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Evaluating service delivery for speech and swallowing problems following paediatric brain injury: an international
1Healthy Development Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia. angela.morgan@mcri.edu.au
Insights
Management of speech and swallowing disorders in children with acquired brain injury (ABI) lacks standardized protocols. This study highlights the infrequent use of guidelines and the reliance on adult-based assessments, indicating a need for paediatric-specific tools and approaches.
Area of Science:
- Neuroscience
- Speech and Language Pathology
- Rehabilitation Medicine
Background:
- Contemporary management of speech and swallowing disorders in pediatric acquired brain injury (ABI) is poorly documented.
- Clinicians face challenges benchmarking their practices due to a lack of evidence and standardized approaches.
Purpose of the Study:
- To establish baseline data on speech and language pathology management for pediatric ABI.
- To assess the utilization of formalized referral criteria, clinical guidelines, protocols, and care pathways.
- To document current assessment and treatment methodologies.
Main Methods:
- An online survey was distributed to speech and language pathology managers and clinicians.
- Participants were recruited from 31 major pediatric rehabilitation centers across Australia, New Zealand, the UK, and Ireland.
Main Results:
- A response rate of 84% was achieved, with 51 speech-language pathologists from 26 centers participating.
- Routine referrals for ABI patients to speech-language pathology were infrequent (12%).
- Assessment protocols (23%) and guidelines (35%) were used more often than treatment guidelines (8%); multidisciplinary care pathways were utilized by 31% of centers. Adult-based motor speech assessments and informal swallowing tools were commonly employed.
Conclusions:
- Limited use of standardized criteria, protocols, and guidelines may lead to inconsistent care and suboptimal outcomes.
- The reliance on adult-based or in-house developed assessment tools is inappropriate, highlighting a critical gap in pediatric-specific resources.
- Further research and consensus-building are essential for developing pediatric-specific assessment tools, management strategies, and clinical guidelines.
Rationale, Aims And Objectives:
Little is documented about contemporary management of speech and swallowing disorders associated with paediatric acquired brain injury (ABI). It is therefore challenging for clinicians in this field to benchmark their clinical management against current evidence or practices undertaken in other centres. To address this issue, we aimed to provide much-needed baseline data on speech and language pathology management of speech and swallowing disorders associated with childhood ABI. Key objectives were to: (i) determine whether clinicians use formalized referral criteria, clinical guidelines, protocols or care pathways; and (ii) to document the specific assessment and treatment approaches used.
Methods:
Speech and language pathology managers and clinicians at 31 major paediatric rehabilitation centres across Australia, New Zealand, the UK and Ireland were invited to participate in an online survey.
Results:
Fifty-one speech and language pathologists responded representing 26 centres (84% response rate). Routine referrals of ABI patients to speech and language pathology occurred relatively infrequently in these centres (12%). Centres utilized assessment protocols (23%) and guidelines (35%) more frequently than treatment guidelines (8%). Multidisciplinary care pathways were applied by 31%. Most centres used adult-based motor speech assessments and informal ('in-house developed') swallowing assessment tools.
Conclusions:
The limited use of referral criteria, protocols, care pathways and guidelines invites the possibility of unequal care, and less than optimal outcomes. Reliance on adult-based or in-house assessments is inappropriate, yet frequently a necessity due to an absence of paediatric-specific tools in this field. Further research is required in parallel with the formation of consensus groups to support the development of: (i) paediatric-specific assessment tools and management approaches; and (ii) clinical protocols and guidelines.