This article presents a co-authored, first-person narrative that offers an intimate look at the long-term cognitive-communication consequences of repetitive head impacts sustained during a professional football career. Through the lived experiences of former National Football League cornerback D.J. Johnson, and with light annotation from peer-reviewed literature, the narrative illustrates how concussion and traumatic brain injury can affect memory, speech, and everyday participation years after retirement. Johnson describes progressive word-finding difficulty, slowed and effortful speech, memory lapses, and episodes of disorientation that disrupted daily life and professional work in acting and sports broadcasting. He underwent medical evaluation and intensive speech-language therapy with treatment focused solely on dysarthria after receiving a diagnosis. Although cognitive-communication difficulties were present, no targeted intervention were provided for these concerns, and his communication challenges continued to fluctuate over time. This viewpoint highlights how repetitive head impacts sustained during professional football can contribute to chronic cognitive-communication deficits well beyond an athlete's playing years. First-person clinical narratives can complement traditional research by revealing subtle, evolving impairments, supporting earlier recognition of postconcussion sequelae, and underscoring the need for long-term, individualized speech-language pathology services.

Aphasia rehabilitation increasingly emphasizes the importance of understanding the mechanisms and ingredients underlying behavioral interventions. Semantic feature analysis (SFA) is a commonly used intervention for anomia in aphasia, but there is little evidence directly examining its active ingredients. Using within-trial responses during SFA, we sought to explore how generating semantic features might facilitate naming improvements. A retrospective analysis evaluated data collected from a clinical trial focused on intensive SFA treatment for individuals with chronic aphasia. The study included 44 adults with chronic aphasia following left-hemisphere stroke. A pretrained semantic model was used to estimate the semantic relatedness between features and targets. Participants were 2.6 (95% confidence interval [CI; 2.16, 3.12]) times more likely to correctly name target words after engaging in feature generation. Each additional feature generated was associated with a three percentage-point increase (95% confidence interval [CI; 0.2, 0.4]) in the probability of a correct response at the end of the trial; a 1 SD increase in semantic similarity (i.e., feature quality) was associated with a six percentage-point increase (95% CI [0.4, 0.10]). Model comparison favored semantic similarity over feature generation count in predicting final response accuracy. Findings provide converging evidence that semantic feature generation is an active ingredient in SFA treatment, emphasizing the importance of feature quantity and semantic quality, consistent with a spreading activation account of SFA's benefits. Further research is warranted to validate relatedness values from semantic model embeddings and to explore the relationship between within-trial feature generation and generalization to semantically related but untreated words. https://doi.org/10.23641/asha.32159406.

Swallowing care in older adults involves multiple providers, but how non-speech-language pathologist (SLP) providers approach dysphagia management is unclear. This study explored perspectives on dysphagia management among geriatrics-focused health care providers. A 21-item mixed-methods online survey study was disseminated to geriatrics-focused, licensed health care providers (excluding SLPs) using Qualtrics software (Qualtrics). The survey was opt-in, and all responses were collected anonymously. Health care providers were identified through various methods, including online forum postings, local and national presentations, and the snowball method. Data were analyzed descriptively, and free-text responses were examined using inductive thematic analysis with a jointly developed codebook. Two coders completed manual coding in Excel, and a third reviewer resolved discrepancies. Eighty-two providers responded. Most felt confident (69.5%) and knowledgeable (81.7%) about dysphagia but wanted more training (74.4%), especially on interventions (75.6%). The primary screening barrier was poor integration into clinical workflows (52.4%), while perceived relevance to care (58.5%) was the primary screening facilitator. Though 92.7% of health care providers referred to SLPs when dysphagia was suspected, most did so for 1%-25% of patients (68.3%). Most respondents asked about swallowing in ≥ 50% of patients with dementia (69.6%). Thematic analysis revealed concerns that SLPs lack person-centered approaches, particularly regarding diet modifications. These concerns appeared related to other systems-level themes identified in the analysis, including limited interdisciplinary collaboration and constrained clinical resources. Our study suggests a need for better collaboration among health care professionals to improve swallowing-related care for older adults. It is likely that structural changes within the broader education and workplace systems will be necessary to improve collaboration and optimize current approaches to swallowing care.

This study examined the prevalence of swallowing-related fatigue in individuals with stroke and its association with self-perceived swallowing difficulties. It also explored differences across stroke phases, lesion sites, and severity levels, and examined the association between the Swallowing and Eating-Related Fatigue Scale (SERF) scores and self-reported dysphagia risk (Eating Assessment Tool [EAT-10], Dysphagia Handicap Index [DHI]). A cross-sectional study was conducted with 170 poststroke adults (120 men, 50 women) recruited at a tertiary care hospital. Participants were categorized into early subacute, late subacute, and chronic phases. Stroke severity was measured using the National Institutes of Health Stroke Scale, and lesion site was determined from radiological reports. Swallowing fatigue was assessed using the SERF scale, general fatigue with the Fatigue Severity Scale, and self-reported swallowing difficulties with the EAT-10 and DHI. Analyses included chi-square test, Spearman correlations, Kruskal-Wallis with post hoc comparisons, and logistic regression. Swallowing-related fatigue was most prevalent in the early subacute phase (92%), among individuals with brainstem lesions (84%), and in those with greater stroke severity (72.7%). SERF scores strongly correlated with EAT-10 and DHI, indicating an association with both functional swallowing impairments and psychosocial handicap. Logistic regression identified stroke phase as a significant predictor, with lower prevalence in later phases. Swallowing-related fatigue emerges as a notable and unique complication of stroke, especially prominent in early recovery and among individuals with brainstem involvement. Incorporating the SERF scale into routine assessment may enable early identification of patients at risk of reduced mealtime endurance and guide targeted rehabilitation.

The aim of this Phase I trial was to assess the safety, compliance, and potential efficacy of iLidcombe, a standalone internet version of the Lidcombe Program for young children who stutter. We used a prospective single-group design involving 6 months of access to iLidcombe. Assessments occurred pretreatment and after 6 months of access. Participants were 20 parents of young children who stuttered. There was evidence of stuttering severity reduction after using iLidcombe for 6 months. Compliance with the program was favorable, and there was no suggestion of any psychologically adverse impact on children. The results of this Phase I trial provide a roadmap for further Phases II-IV clinical trial development.

This single-subject design study examined whether self-reported inner speech (IS)-the subjective experience of retrieving a word internally-can predict item-level outcomes in a cueing-based naming treatment for individuals with poststroke aphasia. Five adults with chronic, poststroke aphasia completed an IS self-report task and naming task to identify appropriate treatment stimuli in two categories: successful IS (sIS) and unsuccessful IS (uIS). Participants then completed 2 weeks of hierarchical, cueing-based naming treatment targeting both sIS and uIS items. Treatment effects were analyzed using Tau U and mixed-effects models, with additional insights from visual analysis of individual performance. In four of five participants, naming accuracy improved significantly for sIS items but not for uIS items. The participant who did not show treatment-based learning had the most severe aphasia and apraxia of speech among the group. Mixed-effects models confirmed that self-reported IS significantly predicted posttreatment naming accuracy, even when controlling for aphasia severity and baseline naming performance. The relationship between self-reported IS and naming accuracy also changed over time, as naming accuracy for sIS items increased to more closely align with participants' initial reports of sIS. Self-reported IS can serve as a clinically useful predictor of naming treatment outcomes in some individuals with aphasia. These findings support our hypotheses and suggest that IS can be a useful tool for guiding treatment stimulus selection and monitoring change during naming therapy. Future research should continue to explore individual variability in the relationship between IS and naming treatment response. https://doi.org/10.23641/asha.31865308.

Informed consent is a legal and ethical requirement in health care, yet limited research has examined how speech-language pathologists (SLPs) document the process when recommending diet modifications. The study investigated the presence of the five components of informed consent in SLP documentation. A retrospective review was conducted on 201 clinical swallow evaluations, videofluoroscopic swallowing study (VFSS), and flexible endoscopic evaluations of swallowing reports. Reports were selected from medical records from two health care companies across acute and outpatient settings. Two raters reached consensus on the presence of the five core components of informed consent: understanding, disclosure, treatment, alternatives, and choice. On average, SLPs documented only two of the five components, and no report contained all five. Documentation of "choice" was significantly higher in outpatient settings compared to acute care (p = .006). Clinical swallowing evaluations were less likely to include "understanding" (p = .02) and "choice" (p > .001) compared to instrumental assessments, such as VFSS and flexible endoscopic evaluations of swallowing. The findings reveal a gap between ethical and legal standards and current documentation practices when recommending diet modifications. Incomplete documentation may compromise personal autonomy and increase the risk of professional liability. Enhanced education, targeted training, and systematic implementation of informed consent protocols are essential to promote best practice and safeguard both people with dysphagia and clinicians.

This study examines the diagnostic accuracy of four measures derived from English narrative language samples for identifying developmental language disorder (DLD) in 5- and 6-year-old Spanish-English bilinguals. Ninety-two children aged 5;0-6;11 (years;months) produced narrative retells in English using Mercer Mayer's frog stories. Forty-six matched pairs of children with DLD and typical language were identified based on age and English language exposure. Percent grammatical utterances (PGU), errors per C-unit (EPC), mean length of utterance (MLU), and subordination index (SI) were calculated. Pooled, covariate-adjusted, and multivariate receiver operating characteristic curves were generated to evaluate the measures' diagnostic performance at optimal cutoffs. Analyses were also performed at different levels of language exposure (i.e., high English, balanced Spanish/English, high Spanish). None of the measures reached 80% for both sensitivity and specificity for the full participant group. Covariate-adjusted curves based on exposure were not significantly different from pooled analyses. When exposure groups were analyzed separately, PGU and EPC each yielded good diagnostic accuracy for the high English group (> 70% exposure) at 94% sensitivity and specificity. Combining these measures with MLU and/or SI yielded similar results. For the balanced exposure group, all measures fell below the 80% threshold. Measures of grammaticality (PGU and EPC) were the best indicators of DLD when analyzing English narrative language samples of young bilinguals with at least 70% exposure to English. None of the measures evaluated were adequate for identifying DLD in bilinguals with less exposure to English. Clinical implications are discussed. https://doi.org/10.23641/asha.31449370.

Hanen programs® have been used by clinicians to support caregivers of young children with communication needs to learn optimal ways to respond in everyday interactions and facilitate child-oriented strategies that promote interaction and language. This review aimed to evaluate peer-reviewed literature regarding Hanen programs® for children with speech, language, and communication needs regarding the credibility, nature, quality, scope of the research, and outcomes of the research findings. The Preferred Reporting Items for Systematic reviews and Meta-Analysis protocol was used. Of 196 papers documenting Hanen interventions, 57 papers met inclusion criteria. Studies were synthesized and evaluated to rate (a) credibility/levels of evidence; (b) nature of existing research: efficacy, effectiveness, and perceived effectiveness; (c) quality of the studies; (d) scope of evidence; and (e) outcomes for each Hanen program® for children with speech, language, and communication needs. Credibility: Studies of Hanen programs® were reviews (7%), randomized controlled trials (17.5%), nonrandomized controlled trials and mixed methods (31.6%), case-control or cohort studies (26.3%), qualitative reviews (1.8%), or employed qualitative methods (15.7%). Nature: The majority were efficacy studies (57.9%), others were perceived effectiveness (24.6%), and others were effectiveness studies (8.8%). Quality: Few studies were rated as high quality. Scope: Most studies related to two Hanen programs® (It Takes Two to Talk® and More Than Words®) conducted across 11 countries (Canada, the United States, Spain, Turkey, Republic of Ireland, the Netherlands, the United Kingdom, Australia, Hong Kong, Singapore, and Malaysia), and a few studies evaluated adaptations of Hanen programs® (e.g., telehealth). The studies reported on dyad interactions; child language, behavior, and autism; and caregiver perceptions, stress, and self-efficacy. Outcomes: Evidence supporting significant communication outcomes for different programs exists; however, mixed results demonstrate a variety of language, interaction, acceptability, feasibility, and maintenance outcomes. A range of evidence supports the use of Hanen programs® in its original format, with acceptability reported by families from target communities (e.g., middle-class families) and educators (e.g., Westernized countries). Effectiveness studies in real-world contexts conclude that future research could evaluate content flexibility and adaptations to meet a diversity of families and communities. A precision family initiative has been suggested to shift future research from "Does Hanen work?" to "How can Hanen-based intervention optimize outcomes for individual families?"

The purpose of this study was to determine the association between the deictic gesture use of toddlers with Down syndrome (DS) and their mothers' use of labels. Relationships between child and maternal deictic gestures; maternal use of labels; and broader, traditional measures of maternal linguistic input were explored. Participants were 25 toddlers with DS (14-31 months) and their mothers. Videos of a 15-min mother-child free-play were coded for child and maternal deictic gesture use. All maternal utterances were transcribed and coded to compute the number of complete and intelligible utterances, mean length of utterance in morphemes, number of different words, use of referential nouns, and labels. Labels were operationally defined as referential nouns appearing alone, in a noun phrase (e.g., blue pants), or in a declarative sentence with the linguistic form pronoun + copula + noun phrase (e.g., that's the duck). Mothers completed the Vineland Adaptive Behavior Scales and the MacArthur-Bates Communication Development Inventory-Words and Gestures about their child. Despite the low frequency of toddlers' deictic gestures and maternal labels, all deictic gestures, all forms of pointing (touch, proximal, distal), and touch points were positively correlated with their mothers' use of labels. The results of this study contribute to the body of work documenting child deictic gestures and maternal labeling in DS, as well as how deictic gestures and labels in adult input are operationally defined. Potential clinical implications are discussed. https://doi.org/10.23641/asha.31141639.