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Purpose-To assess the adequacy of self-report instruments in speech-language pathology for measuring a construct called communicative participation.Method-Six instruments were evaluated relative to (a) the construct measured, (b) the relevance of individual items to communicative participation, and (c) their psychometric properties.Results-No instrument exclusively measured communicative participation. Twenty-six percent (n = 34) of all items (N = 132) across the reviewed instruments were consistent with communicative participation. The majority (76%) of the 34 items were associated with general communication, while the remaining 24% of the items were associated with communication at work, during leisure, or for establishing relationships. Instruments varied relative to psychometric properties.Conclusions-No existing self-report instruments in speech-language pathology were found to be solely dedicated to measuring communicative participation. Developing an instrument for measuring communicative participation is essential for meeting the requirements of our scope of practice. WHO, 2001). The purpose of the ICF is to offer clinical providers a common language for describing human functioning and disability, as well as to provide a conceptual framework for gathering data and measuring clinical outcomes. The ICF framework also is useful for speech-language pathologists (SLPs) for describing the consequences of communication disorders at several levels, including communication in social settings. 1 NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptThe ICF defines a person's functioning and disability in relation to health condition and contextual factors. It has three levels: (a) "Body Functions and Structures," which include the physiological functions of body systems or anatomical elements such as organs, limbs, and their components; (b) "Activities," which are the execution of specific actions; and (c) "Participation," which encompasses involvement in life situations (WHO, 2001). It is well recognized that difficulties in body functions and structures ("Impairments") are the most studied outcomes in communication disorders (Eadie, 2001;Threats, 2000). Impairment measures of speech, language, voice, and fluency include measures of articulatory accuracy, grammatical complexity of language, physiological functioning of the vocal folds, and number of disfluencies, to name but a few. Although many instruments exist at the level of body functions and structures, there is a paucity of instruments as performance challenges become less "biomedical" in nature (Eadie, 2001;Simmons-Mackie, Threats, & Kagan, 2005). This is related to the nature of the problem. That is, it is easier to measure the regularity of vocal fold movement, the accuracy of naming objects, or the percentage of words understood by a listener than it is to measure an individual's ability to participate in valued activities or situations such as negotiating a medical plan with a physician, applying for a job, or persuad...

The amyotrophic lateral sclerosis (ALS) severity scale has been developed to provide an ordinal staging system and a means of rapid functional assessment for patients with ALS. The scale allows an examiner to evaluate the symptoms of ALS numerically in four categories that describe speech, swallowing, lower extremity, and upper extremity abilities. These scores, combined with a vital capacity measured on a hand-held respirometer, provide a rapid, accurate assessment of a patient''s disease status and can be used for treatment planning. The ALS severity scale has been shown to have an average estimated reliability coefficient of 0.95 between examiners. Speech ratings were correlated >0.80 for objective speech measures. Rates of progression of the total score in a small group of patients ranged from –3.4 to –24.0 points/year with a mean of –11.3 points/year.

Surgical endeavors in the field of laryngotracheal reconstruction in children have received much interest in the past 15 years. A unique experience with laryngotracheal reconstruction in 203 children is reviewed. The majority (194) of the cases were classified as acquired; only nine were classified as congenital. Excluded from the study were those cases of stenoses managed endoscopically, all resections and end-to-end anastomoses, all anterior cricoid split procedures, and all cases of anterior glottic stenosis repaired by a laryngeal keel. The degree of stenosis was graded into four categories. Five different methods of laryngotracheal reconstruction were used depending on the pathologic lesion in the larynx and trachea. Of the 203 children, 186 (92%) were decannulated. The results support the use of laryngotracheal reconstruction in children with grades 2, 3, and 4 laryngeal stenosis.

A history of poor weight gain can often be elicited in young children with chronic upper airway obstruction resulting from adenotonsillar hypertrophy. A series of 41 consecutive children under 3 years of age, who underwent inpatient adenotonsillectomy, were reviewed for changes in weight and height. Thirty-seven patients had adequate long-term follow-up. Of these, many had dramatic improvements in growth after adenotonsillectomy. Indications for surgery in this group were recurrent infection in three patients (7%), unilateral tonsillar mass in one patient (3%), and upper airway obstruction in 37 patients (90%). A clear history of sleep apnea was elicited in 59%. At the time of surgery, 19 of 41 patients (46%) were of the fifth percentile or lower for age-corrected weight. The inpatient hospital stay averaged 3.2 days. The postoperative complication rate was 27%, with postoperative stridor as the most common complication. After surgery, 28 children (75%) showed a change to a higher percentile for weight. Twenty-four (65%) had percentile changes of 15% or more. This change is significant according to results of the Wilcoxon signed-rank test (p less than 0.001). We conclude that a relationship exists between improved growth rate and adenotonsillectomy in our study group. The rapid improvement in growth appears to be most obvious in children with upper airway obstruction resulting from adenotonsillar hypertrophy. Upper airway obstruction (including andenotonsillar hypertrophy) should be suspected as a possible cause in the workup of children with suboptimum growth.

A growing body of evidence has linked individual differences in facial structure-in particular, the facial width-to-height ratio (FWHR)-to social behaviors, including aggression, cheating, and nonreciprocation of trust. In the research reported here, we extended this work by demonstrating that the association between FWHR and aggression is moderated by subjective and objective measures of social status. In Study 1 (N = 237 college students), FWHR was positively correlated with aggressive behavior, but only among men reporting relatively low social status. In Study 2 (N = 891 professional hockey players), FWHR was positively correlated with penalty minutes, but only among players who earned relatively low salaries. Collectively, these studies provide compelling evidence for the role of social status in moderating the relationship between facial structure and aggression, indicating that FWHR is a robust predictor of aggressive behavior, but only in the context of relatively low social status.

Patients with bulbar amyotrophic lateral sclerosis (ALS) are often referred to the otolaryngologist/head and neck surgeon and speech pathologist for evaluation and management of dysphagia and dysarthria. These patients comprise an unusual group because of the progressive and multi-system nature of their illness. The neuromuscular disabilities associated with bulbar ALS cause a myriad of related symptoms associated with swallowing, speech, and respiration. Although the rate of progression cannot be predicted, a general pattern of progression is noted. Bulbar disease accounts for the majority of the worst symptoms of ALS. The loss of the ability to swallow changes eating from a pleasurable task to a burden of survival. Loss of communication effectively imprisons the patient in a state of isolation. The progressive weakness of respiration, predominantly a spinal rather than bulbar manifestation, is the cause of death for nearly all ALS patients and is also discussed. The general patterns of progression of bulbar ALS are outlined in this paper. The development of symptoms are correlated with specific treatment recommendations to aid the clinician in devising an orderly plan of management for this progressive disease.

Background and Purpose Swallowing screens after acute stroke identify those patients who do not need a formal swallowing evaluation and who can safely take food and medications by mouth. We conducted a systematic review to identify swallowing-screening protocols that met basic requirements for reliability, validity, and feasibility. Methods We searched MEDLINE and supplemented results with references identified through other databases, journal tables of contents, and bibliographies. All relevant references were reviewed and evaluated with specific criteria. Results Of 35 protocols identified, four met basic quality criteria. These four had high sensitivities of 87% or greater and high negative predictive values of 91% or greater when a formal swallowing evaluation was used as the gold standard. Two protocols had greater sample sizes and more extensive reliability testing than the others. Conclusion We identified only four swallowing-screening protocols for patients with acute stroke that met basic criteria. Cost effectiveness of screening--including costs associated with false positives and impact of screening on morbidity, mortality, and length of hospital stay--requires elucidation.