by the stroke event. The changes the SOs experienced were mainly appraised negatively. The relationships with the PWA and immediate family were least affected by the stroke. The perceived existence and severity of physical, cognitive, and language impairments of the PWA were the variables most strongly associated with the everyday life situation of the participants. The sex and age of the participants and the nature of the relationship with the PWA were only marginally associated with the experience of the situation.

Conclusions: SOs’ perceptions of the PWA’s stroke-related disabilities and need for assistance may be a key factor in identifying SOs who may require support and guidance to help them cope with their new life situation.

Background: About ten years ago surveys were conducted in Sweden and Finland in order to investigate SLP services for people with aphasia [1, 2] and their significant others [3]. Both in Sweden and Finland there are national legislations that demands evidence-based practice. Although there are still no national clinical guidelines on aphasia rehabilitation in Sweden, such evidence-based guidelines can be found internationally, such as Australian Aphasia Rehabilitation Practice [4]. In addition, Simmons-Mackie et al. [5] has through an extensive consensus work developed the top ten best practice statements for aphasia rehabilitation.

Aim: The overall aim of this study was to describe and compare how speech-language pathologists (SLPs) in Sweden and Finland work with persons with aphasia and their significant others and if these speech-language pathology (SLP) practices differ from those reported about ten years ago. Of special interest was if and how the services followed evidence-based clinical guidelines about aphasia rehabilitation.

Methods: The study was conducted as a web-based survey in Sweden and Finland in September 2018. The 43-item questionnaire was responded to by 141 (78 Swedish and 63 Finnish) SLPs working with persons with aphasia and their significant others. Quantitative data were analyzed with descriptive and comparative statistics. Qualitative data (answers to open-ended questions) were analyzed with qualitative content analysis.

Results: The findings suggested that despite some commonalities (such as allocated time for different types of interventions), SLP services differed both within and between the countries. Most within-countries differences were found in relation to in which rehabilitation phase (acute, sub-acute, and chronic) the participants worked but also between private or public SLP services (Finland) or between regions of the countries (Sweden). Differences between the countries concerned for instance time allocated for assessment, measures, goal setting, total number of sessions, the use of specific treatment methods, and the contact with significant others. The majority of the participants, particularly in Sweden, expressed dissatisfaction with the resources allocated to people with aphasia and their significant others. Other expressed barriers to SLP services were lack of treatment material, lack of courses for further education, long distances, too short treatment periods, and lack of SLP services after discharge from hospitals. When comparing today’s SLP services in Sweden and Finland with internationally agreed on aphasia rehabilitation guidelines several gaps were found, particularly regarding duration and intensity of interventions. Moreover, the participants expressed difficulties with evidence-based practice; barriers such as lack of psychometric sound measures, lack of evidence-based treatment methods, and the need for individual adaptations of treatment methods and materials were mentioned. In comparison with the studies of Blom Johansson et al [1, 3] and Klippi et al [2] some positive trends could be identified but no major differences were found.

Conclusion:Today’s SLP services to people with aphasia and their relatives in Sweden and Finland do not fulfill internationally recommended clinical guidelines. To change SLP services and implement clinical guidelines seems to be a time-consuming process that encounters several barriers.

Approximately 50 % of all people with cerebral palsy (CP) have some form of speech or language disorder. Many of these have dysarthria, a neurological disorder that causes an impaired ability to articulate and effects respiration and phonation. Many people with CP consider dysarthria to be the biggest impairment as it has a major impact on their communication. Despite this there are limited voice and speech treatments for this group of patients. The purpose of this study was to evaluate whether treatment of speech and voice functions with intensive voice treatment (LSVT LOUD) can improve the speech intelligibility in patients with dysarthria secondary to CP. Five participants (3 male and 2 female) were recruited and underwent 16 one-hour sessions of intensive voice treatment. A single-case experimental design (SCED) was used and testing occurred two weeks prior to (PRE), during (TREAT) and immediately following (POST) treatment. Measures of sound pressure level (SPL) in decibel (dB) and speech intelligibility on word and sentence level were conducted, alongside perceptual ratings of voice quality. Before and after treatment, participants answered a self-response form to evaluate their speech and communication. In addition to this the participants also estimated how effortful the treatment was. The results showed improvement in speech intelligibility and increased dB SPL on word and sentence level for four of the five participants. Perceptual ratings showed minor improvements in voice quality. Two out of five participants rated an improvement in their speech and communication. Overall the participants estimated the treatment as “very strenuous”. This study has contributed knowledge about the effects of LSVT LOUD on a new age group of people with dysarthria secondary to CP. More research is needed to draw conclusions on the effects of LSVT LOUD on speech intelligibility for people with dysarthria secondary to CP.

ABSTRACT: Listening difficulties are characterized by impaired speech recognition in noisy environments. Listening difficulties often coexist with Developmental Language Disorder (DLD), attention difficulties or reading disorders. The aim of this study was to investigate the early communicative background of preschool children with Developmental Phonological Disorder (DPD), who had – in the ages 7-10 years – showed specific difficulties in one or more subscales of the questionnaire “Evaluation of Children’s Listening and Processing Skills” (ECLiPS, Barry & Moore, 2015; Forsberg & Ohtamaa, 2019). ECLiPS profiles parents’ perception of their children’s listening abilities. Furthermore, the purpose was to investigate how speech and language pathologists (SLPs) assessed listening abilities and to investigate which other care interventions had been given besides the SLPs’. This study was a retrospective medical record study. Text units were analyzed together with nominal and ordinal data. The early communicative background was characterized by a high prevalence of attention difficulties and high heredity for both DLD and reading disorders. Furthermore, there was a lack in SLPs use of valid test instruments for listening ability, for example speech recognition was only assessed face-to-face and in in an optimal sound environment. Referrals to psychologists were made only for a minor part of the children. The results suggest that the state of knowledge in listening difficulties needs to increase within child speech language pathology.

Keywords: Developmental language disorder, Speech Sound disorder, Developmental phonological disorder, Listening difficulties, ECLiPS

SAMMANFATTNING: Lyssningssvårigheter yttrar sig främst som nedsatt taluppfattning i bullriga miljöer. Lyssningssvårigheter förekommer ofta tillsammans med språkstörning, koncentrationssvårigheter eller läs- och skrivsvårigheter. Syftet med föreliggande studie var att undersöka den kommunikativa bakgrunden hos 37 förskolebarn med fonologisk språkstörning som i åldrarna 7–10 år uppvisat särskilda svårigheter inom en eller flera underkategorier i enkäten Evaluation of Children’s Listening and Processing Skills (ECLiPS, Barry & Moore, 2015; Forsberg & Ohtamaa, 2019). ECLiPS prövar föräldrars uppfattning av sitt barns lyssningsförmåga. Vidare var syftet att undersöka hur logopeder bedömer lyssningsförmåga samt vilka andra vårdinsatser utöver den logopediska som hade getts. Studien utgjordes av en retrospektiv journalstudie. En kombinerad analys av textsträngar och data på nominal- och ordinalskalenivå genomfördes. Den kommunikativa bakgrunden utmärktes av hög förekomst av koncentrationssvårigheter samt hög hereditet för både språkstörning och läs- och skrivsvårigheter. Vidare framkom en brist i användning av valida bedömningsinstrument för lyssningsförmåga, exempelvis bedömdes taluppfattningen enbart face-to-face och i optimal lyssningsmiljö. Remittering till psykolog med frågeställning koncentrationssvårigheter framkom i viss utsträckning. Resultaten tyder på att kunskapsläget kring lyssningssvårigheter behöver öka inom det barnlogopediska området.

Nyckelord: språkstörning, fonologisk språkstörning, lyssningssvårigheter, ECLiPS

The effect of aphasia varies across patients and consequently their rehabilitation needs may differ. Access to participation in today’s information society requires good reading skills and this should be considered in a patient's rehabilitation plan. However, there are currently no guidelines available regarding the treatment of acquired reading impairments following stroke. The national guidelines for stroke rehabilitation states that speech and language intervention should be given when necessary and requested. There are currently no national guidelines for aphasia treatment that target specific language functions. The current study aims to gather and review the evidence of reading interventions for people with aphasia. A systematic search was made in medical databases to gather relevant studies. A quality review was conducted for the 19 studies found and information about the different methods used for therapy was gathered. This was followed by an evidence evaluation of each method. Although most studies demonstrated positive results, only 3 out of 13 methods were found to have a moderate to high evidence base. The majority of the methods were supported by single-case studies or lacked in quality, making it difficult to draw any conclusion about whether those methods are suitable to use in the clinic. This result also reflects the focus of the evidence grading system (GRADE) on study design and questions arose of its suitability for this type of aphasia research. 

Purpose: This qualitative study was aimed at increasing the knowledge about Swedish school-based SLPs’ perception of language assessment tools and practises. Purposes of language assessments within a school context, experience of existing tools and an assessment’s optimal content was targeted.

Method: 19 school-based SLPs, selected by purposive sampling, were interviewed using semi-structured interviews in four focus groups. The data was analyzed using qualitative content analysis.  

Results: Several positive opinions that existing tools are partly functional emerged from the results, but also experiences of limitations and demands on flexibility. Purposes of language assessment in a school context as well as its optimal content are highlighted in the results. Finally, the combination of multiple assessment forms and deliveries and collaboration with other professions in school was perceived as essential.

Conclusions: The results have increased our knowledge of how Swedish school-based SLPs perceive language assessments and their opinions on how assessments need to be designed. The present study contributes to the growing body of research that shed light on the importance of combining different assessment forms in order to reach a functional focus.

People who have undergone laryngectomy have described experiences with healthcare professionals who have knowledge gaps regarding their altered airways. This can be life-threatening in an emergency, for example, if nurses or physicians do not know how to provide oxygen or how to ventilate when performing cardiopulmonary resuscitation (CPR). These types of knowledge deficits have been confirmed in formal studies in several countries. The purpose of this study was to examine the level of knowledge among healthcare professionals regarding emergency care of laryngectomees, and how confident the staff feel, working with this group of patients. A survey was conducted at two university hospitals and two county hospitals, including departments of otorhinolaryngology (clinic, surgery, ward), emergency wards, ambulance services, intensive care units, and post anesthesia care units. A total of 160 responses were included from 11 physicians, 90 registered nurses, and 59 assistant nurses. Knowledge gaps were found regarding anatomy, appropriate positioning of oxygen apparatus, and what to do in a tracheoesophageal prosthesis crisis. For example, 50% (17 of 34) of the registered nurses and 26% (7 of 27) of the assistant nurses within emergency and intensive care units at the county hospitals knew that a laryngectomee’s only airway is via the tracheostoma. Many of the responders reported poor self-confidence when working with this group of patients. Although there were large variations, the highest levels of knowledge and self-confidence were found among the otorhinolaryngology staff. In general, the results tended to be better in university hospitals compared with county hospitals. Participants requested information and education. Suggestions for how to increase knowledge and the patient safety are discussed in the article.

Interaction is an important aspect for children’s language development. The intervention model Prevention Education Program for Parents (PEPP) is currently under development within the research project Ord gör skillnad, Karolinska Institutet. PEPP is an intervention for parents to children aged 0–12 months who’s recently been diagnosed with hearing impairment. In PEPP parents receive guidance based on the child’s language environment which is mapped through Language ENvironment Analysis (LENA) and video analysis. LENA is a speech processing technological tool that analyzes the child’s language environment. The video analysis is made manually based on short video records of interactions between child and parent. The purpose of this study was to evaluate these mapping methods reliabilities to measure verbal conversational turns. The study also aimed to investigate if there’s a pattern between the amount of verbal conversational turns in a structured playtime and in the home environment. Four families with children aged 0:26–7:3 months participated. The child and parent interacted in a structured playtime that was analyzed with LENA and video analysis. Each family also made a LENA recording for an entire day in their home environment. The amount of verbal conversational turns in the structured playtime was analyzed by two assessors through video analysis. Inter-rater reliability was calculated, and a qualitative assessment was made for intervals in which the inter-rater reliability was <80%. The conformity between video analysis and LENA in the structured playtime was calculated. Further, a comparison was made between the amount of verbal conversational turns measured with LENA in home environment and structured environment. The inter-rater reliability in this study was high and in the qualitative assessment aggravating factors were identified. The conformity between video analysis and LENA analysis of the structured playtime was moderate. The amount of verbal conversational turns was higher for all participants in the structured environment compared to the home environment. This study indicates that video analysis is a reliable method. However, the aggravating aspects should be remedied in order to increase the reliability. The results confirm previous findings that demonstrate limitations with LENA’s ability to measure conversational turns in young infants. This study indicates that the number of conversational turns is higher in structured environments. To ensure the results in this study further research should be conducted.

Previous research has shown that communicative difficulties between healthcare staff and for example patients with aphasia increase the risk of healthcare injuries, anxiety, and frustration. Currently, it is not known how healthcare professionals, and in this case occupational therapists, do when they have patients with communication difficulties after stroke; if they adapt their communication and if so how, and if they make different adaptations for different types of communication difficulties. The aim of this pilot study was to study the communication between an occupational therapist and patients with or without impaired communication ability after stroke. Video recordings were executed of the interaction between an occupational therapist and three stroke patients: a person with aphasia, a person with deficient Swedish due to a mother tongue other than Swedish, and a person without communicative difficulties. The data was analysed qualitatively using a study-specific observation scheme based on previous research and the Support in Communication (Stöd i Konversation, SiK). The results showed that the occupational therapist used both verbal and non-verbal communicative strategies to facilitate the communication and that the strategies were used differently with the different patients. Furthermore, it emerged that certain modifications need to be made to the study protocol for upcoming projects.

Abstract

Children with hearing disorders face particular challenges in developing their vocabulary. They often have difficulty in acquiring spoken language at the same rate as their normal hearing peers, despite progress regarding hearing aid technology.Aim. The main aim of this study was to describe aspects of expressive vocabulary for school-age children with mild to moderately severe hearing impairment (HI-group), and to compare with results for a group of normal hearing children (NH-group) of the same age. One aim was also to test whether there were differences, between children with hearing impairment and normal hearing children, in the ability to repeat non-words and sentences and to compare these results within each group with results on two newly constructed vocabulary tests. An additional aim was also to investigate whether background factors, such as age of diagnosis, age of hearing aid fitting and amount of hearing aid use, were related to results on vocabulary tests.Method: 24 children age 7-11 with mild to moderately severe bilateral hearing impairment, and 82 normal hearing children of similar age, were included in this cross-sectional study. Assessments of picture naming, word definition, repetition of nonwords and repetition of sentences were performed with all participants. Age, hearing, use of hearing aid and parents' level of education were included in the analyzes.Results: The HI-group performed significantly below the results of the NH-group regarding picture naming, word definition, nonword repetition and repetition of sentences. The HI-group also produced significantly more words with deficiencies in phonological structure, than the NH-group, during picture naming. In the HI-group there was a significant positive correlation between amount of hearing aid use per day and nonword repetition. Age of diagnose and age of hearing aid fitting did not show statistically significant associations with outcomes on the language tests in this study.Conclusion: Despite the technical development of hearing aids, the expressive vocabulary in school-aged children with bilateral, mild to moderately severe, hearing impairment, does not reach the same level as in normal-hearing peers, although there is a variation within the group. Amount of hearing aid use seems to be important for the ability to perceive new words.

Coronavirus disease 2019 (COVID-19) is a contagious infectious disease caused by the virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the outbreak in December of 2019, the virus has spread globally and infected more than 270 million people worldwide. The majority of people infected with COVID-19 will have mild to moderate symptoms, but some will suffer from severe illness which requires hospital care. Many of those who experience severe illness from COVID-19 are diagnosed with swallowing difficulties, or dysphagia, in the acute stage. This study consisted of a retrospective medical chart review and is part of a review of quality control in Region Gävleborg. The aim of the study was to investigate how swallowing difficulties manifest in people who require hospital care due to COVID-19 and who have been referred to the Speech and Language Therapy department. 60 participants were included in the study, of whom 17 were women and 43 were men. The results show that the prevalence of dysphagia was high in the acute stage, where 42 participants (70%) were diagnosed with dysphagia during the first SLT assessment. Many participants recovered from their dysphagia during their hospital stay, but 12 participants (20%) had persistent dysphagia at discharge. The need for nutritional and respiratory support was high. Common findings from the clinical swallowing assessments were coughing, difficulty initiating swallowing as well as affected oral processing. Common SLT recommendations included modified consistencies, posture and oral care. Swallowing ability was graded with the Functional Oral Intake Scale (FOIS) at first SLT assessment and at discharge. At first SLT assessment a majority of the participants were recommended a modified diet (FOIS 1-6) and the average FOIS was 3.5 ± 2.1. At discharge most participants had returned to a normal diet (FOIS 7) and the average FOIS was 6.0 ± 1.8 (p < 0,001). This study shows that a majority of the people who were hospitalized due to COVID-19 in Region Gävleborg and who were referred for an SLT evaluation, had dysphagia in the acute stage and recovered from their swallowing difficulties before discharge. More research and further analyses of how swallowing difficulties manifest in patients hospitalized due to COVID-19 is still needed.