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PubMed1994

Changes in maternal attitudes and perceptions and children's communication skills.

The present investigation had two purposes: (a) to assess significant changes in the attitudes and perceptions of mothers of young children who were enrolled in 15 wk. of individual speech-language therapy and (b) to compare changes in mothers' attitudes and perceptions with university supervisors' ratings of children's over-all communication skills and speech intelligibility. 17 children, ages 2;10 to 5;8, and their mothers were participants. Mothers received speech-language services and counseling from graduate-student clinicians and university clinical supervisors but no special counseling was provided to alter their attitudes and perceptions concerning the intervention process. The typical child in the intervention program received 24 individual speech and language therapy sessions. Mothers and supervisors completed questionnaires before and after the 15-wk. intervention. Neither group was made aware of the purpose of the investigation. Analysis showed a pattern of significant changes in mothers' pre- and postrankings of questionnaire items and significant changes in the total communication and speech intelligibility rankings made by supervisors. Significant relationships were found for changes in attitudes and perceptions of mothers and changes in the children's communication skills. The results bolster the need for use of family-based therapy approaches in intervention programs for young children's communication disorders.

Adult↗
PubMed1998

The measurement of psychological well-being in the person with aphasia.

This paper will introduce the construct of psychological well-being and discuss its relevance to speech and language therapy. Measures of psychological well-being are used routinely in psychological contexts, both as diagnostic and research indicators, and also as outcome measures. There is not a tradition of measuring psychological well-being in the speech and language therapy context, yet the clinical significance of well-being to therapeutic outcome is recognised. This paper will evaluate the existing measures available and discuss the development and validation of the Visual Analogue Self Esteem Scale for use with aphasic speakers (Brumfitt and Sheeran, 1998). Problems inherent in evaluating self-knowledge in communicatively disordered speakers will be discussed.

Aphasia↗
PubMed1998

Specialised service to children with specific language impairment in mainstream schools.

The following report describes a three year project to develop, implement and evaluate a specialised speech and language therapy (SLT) service to children with specific language impairment (SLI) who attend mainstream schools and nurseries. The report describes how the service was set up and the package of care offered. A range of evaluation measures was designed and implemented and the results of these are discussed. The service aimed to enable key-workers to support children with SLI effectively within the context of the school environment. The results suggest that the package of care offered provided an effective and high quality service as judged by the parents, schools and therapists.

Child↗
PubMed1998

The case for early intervention with pre-school dysfluent children.

This paper aims to provide support for the hypothesis that early intervention with young dysfluent children is more successful over a shorter period of time than if speech and language therapy is delayed. The case histories of children between the ages of 3;06 and 5;11 years and 8;00 and 10;11 years who attended the Michael Palin Centre in a one year period were analysed. Those children whose histories included four or more risk factors were included in the study. The amount and duration of speech and language therapy along with the outcome was measured. Outcome was measured by the presence of stammering and parental and child concern. Preliminary findings indicate that the hypothesis will be supported. Full statistical analysis will be presented at the conference. Implications of the findings for service delivery will be discussed.

Age Factors↗
PubMed1992

[New approaches in speech therapy].

Following a brief introduction of the neurological basis and the localization of aphasias, we discuss approaches to language therapy which are based on linguistic theories. We first sketch principles of language-based therapy. Then we introduce communicative aphasia treatment and explain aspects under which the latter represents an extension of the language-based approach. In order to provide neurological arguments in favour of communicative therapy, we discuss the language theory of Hughlings Jackson. Finally, we give examples for communicative therapy paradigms, for some of which implementation in specific computer training programs is available.

Aphasia↗
PubMed2004

Can drug therapies improve language functions of individuals with aphasia? A review of the evidence.

The neurochemistry of language and the neuropharmacology of aphasia are two domains of cognitive neuroscience still in their infancy. In this article we review what is known about these two domains, especially with regard to treating aphasia with drugs. Selected neurotransmitters can improve language function in certain patients with aphasia. We discuss which neurotransmitters work for which language functions in which patients, and why.

Acetylcholine↗
PubMed2003

British Association of Stroke Physicians: benchmarking survey of stroke services.

BACKGROUND: the National Service Framework for Older People requires every general hospital which cares for stroke patients to introduce a specialist stroke service by 2004. OBJECTIVE: to describe the organisation and staffing of specialist hospital-based stroke services in the UK. DESIGN: a national postal survey of consultant members of the British Association of Stroke Physicians (BASP) seeking details of the provision of neurovascular clinics, acute stroke units (ASUs), stroke rehabilitation units (SRUs), and the organisation and staffing of these services. RESULTS: the response rate was 91/126 (72%). Fifty-four neurovascular clinics, 40 ASUs and 68 SRUs were identified. Neurovascular clinics used a number of strategies to maintain rapid access and 30 (56%) were run by a single consultant. Only 50% ASUs usually admitted patients within 24 h of stroke. As the number of beds available on ASUs and SRUs did not reflect the total number of stroke in-patients, 21 (53%) ASUs and 45 (79%) SRUs had admission criteria. Training opportunities were limited: 37% ASUs and 82% SRUs had no specialist registrar. The therapy sessions (1 session=half a day) available per bed per week on a SRU were: physiotherapy 0.8; occupational therapy 0.6; speech and language therapy 0.25. CONCLUSIONS: significant development is needed to achieve the NSF target for hospital-based stroke services as few Trusts currently have all components in place and even when available not all stroke patients have access to specialist care. Stroke specialists will be required to run these services but training opportunities are currently limited. Stroke unit therapy staffing levels were lower than was available in randomised controlled trials.

Aged↗
PubMed1997

Language guiding therapy: the case of dehydration versus volume depletion.

Indiscriminate use of the terms dehydration and volume depletion, so carefully crafted by our predecessors, risks confusion and therapeutic errors. These two conditions should be distinguished at the bedside and in how we speak to one another. Dehydration largely refers to intracellular water deficits stemming from hypertonicity and a disturbance in water metabolism. The diagnosis of dehydration cannot be established without laboratory analysis of p[Na +] or calculation of serum tonicity. In contrast, volume depletion describes the net loss of total body sodium and a reduction in intravascular volume and is best termed extracellular fluid volume depletion. The diagnosis of this condition relies principally on history, careful physical examination, and adjunctive data from laboratory studies. The pathophysiology of both dehydration and extracellular fluid volume depletion must be understood if these conditions are to be recognized and appropriately treated when they occur separately or together. There is no inclusive therapy for all situations. For example, indiscriminate treatment with 0.45% saline cannot be recommended when these conditions coexist because extracellular fluid volume depletion is often treated rapidly with 0.9% saline and dehydration is often treated more slowly with 5% dextrose.

Dehydration↗
PubMed1991

The facts behind the figures: a reply to Enderby and Davies (1989).

In 1989, Enderby and Davies discussed the type and pattern of speech and language therapy provision which would be required to service the needs of the speech- and language-impaired population of the UK, on the basis of statistical information drawn from a wide range of sources. In this paper, some methodological issues arising from their study are addressed and an argument made that alternative models of service provision should be considered when planning for future needs.

Cerebrovascular Disorders↗
PubMed1985

Evidence for sex differences in brain organization in recovery in aphasia.

Ninety-one adult aphasics of both sexes were studied before and after a 3-month period of language therapy. Although no initial sex difference was found in severity of language disorders, females within the global aphasic group showed significantly greater improvement in three tests of language comprehension. It is suggested that more bilateral representation of language functions in the female brain may account for this greater improvement.

Aged↗
PubMed2001

Challenges and opportunities for speech and language therapists in secondary schools.

Language and communication difficulties experienced by secondary school students are outlined. The challenges that the secondary school environment presents for both children and speech and language therapy services are discussed. Two case studies illustrate how speech and language therapists (SLTs) working for the Newham Education Authority Language and Communication Support Service support students in their secondary schools.

Adolescent↗
PubMed1996

Clinical audit, related cycles and types of health care quality: a preliminary model.

This paper is drawn from a study carried out in England, funded by the Department of Health. The aims of the study were to explore clinical audit in the four health professions of clinical psychology, occupational therapy, physiotherapy and speech and language therapy and to develop a model of clinical audit and guidelines for use by practitioners and managers. The focus in this paper is the model development. Included are examples of audits relevant to different types of health care quality that illustrate the process of clinical audit using the model. The modelling process involved interrogating the clinical audit cycle and related cycles against the data and identifying their inter-connecting links. The model was refined and reformulated to include guidelines for the professions on what is needed to make clinical audit work. The position of the professional service manager is crucial. A mandate that includes creating machinery at provider unit level, mobilizing the principal working groups and promoting internalization of audit by practitioners, is essential for audit to be effective.

England↗
PubMed2004

Prescribing therapy services for children with motor disabilities.

Pediatricians often are called on to prescribe physical, occupational, and speech-language therapy services for children with motor disabilities. This report defines the context in which rehabilitation therapies should be prescribed, emphasizing the evaluation and enhancement of the child's function and abilities and participation in age-appropriate life roles. The report encourages pediatricians to work with teams including the parents, child, teachers, therapists, and other physicians to ensure that their patients receive appropriate therapy services.

Activities of Daily Living↗
PubMedDate not supplied

Views of young people using augmentative and alternative communication systems.

Children with physical impairments who cannot use intelligible speech are often recommended augmentative and alternative communication (AAC) systems. In England and Wales, it is usually the job of speech and language therapists to support development in AAC skills. This paper reports findings from discussion with children and young people who use AAC systems concerning their attitudes and opinions towards the organization of speech and language therapy, the role of the speech and language therapist in school and issues concerned with AAC systems themselves. Six young adults and 17 children from London education authorities were interviewed on a one-to-one basis and in focus groups. Children were interviewed who had a communication aid incorporating at least 20 symbols and/or pictures and/or written words, language understanding at the two-word level and above, i.e. they demonstrated understanding of adult requests with at least two information carrying words. For children using communication aids, it is conceivable that their communication systems do not contain appropriate symbol vocabulary to express complex ideas, opinions and feelings. Consequently, a symbol-based interview tool was designed to allow children to express complex issues through visual means. Most children interviewed reported that their AAC system was useful to them. Further analysis of opinions revealed that negative attitudes towards AAC systems were primarily associated with operational issues (technical skills required to operate an AAC system) and issues of self-image/identity, and to some degree, with a lack of perceived benefit in interaction. In apparent contrast to therapists' preferred models of working, children and young people identified a preference for therapy organized on a one-to-one basis targeting linguistic and operational skills. It is suggested that more acceptable and individualized design of AAC systems could have implications for their use in school and other contexts. The value of service users' views in service planning and evaluation are discussed.

Adult↗
PubMed2005

The relation between therapy intensity and outcomes of rehabilitation in skilled nursing facilities.

OBJECTIVE: To examine the relation between therapy intensity, including physical therapy (PT), occupational therapy (OT), and speech and language therapy (SLT), provided in a skilled nursing facility (SNF) setting and patients' outcomes as measured by length of stay (LOS) and stage of functional independence as measured by the FIM instrument. DESIGN: A retrospective analysis of secondary data from an administrative dataset compiled and owned by SeniorMetrix Inc. SETTING: Seventy SNFs under contract with SeniorMetrix health plan clients. PARTICIPANTS: Patients with stroke, orthopedic conditions, and cardiovascular and pulmonary conditions (N=4988) covered by Medicare+Choice plans, and admitted to an SNF in 2002. INTERVENTIONS: Not applicable. MAIN OUTCOMES MEASURES: LOS and improvement in stage of independence in the mobility, activities of daily living (ADLs), and executive control domains of function as determined by the FIM instrument. RESULTS: Higher therapy intensity was associated with shorter LOS ( P <.05). Higher PT and OT intensities were associated with greater odds of improving by at least 1 stage in mobility and ADL functional independence across each condition ( P <.05). The OT intensity was associated with an improved executive control stage for patients with stroke, and PT and OT intensities were associated with improved executive control stage for patients with cardiovascular and pulmonary conditions ( P <.05). The SLT intensity was associated with improved motor and executive control functional stages for patients with stroke ( P <.05). Therapy intensities accounted for small proportions of model variances in all outcomes. CONCLUSIONS: Higher therapy intensity was associated with better outcomes as they relate to LOS and functional improvement for patients who have stroke, orthopedic conditions, and cardiovascular and pulmonary conditions and are receiving rehabilitation in the SNF setting.

Activities of Daily Living↗
PubMed2004

The use of developmental rehabilitation services. Comparison between Bedouins and Jews in the south of Israel.

Some communities have peripheral zones inhabited by persons with a different culture than the majority of the general population, such as the Aboriginals in Australia, the Native Americans in the U.S. and Canada, the Eskimos in Lapland, and the Bedouins in Israel. These citizens are not receiving the same medical or rehabilitation services as the citizens of the metropolitan areas due to the fact that health and welfare programs are not adapted to their unique needs. At the Soroka University Medical Center in Beer-Sheva, Israel, the health and rehabilitation services have a very large and heterogeneous catch-up population serving most of the south of Israel. The purpose of this study was to look at the utilization and the number of appointments for child rehabilitation services by the Bedouin population compared to the general population in the south of Israel at the Zusman Child Development Center (CDC). The records of appointments to the CDC between the years 1995-1999 inclusive were studied and we randomly chose to limit the study to January, April, July, and October of each year, and randomly chose the daily records of nine therapists, three from each discipline (occupational therapy [OT], physical therapy [PT], and speech and language therapy [SLT]). There were 8,504 appointments during these 4 months of the years 1995-1999, 2,255 of which were for Bedouin and 6,249 for Jewish children. Noncompliance with therapy appointments (NCTA) for the same period for both the Bedouins (31%) and Jewish children (26%), with a significant difference between the two populations, was noted. Of all the Jewish childrens' appointments, the percentage of all three services was similar: 33% to PT, 38% to OT, and 29% to SLT, but for the Bedouin children, the percentage between the three services was significantly different: 62% to PT, 34% to OT, and 3% to SLT. These results seem to indicate that the Bedouin families prefer the PT and OT over the SLT. Our results enhanced the need for planning a model for supplying health services adapted to clients coming from different cultures. According to this model, we need to take into consideration the cultural differences, the accessibility to rehabilitation services, and the economical impact on the family; all in all, to give a better solution to the patient with special needs.

Appointments and Schedules↗