Research Articles (Speech-Language Pathology and Audiology)

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Factors influencing person-centred care : speech-language pathologists and audiologists perspective
(AOSIS, 2025-03) Mahomed-Asmail, Faheema; Metcalfe, Louise; Graham, Marien Alet; Eccles, Renata
BACKGROUND : Person-centred care (PCC) is a fundamental aspect of healthcare, and its implementation is primarily based on clinicians’ initiation and sustained efforts and the availability of resources. Recent PCC literature has primarily focused on high-income settings, raising concerns about the feasibility of PCC implementation in low- and middle-income countries. OBJECTIVES : This study examined speech-language pathologists’ (SLPs) and audiologists’ (AUDs) perceptions of barriers and facilitators towards implementing PCC in the diverse South African context, particularly how their demographic factors influence these perceptions. METHODS : A national cross-sectional e-survey pooled 103 clinicians who were providing speech-language pathology and audiological services in South Africa. The e-survey included questions on participants’ demographics, working environment and a seven-point Likert scale rating 10 components that influence PCC. RESULTS : Clinicians scored personal factors (64.7%), followed by their relationships with different professionals (54.9%) as the most facilitating factors for achieving PCC. The most significant perceived barrier was resources, including time and finances (59.8%), followed by the client perspectives (53.9%). Significant associations were found between the components influencing PCC and clinicians’ qualifications, work sectors and populations served. CONCLUSION : The collective findings of this study highlighted the multifaceted nature of PCC implementation within a diverse healthcare context. Client perspectives need to be considered while leveraging clinician attributes and fostering supportive workplace environments for the successful adoption of PCC. CONTRIBUTION : This study contributes to literature of PCC implementation and has captured how the perceptions of speech-language therapists (SLPs) and AUDs call for tailored approaches in diverse healthcare contexts.
Service delivery approaches related to hearing aids in low- and middle-income countries or resource-limited settings
(Public Library of Science, 2024-01-24) Dillard, Lauren K.; Der, Carolina M.; Laplante-Levesque, Ariane; Swanepoel, De Wet; Thorne, Peter R.; McPherson, Bradley; De Andrade, Victor; Newall, John; Ramos, Hubert D.; Kaspar, Annette; Nieman, Carrie L.; Clark, Jackie L.; Chadha, Shelly
Hearing loss is an important global public health issue which can be alleviated through treatment with hearing aids. However, most people who would benefit from hearing aids do not receive them, in part due to challenges in accessing hearing aids and related services, which are most salient in low- and middle-income countries (LMIC) and other resource-limited settings. Innovative approaches for hearing aid service delivery can overcome many of the challenges related to access, including that of limited human resources trained to provide ear and hearing care. The purpose of this systematic scoping review is to synthesize evidence on service delivery approaches for hearing aid provision in LMIC and resource-limited settings. We searched 3 databases (PubMed, Scopus, Ovid MEDLINE) for peer-reviewed articles from 2000 to 2022 that focused on service delivery approaches related to hearing aids in LMIC or resource-limited settings. Fifteen peer-reviewed articles were included, which described hospital-based (3 studies), large-scale donation program (1 studies), community-based (7 studies), and remote (telehealth; 4 studies) service delivery approaches. Key findings are that hearing aid services can be successfully delivered in hospital- and community-based settings, and remotely, and that both qualified hearing care providers and trained non-specialists can provide quality hearing aid services. Service delivery approaches focused on community-based and remote care, and task sharing among qualified hearing care providers and trained non-specialists can likely improve access to hearing aids worldwide, thereby reducing the burden of untreated hearing loss.
Hearing loss characteristics and cerumen management efficacy in low-income South African communities : a cross-sectional study
(Cambridge University Press, 2025-03) Manganye, Sello Marven; Frisby, Caitlin; Reddy, Tarryn Marisca; De Kock, Tersia; Swanepoel, De Wet; dewet.swanepoel@up.ac.za
AIM : To describe the prevalence and characteristics of hearing loss in a self-referred adult cohort in low-income South African communities and to evaluate the effectiveness of a cerumen management protocol within a community-based service setting. BACKGROUND : Hearing loss affects 1.5 billion people globally, with a disproportionate impact on individuals in low- and middle-income countries (LMICs) and the elderly, often attributed to age-related factors and cerumen impaction. Despite the high prevalence, access to ear and hearing care remains challenging, particularly in LMICs, such as Africa. METHODS : A total of 227 participants aged 43–102 were recruited from two community centres in low-income South African communities for hearing evaluation and cerumen management for those with cerumen impaction. A cross-sectional, predominantly quantitative approach was used. FINDINGS : Video otoscopy of 448 ears revealed normal findings in 57.9%, cerumen impaction in 29.1%, and other abnormalities in 1.3%. The prevalence of confirmed hearing loss was 97.8%, primarily mild (45.8%), and sensorineural hearing loss (SNHL) was the most common (55.3%). Cerumen impaction accompanied hearing loss in 28.4% of cases. Post-treatment, 50.9% of participants with cerumen impaction showed normal otoscopy results, with mean hearing improvements of 16.2 dB (±17.9 SD) in the left ears and 15.8 dB (±17.2 SD) in the right ears, though overall significance was limited. CONCLUSION : The high prevalence of hearing loss and cerumen impaction in low-income communities emphasizes the importance of ear care in primary healthcare (PHC) settings, especially for the elderly. Effective community-based cerumen management highlights the potential of integrating community resources and task-shifting strategies for cost-effective ear care in resource-limited settings.
Automatic development of speech-in-noise hearing tests using machine learning
(Nature Research, 2025-04) Polspoel, Sigrid; Moore, David R.; Swanepoel, De Wet; Kramer, Sophia E.; Smits, Cas
Understanding speech in noisy environments is a primary challenge for individuals with hearing loss, affecting daily communication and quality of life. Traditional speech-in-noise tests are essential for screening and diagnosing hearing loss but are resource-intensive to develop, making them less accessible in low and middle-income countries. This study introduces an artificial intelligence-based approach to automate the development of these tests. By leveraging text-to-speech and automatic speech recognition (ASR) technologies, the cost, time, and resources required for high-quality speech-in-noise testing could be reduced. The procedure, named “Aladdin” (Automatic LAnguage-independent Development of the digits-in-noise test), creates digits-in-noise (DIN) hearing tests through synthetic speech material and uses ASR-based level corrections to perceptually equalize the digits. Traditional DIN tests were compared with newly developed Dutch and English Aladdin tests in listeners with normal hearing and hearing loss. Aladdin tests showed 84% specificity and 100% sensitivity, similar to the reference DIN tests (87% and 100%). Aladdin provides a universal guideline for developing DIN tests across languages, addressing the challenge of comparing test results across variants. Aladdin’s approach represents a significant advancement in test development and offers an efficient enhancement to global screening and treatment for hearing loss.
Auditory emotional prosody perception using pseudo-speech stimuli in native and non-native listeners
(Wiley, 2025-04) Gürses, Emre; Cesur, Sidika; Manchaiah, Vinaya
OBJECTIVE : To assess emotional recognition ability using corpora of emotions conveyed through nonlinguistic pseudo-sentences in native and non-native listeners (Turkish and English). METHODS : A cross-sectional design was employed, including a total of 60 young adults (aged 18–25 years). Of these, 30 were American English-speaking participants with no knowledge of Turkish, while the remaining 30 were age-, sex-, and education-matched Turkish participants. Emotional recognition scores and reaction times were assessed following audiological measurements using a one-interval, five-alternative forced choice method. A hundred stimuli recorded by Turkish speakers were presented, including 5 emotions × 2 speakers × 10 pseudo-sentences. The emotions tested were “neutral,” “happy,” “angry,” “surprised,” and “panicked.” RESULTS : No statistically significant differences exist between the groups' recognition of “neutral” and “angry” emotions. However, significant differences were observed in the recognition of happy, surprised, panicked and the mean scores of the emotions. Reaction times showed that nonmeaningful pseudo-sentences elicited similar listening efforts between native and non-native listeners. CONCLUSION : Overall results suggest that while there may be recognizable vocal cues irrespective of languages for expressing angry and neutral emotions, this does not apply to all emotions. These results point to the fact that the type of test materials may play an important role when measuring emotional recognition among different cultures using auditory stimuli. In terms of reaction time results, pseudo-sentences could be used for cross-language auditory emotion recognition, however with certain emotions.
Building IPECP into community health promotion
(Health and Medical Publishing Group, 2024-07-01) Abdoola, Shabnam Salim; Milton, Carmen; shabnam.abdoola@up.ac.za
Due to its culturally and linguistically diverse society, high prevalence of communication disorders, resource limitations, and fragmented healthcare services, South Africa (SA) needs to integrate interprofessional education and collaborative practice (IPECP) into community health promotion. IPECP in health professions education is necessary in preparing ‘collaborative practice-ready’ health care professionals who are socially accountable and prepared to respond to local health needs. Integrating IPECP strategies into existing curricula and placing interprofessional students at the same clinical sites can promote collaborative education and practice. Providing students with interprofessional clinical practice experience provides real world experience and insight, while enhancing an understanding and respect for other professionals.
The acquisition of constructions : does modality matter?
(AOSIS, 2024-06-12) Wright, Richenda; Geertsema, Salome; Le Roux, Mia; Winckel, Elodie; Dąbrowska, Ewa
BACKGROUND: Language analytic ability is well researched in the context of foreign language acquisition but its role in the acquisition of grammar in the native language is under investigation. OBJECTIVES: Our study explored the influence of language analytic ability and print exposure on receptive grammar and reading comprehension in childhood. Additionally, we investigated whether exposure to specific constructions through the written modality held an advantage over exposure in the audio modality. METHOD: We assessed the language analytic ability, reading comprehension, reading fluency, print exposure, and receptive grammar of 12-year-olds. Subsequently, we exposed them to written or spoken target constructions, followed by an assessment of receptive grammar. Linear regression models were used to analyse the contributions of reading fluency, print exposure, and language analytic ability to reading comprehension and receptive grammar. We also examined the influence of the intervention on receptive grammar. RESULTS: Language analytic ability and print exposure significantly predicted receptive grammar. Print exposure significantly predicted reading comprehension and improvement in receptive grammar. CONCLUSION: Language analytic ability is important for grammar and reading comprehension development. Print exposure enhances reading comprehension by supporting vocabulary development and providing exposure to intricate structures. Both language analytic ability and experience are key factors in construction acquisition. CONTRIBUTION: This study adds to the growing body of evidence emphasising the role of language analytic skills in native language grammar acquisition and advocates for explicit grammar teaching. Furthermore, it underscores the importance of adequate print exposure in grammar acquisition and the development of reading comprehension skills.
Constant dizziness versus episodic vertigo in Ménière's disease : health-related quality of life, cognitive dissonance, and postural problems
(AVES, 2024-09-24) Pyykko, Ilmari; Zou, Jing; Manchaiah, Vinaya
BACKGROUND : The aim was to explore and characterize dizziness and vertigo (constant vs episodic) and associated problems in patients with Ménière’s disease (MD) to allow characterization of the impact of the disease. METHODS : The study used a retrospective survey design. A total of 539 people with MD participated in this study. The online questionnaire included 36 items which had mixture of structured and open-ended questions that were focusing on MD symptoms, impact of their symptoms, vestibular rehabilitation, as well as health-related quality of life (HRQoL). RESULTS : Forty-six percent of the patients had episodic vertigo, 6% had constant dizziness, 15% had both episodic vertigo and constant dizziness, and 31% did not have vertigo or dizziness within the last 2 years. Patients with MD without any vertigo rated their HRQoL as 73.9%, those with episodic vertigo as 71.1%, those with constant dizziness as 56.9%, and those with constant dizziness and episodic vertigo as 57.9% indicating significant reduction in HRQoL in constant dizziness patients. Constant dizziness was associated with cognitive visual problems, fatigue, balance problems, vestibular drop attacks and syncope. The impact of balance problem was more severe among those with constant dizziness. The most common balance problem was tripping-off (34%), followed by swaying (25%) or rocking (8%) sensations. In the self-administered rehabilitative training, there were no differences between any of the vertigo or dizziness groups although disease profile of MD differed significantly. CONCLUSION : We emphasize that constant dizziness in MD constitutes a long-term maladaptation to a vestibular and visual cognitive function causing cognitive dissonance. Different types of vertigo and their associated complaints require different treatment strategies to the manage balance problems and to cope with the disease, but best practices is still under research.
Diverse phenotype of Ménière's disease associated with family history, thyroid disorder, migraine and associated disorders
(Elsevier, 2024-10) Pyykko, Ilmari; Gupta, Vinay; Zou, Jing; Vetkas, Artur; Manchaiah, Vinaya
OBJECTIVE: To better understand the clinical phenotype of Ménière's disease (MD), we examined family history, thyroid disorder, migraine, and associated disorders in complaints of people living with MD. METHOD: We designed the study as a retrospective and examined data gathered from 912 participants with MD. Their data were originally collected by the Finnish Ménière Federation (FMF). The survey data included individual case histories for environmental factors, comorbidities, disease-specific complaints, impact-related questions, cognitive complaints, health-related quality of life (HRQoL), and sense of coherence (SOC). RESULTS: We observed significant differences between those with and without sporadic occurrence, family history, thyroid disorder, and migraine-associated complaints. Family history explained 20% of variability in patient complaints. Patients with a family history of MD whose disease started at younger age experienced balance problems, more severe vertigo spells, more severe vestibular drop attacks (VDA), and less nausea, although they had good SOC. Thyroid disorder explained 14% of variability in patient complaints. MD patients with a thyroid disorder comorbidity suffered more often from constant dizziness, balance problems, greater impact of hearing problems, cognitive complaints, and poor HRQoL. Migraine explained 12% of variability in patients’ complaints and was associated with poor SOC and cognitive balance problems. MD patients with both thyroid disorder and migraine used antidepressants more often than other groups. Logistic regression analysis showed comorbidities of ischemic brain disorder (among 7.1%), kidney insufficiency (among 1.2%), and diabetes (among 7.3%) had statistically significant but restricted association with balance and gait problems, VDA, and reduced HRQoL. CONCLUSIONS: Family history of MD and thyroid disorder or migraine comorbidities in MD influence the complaint pattern and partially explain complex symptom profiles, including symptoms of cognitive problems. Confounders play a minimal role in complaint profile and impact of MD whereas comorbidities influence the complaint structure and partly explain the complex symptom profile in MD.
Hearing aid benefit in daily life : a qualitative ecological momentary assessment study
(Frontiers Media, 2024-10-09) Fourie, Chane; Mahomed-Asmail, Faheema; Oosthuizen, Ilze; Manchaiah, Vinaya; Vercammen, Charlotte; Swanepoel, De Wet; dewet.swanepoel@up.ac.za
INTRODUCTION : Understanding hearing aid wearer experiences in real-world settings is important to provide responsive and individualized hearing care. This study aimed to describe real-life benefits of hearing aids (HAs), as reported by hearing aid wearers through Ecological Momentary Assessment (EMA) in various listening environments. METHOD : Qualitative content analysis of 1,209 open-text responses, provided through self-initiated EMAs, was conducted. The de-identified data was collected retrospectively via a smartphone app compatible with these HAs. Only text responses reflecting positive hearing aid experiences were analyzed.The 1,209 open-text responses were categorized into 18 pre-determined sub- categories, further organized into five overarching categories: Conversational, Leisure, Device-related aspects, Lifestyle, and Other factors. RESULTS : Across these categories, 48 self-generated meaning units highlighted the multifaceted benefits of HAs. In particular, participants reported significant improvements in conversational settings, specifically during phone conversations and meetings, attributed to improved sound quality and speech understanding when wearing their HAs. During leisure activities, particularly TV watching and music listening, clearer sound and ease of Bluetooth streaming contributed to experienced benefits. Lifestyle improvements were reported in occupational and social settings, as hearing aid wearers stated enhanced communication and sound awareness. Device-related factors contributing to positive wearer experiences included extended battery life and the convenience of rechargeable batteries. The most prominent sub-category, other factors, underscored overall satisfaction, comfort with the device, and improved auditory experiences across various environments. CONCLUSION : This study reveals the diverse benefits of HAs in improving communication, listening experiences, and quality of life across various settings, as captured through EMA. By emphasizing features like direct streaming and rechargeability, the findings highlight the importance of personalized hearing care and the potential of real-time listener feedback to inform device enhancements and support strategies, advancing more tailored and effective hearing rehabilitation.
A novel consumer-centric metric for evaluating hearing device audio performance
(Frontiers Media, 2024-05-27) Manchaiah, Vinaya; Taddei, Steve; Bailey, Abram; Swanepoel, De Wet; Rodrigo, Hansapani; Sabin, Andrew
BACKGROUND AND AIM : The emergence of direct-to-consumer hearing devices has introduced confusion in making appropriate choices, highlighting the need for users to be well-informed for optimal device selection. Currently, no established metric offers insights into the sound performance of these devices. This study aimed to introduce and assess a novel consumer-centric metric (i.e., SoundScore) for hearing device audio performance. METHOD : The SoundScore metric was created based on five dimensions of hearing device audio performance (i.e., speech benefit in quiet and moderate, speech benefit in loud, own voice perception, feedback control, streamedmusic sound quality). Tests were conducted under lab conditions with an acoustic manikin using two fitting protocols meant to approximate (1) real-world default device settings for amild-to-moderate sloping hearing loss (“Initial Fit”) and (2) an audiological best-practices approach (“Tuned Fit”). A total of 41 hearing devices comprising 10 prescription hearing aids (Rx-HA), 10 self-fitting over-the-counter hearing aids (OTC-SF), 8 pre-set based over-the-counter hearing aids (OTC-PS), and 13 personal sound amplification systems (PSAPs) were evaluated. RESULTS : SoundScore varied significantly between device classifications with Rx-HA yielding the highest average scores and PSAPs the lowest. SoundScore also varied with fitting method, whereby preset based devices scored lower on average than devices programmable by fitting software. Performance across the five composite sound performance metrics generally improved between “Initial” and “Tuned” fits for Rx-HA. However, this was not observed with OTC-SF. Also, no significant difference in SoundScore was found between devices of different form factors (i.e., BTE vs. ITE). CONCLUSIONS : Initial findings suggest that the SoundScore can effectively distinguish between the audio performance of different hearing aids, offering consumers a valuable decision-making tool. Future studies should examine the relationship between the SoundScore and consumer hearing aid benefit/satisfaction.
Hearing and functioning in Everyday Life Questionnaire : psychometric evaluation and revision
(American Speech-Language-Hearing Association, 2024-06) Karlsson, Elin; Manchaiah, Vinaya; Maki-Torkko, Elina; Granberg, Sarah; Gustafsson, Johanna; Dahlstrom, Orjan; Widen, Stephen
PURPOSE : The aim of the current study was to explore the construct validity and internal consistency reliability of the International Classification of Functioning, Disability and Health (ICF)–based original English version of the Hearing and Functioning in Everyday Life Questionnaire (HFEQ) and to revise the HFEQ based on the results. METHOD : This study used a cross-sectional survey design. The data were collected using an online survey. Adults with self-reported hearing disability (n = 513) from the United States were included. The ICF components of body functions, activity and participation, and environmental factors were tested as the underlying structure of the HFEQ using confirmatory factor analysis and then adjusted by triangulation with previous content validation. RESULTS : The results of the current study confirmed the ICF components of body functions, activity and participation, and environmental factors as underlying constructs of the HFEQ. However, after triangulation with previous content validation, fine adjustments were made. The revised version of the HFEQ includes two removed items and a fine-tuned factor structure. CONCLUSION : The results confirm that the structure of the HFEQ aligns with the ICF, and the overall results indicate that HFEQ has acceptable construct validity and internal consistency.
Predictors of hearing loss disability : a multinational study using the ICF core set
(Taylor and Francis, 2025) Mahomed-Asmail, Faheema; Graham, Marien Alet; Swanepoel, De Wet; Manchaiah, Vinaya; Yerraguntlag, Krishna; Karlsson, Elin
PURPOSE : Objective audiological assessments provide valuable insights on physiological dimensions of hearing loss (HL), but not on lived experiences and functional limitations perceived by individuals. This study employed the multidimensional ICF framework to explore how demographic and diagnostic variables predict self-reported disability in adults with HL. METHOD : This cross-sectional study included 571 participants from India (94), South Africa (79), Sweden (219), and the USA (179). Responses from structured interviews based on the ICF were measured against demographic and diagnostic variables. RESULTS : 74.6% of the participants were hearing aid (HA) users with moderate-to-severe HL. Five statistically significant predictors were identified; HA usage, degree of HL, level of education, age, and income bracket. The predictors were associated with the ICF components; body functions (b126, b210, b230, b240), activity and participation (d310, d350) and environmental factors (e125, e250, e310, e355, e410, e460). CONCLUSIONS : This study emphasises that an individual’s experience with HL is significantly influenced by various factors beyond the severity of the HL itself. This underscores the ICF’s utility in capturing the complex interplay of biopsychosocial factors on HL. Identifying significant predictors could aid in tailoring interventions to improve health outcomes and quality of life for individuals with HL.
Editorial : Trends in digital hearing health and computational audiology
(Frontiers Media, 2024-11) Mahomed-Asmail, Faheema; De Sousa, K.C. (Karina); Coco, Laura; faheema.mahomed@up.ac.za
No abstract available.
Cochlear nerve visualization in normal anatomy and inner ear malformations
(Wiley, 2024-12) Assiri, Majed; Khurayzi, Tawfiq; Almuhawas, Fida; Schlemmer, Kurt; Hagr, Abdulrahman; Dhanasingh, Anandhan
OBJECTIVES : This study aimed to qualitatively evaluate the variations in nerve bundles between patients with normal anatomy and those with inner-ear anomalies. METHODS : Magnetic resonance imaging (MRI) scans of the temporal bones of candidates for cochlear implants (CIs) enrolled at a tertiary center were retrospectively reviewed from the clinical database. The 3.0-Tesla MRI scans were analyzed using a three-dimensional slicer to visualize the nerve bundles in the internal auditory canal. RESULTS : A total of 49 ears were analyzed. Twenty ears exhibited normal inner ear anatomy, whereas 29 ears had various inner-ear malformations. The cochlear nerve (CN) was visible on all 20 scans with normal inner-ear anatomy. In addition, the CN was visualized in 18 scans with inner ear malformations. Furthermore, the CN was identified in six of the eight scans with IP type I, whereas in two scans, the CN and vestibular nerve were unclear. Three scans with a common cavity showed only two nerve bundles. CONCLUSION : The findings of this study show that the CN can be visualized in most inner-ear anatomical types. Even in severely malformed inner ears, the common nerve bundle that represents the cochlear and vestibular nerves can be visualized. The MRI is highly recommended for CN assessment before CI surgery. LEVEL OF EVIDENCE : Level IV.
The outcomes of the voice use reduction program on voice quality and vocal fatigue in occupational voice users
(Sage, 2024) Vermeulen, Rouxjeanne; Du Toit, Maria; Van Lierde, K.M. (Kristiane); Graham, Marien Alet; Van der Linde, Jeannie
Please read abstract in the article.
Exploring autonomic dysfunction in functional dysphonia : a protocol for a case-control study and a randomized controlled trial
(Wiley, 2024-11) Meerschman, Iris; D'haeseleer, Evelien; Vanderhasselt, Marie-Anne; Claeys, Sofie; Vonck, Kristl; Vergauwe, Riet; Van Nuffelen, Gwen; Desuter, Gauthier; Roy, Nelson; Van Lierde, K.M. (Kristiane)
BACKGROUND : Although psychological factors have been implicated in patients with functional dysphonia (FD), conventional voice therapy (CVT) typically targets the aberrant voice symptoms exclusively. Yet, CVT is not always successful, and in view of the significant adverse quality of life impact combined with the financial burden on the healthcare system and society, research is needed to elucidate the underlying psychophysiology of FD and improve treatment outcomes. OBJECTIVES : The first objective of this research project is to compare the occurrence and frequency of symptoms and/or disorders related to autonomic nervous system (ANS) dysfunction in patients with FD with gender- and age-matched vocally healthy controls, using a case-control study. The second objective is to compare the effects of a novel therapy for FD based on ANS regulation (i.e., ANS therapy: heart rate variability (HRV) biofeedback) on both autonomic function and voice function versus CVT alone or in combination with ANS therapy (i.e., ANS therapy + CVT), using a randomized controlled trial (RCT). METHODS : Case-control study: Autonomic (dys)function of patients with FD will be compared with gender- and age-matched vocally healthy controls, using both physiological measures (e.g., HRV, skin conductance level) and psychological patient-reported outcome measures (PROMs, e.g., Neuroception of Psychological Safety Scale, Depression Anxiety and Stress Scale). RCT: The FD group will be randomly assigned to the innovative ANS therapy group, the CVT group or the ANS therapy + CVT group. All patients received 1 month of treatment with 20 min of daily practice. Both the autonomic assessment and the voice assessment will be performed pretherapy and immediately after therapy by assessors blinded to group allocation and study phase. EXPECTED RESULTS : Higher occurrences of symptoms and/or disorders related to autonomic dysfunction are expected in patients with FD compared with vocally healthy controls. Physiological outcomes: lower HRV, lower cardiac pre-ejection period, higher respiration rate and higher skin conductance level are hypothesized in patients with FD compared with vocally healthy controls. Psychological PROMs: higher self-report of feelings/symptoms related to autonomic dysfunction (e.g., perceived stress, anxiety) is expected in patients with FD compared with vocally healthy controls. The autonomic function is hypothesized to improve more after the ANS therapy and the ANS therapy + CVT compared with the CVT only. Voice function is expected to improve more after the ANS therapy + CVT compared with the ANS therapy and the CVT alone. WHAT THIS PAPER ADDS : WHAT IS ALREADY KNOWN ON THE SUBJECT : Autonomic dysfunction is well recognized in the field of psychology but remains understudied in the area of voice. Given that the vagus nerve, innervating the larynx, also helps to regulate the ANS, and psychological symptoms commonly observed in patients with FD may reflect ANS dysregulation, research in this area is needed. There is some preliminary evidence that autonomic dysfunction might indeed be associated with FD. However, physiological ANS measures are needed, as well as validated psychological PROMs. WHAT THIS PAPER ADDS TO THE EXISTING KNOWLEDGE : The first objective of this study is to investigate the occurrence and frequency of symptoms and/or disorders related to autonomic dysfunction in patients with FD as compared with a gender- and age-matched vocally healthy control group. Autonomic (dys)function will be determined by employing both physiological measures (e.g., HRV, skin conductance level) and psychological PROMs (e.g., Neuroception of Psychological Safety Scale, Depression Anxiety and Stress Scale). The second objective is to compare the effects of a novel therapy for FD based on ANS regulation (HRV biofeedback) versus CVT alone or in combination with ANS therapy. WHAT ARE THE POTENTIAL OR ACTUAL CLINICAL IMPLICATIONS OF THIS WORK? Success rates of symptomatic CVT for FD are highly variable. This study is expected to lead to innovative results related to the pathogenesis and psychophysiology of FD, a prevalent voice disorder associated with a significant adverse quality of life impact and a substantial financial burden on the healthcare system and society. The results of this study will lead to crucial new insights into both the diagnosis and treatment of FD, contributing to evidence-based practice in the field of voice.
Computerized rotational head impulse test : age-dependent normative data
(American Speech-Language-Hearing Association, 2024-09) Du Plessis, Mangelique; Heinze, Barbara M.; Reddy, Tarryn Marisca; Kiderman, Alexander; Gonzalez, Jorge E.; tarryn.reddy@up.ac.za
Please read abstract in the article.
Nurses’ practices in stroke-related dysphagia in low- and middle-income countries
(AOSIS, 2024-03-28) Rowe, Kristen; Du Toit, Maria Neethling; Pillay, Sarveshvari B.; Kruger, Esedra; esedra.kruger@up.ac.za
BACKGROUND: Nurses are often required to perform dysphagia screening prior to oral intake by people following stroke. Previous studies report limited knowledge of nurses in identifying symptoms of post-stroke dysphagia. OBJECTIVE: To explore existing literature regarding nurses’ practices and knowledge in the identification and management of post-stroke oropharyngeal dysphagia (OPD) in low- and middle income countries (LMICs). METHOD: A scoping review was conducted according to the PRISMA-ScR guidelines. Studies were retrieved from PubMed, Scopus, EBSCOhost (CINAHL and Health source: Nursing and Academic edition), Web of Science Core collection, and Cochrane libraries. No time frame was applied, and all included studies were screened according to predefined eligibility criteria. RESULTS: Eight studies were included from 1 792 initial hits. Studies described nursing practices in acute care pertaining to identification and management of stroke-related dysphagia in LMICs. Increased knowledge was reported in nurses who had greater clinical experience in managing patients with dysphagia. Needs for training relating to dysphagia management and opportunities for interprofessional collaboration with speech-language therapists (SLTs) were identified. Contextual barriers specific to LMICs impacting on optimal nursing management of dysphagia included heavy workloads, staff-shortages and time constraints. CONCLUSION AND CONTRIBUTION: Eight studies described nurses’ practices and identified needs for the improvement of nurses’ dysphagia care in LMICs. This scoping review highlighted the urgency for further research in dysphagia management that provides creative, contextually relevant solutions for improved protocols and training of health care professionals. Findings may be valuable for the multidisciplinary team involved in post-stroke dysphagia care.
Tube feeding in advanced dementia : insights from South African speech-language therapists
(AOSIS Open Journals, 2024-02-12) Pullen, Danette; Pillay, Bhavani S.; Kruger, Esedra; bhavani.pillay@up.ac.za
BACKGROUND : Speech-language therapists (SLTs) may recommend tube feeding even with minimal research evidence of its effectiveness, and an understanding of SLTs’ perceived practices is warranted. OBJECTIVES : To qualitatively describe a sample of South African SLTs’ perceived practices regarding feeding tube placement in people with advanced dementia. METHOD : Semi-structured online interviews were conducted via Microsoft Teams. Eight South African SLTs with a particular interest in advanced dementia, in public and private settings, were recruited. Data were analysed using inductive reflexive thematic analysis. RESULTS : Three main themes were identified: (1) factors influencing SLTs’ decisions for feeding tube placement in people with advanced dementia; (2) nature of clinical setting and SLTs’ decision-making and (3) SLTs’ considerations to improve management of people with advanced dementia. Existing local palliative care guidelines were not employed in decisions about tube feeding. Most participants did not recommend tube feeding during end-of-life care. Perceived burden of care influenced participants’ decisions about tube feeding. CONCLUSION : Speech-language therapists in South Africa likely have an increased reliance on clinical experience rather than recent research and guidelines for decisions about feeding tube placement. Findings accentuate the importance of clinical supervision, mentoring and continuous professional development in the workplace. The findings are an urgent call to action to improve SLTs’ overall practices and ethical service delivery for people with advanced dementia and their families. CONTRIBUTION : Factors and needs regarding SLTs’ decision-making about feeding tubes in people with advanced dementia are highlighted.

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