With communication disorders ranking among the most common disabilities facing Americans across the lifespan, from infants to older adults, roughly 18,000 audiologists, speech-language pathologists, and related professionals will gather in Boston this week to hear and present the latest research and best practices to identify, manage, and treat these disorders at the American Speech-Language-Hearing Association’s (ASHA) 2018 Annual Convention.
Nationally and internationally renowned experts will present on a host of topics, with nearly 3,300 sessions occurring during the Convention, November 15–17. Here is a session sampler:
From the Clinic to the Classroom: Repurposing the Apple Watch to Support Learners with Autism—Although this session covers a series of research studies that address use of the Apple Watch to support learners with autism spectrum disorder (ASD), the primary research being presented is the first known exploration of repurposing the Apple Watch to support receptive and expressive language skills for children with autism—both in the clinic and in a classroom setting. Mentors sent texts and/or photographs to learners’ watches when the learner needed assistance or reminders during activities, in the exact moment that they were required (called “just-in-time” supports). Participants with ASD used these visual prompts to follow one- and two-step directives, ask social questions, and use greetings. The research found that use of the Apple Watch was a motivating strategy for some learners to independently follow directives and to socialize with others. According to the researchers, the ultimate goal is to use the watch to increase the independence of individuals with ASD by reducing in-person prompting, improving the naturalness of a social interaction while maintaining prompts as needed. The research adds to a growing literature related to “wearable” and just-in-time learning supports in the field of augmentative and alternative communication.
Successful Infant Feeding: An Evidence-Based Systematic Review—Infants born prematurely are at significant risk for delayed attainment of oral feeding skills and/or feeding and swallowing disorders. Successful feeding is a developmental milestone that infants must reach in order to qualify for discharge from the neonatal intensive care unit (NICU). But what constitutes “successful” varies greatly based on each individual medical subspecialty represented in the NICU, according to the results of this evidence-based systematic review. Modern NICUs employ physicians, nurses, dieticians, speech-language pathologists, and other therapists. The review found that “successful feeding” is not clearly defined in peer-reviewed literature, and highly divergent criteria are used to define success. In fact, from existing literature, 17 different objective criteria were used. Moreover, the only overlapping criteria across the studies was the patient being in an infant state. The results point to the need for consistent and objective criteria as well as awareness of the potential for discrepancy by NICU staff. It also underscores the importance of speech-language pathologists, who have specialized knowledge and training in feeding and swallowing. This is critical given that the signs and symptoms in infants born prematurely are unique—and must be diagnosed accurately and managed aggressively in order to prevent additional problems in this fragile population. These professionals can assist in timely discharge from the NICU.
ALS and Speech Synthesis, Voice Banking, and Message Banking: History, Current, and Future Trends—Synthetic speech, which consists of computer-generated voices used in assistive technology devices for people who have never spoken or who have lost their ability to speak, and voice banking and message banking, which are two options for people who have not yet but will eventually lose their ability to speak, are in increasing demand nationally and internationally. Pioneered at Boston Children’s Hospital for a younger population, a significant area of focus at the hospital is also on supporting people with amyotrophic lateral sclerosis (ALS) in message banking. Voice banking has historically involved a person recording nearly 2,000 nonsense sentences that are then used to create a synthetic voice to be used in a speech-generating device, allowing someone to communicate by drawing on their own voice after it’s gone. Message banking preserves “self” but is limited to those messages that are banked. It focuses on preserving a person’s unique words, phrases, sentences, and sounds (eg, making a sarcastic sigh)—all of which convey that person’s authentic emotion, humor, sarcasm, or passion. It requires less time and energy for people with ALS while preserving their unique verbal hallmarks but doesn’t offer the comprehensiveness of voice banking. “Our voice is our acoustical fingerprint” that represents who we are to our loved ones and that provides insight on our personality to unfamiliar listeners, notes John Costello, MA, CCC-SLP, and lead presenter and director of the ALS Augmentative Communication Program at Boston Children’s Hospital. In this session, Costello will discuss the latest developments and considerations for clinicians and patients. These include advances made as recently as last month that will allow people who have completed message banking to use their recordings to develop a similar-sounding synthetic voice to expand their library of words—a strategy that Costello calls “double dipping.”
Hidden Hearing Loss: Is Music Noise to the Ears?— Noise exposure is thought to cause hidden hearing loss, a disorder characterized by normal hearing as measured by standard tests but difficulty hearing conversation in the presence of background noise. Researchers evaluated the auditory brainstem responses in college-aged students with normal hearing and in individuals with normal hearing but with a history of noise exposure. The results from this study were compared with those from a previous study of individuals with musical training to determine if the effects on noise and music exposure on hearing were different. Preliminary findings show that musical training and noise exposure have differential effects on the auditory system, suggesting that the nature of auditory changes may depend on the type of “noise” exposure. This is clinically relevant for the identification of hidden hearing loss. The long-term goals of these types of studies is to develop a reliable diagnostic tool for hidden hearing loss—and results may aid clinicians in the early identification of hidden hearing loss as well as the development of preventative and intervention strategies.
Maintaining Interaction While Living in a Screened-In World—Investigators sought to educate parents and caregivers of young children about interactions that can create a language-rich environment, with a special emphasis on techniques that can be employed while using popular technology devices such as tablets or smartphones. Caregivers were provided with an explanation and demonstration of common language development strategies and how they can be incorporated during screen time, as well as a list of recommended apps. In pre- and post-surveys, investigators asked caregivers to rate their knowledge of five topics: language development, play development, interactive play techniques, interactive technology techniques, and the impact of technology on language development. Results showed increased knowledge across all topics, indicating the effectiveness of this sort of community outreach at a time when children are being exposed to screens at much earlier ages, and in much higher quantities, than ever before.
Smart Home Technology as Assistive Technology: Experiences of Individuals with High Spinal Cord Injury—Smart Home Technology, a mainstream technology available commercially to anyone, has potential for individuals with disabilities as a new form of assistive technology. In this presentation, researchers focus on people with high spinal cord injury who are using Smart Home Technology to control lights, doorbells, doors, and entertainment (music, television, books), primarily through voice commands. They will provide results of their qualitative interview study with users, including the interface demands put on people with disabilities using this form of technology and perceptions on how it impacts their quality of life. Results show that participants are benefiting from using Smart Home Technology to regain independence by relying less on caregivers for daily tasks but need support in learning how to use and set up the technology. As Smart Home Technology offerings continue to grow and expand, clinicians can provide support in numerous ways to integrate them into the daily lives of their patients/clients. Speech-language pathologists working with people with spinal cord injury on swallowing, motor speech, voice, and cognitive communication disorders can help them successfully “interact” with this technology and regain some independence. Smart Home Technology also has application beyond individuals with spinal cord injury as an assistive technology.
Sex Differences in Autism: Translating Eye-Tracking Data to Clinical Practice—Using eye-tracking data, presenters explored key differences in the manifestation of ASD symptoms in males and females. Eye tracking provides a noninvasive way to understand attention and motivation, revealing what lies beneath observed behaviors. These researchers’ findings show that girls with ASD may be able to camouflage their social difficulties in situations with minimal social demands (eg, an adult-directed activity such as an instructor leading a dance class), which may give females a social advantage over males with ASD but can also delay or prevent diagnosis and treatment. Additionally, young girls with ASD often have interests that are more similar to typically developing girls than do boys with ASD. These girls may not be diagnosed until later in life, when they can self-identify symptoms or when the increased social demands of adolescence and adulthood exceed their ability to camouflage. Presenters urge clinicians to consider the role of gender in assessment and intervention so females don’t miss out on the significant benefits of early intervention. For example, parent interviews to determine the intensity of a child’s interest and how they play and socialize outside of the assessment environment may be particularly helpful in these cases, as behaviors required to make an ASD diagnosis may not be evident during clinician observation. They also urge parents to follow their instincts, even if others do not share their concerns.