Fundamentals of Clinical Decision-Making Analysis for SLPs and Audiologists: Evidence-Based Approach

Statistical Methods and Reasoning for the Clinical Sciences: Evidence-Based PracticeDr. Satake Photo

By: Eiki B. Satake, PhD, author of Statistical Methods and Reasoning for the Clinical Sciences: Evidence-Based Practice

Over the past decade or so, interest in evidence-based practice (EBP) has steadily increased in many clinical fields—a movement that has emphasized the importance of providing empirical evidence to support various therapy interventions. To succeed in meeting the goals of EBP, clinicians must rely on more than intuition and clinical experience. In addition, they must be well versed in the methods of research and statistics to accurately evaluate and apply evidence that seems to support a particular intervention. As Guyatt et al. (2002) noted, the ability to critically appraise research literature and apply such findings is an essential skill for scientifically based treatment. Yet, my observations suggest that this concern is often neglected in graduate training programs as well as by many clinical practitioners and researchers. Furthermore, in this EBP era, all clinical professionals, not only clinical researchers but also clinical practitioners, are almost required to have the substantial knowledge of (1) how to measure the strength of clinical evidence accurately, and (2) how to interpret and report the findings. These are the essential components of EBP that will lead to improvement of one’s scientific literacy.

Scientific literacy is fundamental to the understanding of research methodology as well as the statistical assumptions and techniques used for the analysis and interpretation of data. In the absence of such understanding, it will be impossible for professionals to stay abreast of a rapidly flowing and ever-changing stream of information related to the study and treatment of speech, language, and hearing disorders. What is ultimately at stake is the credibility of the field to function as an independent discipline that presumably prides itself on contributing to a fund of knowledge leading to scientific advancements, not only in its own specialty areas but also for its contributions to the arena of the health science specialties at large. In the absence of such credibility, we will practice “unethically” by failing to provide the best possible services for the people we serve.

So, how does a clinician determine whether or not she is making an accurate, reliable, and credible EBP-oriented diagnosis and improves scientific literacy? One effective way is to learn how to evaluate the results of a diagnostic test accurately to find out the presence (or absence) of a particular disorder.

According to Hawkins (2005), EBP consists of the following four major steps: 1. Formulate a clear clinical question from a client’s problem; 2. Search the literature for relevant clinical articles; 3. Evaluate or clinically appraise the evidence for its validity and usefulness; 4. Implement useful findings into clinical practice. So, let us apply Hawkins’s principle to the diagnostic screening test process.

Despite the many applications of diagnostic test findings, the primary objective of any such test is to detect a particular disorder or disease when present. A good diagnostic test normally identifies people who have the particular disorder or disease of interest and excludes people who do not. To accurately measure the outcomes of a new test or a screening test, results obtained from it are generally compared with some other established test(s) viewed as the gold standard in yielding valid results. Even though such tests may not prove to be 100% accurate, they serve as the standard against which the merit of a new test can be judged. A logical question to ask is “If a test judged as the gold standard is doing a good job in accurately diagnosing a particular disorder or disease, why not use it in all cases?” The answer is that the gold standard for diagnosis can be time-consuming, expensive, and more difficult to perform. For this reason, a screening test is often used as an option during initial testing to decide who should be given a more definitive evaluation and who should not. Thus, an audiologist might give an audiometric screening test to decide when a more complete audiometric evaluation might be warranted. There are several major probabilities that constitute a screening test for determining the accuracy of the results. They are, namely, as follows:

  1. Prevalence of a disorder (denoted by D): P (D+) = Probability that the disorder (or disease) is present, whereas P (D−) = Probability that the disorder is absent.
  2. Test Results (denoted by T): P (T+) = Probability that the test is positive, whereas P (T−) = Probability that the test is negative.
  3. True Positive: P (D+ and T+) = Probability that the disorder is present and the test result is positive. People with the disorder are correctly identified as test positive.
  4. False Positive: P (D− and T+) = Probability that the disorder is absent but the test result shows positive. People without the disorder are falsely labeled as test positive.
  5. True Negative: P (D− and T−) = Probability that the disorder is absent and the test result is negative. People without the disorder are correctly identified as test negative.
  6. False Negative: P (D+ and T−) = Probability that the disorder is positive but the test result is negative. People with the disorder are falsely identified as test negative.
  7. Sensitivity of a test: It is defined as the probability that the test result is positive (T+) given that the disorder actually exists (D+). Symbolically, it is written as:
    Sensitivity of a test formulaIf a test has high sensitivity, it will have a low false-negative rate, that is, the probability that a subject who tests out as negative but who is actually positive, denoted by P (T− | D+). In such a case, the test result will seldom indicate that the disorder is not present when in fact it is present.
  8. Specificity of a test: It is defined as the probability that the test result is negative (T−) given that the disorder actually does not exist (D−). Symbolically, this is written as follows:
    Specificity of a test formulaA test that has high specificity is one that has a low false-positive rate, denoted by P (T+ | D−), meaning that it will seldom predict the presence of a disorder that does not exist.Although test sensitivity and specificity are important preliminary steps in constructing a diagnostic screening test, these indices alone have limited application to actual diagnosis and clinical decision making. More specifically, although these values may be used to estimate the accuracy of a particular diagnostic test, it is the predictive values of a test that actually have practical/clinical values in detecting a disorder or disease. In the case of measures of sensitivity and specificity, in contrast with predictive values, the disorder or disease status is already known. However, as noted previously, what a clinician really wants to obtain is whether or not a disorder or disease actually exists based on the test result of a diagnostic screening test. Only the predictive values allow for forecasting actual clinical outcomes (EBP) based on test results. There are two major components of predictive values of a diagnostic screening test, namely, predictive value positive (PV+), and predictive value negative (PV−). In short, PV+ and PV− can be viewed as a calculus of evidence to further explore the accuracy of a screening test in a more precise manner.
  9. Predictive Value Positive (PV+): It refers to the probability that a disorder or disease exists when the test result is positive (T+). Symbolically, this is expressed as follows:Predictive Value Positive formula
  10. Predictive Value Negative (PV−): It refers to the probability that a disorder or disease does not exist when the test result is negative. Symbolically, this is written as follows:Predictive Value Negative formula

All probabilities defined above are summarized in Table 1 shown below.

TABLE 1: Probability Estimates of Test Results

Table 1: Probability Estimates of Test Results

Additionally, in communication disorders, clinical practitioners often look at the results of clinical trials they are investigating and are interested in the association (or relationship) between a treatment and an outcome. In some cases, they may find a strong association or, in another case, there may be no significant association. When clinical investigators try to show the degree of association between two events (control versus experimental, treatment A versus treatment B, etc.), they need to know how to measure the strength of association based on what they observed. To answer the question pertaining to measuring the strength of association, we often use such advanced measures as relative risk, absolute/relative risk reduction, and odds ratio.

In summary, the clinical professionals in the field of SLP and audiology have not quite caught up to the level that medical professionals have achieved in terms of EBP statistics education. At the time of my writing, EBP education has become well established as a component of both undergraduate, graduate, and postgraduate medical education. So, why not us? Now is the right time to check our scientific literacy skills and promote better understanding of EBP statistics to a much larger extent, so that all clinical researchers and practitioners in our field are able to interpret the results and make a diagnosis more accurately.

References

Guyatt, G. H., & Rennie, D. (2002). User’s guide to the medical literature: A manual for evidence-based clinical practice. Chicago, IL: AMA Press.

Hawkins, R. C. (2005). The evidence based medicine approach to diagnostic testing: Practicalities and limitations. The Clinical Biochemist Reviews, 26(2), 7–18.

Satake, E. (2014). Evidence-based statistics for clinical professionals: What really prevents us from moving forward. Keynote presentation at the annual research symposium of LSU-School of ALLIED Health, New Orleans, LA.

Satake, E. (2014). Statistical methods and reasoning for the clinical sciences: Evidence-based approach. San Diego, CA: Plural Publishing.

About the Author

Eiki Satake, PhD, is an associate professor of mathematics and statistics at Emerson College in Boston, Massachusetts. He has conducted several research seminars and short courses on evidence-based statistics at national and international academic conferences. His research interests include Bayesian statistical methods and probabilistic approaches to evidence-based practice. He has also written numerous scholastic articles and instructional textbooks on statistical methods and statistics education. His most recent textbook, Statistical Methods and Reasoning for the Clinical Sciences: Evidence-Based Practice, provides practitioners with the scientific literacy needed to understand statistical methods in order to increase the accuracy of their diagnoses.

Plural books honored as Doody’s Core Titles for 2015

We are thrilled to announce that Doody’s has released its Core Titles in the Health Sciences for 2015 which includes 21 Plural books! Doody’s Core Titles in the Health Sciences 2015 is primarily for medical, nursing, and allied health librarians around the world who are charged with making the book buying decisions for their libraries within budget guidelines. A core title is a book or software title that represents essential knowledge needed by professionals or students in a given discipline and is highly recommended for the collection of a library that serves health sciences specialists.

Core Titles for 2015:

Effective Communication: A New Health Care Obligation

Beukelman Effective Communication Image

By: Sarah W. Blackstone, David R. Beukelman, and Kathryn M. Yorkston
Editors of the new Patient-Provider Communication: Roles for Speech-Language Pathologists and Other Health Care Professionals

Prior to his accident, Frank was a 26-year-old energetic, physically active young adult with a wide range of interests and a full social life. A C3–C4 cervical spine injury left him unable to move his limbs. When medically stabilized, he was transferred to the surgical intensive care unit, where he was ventilator dependent and in halo traction. He was unable to speak and his only intentional gesture was a gaze shift. The hospital communication team helped Frank establish a reliable yes/no response (looking up to indicate “yes” and down for “no”). They encouraged his nurses and family to offer other choices as well (“maybe” or “later” or “I don’t know”). A speech-language pathologist showed him a speech-generating device (SGD), but when initially asked if he wanted to use it to “talk,” he responded by looking down, “No.” Later that same day, the team demonstrated the SGD again, showing him how he could use it to control the TV and a fan. When asked if he would be willing to give it a try, he replied, “Yes!” by looking up. Within 24 hours, Frank was using a template on the SGD to call a nurse, ask for medication, control a fan, and turn the TV off and on, all with a simple serial scan method and a switch. Over time, he became an active participant in his recovery process, asking doctors questions and participating in decisions about his treatment plan.

Effective communication between patients and providers is a core component of patient-centered and value-based health care. According to the Joint Commission (2010, p.1), effective patient provider communication is the successful joint establishment of meaning in which patients and health care providers exchange information, enabling patients to participate actively in their care from admission through discharge, and ensuring that the responsibilities of both patients and providers are understood. To be truly effective, communication requires a two-way process (expressive and receptive) in which messages are negotiated until the information is correctly understood by both parties.

The medical encounters that occur across the continuum of health care are usually time constrained and many are stressful, high-stake interactions. When communication breakdowns occur, the impacts can be devastating for patients, family members, providers, and the health care system. Research shows that communication difficulties are among the major causes of sentinel events and can negatively affect patient outcomes, safety, and satisfaction, as well as result in increased readmission rates, length of stay, and additional health care costs. Because of the diversity of patients and families served in our health care systems, successful communication can be very difficult to achieve. In fact, many patients present with multiple communication vulnerabilities.

At age 4 years, 6 months, Guillermo was in the ICU, intubated and awake following a series of surgeries for tracheoesophageal reconstruction. Guillermo and his family were from Honduras and spoke Spanish only. Guillermo was most relaxed when his mother or eldest brother were sitting next to his bed and rubbing his arm. Although hospital policy supported his family remaining at bedside throughout the day and night, there were moments when they needed to step away for personal care, to attend team meetings along with a translator, or for other reasons. The speech-language pathologist provided Guillermo with a simple voice output aid (Ablenet Little Mack) with messages that included, “Where is my family,” recorded in both Spanish and English, so hospital staff could understand him. The speech-language pathologists also made a 20-target Go Talk+ device (Attainment Company) available to him. It featured 15 target photos of family members with messages such as, “I want mom,” “You’re my best friend, Frederico,” “I love you,” and “Hold my hand,” as well as some medical messages. All messages were recorded in both languages.

We define “communication vulnerability” as the diminished capacity of an individual to speak, hear, understand, read, remember, or write due to factors that are inherent to the individual (e.g., disabilities related to receptive and expressive language skills, hearing, vision, speech, cognition, and memory, as well as language spoken, lifestyle, belief system, and limited health literacy), or related to the context or situation (e.g., a noisy environment, being intubated in an intensive care unit after surgery, suffering injury while traveling in a foreign country, having cultural practices, lifestyles, or religious beliefs that are not understood or accepted by providers).

Eleven-year-old Joshua had a bone marrow transplant. He was acutely aware of his suppressed immune system and created and used several communication tools during the time he required the use of a Bi-PAP noninvasive ventilator. Using a simple voice output communication tool, Joshua insisted on having the following message available at all times: “If anything falls on the floor, use the Sani-wipe to clean it before you let it touch me. Also, if your gloves touch the floor when you pick it up, change your gloves before coming near me.”

In the book, Patient-Provider Communication: Roles for Speech-Language Pathologists and Other Health Care Professions, we describe how health care facilities and the providers who work within them can begin to assume a more active role in supporting patients who are communication vulnerable. Speech-language pathologists, nurses, administrators, and physicians are key to improving the “culture of communication” within their facilities, spearheading interprofessional practices that benefit all patients and ultimately providers and the facility’s bottom line. Currently, the role of communication intermediary is assumed by a few providers or family members with a personal commitment; although a rising number of health care organizations are beginning to specify policies and role assignments regarding the coordination of communication support services, communication facilitation for all patients with communication difficulties (not just those who are deaf or have second language issues), or a legal or medical intermediary designated to ensure that communication vulnerable patients accurately participate in legal and medical decisions.

Examples of promising practices and strategies across health care settings are highlighted in individual chapters that focus on doctor visits, emergency services, Intensive and acute care settings for children and adults, inpatient and outpatient rehabilitation, long-term residential care, and end-of-life care. In this book, we have invited authors who have considerable expertise in patient provider communication services across the range of health care settings to share information about the policies, intervention strategies, communication materials, and technologies that are being implemented within their medical settings to support the needs of communication vulnerable patients.

The wife of a person with ALS described his end-of-life experience: He was having a great deal of difficulty breathing and simply could not get comfortable in his hospital bed or wheelchair. We decided to go with in-hospital hospice since his pain management was not well controlled. In hospice, he regularly used his (eye gaze-accessible) SGD to tell us what he did and did not want. I am so grateful that he was able to use it extensively during the last few days of his life. I do not know what we would have done without it.

The authors recognize that there continues to be a considerable gap between clinical research evidence, what is mandated by health care policy, and what is experienced every day by patients, their families, and providers during medical encounters because of the ways in which many health care organizations currently deliver care. In other words, we recognize that implementation, or the process of putting effective patient-provider communication policies into practice, continues to be a challenge within many health care organizations; however, in the final chapter of Patient-Provider Communication we discuss a number of implementation strategies.

References
The Joint Commission. (2010). Advancing effective communication, cultural competence, and patient and family centered care: A roadmap for hospitals. Oakbrook Terrace, IL: Author.

About the Authors
Sarah W. Blackstone, PhD, CCC-SLP, is president of Augmentative Communication, Inc. She has authored multiple texts in the augmentative and alternative communication field as well as articles in Augmentative Communication News and other publications. David R. Beukelman, PhD, CCC-SLP, is the Barkley Professor of Communication Disorders at the University of Nebraska-Lincoln. He has served as director of research and education for the Communication Disorders Division, Munroe-Meyer Institute for Genetics and Rehabilitation at the University of Nebraska Medical Center. Kathryn M. Yorkston, PhD, BC-ANCDS, is a professor of rehabilitation medicine and head of the speech pathology division within the Department of Rehabilitation Medicine at the University of Washington Medical Center.

Reflecting on Autism Awareness Month: Why Is Awareness Important?

Zenko, Catherine

By: Catherine B. Zenko, MS, CCC-SLP

During the rush of activities on April 2nd for World Autism Awareness Day, a journalism student interviewed me to discuss upcoming events at our center and to learn more about Autism Awareness Month. One of the first questions she asked me was, “Why is awareness so important for autism?” It seems like such a simple question, but when I had to put into words why I do what I do every day to promote awareness, it took me a moment articulate the importance of awareness. My response sounded something like, “Ideally, the more people know and understand what autism spectrum disorder (ASD) is—how individuals think, process, and learn differently—the more understanding they will be when they see a person on the spectrum acting ‘out of the ordinary.’”

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, autism spectrum disorder consists of deficits in two domains: (1) social communication and (2) restricted, repetitive, and stereotypic interests and activities (APA, 2013). ASD presents in a myriad of ways, thus inspiring the expression, “once you’ve met one person with autism, you’ve met ONE.” Generally speaking, people with ASD have difficulty communicating: some cannot use speech to communicate; some use a combination of speaking, sign language, pictures, or augmentative/alternative communication (AAC); and some speak too much, not understanding the social rules that a conversation involves two people and both people get to talk. Understanding spoken and written language is also difficult and takes more time to process for most people on the spectrum.

The DSM-5 outlines the diagnostic characteristics of the domain of restricted, repetitive patterns of behavior, interests, or activities as the following: repetitive speech, motor movements, or use of objects; inflexible adherence to routines and/or ritualized patterns of verbal/nonverbal behavior; restricted, fixated interests (intense focus); and hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of environment (APA, 2013). All of the diagnostic criteria translate into people who:
• Are literal interpreters of language and concrete thinkers;
• Have difficulty processing all of the sensory information around them and can have both gross- and fine-motor challenges;
• Are visual learners;
• Have a strong sense of logic that is black and white, not much (if any) room for gray;
• Prefer routines and become extremely upset when a routine is disrupted and are sometimes compelled to finish a task they have started, even when the allotted time has expired;
• Have difficulty taking the perspective of others which makes them appear egocentric;
• Are detail-oriented but have trouble seeing the big picture;
• Have difficulty with attention, starting with joint-attention and engagement with others as well as trouble shifting their attention away from their intense interest area (Janzen & Zenko, 2012; Quill, 1997; Rydell, 2012; Zenko & Hite, 2013).

I like to view autism spectrum disorder more like a difference rather than a disability. The term “neurodiversity” is gaining steam lately and illustrates that just because people on the autism spectrum think and learn differently, they are not disabled. One of Temple Grandin’s most famous quotes embodies this idea of “different, not less.” One social media campaign currently trending is #AutismUniquelyYou. This campaign highlights and celebrates each individual with ASD’s unique personality, instead of lamenting it. Another great campaign is #MakeATinyChange that encourages people to make a difference in the lives of individuals with disabilities through any one of 25 small changes.

There have been several stories circulating this month about how a small gesture of openness and understanding can make a huge difference. One that stood out was a story by ABC News about a man who put away his work and played with a little girl with autism sitting next to him on a plane. The man did not understand why “playing Ninja Turtles with the little girl was a big deal,” but to her mother—who was so relieved when her daughter was met with kindness and acceptance, not pity and annoyance—it meant the world.

Circling back to the question of why awareness is so important, if more people take the time to learn how someone with autism thinks and experiences their surroundings, the more people may embrace the neurodiversity, rather than shy away from the differences and get to know some truly interesting people.

References
American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, DC: American Psychiatric Publishing.

Janzen, J. E., & Zenko, C. B. (2012). Understanding the nature of autism: A guidebook to the autism spectrum disorders (3rd ed.). San Antonio, TX: Hammill Institute on Disabilities.

Quill, K. A. (1997). Instructional considerations for young children with autism: The rationale for visually cued instruction. Journal of Autism and Developmental Disorders, 27(6), 697–714.

Rydell, P. J. (2012). Learning Style Profile for children with autism spectrum disorders. Retrieved from http://itunes.apple.com

Zenko, C. B., & Hite, M. P. (2013). Here’s how to provide intervention for children with autism spectrum disorder: A balanced approach. San Diego, CA: Plural Publishing.

About the Author
zenko_hhtpicasdCatherine B. Zenko, MS, CCC-SLP is a Florida-licensed speech-language pathologist who has worked with individuals on the autism spectrum for over fourteen years. She is an adjunct lecturer at the University of Florida Dept. of Speech Language Hearing Sciences since 2008 teaching a graduate-level Autism and Augmentative and Alternative Communication (AAC) course and has worked at the University of Florida (UF) Center for Autism and Related Disabilities (CARD) since 2000. While at CARD, Catherine has helped hundreds of individuals with ASD, their families and educators by providing consultation or training opportunities on a myriad of topics relating to best practices and ASD. In addition to her work at CARD, Catherine has co-authored Here’s How to Provide Intervention for Children with Autism Spectrum Disorder: A Balanced Approach, a timely resource for speech-language pathologists working with children on the autism spectrum as well as graduate students preparing to work with this demographic.

2015 Plural Publishing Research Award Winners

We are thrilled to announce the winners of the 2015 Plural Publishing Research Awards given in honor of the late Dr. Sadanand Singh. These two scholarships are awarded by the Council of Academic Programs in Communication Sciences and Disorders and the honorees and their faculty sponsors were acknowledged at the annual CAPCSD meeting, which took place this year in Newport Beach, California, April 15-18.

“We received 82 complete applications for the Research Awards this year. The quality was very high in all of these applications, making for a lively review process. In the end, there was one each at the MS/AuD level and the PhD level that were truly outstanding,” according to Richard C. Folsom, who chaired the award committee this year.

Eric Bostwick, 2015 Research Award Winner

Eric Bostwick, 2015 Plural Research Award Winner

At the MS/AuD level, the award went to Eric Bostwick at the University of Wisconsin-Madison. Eric is an AuD student working with Dr. Bob Lutfi and his research is entitled, “Decision Weights and Stimulus-Frequency Otoacoustic Emissions.”

Bridget Perry, 2015 Research Award Winner

Bridget Perry, 2015 Plural Research Award Winner

At the PhD level, the award went to Bridget Perry at the MGH Institute in Boston. Bridget is a PhD student working with Dr. Jordan Green and her research is entitled “Early Detection of Dysphagia in ALS.”

Writing Tips from Plural Authors

Have you ever thought of writing a book in your field? We know that writing a book is no small undertaking, so as part of our 10 year anniversary celebration we enlisted the help of our knowledgeable authors Celeste Roseberry-McKibbin, PhD, Lynn Adams, PhD, CCC-SLP, and Lise Menn, PhD, to share advice on writing a best-selling book! Here you will gain some insight into the inspiration, motivation and hard work that goes into a best-selling Speech-Language Pathology and/or Audiology textbook and professional book.

1. What insight or tips would you offer to a first-time author who is writing a professional development book or textbook in the Speech-Language Pathology and/or Audiology field?

CRM: It is very important to make sure that your contribution is original—something that meets a need in the field. I never write a book that competes exactly with something currently in print. I always make sure that my book is unique, original, and has a perspective that no other book has. The questions I also ask are: who would want to buy my book? Why would they spend money on it? What value does it bring to them? What problems does my book help them solve?
It is so important to think about meeting the needs of your audience. As authors, we have our passions and enthusiasms. Who shares them?

LA: JUST START WRITING…..that is the hardest part!!

LM: Have a colleague in a related but different field read through your book to make sure it’s understandable to someone who doesn’t already know the subject matter.

Go back to the original published sources – amazing amounts of old material are easy to get on-line, and you’ll find that you get fresh insights from reading the classic papers instead of relying on the usual summaries. What you take away from a paper that you read for yourself might be quite different from what everyone else has said about it.

Create or find new examples instead of re-using the standard ones that everyone else uses. You might discover something in the process, too. Continue reading

Interprofessional Education: Future Directions in Pre-professional Instruction

Child and Adolescent Communication DisordersMARIE R. KERINS

By: Marie R. Kerins, EdD, CCC-SLP, Loyola University Maryland
Editor of Child and Adolescent Communication Disorders: Organic and Neurogenic Bases

Interprofessional Education (IPE) is becoming a more recognized model for educating pre-professional students entering the healthcare or education workforce. It is quickly gaining momentum in institutions of higher education as a means of addressing some of the fragmentation observed in the healthcare industry and in the schools, both of which strive to produce positive and lasting outcomes for the individuals and communities they serve. Working collaboratively mends fragmentation, reduces duplicative efforts, and effectively addresses client/student needs. The World Health Organization (WHO) has endorsed IPE and defines it as a period when “two or more professions learn about, from, and with each other to enable effective collaboration and improve [health] outcomes” (WHO, 2010, p. 7). Formalizing IPE through published guidelines from organizations such as the Interprofessional Education Collaborative (IPEC) has helped renew interest in interdisciplinary and collaborative practices that have been around for quite some time but have not been systematically or formally taught in higher education settings. While the WHO and IPEC are geared more toward international health care practices, professionals working in schools have also joined in the conversation and are adopting the language of IPE. One goal of IPE is to develop a practice ready workforce where professionals can immediately implement knowledge and skills they have practiced while training in an integrated and interdisciplinary manner. Evidence is mounting to support interprofessional care (see Reeves, Perrier, Goldman, Freeth, & Zwarestein, 2013; WHO, 2010). IPE and collaborative practice will become an established manner of service delivery to improve patient/student care, if we can embrace interprofessional education as a shared vision with an understanding of the benefits of this new collaborative curriculum.

Collaborative Internship Experience: Speech-Language Pathologists and Reading Specialists

Continue reading

Handbook of Central Auditory Processing Disorder Reviewed

Handbook of Central Auditory Processing Disorder, Volume 1, 2nd Edition

Peer review of Handbook of Central Auditory Processing Disorder: Auditory Neuroscience and Diagnosis, Volume I, Second Edition edited by Frank Musiek, PhD, CCC-A and Gail Chermak, PhD, CCC-A.

Review by Herbert Jay Gould, PhD, Associate Professor, School Communication Sciences and Disorders, The University of Memphis

The addition of several new chapters to the Handbook of Auditory Processing Disorders Volume 1 is a significant enhancement and expansion of the first edition. The general layout and writing is consistently high quality throughout the book. Several chapters and areas of discussion are particularly valuable to the reader’s basic understanding of CAPD.

The initial section on auditory neuroscience has excellent chapters by Jos Eggermont on central auditory system development and by Phillips on central auditory neuroscience. These two chapters provide a strong basic science underpinning to the remainder of the book. Dr. Eggermont’s chapter ties the anatomic and electrophysiologic activity of the system to the normal behavioral measures of basic signal processing and speech perception of the developing nervous system. The extraordinarily long time course of this system’s maturation exemplifies the difficulties of separating a slowly maturing, but normal system, from a significantly disordered one. Continue reading

Are Your Services Educationally Relevant?

Jean BlosserSchool Programs in Speech-Language Pathology 5th Edition

Jean L. Blosser, EdD, CCC-SLP
President, Creative Strategies for Special Education
Author, School Programs in Speech-Language Pathology: Organization and Service Delivery, Fifth Edition, Plural Publishing, 2012

Educational Relevance—What an Important Concept!
Does a child’s disability impact his or her performance in the classroom? If yes, would services such as speech-language intervention, occupational therapy, or physical therapy make a difference? Should those services be intensive, provided face-to-face or via technology, or integrated into the classroom? The primary question is, if therapy services are offered, will the intervention provided make a difference in the student’s classroom performance, ability to access the curriculum, and/or ability to reach his or her potential?

These are huge questions that administrators, educators, clinicians, and parents ponder every day. When school teams evaluate a student, they seek to determine how the disability may be interfering with the student’s learning. Key educational areas that may be affected are academic, social-emotional, and vocational performance. If everyone agrees there is an adverse effect on educational performance, the student’s eligibility for services is confirmed.

How Do We Guarantee Educational Relevance? Continue reading

Plural Author Blake Wilson Awarded Fritz J. and Dolores H. Russ Prize

Blake WilsonOn January 7, 2015 the National Academy of Engineering announced that the 2015 Fritz J. and Dolores H. Russ Prize would be awarded to Blake S. Wilson, Grame M. Clark, Erwin Hochmair, Ingebord J. Hochmair-Desoyer, and Michael M. Merzench “for engineering cochlear implants that enable the deaf to hear.” The $500,000 biennial award recognizes a bioengineering achievement that significantly improves the human condition.1

“This year’s Russ Prize recipients personify how engineering transforms the health and happiness of people across the globe,” said NAE President C.D. Mote Jr. “The creators of the cochlear implant have improved remarkably the lives of people everywhere who are hearing impaired.”1

Dr. Blake S. Wilson is the Co-Director (with Debara L. Tucci, MD) of the Duke Hearing Center and is an adjunct professor in each of two departments at Duke, Surgery and Electrical Engineering. He also is the chief strategy advisor for MED-EL Medical Electronics GmbH of Innsbruck, Austria, and a Senior Fellow Emeritus of the Research Triangle Institute (RTI) in the Research Triangle Park, NC, USA. He has been involved in the development of the cochlear implant (CI) for the past three decades, and is the inventor of many of the signal processing strategies used with the present-day devices.

Dr. Wilson and the teams he has directed have been recognized with a high number of awards and honors, most notably the 1996 Discover Award for Technological Innovation; the American Otological Society’s President’s Citation in 1997 for Major contributions to the restoration of hearing in profoundly deaf persons (to the RTI team); the 2007 Distinguished Alumnus Award from the Pratt School of Engineering at Duke; the Neel Distinguished Research Lectureship at the 2008 Annual Meeting of the American Academy of Otolaryngology, Head & Neck Surgery; and recently the Lasker-De-Bakey Clinical Medicine Research Award in 2013.

Better Hearing with Cochlear ImplantsDr. Wilson co-authored Plural Publishing book Better Hearing with Cochlear Implants which provides a comprehensive account of a decades-long research effort to improve cochlear implants (CIs). The research was conducted primarily at the Research Triangle Institute (RTI) in North Carolina, USA, and the results provided key pillars in the foundation for the present-day devices.

 

1. National Academy of Engineering. Inventors of Cochlear Implant Win 2015 Fritz J. and Dolores H. Russ Prize [Press Release]. Retrieved from http://www.nae.edu/Projects/MediaRoom/20095/107830/129146.aspx