An initial framework for use of ultrasound by speech and language therapists in the UK: Scope of practice, education and governance

Usability of Two Ultrasound Tongue Imaging Devices in Speech-Language Pathology

PURPOSE

Ultrasound tongue imaging is a promising tool in speech-language pathology; however, little is known about the usability of ultrasound scanners for speech-language pathologists (SLPs), who typically have low familiarity with ultrasound imaging. This study looks at the usability of two ultrasound scanner models for SLPs: a Sonosite all-in-one scanner with a wired probe, and a Clarius wireless probe scanner, used with a tablet app.

METHOD

Twelve SLPs and phonetics experts (all female) participated in two filmed sessions in our lab where they learned to use the two models of scanners with custom-written manuals. Each scanner was used in each session to complete a simple task including recording videos of their or the experimenter's tongue. After each use of a scanner, participants completed a modified and translated version of the System Usability Scale. The time required to complete the task was measured. Two expert judges rated the quality of the video recordings.

RESULTS

Participants took less time to complete the task and improved their choice of settings from the first to the second session, regardless of the scanner being used. In the usability scale, SLPs showed a higher satisfaction with the wireless tablet interface than with the all-in-one ultrasound interface. The tablet interface with the wireless scanner also allowed better choices of settings. However, in the second session, positioning of the probe was better with the all-in-one scanner, which has a smaller and lighter probe.

CONCLUSIONS

For SLPs, the usability of a wireless ultrasound scanner with a mobile application seems better than that of an all-in-one scanner. However, its cumbersome probe seems to hamper probe positioning. Future studies should include a lightweight ultrasound scanner that connects via USB to a laptop or tablet and provide image interpretation training for the SLPs.

Clinicians' Perspectives on Using Ultrasound Visual Biofeedback for Research and Practice with People with Cleft Palate ± Cleft Lip

ObjectiveUltrasound visual biofeedback has the potential to be a useful tool in cleft palate ± lip care but there is little research on its effectiveness, nor on clinicians' views on using it in research and practice. This study reports on cleft-specialist speech and language therapists' (SLTs) views on the acceptability of the technique in clinical practice and on their readiness to contribute to future clinical trials of its effectiveness.DesignA qualitative design comprising semi-structured focus groups/interviews.SettingClinicians reflected on how easy it would be to use ultrasound in their regional cleft services.ParticipantsClinicians were recruited via invitation to a UK-wide list of cleft-specialist SLTs. Eleven participants took part over 2 focus groups and 2 interviews.AnalysisFocus groups/interviews were recorded, transcribed verbatim, and an inductive thematic analysis was undertaken. Once complete, a deductive analysis using the theoretical framework of acceptability was conducted to summarise the findings.ResultsFour themes emerged: (1) value of ultrasound as an approach; (2) intrinsic drawbacks of acquiring and utilising ultrasound; (3) competence in effective performance within a clinical trial; and (4) incentives for clinicians and patients in participation in research.ConclusionsParticipants were positive about the benefits of ultrasound for visualising the articulators and improving patient outcomes. Barriers to adoption included the cost of the equipment and the time to travel to appointments. Across clinical and research uses of ultrasound the need for high-quality training and networking within a community of practice was highlighted.

An Audio-Ultrasound Synchronized Database of Tongue Movement for Mandarin speech

Ultrasound imaging has been widely adopted in speech research to visualize dynamic tongue movements during speech production. These images are universally used as visual feedback in interventions for articulation disorders or visual cues in speech recognition. Nevertheless, the availability of high-quality audio-ultrasound datasets remains scarce. The present study, therefore, aims to construct a multimodal database designed for Mandarin speech. The dataset integrates synchronized ultrasound images of lingual movement, and the corresponding audio recordings and text annotations elicited from 43 healthy speakers and 11 patients with dysarthria through speech tasks (including vowels, monosyllables, and sentences), with a total duration of 22.31 hours. In addition, a customized helmet structure was employed to stabilize the ultrasound probe, precisely controlling for head movement and minimizing displacement interference, The proposed database carries apparent values in automatic speech recognition, silent interface development, and research in speech pathology and linguistics.

Clinical Governance in Musculoskeletal Care-An Online Cross-Sectional Survey of What Allied Health Professionals Participate in, and What They Value

RATIONALE

Clinical governance (CG) is a systematic approach to improving care quality, ensuring healthcare organisations and professionals are accountable for safe, effective, and continuously advancing practice. Traditionally, CG frameworks follow the 'seven pillars' model: risk management, education and training, patient and carer experience, information management, clinical effectiveness, clinical audit, and staff management. However, optimal CG may also require additional elements. Despite its importance, research on CG, and clinicians' views, remains limited, particularly in musculoskeletal (MSK) care where calls for reform are growing.

AIM

To explore the views of NHS MSK Allied Health Professionals (AHPs) on CG, establishing what activities are undertaken and valued. An additional objective was to identify any differences between clinical leads and non-leads.

METHODS

This exploratory study used an anonymous online cross-sectional survey built with Qualtrics software. Questions were informed by evidence and MSK think-tank discussions, enhancing content validity. The survey evaluated general opinions as well as perspectives on the seven pillars and 23 additional CG activities, including teamwork, culture, and leadership. It was disseminated via social media (X) and Interactive CSP (iCSP) to maximise the response rate. Predominantly ordinal data were analysed using descriptive statistics, with qualitative comments examined using content analysis.

RESULTS

Data from 52 participants were analysed. 96.15% were physiotherapists, 90.38% worked in the NHS, and 53.85% held clinical leadership roles. Respondents viewed CG positively, with 73.08% strongly agreeing it was essential for care quality. Most participated in and valued both the seven pillars and additional activities. No substantial variance was observed between clinical leads and non-leads.

CONCLUSION

MSK AHPs in this study strongly supported CG and valued a broader range of activities than the seven pillars model asserts. Findings suggest current approaches may not fully reflect the scope of CG as perceived by clinicians, highlighting the need for more inclusive CG frameworks.

Ultrasound Tongue Imaging in Research and Practice with People with Cleft Palate ± Cleft Lip

Ultrasound tongue imaging is becoming popular as a tool for both phonetic research and biofeedback for treating speech sound disorders. Despite this, it has not yet been adopted into cleft palate ± cleft lip care. This paper explores why this might be the case by highlighting recent research in this area and exploring the advantages and disadvantages of using ultrasound in cleft palate ± cleft lip care. Research suggests that technological advances have largely overcome some of the difficulties of employing ultrasound with this population and we predict a future increase in the clinical application of the tool.

Practical recommendations for swallowing and speaking during NIV in people with neuromuscular disorders

Objectives

The functions of eating, drinking, speaking, and breathing demand close coordination of the upper airway musculature which may be challenged by the long-term use of daytime non-invasive ventilation (NIV). This rapid review explores the challenges and practicalities of these interactions in people with neuromuscular disorders.

Methods

A search was performed on PubMed (period 2000-2023) using generic terms to refer to eating, drinking, and speaking related to people with neuromuscular disorders on NIV. A narrative approach was used to summarize the available literature.

Results

Our review shows only a small number of studies exist exploring the use of NIV on swallowing and speaking in people with neuromuscular disorders. We summarize study findings and provide practical advice on eating, drinking and speaking with NIV.

Conclusions

By understanding breathing, NIV mechanics and upper airway interactions, it is possible to optimize swallowing and speaking whilst using NIV. There is a lack of specific guidelines, and concerns regarding aspiration warrant further research and guideline development.

Assessing Swallowing Dysfunction Aggravation in Chronic Obstructive Pulmonary Disease Patients Using Ultrasonic Measurements With Swallowing Movement Parameters

OBJECTIVE

To investigate the correlation between ultrasonic measurements of swallowing movement parameters and aggravation of swallowing dysfunction in patients with chronic obstructive pulmonary disease (COPD).

METHODS

COPD patients with swallowing dysfunction (n = 120) and COPD patients with normal swallowing function (n = 100) treated in our hospital between January 2020 and January 2023 were included in observation and control groups, respectively. The correlation between ultrasonic measurements of swallowing movement parameters and COPD with swallowing dysfunction was analyzed. The observation group was divided into mild and severe groups according to their Gugging Swallowing Screen (GUSS) scores. The correlation between ultrasonic measurements of swallowing movement parameters and COPD exacerbation combined with swallowing dysfunction was analyzed.

RESULTS

In the observation group, Hyoid muscle thickness, hyoid bone displacement, geniohyoid muscle movement distance, HLAS, and CSR were lower compared to the control group, negatively associated with COPD-related swallowing issues. Conversely, geniohyoid muscle movement time and minimum hyohyoid distance (NHLA) were higher in the observation group, positively correlated with COPD-related swallowing dysfunction. In COPD patients with swallowing problems, the severe group exhibited lower values for lingual muscle thickness, hyoid bone displacement, geniohyoid muscle movement distance, HLAS, and CSR compared to the mild group, while geniohyoid muscle movement time and NHLA were higher in the severe group. Receiver operating characteristic (ROC) curves were created, indicating the promising diagnostic utility of these parameters for assessing the presence and severity of swallowing dysfunction in COPD patients.

CONCLUSION

The ultrasonic measurement of swallowing motion parameters can effectively assess swallowing dysfunction in COPD patients.

Ultrasound image guided injection of botulinum toxin for the management of spasticity: A Delphi study to develop recommendations for a scope of practice, competency, and governance framework

Objective

To establish a scope of practice, competency (through education) and governance framework for ultrasound image guided injection of botulinum toxin in the management of spasticity.

Design

Delphi study.

Setting

International, web-based survey.

Participants

A purposively selected multidisciplinary (physicians, physiotherapists, occupational therapists) panel of experts (n=15) in the use of ultrasound image guided injection of botulinum toxin for management of spasticity. Panel members were predominantly based in the UK (11/15).

Interventions

In round 1, open-ended questions were posed relating to potential scope of practice for 'ultrasound imaging in spasticity management'; (specifically relating to ultrasound image guided injection of Botulinum Toxin) education/competency and governance considerations. In round 2, respondents were asked to rate their level of agreement with the statements generated.

Outcome measures

5-point Likert scale used for rating the statements. Threshold for consensus agreement was set at 70% or above.

Results

Three different scopes of practice relating to ultrasound imaging in spasticity management were accepted. The primary scope of practice was the use of ultrasound imaging to guide safe and accurate delivery of botulinum toxin. Relating to this primary scope, 7 competency requirements were agreed relating to areas including image optimization and interpretation, needle visualization and safety. A singular, broad governance statement was generated.

Conclusion

Relating specifically to guided injection of botulinum toxin for management of spasticity, we present a scope of practice, competency, and governance framework. These are integrated within a framework approach to provide a mechanism for increased patient access to accurate, safe, and effective focal spasticity treatment. The framework supports focused training routes, greater inter-profession communication and wider clinical community engagement in spasticity management using this modality.

Removing Barriers to Emergency Medicine Point-of-Care Ultrasound: Illustrated by a Roadmap for Emergency Medicine Point-of-Care Ultrasound Expansion in India

Point-of-care ultrasound (PoCUS) has a potentially vital role to play in emergency medicine (EM), whether it be in high-, medium-, or low-resourced settings. However, numerous barriers are present which impede EM PoCUS implementation nationally and globally: (i) lack of a national practice guideline or scope of practice for EM PoCUS, (ii) resistance from non-PoCUS users of ultrasound imaging (USI) and lack of awareness from those who undertake parallel or post-EM patient care, and (iii) heterogeneous pattern of resources available in different institutes and settings. When combined with the Indian Preconception and Prenatal Diagnostic Techniques (PCPNDT) Act, this has led to the majority of India's 1.4 billion citizens being unable to access EM PoCUS. In order to address these barriers (globally as well as with specific application to India), this article outlines the three core principles of EM PoCUS: (i) the remit of the EM PoCUS USI must be well defined a priori, (ii) the standard of EM PoCUS USI must be the same as that of non-PoCUS users of USI, and (iii) the imaging performed should align with subsequent clinical decision-making and resource availability. These principles are contextualized using an integrated PoCUS framework approach which is designed to provide a robust foundation for consolidation and expansion across different PoCUS specialisms and health-care settings. Thus, a range of mechanisms (from optimization of clinical practice through to PoCUS educational reform) are presented to address such barriers. For India, these are combined with specific mechanisms to address the PCPNDT Act, to provide the basis for influencing national legislation and instigating an addendum to the Act. By mapping to the recent Lancet Commission publication on transforming access to diagnostics, this provides a global and cross-discipline perspective for the recommendations.