**3. Results**

## *3.1. Descriptive Quantitative Data*

As the first step, abstract counts for all search terms were generated and used to obtain abstracts for manifest and latent thematic content analysis. First, the focus was on searching the abstracts in Scopus and EBSCO ALL for different neuro-related terms in conjunction with "speech therap\*", "speech patholog\*", "speech language" or "audiolog\*" OR the term "speech" (Table 1).




**Table 1.** *Cont.*

Hit counts were also done in Scopus to search "speech" and "audiolog\*" in the journal title and different neuro-related terms in the abstract (Table 2). The results are as follows:


**Table 2.** Hit count results for abstracts mentioning di fferent neuro-related terms within "speech" and "audiolog\*" journals.


**Table 2.** *Cont.*

Finally, the full texts of Canadian newspaper articles were searched in the database Canadian *Newsstream* for di fferent neuro-related terms in conjunction with "speech therap\*", "speech patholog\*", "speech language" or "audiolog\*" (Table 3) and downloaded for manifest and latent thematic content analysis.

**Table 3.** Mentioning of the terms "speech therap\*", "speech patholog\*", "speech language" or "audiolog\*" in conjunction with terms indicating neuro-advancements within Canadian Newspapers.



**Table 3.** *Cont.*

All three tables indicate that "neuro\*", which can include words such as neurotoxicity and other terms that one would not link to speech-related professionals, and "cochlear implant\*" are the only terms leading to substantial hits. The terms "neurosc\*" for neuroscience, "neurote\*", and "neuroen\*" and most of the 49 neuro-related terms did not generate many hits, if any. Phrases containing the term "brain" and "human–computer" had some hits in the academic literature we investigated but not in the newspapers.

In a second step, manifest and latent content coding was performed on the academic abstracts and newspaper articles downloaded. The below is separated into two main parts: academic abstract content analysis and Canadian newspaper full text article content analysis.

The academic abstract part is subdivided into 3 sub-parts: the role of speech-related professionals (a) evident in abstracts containing the terms "neurosc\*", or "neuroen\*" or "neurote\*" or 49 neuro-related terms and speech-related terms; (b) evident in abstracts containing the terms "neurosc\*", or "neuroen\*" or "neurote\*"or 49 neuro-related terms and the terms speech\* or audiolog\* in the title of the journal; and (c) in relation to CIs.

The Canadian newspaper part is also subdivided into 3 sub-parts: the role of speech-related professionals (a) evident within the context of neuro-advancements (not CI), (b) evident within the CI of neuro-advancement, and (c) evident outside context of neuro-advancements. In all sections, content linked to "speech" is first examined and then content linked to "audiolog\*".

## *3.2. Qualitative Data*

## 3.2.1. Academic Literature

Roles of Speech-Related Professionals Evident in Abstracts Containing the Terms "Neurosc\*", or "Neuroen\*" or "Neurote\*", or 49 Neuro-Related Terms Omitting CIs (Search Strategy 1)

In total, *n* = 368 academic abstracts were downloaded and looked at. Within the downloaded abstracts, it is made explicit that neurology has an interest in and influences areas that are also of interest to speech-related professions such as speech therapy [60], audiology [61] and speech language pathology [62], and that cooperation between neuro- and speech-related professionals is warranted [63]. To give one quote: "The analysis of aphasia as a matter of fact is a crucial question not only for neurology and related clinical areas, but also for linguistics, neuropsychology, psychology, and speech therapy" [60] (p. 267). It is seen as important that speech language pathology students learn about the "neuro-anatomy and neurophysiology of the normal speech, language, swallowing, and hearing systems" [64] (p. 27).

Neurotechnologies mentioned within abstracts containing the terms "neurosc\*" include EEG, neurostimulation, neuro-pharmaceuticals, imaging technology, neuro-scans, rTMS, tDCS and MRI. The terms "neuroen\*" and "neurote\*" did not mention any neurotechnologies. Instead, "neuroen\*" was used to describe individuals with neuroendocrine dysfunctions and their possible vocal symptoms; however, the role of SLPs and audiologists was not mentioned. Furthermore, there was no relationship with the keyword "neurote\*" and speech-related professionals. Two abstracts mentioned that transcranial brain stimulation (TMS and tDCS) might be worthwhile as a complimentary method to speech therapies and useful for SLPs [65,66].

As to the role of speech-related professionals, it was noted that neurotechnologies such as Neuroimaging Techniques, Magnetoencephalography Imaging, diffusion Tensor MRI, Transcranial Magnetic Stimulation, Transcranial Direct Current Stimulation, Laryngeal Imaging and biofeedback for Acquired Apraxia will impact the practice of SLPs and audiologists [67]. SLPs were mentioned as evaluators in *n* = 6 abstracts and as a clinical service provider in *n* = 5 abstracts. The role of researcher was evident in *n* = 4 abstracts, of which *n* = 3 were linked to providing grouping/classification of research subjects. The role of knowledge consumer was evident in *n* = 3 abstracts. The role of producer of best practice guidelines, knowledge producers (refining communication disorder phenotypes) [68] (p. 245), advocate, and preventing worsening of a condition were mentioned once. Furthermore, audiologists were mentioned in their role of evaluator in *n* = 4 abstracts and as programmers in *n* = 2 abstracts.

The keyword "neuroethics" had *n* = 0 results in the downloaded academic abstracts and only one mentioned ethics but not in relation to SLP. Essentially, SLPs and audiologists were not mentioned as influencers of neuro-governance or neuroethics discourses. Furthermore, lifelong learning was not mentioned as a mechanism or tool for SLPs and audiologists to update their knowledge.

Roles of Speech-Related Professionals Evident Containing the Terms "Neurosc\*", or "Neuroen\*" or "Neurote\*" or 49 Neuro-Related Terms in the Abstracts and the Terms "Speech\*" or "Audiolog\*" in the Title of the Journal (Search Strategy 3)

In this section, the findings of *n* = 353 downloaded academic abstracts are reported on. As to the role of speech-related professionals, none mentioned a role using the terms "audiologist\*" or "therapist\*". Using the word "pathologist\*", one abstract of an article reported on the results of a systematic literature review that investigated the involvement of SLPs in communication interventions of people with dementia, whereby it is concluded that cognitive stimulation approaches might be useful, and that the findings of the literature review might have implications for clinical services of SLPs [69] thereby indicating the role of knowledge consumer. One abstract listed challenges for SLP practice such as "preparation of future speech-language pathologists, reimbursement for services, availability of appropriate technology, and widespread connectivity" [70] (p. 189). These challenges were all linked to clinical services, although one could envision that the role of advocate and educator might also fit to face the challenges. Another abstract mentioned SLPs in the role of evaluator of a patient in a clinical trial. SLPs as knowledge consumers, researchers, clinical service providers and evaluators were mentioned once. SLPs and audiologists were not mentioned as influencers of neuroethics and neuro-governance discussions. They were also not mentioned as lifelong learners of neuro-advancements and the implications that can arise with the use of such advancements. Ethics was not mentioned in the abstracts.

Roles of Speech-Related Professionals in Relation to CIs (Search Strategy 2)

Regarding CIs *n* = 251 academic abstracts were downloaded and analyzed for the roles linked to speech-related professionals in relation to CIs (Table 4).


**Table 4.** Role narrative of speech-related professionals linked to CIs.

As is evident from Table 4, the main role of speech-related professionals was linked to providing a service to a client with the main role being to evaluate the usability of CIs and the applicability of a CI for a potential user. The role of programming CIs was linked mostly to audiologists. Other researchers discussed SLPs' important role in pretreatment counseling [71].

To be part of a team was mentioned as being important for SLPs and audiologists. Teagle and Moore (2002) outlined the pivotal role SLPs have in the CI team [72]. This role was described as the "need to recognize symptoms and make prompt recommendations for quick intervention". Researchers in another abstract outlined that audiologists have a role in the CI team, particularly in the rehabilitation phase [73].

Some abstracts linked with the "educator" role of speech-related practitioners, whereby the education role was linked to educating individuals on the clinical benefits and uses of CIs [74].

The term "educational audiologist" was present in *n* = 7 abstracts, whereby this role was linked to the role of ensuring compliance [75], ensuring the benefits of CIs [76], that special education teachers benefit from CIs [77], having a role in the school of the deaf [78], providing education that increases auditory learning of children [79,80], and providing good devices to students [81]. A study from 2009 called "*Preparation and perceptions of speech-language pathologists working with children with cochlear implants*" "examined the level of preparedness of North Carolina speech-language pathologists (SLPs) who serve school-aged children with cochlear implants (CIs)" [82] (p. 142). The study concluded that SLPs and audiologists need "to engage in continuing education to update their knowledge of emerging innovations in CI technology and habilitation" [82] (p. 142). Another study argued that audiologists should educate pediatricians [83]. One abstract indicated that providing "specialty training for SLPs working with deaf and hard of hearing children" [84] (p. 297) improves the ability "to work with culturally diverse children who are deaf or hard of hearing and in particular, those who use cochlear implants and have differing experiences with spoken language" [84] (p. 297).

Berg (2007) highlighted the idea that audiologists should be trained and increase their knowledge of educational audiology and deaf culture perspective to gain better discussions with clients on CI [85]. Researchers in another abstract concluded that the role of an audiologist is not only to provide assessment, but also to provide information and knowledge of speech and CIs to families so parents "can continue to respond to their child" [86]. This role is reflected in the quotes, "the role of the audiologist is therefore not just to assess the child's auditory thresholds and provide e ffective amplification, but perhaps more importantly, to support parents through the stages of grief by fine-tuning the amplification so that parents can see their infant's early responses to sounds" and "By more closely fulfilling the needs and expectations of parents, audiologists are better placed to achieve improved speech, language, and social outcomes for children with early identified hearing loss" [86] (p. 3).

There were *n* = 3 abstracts that mentioned speech-related professionals as stakeholders in relation to CIs, with one abstract describing their role as "stakeholders in the adoption process" [87]. The second abstract discussed the importance of the support of all stakeholders, including speech therapists, for commencement of a CI program [88]. The third abstract indicated audiologists as stakeholders by stating that audiologists see themselves in the role of providing sensory management, but that aural rehabilitation is done by others [89].

Some abstracts sugges<sup>t</sup> the role of knowledge consumer by indicating gaps of knowledge within speech-related professionals. One study from the UK suggested that "audiologists support cochlear implantation, but due to a lack of training and familiarity, not all are confident in discussing CIs with patients and making an appropriate referral" [90] (p. 213). A study from Brazil concluded that audiologists and other involved professionals do not have enough knowledge of CIs [91]. A 2018 abstract "*Awareness and Knowledge of Cochlear Implants among Speech-Language Pathologists*" concluded that SLP in Mississippi lack CI related knowledge and skills to work with CI clients [92].

In one abstract, "*Exploring the Identities of Hearing Parents Who Chose Cochlear Implantation for Their Children with Hearing Loss*", four identities of parents were identified: advocates, resilient parents, obedient worriers, and matter-of-fact narrators. Identifying and understanding these parent identities was seen as useful knowledge to "improve audiologists' abilities to help families seek out, implement, and follow-through with family centered hearing healthcare" [93] (p. 131).

As to lifelong learning, one abstract mentioned the use of technology to advance professional development [94]. Another abstract made the case that "experts in their respective fields, including neuroscience, speech-language pathology, and educational psychology" do not know enough about the literacy field and the case is made in the abstract for these experts to "attend professional development sessions concerning big picture perspectives and make observations in schools where these perspectives have been e ffectively implemented" [95] (p. 1).

## 3.2.2. Canadian Newspapers

In the final step of our analysis, we investigated the full text of Canadian newspaper articles (Table 5). Although an article might mention speech-related professionals and neuro-advancements it is not a given that these two areas are mentioned in relation to each other. They might be linked to totally di fferent stories and as such could be classified as non-relevant or false-positives. Therefore, we report in Table 5 the roles of speech-related professionals in relation to neuro-advancements and in relation to non neuro-advancements (search strategy 1–3). As to the articles containing CIs (search strategy 4), not one mentioned SLPs or audiologists in a non-relevant fashion. All mentions were linked to some aspects of CI whether technical aspects or mentioning of social discussions around CI. As such, Table 5 has only one column for CIs (search strategy 4).


**Table 5.** Role narrative of speech-related professionals linked to neuro-advancements vs linked to neuro-advancements and linked to CIs.

Table 5 indicates that for the non-CI content, roles of speech-related professionals were mentioned much less in relation to neuro-advancements than outside of neuro-advancements. However, between the two non-CI columns which roles were mentioned most, and which roles were rarely or not mentioned were mostly the same.

Within the CI content, there were certain specific roles highlighted, such as programmer of CI, which could be seen also as service provision. However, the role of influencer of policy, ethics and governance discourses was also not mentioned as in the non-CI content.

## Roles Evident within Context of Neuro-Advancements Omitting CIs

As reflected in Table 5, the role of SLPs and audiologists was rarely mentioned. Even the role of service provider the role mentioned the most was mentioned only *n* = 3 times. Within all the downloaded newspaper articles not one article reported on the role of SLPs or audiologists as advocates, researchers or influencers of neuro-advancements including neuro-policy, neuro-ethics and neuro-governance discussions.

## Roles Evident within Context of CIs

As to the content reflected in Table 5 relating to CIs, the top roles mentioned for SLPs and audiologists were expert (*n* = 16 articles), educator of others (*n* = 8 articles), and service provider or advocates for their fields (*n* = 6 articles).

Beyond these roles for SLPs, one article reported on a camp run by SLPs for children to meet other implant users and learn communication skills [96]. Another article described SLPs as members of the CI team needing to provide assessment, therapy, and rehabilitation [97].

One article reported on a workshop that was held for the personal and professional development of women in the speech field, specifically on CIs [98].

As to CIs, some roles were exclusively linked to audiologists such as: promoter of CI (*n* = 5 articles all before the year 2000) and programmer of CI (*n* = 2 articles). As to the promoter of CI role, this was seen as either negative; for example, "So what does this device do? It o ffers false hope to the parents of deaf children. However, do parents have enough information on the alternative? Not likely: they are mobbed by the doctors or audiologists from the day deaf babies are born" [99], or as needed; for example, "However, Dr. Sipke Pijl, an audiologist at St. Paul's hospital, who does about five or six operations every year says he takes exception to the deaf community dictating what other people should do with their lives" [100]. Two articles highlighted audiologists' input on CIs, with one stating that CIs are not the only solution to hearing loss, as there is a lot of therapy and rehabilitation in the

process as well [101]. The other reported on an audiologist's opinion that CIs work best in people who could speak before being deaf [102].

Roles Evident Outside Context of Neuro-Advancements

Canadian newspapers rarely linked the role of the speech-related field to neuro-advancements including CIs. As to the roles evident without linkage to -neuro-advancements and CIs, one article from 2004 stated:

"Speech-Language Pathologists (SLPs) and Audiologists (Auds) are highly trained professionals who can help people make their lives richer, more productive and enjoyable through improved communication skills. What we do: Identify, assess, and rehabilitate children and adults with hearing di fficulties and communication disorders. We counsel clients and families and provide referrals to other professionals. We are committed to ongoing research, public education, and training of new speech-language pathologists and audiologists. What we study: Acoustics, anatomy, assessment, counseling, hearing disorders, hearing aids, language development disorders, linguistics, neurology, neurophysiology, non-vocal communication, parent training, psychology phonetics, voice, speech and voice disorders, statistics, stuttering and research methods. Where we work: Speech-language pathologists and audiologists work in private practice, child development centres, pre-schools, schools, hospitals, rehabilitation centres, governmen<sup>t</sup> agencies, health units, industry, colleges, universities and research centres throughout the world. We are often part of teams which include physicians, psychologists, social workers, nurses, teachers, counselors, occupational therapists and physical therapists". [103]

The results are summarized in Table 5. More specifically, the role of service provider, whether in a clinical setting or in-home service, was evident in over *n* = 71 articles, while the role of being an expert was indicated *n* = 30 times by the many speech-related professionals quoted by name and the quoting of speech professional organizations and phrases such as: "audiologists say ... ".

The role of being an educator was evident in *n* = 5 articles that highlighted talks given by professionals. The role of being an advocate for one's profession was present in *n* = 9 articles, whether in questioning negative consequences such as cuts in numbers or changes of status, or positive aspects such as awareness month.

Being a researcher was evident in *n* = 4 articles; for example, one article stated that audiologists are "committed to ongoing research, public education, and training of new audiologists" [103]. Being an influencer of policy decision beyond advocating for one's profession was only evident in *n* = 2 articles. To give one quote, "The Canadian Pediatric Society and the Canadian Association of Speech-Language Pathologists and Audiologists (CASLPA) recommend hearing screening for all newborns" [104]. That one has to learn was present in one article [105]. However, the issue of professional development and lifelong learning was not discussed. No article highlighted the importance of the role of the speech-related professionals to deal with neuro-advancement related policy, ethical, social and governance issues arising in relation to their fields.
