Professor Bronwyn Hemsley

In March-April 2016, 3288 original tweets tagged with #MND #ALS and other minor related tags (e.g., #cureALS #cureMND) were analysed using mixed quantitative and qualitative methods on tweet data and content. In this paper we outline the technical methods used in gathering and selecting relevant tweets for analysis, and present the results including inductive coding of content themes. The findings will inform (a) future social media research in relation to MND/ALS, (b) improved supports for people with MND/ALS and their families to use Twitter for information exchange, advocacy, and as a non-verbal form of communication, and (c) knowledge for MND/ALS service providers and philanthropic organisations on ways to engage with adults with MND/ALS in Twitter.

Background: The use of telepractice in delivering speech-language pathology services is increasing and speech-language pathologists are providing supervision to students on clinical placements through telesupervision. The review examined literature on telesupervision for speech-language pathology students on a clinical placement. Aims: To systematically review the literature on how, when, and why telesupervision is used by speech-language pathologists supervising students; and the views and experiences of students, practice educators, and clients on telesupervision. Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines through searches in six databases (CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science and Educational Resources Information Center). Quality of the studies was examined using the Quality Assessment Tool for Studies with Diverse Designs. Main Contribution: In total, the eight studies included in the review described the use of telesupervision with speech-language pathology students. The studies revealed that telesupervision is considered an effective supervision model for speech-language pathology students, as an adjunct to in-person supervision. Multiple aspects of telesupervision in the studies related to workplace settings, access to and training of technology, type of caseload, practice educator attributes, and the student¿educator supervisory relationship. Conclusions and Implications: Speech-language pathology educators and students consider telesupervision to be a useful and effective model of supervision, when used as an adjunct to in-person supervision. Although there is limited research to date examining the use of telesupervision in speech-language pathology, the findings of this review can be used to guide support of educators and students as well as inform future research in this area. WHAT THIS PAPER ADDS: What is already known on this subject Telesupervision in speech-language pathology allows for an extension of clinical placement opportunities into a wider variety of locations including rural and remote settings and where a practice educator might not be available in person. Telesupervision can reduce costs and travel time and increase the time in the day available for supervision. What this study adds to existing knowledge Considering the potential for telesupervision to expand placement opportunities, this review provides important insights into educator and student views on its implementation and outcomes. All studies in this review occurred prior to COVID-19 restrictions on placements and so provide a context for any developments since and inform future research on telesupervision. What are the clinical implications of this work? While there is some evidence that practice educators and students alike consider that telesupervision can be effective, no studies were found to report on telesupervision as a standalone supervision method. Review findings could be used by speech-language pathology student placement co-ordinators and practice educators in (a) deciding if telesupervision holds potential for the specific work setting and clinical caseload, (b) determining if they have suitable technology and support in the use of the technology, and (c) identifying ways to support the educator¿student relationship when using telesupervision.

Purpose: This pilot study aimed to (a) investigate opportunities for immersive Virtual Reality (VR) technology in communication, physical, and visual rehabilitation by examining the interaction of people without disabilities in a range of structured virtual environments; and (b) validate research protocols that might be used to evaluate the physical, visual, and verbal interaction of users in virtual worlds, and their safety while using the technology. Methods: Thirteen adults identifying as people without disability were exposed to VR via a head-mounted display. A video-review method was used to qualitatively code and analyse each participant's communication, movement, orientation, and support needs. Results: All participants oriented to their virtual environments sufficiently to use applications. Their spoken language was effective for interaction, although unconventional social behaviours were also observed. Two participants reported minor adverse reactions consistent with mild cybersickness. Conclusion: The results provide insight into the types of environments and characters that support the greatest communicative, physical, and visual interaction in immersive VR. The tested protocols are useful to assess safety when using VR, and to observe communicative, physical, and visual interaction with virtual environments and characters. Implications for future research and use of VR with people with communication, physical and visual disability are discussed.

In this article, we describe the sources of funding cited, and topics of research associated with that funding, in Australian disability research. We conducted a systematic search for publicly available peer-reviewed papers reporting the findings of Australian disability research studies focused on Australia in the 2018¿2020 period. Papers identified were analyzed according to research topic, participant group, study methodology, and funding sources acknowledged. In total, 1,241 relevant papers were identified. Of these, 582 papers (47%) reported at least one funding source. Government sources accounted for most funding identified (n = 487), followed by university sector (n = 112), nongovernment organizations (n = 99) and for-profit organization funding (n = 17). The most funding went to intellectual disability (22%), autism (15%), and psychosocial disability (12%). Only 16 (1.3%) papers citing funding sources reported their research was conducted in partnership with people with disability. Research funding influences the priorities of disability research, how it is conducted, and its outputs. Funding therefore shapes the information available to build evidence-based systems of service and support for and with people with disability. It is essential that research funding policies are considered in relation to broader disability policy goals and the research priorities of the disability community.

Purpose: Difficulty with communicating basic needs and attracting the attention of health professionals may contribute to falls for patients with communication disability after stroke. The aim of this study was to explore the views of hospital-based health professionals on: (a) the effect of communication disability on falls in patients with stroke; (b) falls prevention strategies for patients with communication disability following stroke; and (c) the roles of speech pathologists in the assessment, management, and prevention of falls in this population. Materials and Methods: Online focus groups were conducted and analysed using content thematic analysis. Results: In total, 11 health professionals participated in four focus groups. Clinicians viewed that: (a) the effects of falls in patients with communication disability are far-reaching; (b) communication disability complicates falls risk assessment and falls management; (c) current falls prevention strategies do not meet the needs of patients with communication disability; and (d) strong relationships have a central role in decreasing falls in this population. Conclusions: Health professionals articulate concerning gaps in falls prevention strategies for patients with communication disability. Further research should investigate strategies enabling falls prevention and management to be more inclusive of patients with communication disability following stroke and consider ways in which speech pathologists could contribute to this field.

Texture-modified foods are a common component of interventions provided to people with dysphagia (swallowing disorders) to maintain their respiratory health, nutritional health and to reduce the risk of aspiration-related illness or choking on food. However, the unsightly and unappetizing appearance of texture-modified foods may negatively impact on the mealtime experience and acceptance of texture-modified foods of persons with dysphagia. The aim of this review was to determine what is known about the impact of specific elements of food design ¿ food struc-ture and visual appeal ¿ on the mealtime experiences of people with dysphagia. This review of 35 studies presents evidence on how the physical characteristics of texture-modified foods for people with dysphagia can be considered during food production, formulation or service to improve their mealtime experience. Overall, the visual appeal, texture, taste, aroma, temperature, mealtime environment and mealtime assistance all impact upon mealtime experiences and should be considered carefully in the design of a person's mealtime plan and food-related dysphagia interventions to improve their mealtime-related quality of life. Further research needs to include the views of people with dysphagia, particularly those with life-long conditions, who might require texture-modified food for an extended period over their lifespan.

Background: Effective communication and collaboration in interprofessional teams are fundamental to the provision of high quality and safe healthcare. The aim of this study was to explore the experiences of interprofessional, pre¿qualifying health professional students engaged in a simulated patient care scenario. Methods: Students from five healthcare disciplines were immersed in a collaborative simulation experience of managing a patient with stroke, from admission to discharge. Three focus groups were used to evaluate students' experiences. Results: Three key themes emerged from participant narratives: (a) Learning to Speak the Same language: Working Together to Understand the Healthcare Team, (b) Progressing from Uncertainty to Collaborative Practice: Reflecting on Practice and Transition, and (c) Lessons Learned in Developing the Simulation: Barriers and Enablers to Learning. Conclusions: Immersion of healthcare students in interprofessional simulation experiences enhances role understanding, collaborative decision making, and communication skills.

This review investigated virtual reality and augmented reality (VR/AR) communication interventions for children, adolescents, and adults with communication disability and neurodevelopmental disorders, as well the feasibility of these technologies. A search of five scientific databases yielded 5385 potentially relevant records of which 69 met inclusion criteria. Studies reported on a wide range of VR/AR devices, platforms, and applications for people with autism spectrum disorder, communication disorders, and intellectual disability. Some VR/AR systems hosted effective communication interventions; however, participant outcomes varied across the included studies. Most participants with neurodevelopmental disorders and their supporters were able to access learning experiences using VR/AR and few adverse effects were reported. Directions for future research are discussed.

In this study, we aimed to identify processes that enabled the involvement of a person with complex speech and motor disorders and the parent of a young person with these disorders as co-researchers in a U.K. research project. Semi-structured individual and focus group interviews explored participants' experiences and perceptions of public involvement (PI). Sixteen participants were recruited, with representation from (a) the interdisciplinary project team; (b) academics engaged in discrete project activities; (c) individuals providing organizational and operational project support; and (d) the project's two advisory groups. Data were analyzed using Framework Analysis. Five themes were generated: (a) the challenge of defining the co-researcher role; (b) power relations in PI; (c) resources used to enable PI; (d) perceived benefits of PI; and (e) facilitators of successful PI. Our findings provide new evidence about how inclusive research teams can support people with complex speech and motor disorders to contribute meaningfully to co-produced research.

Purpose: The aim of the study was to investigate the experiences of people with traumatic brain injury (TBI) and rehabilitation professionals in use of social media after TBI. Design: Metasynthesis of a multilevel mixed-methods research design was used in the study. Method: A qualitative metasynthesis of (a) evidence in the literature regarding the use of communication technologies and social media after TBI, (b) Twitter data and network analysis, (c) interviews with people with TBI (n = 13), (d) focus groups with TBI rehabilitation professionals (n = 11), and (e) a review of current guidance on safe use of social media was conducted. Results: People with TBI adopt a trial-and-error approach to using social media. Their meaningful use and a sense of connection enable them to develop social media mastery. TBI rehabilitation professionals' concerns regarding potential risks associated with using social media might lead them to restrict social media use during rehabilitation. Conclusions: Access to proactive training in social media use and a supportive network of rehabilitation professionals, family, and friends can enable people with TBI to develop social media mastery through working collaboratively on social media goals. This metasynthesis of research culminates in an evidence-based protocol for assessing and supporting a person with TBI's social media goals to guide clinical practice and future research in the field.

Purpose: Rehabilitation professionals support people with traumatic brain injury (TBI) to return to meaningful participation in life and society¿which now includes the use of social media. However, the role of health professionals in supporting the use of social media by adults with TBI is not yet known. This study aimed to investigate the experiences and views of rehabilitation professionals on the use of social media by people with TBI during rehabilitation. Method: Two focus groups were conducted and analysed qualitatively for content themes. Results: Eleven rehabilitation professionals, including allied health, recreational therapy, and service management, took part in this study. Participants identified potential benefits to people with TBI using social media, including reduced social isolation. However, they expressed concerns about social media risks relating to the vulnerability, exploitation, and reputation management for people with TBI. Rehabilitation professionals viewed their role as being to protect people from these risks of harm, either through imposing restrictions on social media use or responding to problems after these occurred. Conclusion: A knowledge translation approach might help guide and support rehabilitation professionals in enabling adults with TBI to safely access and experience the benefits of meaningful engagement in social media during rehabilitation.Implications for rehabilitation Rehabilitation professionals can start addressing social media use during collaborative goal setting, in order to support people with traumatic brain injury to use social media successfully during rehabilitation and beyond. To do this, professionals can inquire as to the person's previous social media use and identify priority areas for the person for short- and long-term goals. Rehabilitation targeting social media use should include instruction for participation in social media platforms, providing education and feedback that is¿positive and constructive, as well as risk management education. Policy and guidance is needed for rehabilitation professionals to more actively support people with traumatic brain injury to access social media for improved participation and inclusion in online communities. Addressing social media goals in rehabilitation should be informed by existing successful traumatic brain injury rehabilitation approaches (e.g., functional rehabilitation) and adopting strategies used in rehabilitation supporting other higher risk goals (e.g., return to driving).

People with intellectual and/or developmental disability (I/DD) commonly have complex health care needs, but little is known about how their health information is managed in supported accommodation, and across health services providers. This study aimed to describe the current health information infrastructure (i.e., how data and information are collected, stored, communicated, and used) for people with I/DD living in supported accommodation in Australia. It involved a scoping review and synthesis of research, policies, and health documents relevant in this setting. Iterative database and hand searches were conducted across peer-reviewed articles internationally in English and grey literature in Australia (New South Wales) up to September 2015. Data were extracted from the selected relevant literature and analyzed for content themes. Expert stakeholders were consulted to verify the authors' interpretations of the information and content categories. The included 286 sources (peer-reviewed n¿=¿27; grey literature n¿=¿259) reflect that the health information for people with I/DD in supported accommodation is poorly communicated, coordinated and integrated across isolated systems. 'Work-as-imagined' as outlined in policies, does not align with 'work-as-done' in reality. This gap threatens the quality of care and safety of people with I/DD in these settings. The effectiveness of the health information infrastructure and services for people with I/DD can be improved by integrating the information sources and placing people with I/DD and their supporters at the centre of the information exchange process.

Purpose: The purpose of this study was to conduct an integrative review of original research, across adult populations relating to fatal or nonfatal choking on food, to understand ways to respond to and prevent choking incidents. Method: Four scientific databases (CINAHL, Medline, Web of Science, and EMBASE) were searched for original peerreviewed research relating to fatal or nonfatal choking on foods. Data were extracted on study characteristics; factors leading up to, events at the time of, and actions taken after the choking incident; and impacts of choking incidents. An integrative review of the findings across studies identified several risk factors and recommendations to reduce the risk of choking. Results: In total, 52 studies met the criteria for inclusion in this review, of which 31 were quantitative, 17 were qualitative, and 4 were of a mixed methods design. Studies reported the observations and narratives of bystanders or researchers, or else were large-scale autopsy studies, and included both the general public and people at risk of dysphagia. A range of food types were involved, and several actions were reported in response to food choking. Strategies to reduce the risk of choking were identified in the studies and are presented in 5 main categories. Conclusions: Factors leading up to choking incidents extend well beyond the individual to the environment for mealtimes; the provision of appropriate mealtime assistance and oral care; and regular monitoring of general health, oral health, and medications. Bystanders' increased awareness and knowledge of how to respond to choking are vital. The results of this review could be used to inform service policy and training, for individuals at risk of choking, the people who support them, and the general public. Further research is needed to explore choking prevention and airway protection in individuals with dysphagia.

Objective: To examine the views and experiences of patients and their health care providers on developing advance care planning (ACP) and advance care directives (ACD); and determine barriers and facilitators to ACD development, storage, and use, including implications for people with communication disability. Method: An integrative review of 93 studies, analysed according to their content themes. Results: Content themes encapsulated the initiation, documentation, and implementation stages of ACP/ACD. Lack of guidance for initiating and supporting ACP/ACD impedes discussions, and both patients and healthcare providers avoid discussions owing to fear of dying and reluctance to think about end-of-life. Conclusions: There are several barriers and facilitators to the initiation of ACP discussions, documentation and implementation of ACD, and little research exploring the views of legal professionals on the development, storage, or use of ACP documents. Further research is needed to explore the timing and responsibility of both legal and health professionals in initiating and supporting ACP discussions. Practice Implications: It is important for healthcare providers to raise ACP discussions regularly so that patients have time to make informed advance care decisions. Storage of the document in an electronic health record might facilitate better access to and implementation of patients' end-of-life care decisions.

This systematic review is aimed at examining the effectiveness of the rapid prompting method (RPM) for enhancing motor, speech, language, and communication and for decreasing problem behaviors in individuals with autism spectrum disorder (ASD). A multi-faceted search strategy was carried out. A range of participant and study variables and risk and bias indicators were identified for data extraction. RPM had to be evaluated as an intervention using a research design capable of empirical demonstration of RPM's effects. No studies met the inclusion criteria, resulting in an empty review that documents a meaningful knowledge gap. Controlled trials of RPM are warranted. Given the striking similarities between RPM and Facilitated Communication, research that examines the authorship of RPM-produced messages needs to be conducted.

Background and aims: Facilitated Communication (FC) is a technique that involves a person with a disability pointing to letters, pictures, or objects on a keyboard or on a communication board, typically with physical support from a "facilitator". Proponents claim that FC reveals previously undetected literacy and communication skills in people with communication disability. However, systematic reviews conducted up to 2014 reveal no evidence that the messages generated using FC are authored by the person with a disability. This study aimed to conduct a systematic review of the literature on FC published between 2014 and 2018 to inform the 2018 update of the 1995 American Speech-Language-Hearing Association Position Statement on FC. Method: A systematic search was undertaken to locate articles about FC in English published in the peer reviewed literature since 2014; and to classify these according to the study design for analysis. Studies meeting the inclusion criteria were classified according to four categories of evidence: (a) quantitative experimental data pertaining to authorship, (b) quantitative descriptive data on messages produced using FC, (c) qualitative data, or (d) commentary material on FC. Main contribution: In total, 18 studies met the inclusion criteria. There were no new empirical studies and no new descriptive quantitative studies addressing the authorship of messages delivered using FC. Three new qualitative studies qualified for inclusion; these did not first establish authorship. Of the 15 new commentary papers on FC located, 14 were critical and one was non-critical. The results could be used to inform the development or update of current position statements on FC held locally, nationally, and globally. Conclusion: There are no new studies on authorship and there remains no evidence that FC is a valid form of communication for individuals with severe communication disabilities. There continue to be no studies available demonstrating that individuals with communication disabilities are the authors of the messages generated using FC. Furthermore, there is substantial peer-reviewed literature that is critical of FC and warns against its use. Implications: FC continues to be contested in high profile court cases and its use promoted in school settings and workshops at university campuses in the US. Our empty systematic review will influence both clinical practice and future clinical guidance; most immediately the American Speech-Language-Hearing Association Position Statement on FC and any future guidance issued by the 19 associations worldwide with positions against FC.

Objective: The aims of this study were to: (a) determine how Twitter is used by people with traumatic brain injury (TBI) and TBI organisations, (b) analyse the Twitter networks and content of tweets tagged with TBI-related hashtags, and (c) identify any challenges people with TBI encounter in using Twitter. Research Design: Mixed methods in a Twitter hashtag study. Methods: Mixed methods in a Twitter hashtag study. Tweets tagged with TBI-related hashtags were harvested from the Twitter website over a one-month period in 2016 and analysed qualitatively and quantitatively. Results: The sample of 29,199 tweets included tweets sent by 893 @users, 219 of whom had a brain injury. Twitter was used to: (a) discuss health issues, (b) raise awareness of TBI, (c) talk about life after TBI, (d) talk about sport and concussion, and (e) communicate inspirational messages. Conclusions: Twitter is an important platform for research and knowledge translation on TBI, and for hearing the voices of people with TBI as they express their personal views and stories of living with TBI and become more visible and influential in Twitter communities. TBI clinicians could use these narratives of people with TBI in Twitter to develop more effective and personally meaningful rehabilitation goals.

Objective To integrate the findings of research on electronic personal health records (e-PHRs) for an understanding of their health literacy demands on both patients and providers. Methods We sought peer-reviewed primary research in English addressing the health literacy demands of e-PHRs that are online and allow patients any degree of control or input to the record. A synthesis of three theoretical models was used to frame the analysis of 24 studies. Results e-PHRs pose a wide range of health literacy demands on both patients and health service providers. Patient participation in e-PHRs relies not only on their level of education and computer literacy, and attitudes to sharing health information, but also upon their executive function, verbal expression, and understanding of spoken and written language. Conclusion The multiple health literacy demands of e-PHRs must be considered when implementing population-wide initiatives for storing and sharing health information using these systems. Practice implications The health literacy demands of e-PHRs are high and could potentially exclude many patients unless strategies are adopted to support their use of these systems. Developing strategies for all patients to meet or reduce the high health literacy demands of e-PHRs will be important in population-wide implementation.

Purpose: To review the literature on communication technologies in rehabilitation for people with a traumatic brain injury (TBI), and: (a) determine its application to cognitive-communicative rehabilitation, and b) develop a model to guide communication technology use with people after TBI. Method: This integrative literature review of communication technology in TBI rehabilitation and cognitive-communication involved searching nine scientific databases and included 95 studies. Results: Three major types of communication technologies (assistive technology, augmentative and alternative communication technology, and information communication technology) and multiple factors relating to use of technology by or with people after TBI were categorized according to: (i) individual needs, motivations and goals; (ii) individual impairments, activities, participation and environmental factors; and (iii) technologies. While there is substantial research relating to communication technologies and cognitive rehabilitation after TBI, little relates specifically to cognitive-communication rehabilitation. Conclusions: Further investigation is needed into the experiences and views of people with TBI who use communication technologies, to provide the 'user' perspective and influence user-centred design. Research is necessary to investigate the training interventions that address factors fundamental for success, and any impact on communication. The proposed model provides an evidence-based framework for incorporating technology into speech pathology clinical practice and research.

Background Risk assessments are needed to identify adults with intellectual and developmental disability (IDD) at high risk of choking and pneumonia. Aim To describe the development and validation of the Choking Risk Assessment (CRA) and the Pneumonia Risk Assessment (PRA) for adults with IDD. Methods Test items were identified through literature review and focus groups. Five-year retrospective chart reviews identified a positive choking group (PCG), a negative choking group (NCG), a positive pneumonia group (PPG), and a negative pneumonia group (NPG). Participants were tested with the CRA and PRA by clinicians blind to these testing conditions. Results The CRA and PRA differentiated the PCG (n = 93) from the NCG (n = 526) and the PPG (n = 63) from the NPG (n = 209) with high specificity (0.91 and 0.92 respectively) and moderate to average sensitivity (0.53 and 0.62 respectively). Further analyses revealed associations between clinical diagnoses of dysphagia and choking (p = 0.043), and pneumonia (p < 0.001). Conclusions The CRA and PRA are reliable, valid risk indicators for choking and pneumonia in adults with IDD. Precautions for mitigating choking and pneumonia risks can be applied selectively thus avoiding undue impacts on quality of life and unnecessary interventions for low risk individuals.

Background: Nurses communicating with patients who are unable to speak often lack access to tools and technologies to support communication. Although mobile communication technologies are ubiquitous, it is not known whether their use to support communication is feasible on a busy hospital ward. Purpose: The aim of this study was to determine the views of hospital nurses on the feasibility of using mobile communication technologies to support nurse-patient communication with individuals who have communication impairments. Method: This study involved an online survey followed by a focus group, with findings analyzed across the two data sources. Findings: Nurses expected that mobile communication devices could benefit patient care but lacked access to these devices, encountered policies against use, and held concerns over privacy and confidentiality. Conclusion: The use of mobile communication technologies with patients who have communication difficulties is feasible and may lead to improvements in communication and care, provided environmental barriers are removed and facilitators enhanced.

This review provides a summary and appraisal commentary on the treatment review by Deacy, E., Jennings, F., & O'Halloran, A. (2016). Rapid Prompting Method (RPM): A suitable intervention for students with ASD? REACH Journal of Special Needs Education in Ireland, 29, 92¿100. Source of funding and declaration of interests: This review was supported in part by funding from the Australian Research Council [grant number DE140100443].

Abstract: In this reply to Lilienfeld, Marshall, Todd, and Shane (2015) we provide a social marketing perspective on ways that facilitated communication (FC) is presented and discussed on social media platforms, in the field of augmentative and alternative communication (AAC). The growth in uptake and use of FC in recent years has occurred in the context of rapid growth in mobile technologies and AAC integrated with social media and online learning. Social media have been used to disseminate both materials that are supportive of FC and materials that provide scientific evidence of facilitator influence over authorship in FC. In order to illustrate how social media are being used to spread information about FC, we present a limited scan of two social media sites¿Twitter¿ and YouTube¿¿for information about FC. In this paper we discuss barriers to evidence and facilitators for FC in social media and consider the role that social marketing might play in relation to FC. Clinical implications for using social media to counter FC and directions for future research are discussed.

Facilitated Communication (FC) is a technique whereby individuals with disabilities and communication impairments allegedly select letters by typing on a keyboard while receiving physical support, emotional encouragement, and other communication supports from facilitators. The validity of FC stands or falls on the question of who is authoring the typed messages-the individual with a disability or the facilitator. The International Society for Augmentative and Alternative Communication (ISAAC) formed an Ad Hoc Committee on FC and charged this committee to synthesize the evidence base related to this question in order to develop a position statement. The purpose of this paper is to report this synthesis of the extant peer-reviewed literature on the question of authorship in FC. A multi-faceted search was conducted including electronic database searches, ancestry searches, and contacting selected authors. The authors considered synopses of systematic reviews, and systematic reviews, which were supplemented with individual studies not included in any prior reviews. Additionally, documents submitted by the membership were screened for inclusion. The evidence was classified into articles that provided (a) quantitative experimental data related to the authorship of messages, (b) quantitative descriptive data on the output generated through FC without testing of authorship, (c) qualitative descriptive data on the output generated via FC without testing of authorship, and (d) anecdotal reports in which writers shared their perspectives on FC. Only documents with quantitative experimental data were analyzed for authorship. Results indicated unequivocal evidence for facilitator control: messages generated through FC are authored by the facilitators rather than the individuals with disabilities. Hence, FC is a technique that has no validity.

Many adults with cerebral palsy and complex communication needs rely upon the support of their unpaid carers when they are in hospital. In this paper, the authors present some of the findings of a larger qualitative study of the experiences of unpaid carers of hospitalized adults with cerebral palsy and complex communication needs who did not have access to their usual augmentative and alternative communication (AAC) systems. Drawing upon the stories of unpaid carers, communication issues associated with cerebral palsy and complex communication needs and the absence of AAC are discussed. Such information can be used to assist AAC specialists, hospital staff, and hospital policy developers to improve care provided to not only people with cerebral palsy and complex communication needs, but also to other people who are unable to speak in hospital. © 2004 Taylor & Francis Ltd.

Effective functional communication is important for successful management of dysphagia with individuals who have lifelong disability and complex communication needs (CCN).1CCN is a broad term used to describe functional outcome in communication according to skills and needs: "Some people have complex communication needs associated with a wide rangeof physical, sensory and environmental causes which restrict/limit their ability to participate independently in society. They and their communication partners may benefit from using Alternative or Augmentative Communication (AAC) methods either temporarily or permanently" (Balandin, 2002, p. 2). Many people with dysphagia have associated communication difficulties that may affect their ability to participate in their dysphagia management plan. Speech pathologists are well placed to ensure, wherever possible, that individuals with dysphagia not only have an appropriate dysphagia management plan but also have a functional communication system that will support their involvement in the planning and ongoing management process. In this article, the importance of a functional communication system for individuals with dysphagia is highlighted in relation to ethical decision making in dysphagia management. © 2003 Informa UK Ltd All rights reserved.