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PubMedDate not supplied

Phonological assessment: a systematic comparison of conversation and picture naming.

The purpose of the present study was to systematically compare two methods of speech elicitation for phonological assessment: conversation and picture naming. Subjects were 13 male, phonologically impaired children (aged 4.2 to 5.11 years). All were English speaking and had received no prior speech-language therapy. The children's performance was assessed on a conversational speech task (CST) and a 162-item picture naming task (PNT) using three levels of phonological analysis. The CST and PNT generally yielded similar sound error patterns, and severity measures on the two tasks were highly correlated. However, the PNT yielded more phonological errors. It is suggested that both methods of speech elicitation are useful clinical tools for assessment. However, to obtain a thorough sample of a child's speech output, an extensive, well-designed PNT may tap the child's phonological system more deeply, may be more efficient in some cases, and may represent a good index of phonological ability.

Child, Preschool↗

PubMed1995

Multidisciplinary management of dysphagia: the first 100 cases.

A report of the first 100 patients treated in the multidisciplinary Dysphagia Clinic in Salisbury District Hospital is presented. It was established in January 1992 and involves the Departments of ENT Surgery, Clinical Radiology and Speech and Language Therapy. In the first 18 months, 100 patients have been assessed and treated. These included 46 males and 54 females, between the ages of four and 93 years. Neurological problems accounted for 39 cases. The management comprised the assessment clinic, videofluoroscopy in 83 patients, and finally the appropriate treatment. Forty-four patients were treated primarily by swallowing therapy. Seventy-three patients showed complete recovery, resolution of their symptoms or did not require treatment. Two patients were still under treatment at the time of writing this paper.

Adolescent↗

PubMed2006

Management of the transgender voice.

Transsexualism is a condition involving a paradoxical feeling of belonging to the opposite sex. Acquiring a sex-appropriate voice is a crucial part of the patient gaining acceptance in their new gender. Speech and language therapists and otolaryngologists play an important role in influencing communication behaviour in transgender patients by altering the fundamental frequency of speech to one acceptable for the patient's sex. Review of the literature suggests that speech and language therapy is successful at creating an acceptable fundamental frequency in transgender patients, as well as influencing other communication behaviours. Laryngeal surgery, such as cricothyroid approximation, has an important role in raising the fundamental frequency in those who do not achieve acceptable voice via non-surgical means. There is little information on patient satisfaction and quality of life measures. Research is currently underway to explore this aspect further.

Female↗

PubMed2004

Effect of phonemic perception training on the speech production and phonological awareness skills of children with expressive phonological delay.

Children with expressive phonological delays often possess poor underlying perceptual knowledge of the sound system and show delayed development of segmental organization of that system. The purpose of this study was to investigate the benefits of a perceptual approach to the treatment of expressive phonological delay. Thirty-four preschoolers with moderate or severe expressive phonological delays received 16 treatment sessions in addition to their regular speech-language therapy. The experimental group received training in phonemic perception, letter recognition, letter-sound association, and onset-rime matching. The control group listened to computerized books. The experimental group showed greater improvements in phonemic perception and articulatory accuracy but not in phonological awareness in comparison with the control group.

Articulation Disorders↗

PubMed1976

Spouses' understanding of the communication disabilities of aphasic patients.

The language skills of 11 aphasic patients were assessed through the use of the PICA. Spuses's understanding of the aphasic partner's language deficits was measured by rating the aphasic spouse on the Functional Communication Profile. Results indicate that spouses of aphasic patients view the patient's communication to be less impaired than it actually is. Implications for the counseling role of the speech pathologist in language therapy are discussed.

Adult↗

PubMed1977

Effect of auditory prestimulation on naming in aphasia.

In five aphasic subjects, picture naming alone was compared with picture naming in the presence of four different auditory cues. Eighty words represented by pictures were associated with the following auditory cues: the first phoneme of the target word; an open-ended sentence designed to elicit the target word; three words, one of which was the target word; three words, all semantically related to the target word. Three conditions--the phonetic cue, the open-ended sentence, and the set of three words containing the target word--facilitated naming significantly. The condition making use of semantically related words resulted in a significant decrease in naming performance. Implications of these findings for theories of verbal recall, impairment of verbal recall in aphasia, and language therapy are discussed.

Acoustic Stimulation↗

PubMed2000

Dyslexia: a developmental language disorder.

The acquisition of literacy in an alphabetic script such as English makes heavy demands on linguistic skills. The relation between spoken and written language however, is far from straightforward. This article reviews the research that suggests that phonological processing skills are crucial in the translation of symbols to sounds, and the development of rapid and automatic decoding skills. It examines research that indicates that children whose phonological processing skills are compromised in some way, are at-risk of experiencing difficulties in the acquisition of literacy; it supports the suggestion that dyslexia can be viewed as lying on the continuum of developmental language disorders. It goes on to relate theory to practice and discusses the responsibilities of health care professionals in relation to the early identification of dyslexia, and makes suggestions regarding intervention. In particular, it looks at the responsibilities of speech and language therapy services in the care and management of children with dyslexia.

Child↗

PubMed2004

[Development of guidelines for rehabilitation of patients with stroke: analysis of therapeutic procedures].

The Federal Insurance Institute for Salaried Employees (BfA, Bundesversicherungsanstalt für Angestellte) in Berlin took the initiative to develop evidence-based guidelines for rehabilitation including stroke rehabilitation. In the present study we performed a systematic survey of the scientific literature on stroke rehabilitation and deduced 8 evidence-based therapeutic modules. They were supplemented by 5 practice-based modules to cover the full range of interventions currently applied in stroke rehabilitation. Modules are clusters of various interventions which were aggregated according to the rehabilitative goal they have in common. Data were analysed from 8,876 BfA patients, the total population of "neuro"-patients in 2001 and 2002 with 142,951 interventions and 1,071,885 appointments. Stroke diagnoses covered ICD-10 codes I60, I61, I62, I63, I64 or were coded by G45, G81 and one of these I-codes. Stroke rehabilitation as provided in daily practice was found to be a complex multimodal treatment programme in all hospitals which were studied. On average, patients receive treatments from 7.3 therapeutic modules. A dominating role is played by "motor modules". Obviously, they play a major role in acute stroke rehabilitation in all hospitals compared to cognitive retraining, language therapy and especially improvement of psychic functions, which were significantly less applied. A dramatic variation could be shown to exist between the rehabilitation hospitals (1) with respect to the number of patients who were treated with a given module (e. g., some modules showed variations between 18 % and 100 %), and (2) with respect to treatment intensity and treatment duration per week. Several factors can be taken into account for interpretation of this high variance. Intrinsically, the high variation in symptomatology after stroke can play a major role, as both the deficit profile and the level of severity of a given deficit and the combined severity level can vary from patient to patient. On the other hand, extrinsic factors such as lack of staff may also account for some of the differences. In any case, the results show the necessity to optimize stroke rehabilitation by development and implementation of guidelines. Yet, they also point to a need for further research into rehabilitation interventions and procedures to yield evidence for the approximately 30 % of "only" practice-based interventions.

Adult↗

PubMed2006

Teaching young children with autism to talk.

Frequent functional spoken communication is a common goal for young children with autism. We propose that the number of different nonimitative, referential, conventional, and communicative words used in a language sample is a reasonable measure of the behavior we wish to increase in such children. We review our own and others' studies focusing on young (i.e., 2 to 3 years old) children with autism to provide a rationale for including object play and nonverbal communication as potentially important treatment goals. Children who are not yet fluent in object play and nonverbal communication may need to improve these skills to facilitate the implementation and uptake of direct language therapy. Past research has shown that object play, nonverbal communication, and useful speech all are influenced by various types of interventions in young children with autism.

Autistic Disorder↗

PubMed2005

Cochlear implantation in Waardenburg's syndrome.

CONCLUSIONS: Children with Waardenburg's syndrome (WS) derive significant benefit from cochlear implantation (CI) and do so to an extent that is comparable to that of the general population of implanted children. Although we report on a relatively small cohort, our data are useful for counseling the parents of children with WS considering CI. OBJECTIVE: To present our experience with CI in patients with WS. MATERIAL AND METHODS: A retrospective record review was conducted for five children who underwent CI in our department between 1993 and 2004. RESULTS: Children with WS comprised 1.9% of our entire pediatric CI population: four girls had a familial history of WS and the phenotype of WS Type I, and one boy met the criteria for WS Type II. They were all diagnosed as having bilateral profound sensorineural hearing loss 4-24 weeks after birth. Rehabilitation was initiated immediately and included bilateral fitting of hearing aids and intensive speech and language therapy. Otoscopic and temporal bone high-resolution CT findings were normal in all patients. At surgery, all children were found to have a patent cochlea, and the electrodes were implanted into the scala tympani without difficulty. After 1.3-10.2 years of implant use all children achieved open-set recognition of 2-syllable words, with an average score of 81%. Four of the 5 children achieved open-set recognition of monosyllabic words (average score 40%) and 3 achieved open-set recognition of words in sentences (average score 81%).

Adolescent↗

PubMedDate not supplied

Learning and teaching phonetic transcription for clinical purposes.

This paper explores the theoretical issues surrounding clinical phonetic transcription which are pertinent to the education of speech and language therapy students. It draws on theoretical literature and practical experience, to consider issues of rationale, timing, structure, and content of courses in phonetic transcription for clinical purposes, and explores the problems and pitfalls inherent in the process. It is not a tutorial in clinical practical phonetics, but an examination of the issues which teachers of the subject need to consider in delivering such courses.

Humans↗

PubMedDate not supplied

Interaction training for conversational partners of children with cerebral palsy: a systematic review.

BACKGROUND: Research has shown that children with cerebral palsy have difficulties acquiring communication skills and that conversation with familiar partners follows restricted patterns, which are characterized by high levels of partner control and children's responsivity. Speech and language therapy often includes training for conversational partners to help to them recognize children's communicative signals and to create opportunities for children to take a more equal and independent role in conversation. However, the effectiveness of this indirect therapy has not been demonstrated reliably. AIMS: To review systematically all experimental research on communication training for conversational partners of children with cerebral palsy and to evaluate the effectiveness of this type of intervention. METHODS & PROCEDURES: As part of a wider review, health, psychology and education electronic databases were searched up to December 2002 for reports of experimental studies on the training of conversational partners to facilitate the communication of children with cerebral palsy, which contained an element of control. References from identified studies were followed-up and relevant journals and conference reports were hand-searched. Identified studies were assessed for inclusion by the first author. Two reviewers independently abstracted data on the quality and content of each study. OUTCOMES & RESULTS: Four studies were identified from five research reports that met the criteria for inclusion in the review, comprising three group studies and one single case experiment. Common targets for training were observed across the studies. These included positioning of the conversational partner and child for interaction, creating communication opportunities and responding to children's communicative signals. Changes were observed in the conversation patterns used by conversational partners, which should facilitate the communication of children with cerebral palsy. However, the studies contain methodological flaws and as a result they cannot demonstrate that the changes were definitely a result of the intervention. CONCLUSIONS: Research on the effectiveness of interaction training for conversational partners of children with cerebral palsy is in its early stages. Training has incorporated common targets, which are widely acknowledged by clinicians to affect the communication of children with motor disorders. Trends in behaviour change have been suggested by research to date, but further studies that address the methodological inadequacies of the original research are needed to evaluate the effectiveness of this type of intervention. Suggestions of ways to improve the design and reporting of future studies, that will allow the mapping of interventions to clients, are discussed in this review.

Adolescent↗

PubMedDate not supplied

Active versus passive cleft-type speech characteristics.

Cleft palate speech is generally described in terms of nasal resonance, nasal emission and compensatory articulations. A longitudinal study of children at different stages of surgical treatment revealed a distinction between passive and active cleft-type speech characteristics whereby passive characteristics were thought to be the product of structural abnormality or dysfunction and active characteristics were specific articulatory gestures replacing intended consonants. Passive and active patterns of articulation are described and defined in the context of three longitudinal studies of subjects who were at various stages of two different surgical regimes: five bilateral cleft lip and palate (BCLP) subjects aged 1;6-4;6, 12 mixed unilateral cleft lip and palate (UCLP) and BCLP subjects aged 4;6-7;6 and nine mixed UCLP and BCLP subjects aged 9;0-11;0. Reference is also made to data from 12 mixed cleft-type subjects aged 13;0 who had been treated with different surgical timing regimes. Comparison is made between the incidence of active versus passive processes in relation to oral structure. At age 4;6 speech samples taken from BCLP subjects who had been treated with 1-stage versus 2-stage palate repair all evidenced both active and passive processes. The lack of differentiation in speech results irrespective of their current surgical status, i.e. completely repaired palates versus residual cleft of the hard palate, was unexpected. Cleft-type processes in completely repaired subjects might be accounted for by the inevitable anterior defect following repair of a bilateral cleft. Older subjects with structural defects also evidenced more cleft-type processes. The relevance of distinguishing between active and passive processes is underlined by consideration of the effects of structural changes following surgery. The effect of surgery on seven subjects' speech is discussed using the active/passive distinction. Active cleft-type characteristics did not change as a direct result of surgery, whereas passive characteristics were largely eliminated following surgery. A specific distinction is made between active and passive nasal fricatives, with the implication that active nasal fricatives may not be affected by surgical intervention, whereas passive nasal fricatives may be eliminated by surgery. Accurate distinction between active and passive patterns of articulation may serve to identify those cleft-type speech error patterns most likely to respond to surgical intervention. Indications from this study are that active cleft-type characteristics require destabilization in a course of speech and language therapy before the potential benefits of surgery can be properly assessed. An analytical protocol for the interpretation of speech samples is presented and some therapy strategies are proposed for active and passive processes.

Child↗

PubMed2002

Clinical pilot study assessment of a portable real-time voice analyser.

The use of computer-based real-time visual displays is now well established in voice clinics. A number of situations exist, however, where a computer-based system is inconvenient and a battery-powered hand-held version would be preferred. This would, for example, enable voice monitoring to be carried out at any time and place, including during home visits. This paper describes a purpose-built device that provides real-time displays of fundamental frequency and larynx closed quotient (CQ) derived from the electrolaryngograph output. The fundamental frequency data can in addition, be acquired from a microphone. The system has been in use recently in a speech and language therapy clinic in Sheffield, UK and the advantages and disadvantages noted during that trial are discussed.

Electric Stimulation↗

PubMed2006

A semantically enabled formalism for the knowledge management of Parkinson's disease.

Bio-ontology is a formal representation of biological concepts that is used in the interchange of communication between computers and humans alike. They can then be used in the formulation and retrieval of knowledge. In developing a knowledge-based system for Parkinson's Disease, a procedure of knowledge map was used to capture and harness the intellectual resources of an organization, and new paradigms for knowledge mapping were also formulated. Knowledge bases for symptoms and drugs, physiotherapy, speech and language therapy, and dieting that affect patient care were developed. Finally, the knowledge bases were merged to form a single central repository of knowledge base.

Diet↗

PubMed2000

The combination of bedside swallowing assessment and oxygen saturation monitoring of swallowing in acute stroke: a safe and humane screening tool.

BACKGROUND: dysphagia is common in acute stroke. Accurate detection of the presence or absence of aspiration by bedside swallowing assessment is difficult without objective methods, tending to over-diagnose aspiration. As a result, some patients suffer restricted oral intake unnecessarily. OBJECTIVE: we examined the predictive values of pulse oximetry and speech and language therapy bedside swallowing assessment in the detection of aspiration compared with videofluoroscopy. DESIGN: a double-blind observational study. SETTING: two university teaching hospitals. SUBJECTS: we studied 53 patients whose acute strokes were confirmed by computed tomography scan. METHODS: Each subject had initial standard bedside swallowing assessment, closely followed by simultaneous and mutually blinded pulse oximetry, swallowing assessment and videofluoroscopy. RESULTS: 15 of 53 subjects aspirated. Bedside swallowing assessment and saturation assessment at > or = 2% desaturation gave good sensitivity (80% and 87% respectively), but low positive predictive values (50% and 36% respectively). Both assessments mistook laryngeal penetration for aspiration. Re-analysis with aspiration +/- penetration as a new endpoint improved bedside swallowing assessment positive predictive values to 83% (chi2 =3.59, P=0.032). Sensitivity of saturation assessment was maintained at 86%, positive predictive values of saturation assessment improved to 69% (chi2=6.74, P=0.009). The combination of bedside swallowing assessment and saturation assessment versus aspiration + penetration gave a positive predictive value of 95%. CONCLUSIONS: screening by saturation assessments detects 86% of aspirators/penetrators and should be followed immediately by bedside swallowing assessment, as the combination of the two assessments gives the best positive predictive value. For patients with acute stroke, we advocate a 10 ml water-swallow screening test with simultaneous pulse oximetry by suitably trained medical and nursing staff. Use of this screening test would improve dysphagia detection whilst minimizing unnecessary restriction of oral intake in stroke patients.

Acute Disease↗

PubMed2005

Improving care for patients with dysphagia.

BACKGROUND: Early diagnosis and effective management of dysphagia reduce the incidence of pneumonia and improve quality of care and outcome. Dysphagic stroke patients rarely perceive that they have a swallowing problem, and thus carers have to take responsibility for following the safe swallow recommendations made by the Speech and Language Therapist (SLT). Published work and observations in our own Trust indicated that patients with dysphagia may be fed in a manner which places them at significant risk of aspiration, despite SLT advice for safe swallowing. OBJECTIVE: To determine compliance with swallowing recommendations in patients with dysphagia and to investigate the effectiveness of changes in practice in improving compliance. DESIGN: Sequential observational study before and after targeted intervention. SETTING: An acute general and teaching hospital in an inner city area. SUBJECTS: All patients with dysphagia on the caseload of the speech and language therapy department at the time of the study. METHODS: Observations were made on compliance with the recommendations of SLTs regarding consistency of fluids, dietary modifications, amount to be given at a single meal/drink, swallowing strategies, general safe swallow recommendations and whether supervision was required. A dysphagia link nurse programme was established, together with modification of an in-house training scheme, use of pre-thickened drinks and modification of swallowing advice sheets. The same observations were repeated after this intervention. RESULTS: Thirty-one patients were observed before and 54 after the intervention. There was improvement in compliance with the recommendations on consistency of fluids (48-64%, P<0.05), amount given (35-69%, P<0.05), adherence to safe swallow guidelines (51-90%, P<0.01) and use of supervision (35-67%, P<0.01). There were no significant differences in compliance with dietary modifications or swallowing strategies. Improvement in compliance was demonstrated in medical and geriatric wards and the stroke unit, but not in the surgical wards. Compliance with 'nil by mouth' instructions was 100% throughout. CONCLUSIONS: Relatively simple and low-cost measures, including an educational programme tailored to the needs of individual disciplines, proved effective in improving the compliance with advice on swallowing in patients with dysphagia. It is suggested that this approach may produce widespread benefit to patients across the NHS.

Aged↗

PubMed2006

Life with communication changes in Parkinson's disease.

BACKGROUND: Acoustic and perceptual changes to speech in Parkinson's disease (PD) have been widely studied. Little empirical evidence exists concerning the individual's own perception of changes, the impact these have on their life and coping strategies to deal with them. OBJECTIVE: To establish if, and how, changes in communication impact on the lives of people with PD. DESIGN: In-depth interviews with qualitative analysis of content. SETTING: Community. SUBJECTS: Twenty-three men and 14 women with PD. METHODS: Participants were purposively sampled to give a mix of men, women, family circumstances, stage and duration of PD and severity of speech symptoms. Individuals were interviewed at home. Interviews were transcribed. Emergent themes were identified and fed back to participants for confirmation and clarification. RESULTS: Participants identified changes to voice and articulation. Language changes featured prominently. Four impact themes: (i) interaction with others, (ii) problems with conversations, (iii) feelings about intelligibility and (iv) voice; and four corresponding coping themes (a) helping others understand, (b) managing conversations, (c) monitoring and adjusting and (d) physical strategies emerged. Of main concern was not the nature of speech-voice-language changes, but how these affected self-concept, participation inside and outside the family and family dynamics. Individuals employed a range of fluid coping strategies moving from background withdrawal to foreground striving strategies. CONCLUSIONS: Speech and language changes in PD impact upon individual and family life long before frank impairment of intelligibility is apparent. The role of early referral to speech and language therapy is therefore worthy of detailed investigation.

Aged↗