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PubMed2004

Inpatient rehabilitation of patients requiring hemodialysis.

OBJECTIVE: To evaluate the outcomes of patients who require hemodialysis and are admitted to an inpatient rehabilitation unit. DESIGN: Retrospective review of the data of all admissions to an inpatient rehabilitation unit in 2001. SETTING: University medical center. PARTICIPANTS: All inpatient rehabilitation admissions in 2001 (N=531), including 497 patients who did not require hemodialysis and 34 who required hemodialysis. INTERVENTION: A comprehensive rehabilitation program including physical therapy and occupational therapy. Speech and language therapy and rehabilitation psychology were provided when necessary. MAIN OUTCOME MEASURES: Length of stay (LOS), change in total score on the FIM instrument, FIM efficiency, and place of discharge. RESULTS: Admission and discharge FIM scores of the patients requiring hemodialysis were virtually identical to those of the other patients admitted to the unit. The average LOS of the hemodialysis patients was 5.4 days longer than that of the other patients, and, therefore, efficiency scores of the dialysis group were less than those of the other patients. The rate of discharge to the community did not differ significantly for the dialysis group. CONCLUSIONS: Patients who require hemodialysis can benefit from rehabilitation services. Their improvement on the FIM instrument is comparable to that of other patients, but their LOS may be longer than that of other patients.

Aged↗
PubMedDate not supplied

The value of the role of the rehabilitation assistant.

This article outlines the experiences of nursing and therapy staff regarding the introduction of rehabilitation assistants. The authors discuss issues concerning a role (the rehabilitation assistant) that was created after staff identified that therapeutic input (nursing, physiotherapy, occupational therapy, speech and language therapies), which was provided from Monday to Friday, was not continued over weekend periods. A small-scale audit was carried out to assess the role and the efficacy of the rehabilitation assistant. The results demonstrate specific areas of the rehabilitative process that patients and their carers considered important. These include activities of living, general wellbeing and the patient's view towards rehabilitation over the weekend. This article demonstrates the value of the role of the rehabilitation assistant and how, together with effective multidisciplinary team working, it provides the impetus for a consistent and goal-directed rehabilitative process.

Activities of Daily Living↗
PubMedDate not supplied

The King's College Hospital Acute Stroke Unit.

The King's College Hospital (KCH) Acute Stroke Unit (ASU) was set up in January 1994 in order to provide acute management for patients admitted with stroke and to undertake biomedical research. Of 206 patients admitted to KCH with a stroke or suffering an in-hospital stroke, 141 (68%) patients were admitted to the ASU over its first 6 months of operation: 120 (85%) were from the Accident and Emergency Department and 21 (15%) from other wards. Management included resuscitation and medical stabilisation, investigation, prevention of stroke complications (including aspiration, venous thrombosis, and pressure sores), rehabilitation (physiotherapy, occupational therapy, speech and language therapy), nutrition (dietetics) and initiation of secondary prevention measures (aspirin or anticoagulation, blood pressure and lipid lowering, and carotid endarterectomy). All aspects of management are driven by agreed guidelines. Patients remain under the care of the admitting physician but specific stroke management and guidance is provided by two research doctors and the unit's nurses, therapists and dietician. The unit also facilitates research into stroke pathophysiology and acute therapeutic interventions. Our experience suggests that an ASU is relatively easy to set up and may contribute to improved care. Whether ASUs improve patient survival and functional outcome, and are cost-effective, requires further study.

Acute Disease↗
PubMed2001

What is the association between the different components of stroke rehabilitation and health outcomes?

OBJECTIVES: To describe the rehabilitation input stroke patients received from health professionals during the early post stroke period and to explore possible associations between health outcomes and these rehabilitation inputs. DESIGN: Community-based study with prospective identification of stroke patients from a random sample of 24 general practices stratified by geographical area and practice size. SETTING: Ayrshire and Arran Health Board area, West of Scotland. INTERVENTIONS: All physiotherapy, occupational therapy, dietetics, podiatry, speech and language therapy and community nursing inputs given to stroke patients in the course of normal treatment were recorded. OUTCOME MEASURES: Barthel Index and Medical Outcomes Study Short Form-36 (SF-36). Both recorded at one, three and six months post stroke. RESULTS: Of the 152 people providing data, more had received physiotherapy than any other rehabilitation input at all three follow-ups (81%, 47%, 39%), with occupational therapy being the next most common service (65%, 44%, 25%). Amount of rehabilitation input was significantly negatively correlated with health outcomes measured at each discrete time point: those patients with the poorest outcomes received greatest input. However, regression analysis of change in outcome scores showed that increasing amounts of rehabilitation input were significantly associated with a reduction in disability, particularly between one and three months post stroke. CONCLUSIONS: Not only have we shown that those stroke patients with poorest outcomes received most rehabilitation input, but, from analysis of the individual rehabilitation inputs, we have identified some rehabilitation inputs that significantly predict improved outcomes. This suggests that there would be merit in further investigation of these associations.

Activities of Daily Living↗
PubMed1985

Goldenhar's syndrome: a case study.

Goldenhar's Syndrome, a rare symptom complex involving craniofacial and vertebral malformations, is reviewed and a detailed case history of a 19-mo-old exhibiting the syndrome is described. This multiple-problem child exhibited a 6-mo deficit in communication skills at 12 mo of age. After 6 mo of participation in a multidisciplinary early intervention program, including speech-language therapy, the child exhibits normal language although he has articulation problems consistent with his craniofacial defects.

Goldenhar Syndrome↗
PubMed2006

Disorders of speech and language: aphasia, apraxia and dysarthria.

PURPOSE OF REVIEW: We review recent important papers pertaining to acquired aphasia, apraxia of speech and dysarthria with special attention to clinically significant work published in the last 12 months. RECENT FINDINGS: The role of the contralateral inferior frontal gyrus in language recovery after stroke is controversial, but is an area of active research, particularly in functional imaging studies. Recent treatment studies in poststroke aphasia have shown that intensity of language therapy may be more important than the method of therapy. Some studies have indicated that amphetamines, piracetam and repetitive transcortical magnetic stimulation may be effective adjuncts to speech and language therapy. Treatment studies for poststroke dysarthria indicate that speech supplementation strategies may be effective and deserve further study. SUMMARY: Recent studies of aphasia provide clues regarding language recovery poststroke, but further studies of the role of the ipsi and contralateral inferior frontal gyrus are necessary, and should be longitudinal. There are relatively few recent studies on the treatment of acquired disorders of speech and language, other than poststroke aphasia.

Aphasia↗
PubMed1998

What is the outcome of the outcomes? Evaluation of the therapy outcome measures.

In 1996, the Speech and Language Therapy Departments of First Community Health NHS Trust and Kidderminster Care NHS Trusts agreed to take part in a year's pilot study of the Therapy Outcome Measures developed by Enderby and John (1997). This paper will discuss the rationale for choosing to pilot these outcome measures and discuss the implementation of the project from a service manager's perspective. The discussion will focus upon what has been learnt from piloting the Therapy Outcome Measures.

Evaluation Studies as Topic↗
PubMedDate not supplied

An investigation into the effectiveness of an early intervention method for delayed language development in young children.

Delayed language development is common and has serious sequelae into adulthood in terms of educational, social and emotional development. The objective of this study was to test the hypothesis that a group of language-delayed infants detected in the first year of life by the screen developed in the author's previous study, and receiving intervention at that stage, would not show language impairment at the age at which children are usually referred for speech and language therapy, whereas an untreated control group would do so. A sample (n = 122), of very young language-delayed children was divided into matched experimental and control groups. The mean (range) age of the sample was 10.6 (8-21) months. The experimental group received intervention, and both groups were followed up until they were 3 years of age to determine whether there were differences in language development at that stage. The results showed that at 3 years, 85% of controls showed language delay while only 5% of the experimental group did so. The differences in mean language quotient in experimental and control groups were statistically significant (t = 2.701, p < 0.01). At this stage, 30% of the controls had been referred for speech and language therapy, while none of the experimental group had so been. The intervention was found to take relatively little resource and the low dropout rate and high take-up indicated that it was popular with carers.

Caregivers↗
PubMed2005

The cognitive competence of speakers with acquired dysarthria: judgements by doctors and speech and language therapists.

BACKGROUND: Studies have shown that listeners make negative attributions towards people with communication impairments. This appears to be the case for health care professionals as well as non-professional listeners. AIMS: This study extends this line of research to speakers with acquired dysarthria. These clients often complain that listeners treat them differently after the onset of their speech impairment. The study examines judgements of the cognitive status of speakers with acquired dysarthria made by health care professionals. METHODS AND PROCEDURES: Doctors, speech and language therapists and speech and language therapy students viewed videos of speakers with acquired dysarthria and of controls matched for age and gender who had acquired neurological deficits that did not affect their speech. Listeners judged whether speakers could carry out a number of everyday tasks. All the tasks were known to be within the speakers' competence. OUTCOMES AND RESULTS: Doctors were significantly less confident of the competence of speakers with dysarthria than of the controls. No difference was found for speech and language therapists or speech and language therapy students. CONCLUSIONS: Although caution is required in generalizing these results to other speakers, the results lend some support to the complaints of clients with acquired dysarthria that their speech leads others, in this case doctors, to misjudge their cognitive competence.

Adult↗
PubMed2006

Parental satisfaction with health services provided to children with Down syndrome in north-west England: an ENT perspective.

AIMS: To evaluate parents' satisfaction with medical and allied health services provided to children with Down syndrome in north-west England, comparing ENT and its allied services with other areas of health service provision. METHODS: A questionnaire survey of parents attending a north-west England Down syndrome association conference. Demographic data, departments visited, satisfaction with each service (scored one to five), waiting times for each service (scored one to five), service need (scored one to three) and accessibility (scored one to three) were recorded. RESULTS: Otolaryngology had been used by 50 per cent of children, with a satisfaction of 2.63 (the second worst score). Speech and language therapy was used by 90 per cent of the children, with a satisfaction of 3.26 (the worst score). The service felt to be most needed and also most difficult to access was speech and language therapy. CONCLUSION: Otorhinolaryngology departments should assess how they can improve their service to this population with specific ENT needs. Speech and language services for children with Down syndrome should be expanded.

Adolescent↗
PubMed2003

A 12-month follow-up of preschool children investigating the natural history of speech and language delay.

AIM: The aim of this paper is to examine the natural history of early speech and language delay in preschool children over a 12-month period. METHODS: The study reports data on 69 children under the age of 3.5 years who were referred for speech and language therapy because of early speech and language delay. The children were monitored over a 12-month period but received no direct intervention during that time. Assessment of their comprehension, expressive language and their phonology took place at baseline and again at 6 and 12 months after baseline. RESULTS: The results show a general picture of improvement, although there was considerable individual variation. By the end of the 12 months, two-thirds of the children were still eligible on the study intake criteria. Therapist's rating of a child's functional communication at the outset was a significant predictor of the child's outcome at the end of the 12-month period. DISCUSSION: The paper discusses the appropriateness of a 'monitoring' approach to the management of early language delay and highlights the need to consider the social issues and views of parents as well as the severity of a child's difficulties.

Articulation Disorders↗
PubMedDate not supplied

Education of speech and language therapists in the Republic of Ireland and in the UK.

A brief history of speech and language therapy education in the Republic of Ireland and in the UK is provided, with reference to early 20th century developments. Current practice regarding the regulation and accreditation processes of education courses in the two countries is outlined. A general account of the development of undergraduate curricula of speech and language therapy is provided.

Curriculum↗
PubMed2001

Educational needs of speech and language therapists in the field of audiology.

Speech and language therapists have rather diverse educational backgrounds globally. Their qualifications vary from a 1 to 2-year diploma or certificate programme in a non-university educational setting, to a 6-year university graduate education. Although speech and language therapy is generally considered an interdisciplinary profession, both in education and in clinical practice, in some countries the main emphasis may still be on special education, medicine (mainly medical audiology) or, because of a joint qualification, psychology. This article discusses the requirements for audiological education in proper assessment and (re)habilitation of hearing impairments. Future challenges of both the profession and the discipline of speech and language therapy are also highlighted.

Audiology↗