The aim of this study was to investigate the impact of vocal cord palsy (VCP), acquired intraoperatively during cardiac surgery, on the feeding outcomes of infants. An additional aim was to obtain preliminary information on the impact of feeding difficulties in this group on the quality of life of families. A review of 48 patients who had been referred to the speech pathology service was undertaken. Participants presented with heterogeneous cardiac diagnoses, and had an initial Videofluoroscopic Swallow Study (VFSS) at a median corrected age of 3.6 weeks. Sixty percent of participants presented with silent aspiration on VFSS. Thirty percent of participants required supplementary tube feeding more than 6 months post-surgery. Findings revealed no significant relationship between participant factors and the presence of feeding difficulties, however, infants with concomitant genetic and syndromic conditions were found to be most at-risk for long-term feeding difficulties. Analysis of informal questionnaire responses indicated parents/carers experienced stress and anxiety after their child’s discharge in relation to feeding, which impacts quality of life across a number of domains. Findings of this study highlight the importance of communicating the potential feeding difficulties to parents of at-risk infants prior to cardiac surgery. This study further highlighted the importance of routine post-operative Ear Nose and Throat examinations following high-risk surgeries, as well as speech pathology management for all infants identified with VCP. Post-operative input from appropriately-trained Speech Pathologists is vital in assisting parents to mitigate their child’s difficulties through the provision of early intervention for feeding difficulties.

Submission Statement:
This poster outlines the importance of proactively responding to infants at risk of vocal cord palsy as a result of cardiac surgery. ENT screening of infants following high risk surgeries allows for speech pathology input to be instigated early and aspiration risk to be managed proactively to avoid development of respiratory sequelae and feeding aversion.

Introduction/Rationale: The selection of suitable AAC requires consideration of multiple factors. Critically ill patients with an artificial airway typically have difficulty communicating, and staff knowledge and confidence in supporting these patients with communication is reportedly low.
Aim: To increase health professionals knowledge and confidence in selecting AAC and supporting their patients to communicate.
Methods: 1) Literature and clinical experience was synthesised to inform the development of a clinical decision-assist tool. 2) An interactive e-learning module was developed. Pre and post measures of knowledge and confidence in supporting patients to communicate were recorded. 3) Two snapshot audits of AAC devices available in the ICU were undertaken. A suite of low and high tech AAC devices were collated.
Results: 1) A clinical decision-assist tool was developed, incorporating patient level of function, access needs, communicative output and type of AAC device. 2) An interactive e-learning module was developed which included several instructional videos of how to support patients using AAC devices. Pre and post measures of knowledge and confidence in supporting patients with an artificial airway to communicate were analysed. 3) There was an overall 81% increase in access to AAC devices in ICU for patient, family member and staff use.
Discussion/Conclusion: The development of a clinical decision-assist tool will facilitate speech pathologists holistically selecting suitable AAC options in the hospital setting. Targeted education for multi-professional ICU staff and a substantial increase in the accessibility of AAC devices in the ICU will support more patients to communicate during a most vulnerable period.

Key words: communication, AAC, critical illness, artificial airway, multi-professional

Submission Statement: Delegates will reflect on their clinical decision-making when selecting AAC for hospital inpatients, the role of other healthcare professionals in supporting patients with an artificial airway to communicate.

Introduction: Pharyngoplasty surgery to correct velopharyngeal insufficiency (VPI), aims to improve speech understandability by facilitating proper soft palate closure in the pharynx. Unfortunately, post-operative complications commonly include obstructive sleep apnoea. Little is known about the extent to which speech and/or sleep outcomes are sustained beyond a few months, as well as their impact on quality-of-life (QOL). Previous studies often excluded important populations e.g., 22q deletion syndrome, or used inconsistent assessment procedures so results could not be applied to the entire VPI population.

Aims: The current study aims to investigate longer-term changes in speech and sleep outcomes, as well as QOL post-operatively in a paediatric population including children with syndromes.

Methods: Subjects: A cohort of 104 paediatric participants had pharyngoplasty surgery performed in the period 2011 to 2020 at a paediatric tertiary hospital. Data: An online (REDCap) parent survey containing various questions about the child’s post-operative speech, sleep and QOL outcomes, with short-answer responses to enhance the research. Analysis: Mixed-methods - cross-sectional and thematic analysis.

Anticipated Results: In the 1-10 years following pharyngoplasty, we expect general improvement in their child’s speech outcomes, and a deterioration in their sleep outcomes. Overall QOL may improve post-operatively. Patients with syndromic diagnoses may present with poorer sleep and/or speech outcomes compared to those without syndromic diagnoses or causes for their VPI.

Conclusion: This study may provide new information about longer-term speech, sleep and QOL outcomes post-pharyngoplasty, with potential to fuel further research and enhance patients’ decision-making for management of VPI.

KEY WORDS
Sleep, speech, child, pharyngoplasty, velopharyngeal, apnoea

SUBMISSION STATEMENT
The present study aims to reflect current knowledge of pharyngoplasty outcomes by drawing links between current evidence and parents’ reports of their child’s post-operative experience. Respect for diverse VPI populations will include all patient subgroups, and respond by improving current knowledge of patients’ experiences of this surgery.

Introduction:
New research reflects best practice recommendations for aphasia therapy post stroke, recommending aphasia therapy commence within the first 4 weeks post stroke and >3 hours weekly for best overall language and functional communication gains (Rose, M., 2022). Adherence to aphasia management practices in hospitals is inconsistent with guideline recommendations due to contextual and environmental barriers.
Aims:
To explore aphasia therapy provision in rehabilitation units
To identify changes required in service delivery

Method:
Retrospective audit of medical files and prospective data collection across two metropolitan rehabilitation units over a four-month period. Descriptive statistics to be used to describe the therapy modality types (1:1, group intervention, telehealth and self-directed), intensity and resources on discharge (groups, counselling services) with pre and post outcome measures.

Results:
The results will provide findings on the mode and intensity of therapy currently provided as well as identify how the key rehab learnings have been implemented to increase therapy provision and incorporate biopsychosocial approach to address aphasia management.

Conclusion:
Provision of aphasia therapy in the inpatient subacute setting remains variable and not within the recommended intensity or emerging best practice recommendations. Flexibility and creativity in service delivery and therapy programs whilst incorporating a holistic approach focusing on biopsychosocial aspects are essential in order to provide the recommended service as outlined by the latest aphasia and stroke guidelines and to maximise functional outcomes.

Keywords:
Aphasia, therapy, communication, intensity, stroke, rehabilitation

Submission statement:
In reflecting on Miranda Rose’s keynote presentation at the 2022 SPA conference, we were inspired to respect the advocacy for early and intense communication therapy and respond by evaluating and reviewing the provision of therapy to patients with aphasia in the inpatient subacute setting and implement key learnings.

Introduction: Individuals with an altered airway (AA) experience a high degree of associated morbidity. Speech Pathologists have a role in mitigating acute and long-term morbidity, optimising communication and swallowing and enhancing quality of life. Centralisation of specialist services to tertiary metropolitan hospitals creates recognised inequities for rural consumers and limits access for all consumers to high frequency community rehabilitation in their local context.

Aim(s): Implement a proactive and preventative community-based speech pathology service for clients with an AA utlising telepractice; improve equity of access to high quality interventions for metropolitan and regional consumers; mitigate risks and optimise rehabilitation outcomes; build capacity within the regional workforce.

Methods: Utilising a convergent parallel mixed methods design to synchronously analyse quantitative service metrics and qualitative consumer reporting. Data points include, service activity; admission data; individual outcome measures; consumer, carer and staff evaluations. Eligible participants include all new and existing Monash Health clients with an AA. Partner health services across South East Victoria include public health providers; aged care facilities and/or private speech pathology service caring for a client with an AA or with an interest in building capacity.

Results: Mid project reportables include consumer engagement, development and evaluation of multidisciplinary education resources, strengths and limitations of shared care and telepractice service delivery. Preliminary recruitment rates, admission data and consumer experience evaluations will be presented.

Conclusions: This project highlights the facilitators and barriers to implementing a novel model of service. It offers potential to improve health outcomes and support capacity within the regional speech pathology workforce.

Keywords - laryngectomy, tracheostomy, speech pathology, telepractice, community-based care, quality improvement

Submission Statement: Reflecting known centralisation of specialist head and neck services and subsequent workforce challenges. Respecting the rights of individuals to access equitable high quality services. Responding to an identified need for higher frequency, in place, management and rehabilitation for clients with an AA..

Introduction:
Diphtheria, a rare vaccine-preventable disease, is an acute bacterial infection that affects mainly the upper respiratory tract. Symptoms at presentation are a thick and grey membrane covering the pharynx and tonsils, odynophagia, hoarseness and cervical lymphadenopathy.
Aim:
This poster describes assessment findings and management of a rare presentation of a 32 year old female from a remote Far North Queensland community who was diagnosed with Corynebacterium diphtheriae, C. ulcerans.
Method:
A summary of the patient presentation along with relevant ENT findings will be described along the trajectory of the case. Assessment of laryngeal, respiratory and dysphagia symptoms, subsequent management, recovery and patient outcomes will be presented.
Results:
Despite there being clear medical treatment guidelines for Diphtheria, there is a paucity of evidence for speech pathology management regarding respiratory diphtheria. Given the inconsistent trajectory of this condition, establishing clear treatment guidelines remains challenging.
Conclusion:
The goal of this case study is to add to the speech pathology knowledge base regarding assessment and management considerations of a very rare presentation of respiratory Diphtheria.

Keywords - Dysphagia, Dysphonia, Speech Pathology, Videofluoroscopy, Tracheostomy, Nasendoscopy.

Submission Statement: This case demonstrates the importance of reflecting on personal and professional knowledge bases and gaps to ensure respectful patient centred care is provided. The importance of providing a responsive and adaptable service is highlighted given the rapid progression of this condition.

Nations differ in orthographic complexity (regularity of spelling patterns), which impacts ease and speed of reading and writing development. In contrast to the world’s many regular-orthography nations, English word-reading and word-writing development is extremely slow, with difficulties more frequent and severe (Galletly, 2022, 2023; Knight, Galletly & Gargett, 2017).

Orthographic Advantage Theory (Knight, Galletly & Gargett, 2019) proposes that, according to their level of orthographic complexity, nations experience disadvantage and potential advantage in multiple areas of child development, educational and national functioning. It highlights dimensions of advantage and disadvantage, including
1. Ease of early literacy development,
2. Ease of school instruction and learning,
3. Ease of improving education,
4. Impacts of workplace literacy levels,
5. Levels of adult life advantage, and
6. Generational advantage through parent literacy levels supporting child development.

It is offered as a tool for allied-health professionals, educators and researchers towards optimising Australian literacy, language, learning and life outcomes.

Galletly, S. A. (2022). Bunyips in the Classroom: The 10 Changes. Australian Reading Woes (Vol. 1). Literacy Plus: Australia.

Galletly, S. A. (2023). The Research Tours: The Impacts of Orthographic Disadvantage. Australian Reading Woes (Vol. 2). Literacy Plus: Australia.

Knight, B. A., Galletly, S. A., & Gargett, P. S. (2017). Managing cognitive load as the key to literacy development. In R. Nata (Ed.), Progress in Education (Vol. 45, pp. 61-150). New York: Nova Science Publishers.

Knight, B. A., Galletly, S. A., & Gargett, P. S. (2019). Orthographic Advantage Theory. Asia Pacific Journal of Developmental Differences, 6(1, January), 5-29.

Introduction: Augmentative and alternative communication (AAC) is a core component of speech pathology practice however international literature has highlighted that speech language pathologists (SLPs) do not feel confident in this area. Data published in 1998 indicated that the majority of Australian SLPs had limited knowledge in AAC. (Balandin & Iacano, 1998). However, since the release of that data, the training, and practices of Australian SLPs has changed due to the introduction of Multi-Modal Communication as Range of Practice Area by Speech Pathology Australia in 2012.

Aim: To investigate the knowledge, confidence, and attitudes of SLPs in paediatric AAC specific to the current Australian context.

Methods: Using an online survey, Australian SLPs are asked to respond to 21 questions using a 7-point Likert scale adapted from the work of Meredith et al. (2018). This survey is being disseminated from October 2022 to November 2022.

Results: Data analysis will be completed in January 2023.

Conclusion: It is hoped that this research will provide a current snapshot of the Australian paediatric AAC workforce including any changes that have occurred since Multi-Modal Communication was included as a Range of Practice Area. This research will also create a greater understanding of the requirements of the current workforce in relation to knowledge and confidence building activities such as training at the University and workforce levels. A discussion of strengths in regard to SLPs’ knowledge, confidence, and attitudes in paediatric AAC will be discussed alongside potential training needs.

Keywords: Augmentative and Alternative Communication, Confidence, Knowledge, Attitudes

Submission Statement: Participants will be prompted to reflect on the knowledge, confidence and attitudes of our current disability workforce and respond by considering how we may effectively increase our own capabilities to ensure quality service provision to those who are vulnerable.

Supporting the comprehension of students with ASD and intellectual disability is vital for developing independence and a sense of self-confidence in all contexts. Understanding an individual’s level of comprehension and where the breakdown occurs is imperative to decision making about the strategies used to support expressive communication, transitions, creation of routines as well as the appropriate adult interactional style for that student. A breakdown in an individual’s comprehension often results in students feeling confused, overwhelmed and stressed and some may express these feelings in inappropriate or challenging ways.

At Giant Steps, a school for individuals with ASD, comprehension is a focus and often the number one priority particularly for younger students first starting school. Level of comprehension is functionally assessed, goals are set and supports are implemented on a daily basis to ensure a student is confident in their role within an ever-changing complex world. The findings show that when an individual’s comprehension is addressed, there are increases visual literacy, expressive language, choice making (autonomy), improved transitions, more likely to be flexible and accept changes as well as decreases in anxiety and periods of dysregulation.

Comprehension is complex and often overlooked as it is difficult to assess where the breakdown occurs as we cannot ‘see’ comprehension. Comprehension is the power that fuels expressive language. Practitioners will learn the importance of targeting comprehension in creative ways that is appropriate to an individual’s needs and that in order to enhance one’s expressive communication, comprehension cannot be forgotten.

AAC, comprehension, assessment, autism, foundation, decision-making

Considering comprehension as fundamental to support an Autistic person to fully participate in their world is RESPECTful. It is advocating for their needs and engaging with other professionals to target comprehension even though it is challenging to assess in order to RESPOND and prompt professionals to REFLECT on the approaches.

Introduction/Rationale:
Augmentative and alternative communication (AAC) is designed to give individuals who have complex communication needs a method of communicating through the use of a speech generating device. AAC allows a child to develop relationships, build independence and advocate for self however relies on caregiver, siblings and educator support within naturalistic settings. Research shows that less than 40% of AAC systems are used beyond one year. This paper addresses a clinical problem: how can speech pathologists reduce device abandonment within early intervention?

Aim(s):
This paper explores:
- The barriers towards AAC usage
- How can these barriers be addressed and minimised
- Implementation of a pilot program to address barriers
- Impact of program on the child and family unit

Methods:
- Literature review to identify barriers
- Qualitative information collected from parents pre-program to identify caregiver perspectives and barriers to access
- Implementation of pilot program with the aim to address and overcome barriers
- Post program data collected to evaluate impact

Results:
Post program participation, there was an increase in participant knowledge about AAC and caregivers felt more empowered to facilitate device use in naturalistic contexts. Program encouraged sibling and caregiver AAC use which built parental support networks. Observed increase in peer/social awareness through shared device use.

Conclusion:
For AAC to be accessible to all people with a communication disability, speech pathologists have a responsibility to address and support key stakeholders to overcome barriers to usage.

Keywords: capacity building, AAC, device abandonment, accessibility

Submission Statement: Speech pathologist have a duty to continuously reflect on practice to support the needs of our neurodiverse population. Respond to the needs and gaps that AAC users and key stakeholders experience and adapting practise to support this.

Background: Family-centred practice is a primary tenet of speech pathology practice. Gendered parental roles (mother/father – or primary/secondary caregiver) contribute differently to the development of a child’s communication. In paediatrics, training conversation partners necessitates the training of caregivers that include any person who has responsibility for a child’s care. Given increasing gender diversity and roles within modern families, speech pathology caregiver training should seek to ensure that all family dynamics are represented within the research.
Aims. Within paediatric caregiver training research to describe participants: (1) gender, and (2) primary or secondary caregiver status.
Methods. The systematised review involved comprehensive searching of six databases, forward and reverse citation searching, application of eligibility criteria during the search process, quality review, data extraction, and inductive thematic analysis.
Main Contribution. Forty-nine papers met the inclusion criteria for the review. With regards to gender of participants in the studies, 13 included only mothers, 27 included both fathers and mothers, and nine did not report gender of participants. Across the papers there were 880 mothers and 91 fathers. Twenty-nine papers included only primary caregivers, whilst 13 included both primary and secondary caregivers. The remaining seven papers did not report caregiver family status. Across the papers there were 943 primary caregivers and only 49 secondary caregivers.
Conclusions. This review identified the disparities in participant characteristics in published paediatric caregiver research. Future research should ensure that diverse families are represented and that participant demographics, including gender and role, are identified.

Introduction: Parkinson’s disease (PD) is a neuro-degenerative disorder which affects >84,000 Australians. A Ramsay Health Care (RHC) Specialist Matter Expert panel (SMEP) in neurology was tasked with ensuring RHC allied health and nursing clinicians are providing best clinical practice in managing people with PD.

Aims:
1. Gain qualitative and quantitative data from allied health and nursing staff at RHC sites on their level of discipline-specific knowledge and skills in working with people with PD.
2. Gain an understanding of current PD specific services and resources at all RHC sites for gap analysis.
3. Use results to ensure appropriate education and resources are available to RHC clinicians to provide best evidence based practice in working with people with PD.

Methods:
1. Complete a literature search using electronic databases on clinical best practice principles when working with people with PD.
2. Survey clinicians at all RHC sites to compare clinicians’ skills and knowledge against discipline-specific checklists.
Results:
• N = 239
• 65% of responders did NOT meet all criteria.
• >80% had NOT completed PD specific training/education in past 12 months.
• 63% completed <5 hours.
• 66.5% were unaware of, or did not have, PD-specific resources at their site.
• 88% were interested in forming a national RHC PD site network.

Conclusions:
• RHC funded increased access to professional development opportunities.
• An RHC PD Site Advocate national network was formed across 26 sites to share resources and education.
• A repeat survey will be completed end of 2022 to measure changes – results pending.

Keywords: Parkinson’s disease, multi-disciplinary, evidence based practice.
Submission Statement: There are many evidence based clinical practices that have been proven to slow the progress of motor and non-motor symptoms in PD. This project reflected on those practices and responded to survey results to fill gaps in knowledge and service.