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PubMed2005

Treatment planning for patients with autism spectrum disorders.

Patients with autism spectrum disorders (ASDs) can present with extremely heterogeneous issues, and, therefore, their treatment can be very challenging. Most patients with ASDs will benefit from contact with a multitude of disciplines. In this article, treatment planning is structured in terms of the patient's life stages. Early on, assessment of developmental milestones, metabolic conditions, and hearing; making the diagnosis of ASD; and providing genetic counseling are salient. As the child grows, speech and language therapy, early intensive intervention, special education, parent training, and neurologic assessment become important. With greater age, behavior therapy, pharmacotherapy, occupational therapy, and sexuality issues are often in ascendancy. As the patient approaches and proceeds through adulthood, transition training, housing options, and guardianship issues may be priorities. Advocacy is relevant throughout the life span. Professionals have an obligation to familiarize parents with interventions likely to be fruitful or unhelpful. There is growing evidence that early intensive behavior intervention, though expensive, may produce lifelong gains in functioning. A variety of experimental and/or unproven treatments are identified; mental health professionals can help families with members who have ASDs by guiding them toward effective treatments and away from therapies of unknown value but with potential risks and/or costs.

Age Factors↗
PubMed1998

Evaluation of an approach for adults with profound learning difficulties.

A local day care unit for adults with profound learning disabilities is a popular community project. It receives many visits from students and volunteers and is also visited by a variety of support staff. The presence of these visitors makes an impact on the Unit's communication environment. A nursing and speech and language therapy project used photography to address the visitors' perceptions of the clients' communication and identify the visitors' information needs about the clients' communication skills. As a result of this evaluation the induction policy was changed and the leaflets were introduced. The time commitment to the initial project for therapy and nursing staff is discussed in relation to the effective and alternative use of therapeutic time for this client group.

Adult↗
PubMed1997

Outcome measures for aphasia therapy: it's not what you do, it's the way that you measure it.

The development of outcome measures is now seen as crucial within the National Health Service (NHS), and the outcome of aphasia therapy is an area which has for some years been under particular scrutiny. Many districts have developed their own measures and others have taken part in cross-district pilot schemes, but it is not clear how widely used measures are, nor what form they take. This paper presents the results of a questionnaire survey of speech and language therapy services in England and Wales regarding their use of outcome measures for aphasia therapy. The questionnaire requested factual information about the use of measures, and therapists' opinions of their benefits and drawbacks, and also asked for examples of outcome measures currently in use. We summarise the results of the questionnaire and discuss the therapists' and our own perceptions of the merits of the different approaches reported.

Aphasia↗
PubMed1998

An audit tool for health visitors and SLTs working with the pre-school population.

This paper will present the preliminary findings of a national Royal College of Speech and Language Therapists audit of speech and language therapy and health visiting services to the pre-school population. The audit was carried out in six districts of the United Kingdom, representing a broad range of locations and models of service delivery. The purpose of the audit was to evaluate specific aspects of the management of children with speech and language difficulties. Audit tools were applied to referral and selection procedures, inservice training and parent programmes. Preliminary findings and their implications are discussed.

Child, Preschool↗
PubMed2002

Cross-sector working: speech and language therapists in education.

Current policies and practices concerning speech and language therapy provision in schools are reviewed and issues which remain to be addressed are considered A general move to cross-sector approaches has resulted in a move to indirect therapy through assistants, and the effectiveness of this requires to be established. Funding streams for therapy differ across the UK, and despite extensive research and policy development remain somewhat unclear and vulnerable. The implications for policies on 'joined up thinking" are considered.

Allied Health Personnel↗
PubMed1984

Assessment of efficacy of intervention in hearing impaired children with speech and language deficits.

The diagnosis of hearing loss in children with speech and language deficits by the otorhinolaryngologist involves a large allocation of sources. The ability to assess the efficacy of intervention in order to minimize speech and language deficits is an aspect in the care of these children which has not been generally considered as part of the child's ongoing medical care. These children have speech and language deficits predominantly from hearing impairment and occasionally from a primary language disorder. The effect of intervention (usually a hearing aid), the special education program for the hearing impaired child, and the language therapy for the child with a primary language disorder are seldom measured. The ability to assess and monitor the child's progress is essential for the care of these patients. The continual monitoring of the child's progress is accomplished by periodic assessment of the child's speech and language. An instrument to do this has been developed and used by the Department of Otorhinolaryngectomy at the Albert Einstein College of Medicine for a number of years. The utilization of this instrument, as demonstrated by a series of case reports, will be presented. These will include children in which intervention was successful and those for whom it was unsuccessful, with an analysis of the reasons underlying the effectiveness for each child. It is recommended that every child with a speech and language deficit should be monitored periodically so that the child's progress, or lack of progress, can be determined. If the child is not progressing, additional remediation can be instituted to attempt to prevent a permanent speech and language deficiency.

Child↗
PubMed1978

The development of pronoun usage in the psychotic child.

Twenty-three psychotic children ranging in age from 5 to 16 were interviewed in half-hour play sessions. The play session comprised three activities designed to elicit statements using the pronouns I, you, and he to express the concepts of possession, action, and description. It was hypothesized that psychotic children would use the third-person pronoun he more readily than the first-person pronoun I (Hypothesis I), and that possession, action, and description statements would develop in an orderly sequence as predicted by Bosch (1962/1970) (Hypothesis II). Hypothesis I was not confirmed: Some of the least advanced psychotic children used the pronoun I, and only the most advanced children used you and he. Hypothesis II was confirmed: the least advanced children used pronouns correctly in statements expressing the concept of possession, whereas the most advanced children had mastered all three contexts of pronoun use. These results have implications for language therapy, and they are concordant with the language theories of Piaget and Werner and Kaplan.

Adolescent↗
PubMedDate not supplied

Kindergarten risk factors, cognitive factors, and teacher judgments as predictors of early reading in Dutch.

This study focused on the predictive value of risk factors, cognitive factors, and teachers' judgments in a sample of 462 kindergartners for their early reading skills and reading failure at the beginning of Grade 1. With respect to risk factors, enrollment in speech-language therapy, history of dyslexia or speech-language problems in the family, and the role of gender were considered. None of these risk factors were significantly related to reading performance. Cognitive factors in this study included letter knowledge, rapid naming ability, and nonword repetition skills. Of these skills, letter knowledge seemed to have the highest correlation with reading. Kindergarten teachers' judgments, including a task assignment scale and teachers' predictions, demonstrated a significant relationship with reading. Finally, to judge whether these predictors could identify reading disabilities, the discriminatory power of all predictors was assessed and appeared to be insufficient. Implications for screening purposes are discussed.

Child↗
PubMed1998

Three into one will go! Collaborative practice in practice.

This paper is concerned with three speech and language therapy services from neighbouring NHS trusts and the single education authority they all share. The authors have always been committed to working collaboratively with local services but found the competitive health care environment of the late 1980s and early 1990s often-made this difficult. It describes how the three services came together to identify common service issues for children of school-age with speech and language difficulties and how these were addressed.

Age Factors↗
PubMed1981

The effectiveness of operant language training with autistic children.

Studies of operant language therapy with autistic children have indicated that behavioral techniques may be of value in increasing the language skills of such children. A review of recent studies, however, suggests that in the absence of adequate experimental controls, misleading conclusions may be drawn about the effectiveness of treatment. It is also apparent that the effects of therapy vary according to the linguistic competence of the children involved, and to the different aspects of language ability being taught. The implications of recent findings for our understanding of the basic deficit underlying early childhood autism are discussed.

Autistic Disorder↗
PubMed1998

PATSy: a distributed multimedia approach to client assessment skills training.

This paper describes the development of an interactive distributed multimedia system (PATSy). When completed, it will serve as a repository of brain-injured clients and their test data for use by speech and language therapy students and researchers. In education, PATSy will be a resource which is flexible enough to accommodate various teaching pedagogies as well as support student learning in clinical assessment and diagnosis of various disorders.

Clinical Competence↗
PubMed1996

Nonword repetition as a behavioural marker for inherited language impairment: evidence from a twin study.

The Children's Nonword Repetition Test (CNRep) was given 39 children with persistent language impairment (LI), 13 with a history of having received speech-language therapy (resolved LI), and 79 controls, all aged from 7 to 9 years. The children with LI were twins who had participated in a previous genetic study. Children with resolved LI, as well as those with persistent LI, were significantly impaired on the CNRep. Comparisons of MZ and DZ twins indicated significant heritability of a CNRep deficit. It is concluded that CNRep provides a marker of the phenotype of heritable forms of developmental language impairment.

Child↗
PubMed1998

Why are there so few ethnic minority speech and language therapists?

This report summarises the outcome of a pilot study to investigate the recruitment of ethnic minority students to speech and language therapy, physiotherapy and dietetics courses. The study also sought to identify factors contributing to the low representation of these students on the named courses through interviews and questionnaires to careers advisors, school students and course admissions tutors. Recommendations for changes in practice are made.

Dietetics↗
PubMed2003

Bilateral cochlear implantation in children.

AIMS: to determine the benefit of bilateral cochlear implantation in a child on speech and language development. METHOD: This child got her first implant, a Nucleus 24-system, on the right side at the age of 2.5 years. The left side was implanted at the age of 4.4 years with a Nucleus 24Contour-system. On the right side she's now wearing an Esprit 24-speechprocessor (SPR). On the left side she has a Sprint-SPR. M. goes to a mainstream school and receives Speech and Language therapy in a Speech and Hearing Rehab Centre. The etiology of her deafness was hyperbilirubinemia. Auditory capacity and speech recognition tests were performed for both ears separately and together. RESULTS: Aided thresholds give a PTA of 28 dBA with the first implant, 22 dBA with the second implant and with both implants we get a PTA of 23 dBA. Results for speech identification and recognition demonstrated an increased performance when both implants are used together. Speech and language development was equivalent to the mean of age 4.5. At the time of testing M. was 4.8 years. At this time the speech and language development show no delays with normal hearing children. CONCLUSIONS: bilateral cochlear implantation in children may have additional value for their speech and language development. Also, implantation may be considered when auditory neuropathy is likely.

Child, Preschool↗
PubMed1998

Use of elaborative encoding to facilitate verbal learning after adolescent traumatic brain injury.

OBJECTIVE: To investigate the effectiveness of elaborative encoding in learning and remembering word definitions after traumatic brain injury (TBI). DESIGN: Two case studies. SETTING: University outpatient clinic. PARTICIPANTS: Two adolescents with severe memory impairments after TBI who needed specific vocabulary for school. INTERVENTIONS: A series of individual speech-language therapy sessions incorporating clinician- and subject-generated strategies to facilitate elaborative encoding. Target words were based on school requirements and pretreatment test results and were assigned randomly to treatment or control groups. MAIN OUTCOME MEASURE: Accuracy of free-recalled definitions at the conclusion of therapy and after 1 month with no therapy. RESULTS: Significant improvement in expressed word knowledge at the conclusion of therapy, with improvement on treated words maintained at 1 month for both subjects. CONCLUSIONS: Elaborative encoding was an effective tool for teaching specific information required for school. Patterns of response differed substantially from those of normally developing children. Generalization to classroom use was planned for and should be measured in future research.

Accidents, Traffic↗
PubMed1998

Addressing the needs of a clinical service in the operational constraints of commissioning.

Limited resources, increased demand and current commissioning structures has put the rationalisation of health care high on the agenda. Any prioritisation process needs to be clinically led and client driven so reactive ad hoc arrangements are minimised and structures for good practice enabled. This paper argues that the current context be used as an opportunity to critically evaluate the services speech and language therapy aim to provide. By defining our aims and demonstrating the range and boundaries of our effect we can be proactive in structuring our services appropriately. Such an exercise currently underway in City and Hackney is outlined which aims to: describe an optimum structure for provision and the resources required, propose possible models within current resource and highlight the gap between the two.

Child↗