This article reviews legal and scientific literature relating to Advance Care Planning (ACP) and Advance Care Directives (ACDs) in Australia, for information about (a) opportunities or benefits of ACP and ACDs and (b) risks, barriers or difficulties in relation to ACP and ACDs. These are discussed in relation to
Background: Linguistic discourse analysis is frequently used in aphasia research but is met with frequent calls for greater clinical application by speech pathologists and discussion of barriers and facilitators to clinical use. When examined in the clinical context, applications of linguistic discourse analysis were reportedly limited by knowledge and time-based barriers. Implementation science was used to guide the development of an intervention to overcome these barriers and bridge a Knowledge-to-Action gap.Aims: This study aimed to examine whether speech pathologists were able to translate knowledge and skills acquired during an implementation intervention to the assessment of a person with aphasia. The content of the intervention and the feasibility of the implementation strategy were also investigated. Transcription-based and transcription-less approaches to linguistic discourse analysis were compared.Methods & Procedures: Twenty-nine students in their final year of Australian speech pathology university degrees participated in a preliminary Knowledge-to-Action Intervention. Four intervention conditions targeted different evidence-based modes of discourse analysis: one transcription-less approach (judgement-based analysis) and three transcription-based approaches (manual, computer-assisted, and automated analysis). Participants completed evaluations at pre- and post-intervention and a six-month follow-up examining the knowledge acquisition, application, and implementation to practice. Outcomes were subject to content and statistical analysis to examine changes across time-points.Outcomes & Results: Following the intervention, participants set significantly more goals within contexts of discourse production and described significantly more discourse-based therapy approaches. Knowledge and skills acquired during the intervention were adapted by participants, with moderate maintenance observed at follow-up. Participants reported a lack of opportunity to implement their newly acquired skills to clinical practice.Conclusions & Implications: Specific training in the use of discourse analysis led to significant changes in assessment outcomes across all discourse analysis conditions. However, training alone did not remove the challenges involved in implementation. Participant feedback will help guide a more comprehensive intervention strategy with refined content to better facilitate the implementation of linguistic discourse analysis research in speech pathology practice.
Narrative discourse is central to effective participation in conversations. When discourse is assessed in people with communication disability, structured tasks (e.g., picture descriptions) provide experimental control, while unstructured tasks (e.g., personal narratives) represent more natural communication. Immersive virtual reality (VR) technology may provide a solution by creating standardized experiences for narrative retell, therefore balancing ecological validity and experimental control in discourse assessment. Research is needed to understand how VR immersion affects narrative retell, first for adults with no communication disability, before application with adults with aphasia or related communication disability.To assess (1) the effects of VR immersion on the linguistic content and structure of narrative retells in a healthy adult population; and (2) whether VR immersion can influence the way a narrative is retold so that the speaker conveys their own experience, rather than the experience of the characters they are watching.In this pilot cohort study, 13 healthy adult participants with no reported communication disability watched an animated short film and a comparable immersive VR short film in a randomized order. Participants were asked to retell the events of the story after each condition in as much detail as possible.Mean length of utterance (in morphemes) was significantly higher in the video condition compared with the VR condition. Significantly more first-person pronouns were used in the VR condition compared with the video condition. No other measures of linguistic content or structure were significantly different between the VR and video conditions.Increased morpho-syntactic length and complexity in the video condition may suggest effects of elicitation stimulus on the narrative produced. The larger number of first-person pronouns in the VR condition may reflect that participants experienced a sense of presence in the virtual environment, and therefore were able to retell their communication experience rather than narrating the experiences of characters from an external perspective. Given the increasing need for more functional assessment of discourse in people with communication disability, further research is needed to validate these findings.What is already known on this subject As an ecologically valid tool, discourse analysis is often used to assess daily communicative exchanges in adults with acquired communication disability. Clinicians and researchers using narrative discourse assessment must balance the experimental control and diagnostic reference sample capabilities of structured tasks with the ecological validity and real-life transferability of unstructured personal narratives. What this study adds to existing knowledge This study explores the use of immersive VR technologies to create standardized, replicable, immersive experiences as a foundation for narrative discourse assessment. It highlights how the 'sense of presence' in a virtual world can prompt healthy adult speakers to retell a narrative of a personal experience that can be replicated for many different participants. The results suggest that immersive VR narrative assessment for adults with communication disability may balance ecological validity with measurement reliability in discourse assessment. What are the potential or actual clinical observations of this work? Immersion in VR resulted in the production of narratives with morpho-syntactic features that aligned with typical narrative generation, rather than retell. Participants used more first-person pronouns, suggesting retelling of personal experience. Though further study is needed, these preliminary findings suggest clinicians can use immersive VR stimuli to generate structured story generations that balance experimental and diagnostic control with ecological validity in narrative discourse assessment for adults with communication disability.
Purpose: Much is promised in relation to the use of three-dimensional (3D) food printing to create visually appealing texture-modified foods for people with dysphagia, but little is known of its feasibility. This study aimed to explore the perspective of allied health professionals on the feasibility of using 3D food printing to improve quality of life for people with dysphagia. Method: Fifteen allied health professionals engaged in one of four 2-hr online focus groups to discuss 3D food printing for people with dysphagia. They discussed the need to address the visual appeal of texture-modified foods and watched a video of 3D food printing to inform their discussions on its feasibility. Focus group data were transcribed verbatim, de-identified, and analyzed using thematic content analysis. Participants verified summaries of the researchers' interpretation of the themes in the data. Results: Participants suggested that 3D food printing could improve the mealtime experience for people with dysphagia but noted several barriers to its feasibility, including the time and effort involved in printing the food and in cleaning the printer. They were not convinced that 3D-printed food held higher visual appeal or looked enough like the “real food” it represented. Conclusions: Allied health professionals considered that 3D food printing could benefit people with dysphagia by reducing the negative impacts of poorly presented texture-modified foods. However, they also considered that feasibility barriers could impede uptake and use of 3D food printers. Further research should consider the views of people with dysphagia and address barriers reported in this study.
Virtual reality (VR) lends itself to communication rehabilitation by creating safe, replicable, and authentic simulated environments in which users learn and practice communication skills. The aim of this research was to obtain the views of health professionals and technology specialists on the design characteristics and usability of a prototype VR application for communication rehabilitation.
Background: A reduced quality of life for people with aphasia is in part associated with their loss of friendships and social networks. Twitter offers people with communication disability a way to exchange information, develop and maintain their social networks and connections, and participate in society online. However, little is known about how Twitter is used to exchange information about aphasia or to build communities online that might support people with aphasia in their communication goals.Aims: To examine the network data and content of tweets tagged with #aphasia to understand more about how Twitter is used by people with aphasia, aphasia organisations, aphasiologists, clinicians, and the public.Method: A Twitter hashtag study was conducted to locate tweets highly relevant to aphasia. A daily tweet capture using the Twitter search bar was conducted for one month, November 2018, searching for publicly available tweets tagged with aphasia-related hashtags. The tweets collected were analysed using both qualitative and quantitative methods.Results: A sample of 2,519 tweets were included in the analysis. The sample comprised 865 original tweets and 1,654 retweets which included “quote tweets”, sent by 839 unique Twitter @Users. Tweet content reflected users discussing aphasia research, exchanging health information, advice and inspiration, providing personal stories, raising awareness about aphasia, and an emergent aphasia community online.Conclusion: The aphasia community in Twitter is relatively small compared to other communities focused on communication disability and is emergent in terms of its size and the strength of connections. The majority of people or organisations tweeting about aphasia, and hence influencing the network, were health professionals working in the field of aphasia. There was minimal conversational interaction evident. These results demonstrate that Twitter is underutilised as a platform for interaction and engagement in relation to aphasia, and further research is needed.
This study examined Alexander's Dislocation Theory of Addiction, which suggests that the isolating nature of free market forces may lead to increases in addiction rates during periods of economic downturn. This was achieved by analysing the experience of New Jersey during the financial crash of the early 21st century.
Background Emerging technologies such as robotics and virtual reality (VR) are being trialled and implemented into physiotherapy practice. As emerging technologies compete for market share, trials on emerging technologies are at risk of spin. For consumers to make informed decisions about whether to use a new technology, trials should accurately portray the results. If spin is present, outcomes may not be comparable to the results reported when interventions are implemented clinically.Objectives To determine the amount and type of spin in abstracts of physiotherapy clinical trials that use robotic or VR interventions. A secondary objective is to determine the agreement between raters, both experienced and inexperienced, using an existing 7-item checklist with updated item definitions.Methods We will perform two meta-research reviews on a random set of 100 robotics (study 1) and 100 VR (study 2) trials, from any year, indexed in the PEDro database. Using the updated spin checklist, the abstract of each trial will be assessed in corroboration with full-text. The total spin score and proportion of studies with spin for each item will be reported. Agreement between experienced and inexperienced raters will be determined using kappa statistics. Rater confidence in rating each item will be collected.Discussion We will identify if spin is present in robotics and VR literature and evaluate if the spin checklist can be confidently and consistently used by raters. We hope this research will facilitate best-practice reporting of research findings so emerging technologies will be implemented with realistic expectation of clinical outcome.
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