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The purpose of this study was to investigate the efficacy of an 18-week program of direct and extended vocabulary instruction with kindergarten students on both proximal measures of target word knowledge and transfer measures of generalized language and literacy. A second purpose was to examine whether treatment effects would be moderated by initial receptive vocabulary knowledge measured at pretest. In a quasi-experimental design, 80 kindergarten students from schools serving large at-risk populations were taught the meanings of 54 vocabulary words within interactive story read alouds over 36 half-hour instructional lessons (2 lessons per week over 18 weeks). An additional 44 students served as a no-treatment control. Findings indicated that students who received vocabulary instruction outperformed controls on a measure of target word knowledge as well as measures of generalized receptive vocabulary and listening comprehension. In addition, initial receptive vocabulary was strongly related to posttest performance on all measures. Implications are discussed in relation to supporting vocabulary development in the early grades within a multitier framework of instruction and 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.

Purpose A frequent complaint by older adults is difficulty communicating in challenging acoustic environments. The purpose of this work was to review and summarize information about how speech perception in complex listening situations changes across the adult age range. Method This article provides a review of age-related changes in speech understanding in complex listening environments and summarizes results from several studies conducted in our laboratory. Results Both degree of high frequency hearing loss and cognitive test performance limit individuals' ability to understand speech in difficult listening situations as they age. The performance of middle-aged adults is similar to that of younger adults in the presence of noise maskers, but they experience substantially more difficulty when the masker is 1 or 2 competing speech messages. For the most part, middle-aged participants in studies conducted in our laboratory reported as much self-perceived hearing problems as did older adult participants. Conclusions Research supports the multifactorial nature of listening in real-world environments. Current audiologic assessment practices are often insufficient to identify the true speech understanding struggles that individuals experience in these situations. This points to the importance of giving weight to patients' self-reported difficulties. Presentation Video http://cred.pubs.asha.org/article.aspx?articleid=2601619

Background: Safe and timely oral alimentation is crucial for optimum patient care.Objective: To determine the short-term success of recommending specific oral diets, including drinking thin liquids, to acute care hospitalized patients at risk for dysphagia based on passing a 3-ounce water swallow challenge protocol.Design: Prospective single group consecutively referred case series.Setting: Large, urban, tertiary care, teaching hospital.Participants: 1000 hospitalized patients.Intervention: 3-ounce (90 cc) water swallow challenge protocol.Measurements: Specific diet recommendations and volume (in cc) of liquid ingested at the next day's meal 12–24 h after passing a 3-ounce challenge protocol were accessed electronically from oral intake information entered on each participant's daily care logs. Eating and drinking success, clinically evident aspiration events and compliance with ordering the recommended diet were recorded. Care providers were blinded to the study's purpose.Results: Of 1000 patients, 907 met the inclusion criteria of stable medical, surgical or neurological conditions 12–24 h after passing a 3-ounce water swallow challenge protocol. All 907 were both eating and drinking thin liquids successfully and without overt signs of dysphagia. Median volume of liquid ingested was 340 cc [interquartile range (IQR), 240–460]. Specific diet recommendations were followed with 100% accuracy.Conclusions: A 3-ounce water swallow challenge protocol successfully identified patients who can be safely advanced to an oral diet without subsequent identification of overt signs of aspiration within 12–24 h of testing. Importantly, when a clinical 3-ounce challenge protocol administered by a trained provider is passed, specific diet recommendations, including drinking thin liquids, can be made safely and without the need for additional instrumental dysphagia testing.

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.

Purpose This longitudinal study investigated the emergence of English tense marking in young (Spanish–English) dual language learners (DLLs) over 4 consecutive academic semesters, addressing the need for longitudinal data on typical acquisition trajectories of English in DLL preschoolers. Method Language sample analysis was conducted on 139 English narrative retells elicited from 39 preschool-age (Spanish–English) DLLs (range = 39–65 months). Growth curve models captured within- and between-individual change in tense-marking accuracy over time. Tense-marking accuracy was indexed by the finite verb morphology composite and by 2 specifically developed adaptations. Individual tense markers were systematically described in terms of overall accuracy and specific error patterns. Results Tense-marking accuracy exhibited significant growth over time for each composite. Initially, irregular past-tense accuracy was higher than regular past-tense accuracy; over time, however, regular past-tense marking outpaced accuracy on irregular verbs. Conclusions These findings suggest that young DLLs can achieve high tense-marking accuracy assuming 2 years of immersive exposure to English. Monitoring the growth in tense-marking accuracy over time and considering productive tense-marking errors as partially correct more precisely captured the emergence of English tense marking in this population with highly variable expressive language skills. Supplemental Materials https://doi.org/10.23641/asha.5176942