Communication disorders: Make the best decisions possible
 |
|
|
|
|
Every day you're called on to make decisions about the best treatment options for the people you work with who have communication disorders or language deficits. How do you decide on the best approach?
A number of just-published resources can help you sort out the types of questions you may encounter in weighing your options. Here are a few insights from those resources—representing different aspects of the broad range of services for people with communication or language disorders—to help you make decisions that result in the best outcomes for the people you work with.
Understanding what is meant by "evidence-based practices"
In her work teaching about pediatric communication disorders, Dr. Christine Dollaghan had difficulty finding a single source of information she could direct students to for a solid introduction to the concept of evidence-based practices. So, she developed The Handbook of Evidence-Based Practice in Communication Disorders.
In the guide, she dismisses any suggestion that before the term "evidence-based practice" came into vogue, practitioners were basing their clinical decisions on something other than evidence. She also clears up the misconception that commitment to the use of evidence-based practice somehow precludes the use of clinical judgment. That is simply not true.
In fact, evidence-based practice involves the integration of three elements, which Dr. Dollaghan calls E³BP:
1. the best available clinical evidence from systematic research, external to the practice
2. the best available clinical evidence, internal to the practice, and
3. the best available evidence concerning the preferences of a fully informed patient.
In the past, the emphasis on scientific evidence has overshadowed the other two components, but, she points out, all three types are critical to providing the best service. In The Handbook for Evidence-Based Practice, Dr. Dollaghan lays out how to systematically evaluate all three components so you can reduce uncertainty in your decision-making process. (See a sample of the checklists included in The Handbook for Evidence-Based Practice in this free download of Dr. Dollaghan's patient preference checklist.)
Translating research into practice for developmental language disorders
In her graduate course in language learning disabilities, Bonnie Singer's professor used to say, "Okay, the research says this, so what are you going to do on Monday morning with your kids?"
Each chapter in the new Clinical Decision Making in Developmental Language Disorders introduces you to a case in which a practitioner decides on an approach to treatment for someone with a particular language deficit or disorder. The authors, specialists in their fields, walk you through the clinical application of the research, demonstrating the steps they follow and the tools they use to determine their approach.
From facilitating emerging language skills in very young children to supporting progress of secondary school students for graduation, Clinical Decision Making gives you a frontseat view of the experts' thought processes as they determine the best options for each individual circumstance. (See the considerations Dr. Singer weighed in the story of "Henry," an adolescent whose language difficulties have made academic success elusive for him throughout school.)
Integrating AAC services into care for adults with acquired medical conditions
Clinicians working with people with acquired medical conditions such as amyotrophic lateral sclerosis (ALS), dementia, or traumatic brain injury may not think to consider the role of augmentative and alternative communication (AAC) in their work. Making decisions about AAC services can be tricky for professionals who have not been trained to provide compensatory (rather than restorative) interventions. And the individuals themselves often have not expected to lose their ability to speak and to have to use pictures, objects, printed cards, or speech-generating devices to communicate.
The new book Augmentative Communication Strategies for Adults with Acute or Chronic Medical Conditions gives specific examples of how clinicians, people with complex communicative needs, and those who support them can systematically integrate AAC into care for acquired medical conditions. The editors encourage a multimodal approach that uses augmentative strategies to build on the individual's residual speech and language. (See how AAC intervention was planned in the case of Roger, a 29-year-old who sustained a traumatic brain injury, in the example of AAC assessment and intervention.)
Getting clues from the study of language development in people with Down syndrome and fragile X syndrome
Much remains to be learned about the genetic and biological components of speech and language development. In the new book Speech and Language Development and Intervention in Down Syndrome and Fragile X Syndrome, the editors examine two of the most commonly occurring genetic causes of intellectual disability.
Down syndrome and fragile X syndrome result in very different developmental and behavioral profiles. In both conditions, speech and language development is affected, but in different ways. These differences have important implications not only for treatment but also ultimately for understanding the genetic bases of speech and language development. (To learn more about these syndromes, be sure to see the list of key DS and FXS organizations.)
*Adapted from The Handbook for Evidence-Based Practice in Communication Disorders by Christine A. Dollaghan; Clinical Decision Making in Developmental Language Disorders edited by Alan G. Kamhi, Julie J. Masterson, and Kenn Apel; Augmentative Communication Strategies for Adults with Acute or Chronic Medical Conditions edited by David R. Beukelman, Kathryn L. Garrett, and Kathryn M. Yorkston; and Speech and Language Development and Intervention in Down Syndrome and Fragile X Syndrome edited by Joanne E. Roberts, Robin S. Chapman, and Steven F. Warren.
