Papers by Naomi MacBean Hartley
Purpose: The purpose of this study was to investigate current practices of speech-language pathol... more Purpose: The purpose of this study was to investigate current practices of speech-language pathologists (SLPs)
in the management of pediatric vocal health, with specific analysis of the influence of clinical specialty and workplace setting on management approaches.
Method: American Speech-Language-Hearing Association– certified clinicians providing services within the United States (1%–100% voice caseload) completed an anonymous online survey detailing clinician demographics; employment location and service delivery models; approaches to continuing professional development; and specifics of case management, including assessment, treatment, and discharge procedures.
Results: Current practice patterns were analyzed for
100 SLPs (0–42 years of experience; 77 self-identifying as voice specialists) providing services in 34 U.S. states across a range of metropolitan and nonmetropolitan workplace settings. In general, SLPs favored a multidisciplinary approachto management; included perceptual, instrumental, and quality of life measures during evaluation; and tailored intervention to the individual using a combination of therapy approaches. In contrast with current practice guidelines, only half reported requiring an otolaryngology evaluation prior to initiating treatment. Both clinical specialty and workplace setting were found to affect practice patterns. SLPs in school settings were significantly less likely to consider themselves voice specialists compared with all other work environments. Those SLPs who considered themselves voice specialists were significantly more likely to utilize voice-specific assessment and treatment approaches.
Conclusion: SLP practice largely mirrors current professional practice guidelines; however, potential exists to further enhance client care. To ensure that SLPs are best able to support children in successful communication, further research, education, and advocacy are required.
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Objective: To develop a tool for assessing audiology students taking a case history and giving fe... more Objective: To develop a tool for assessing audiology students taking a case history and giving feedback with simulated patients (SP).
Design: Single observation, single group design. Study sample: Twenty-four first-year audiology students, five simulated patients, two clinical educators, and three evaluators.
Results: The Audiology Simulated Patient Interview Rating Scale (ASPIRS) was developed consisting of six items assessing specific clinical skills, non-verbal communication, verbal communication, interpersonal skills, interviewing skills, and professional practice skills. These items are applied once for taking a case history and again for giving feedback. The ASPIRS showed very high internal consistency (α = 0.91–0.97; mean inter-item r = 0.64–0.85) and fair-to-moderate agreement between evaluators (29.2–54.2% exact and 79.2–100% near agreement; κweighted up to 0.60). It also showed fair-to-moderate absolute agreement amongst evaluators for single evaluator scores (intraclass correlation coefficient [ICC] r = 0.35–0.59) and substantial consistency of agreement amongst evaluators for three-evaluator averaged scores (ICC r = 0.62–0.81). Factor analysis showed the ASPIRS’ 12 items fell into two components, one containing all feedback items and one containing all case history items.
Conclusion: The ASPIRS shows promise as the first published tool for assessing audiology students taking a case history and giving feedback with an SP.
Key Words: Simulated patients, student assessment
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Objective: To compare simulated patients (SP) versus seminars for training audiology students to ... more Objective: To compare simulated patients (SP) versus seminars for training audiology students to take a case history and give feedback with adult patients. Design: A randomized controlled trial with cross-over. Study sample: Twenty-four audiology students, five SPs, two clinical educators (CE) and three evaluators. Students were randomly allocated to Group 1 who completed SP then seminar training or Group 2 who completed seminar then SP training. The SP training saw each student work with an SP in a clinic room and receive individualized feedback. The seminar training saw the student group work with a single CE in a lecture room and receive group feedback. All students were assessed taking a case history and giving feedback to an SP before, between, and after the training blocks. Results: Mixed model analyses of derived factors for case history and feedback showed significant (p < 0.05) effects for assessment occasion (i.e. student skills improved with more training) but not for training sequence (i.e. order of training did not affect skill improvements) or training type (i.e. type of training did not affect skill improvements). Conclusion: SP training provided no benefit over seminar training in audiology students learning case history and feedback skills with adult patients.
Key Words: Simulated patients (SPs), student assessment, seminars, case history, feedback, randomized controlled trial,
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Disability and Rehabilitation, 2015
Purpose: Communication is powerful predictor of health-related quality of life and overall wellbe... more Purpose: Communication is powerful predictor of health-related quality of life and overall wellbeing, yet its role in promoting rehabilitation outcomes in spinal cord injury (SCI) is rarely mentioned. This article systematically analyzes and synthesizes literature from multiple disciplines according to a biopsychosocial perspective, providing an evidence base for clinical practice and clear direction for future research. Method: Systematic literature review and analysis, incorporating mapping to International Classification of Functioning, Disability and Health (ICF) codes.
Results: In total 4338 entries were retrieved from CINAHL, PsychInfo, Medline, PubMed and SpeechBite databases for the period 1990–2014. A total of 115 treatment and observational studies (quantitative and qualitative) detailed aspects of communication according to structure, function, activity, participation and environmental factors; evident of the
complex interactions between communicative function with daily living after SCI.
Conclusions: Communication is a relative strength in SCI, key to empowerment, independence, social interaction, and well-being, yet its potential to enhance SCI rehabilitation outcomes remains largely underexplored and untapped. Through elucidating interactions between communication
and functioning, the adapted ICF framework affords clinicians and researchers insight into areas of intervention most likely to result in widespread gains. Conscious consideration should
be given to the role of communication, within an integrative, strengths-based, multidisciplinary approach to clinical practice and future research.
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Objectives. To examine the current state of the science regarding the role of systemic hydration ... more Objectives. To examine the current state of the science regarding the role of systemic hydration in vocal
function and health.
Study Design. Literature review.
Methods. Literature search spanning multiple disciplines, including speech-language pathology, nutrition and dietetics,
medicine, sports and exercise science, physiology, and biomechanics.
Results. The relationship between hydration and physical function is an area of common interest among multiple professions.
Each discipline provides valuable insight into the connection between performance and water balance, as well
as complimentary methods of investigation. Existing voice literature suggests a relationship between hydration and
voice production; however, the underlying mechanisms are not yet defined and a treatment effect for systemic hydration
remains to be demonstrated. Literature from other disciplines sheds light on methodological shortcomings and, in some
cases, offers an alternative explanation for observed phenomena.
Conclusions. A growing body of literature in the field of voice science is documenting a relationship between hydration
and vocal function; however, greater understanding is required to guide best practice in the maintenance of vocal
health and management of voice disorders. Integration of knowledge and technical expertise from multiple disciplines
facilitates analysis of existing literature and provides guidance as to future research.
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Cervical spinal cord injury (CSCI) typically results in impaired general respiratory function. Ho... more Cervical spinal cord injury (CSCI) typically results in impaired general respiratory function. However, little is known about respiratory mechanics during speech production, with participants involved in research to date showing considerable variation in function and speech output. The current study documented respiratory function (general and during speech) of 17 non–ventilator-dependent individuals after CSCI using perceptual and instrumental (spirometric and kinematic) techniques. As a group, the CSCI participants were found to have reduced general respiratory function; however, considerable individual variation was present. Kinematic analysis revealed the use of typical and atypical speech breathing patterns in relation to control participants, including complete prolonged ribcage paradox and apparent phonation during inspiration. Individuals after CSCI showed adequate respiratory function for speech production during quiet situations, but demonstrated impairment in maximum effort respiratory-phonatory control tasks and in the suprasegmental aspects of speech. The present study confirms that individuals greater than 12 months post-CSCI may continue to present with compromised respiratory capacity and coordination of respiratory musculature during speech production.
Further research incorporating the use of electromyography to monitor muscle activation may be beneficial to explain the mechanisms involved in the atypical traces observed and to document the compensatory mechanisms used by individuals after CSCI.
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International journal of speech-language pathology, 2013
The aim of the investigation was to examine the changes in phonation and related quality-of-life ... more The aim of the investigation was to examine the changes in phonation and related quality-of-life in the acute and subacute
stages of recovery post-cervical spinal cord injury (CSCI). A prospective examination of phonation was conducted
using perceptual and instrumental measures of respiratory and laryngeal functioning alongside a quality-of-life rating scale.
Change was present across measures for both cases at each time point. Overall, a general pattern of recovery was seen,
although some areas deteriorated between 6 – 12 months. Severity of impairments, extent of change, and impact on qualityof-
life differed between the cases. Measures varied in sensitivity to change in function. Phonation can be impaired following
both complete and incomplete CSCI, with type and severity of impairment/s undergoing change throughout the acute and
sub-acute period post-injury. Spontaneous physiological recovery does not necessarily result in improved phonation and/
or quality-of-life. Potential exists for targeted speech-language therapy in this population, throughout recovery, to best
capitalize on the physical changes that are occurring and to maximize functional application of skills to improve qualityof-
life. Further research is warranted to examine this recovery period on a larger scale.
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International Journal of Language & Communication Disorders, 2009
Background: Mechanical ventilation is commonly used during the acute management of cervical spina... more Background: Mechanical ventilation is commonly used during the acute management of cervical spinal cord injury, and is required on an ongoing basis in the majority of patients with injuries at or above C3. However, to date there have been limited systematic investigations of the options available to improve speech while ventilator-assisted post-cervical spinal cord injury.
Aims: To provide preliminary evidence of any benefits gained through the addition of positive end expiratory pressure (PEEP) and/or a tracheostomy speech valve to the condition of leak speech.
Methods & Procedures: Speech production in the three conditions was compared in two ventilator-assisted participants using a series of instrumental and perceptual speech measures.
Outcomes & Results: The addition of PEEP or the use of a speech valve resulted in speech that was superior to leak speech for both participants; however, individual variation was present.
Conclusions & Implications: Leak speech alone or with the addition of PEEP or a tracheostomy speech valve can facilitate functional communication for the ventilated patient, though PEEP and valve speech were found to be superior in the current study. These findings will be of assistance for clinicians counselling the growing population of patients who may require tracheostomy positive
pressure ventilation long-term regarding communication options.
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International Journal of Therapy and Rehabilitation, 18(9). 511-512, Sep 2011
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International journal of speech-language pathology, 2013
The rising demand for health professionals to service the Australian population is placing pressu... more The rising demand for health professionals to service the Australian population is placing pressure on traditional approaches to clinical education in the allied health professions. Existing research suggests that simulated learning environments (SLEs) have the potential to increase student placement capacity while providing quality learning experiences with comparable or superior outcomes to traditional methods. This project investigated the current use of SLEs in Australian speech-language pathology curricula, and the potential future applications of SLEs to the clinical education curricula through an extensive consultative process with stakeholders (all 10 Australian universities offering speech-language pathology programs in 2010, Speech Pathology Australia, members of the speech-language pathology profession, and current student body). Current use of SLEs in speech-language pathology education was found to be limited, with additional resources required to further develop SLEs and maintain their use within the curriculum. Perceived benefits included: students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; increased clinical skills prior to workforce placement, additional exposure to specialized areas of speech-language pathology practice, inter-professional learning, and richer observational experiences for novice students. Stakeholders perceived SLEs to have considerable potential for clinical learning. A nationally endorsed recommendation for SLE development and curricula integration was prepared.
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Asia Pacific Journal of Speech Language and Hearing, 8(1), 24-35., 2003
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Conference Presentations by Naomi MacBean Hartley
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Papers by Naomi MacBean Hartley
in the management of pediatric vocal health, with specific analysis of the influence of clinical specialty and workplace setting on management approaches.
Method: American Speech-Language-Hearing Association– certified clinicians providing services within the United States (1%–100% voice caseload) completed an anonymous online survey detailing clinician demographics; employment location and service delivery models; approaches to continuing professional development; and specifics of case management, including assessment, treatment, and discharge procedures.
Results: Current practice patterns were analyzed for
100 SLPs (0–42 years of experience; 77 self-identifying as voice specialists) providing services in 34 U.S. states across a range of metropolitan and nonmetropolitan workplace settings. In general, SLPs favored a multidisciplinary approachto management; included perceptual, instrumental, and quality of life measures during evaluation; and tailored intervention to the individual using a combination of therapy approaches. In contrast with current practice guidelines, only half reported requiring an otolaryngology evaluation prior to initiating treatment. Both clinical specialty and workplace setting were found to affect practice patterns. SLPs in school settings were significantly less likely to consider themselves voice specialists compared with all other work environments. Those SLPs who considered themselves voice specialists were significantly more likely to utilize voice-specific assessment and treatment approaches.
Conclusion: SLP practice largely mirrors current professional practice guidelines; however, potential exists to further enhance client care. To ensure that SLPs are best able to support children in successful communication, further research, education, and advocacy are required.
Design: Single observation, single group design. Study sample: Twenty-four first-year audiology students, five simulated patients, two clinical educators, and three evaluators.
Results: The Audiology Simulated Patient Interview Rating Scale (ASPIRS) was developed consisting of six items assessing specific clinical skills, non-verbal communication, verbal communication, interpersonal skills, interviewing skills, and professional practice skills. These items are applied once for taking a case history and again for giving feedback. The ASPIRS showed very high internal consistency (α = 0.91–0.97; mean inter-item r = 0.64–0.85) and fair-to-moderate agreement between evaluators (29.2–54.2% exact and 79.2–100% near agreement; κweighted up to 0.60). It also showed fair-to-moderate absolute agreement amongst evaluators for single evaluator scores (intraclass correlation coefficient [ICC] r = 0.35–0.59) and substantial consistency of agreement amongst evaluators for three-evaluator averaged scores (ICC r = 0.62–0.81). Factor analysis showed the ASPIRS’ 12 items fell into two components, one containing all feedback items and one containing all case history items.
Conclusion: The ASPIRS shows promise as the first published tool for assessing audiology students taking a case history and giving feedback with an SP.
Key Words: Simulated patients, student assessment
Key Words: Simulated patients (SPs), student assessment, seminars, case history, feedback, randomized controlled trial,
Results: In total 4338 entries were retrieved from CINAHL, PsychInfo, Medline, PubMed and SpeechBite databases for the period 1990–2014. A total of 115 treatment and observational studies (quantitative and qualitative) detailed aspects of communication according to structure, function, activity, participation and environmental factors; evident of the
complex interactions between communicative function with daily living after SCI.
Conclusions: Communication is a relative strength in SCI, key to empowerment, independence, social interaction, and well-being, yet its potential to enhance SCI rehabilitation outcomes remains largely underexplored and untapped. Through elucidating interactions between communication
and functioning, the adapted ICF framework affords clinicians and researchers insight into areas of intervention most likely to result in widespread gains. Conscious consideration should
be given to the role of communication, within an integrative, strengths-based, multidisciplinary approach to clinical practice and future research.
function and health.
Study Design. Literature review.
Methods. Literature search spanning multiple disciplines, including speech-language pathology, nutrition and dietetics,
medicine, sports and exercise science, physiology, and biomechanics.
Results. The relationship between hydration and physical function is an area of common interest among multiple professions.
Each discipline provides valuable insight into the connection between performance and water balance, as well
as complimentary methods of investigation. Existing voice literature suggests a relationship between hydration and
voice production; however, the underlying mechanisms are not yet defined and a treatment effect for systemic hydration
remains to be demonstrated. Literature from other disciplines sheds light on methodological shortcomings and, in some
cases, offers an alternative explanation for observed phenomena.
Conclusions. A growing body of literature in the field of voice science is documenting a relationship between hydration
and vocal function; however, greater understanding is required to guide best practice in the maintenance of vocal
health and management of voice disorders. Integration of knowledge and technical expertise from multiple disciplines
facilitates analysis of existing literature and provides guidance as to future research.
Further research incorporating the use of electromyography to monitor muscle activation may be beneficial to explain the mechanisms involved in the atypical traces observed and to document the compensatory mechanisms used by individuals after CSCI.
stages of recovery post-cervical spinal cord injury (CSCI). A prospective examination of phonation was conducted
using perceptual and instrumental measures of respiratory and laryngeal functioning alongside a quality-of-life rating scale.
Change was present across measures for both cases at each time point. Overall, a general pattern of recovery was seen,
although some areas deteriorated between 6 – 12 months. Severity of impairments, extent of change, and impact on qualityof-
life differed between the cases. Measures varied in sensitivity to change in function. Phonation can be impaired following
both complete and incomplete CSCI, with type and severity of impairment/s undergoing change throughout the acute and
sub-acute period post-injury. Spontaneous physiological recovery does not necessarily result in improved phonation and/
or quality-of-life. Potential exists for targeted speech-language therapy in this population, throughout recovery, to best
capitalize on the physical changes that are occurring and to maximize functional application of skills to improve qualityof-
life. Further research is warranted to examine this recovery period on a larger scale.
Aims: To provide preliminary evidence of any benefits gained through the addition of positive end expiratory pressure (PEEP) and/or a tracheostomy speech valve to the condition of leak speech.
Methods & Procedures: Speech production in the three conditions was compared in two ventilator-assisted participants using a series of instrumental and perceptual speech measures.
Outcomes & Results: The addition of PEEP or the use of a speech valve resulted in speech that was superior to leak speech for both participants; however, individual variation was present.
Conclusions & Implications: Leak speech alone or with the addition of PEEP or a tracheostomy speech valve can facilitate functional communication for the ventilated patient, though PEEP and valve speech were found to be superior in the current study. These findings will be of assistance for clinicians counselling the growing population of patients who may require tracheostomy positive
pressure ventilation long-term regarding communication options.
Conference Presentations by Naomi MacBean Hartley
in the management of pediatric vocal health, with specific analysis of the influence of clinical specialty and workplace setting on management approaches.
Method: American Speech-Language-Hearing Association– certified clinicians providing services within the United States (1%–100% voice caseload) completed an anonymous online survey detailing clinician demographics; employment location and service delivery models; approaches to continuing professional development; and specifics of case management, including assessment, treatment, and discharge procedures.
Results: Current practice patterns were analyzed for
100 SLPs (0–42 years of experience; 77 self-identifying as voice specialists) providing services in 34 U.S. states across a range of metropolitan and nonmetropolitan workplace settings. In general, SLPs favored a multidisciplinary approachto management; included perceptual, instrumental, and quality of life measures during evaluation; and tailored intervention to the individual using a combination of therapy approaches. In contrast with current practice guidelines, only half reported requiring an otolaryngology evaluation prior to initiating treatment. Both clinical specialty and workplace setting were found to affect practice patterns. SLPs in school settings were significantly less likely to consider themselves voice specialists compared with all other work environments. Those SLPs who considered themselves voice specialists were significantly more likely to utilize voice-specific assessment and treatment approaches.
Conclusion: SLP practice largely mirrors current professional practice guidelines; however, potential exists to further enhance client care. To ensure that SLPs are best able to support children in successful communication, further research, education, and advocacy are required.
Design: Single observation, single group design. Study sample: Twenty-four first-year audiology students, five simulated patients, two clinical educators, and three evaluators.
Results: The Audiology Simulated Patient Interview Rating Scale (ASPIRS) was developed consisting of six items assessing specific clinical skills, non-verbal communication, verbal communication, interpersonal skills, interviewing skills, and professional practice skills. These items are applied once for taking a case history and again for giving feedback. The ASPIRS showed very high internal consistency (α = 0.91–0.97; mean inter-item r = 0.64–0.85) and fair-to-moderate agreement between evaluators (29.2–54.2% exact and 79.2–100% near agreement; κweighted up to 0.60). It also showed fair-to-moderate absolute agreement amongst evaluators for single evaluator scores (intraclass correlation coefficient [ICC] r = 0.35–0.59) and substantial consistency of agreement amongst evaluators for three-evaluator averaged scores (ICC r = 0.62–0.81). Factor analysis showed the ASPIRS’ 12 items fell into two components, one containing all feedback items and one containing all case history items.
Conclusion: The ASPIRS shows promise as the first published tool for assessing audiology students taking a case history and giving feedback with an SP.
Key Words: Simulated patients, student assessment
Key Words: Simulated patients (SPs), student assessment, seminars, case history, feedback, randomized controlled trial,
Results: In total 4338 entries were retrieved from CINAHL, PsychInfo, Medline, PubMed and SpeechBite databases for the period 1990–2014. A total of 115 treatment and observational studies (quantitative and qualitative) detailed aspects of communication according to structure, function, activity, participation and environmental factors; evident of the
complex interactions between communicative function with daily living after SCI.
Conclusions: Communication is a relative strength in SCI, key to empowerment, independence, social interaction, and well-being, yet its potential to enhance SCI rehabilitation outcomes remains largely underexplored and untapped. Through elucidating interactions between communication
and functioning, the adapted ICF framework affords clinicians and researchers insight into areas of intervention most likely to result in widespread gains. Conscious consideration should
be given to the role of communication, within an integrative, strengths-based, multidisciplinary approach to clinical practice and future research.
function and health.
Study Design. Literature review.
Methods. Literature search spanning multiple disciplines, including speech-language pathology, nutrition and dietetics,
medicine, sports and exercise science, physiology, and biomechanics.
Results. The relationship between hydration and physical function is an area of common interest among multiple professions.
Each discipline provides valuable insight into the connection between performance and water balance, as well
as complimentary methods of investigation. Existing voice literature suggests a relationship between hydration and
voice production; however, the underlying mechanisms are not yet defined and a treatment effect for systemic hydration
remains to be demonstrated. Literature from other disciplines sheds light on methodological shortcomings and, in some
cases, offers an alternative explanation for observed phenomena.
Conclusions. A growing body of literature in the field of voice science is documenting a relationship between hydration
and vocal function; however, greater understanding is required to guide best practice in the maintenance of vocal
health and management of voice disorders. Integration of knowledge and technical expertise from multiple disciplines
facilitates analysis of existing literature and provides guidance as to future research.
Further research incorporating the use of electromyography to monitor muscle activation may be beneficial to explain the mechanisms involved in the atypical traces observed and to document the compensatory mechanisms used by individuals after CSCI.
stages of recovery post-cervical spinal cord injury (CSCI). A prospective examination of phonation was conducted
using perceptual and instrumental measures of respiratory and laryngeal functioning alongside a quality-of-life rating scale.
Change was present across measures for both cases at each time point. Overall, a general pattern of recovery was seen,
although some areas deteriorated between 6 – 12 months. Severity of impairments, extent of change, and impact on qualityof-
life differed between the cases. Measures varied in sensitivity to change in function. Phonation can be impaired following
both complete and incomplete CSCI, with type and severity of impairment/s undergoing change throughout the acute and
sub-acute period post-injury. Spontaneous physiological recovery does not necessarily result in improved phonation and/
or quality-of-life. Potential exists for targeted speech-language therapy in this population, throughout recovery, to best
capitalize on the physical changes that are occurring and to maximize functional application of skills to improve qualityof-
life. Further research is warranted to examine this recovery period on a larger scale.
Aims: To provide preliminary evidence of any benefits gained through the addition of positive end expiratory pressure (PEEP) and/or a tracheostomy speech valve to the condition of leak speech.
Methods & Procedures: Speech production in the three conditions was compared in two ventilator-assisted participants using a series of instrumental and perceptual speech measures.
Outcomes & Results: The addition of PEEP or the use of a speech valve resulted in speech that was superior to leak speech for both participants; however, individual variation was present.
Conclusions & Implications: Leak speech alone or with the addition of PEEP or a tracheostomy speech valve can facilitate functional communication for the ventilated patient, though PEEP and valve speech were found to be superior in the current study. These findings will be of assistance for clinicians counselling the growing population of patients who may require tracheostomy positive
pressure ventilation long-term regarding communication options.