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PubMed2001

Neuropsychological evaluation in rehabilitation planning and evaluation of functional skills.

This paper focuses on the benefits of neuropsychological assessment for evaluating a brain-injured person's functional abilities and rehabilitation needs. The importance of early assessment in addressing these goals is discussed. Strengths and weaknesses of neuropsychological assessment for predicting a person's ability to participate in normal activities of daily living are considered. Test data taken alone often lack ecological validity, but nevertheless, specific test findings can be used to predict functional skills. The ecological validity of neuropsychological testing can be extended by observing the patient's approach to tasks in the assessment environment and by observing the patient in his or her normal activities. Evaluation information obtained by allied rehabilitation professionals, including occupational and speech and language therapies, can be integrated with neuropsychological test data to both extend the generalizability of our findings and to validate hypotheses generated from our test data. The use of neuropsychological test data in planning a cognitive rehabilitation program is also considered.

Journal Article↗
PubMed2001

The psychological effects of traumatic brain injury on the quality of life of a group of spouses/partners.

This study explored the psychosocial impact of traumatic brain injury on the perceived quality of life of a purposefully selected group of 14 spouses/partners of head injured persons by means of a self-administered questionnaire. Analysis of responses revealed that spouses/partners' altered communication patterns were perceived to have affected interpersonal relationships and quality of life extensively, indicating the need for speech-language therapy. Decreased income was noted due to the low incidence of return to work. Participants reported changes in family relationships, particularly between the injured person and their children as well as deterioration in marital relationships, suggesting the necessity for family therapy and marital counselling. Various emotional reactions were documented in response to injury. Yet most respondents expressed acceptance of their new roles and responsibilities despite the difficulties entailed. Since injured persons were dependent on their spouses/partners to a large extent, most of the latter reported feeling tied down. Loneliness predominated as a social consequence despite the support of pre-injury friendships. In terms of coping resources, friends, family, religion and support groups were perceived to be most effective. Results are discussed in terms of their clinical implications for psychosocial rehabilitation and spouse/partner counselling.

Adult↗
PubMedDate not supplied

Speech-language and hearing findings in the cardio-facial-cutaneous syndrome.

BACKGROUND: Cardio-facial-cutaneous syndrome. AIM: To describe the clinical findings of a patient with cardio-facial-cutaneous syndrome and to characterize her communication. METHOD: To investigate the following areas: genetic, speech-language and hearing, otolaryngological, and psychological. RESULTS: Cardiac, cutaneous, and craniofacial alterations were observed, as well as cognitive deficits and significant language impairment with the absence of oral speech. CONCLUSION: The importance of assessing these patients is highlighted, for diagnostic and intervention purposes, so that the work developed in the speech and language therapy can be better directed.

Abnormalities, Multiple↗
PubMedDate not supplied

Oropharyngeal dysphagia--the need for effective management.

Increasing international recognition of the high incidence of oropharyngeal dysphagia has incited Speech and Language Therapists to establish a service for the management of this life-threatening disorder. This study evaluates the first such Irish service instigated in St. James's Hospital four years ago. Retrospective analysis of Speech and Language Therapy departmental records for a twelve month period examined incidence of referral for dysphagia, subsequent clinical and objective assessment findings and management recommendations. A referral rate of 52% emerged with a mean of 74 years. CVA was found to be the commonest etiology. Therapeutic intervention was implemented with 68% of dysphagic subjects considered suitable candidates and improvement evidenced in 78% of treated cases. These results highlight the prevalence of oropharyngeal dysphagia in a neurologically impaired Irish adult population and the efficacy of a dysphagia service in its management, while categorically stating the need for such service provision nationwide.

Deglutition Disorders↗
PubMed1976

Relaxation training: effects on the communicative ability of aphasic adults.

A verbal test battery (VTB) of four 15-item tests was administered to 16 aphasic adults following a period of relaxation training and a control period. Results indicate that verbal communication of aphasic persons is positively influenced by relaxation training. Subjects had significantly higher overall VTB scores and naming test scores following relaxation. Findings are discussed in terms of the use of relaxation procedures as an adjunct to conventional language therapy approaches for the aphasic adult.

Adult↗
PubMedDate not supplied

Deafness in childhood: 1. Diagnosis and treatment of deaf babies and children.

Recent technological advances make it possible to detect hearing impairments in very young babies. Babies as young as a few weeks old can now be helped with hearing aids and early language therapy. The earlier the diagnosis and start of treatment, the better the later performance in speech. Nurses and midwives, together with the parents, are often the first to suspect a baby has a hearing loss. Bear in mind the risk factors--low birth weight, neonatal jaundice, family history of deafness etc-and if in doubt, always refer. There are different degrees of hearing loss and it is possible to be misled into thinking a child with partial hearing can hear normally. Again, if in doubt, refer. Hearing aids are essential for almost all children with sensori-neural hearing loss and can also be helpful for moderate conductive hearing loss. Remember that while some parents are the first to suspect deafness and seek treatment, others may deny their suspicions and even refuse to accept a diagnosis of hearing loss. They want to be able to believe that their child is normal.

Child, Preschool↗
PubMed1997

Context effects in auditory training with children.

The effects of acoustic/linguistic complexity of training stimuli (i.e., isolated words vs. words in sentences) on speech perception performance was measured in 17 young children (four-to-eight years old) with severe-to-profound sensorineural hearing losses. Phase I of the study involved training on isolated words (n = 9), while Phase II involved training on words in sentences (n = 8). A four-week period of experimental training was counterbalanced with a four-week period of traditional speech-language therapy across participants and Phases. Pre- and post-treatment testing was conducted for both words in isolation and in sentences at the end of each period. Significant improvements were found as a result of experimental training in both phases. Evidence of transfer of learning was greater when sentence level stimuli (Phase II) rather than isolated word stimuli were used (Phase I). Clinical implications are discussed.

Child↗
PubMedDate not supplied

[Rehabilitation of memory: strategies, indications and limits].

The rehabilitation of memory must be defined in terms of patient selection, therapist support and techniques as accurately as for language therapy. Three objectives can be offered for organic amnesia: reorganizing the memory by using alternative intact routes; working with remaining intact memory as the implicit focus, modification of surroundings with 'mnemonics protheses' such as a diary, alarms. The approach must be cognitive for the theoretical support of therapists, but also pragmatic to respect the patient's needs and wishes in the context of family and job. Patient selection must be based not only on rigorous aetiological and neurological grounds but also on an individual and cognitive understanding of each patient.

Avoidance Learning↗
PubMed2005

Therapy-related reorganization of language in both hemispheres of patients with chronic aphasia.

The brain processes of language recovery after stroke are poorly understood, partly because past research did not allow to differentiate the effects of spontaneous restitution processes from those of learning-related cortical reorganization. Here, we use a new approach offered by recently developed intense neuropsychological therapy methods, which allow for improving language functions within a short time period. Stroke patients with chronic aphasia received intense language therapy for 2 weeks and, over this period, improved their language performance as assessed using clinical tests. Neurophysiological activity elicited by words and pseudowords was measured before and after treatment. Over the therapy interval, early word evoked potentials (latency 250-300 ms) became significantly stronger whereas pseudoword responses did not change. Word-specific changes were documented by analyses of ERP amplitudes and root mean square values, which revealed interactions of the factors Assessment time (before vs. after therapy) and Wordness (word vs. pseudoword). Source localization using Minimum Norm Current Estimates showed that bilateral cortical sources activated by word stimuli contributed to the change, suggesting that neuronal networks distributed over both hemispheres are the substrate of cortical reorganization of language processing in intense aphasia therapy. Word-evoked differences in source strengths were significantly correlated with performance on a clinical language test, demonstrating a link between behavioral and neurophysiological changes. We suggest that the early word-evoked negativity might represent an index of reorganization of language after stroke and thus an aphasia recovery potential.

Adult↗
PubMed2002

Efficacy of speech therapy in children with language disorders: specific language impairment compared with language impairment in comorbidity with cognitive delay.

OBJECTIVE: this article discusses the effect of speech therapy on language comprehension, language production and non-verbal functioning in two groups of children with developmental language disorders. DESIGN: retrospective study-a follow-up after a mean of 2 years. MATERIALS AND METHODS: verbal and non-verbal functioning before and after therapy were examined in 31 language-impaired children with normal hearing and good health. In 16 children the language functioning was substantial behind their non-verbal functioning. They were categorised as children with specific language impairment (SLI). In 15 children the language problem was in comorbidity with cognitive delay, and these were categorised as children with non-SLI. At the first examination the children were at the age of 1;5-5;4 years and at the second examination they were at the age of 3;4-6;11 years. The children were examined for language comprehension (Standardised Dutch version of the Reynell Developmental Comprehension Scale), spontaneous language production (Groningen Diagnostic Speech norms) and non-verbal functioning (Snijders-Oomen non-verbal intelligence scale for children between 2 1/2 and 7 years). RESULTS: in both groups, a significant improvement was found in language functioning as well as in non-verbal functioning. Language comprehension and non-verbal IQ-scores in both groups improved by about the same amount. Language production made significantly more progress in the SLI group than in the non-SLI group. The improvements in the SLI group were mainly reached by speech therapy, whereas in the non-SLI group this was less the case. CONCLUSIONS: verbal and non-verbal development can improve in young children with developmental language delay. This underlines the idea that language and cognitive development are interacting and influencing each other in a positive way. Children with SLI seem to benefit more from speech therapy, whereas children with cognitive delay seem to benefit more from special education.

Child↗
PubMedDate not supplied

Becoming a manual occupation? The construction of a therapy manual for use with language impaired children in mainstream primary schools.

BACKGROUND: The construction of therapy protocols for a large-scale randomized controlled trial comparing speech and language therapists and assistants, and group and individual therapy approaches for children aged 6-11 in mainstream schools is outlined. AIMS: The aim was to outline the decision-making processes that led to the construction of the research therapy manual, and to give a preliminary report on compliance with the manual. METHODS & PROCEDURES: A search of the research and professional literature and of published therapy materials was conducted to locate usable examples of effective language therapy for primary school children. Results were collated into a manual of therapy principles and activities to structure research intervention. The use of the manual with children (n=30) receiving individual or group direct therapy from a speech and language therapist in the first phase of intervention was audited. OUTCOMES & RESULTS: Very few high-level research studies were found, but the professional literature gave added information. Therapies for comprehension monitoring, vocabulary development, later grammar and narrative were adapted for the research intervention, and procedures compiled into a manual to guide research speech and language therapists and assistants. The audit of direct therapy suggested that the manual was useable, providing a suitable range of activities and materials for therapy intervention. Its use helped to record the therapy offered to research children, and formed a sound basis for discussion amongst speech and language therapists and between speech and language therapist/assistant pairs. CONCLUSIONS: The construction and use of a therapy manual allowed the provision of replicable therapy within the research project whilst maintaining flexibility.

Child↗
PubMedDate not supplied

Written communication in undifferentiated jargon aphasia: a therapy study.

A subject, R.M.M., with a 2-year history of jargon aphasia is described. At the beginning of this study she had minimal meaningful spoken output and showed little awareness of her speech despite having relatively well-preserved auditory comprehension. Her spoken output had proved resistant to earlier periods of therapy. In contrast, R.M.M.'s written output showed some ability to access orthographic information and monitoring of this modality was shown by an acute awareness of her errors. A 3-stage therapy programme is described. This was designed to improve R.M.M.'s writing of single words and to encourage use of writing as an alternative means of communication. The initial stage of therapy aimed to increase R.M.M.'s access to written word forms by use of picture stimuli. She showed significant improvement in writing treated items in response to pictures both immediately after therapy and at re-assessment 6 weeks later. Despite the acquisition of these skills, R.M.M. failed to use them in communicative contexts. A second stage of therapy replicated the results of the first and sought to facilitate R.M.M.'s functional use of her written vocabulary by asking her to write words to spoken questions. She again showed improved written naming of the treated items and could now produce written names appropriately in a questionnaire-type assessment. Generalization of this ability extended to items that had not been trained in this way. Functional use of writing in everyday communication remained absent, however. The final stage of therapy made explicit the potential links between items which R.M.M. could now write and functional messages which they might convey. She again showed significant changes in the acquisition of new vocabulary and, encouragingly, progress was also seen in her use of the strategy in functional communication. R.M.M.'s speech is almost entirely incomprehensible. It has remained unchanged for 2 years and has not responded to therapy. Relatively well-preserved auditory comprehension and good monitoring of written output allowed therapy to effectively target a small written vocabulary. Despite significant progress in the acquisition of new items, transfer of this skill to functional communication was initially absent. Further therapy which specifically targeted the impairment causing this failure was needed before functional use was seen. The potential for treating written output in cases of jargon aphasia which have been resistant to therapy for spoken language is discussed.

Aged↗
PubMed1996

Treatment of attention deficit hyperactivity disorder: a multi-modal model for schools.

Treatment of ADHD in schools has received comparatively little attention, even though children spend more time in school than in most other structured environments and have their most consistent, extensive contact with a variety of trained professionals there. Because schools could play a strategic role in treating ADHD children, a multi-modal treatment model for children with ADHD in school settings is presented, and logistic factors likely to increase its effective implementation are reviewed. Then, a functional approach to the assessment and treatment of ADHD that focuses on identifying individual-specific deficiencies and environmental factors that may prevent these children from performing appropriate behavior is discussed.

Affect↗