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PubMed2004

Intensive language training enhances brain plasticity in chronic aphasia.

BACKGROUND: Focal clusters of slow wave activity in the delta frequency range (1-4 Hz), as measured by magnetencephalography (MEG), are usually located in the vicinity of structural damage in the brain. Such oscillations are usually considered pathological and indicative of areas incapable of normal functioning owing to deafferentation from relevant input sources. In the present study we investigated the change in Delta Dipole Density in 28 patients with chronic aphasia (>12 months post onset) following cerebrovascular stroke of the left hemisphere before and after intensive speech and language therapy (3 hours/day over 2 weeks). RESULTS: Neuropsychologically assessed language functions improved significantly after training. Perilesional delta activity decreased after therapy in 16 of the 28 patients, while an increase was evident in 12 patients. The magnitude of change of delta activity in these areas correlated with the amount of change in language functions as measured by standardized language tests. CONCLUSIONS: These results emphasize the significance of perilesional areas in the rehabilitation of aphasia even years after the stroke, and might reflect reorganisation of the language network that provides the basis for improved language functions after intensive training.

Adult↗

PubMed2006

The effect of a therapy dog on the communication skills of an adult with aphasia.

UNLABELLED: Little evidence-based research has been published within the field of communication disorders on the role of dogs as catalysts for human communication. This single participant study, a point of entry into this realm of research, explores the effects of a therapy dog on the communication skills of a patient with aphasia receiving intensive speech and language therapy within a rehabilitation setting. The researchers conclude that the presence of the dog does have the potential to stimulate both overt social-verbal and social-nonverbal communication. LEARNING OUTCOMES: As a result of this activity the reader will be able to (1) describe the beneficial role of dogs to serve as catalysts for human communication (2) describe ways in which a person with aphasia may be assisted by a therapy dog and (3) become familiar with an animal-assisted therapy (AAT) program set-up for patients with communication disorders within a rehabilitation setting.

Affect↗

PubMed1997

Promoting recovery in chronic aphasia with an interactive technology.

OBJECTIVE: To assess chronic aphasic patients' responses to resumption of therapy using an innovative, computer-based treatment system. DESIGN: Patients were assessed pretreatment and posttreatment using standardized assessment tools. Pretreatment and posttreatment performance score means were computed and compared, with statistical significance of the differences established using a one-tailed, matched t test. SETTING: The work was conducted at (1) a Veterans Affairs medical center participating in treatment research and (2) a regional aphasia center delivering therapy services for reimbursement. PATIENTS: Chronic aphasic patients (n = 23) from 6 months to more than 15 years postonset were enrolled in the study. They included a wide range of types and severities of aphasia, and all had received traditional speech-language therapy services earlier. INTERVENTIONS: All patients were treated in 1-hour clinical sessions by speech-language pathologists using the designated computer-based treatment system. All but one of the patients had access to the computer-based treatment system at home for practice between clinical therapy sessions. MAIN OUTCOME MEASURES: The outcome measures used were (1) the Porch Index of Communicative Ability (PICA), (2) the Boston Naming Test (BNT), (3) the Western Aphasia Battery (WAB), and (4) the Boston Diagnostic Aphasia Examination (BDAE). RESULTS: The majority of patients improved significantly in multiple modalities as assessed by these instruments. CONCLUSIONS: Specific measures of language function can be broadly, positively, and significantly influenced by computer-based language therapy in chronic aphasia.

Adult↗

PubMed1999

Myofunctional therapy: brief intervention.

This study addresses speech-language therapy in orofacial myology utilizing a Brief Intervention (in Portuguese: IntervenAão Fonoaudiológica Breve) (IFB). IFB is applied to patient groups between the ages of 8 and 15 years with orthodontic/orthopedic appliances in 1997. Results are presented indicating the advantages of using IFB for breathing, feeding, oral-facial habits, buccal hygiene and corporal posture/physical activity. It concludes that Brief Intervention can be accomplished in 8 sessions, is economically advantageous for use in group therapy, and may be used before or in conjunction with Myofunctional Therapy/Myotherapy.

Adolescent↗

PubMed1998

Equitable service provision for inclusive education and effective early intervention.

This paper illustrates one model of providing an integrated paediatric speech and language therapy service which attempts to meet the demands of both inclusive education and effective early intervention. A move has been made from location-oriented therapy provision to offering children and their families equal opportunities to have appropriate intervention according to need. The model incorporates the philosophy of inclusive education and supports the development of current specialist educational establishments into resource bases of expertise for children with special needs in mainstream schools.

Child↗

PubMed2006

The role of music therapy in an interdisciplinary approach to address functional communication in complex neuro-communication disorders: a case report.

PURPOSE: This paper presents a case report of collaborative work between speech and language therapy (SLT) and music therapy (MT) in the case of an individual presenting with complex communication difficulties and lability caused by pseudo-Parkinsonian vascular disease. DESIGN: MT intervention was used to investigate whether participation could be enabled in a client presenting with complex problems as well as facilitate change in communication parameters which remained unresponsive to conventional SLT intervention. A single case design measured communication and well-being parameters using pre-, during and post-intervention measures. In addition, analysis of the client's musical responses was undertaken to examine changes in vocal functioning which are involved in communication. RESULTS: Analysis of the client's performance during MT intervention revealed improvements in prosody and phonation, with positive reports of participation, reduced incidence of lability and improvements in measures of well-being. CONCLUSIONS: The results indicate the value of such collaborative working in addition to making recommendations for the modification of existing treatment protocols. The findings highlight that fatigue is a major consideration when working with people with severe and complex clinical presentations.

Aged↗

PubMed2005

High scores on the Western Aphasia Battery correlate with good functional communication skills (as measured with the Communicative Effectiveness Index) in aphasic stroke patients.

OBJECTIVE: To examine the correlation between an impairment-level and a functional-level assessment scale of aphasia. DESIGN: Prospective, longitudinal study. SETTING: A stroke rehabilitation unit. SUBJECTS: Sixty-seven aphasic acute stroke patients who were undergoing a multi-disciplinary rehabilitation programme, including conventional speech and language therapy (SLT). INTERVENTION: Patients were assessed on study entry and 4, 8, 12 and 24 weeks after the start of SLT. The language impairment was assessed with the Western Aphasia Battery (WAB) and the communicative functional limitation associated with aphasia was measured with the Communicative Effectiveness Index (CETI).Results. There was a statistically significant correlation between the two scales for all assessment periods (Pearson's r=0.71; P<0.01). CONCLUSION: The study suggests that in the acute and subacute stages of stroke the scores of WAB and CETI can be surmised from one another.

Acute Disease↗

PubMed1980

Cri du Chat: report of a case.

Since Lejeune et al. (1963) first described the syndrome of Cri du Chat (Cry of the Cat), cases have been described in the literature in terms of genetic abnormalities. All cases were severely retarded and the mental impairment has been believed to be progressive, although no longitudinal studies have been reported. Descriptions of speech and language behavior have been scarce. This paper presents a case of a 7-yr, 6 mo-old girl with Cri du Chat who has received speech and language therapy for five years. Her speech, language, and mental development are noted and are not consistent with cases reported previously.

Child↗

PubMed2004

Are there inequalities in the provision of stroke care? Analysis of an inner-city stroke register.

BACKGROUND AND PURPOSE: There is evidence of unequal access to health care interventions even where universal health systems operate. We investigated associations between patients' sociodemographic characteristics and the provision of acute and longer-term stroke care in a multiethnic urban population. METHODS: We used data from 1635 patients with first-ever stroke, collected by a population-based stroke register from 1995 to 2000. Using multivariable analyses, controlled for sociodemographic and clinical factors, we investigated access to 22 evidence-based components of care. RESULTS: 1392 patients (85.1%) were admitted to hospital; of these, 354 (25.4%) were admitted or transferred to a stroke unit. Of those with clinical need, 607 (70.7%) received physical therapies; 477 (59.8%) received speech and language therapy. Older age was associated with lower odds of hospitalization (odds ratio [OR], 0.50; 95% CI, 0.32 to 0.77, P=0.02) and diagnostic brain imaging (OR, 0.15; 95% CI, 0.08 to 0.30, P<0.01) but higher odds of receiving physical therapy (OR, 4.24; 95% CI, 1.22 to 14.73, P<0.01). Black ethnicity was associated with higher odds of stroke unit admission (OR, 1.59; 95% CI, 1.01 to 2.49, P<0.04). There was a weak association between socioeconomic status and admission to hospital and stroke unit. Gender was associated only with treatment of hypertension before stroke. CONCLUSIONS: Provision of individual components of care over 1 year varied for specific sociodemographic categories, but there was no consistent pattern of inequality. Clinical decision-making processes are likely to influence these patterns. Further information about clinician and patient roles in decision making is required.

Aged↗

PubMed1996

A content analysis of the professional journal of the British Society of Speech Therapists. I: The first 10 years. Spotlight on 'Speech' 1935-1945.

The 24 editions of the professional journal 'Speech' published between 1935-1945 were examined by use of content analysis. The use of this approach enabled an in-depth survey of the professional, clinical and political issues of the period which saw the beginning of speech and language therapy as a profession. Two main areas were focused upon: the development of the professional body and the authored papers which appeared in the journal. 'Speech' at that time can be viewed as a blend of today's 'European Journal of Disorders of Communication' with today's 'Bulletin'.

Bibliometrics↗

PubMed1998

Innovation and partnership: the voluntary sector contribution.

I CAN building on its long experience of integrating education and speech and language therapy in its specialist speech and language schools, has pioneered a variety of new approaches to collaborative working for the benefit of children. This paper describes three examples of relatively new services: Specialist nurseries; Teach Speech: a pilot project for primary aged children using videoconferencing; and Secondary School Language Resources within mainstream schools. Studies to evaluate the effectiveness of some of the services are also reported. All three types of service described demonstrate effective collaboration between at least two of the following three sectors: voluntary, statutory and private. The potential and benefits of this collaboration are highlighted.

Adolescent↗

PubMed1996

Bridging the gap between theory and practice: a multimedia tutorial for students of voice therapy.

A computer-based tutorial for speech and language therapy students is described in which a digitized video-recording of a diagnostic interview with a voice-disordered client was dynamically linked to an on-screen transcript window. A student-centered tutorial package, which provided guidance through questions, assessment tasks, and commentary from an experienced speech and language pathologist as well as the lecturer in voice disorder, was constructed. Evaluation of the tutorial as an aid to active learning, including feedback from students and supervising clinicians, is reported and the role of this type of program as a preparation for clinical practice is discussed.

Adult↗

PubMed1989

An effective day treatment model for young children with pervasive developmental disorders.

A day treatment program was provided for 31 children (ages 2 through 6) with DSM-III diagnoses of infantile autism or pervasive developmental disorder. The main intervention strategies were use of positively charged affective experiences to aid the development of close interpersonal relationships, use of play in all its interpersonal, cognitive, and structural variety, and a pragmatics-based language therapy model delivered within a highly predictable and carefully structured milieu. Over a 6-month intervention period, subjects demonstrated significant treatment effects in cognition, perceptual/fine motor, social/emotional, and language skills, which were maintained or increased over a 12- to 18-month treatment period. Play skills increased significantly in symbolic complexity, symbolic agency, and symbolic substitutions. Additionally, there was significant reduction of autistic symptomology.

Affect↗

PubMed1998

Outcome measurement in adult stuttering therapy: a self-rating profile.

The speech and language therapy profession is committed to the use of outcome measurement to maximise both efficiency and efficacy. However, measuring change in adult stuttering therapy is particularly problematic. It is proposed that outcomes of therapy should include stuttering behaviours, reactions to stuttering and handicap resulting from stuttering. Current methods of measuring change are reviewed. The Wright & Ayre Stuttering Self-Rating Profile (WASSP) is described which includes clients' perceptions of stuttering behaviours, avoidance, feelings and disadvantage. Issues of reliability and validity are considered.

Adult↗

PubMed2000

Factors affecting language development in West African children: a pilot study using a qualitative methodology.

Data on referral patterns to pre-school facilities for speech- and language-delayed children suggest that West African children are over represented relative to other ethnic/language groups. This study was set up as a pilot to explore some of the issues which distinguish this group of children and their families. A qualitative methodology was adopted to access the views of a small group of parents (nine) and professionals with direct experience of these services (three). Between them the parents had a total of 11 children who had received speech and language therapy services. Extensive in-depth interviews were transcribed and coded. The families are predominantly well educated with high expectations for their children. Their beliefs about child development in general and language development often differed from those of the professionals interviewed. For example, parents saw little direct link between very early language stimulation and subsequent school performance. West African parents also perceived that they had different (higher) expectations of behaviour than other families. It was generally accepted by all parties that the West African community experiences a high degree of stress resulting from a combination of interacting factors, namely pressures relating to employment, to immigration status, to matters financial and to expectations from family back in their own country. It is unclear exactly how these impact on the development of the child but there is an awareness that there may be a negative effect of such stress and that children's speech and language development may be one aspect of development that is affected. As a result of this pilot study a number of mechanisms relating to the relationship between environment factors and language development are proposed and suggestions are made regarding service provision for this community.

Africa↗

PubMed2006

Fibreoptic endoscopic evaluation of swallowing and videofluoroscopy: does examination type influence perception of pharyngeal residue severity?

OBJECTIVES: The aim of the study was to investigate whether the type of instrumental swallowing examination (Fibreoptic Endoscopic Evaluation of Swallowing (FEES) or videofluoroscopy) influences perception of post-swallow pharyngeal residue. DESIGN: Prospective, single-blind assessment of residue from simultaneous videofluoroscopy and FEES recordings. All raters were blind to participant details, to the pairing of the videofluoroscopy and FEES examinations and to the other raters' scores. SETTING: Tertiary specialist ENT teaching hospital. PARTICIPANTS: Fifteen adult participants consecutively recruited; seven women and eight men aged between 22 and 73, mean age 53. All participants underwent one FEES examination and one videofluoroscopy examination performed simultaneously. INCLUSION CRITERIA: referred to speech and language therapy for assessment of dysphagia. EXCLUSION CRITERIA: nil by mouth or judged to be at high risk of aspiration. MAIN OUTCOME MEASURES: The FEES and videofluoroscopy examinations were recorded simultaneously. Fifteen speech and language therapists independently scored pharyngeal residue as none, coating, mild, moderate or severe. All examinations were scored twice by all raters. RESULTS: Intra- and inter-rater agreement were similar for both examinations. There were significant differences between FEES and videofluoroscopy pharyngeal residue severity scores (anova, P < 0.001). FEES residue scores were consistently higher than videofluoroscopy residue scores. CONCLUSIONS: Pharyngeal residue was consistently perceived to be greater from FEES than from videofluoroscopy. These findings have significant clinical implications as FEES and videofluoroscopy findings are used to judge aspiration risk and to make recommendations for oral intake. Further research is required to examine the impact of FEES and videofluoroscopy examinations on treatment decisions.

Adult↗

PubMed2005

Effects of computer-based intervention through acoustically modified speech (Fast ForWord) in severe mixed receptive-expressive language impairment: outcomes from a randomized controlled trial.

Seventy-seven children between the ages of 6 and 10 years, with severe mixed receptive-expressive specific language impairment (SLI), participated in a randomized controlled trial (RCT) of Fast ForWord (FFW; Scientific Learning Corporation, 1997, 2001). FFW is a computer-based intervention for treating SLI using acoustically enhanced speech stimuli. These stimuli are modified to exaggerate their time and intensity properties as part of an adaptive training process. All children who participated in the RCT maintained their regular speech and language therapy and school regime throughout the trial. Standardized measures of receptive and expressive language were used to assess performance at baseline and to measure outcome from treatment at 9 weeks and 6 months. Children were allocated to 1 of 3 groups. Group A (n = 23) received the FFW intervention as a home-based therapy for 6 weeks. Group B (n = 27) received commercially available computer-based activities designed to promote language as a control for computer games exposure. Group C (n = 27) received no additional study intervention. Each group made significant gains in language scores, but there was no additional effect for either computer intervention. Thus, the findings from this RCT do not support the efficacy of FFW as an intervention for children with severe mixed receptive-expressive SLI.

Analysis of Variance↗

PubMed1995

Parents and families of children with communication disorders.

The role of parents in the development of the communicative competence of their children has been of growing interest to researchers and practitioners in the field of speech and language therapy. Researchers have attempted to define and test specific hypotheses regarding the nature and degree of the influence of parental interaction styles upon the developing child's pragmatic skills. The literature includes studies regarding normal children and those with speech and language impairments. Practitioners have endeavoured to move towards a firmer framework of partnership with parents which will ultimately be of benefit to children with speech and language impairments and their families.

Child↗