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PubMed1992

Can the Lombard effect be used to improve low voice intensity in Parkinson's disease?

Low voice intensity is a common problem in Parkinson's disease. It is typically resistant to drug therapy and often persists despite extensive behavioural speech and language therapy. Based on previous findings that masking noise will produce a consistent increase in voice intensity in most normal individuals, the effects of white masking noise, presented at a sound pressure level of 90 dB, was examined in 10 parkinsonian patients with low voice intensity. Results indicated that all Parkinson's disease patients showed a marked increase in their voice intensity. Given this finding, it is proposed that masking noise may be an effective treatment for reduced voice intensity in parkinsonian speakers, particularly with the future adaptation of portable voice-activated maskers, such as the Edinburgh Masker.

Aged↗

PubMed2001

Voice therapy outcomes in vocal fold nodules: a retrospective audit.

Twenty-six speech and language therapy (SLT) clinical files, in which patients presented with a medical diagnosis of bilateral or unilateral vocal fold nodule(s), were audited retrospectively over a six year period (1992-1998). The objective of the study was to evaluate current practice within our trust in the management of patients with vocal fold nodules against what was considered 'best practice' and to take action for improvements where deficits were identified. Multidimensional outcome measurements were employed. This study lends support to experimental findings of treatment effectiveness. Results demonstrated elimination and/or reduction of vocal fold nodules in over 70% of clinical files audited. Post-therapy over 80% of patients presented with either a normal voice quality or a mild degree of dysphonia.

Adolescent↗

PubMed1998

Making team working work--a real life experience.

Southern Derbyshire Speech and Language Therapy Department has a team of six specialist speech and language therapists who support children with Specific Language Impairment in their mainstream schools via joint commissioning with education. As the team expanded in October 1995 this coincided with health trust and education changes and produced great instability and insecurity within the team. This paper outlines the implementation of a formal team working package using a facilitator provided by the trust's quality team and shows how it is possible to problem solve and develop within a framework of group rules, such as honesty and openness. Following its success its principles have allowed us to co-operate more effectively with both school staff and the community team and to support colleagues through a re-organisation of their service.

Education, Special↗

PubMed1991

Follow-up of infants treated with extracorporeal membrane oxygenation for newborn respiratory failure.

Follow-up studies were conducted to assess the medical and developmental outcome of 92 infants treated with extracorporeal membrane oxygenation at the University of Michigan. Of 118 near-term (greater than 34 weeks' gestation) infants who received extracorporeal membrane oxygenation, 103 (87%) were surviving and available for follow-up at between 1 and 7 years of age. Ninety-two of these children were seen on at least one occasion. Each visit included a history and physical examination, an evaluation by a physical therapist, and developmental testing by a pediatric psychologist. Medical outcome during year 1 found 31% of the children rehospitalized, primarily with respiratory illness. Outpatient-treated lower respiratory tract illness was seen in an additional 31% of the children. New or nonstatic neurologic problems were noted in 6% of the children. Abnormal growth during year 1 occurred in 26% of the children. At last clinic visit 16% of the children exhibited moderate-to-severe neurologic abnormalities, and 8% had moderate-to-severe cognitive delay. Sensorineural hearing loss occurred in 4% of children. Nine percent of the children were receiving speech and language therapy; screening tests showed that an additional 6% had speech and language delay. Overall, at last visit 16 (20%) of the children exhibited some type of handicap. A review of the literature on follow-up studies of non-extracorporeal membrane oxygenation-treated infants with persistent pulmonary artery hypertension produced an impairment rate of 18.5%. Outcome post-extracorporeal membrane oxygenation appears similar to that seen in less ill cohorts of infants treated with more "conventional" therapy. Long-term follow-up of all such infants remains essential.

Child↗

PubMed1991

[Speech cannula for children with tracheotomy and oxygen inhalation therapy].

Because of various possible problems tracheotomy in children should be performed only in urgent cases and should be sewed up as soon as possible. Early language therapy and the use of cannulas with speaking device promote language development. We propose a special silver cannula with speaking device for children with oxygen dependence due to bronchopulmonary dysplasia.

Bronchopulmonary Dysplasia↗

PubMed1993

A material-control single-case study of the efficacy of treatment for written and oral naming difficulties.

Twenty-two right-handed aphasics with written and/or oral naming difficulties were treated with a traditional language therapy: copying and repetition of words. The efficacy and maintainability of the treatment were evaluated using a variation of the single-case design, which was termed the material-control single-case design. Effectiveness of the treatment for written naming difficulty was demonstrated for 9 of 21 subjects in a first treatment and 3 of 14 subjects in a second treatment. Three of the 14 subjects benefitted overall from both treatments in written naming. In oral naming, 2 of 18 subjects responded well to the first treatment while 2 of 16 responded well to the second treatment. One of the 16 subjects showed benefits from both the first and second treatments in oral naming. Although written and oral naming disturbances were difficult to improve using ordinary language treatment, a small proportion of subjects clearly showed effectiveness of the therapy. Maintenance of the effects of treatment was observed in all of the improvers.

Adult↗

PubMedDate not supplied

Treating children with expressive phonological disorders: does phonological awareness therapy work in the clinic?

BACKGROUND: Recent research has shown that phonological awareness therapy can improve speech production in children with expressive phonological disorders. This approach may be appealing to clinicians as the therapy may also benefit the children's general phonological abilities and lead to gains in their literacy skills. AIMS: To examine the effectiveness of phonological awareness therapy under conditions more similar to those prevailing in many speech and language therapy clinics. Children were treated in small groups and less intensive therapy was offered than in previous studies. METHODS & PROCEDURES: Twenty children were randomly assigned to treated and untreated groups. A pre-/post-test design was used to monitor their progress in phonological awareness, literacy and speech production. Children were treated in groups of three. They received 12 hours of therapy. OUTCOMES & RESULTS: Comparisons of the groups showed that the treated group made significantly greater gains in phonological awareness. However, differences between the groups in the measures of literacy and speech production were smaller and non-significant. Considerable variation was detected in the response of individual children to the therapy. CONCLUSIONS: The results show the effectiveness of phonological awareness therapy in benefiting children's general phonological skills. However, the comparison of these and previous findings suggest that children may require more therapy than is often available if literacy and speech production are also to benefit. Further research is required to confirm the duration and intensity of therapy required. Until such information is available, clinicians might want to take a cautious approach and combine therapies that target phonological awareness with more traditional approaches, that target speech production more directly.

Articulation Disorders↗

PubMed1998

Role of speech therapy and sign language prior to cochlear implantation.

The speech therapist should assess and develop the communication skills of the deaf child prior and after a cochlear implantation. The goals are first the acquisition of a useful communication system by the deaf child (for avoiding a cognitive stimulation lack) and parallely the acquisition of good oral language competencies. The different modes of communication useable in the profoundly deaf education are presented. Exclusive sign language use is not indicated in implanted children. It is well demonstrated that an exclusive oral communication is associated with an insufficient knowledge of the oral language. The total communication (combination of listening, speech reading, signing with or without finger spelling) is a defective communication mode with a bad representation of the morpho-syntactic and the phonologic aspects of the oral language. The best choice seems to be the simultaneously use of a spoken language and a manually coding of their phonological structures. The limits of this alternative are discussed.

Child↗

PubMed1994

Stuttering therapy with British-Asian children. I: A survey of service delivery in the United Kingdom.

The results of a UK survey of speech and language therapy services offered to Asian children and adolescents who stutter are set in the context of current therapy approaches favoured in the UK. Eighty-seven speech and language therapists from the major centres of Asian population in the UK completed a postal questionnaire. This yielded data on: service delivery to stuttering children in general; the size and nature of the Asian populations served; therapists' own cultural backgrounds; steps taken by therapists to increase their skill in this area; interpreter services available; changes made to usual working practices aimed at accommodating the cultural needs of Asian clients. The results revealed a service mostly provided by non-specialist therapists, who treated small numbers of both stuttering and Asian clients. Therapists were serving clients from up to four different cultural and linguistic backgrounds, yet access to interpreter services was poor. Therapists were on the whole poorly trained and equipped to treat Asian clients. A range of changes to working practices are described, but no cohesive approach was apparent. The issues involved in appropriate and accessible service delivery are discussed.

Adolescent↗

PubMed2003

Services for aphasia, other acquired adult neurogenic communication and swallowing disorders in the United Kingdom, 2000.

PURPOSE: We developed a questionnaire designed to determine the state of services provided by the National Health Service within the UK for adults with acquired neurologically caused communication disorders. A further aim was to compare our results with those from a similar survey conducted 10 years ago by Mackenzie et al. METHOD: We sent questionnaires to 264 managers and directors of adult speech and language therapy services in the UK. We asked questions about staffing levels, regional variations, patterns of service delivery at acute and chronic stages and staff time spent working with different communication and swallowing problems. RESULTS: Nearly 53% of average staff time was spent working with swallowing disorders accompanying neurological damage (dysphagia) compared to 24% with aphasia. As the percentage of time spent working with swallowing increased, the percentage of time spent working with aphasia reduced. Out of the time spent on aphasia treatment, 48% averages less than 3 h per week duration and just 4.8% averages more than 3 h per week, which was correlated with total number of speech and language therapists employed by a service. We found a significant difference only between London, with the highest total staff numbers, and the South West, with the lowest. We also found significant relationships between staff numbers and population size and staff numbers and the level of referrals to the service. CONCLUSIONS: Our main conclusions are: (1) while there may have been an increase in the number of speech and language therapists working with acquired and progressive neurogenic conditions in the past 10 years, they are mainly working with swallowing disorders, and (2) findings agree with recent studies showing that the amount of treatment or therapy that aphasic clients receive is well below that recommended by the literature.

Aphasia↗

PubMed2007

Children with Down syndrome: oral development and morphology after use of palatal plates between 6 and 48 months of age.

OBJECTIVE: The aim of this study was to describe the number of erupted teeth, sucking habits, tongue morphology, facial expression and speech in children with Down syndrome (DS) aged 48 +/- 6 months and treated from 6 months of age with palatal plates in combination with speech and language therapy. METHODS: The research took the form of a multicentre, multidisciplinary, longitudinal study of children with DS followed from the age of 6 months. A total of 37 children with DS were included. One child could not cooperate at all and was excluded from the evaluations. In combination with speech and language intervention provided by speech and language therapists, the children used palatal plates provided by dentists from 6 months of age. In the evaluation, the children in the sample (n = 36) were compared with two similarly aged control groups: one group of children with DS who never had used palatal plates (n = 31) and one group of children with normal development (n = 36). The evaluation of oral parameters was performed by dentists after calibration. Registration of facial expression and speech was done by a speech and language therapist, and the evaluation was done by two speech and language therapists and one phonetician who were calibrated in joint discussions. RESULTS: In contrast to the children with DS in the control group, the subjects in the study were found to have as many erupted teeth as the children with normal development. The prevalence of sucking habits did not differ between the three groups. Only children with DS sucked their tongue, a toy or other things in addition to a thumb or dummy. The prevalence of tongue diastase in the study group with DS was of the same magnitude as in the evaluation at the age of 18 +/- 3 months. The palatal plates were used by 57-65% of the children without any larger problems. In the study sample, the possible beneficial effects of palatal plate therapy were a lower prevalence of posterior cross-bite, a higher prevalence of frontal cusp-to-cusp relation and a lower prevalence of frontal open bite. Evaluation of facial expression and speech showed a higher score for facial expression and a better communicative capacity in the children in the study group than in the control children with DS. CONCLUSIONS: In children with DS, palatal plate therapy between 6 and 48 months of age in connection with speech and language intervention had a positive effect on occlusion, oral motor function, facial expression and speech. No harmful effects were observed. Although this is a valuable method, however, it must be emphasized that palatal plate therapy puts additional demands on already burdened children and their caretakers.

Case-Control Studies↗

PubMedDate not supplied

Evaluating changes in the communication skills of deaf children using vibrotactile stimulation.

Results of a 9-mo longitudinal study designed to evaluate the efficacy of a vibrotactile aid, the SRA-10, with four profoundly deaf preschool children are reported. During the study the subjects were enrolled in 30-min triweekly language therapy sessions, and changes in communication skills in connected discourse (vocalization only, sign language only, and vocalization plus sign language) were measured using a computer-based observation system. Changes in structural and semantic aspects of language were also measured. The four subjects were evaluated during one 16-week phase in which the aid was used (aid-on condition) and another 8 weeks in duration in which the aid was not used (aid-off condition). Communication skills improved in the aid-on condition and decreased in the aid-off condition. The changes were found to be significant for the communication involving the vocalization plus sign language (Total Communication) measure, indicating that the vibrotactile stimulation was positively associated with the communicative act.

Child, Preschool↗

PubMed2003

Intensity of aphasia therapy, impact on recovery.

BACKGROUND: It has been speculated that the conflicting results demonstrated across poststroke aphasia therapy studies might be related to differences in intensity of therapy provided across studies. The aim of this study is to investigate the relationship between intensity of aphasia therapy and aphasia recovery. METHODS: A MEDLINE literature search was conducted to retrieve clinical trials investigating aphasia therapy after stroke. Changes in mean scores from each study were recorded. Intensity of therapy was recorded in terms of length of therapy, hours of therapy provided per week, and total hours of therapy provided. Pearson correlation was used to assess the relationship between changes in mean scores of outcome measures and intensity of therapy. RESULTS: Studies that demonstrated a significant treatment effect provided 8.8 hours of therapy per week for 11.2 weeks versus the negative studies that only provided approximately 2 hours per week for 22.9 weeks. On average, positive studies provided a total of 98.4 hours of therapy, whereas negative studies provided 43.6 hours of therapy. Total length of therapy time was found to be inversely correlated with hours of therapy provided per week (P=0.003) and total hours of therapy provided (P=0.001). Total length of therapy was significantly inversely correlated with mean change in Porch Index of Communicative Abilities (PICA) scores (P=0.0001). The number of hours of therapy provided in a week was significantly correlated to greater improvement on the PICA (P=0.001) and the Token Test (P=0.027). Total number of hours of therapy was significantly correlated with greater improvement on the PICA (P<0.001) and the Token Test (P<0.001). CONCLUSIONS: Intense therapy over a short amount of time can improve outcomes of speech and language therapy for stroke patients with aphasia.

Aphasia↗

PubMed1980

Speech therapy after total laryngectomy and esophageal replacement in a preschool patient: a case study.

This case study reports the development of a speech and language therapy program for a preschool boy laryngectomized at age two and three-quarters. Etiology was attributed to the accidental ingestion of lye, which caused severe burns and subsequent damage to both the larynx and esophagus. During the 20-month hospital stay, colon transplantation to the pharynx and laryngectomy were performed and a speech therapy program was initiated. The speech pathologist worked closely with the patient by stimulating his speech and language, developing his articulation skills, and finally providing him with a means of using expressive speech via an electrolarynx designed for him. In addition to the case study, this report reviews the different methods of alaryngeal speech, and suggests the need for further research in developing these methods as viable alternatives for the young laryngectomized child.

Child, Preschool↗

PubMedDate not supplied

Reliability of speech and language therapists using therapy outcome measures.

The Therapy Outcome Measure (TOM) aims to provide Speech and Language Therapists (SLT) with a practical tool to measure outcomes of care by providing a quick and simple measure which can be used over time with patients and clients in a routine clinical setting. The TOM allows therapists to reflect their clinical judgement on the dimensions of impairment, disability/activity, handicap/participation and well-being on an 11-point ordinal scale. The purpose of this paper is to examine the reliability and the influences on reliability of SLT using this measure. Three studies are presented and give information on 73 SLT using the measure with different client groups. Study one assesses the degree of reliability of six SLT using the TOM following training and practice. Reliability was studied on three occasions and the results demonstrate the influence of training and practice. Study two included 56 SLT to examine reliability over a broader range of client groups and to investigate the effect of the SLT specializing on rating patients from within or -out that specialism. Eleven therapists were included in the study, which examined the influence of a specific training approach. The participating SLT achieved a substantial-moderate level of reliability; this was established in all domains. The degree of reliability achieved on the TOM was affected by some, but not extensive, training and experience.

Clinical Protocols↗

PubMed2000

An assessment battery for identifying language impairment in African American children.

This investigation compares the performances of 24 African American children, diagnosed as language impaired (LI) and receiving school-based language therapy, to 2 groups of typically developing peers (N = 48) on 5 traditional types of language assessment measures. Three of the measures were derived from child-centered free play language sample analyses and included average length of communication units (MLCU), frequencies of complex syntax, and numbers of different words. Two of the measures examined language comprehension and included responses to requests for information in the form of Wh-questions and responses to probes of active and passive sentence constructions. The performances of the group of children with language impairments were significantly lower on each measure than that of chronological age matched African American children who were typically developing. Sensitivity and specificity of the battery appeared excellent. The findings are discussed in terms of the potential of these informal language measures to contribute to a culturally fair assessment protocol for young African American children.

Black or African American↗

PubMed2004

Life experiences of people who stutter, and the perceived impact of stuttering on quality of life: personal accounts of South African individuals.

UNLABELLED: The purpose of the study was to investigate the life experiences of a group of South African adults who stutter and the impact of stuttering on their quality of life. Participants were 16 adults with a mean age of 28.9 and ranging from 20 to 59 years. Methods involved individual interviews designed to explore the life domains of education; social life; employment; speech therapy; family and marital life; and identity, beliefs and emotional issues. Main findings of the study indicated that the majority of participants perceived their stuttering to have impacted on their academic performance at school, and relationships with teachers and classmates. Although their stuttering was not perceived to adversely influence their ability to establish friendships, people generally reacted negatively to their stuttering. Many felt that their stuttering did not have an adverse effect on their choice of occupation, ability to obtain work, and relationships with managers and co-workers, although it was perceived to influence their work performance and hamper their chances for promotion. Although the majority viewed their speech therapy experiences as being negative; more than half the sample believed that speech therapy had, nevertheless exerted a positive effect on their quality of life. Overall, stuttering did not appear to have influenced participants' family and marital life. Most participants felt that stuttering had affected their self-esteem and self-image, and had evoked strong emotions within them. Findings are taken to suggest the need to incorporate subjective feelings about stuttering into the clinical practice of speech-language therapy; to provide information and coping strategies for teachers and employers; and for further research. EDUCATIONAL OBJECTIVES: After completing this activity, the reader will be able to: (1) describe and explain the perceived impact of stuttering on quality of life in terms of education; social life; employment; speech therapy; family and marital life; and identity, beliefs and emotional issues; (2) to interpret and utilize the subjective meanings that individuals attach to their stuttering to improve stuttering treatment, counseling and research.

Achievement↗

PubMed2002

Communicating in the real world: accounts from people who stammer.

UNLABELLED: This qualitative study used in-depth interviews to explore the communicative experiences and coping strategies of 14 adults who stammer. Their accounts revealed that those participants with persistent developmental dysfluency felt that stammering had limited their lives especially in the areas of employment, education and self-esteem. All participants shared key styles of communicative management with avoidance and confrontation developing during childhood. The participants who had undertaken therapy during adulthood, relied upon a range of speech management techniques including self-evolved and therapeutic strategies. Many of the strategies regularly used by the respondents contributed to the limiting experience of stammering. This study highlights the experience of stammering on the individual, discusses the variety of strategies used to manage dysfluency and indicates the complexities of day-to-day communication. These findings are discussed in relation to speech and language therapy for adults who stammer. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to give examples of: (1) the lived experience of stammering; (2) the communicative strategies used by adults; and (3) the situational management of stammering.

Adaptation, Psychological↗