2016 Awards and Honors

We are thrilled to announce the winners of the 2016 Plural Publishing Research Awards given in honor of the late Dr. Sadanand Singh, Plural’s founder. These two scholarships are awarded by the Council of Academic Programs in Communication Sciences and Disorders and the honorees and their faculty sponsors will be acknowledged at the annual CAPCSD meeting award banquet, in San Antonio, TX on March 31.

At the MS/AuD level, the award went to Chelsea Hull of the University of Nebraska-Lincoln. Working with advisor Dr. Sherri Jones, Chelsea is researching the impact of Sound Field Amplification (SFA) devices, specifically the REDCAT amplification system, on student academic outcomes and teacher perspectives of this amplification system on academic improvement.

CAPCSD Scholarship Chelsea Hull

Chelsea Hull                                                         Au.D. Student                                             University of Nebraska-Lincoln

At the PhD level, the award was given to Nancy Quick of the University of North Carolina. Under advisor Dr. Melody Harrison, the focus of Nancy’s research is on investigating the impact of underlying linguistic sources of knowledge on spelling among children with hearing aids, cochlear implants and normal hearing, utilizing a multilinguistic analytic approach.

CAPCSD Scholarship Nancy Quick

Nancy Quick, M.S. CCC-SLP               University of North Carolina at Chapel Hill PhD Candidate in Speech and Hearing Sciences, Class of 2017

Congratulations Chelsea and Nancy on your achievements!

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The Changing Indications for Cochlear Implantation

Theodore R. McRackan, MD Otology, Neurotology, and Skull Base Surgery

By Ted McRackan, MD, co-editor of Otology, Neurotology, and Skull Base Surgery: Clinical Reference Guide

Cochlear implantation is the gold standard for treatment of severe to profound sensorineural hearing loss. Cochlear implants (CIs) were approved by the Food and Drug Administration (FDA) in 1985 and have been suggested to be the most successful neural prosthesis created to date. Over 300,000 cochlear implants have been performed worldwide, with over 50,000 performed in the past year alone. Cochlear implantation involves a surgical procedure whereby an electrode array is placed in the cochlea of the inner ear, which is organized in a tonotopic fashion with decreasing characteristic frequency along its length. Modern CIs contain between 12 and 22 electrodes, which are spaced with the intention of each electrode stimulating a unique area of the spiral ganglia of the auditory nerve. Cochlear implants work by having an external microphone and an external processor convert an acoustic signal to an electrical signal. It is then sent to a speech processor, which is designed to enhance the signal and reduce noise before sending the information to the spiral ganglion through the CI electrode array.

Cochlear implantation is currently at an exciting time point due to the combination of improving technology and proven outcomes that has led to rapid expansion of its indications. The FDA approved the first single-channel CI electrode for adults in 1984, followed by the multichannel electrode in 1987. Cochlear implants were then approved in 1990 for children older than 2 years, in 1998 for children over 18 months, and ultimately in 2000 for children older than 12 months. There has been a recent push to implant children younger than 12 months due to evidence that children implanted at this age are more likely to catch up to normal-hearing peers at an earlier time point. Three major obstacles have hampered this movement. First, obtaining accurate hearing diagnostic testing in a timely manner can often be difficult in those less than 12 months. Second, there is a slight increased risk of surgical complications due to the low blood volume in this age group. Third, it can be extremely difficult to perform cochlear implant programming in this age group. Nonetheless, the clear benefits of early implantation likely outweigh these risks. Pediatricians, audiologists, and otolaryngologists are encouraged to identify infants with hearing loss as soon as possible for hearing rehabilitation. The earlier this is performed, the earlier children with profound hearing loss can be identified, and the earlier they can be implanted, leading to better CI outcomes.

Use of cochlear implantation in patients with residual hearing has been another area of rapid expansion. It was initially thought that all hearing would be lost with cochlear implantation and that if hearing was preserved, patients would not be able to process electrical and acoustic hearing. However, through the trials of the Cochlear Hybrid electrode and the MED-EL EAS electrode, it appears that both are possible. Through these and other trials, most patients had preserved residual hearing after cochlear implantation. Additionally, these patients showed improved hearing outcomes compared to patients without residual hearing. At the present time, it is not clear whether this preserved hearing is sustainable over time. This is an active area of investigation and will continue to be studied for years. Nevertheless, this technology has greatly expanded the indications for cochlear implantation beyond traditional candidacy.

As discussed above, it was previously thought that individuals would not be able to process combined electrical and acoustic hearing. However, cochlear implantation in patients with residual hearing proved this incorrect. This has led to the more widespread use of CIs in individuals with single-sided deafness. Current standard treatment for single-sided deafness includes devices that essentially ignore the deafened ear. However, with cochlear implantation, hearing can be restored to that ear. This was initially performed in patients with severe tinnitus in the deafened ear but is now being more commonly performed in the absence of tinnitus. Further work is certainly needed to develop a more comprehensive understanding of cochlear implantation in this population, but preliminary data show decreased head shadow effect and improvement in binaural summation, spatial release from masking, and potentially sound localization.

Beyond cochlear implantation, the use of auditory brainstem implants (ABIs) in children is another area of expansion. Although this has been performed in Europe for years, it is only more recently being performed in the non-neurofibromatosis type II population in the United States. Several centers have active clinical trials to perform ABIs in children unlikely to benefit from cochlear implantation due to either absent cochlear nerves or cochlear malformations. This is an unfortunate population as they have limited hearing rehabilitation options. Auditory brainstem implants provide an opportunity for hearing in this population, and the neurotology community is excited to hear the results of these trials.

We have come a long way since Bill House developed the first single-channel CI. As outcomes and technology continue to improve, the indications for cochlear implantation will grow. The audiology and otology communities are eager to see what the future holds for cochlear implantation.

About the Author
Dr. Theodore R. McRackan is an assistant professor of otolaryngology at the Medical University of South Carolina. He received his medical degree from the Medical University of South Carolina and completed his otolaryngology residency at Vanderbilt University. Dr. McRackan then completed his fellowship in neurotology-skull base surgery at the House Ear Clinic. His professional interests include neurotologic outcomes and quality of life research. Dr. McRackan and Derald E. Brackmann, MD co-edited Otology, Neurotology, and Skull Base Surgery, which serves as both a study resource for qualifying exams and a portable clinical reference guide. This text features a concise and approachable outline format, contributions by leaders in the field, and key topics such as anatomy and embryology, hearing loss, cochlear implantation, skull base tumors, vestibular disorders, and pediatric otology. View sample pages and place your order at www.PluralPublishing.com.

Tinnitus: In the Brain of the Beholder

Marc_Fagelson    Baguley_PTINN    David_Baguley


By: Marc Fagelson, BA, MS, PhD and David M. Baguley, BSc, MSc, MBA, PhD

Co-editors of Tinnitus: Clinical and Research Perspectives

Most audiologists and patients understand tinnitus to be the perception of a sound that is not connected in any way to an environmental event. For some patients, the sound produces minimal discomfort and is noticeable only a fraction of the time. Other patients are not so fortunate, and their tinnitus may persist and prove distracting when they are in the presence of other sounds or when they try to communicate. A relatively small proportion of patients with tinnitus, still probably more than 10 million people worldwide, have bothersome tinnitus that consistently reduces their quality of life and affects most routine activities. Such patients often respond to tinnitus as though its presence merits the attention and concern consistent with that demanded by a sound that is recognized as a threat. These patients illustrate some of the more confounding elements of tinnitus: it is a sound experience that may produce, or be associated with, powerful emotions and physiologic responses consistent with those demonstrated in fear-avoidance research.

A person’s experience with tinnitus may be complex and multi-faceted. Some patients link tinnitus to traumatic events, perhaps those that triggered the tinnitus onset. Other patients report psychological conditions such as anxiety and depression appear to exacerbate tinnitus and may be reinforced by tinnitus-related negative associations. Often, tinnitus severity is dictated not by the sound, but by the patient’s interpretation of and response to the sound. In this regard, the power of tinnitus to exert influence over a person’s life is in the eye, or ear, of the beholder.

Tinnitus interventions, then, may be viewed as proceeding along parallel tracks: abolishing or attenuating the sound may be the target of a treatment strategy, or the patient’s response to tinnitus may be the target of a management strategy. Both approaches are considered in detail, and with many examples, in Tinnitus: Clinical and Research Perspectives. Continue reading

How to Work with Interpreters and Translators

Henriette_Langdon  Langdon_WWIT  Terry_Saenz

By Henriette W. Langdon, Ed.D., FCCC-SLP and Terry I. Saenz, Ph.D., CCC-SLP, authors of Working with Interpreters and Translators: A Guide for Speech-Language Pathologists and Audiologists

Our world is increasingly heterogeneous. English is no longer the only language spoken in the United States, England, or Australia. French is not the only main language spoken in France and neither is German the only language spoken in Germany. Immigration caused by political and economical changes has dispersed many people to other countries in the world in search of better opportunities. Consequently, communication between these individuals and residents of the different countries is often disrupted due to the lack of a common language. This challenge has existed throughout humankind, but it seems that it has increased in the last century or so. There have always been people who knew two languages that needed bridging, but now this urgency is more pronounced. The need for professionally trained interpreters was first noted following the end of WWI when the Unites States was first involved in world peace talks alongside many nations with representatives who all spoke a variety of languages. This historical event eventually led the League of Nations to the foundation of the École d’Intèrpretes in Geneva, Switzerland in 1924. Since that time, many other schools that train bilingual interpreters to participate in international conferences have been established. The AIIC [Association Internationale des Interprètes de Conférence (International Association of Conference Interpreters)] Interpreting Schools directory lists a total of 87 schools worldwide: http://aiic.net/directories/schools/georegions. The reader can gather information on which specific language pairs are emphasized in the various training schools; for example, Arabic-English; French-Spanish, Chinese-English, and so forth. Thus, interpreting for international conferences is a well-established profession today, offering specific training and certificates. However, interpreting is necessary not only for international conferences, but also to assist in bridging the communication in everyday contexts such as medical or health, judicial, educational (schools) and the community at large. Training and certification in areas such as medical and judicial have slowly emerged and are available to those who need them in various states throughout the United States. Legislation has been the primary force in the establishment of certificates in the areas of medical and legal interpreting. However, training in other areas where interpreting is needed such as education, and our professions, speech pathology and audiology, are notoriously lacking. There are some situations where medical interpreters can assist speech-language pathologists (SLPs) and audiologists in a hospital or rehabilitation center, but even those interpreters may not have the specific terminology and practice or procedures to work effectively with our professionals. Working with Interpreters and Translators: A Guide for Speech-Language Pathologists and Audiologists is a second revised and expanded edition on this topic that provides SLPs, audiologists, and interpreters who collaborate with them some concrete tools and strategies on how best to conduct interviews, conferences, and assessments when the client and/or family does not speak English fluently.  The proposed process is based on information gathered from other interpreting professions. The research, and some personal interviews with audiologists in particular that were conducted to assemble this information, indicate that the process is conducted haphazardly at best.  The literature available on the collaboration between SLPs and interpreters indicates that both parties are not secure about procedure and must learn how to work together by trial and error. Often the SLP does not trust the interpreter and the interpreter does not follow suggested procedures, such as failing to interpret all that is being said, conducting a side conversation with a parent during a meeting, and giving the child unnecessary cuing during testing (if tests are available in the child’s language, which is primarily Spanish). Literature on working effectively with audiologists is almost nonexistent; therefore, the first author resorted to several personal interviews with audiologists, a specialist of the deaf and hard of hearing, and professors of audiology throughout the country. Often individuals who perform the duties and responsibilities of the interpreter and who are hired to do this job are not fully bilingual; they may speak the two languages, but may not be able to read or write the language they are using to interpret. These interpreters are often not respected, are not treated as professionals, and their pay is very low.

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ASHA 2015 Preview

The 2015 ASHA Convention starts November 12 in Denver and is shaping up to be one of the largest ever. If you are attending this year’s meeting, please stop by our booth (#804) for the following:

  • Save 20% with free shipping!
  • Connect with experts at one of our Meet the Author sessions (schedule to be announced November 11)
  • Browse our new textbooks and request a review copy for your course
  • Meet with Valerie Johns, Executive Editor, about any ideas for a new book

Attend the session, then buy the book!
We have many new books debuting by authors that are presenting at ASHA 2015 on their book topics.

Session Title: Drawing from Different Settings: A Panel Presentation on School-Based Swallowing & Feeding
Presenter(s):  Emily Homer (presenting author); Lisa Mabry-Price (presenting author); Kim Priola (presenting author); Gayla Lutz (presenting author); Donna Edwards  (presenting author); Lissa Power-deFur (presenting author)
Day: Thursday, November 12, 2015 Time: 10:30 AM – 12:30 PM                                     Book title(s): Management of Swallowing and Feeding Disorders in Schools and Common Core State Standards and the Speech-Language Pathologist: Standards-Based Intervention for Special Populations

Session Title: Assessing the Validity of Remote MAPping for Children With Cochlear Implants
Presenter(s): Emma Rushbrooke (presenting author); Louise Hickson; Belinda Henry; Wendy Arnott
Day: Thursday, November 12, 2015 Time: 11:00 AM – 11:30 AM
Book title(s): Telepractice in Audiology and Evidence-Based Practice in Audiology: Evaluating Interventions for Children and Adults with Hearing Impairment 

Session Title: Trauma & Tinnitus
Presenter(s): Marc Fagelson (presenting author)
Day: Thursday, November 12, 2015 Time: 1:30 PM – 2:30 PM
Book title: Tinnitus: Clinical and Research Perspectives 

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Brain-Based Listening and Spoken Language: The Focus of the Third Edition of Cole and Flexer (2016)


By Elizabeth B. Cole and Carol Flexer, author of Children With Hearing Loss: Developing Listening and Talking, Birth to Six, Third Edition

Spoken language is acoustically based. When the expectation is that a child will learn spoken language, hearing loss presents a critical spoken language-information-accessing obstacle to the child’s brain. When, through the miracle of modern technology and expertise, the audiologist provides the child’s ears with appropriately selected and programmed hearing aids or cochlear implants, the child’s brain now has access to the acoustic information encoded in spoken language. Looking at it this way, for the child who is learning spoken language, untreated hearing loss presents not only an ear problem, but also a brain access problem. Luckily, given sufficient acoustic access to spoken language in meaningful, varied-but-repetitive contexts, the child’s brain learns to make sense of the auditory input and learns to understand and produce spoken language. That process can be described in just one sentence, but is far from simple. The process of helping a child with hearing loss learn to listen and talk fluently requires a great deal of time, commitment, and sustained effort from all those who care for the child.

In recent years, there has been a veritable explosion of information and technology about testing for and managing hearing loss in infants and children, thereby enhancing their opportunities for auditory brain access. The vanguard of this explosion has been newborn hearing screening. As a result, in this day and age, we are dealing with a vastly different population of children with hearing loss, a population that we’ve never had before in our history. With this new population whose hearing loss is identified at birth, we can facilitate access of enriched auditory/linguistic information to the baby’s brain. The miracle is that we can prevent the negative developmental and communicative effects of hearing loss (such as delayed speech, language, reading and social skills) that were so common just a few years ago. With these babies and young children, we can now work from a neurological, developmental, and preventative perspective rather than a remedial, corrective approach. As we implement brain-based science, the effects on the field of hearing loss are truly revolutionary.

The following are some suggestions for families and practitioners who want to grow the baby/child’s brain for listening and spoken language. Many of the suggestions describe things that any devoted parent would likely do with a child. Beyond the technology, what is different for the parent of a child with hearing loss is the requirement for constant vigilance for decreasing noise and distance, and the requirement for sustained effort at increasing appropriate and meaningful verbal interactions with the child. These are the so simple, yet so difficult, keys for successfully laying the spoken language foundation that the child needs for the rest of his or her life. The authors take their hats off to all of the thousands of parents who have internalized all of the strategies and accomplished just exactly that!

  1. Your child must wear his or her hearing aid or cochlear implant every waking moment and every day of the week—“eyes open, technology on” (even when bathing or swimming, use technology that is water resistant/proof). The brain needs constant, detailed auditory information in order to develop. The technology is your access to the brain and your child’s access to full knowledge of the world around him or her. If your child pulls off the devices, promptly, persistently, and calmly replace them.
  2. Check your child’s technology regularly. Equipment malfunctions often. Become proficient at troubleshooting.
  3. The quieter the room and the closer you are to your child, the better you will be heard. The child may have difficulty overhearing conversations and hearing you from a distance. You need to be close to your child when you speak, and noise in the environment (especially from nonstop TV or other electronics) needs to be greatly reduced or eliminated. Keep the TV, computer/tablet, and CD player off when not actively listening to them.
  4. Use an FM system at home to facilitate distance hearing and incidental learning. An FM system can also be used when the child is reading out loud to improve the signal-to-noise ratio and to facilitate the development of auditory self-monitoring. Place the FM microphone on the child so that he or she can clearly hear his or her own speech, thereby facilitating the development of the “auditory feedback loop.”
  5. Focus on listening, not just watching. Call attention to sounds and to conversations in the room. Point to your ear and smile, and talk about the sounds you just heard and what they mean. Use listening words such as “You heard that,” “You were listening,” and “I heard you.”
  6. Maintain a joint focus of attention when reading and when engaged in activities. That is, the child should be looking at the book or at the activity while listening to you so that he or she has a chance to gain confidence in his or her ability to listen and understand without watching.
  7. Speak in sentences and phrases, not single words, with clear speech and correct grammar using lots of melody. Speak a bit slower to allow the child time to process the words, but be careful not to exaggerate your mouth movements. Many adults speak faster than most children can listen.
  8. Read aloud to your child daily. Even infants can be read to, as can older children. Try to read at least ten books to your baby or child each day. You should be reading chapter books by preschool.
  9. Sing and read nursery rhymes to your baby or young child every day. Fill his or her days with all kinds of music and songs to promote interhemispheric transfer. Singing is a whole brain workout!
  10. Constantly be mindful of expanding your child’s vocabulary. Deliberately use new words (in appropriate phrases and sentences) with the child for objects, foods, activities, and people as you encounter them in the environment during daily routines.
  11. Talk about and describe how things sound, look, and feel.
  12. Talk about where objects are located. You will use many prepositions such as in, on, under, behind, beside, next to, and between. Prepositions are the bridge between concrete and abstract thinking.
  13. Compare how objects or actions are similar and different in size, shape, quantity, smell, color, and texture.
  14. Describe sequences. Talk about the steps involved in activities as you are doing the activity. Sequencing is necessary for organization and for the successful completion of any task.
  15. Tell familiar stories or stories about events from your day or from your past. Keep narratives simpler for younger children, and increase complexity as your child grows.

Above all, love, play, and have fun with your child!


Please read Dr. Cole and Dr. Flexer’s Children With Hearing Loss: Developing Listening and Talking, Birth to Six, Third Edition for detailed information about audiology, technology, parent coaching, and listening and spoken language development.

Insight into the Significance of Supporting Caregivers from Dr. Payne’s New Book

Joan_Payne Payne_SFC

By Joan C. Payne, PhD

Author of the new Supporting Family Caregivers of Adults With Communication Disorders: A Resource Guide for Speech-Language Pathologists and Audiologists

In the United States, there are nearly 44,443, 800 family caregivers over the age of 18 who are caring for someone aged 50 years and older (Alzheimer’s Association, 2011; National Alliance of Caregivers in collaboration with AARP, 2009). Family, or informal, caregivers are family members and friends who provide unpaid care and advocacy for a chronically ill or disabled person for 20 hours a week or more. As such, family caregivers are the nexus between the formal health care system and the community for many individuals. Family caregivers, also called informal caregivers as opposed to those who are paid to render care, are vital extensions of the health care system. Without them, many persons discharged from acute and rehabilitative hospitals would not be able to care for themselves. The efforts of family caregivers are so important to the health, positive mental outlook, and indeed, survival of care recipients that their services are invaluable and predicted to be needed more and more as the 21st century continues.

This is why I am so excited about my book! Supporting Family Caregivers of Adult with Communication Disorders. A Resource Guide for Speech-Language Pathologists and Audiologists represents the first time that caregiver issues and resources have been organized and put in one place for the benefit of health professionals and the families of their patients. Much of my passion for the topic of caregivers comes from my remembering how stressful caregiving was because I really did not know what to do 20 years ago even though I had advanced degrees in speech-language pathology. The purpose of putting this information in one place where it is readily accessible is to empower speech-language pathologists and audiologists and other health professionals to support family caregivers of adults with disorders of communication and swallowing.

Caregiving is a deeply personal and intensive enterprise. Many caregivers report that they have appreciated the time to forge more intimate and caring relationships with their loved ones. At the same time, a significant body of research indicates that caregiving is also costly in terms of time, effort and financial sacrifice. Many caregivers are placed in the primary role of helping others without adequate resources with which to provide the best care. Caregiving can be so stressful that caregivers can themselves develop diseases and disabling conditions which affect their caregiving and those who depend upon them. For some, the stress can be so crippling that some caregivers are forced to abandon providing care altogether, or they become terminally ill.

To that end, each chapter addresses the issues of caregiving of adults with communication and swallowing disorders. Chapter 2 gives an overview of statistics on family caregivers, caregiver responsibilities for care, the economics of family caregiving, and concepts of caregiver burden, strain and stress. In addition, information on the effects of caregiving on physical, mental and emotional health of those who provide care is also provided. Caregiving has been recognized as an important national resource. There are laws that protect and support caregivers at the local and national levels, and Chapter 2 also includes national and state legislation that supports family caregivers when they deliver care. Chapter 3 describes the diversity of caregivers and how culture and tradition prescribe who will care for disabled adults as well as how caregivers use both internal and external resources. There are important differences in how caregivers perceive and accept caregiving responsibilities across ethnic and cultural groups. These differences have implications for how caregivers manage when the responsibilities becomes stressful. There are also some differences in how caregivers may accept and comply with counseling and referrals. Chapter 4 discusses basic characteristics of various brain-based diseases and disorders that affect communication and swallowing with a focus on how these disabling conditions affect communication and swallowing disorders and to assist caregivers in minimizing communication breakdowns.

Chapter 5 is developed from the perspective of audiologists and includes basic information on hearing loss, auditory processing disorders, balance disorders, cochlear implants and hearing aids, as well as the impact on caregivers. Included in this chapter is information on helping caregivers with hearing aid upkeep. A major portion of the chapter is devoted to assistive and augmentative technologies which audiologists can use to educate caregivers of adults with hearing loss who can benefit from these devices. Perceptions of burden, strain and stress interfere with a caregiver’s ability to provide quality and sustained care.

Chapter 6 describes assessments that measure caregiver strain, burden, stress and coping with caring responsibilities. Chapter 7 introduces concepts of education and counseling caregivers within the clinical setting and within the scope of practice. Educating and training caregivers can be helpful in improving communication and providing a continuum of therapy outside of the clinical setting. Although speech-language pathologists do not provide counseling in many areas of need, resource information is provided that can be shared with caregivers that will empower them to find answers to their most important questions, like respite or hospice care, elder law, and insurance. Chapter 8 provides information on other health care professionals and their areas of expertise. It is designed to inform speech-language pathologists and audiologists about the most appropriate professionals to whom caregivers should be referred when they need counseling in specific areas outside of the scope of practice.

Chapter 9, the final chapter, describes a case of a newly-wed husband who suffers a stroke and how his stroke affects his wife and their relationship. Without support from health professionals, his wife flounders in her caregiving role. Their story ends tragically, but questions are presented to guide clinicians to avoid missing caregiver needs.

It is hoped that this book will serve as a resource for health professionals and students in speech-language pathology and audiology and that it will become part of the toolkit for assisting caregivers. It is also the intent that this resource book will be helpful to those who are involved in caregiving now and in the future.


Alzheimer’s Association (2011). Alzheimer’s disease facts and figures. Retrieved from http://www.alz.org/downloads/facts_figures_2011.pdf

National Alliance for Caregiving and AARP (2009). Caregiving in the U.S. Retrieved from http://www.caregiving.org/data/Caregiving_in_the_US_2009_full_report.pdf

About the Author

Joan C. Payne, PhD, is a Fellow of the American Speech-Language-Hearing Association (ASHA) and is a professor of communication disorders at Howard University in Washington, DC, where she has been a member of the faculty for more than 40 years. She is nationally and internationally recognized for her work in neurogenic language disorders from an ethnobiological perspective and is the 2014 recipient of the Scholar-Mentor Award from the National Black Association for Speech-Language and Hearing.

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.

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.

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.”