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PURPOSE: Artificial intelligence (AI) chatbots based on large language models (LLMs) can deliver medical information, but their performance on specialized topics such as central auditory processing disorder (CAPD) remains unexplored. This study evaluated the accuracy and completeness of three AI chatbots (ChatGPT, Gemini, and Claude) in providing CAPD-related information across varying levels of question complexity. METHOD: Forty-four questions, categorized into four difficulty levels (patient level, easy, intermediate, and specialized; n = 11 each), were submitted to each chatbot, generating 132 responses. Seven clinical experts, blinded to chatbot identity, independently rated accuracy and completeness on a 1-5 Likert scale. Data were analyzed with analyses of variance, correlations, and interrater comparisons. RESULTS: Chatbot performance was similar, with mean accuracy below 4.0 and completeness about 3.5. Complex questions often scored below 3.0 across experts. Only three of the 44 questions, primarily patient level or relatively simple, received consistently high expert ratings (≥ 4 for both accuracy and completeness) across all three chatbots. Performance declined with question difficulty, although differences were not statistically significant. Accuracy and completeness were correlated across chatbots. CONCLUSIONS: Current AI chatbots provided generally accurate CAPD information but fell short of clinical standards, particularly on specialized questions. Their limited performance underscores the need for clinician oversight in CAPD assessment and management. Chatbots may serve as helpful adjuncts but should not replace expert evaluation and guidance in clinical settings. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.31975101.

Nasopharyngoscopy is a minimally invasive endoscopic procedure that allows visual observation and analysis of the velopharyngeal mechanism during speech. It can be used to assess both anatomic and physiologic abnormalities of the velopharyngeal valve. In cases of suspected velopharyngeal insufficiency (VPI), nasopharyngoscopy is particularly useful in determining the size, location, and cause of the velopharyngeal opening. This information is very important for surgical planning. Nasopharyngoscopy is also useful in the assessment of secondary surgery that was done for VPI. It can help determine the need for revision and the type of revision surgery that is most likely to be successful. The purpose of the chapter is to explain how nasopharyngoscopy is used in the evaluation of velopharyngeal function. This chapter includes specific tips for achieving a successful examination in children as young as age 3. Finally, important observations from nasopharyngoscopy are described. © 2025 The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG.

In this article, the authors assist teachers who are working with young students at risk for reading disabilities by helping make sense of the large—but unwieldy—scientific knowledge base. They offer a conceptual framework for thinking about beginning reading instruction and intervention across three dimensions: the content of instruction (what to teach), the delivery of instruction (how to teach), and the timing of instruction (when to teach). The authors discuss each of these dimensions and describe how teachers can use them to help organize and make sense of what we know about beginning reading instruction for students experiencing reading difficulties.

Two approaches to systematic word review were integrated into an 18-week program of extended vocabulary instruction with kindergarten students from three high-need urban schools. Words in the embedded and semantically related review conditions received systematic and distributed review. In the embedded review condition, brief word definitions were integrated into the narratives of multiple storybooks. In the semantically related review condition, in-depth word review with explicit emphasis on semantic features and associations was provided during extension activities. Systematic review resulted in an almost twofold increase in target word learning. Embedded review was effective and time efficient, whereas semantically related review was time intensive but resulted in higher levels of word learning. There was a significant gain in Peabody Picture Vocabulary Test—III standard scores following the intervention.

The purpose of this study was to examine the effectiveness of a vocabulary intervention designed to supplement research–based classroom vocabulary instruction, implemented with students who may be at risk for language and learning difficulties. Participants included 43 kindergarten students who received research–based classroom vocabulary instruction. Students with the 20 lowest scores on the Peabody Picture Vocabulary Test–III administered at pretest received additional small–group supplemental vocabulary intervention. Results of within–subjects comparisons indicated that, overall, at–risk students made greater gains in word knowledge on target words that received the supplemental intervention as compared to words that received only classroom–based instruction. In addition, at–risk students who received the supplemental intervention demonstrated word–learning gains that approached those of their peers who received classroom instruction alone. Implications along with limitations of the current study and directions for future research are discussed.

The purpose of this prospective study was to determine if fiberoptic endoscopic evaluation of swallowing (FEES) maintains high intra- and interrater reliability in detecting pharyngeal dysphagia and aspiration without the addition of FD&C Blue No. 1 to food. Twenty consecutive adults referred for a swallow evaluation participated. Nine subjects received blue-dyed food and 11 subjects received regular nondyed food, i.e., yellow pudding and white skim milk. Four variables were rated: (1) the stage transition characterized by depth of bolus flow to at least the vallecula prior to the pharyngeal swallow; (2) evidence of bolus retention in the vallecula or pyriform sinuses after the pharyngeal swallow; (3) laryngeal penetration defined as material in the laryngeal vestibule but not passing below the level of the true vocal folds either before or after the pharyngeal swallow; and (4) tracheal aspiration defined as material below the level of the true vocal folds either before or after the pharyngeal swallow. Three speech–language pathologists experienced in interpreting FEES results independently and blindly reviewed the digitized videotape three times. Intrarater agreements for the four variables with blue-dyed and non-blue-dyed food trials were 100% and monochrome trials ranged from 95% to 100%. Average kappa values for interrater reliability ranged from moderate to excellent agreement (0.61–1.00) for all viewing conditions. Kappa values for blue-dyed trials versus monochrome trials were 0.83 and for non-blue-dyed trials versus monochrome trials were 0.88, indicative of excellent reliability under both viewing conditions. FEES maintains both high intra- and interrater reliability in detecting the critical features of pharyngeal dysphagia and aspiration using either blue-dyed or non-blue-dyed foods. The endoscopist, therefore, can be assured of reliable FEES results using regular, non-dyed food trials.

In the acute-care setting patients with altered mental status as a result of such diverse etiologies as stroke, traumatic brain injury, degenerative neurologic impairments, dementia, or alcohol/drug abuse are routinely referred for dysphagia testing. A protocol for dysphagia testing was developed that began with verbal stimuli to determine patient orientation status and ability to follow single-step verbal commands. Although unknown, it would be beneficial to ascertain if this information on mental status was predictive of aspiration risk. The purpose of this investigation was to determine if there was a difference in odds for aspiration based upon correctly answering specific orientation questions, i.e., 1. What is your name? 2. Where are you right now? and 3. What year is it?, and following specific single-step verbal commands, i.e., 1. Open your mouth. 2. Stick out your tongue. and 3. Smile. In a consecutive retrospective manner data from 4070 referred patients accrued between 1 December 1999 and 1 January 2007 were analyzed. The odds of liquid aspiration were 31% greater for patients not oriented to person, place, and time (odds ratio [OR] = 1.305, 95% CI = 1.134–1.501). The odds of liquid aspiration (OR = 1.566, 95% CI = 1.307–1.876), puree aspiration (OR = 1.484, 95% CI = 1.202–1.831), and being deemed unsafe for any oral intake (OR = 1.688, 95% CI = 1.387–2.054) were, respectively, 57, 48, and 69% greater for patients unable to follow single-step verbal commands. Being able to answer orientation questions and follow single-step verbal commands provides information on odds of aspiration for liquid and puree food consistencies as well as overall eating status prior todysphagia testing. Knowledge of potential increased odds of aspiration allows for individualization of dysphagia testing thereby optimizing swallowing success.

Background:  Pulmonary aspiration is a leading cause of nosocomial infection in the intensive care unit (ICU) and step-down unit (SDU). A key goal is to identify patients who exhibit increased aspiration risk before beginning oral alimentation. This study investigated the success of recommending specific oral diets to ICU and SDU patients based on passing a 3-oz water swallow challenge. Methods:  A referral-based sample of 401 ICU and 92 SDU patients were prospectively analyzed. Amount of liquid and food ingested at the next day's meal 12 hours to 24 hours after passing a 3-oz challenge and specific diet recommendations were accessed electronically from oral intake information entered on each participant's daily care sheets. Drinking and eating success, clinically evident aspiration events, and accuracy of diet order recommendations were recorded. Care providers were blinded to the purpose of the study. Results:  All 401 ICU and 92 SDU patients were successfully drinking thin liquids and eating 12 hours to 24 hours after passing a 3-oz challenge. Mean volume of liquid ingested at the next day's meal was 360 mL ± 181.2 mL for ICU and 356.4 mL ± 173.5 mL for SDU patients. Percent of meal eaten ranged from 10% to 100%. Patient care sheets indicated specific diet recommendations were followed with 100% accuracy. Conclusions:  Successfully recommending specific oral diets for ICU and SDU patients based on passing a 3-oz water swallow challenge was supported. Importantly, when a simple bedside 3-oz challenge administered by a trained provider is passed, specific diet recommendations can be made safely and confidently without the need for further objective dysphagia testing.

Objective. To determine what effect, if any, the presence or absence of a nasogastric (NG) tube in the same person had on the incidence of anterograde aspiration. Design. Case series with planned data collection. Setting. Large, urban, tertiary care teaching hospital. Subjects and Methods. Referred sample of 62 consecutively enrolled adult inpatients for fiber-optic endoscopic evaluation of swallowing (FEES). Group 1 (n = 21) had either small-bore (n = 13) or large-bore (n = 8) NG tubes already in place and had a FEES first with the NG tube in place and a second FEES after NG tube removal. Group 2 (n = 41) did not have an NG tube and had a FEES first without an NG tube and a second FEES after placement of a small-bore NG tube. Time between FEES was approximately 5 minutes. Patients were tested with thin liquid and puree food consistencies. Occurrence of aspiration for each consistency dependent on the presence or absence of an NG tube was recorded. Results. There were no significant differences (P > .05) in aspiration status for both liquid and puree consistencies in the same person dependent on presence or absence of either a small-bore or large-bore NG tube. Conclusions. Since objective swallowing evaluation (eg, FEES) can be performed with an NG tube in place, it is not necessary to remove an NG tube to evaluate for aspiration. Similarly, there is no contraindication to leaving an NG tube in place to supplement oral alimentation until nutritional requirements are achieved.