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PURPOSE: Adults with acquired communication disorders are particularly vulnerable to potential negative effects from the changes that arose during the COVID-19 pandemic. In this longitudinal study, we asked: How did the self-perceived impacts of the pandemic on adults with acquired communication disorders change over time? METHOD: We developed an online survey to investigate changes in day-to-day behaviours, psychosocial elements, and communication abilities among members of a community-based stroke recovery centre in the USA. Participants included adults with aphasia or other cognitive-communication disorder from stroke or brain injury. We compared survey responses from summer 2020 (n = 50) and summer 2021 (n = 24) using a concurrent mixed methods design. RESULT: The impacts of the pandemic changed over time. By 2021, participants reported a more "normal" amount of time spent on in-person socialising and healthcare, improved quality of life and connectedness to others, and an improvement in overall communication ability. Across both years, participants shared comments regarding changes in routine, increased use of technology, and the positive benefit of therapy groups. CONCLUSION: Self-perceived psychosocial elements and communication abilities among stroke and other brain injury survivors changed over the course of the pandemic. Clinicians and researchers should continue providing this population with support and opportunities for engagement.

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BACKGROUND: Social determinants of health (SDOH) are the nonmedical factors that influence health outcomes. SDOH can be grouped into 5 domains: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. SDOH impact people's health and quality of life but may also contribute to disparities in access to food, education, and healthcare. SDOH uniquely influence parent feeding practices in the neonatal intensive care unit (NICU) in a variety of ways, ranging from logistical considerations for parent visitation to cultural beliefs such as family perception of human milk feeding. EVIDENCE ACQUISITION: A hypothetical case example of a preterm infant with a feeding disorder in the NICU is used to connect SDOH that influence prenatal health, parental lived experience, and postnatal medical care to maternal and infant outcomes with implications for feeding practices. Barriers and facilitators to successful feeding practices in the NICU and at discharge are considered for each SDOH domain. RESULTS: This case example increases awareness of SDOH and how they influence parent feeding practices in the NICU, focusing on the intersection of SDOH, parent stress, and oral feeding outcomes. Examples were provided for how to support applying findings into practice. IMPLICATIONS FOR PRACTICE AND RESEARCH: By being creating a culture of SDOH awareness, NICU staff can assist families in overcoming barriers by putting supports in place to increase equitable participation in developmentally supportive feeding practices during the NICU stay.

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Purpose The COVID-19 pandemic has led to stay-at-home orders and social distancing guidelines that have the potential to greatly impact individuals' behavior and social engagement. Adults recovering from stroke or other brain trauma, who often have communication difficulties and other long-term challenges, are a population already at risk of isolation and lower quality of life. We investigated the impact of public health guidelines and related behavioral changes on self-perceptions of communication abilities and psychosocial factors in this population. Method The Stroke Comeback Center, a community-based center for stroke and other brain trauma survivors with communication impairments, disseminated an online survey to current members to investigate changes in communication, social engagement, and quality of life. Results Participants (N = 50) reported a number of changes in their day-to-day activities that reflect the current social distancing guidelines, such as reduced outings into the community and fewer in-person conversations with those living outside one's home. Overall, feelings of connectedness to others and overall quality of life were reported to be decreased when compared to before the COVID-19 pandemic, whereas receptive language abilities and technology skills were reported to have improved. Perhaps most interestingly, certain behavioral changes (including healthy movement activities and participation in virtual programs) had specific relationships with perceived communication abilities and social engagement. Conclusions Changes in daily life resulting from the COVID-19 pandemic have had a tangible impact on self-perceived psychosocial elements (e.g., quality of life) and communication abilities among stroke and other brain trauma survivors. Clinicians and researchers may consider these perceived changes when engaging with this population as the effects of the pandemic continue and in the period of community re-entry that may follow. Supplemental Material https://doi.org/10.23641/asha.14830881.

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BACKGROUND: Individuals with aphasia often receive therapy from a speech-language pathologist during acute rehabilitation. The literature demonstrates that group-based therapy provides a natural, social environment for language rehabilitation in mild-moderate and/or chronic aphasia; however, the communication of persons with acute, severe non-fluent aphasia during group treatment has not been fully explored. OBJECTIVE: This observational study investigated patient communication during acute rehabilitation. The primary objective was to determine whether participants initiate more communication during group therapy sessions when compared to individual therapy sessions. METHOD: Ten participants with severe non-fluent aphasia were observed during one individual and one group session during their stay in an acute, inpatient rehabilitation facility. Communicative initiations were tallied and categorized based on type, target, and purpose. RESULTS: Participants initiated communication more often during group sessions than during individual sessions. During groups, participants used more vocalizations and facial expressions to communicate, and the purpose was more often for social closeness than in individual sessions. Participants produced fewer different, real words in group vs. individual sessions, but other measures of communication skill did not differ significantly between the two settings. CONCLUSION: In the aphasia group treatment described in this study, participants initiated more communication, with greater diversity of expressive modalities and more varied communicative purposes. Participants in group therapy also showed an increased tendency to communicate for the purpose of social closeness. These findings suggest that there are important differences in the communication of patients participating in group vs. individual speech therapy for treatment of acute, severe non-fluent aphasia.

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Research indicates that augmentative and alternative communication (AAC) approaches can be used effectively by patients and their caregivers to improve communication skills. This article highlights strategies and tools for re-establishing communication competence by considering the complexity and diversity of communication interactions in an effort to maximize natural speech and language skills via a range of technologies that are implemented across the continuum of care rather than as a last resort.

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UNLABELLED: Hatfield B, Millet D, Coles J, Gassaway J, Conroy B, Smout RJ. Characterizing speech and language pathology outcomes in stroke rehabilitation. OBJECTIVES: To describe a subset of speech-language pathology (SLP) patients in the Post-Stroke Rehabilitation Outcomes Project and to examine outcomes for patients with low admission FIM levels of auditory comprehension and verbal expression. DESIGN: Observational cohort study. SETTING: Five inpatient rehabilitation hospitals. PARTICIPANTS: Patients (N=397) receiving post-stroke SLP with admission FIM cognitive components at levels 1 through 5. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Increase in comprehension and expression FIM scores from admission to discharge. RESULTS: Cognitively and linguistically complex SLP activities (problem-solving and executive functioning skills) were associated with greater likelihood of success in low- to mid-level functioning communicators in the acute post-stroke rehabilitation period. CONCLUSIONS: The results challenge common clinical practice by suggesting that use of high-level cognitively and linguistically complex SLP activities early in a patient's stay may result in more efficient practice and better outcomes regardless of the patient's functional communication severity level on admission.

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Although stroke survivors are the largest consumer group for postacute rehabilitation services, there has been little quantification of the details of poststroke rehabilitation (PSR), with the major exception of the AHCPR Clinical Practice Guidelines #16 of 1995. The gold standard research methodology of a randomized controlled trial cannot practically encompass PSR. Using clinical practice improvement (CPI), a statistically based, validated research methodology, a mathematical representation of the inpatient stroke rehabilitation experience has been constructed. This article examines the principle aspects of CPI methodology and how it was adapted to a multicenter study of inpatient PSR.

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Today, speech-language pathologists (SLPs) practice stroke rehabilitation in environments where they have less time to manage the communication impairments of patients who are more medically fragile than ever before. Many SLPs have creatively adapted their practice to maximize functional outcomes for their patients. This article highlights three techniques designed to enhance functional SLP outcomes: maximizing family member input; providing group treatment; and providing treatment in remote, functional settings via telepractice technology.

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