Introduction/or rationale: To date, there is little research examining the views of people with dysphagia, their supporters, and allied health professionals on food shaping techniques for people with dysphagia and the importance of food design on dysphagia-related quality of life.

Aim(s): To examine the views of people with dysphagia, supporters of people with dysphagia, and allied health professionals on (a) food design strategies used in texture-modified meals; and (b) the feasibility of 3D food printing.

Methods: An online survey of 30 people with dysphagia, four supporters of people with dysphagia, and 18 allied health professionals was conducted. Data were analysed using descriptive statistics and content coding of free-text responses.

Results: The majority of respondents used at least one food design strategy to improve the appeal of texture-modified foods. Approximately two thirds of supporters and allied health professionals, and one third of participants with dysphagia considered that 3D food printing would improve the appearance and enjoyment of food. However, results also suggested that feasibility of 3D food printing is low, related to the financial cost as well as effort needed for its use, indicating a need for greater user-centred co-design of food shaping technologies.

Conclusions: The views of people with dysphagia, their supporters, and allied health professionals vary widely in relation to the importance of food design for texture-modified meals. 3D food printing may not fulfil the expectation of improving mealtime-related quality of life, and further co-design is needed to increase its feasibility in the future.

Keywords: Dysphagia, food design, 3D food printing, survey.

Submission Statement: Speech pathologists should reflect on their recommendations relating to food design strategies with people with dysphagia. The views of people with dysphagia should be respected and adequately responded to in all components of the mealtime process to ensure a positive mealtime experience.

Introduction:
Literacy skills are fundamental for children to develop (ACARA, 2017). Recent studies with teachers have shown that many feel unprepared to support literacy development (Weadman, et al, 2021). In response to this finding, methods to support teachers to develop literacy in school-aged children need to be investigated (Flynn et al 2021).

Aims:
To explore the current approaches that Australian teachers use to teach literacy and the types of classroom support they have to develop the literacy skills of children.

Methods:
An online mixed-methods survey of teachers.

Results:
Forty-eight responses were included in the analysis. Most participants indicated that their university degree did not prepare them to teach or support literacy skills. However, many of the respondents had sought ongoing professional development in systematic phonic approaches. This had improved their knowledge and skills and some reported that collaborations with SLPs were useful.

Conclusions:
Despite initial feelings of unpreparedness, many of the respondents have continued to improve their understanding of effective literacy instruction through professional development and ongoing support from SLPs.

Keywords:
Literacy instruction, teacher training, classroom support.

Statement
This research demonstrates our endeavour to reflect on the experiences of teachers and to be responsive to their needs and work collaboratively with them to build the literacy skills of Australian children. This has been achieved by respecting the participants' contribution in sharing their experiences.

References:
Australian Curriculum, Assessment and Reporting Authority (ACARA). (2017). Introduction to the national literacy and numeracy learning progressions. https://www.australiancurriculum.edu.au/media/3782/introduction.pdf

Flynn, N., Powell, D., Stainthorp, R., & Stuart, M. (2021). Training teachers for phonics and early reading: developing research‐informed practice. Journal of Research in Reading, 44(2), 301–318.

Weadman, T., Serry, T., Snow, P.C. (2021). Australian early childhood teachers’ training in language and literacy: A nation-wide review of pre-service course content. The Australian Journal of Teacher Education, 46(2), 29–56.

Objective:  This poster presents the outcomes of a scoping review investigating how conversation and pragmatic skills develop in children who are deaf or hard of hearing (DHH).


Design:  The review was conducted in line with Arksey & O’Malley’s (2005) methodological framework. Five online databases were systematically searched for articles about conversation and pragmatic skill development in DHH children, published between January 2000 and June 2022. Reference lists from studies published in the last five years were also hand searched for completeness. Citations were uploaded into Covidence, an online tool used to conduct scoping and systematic reviews. Two authors completed the screening of articles by title and abstract, followed by full text screening against a-priori inclusion and exclusion criteria; conflicting viewpoints were discussed until consensus was reached. Quality appraisal of included studies was then conducted using the Johana Briggs Institute checklist for analytical cross-sectional studies. The quality of a random selection of articles was appraised by two authors and again, conflicting viewpoints were discussed until consensus was reached.


Results:  In total, 1130 articles were identified, including 538 duplicates, which were removed. 592 articles were screened by title and abstract, 498 were marked as irrelevant, and 94 full-text articles were assessed for eligibility. After full text screening, 36 studies were included.  

All studies presented cross sectional research (level 4b evidence). Sample sizes were generally small and heterogenous. Methodological rigour varied with the studies using a variety of assessment measures and research designs. Few studies provided a valid comparison group e.g. comparing to typically hearing (TH) matched peers. Most research focused on school-aged children. Heterogeneity within subject groups, small sample sizes, and the quality of the methodological designs used makes drawing conclusions about pragmatic and/or conversation skill development and assessment in children who are D/HH challenging.


Conclusions:  The review highlighted that many aspects of conversation and pragmatic skill development in children who are DHH remain unclear. Some studies described significant differences between skill development in children who are DHH compared to peers with typical hearing while others reported, no significant differences between the two groups. This review highlights the need for additional research to develop our understanding of how children who are DHH develop conversation and pragmatic skills.

Introduction
Children with Developmental Language Disorder (DLD) have difficulties with inferential comprehension, narrative production and word learning. Evidence from a randomized control trial (Dawes et al., 2015) revealed that the theory-driven Oral Inferential Comprehension Intervention (OICI) program was efficacious with pre-primary children with DLD. Although the trial included only inferential and literal comprehension as outcome measures, OICI also addressed vocabulary and story retell.

Aims
In this modified version of OICI, we defined and specified dose number and measured outcomes on vocabulary and story macrostructure in addition to literal and inferential comprehension.

Methods
Four children, aged 5;09 to 6;06, participated based on teacher referral and parental concern, althoughDLD diagnosis was not confirmed via norm-referenced tests. An ABA multiple-baseline across participants design with a staggered baseline phase was used. The 11-week program included three pre-treatment baseline, 16 treatment sessions with four probes, and a two-week post-treatment maintenance.

Results
The weighted average Tau-U values for all children suggested a medium effect size for inferential comprehension, and a small effect size on the number-of-different-word measure in the narrative retell task. Both results were statistically significant. The weighted Tau-U average for literal comprehension and macro-structure revealed a non-significant small effect.

Conclusions
This study replicated and extended earlier findings on OICI on children learning a language other than English.

Contributions and implications
The manualized OICI demonstrated efficacy when translated into another language and culture. It can be useful for clinicians working with children from culturally and linguistically diverse backgrounds.

Key words

Inferential comprehension, intervention, early efficacy, DLD, interactive book reading, vocabulary

Submission statement

Research evidence on language intervention comes primarily from English-speaking children. On reflection, we ask ourselves: Do intervention approaches that are driven by theoretical principles necessarily work for children from different language backgrounds? Can the essential elements of an efficacious intervention be in conflict with typical adult-child interactions in other cultures?

Introduction

Reducing teat flow rate is important in supporting swallow coordination in vulnerable neonates. However, recent studies have demonstrated that flow rate is not standardised across teat brands, and also inconsistent within brands. As a prelude to this study, replication of the previous flow testing methodology was attempted, but this was difficult to reproduce, particularly with regards to seal and subsequent pressure consistency. It was hypothesised that optimising the original methodology could improve the reliability of testing.

Aim

To optimise the methodology for teat flow testing trialled in previous experiments.

Methods and Results

This project included three iterations of testing design. The first iteration optimised the bottle attachment to the testing apparatus for easier preparation, tilt, and consistency of testing angle. The second iteration explored means of improving seal between the teat and the breast-pump attachment. This design resulted in improved consistency of test results for the three teats tested, however, the seal was flimsy and difficult to manage. The final iteration explored the use of a 3D printed collar piece that encased the teat, to eliminate the issues with seal design, and support improved pressure consistency. Calibration with original experiment results was being finalised at the time of writing.

Conclusions

Previous teat flow testing methodology required optimisation for reproducibility. Early results from this revised model support improved reliability of teat flow testing, which will, in turn result in enhanced safety outcomes for fragile neonates.

Keywords:

Infant feeding, equipment, teats, flow testing, paediatric dysphagia

Submission statement:

This abstract is an example of an improvement process that involved proactive collaboration with engineering. The authors respected the original design, reflected on limitations, and responded to these by making and testing modifications in a rigorous manner. These modifications will have significant implications for better feeding outcomes in fragile infants.

Introduction: Dysphagia involves discomfort or impairment of swallowing musculature, which if untreated can lead to premature death via aspiration pneumonia. Dysphagia assessment and intervention is likely to vary across patient diagnoses, however, whether practice also differs by clinician experience, geographic region, patient age, and clinical setting, is unknown.
Aims: This survey aimed to 1. gain a greater understanding of standard care of dysphagia, 2. examine whether standard care aligns with evidence, and 3. determine if there are significant differences in dysphagia practice by clinician experience, geographic region, patient age, and clinical setting.
Methods: A 17-question online global survey of dysphagia clinicians asked participants to report various aspects of their dysphagia practice for the preceding 12-months. The 231 responses were analysed using descriptive statistics.
Results: Despite strong evidence for instrumental assessments, 11% of clinicians had not referred for instrumental assessment, those who did refer, preferenced VFSS over FEES although evidence suggests both are gold-standard. Though there is clear value in use of validated published assessments, all inpatient clinicians used their own knowledge for infant dysphagia assessments. While research suggests motor-learning principles are most likely to improve dysphagia, all clinicians preferenced compensatory strategies over direct interventions, particularly senior and adult clinicians. And although plasticity occurs more readily in younger brains, paediatric clinicians saw their patients less intensively than adult clinicians.
Conclusions: These results indicate that practice does not align with evidence, highlighting a need for education and review of funding to support the implementation of best-practice and equitable services.

Keywords: Feeding · Swallowing · Dysphagia · Assessment · Intervention

Submission statement: This study facilitates reflection on current service provision for infants, children, and adults with dysphagia. Reflection shows that practice does not align with evidence, thus not respecting our patients’ rights to best-practice services. It invites us to respond by advocating for additional services, knowledge, and funding.

Is blue better? The impact of blue versus white dishes on the amount of food consumed by inpatients with dementia. A controlled, randomized, crossover, single site pilot study

Introduction: People with dementia are at high risk of malnutrition due to multiple factors including changes in perception and dysphagia. Modifying diet textures may add to reduced oral intake. Contrast sensitivity and colour discrimination have been shown to be the most consistent visual perceptual deficit for people with dementia. Promising but limited research shows oral intake may improve when high contrast blue dishes are used for meals rather than white dishes.

Aim: Determine whether using high contrast blue dishes are associated with a significant increase (≥25%) in the amount of food eaten by inpatients with dementia.

Methods: Inpatients with a confirmed diagnosis of dementia, MMSE ≤25, on any IDDSI diet texture, able to self-feed and with adequate vision will be randomly allocated to one of two groups: receive meals on blue (B) dishes for 2 days, then white (W) dishes for 2 days (BBWW) or the reverse (WWBB) with N = 20. Photos to be taken pre- and post each meal, de-identified and independently analysed by 4 clinicians. Patient characteristics will be described using mean and standard deviation (or median and interquartile range) or frequency and percentage. Mixed effect model will be performed. Statistical analyses will be performed using Stata MP/16 (StataCorp, Texas).
Results: Awaiting results and will update when results are collaborated.

Conclusions: Conclusions will be addressed once data has been analysed. Results will indicate whether implementing high contrast blue dishes may increase the amount of diet consumed by inpatients with dementia.

Keywords: Dementia, dysphagia, blue dishes, feeding, malnutrition.

Introduction: It is difficult to access timely Videofluoroscopy Swallow Studies (VFSS) outside of the hospital system. It is also difficult to access VFSS clinics tailored to clients with neurodevelopmental conditions and much of expertise is held within the hospital system. The aim of this study was to launch a VFSS service to improve access to VFSS and improve the diagnosis and management of feeding and swallowing disorders in adults in the community.

Methods: VFSS are conducted from two radiology clinics in Melbourne for NDIS clients with both acquired and neurodevelopmental conditions. This is run by two senior speech pathologists with VFSS competencies and one radiographer. A protocol, rating tool and report templates were developed from best practice and feedback obtained from speech pathologists working in the community.

Results: To date, 22 VFSS have been completed across two sites and has resulted in: diet texture modifications, provision of additional information to assist in informed decision making (including Eating & Drinking with Acknowledged Risk plans) and identification of targets for dysphagia rehabilitation.

Conclusions: VFSS can safely be completed in the community. So far, the results show that this is likely to increase access to VFSS for adults with feeding and swallowing disorders in the community, particularly adults with neurodevelopmental conditions. This study highlighted that research and guidelines on the assessment of dysphagia in neurodevelopmental populations, particularly in regards to instrumental assessment, was virtually non-existent. This has resulted in a research collaboration with a university in Melbourne to further explore this area.

Keywords: videofluoroscopy, community, dysphagia, NDIS

This project originated from reflection about how VFSS are currently conducted. We felt that the use of VFSS in the neurodevelopmental population should be afforded the same respect as the acquired neurological population. Therefore, our response was to create high quality service that would be accessibility to adults in the community.

Introduction/or rationale
Challenges exist in delivering high quality dysphagia services in Singapore. Engaging with the speech pathology workforce is necessary to address these challenges and achieve meaningful service improvements.

Aim(s)
Develop a set of prioritised enhancements that speech pathologists (SPs) and managers perceive are needed to improve the delivery of dysphagia care in Singapore.

Methods
Using a concept mapping approach, 19 SPs and 10 managers from acute and subacute settings in Singapore reflected on their experiences of providing dysphagia services, and listed suggestions for service optimisation. Within their groups, the collated suggestions were sorted based on similarity, and individually rated on a 5-point scale based on importance and changeability. Using multidimensional scaling and bivariate analysis, clusters of similar suggestions were decided, and highly important and changeable suggestions for service optimisation were identified.

Results
The 73 unique suggestions made by the SPs, and the 51 unique suggestions proposed by the managers, were analysed separately. Analysis revealed the suggestions fell within 6 clusters for both groups with similar themes being: consumer’s needs, workforce capability, and cross-institution collaboration. All clusters were rated as more important than changeable, and the least important clusters were also the least changeable. The SPs rated their suggestions as less changeable than the managers. The SPs and managers rated 37% (27/73) and 43% (22/51) suggestions respectively, as both highly important and changeable, with similar priorities being: accessible resources and services, and better cross-institution collaboration.

Conclusions
The speech pathology workforce in Singapore developed a set of prioritised enhancements, providing direction for dysphagia service optimisation in Singapore.

Introduction
With the increasing diagnosis of Paediatric Feeding Disorder (PFD) diagnosis, there are currently few standardised outcome measures to assess the effectiveness of an intervention. The few tools currently available have inconsistent psychometric properties, are limited to a particular age, and are without a salient and standardised measure specifically for children with PFD.

Aim
This study aimed to pilot the use of a clinical outcome tool to measure effectiveness for children with Paediatric Feeding Disorder (PFD) at a tertiary hospital within a paediatric population in Perth, Western Australia.

Methods
A mixed methods research design was applied. A pilot battery of outcome measures was trialled by two clinicians within paediatric speech pathology in a tertiary hospital with paediatric services. Eighteen children from 3 months to 9 years seen for swallowing and feeding management were measured pre and post-intervention on the outcome measures, and follow-up interviews were conducted with managing clinicians to obtain feedback on the implementation of the outcome measure tool in clinical practice.

Results
Analysis of outcome measure data before and after intervention provided statistically significant changes, indicating that the outcome measurement battery was successful in indicating change after intervention. Content analysis of interview data supported the comprehensive measurement within the tool but suggested the need for an accompanying administration protocol and more relevant outcomes to measure therapeutic management for younger clients under six months.

Conclusion
The tool contributes new knowledge to the development of a tool which can be adopted for use in clinical contexts working with patients with PFD in the future.

Introduction

The recommended treatment frequency for speech sound disorders is rarely met. Speech pathologists routinely prescribe home practice to increase treatment frequency. However, parents have difficulty achieving the required amount of home practice and completing it as described. Common barriers to completing home practice are parents forgetting how to conduct activities, speech pathologists suggesting unsuitable activities, children’s behaviour, motivation, and time restraints.

Aim(s)

Our research explores whether using apps in home practice may reduce barriers to completing home practice.

Methods

Four children with speech sound disorder and their parents participated. The study utilised a mixed methods research design comprising a single-subject crossover design with multiple baselines followed by a qualitative thematic analysis of parent interviews. The crossover component had five phases: Baseline, Treatment Phase 1, Washout Phase, Treatment Phase 2, Maintenance Phase. Children completed parent-led home practice for one treatment phase, and app-assisted home practice for the other. Parents received training based on the teach-model-coach-review approach. Treatment outcomes for children will be measured using individualised probes. Parent preferences regarding home practice will be explored using semi-structured interviews.

Results

Available December 19th 2022

Conclusion

Our study will provide new knowledge on whether apps can reduce barriers to completing home practice. If proven, this may enable shorter treatment durations for children with speech sound disorders, addressing waitlist issues.

Background: People in contact with the ‘justice’ system reportedly present with higher rates of speech, language, and communication needs (SLCN) compared to the general population. The experience of people with SLCN in the justice system can be greatly impacted by interactions with police, for better or for worse, with an increased risk of negative outcomes if communication breakdown occurs.
Aims. To investigate how and for what purposes speech pathologists collaborate with police.
Methods. The systematised review involved comprehensive searching of six databases, review of the contents of two journals since 2000, forward and reverse citation searching, application of eligibility criteria during the search process, quality review, data extraction, and inductive thematic analysis.
Main Contribution. Twenty-five papers were included in the review with 14 of these published since 2017. Through thematic analysis, four broad and interrelated themes involving both existing and potential police and speech pathology collaboration were identified: (1) a lack of police knowledge concerning the impact of SLCN, (2) the urgent need for police training on how to communicate with people who have SLCN, (3) the need for greater speech pathology and police collaboration, and (4) the need for greater access to speech pathologists to assist people with SLCN in custody.
Conclusions. This review found support for speech pathology and police collaboration for training purposes and supporting people with SLCN in custody. As most existing research focused on the youth justice system there is a need for more research on adults with SLCN in custody.

Introduction
A relationship between language impairment and behaviours of concern (BoC), e.g., fighting and losing temper, is often assumed for autistic children. Previous findings have been inconclusive, with the contribution of different linguistic domains (e.g., receptive or expressive language) to BoC yet to be elucidated. A better understanding of this may enable provision of appropriate preventative measures.

Aims
This study aims to investigate the longitudinal association between language ability and BoC for autistic children using a large population-based sample. This research explored whether receptive and expressive language ability is associated with BoC in autistic children and whether associations hold true when covariates are included in analyses.

Methods
Autistic participants were drawn from the Longitudinal Study of Australian Children (LSAC). Receptive and expressive measures of language (ages 4-5 years) included the Peabody Picture Vocabulary Test, and LSAC parent questionnaires. The BoC outcome measure (ages 8-9 years), was the Strengths and Difficulties Questionnaire – Conduct Problems subscale. Correlation and regression analyses were conducted, with covariates including socio-economic status, non-verbal IQ and pro-sociality.

Results
No association was found between receptive or expressive language impairment and BoC outcomes for all children. Covariates, Non-verbal IQ and Pro-sociality, were significantly associated with BoC for half of the sample, contributing to 14% of the variance in BoC outcomes.

Conclusions
While no association between language and BoC outcomes was found in this population sample, the results highlight variables, peer socialisation and non-verbal IQ, that may be more relevant. Findings provide important prognostic information, particularly outlining priority areas requiring support.

Keywords:
Autism, language, behaviours of concern, association, longitudinal.


Furthering knowledge about the correlation of language difficulties and behaviours of concern in autistic children can help the speech pathology profession reflect on evidence, potentially leading to optimisation of speech pathology screening and intervention services. This supports respecting the autistic population and responding appropriately to their needs.

Between 30-50% of infants and children with pediatric feeding disorders demonstrate oropharyngeal aspiration. Thickening fluids is a compensatory strategy that is commonly recommended by speech pathologists for the management of oropharyngeal aspiration. Ongoing variability in the preparation of thickened fluids across infant formulas and healthcare facilities continue to limit the standardization of the preparation of thickened infant and pediatric formulas. No studies exist which examine the influence of nutritional properties of different infant formula types on IDDSI thickness levels. Our study aimed to describe the impact of standardized resting times; and understand the influence of nutritional properties on a variety of thickened ready-to-feed liquid and powder-based formulas within an Australian context. A total of 27 ready-to-feed liquid and powder-based formulas were tested for viscosity level at baseline and when thickener was added on at least 2 trials. Frequency counts and percentages were used to describe categorical data. Logistic regression was used to model the binary outcome and calculate the odds ratios and their 95% confidence intervals. Three-quarters of commonly used powder-based and ready-to-feed formulas in Australia thickened to IDDSI slightly thick (level 1) when prepared in a standardized manner and allowed to rest for 5 minutes. Formulas with higher protein totals were more likely to thicken sufficiently, while formulas with higher sugar totals or those used for enteral feeds were less likely to thicken sufficiently. This study highlights the importance of using the IDDSI Flow Testing Method regularly when recommending thickened infant formula recipes for managing aspiration in infants and children.

Introduction/or rationale: Videofluoroscopic Swallowing Study (VFSS) is considered gold-standard assessment for investigation of oropharyngeal dysphagia. However, in acute Australian hospitals patients with suspected oropharyngeal dysphagia do not routinely receive a VFSS, and the characteristics and appropriateness of VFSS for these patients are not known.
Aim(s): To investigate the proportion and characteristics of acute adult patients with suspected dysphagia who receive versus do not receive VFSS in a predominantly metropolitan local health district (LHD).
Methods: The proportion of acute patients referred for swallowing assessment who received a VFSS was calculated retrospectively using local service data. A prospective file audit of routine clinical data has also been commenced. Over two one-month periods the files of all patients referred for swallow assessment will be audited for demographic characteristics, assessments received and dysphagia diagnosis/outcomes. Multivariable logistic regression will be used to compare characteristics of patients who do and not receive a VFSS.
Results: During 2020, 7.4% of 7268 acute adult inpatients referred for swallow assessment received a VFSS, with the proportion of patients who received a VFSS ranging from 1.4%-12.7% across five acute-care settings. Results from the prospective file audit will also be presented.
Conclusions: This study highlights an evidence-practice gap, in that the ‘gold-standard’ assessment is not routinely implemented for most acute-care patients referred for dysphagia investigation. In gaining a better understanding of patient and service-based factors impacting access to VFSS and patient outcomes in real-world practice, this research will facilitate the development of guidelines for managing patients with dysphagia in acute-care settings.

Key words: VFSS, dysphagia, acute care, clinical reasoning, practice-based research

Submission statement: This practice-based research provides ‘real world’ insights that will allow clinicians to better reflect on current practices. It may inform the development of evidence-based care pathways that better respond to the complex physical and psychosocial needs of patients with dysphagia in the acute setting.