Healthy Development Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
J Eval Clin Pract. 2011 Apr;17(2):275-81. doi: 10.1111/j.1365-2753.2010.01436.x. Epub 2010 Oct 4.
RATIONALE, AIMS AND OBJECTIVES: Little is documented about contemporary management of speech and swallowing disorders associated with paediatric acquired brain injury (ABI). It is therefore challenging for clinicians in this field to benchmark their clinical management against current evidence or practices undertaken in other centres. To address this issue, we aimed to provide much-needed baseline data on speech and language pathology management of speech and swallowing disorders associated with childhood ABI. Key objectives were to: (i) determine whether clinicians use formalized referral criteria, clinical guidelines, protocols or care pathways; and (ii) to document the specific assessment and treatment approaches used.
Speech and language pathology managers and clinicians at 31 major paediatric rehabilitation centres across Australia, New Zealand, the UK and Ireland were invited to participate in an online survey.
Fifty-one speech and language pathologists responded representing 26 centres (84% response rate). Routine referrals of ABI patients to speech and language pathology occurred relatively infrequently in these centres (12%). Centres utilized assessment protocols (23%) and guidelines (35%) more frequently than treatment guidelines (8%). Multidisciplinary care pathways were applied by 31%. Most centres used adult-based motor speech assessments and informal ('in-house developed') swallowing assessment tools.
The limited use of referral criteria, protocols, care pathways and guidelines invites the possibility of unequal care, and less than optimal outcomes. Reliance on adult-based or in-house assessments is inappropriate, yet frequently a necessity due to an absence of paediatric-specific tools in this field. Further research is required in parallel with the formation of consensus groups to support the development of: (i) paediatric-specific assessment tools and management approaches; and (ii) clinical protocols and guidelines.
背景、目的和目标：关于与小儿获得性脑损伤（ABI）相关的言语和吞咽障碍的当代管理，文献记载甚少。因此，该领域的临床医生很难将其临床管理与当前证据或其他中心的实践进行基准比较。为了解决这个问题，我们旨在为与小儿 ABI 相关的言语和吞咽障碍的言语病理学管理提供急需的基线数据。主要目标是：（i）确定临床医生是否使用正式的转诊标准、临床指南、方案或护理途径；以及（ii）记录使用的特定评估和治疗方法。
邀请澳大利亚、新西兰、英国和爱尔兰的 31 个主要儿科康复中心的言语语言病理学经理和临床医生参加在线调查。
51 名言语语言病理学家代表 26 个中心（84%的回复率）做出了回应。这些中心的 ABI 患者常规转介给言语语言病理学治疗的情况相对较少（12%）。中心比治疗指南（8%）更频繁地使用评估方案（23%）和指南（35%）。31%的中心采用了多学科护理途径。大多数中心使用成人基础的运动言语评估和非正规（“内部开发”）吞咽评估工具。
转诊标准、方案、护理途径和指南的使用有限，这可能导致护理不平等和结果不理想。依赖成人基础或内部评估是不恰当的，但由于该领域缺乏儿科特定工具，这往往是必要的。需要进一步研究，并与共识小组的形成并行，以支持：（i）儿科特定的评估工具和管理方法的发展；以及（ii）临床方案和指南的制定。
