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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↗

Central pattern generation and the motor infrastructure for suck, respiration, and speech.

UNLABELLED: The objective of the current report is to review experimental findings on centrally patterned movements and sensory and descending modulation of central pattern generators (CPGs) in a variety of animal and human models. Special emphasis is directed toward speech production muscle systems, including the chest wall and orofacial complex during patterned motor output. Experimental results indicate that CPGs subserving orofacial motor behavior can be modulated via descending and sensory inputs. This feature of control may also operate in the control of other centrally patterned motor behaviors including speech breathing, suck, mastication, and the recombination of CPG processes for the development and production of speech. LEARNING OUTCOMES: Readers will be able to: (1) define the salient characteristics of CPGs, (2) list five factors which influence the development and operation of a CPG over the lifespan, (3) define sensorimotor entrainment of CPGs, and (4) describe one new application for therapeutic training of the non-nutritive suck in premature infants.

Animals↗

Brainstem circuits that control mastication: do they have anything to say during speech?

UNLABELLED: Mastication results from the interaction of an intrinsic rhythmical neural pattern and sensory feedback from the mouth, muscles and joints. The pattern is matched to the physical characteristics of food, but also varies with age. There are large differences in masticatory movements among subjects. The intrinsic rhythmical pattern is generated by an assembly of neurons called a central pattern generator (CPG) located in the pons and medulla. The CPG receives inputs from higher centers of the brain, especially from the inferio-lateral region of the sensorimotor cortex and from sensory receptors. Mechanoreceptors in the lips and oral mucosa, in muscles, and in the periodontal ligaments around the roots of the teeth have particularly powerful effects on movement parameters. The central pattern generator includes a core group of neurons with intrinsic bursting properties, as well as a variety of other neurons that receive inputs from oral and muscle spindle afferents. Reorganization of subpopulations of neurons within the CPG underlies changes in movement pattern. In addition to controlling motoneurons supplying the jaw, tongue, and facial muscles, the CPG also modulates reflex circuits. It is proposed that these brainstem circuits also participate in the control of human speech. LEARNING OUTCOMES: Readers will be able to: (1) describe the general location and function of the central pattern generator for mastication, (2) identify the primary nuclei involved in the central pattern generator for mastication, (3) describe the general interactions among the central pattern generators of speech, mastication, respiration, and locomotion, and (4) compare/relate the brainstem systems controlling mastication and speech.

Animals↗

Speech motor development: Integrating muscles, movements, and linguistic units.

UNLABELLED: A fundamental problem for those interested in human communication is to determine how ideas and the various units of language structure are communicated through speaking. The physiological concepts involved in the control of muscle contraction and movement are theoretically distant from the processing levels and units postulated to exist in language production models. A review of the literature on adult speakers suggests that they engage complex, parallel processes involving many units, including sentence, phrase, syllable, and phoneme levels. Infants must develop multilayered interactions among language and motor systems. This discussion describes recent studies of speech motor performance relative to varying linguistic goals during the childhood, teenage, and young adult years. Studies of the developing interactions between speech motor and language systems reveal both qualitative and quantitative differences between the developing and the mature systems. These studies provide an experimental basis for a more comprehensive theoretical account of how mappings between units of language and units of action are formed and how they function. LEARNING OUTCOMES: Readers will be able to: (1) understand the theoretical differences between models of speech motor control and models of language processing, as well as the nature of the concepts used in the two different kinds of models, (2) explain the concept of coarticulation and state why this phenomenon has confounded attempts to determine the role of linguistic units, such as syllables and phonemes, in speech production, (3) describe the development of speech motor performance skills and specify quantitative and qualitative differences between speech motor performance in children and adults, and (4) describe experimental methods that allow scientists to study speech and limb motor control, as well as compare units of action used to study non-speech and speech movements.

Adolescent↗

Answering contextually demanding questions: pragmatic errors produced by children with Asperger syndrome or high-functioning autism.

UNLABELLED: This study examined irrelevant/incorrect answers produced by children with Asperger syndrome or high-functioning autism (7-9-year-olds and 10-12-year-olds) and normally developing children (7-9-year-olds). The errors produced were divided into three types: in Type 1, the child answered the original question incorrectly, in Type 2, the child gave a correct answer, but when asked a follow-up question, he/she explained the answer incorrectly, and in Type 3, the child first gave a correct answer or explanation, but continued answering, which ultimately led to an irrelevant answer. Analyses of Type 1 and 2 errors indicated that all the children tried to utilize contextual information, albeit incorrectly. Analyses of Type 3 errors showed that topic drifts were almost non-existent in the control group, but common in the clinical group, suggesting that these children had difficulties in stopping processing after deriving a relevant answer. LEARNING OUTCOMES: The reader becomes aware of the different instances which may lead to the irrelevance of answers and get knowledge about features of answers of children with AS/HFA.

Aptitude↗

An investigation of language and phonological development and the responsiveness of preschool age children to the Lidcombe Program.

UNLABELLED: Knowledge of variables that predict treatment time is of benefit in deciding when to start treatment for early stuttering. To date, the only variable clearly related to treatment time with the Lidcombe Program is pre-treatment stuttering frequency. Previous studies have shown that children whose stuttering is more severe take longer to complete Stage 1 of the program. However, studies to date have not investigated phonology and language as predictors of treatment time. In the context of a Phase II clinical trial, the present prospective study showed that phonological development does not predict treatment time but that, together, stuttering severity, MLU and CELF Receptive Score predict 35-45% of the variance for time taken to complete Stage 1. LEARNING OUTCOMES: The reader should be able to (1) understand guidelines developed for the timing of intervention with the Lidcombe Program based on previous retrospective studies, (2) determine whether pre-treatment language and phonological development play a role in treatment-led recovery with the Lidcombe Program and (3) understand recent empirical evidence on time taken by preschool children to complete Stage 1 of the Lidcombe Program.

Behavior Therapy↗

Anxiety in speakers who persist and recover from stuttering.

PURPOSE: The study was designed to see whether young children and adolescents who persist in their stutter (N=18) show differences in trait and/or state anxiety compared with people who recover from their stutter (N=17) and fluent control speakers (N=19). METHOD: A fluent control group, a group of speakers who have been documented as stuttering in the past but do not stutter now and a group of speakers (also with a documented history of stuttering) who persist in their stuttering participated, all aged 10-17 years. The State-Trait Anxiety Inventory for Children was administered. RESULTS: There were no differences between persistent, recovered and control groups with regard to trait anxiety. The persistent group had higher state anxiety than controls and the recovered group for three out of four speaking situations. CONCLUSION: The findings are interpreted as showing that anxiety levels in certain affective states appear to be associated with the speaking problem. LEARNING OUTCOMES: A reader should be able to appreciate the difference between state and trait anxiety understand views about how the role anxiety has on stuttering has changed over time appreciate different views about how anxiety affects speakers who persist and recover from stuttering see why longitudinal work is needed to study these issues.

Adaptation, Psychological↗

Voice onset time for female trained and untrained singers during speech and singing.

UNLABELLED: The purpose of this study was to examine the voice onset times of female trained and untrained singers during spoken and sung tasks. Thirty females were digitally recorded speaking and singing short phrases containing the English stop consonants /p/ and /b/ in the word-initial position. Voice onset time was measured for each phoneme and statistically analyzed. Mixed-ANOVAs revealed significantly longer voice onset time durations during speech for /p/ as compared to sung productions. No significant differences between the trained singers and untrained singers were observed. In addition, no task differences occurred for the /b/ productions. The results indicated that the type of phonatory task influences VOT for voiceless stops in females. LEARNING OUTCOMES: As a result of this activity, the reader will be able to (1) understand articulatory and phonatory differences between spoken and sung productions; (2) understand the articulatory and phonatory timing differences between trained singers and untrained singers during spoken and sung productions.

Adult↗

The prevalence of lisping in young adults.

UNLABELLED: This paper reports the results of a pilot study that investigated the prevalence of lisping in a cohort of young adults. The motivation for the study was the observation that a substantial number of incoming students in speech language pathology at the Ghent University (Belgium), still presented with frontal lisping of the /s/, /z/ and sometimes other alveolar sounds too. Seven hundred and forty eight students (374 females, 374 males), native speakers of Dutch, were video-recorded while reading aloud the Dutch version of the text "The north wind and the sun..." from the International Phonetic Association (1974). Analysis of the samples yielded an overall prevalence of lisping of 23.3%. Significantly less participants presented with lisping among students of humanities than among students of natural sciences or social sciences. No significant difference was found between males and females. It remains to be determined if this high prevalence of lisping in adults represents a recent trend or if the persistence of the pattern of lisping into adulthood in some individuals is perhaps quite normal. LEARNING OUTCOMES: As a result of this activity, the participant will be able to (1) discuss the nature and prevalence of residual phonological errors in general and (2) to discuss the prevalence of lisping in young adult native speakers of Dutch in particular.

Adolescent↗

Evaluation strategies for midwifery education linked to digital media and distance delivery technology.

The goal of the teaching and learning process for health professionals is the acquisition of a fundamental core of knowledge, the demonstration of critical thinking ability, and the demonstration of competency in the performance of clinical skills. Teaching and learning in distance education programs require that the administration, teachers, and students be creative in developing evaluation strategies that can be adapted to the challenges of the cyberspace on-line educational environment. Evaluation standards for distance education programs recently have been delineated by federal agencies, private organizations, and academic accreditation associations. These standards are linked to principles of sound education practice that promote program quality, high levels of student-faculty interaction, and support effective teaching and learning in the distance education context. A growing body of evidence supports the conclusion that technology-enhanced teaching is equivalent in effectiveness compared with traditional methods when student-learning outcomes are the focus of measurement. An allied body of literature offers model approaches that can be useful to educators who must also conduct the evaluation of clinical skills, provide feedback, and promote socialization to the nurse-midwifery/midwifery role for students being educated in whole or in part through instruction delivered at a distance.

Benchmarking↗

Using a communication audit to improve communication on clinical placement in pre-registration nursing.

This article describes a novel communication audit conducted with those concerned with the practice placements of pre-registration Nursing students. The study, uniquely, addressed all who were involved in communication concerning placement in what is described as an organisational analysis. The aim of the audit was to identify levels of satisfaction and dissatisfaction with present communication processes and to identify points for improvement. The audit used the Hogard-Barker Communication Audit of Practice a customized version of a well established tool, devised to cover issues relevant to practice placements. A key feature of the tool is the opportunity for participants to identify the amount of communication they are receiving on particular topics and issues against the amount they would like to receive. Participants in the audit included students, assessor mentors, ward managers, clinical facilitators and link tutors. Overall there was considerable dissatisfaction with what was perceived to be the insufficient amount of communication received on a number of topics including allocations, the curriculum, students' learning outcomes and commitments in terms of college work. In addition to identifying points for improvement the audit provides a baseline against which progress can be assessed through a future audit.

Consumer Behavior↗

Predictors of course satisfaction and perceived course impact of addiction nurses undertaking a postgraduate diploma in addictive behaviour.

The effectiveness and impact of continuing education for specialist nurses working with drug and alcohol had been poorly documented and the purpose of this study was to enhance our understanding of this process. The aims of the study were to identify predictors of course satisfaction and perceived course impact and to examine students' satisfaction with modules' learning outcomes and their applications to practice. This study was a cross-sectional survey of 46 part-time students enrolled a Postgraduate Diploma in Addictive Behaviour. Three instruments were used to measure modules' satisfaction, post-course satisfaction (PCSQ-18) and on-the-job impact (CIQ-17). The findings provided some support on the effect and impact of an educational programme on the practice development of addiction nurses. Within the multilayered hypothesis, the results indicate that expectations on the Health Education and Prevention Module were the only significant predictor of course satisfaction and Expectation of the Special Population Module was the only significant predictor of course impact on professional practice. Clinical placements have had a significant impact on professional practice of addiction nurses. Further evaluative studies need to be undertaken to examine the impact of educational programmes on its applications to clinical practice and the quality of care provided.

Adult↗

Health protection: communicable disease, public health and infection control educational programmes--a case study from the UK.

The health protection (HP) landscape is changing. Issues related to infectious diseases in the context of global health are receiving the attention of world leaders and policy makers. In the UK, the national health policies resonate with such transformations, presenting a range of opportunities and challenges. The opportunities include the formation of a new national organisation dedicated to protecting the people's health and reducing the impact of infectious disease, the Health Protection Agency. The opportunities also include the opening of non-medical specialists's pathways in public health. The challenges represent the limited number of centres offering infection control education; the hospital focus and bias of the courses; new, resurgent and emerging infections; globalisation and travel; bacterial resistance; vaccine safety and coverage; bioterrorism; global response capacity; and visa restrictions. Within this context, this paper presents a case study of a HP educational programme at a British university in the south of England. It outlines the course design and philosophy, participants, recruitment, aims, descriptions and learning outcomes. A range of teething problems associated with the initiation and running of such programmes is considered. These include aspects related to the university, features associated with the modules, characteristics of the students, and other interconnected larger scale international issues. Some suggestions for the way forward are presented. Collectively, attention to the suggested measures can ensure that the processes that teaching programmes embrace to refine their content and delivery will equip tomorrow's professionals with the requisite HP knowledge and skills.

Communicable Disease Control↗

Intelligibility of stops and fricatives in tracheoesophageal speech.

UNLABELLED: Listener accuracy in identifying voiced and voiceless stops and fricatives in tracheoesophageal (TE) and laryngeal speech were compared. Sixteen TE and ten laryngeal speakers produced ten phonemes embedded in a nonsense word in a carrier phrase. Four experienced listeners phonetically transcribed the experimental phonemes. As expected, perceptual error rates were higher for the TE samples for all comparisons completed. The dominant error for laryngeal samples was a misperception of manner of production. The dominant error for TE samples was a perception of voiced for voiceless phonemes. Such voicing misperceptions occurred more frequently for fricatives than stops. Previous studies have implicated the vibratory characteristics of the pharyngoesophageal (PE) segment for the voicing errors in TE speech. However, PE features would not fully explain why stops were less affected than fricatives and why the expected error was reversed for two TE phonemes (perceptions of voiceless for voiced consonants). LEARNING OUTCOMES: (1) As a result of this activity, the participant will be able to identify the most common listener misperceptions of tracheoesophageal speech. (2) As a result of this activity, the participant will be able to discuss possible reasons for the predominant error that occurs.

Aged↗

Attention deficity/hyperactivity in SLI children increases risk of speech/language disorders in first-degree relatives: a preliminary report.

UNLABELLED: Specific language impairment (SLI) or developmental dysphasia denotes the inability to acquire normal expression and/or comprehension of language in the absence of peripheral hearing impairment, neurological disorder, and mental retardation. The presence of attention deficit/hyperactivity in some SLI children has previously been documented. This family history study used 27 SLI families, identified through the parents from the Dysphasia Association, to examine the relationship between attention deficit/hyperactivity in SLI children and the risk to first-degree relatives. All SLI children were clinically diagnosed with speech/language disorder; medical records were searched for the presence of any of the exclusion criteria noted above. The 13 SLI children with medical record of attention deficit/hyperactivity had a significantly higher chance of having first-degree relatives with speech/language disorders than 14 SLI children without such record (15/27 and 4/46, respectively). This preliminary report suggests that additional study is warranted to investigate the relationship between speech/language disorders and attention deficit/hyperactivity in families of SLI children. LEARNING OUTCOMES: As a result of this activity, the participant will be able to describe the SLI phenotype, its prevalence, and complexity and to recognize the relationship between comorbid attention deficit/hyperactivity in SLI children and the risk of speech/language disorder in their relatives.

Attention Deficit Disorder with Hyperactivity↗

Perceptions of communicative disorders: verification and specification of rater variables.

UNLABELLED: Using semantic differential scales with nine trait pairs, 600 students at three universities rated five descriptions, one depicting an individual without a disorder and four portraying individuals with communicative disorders. Statistical analyses indicated that the description with no disorder was rated as significantly less ambitious than the described articulation disorder. Other differences emerged when raters were divided by gender and age. Male subjects rated the portrayed individuals as more highly stressed than did females. A significant negative correlation was found for age of respondent and ratings of self-esteem. Results support previous research suggesting that rater gender and age impact perceptions of communicative disorders. LEARNING OUTCOMES: As a result of this activity, the participant will be able to: (1) identify the different means by which investigators have studied the stereotyping of people with communicative disorders, (2) discuss how listeners perceive those with and without communicative disorders, and (3) identify listener traits that may be associated with negative perceptions of people with communicative disorders.

Adolescent↗

Using and building theory in clinical action.

UNLABELLED: The unique contribution of speech-language pathologists to human welfare is shaped by clinical decisions. These decisions are, consciously or unconsciously, guided by theory, yet, clinicians are not routinely given the tools to construct and communicate theoretical practices in their work. This paper provides clinicians with two ways of thinking about theory so it can be used in clinical action. The first is a discussion of the relationship between specific and general theory so each can be recognized in clinical practices. The second is presentation of Bamberg's hexad as a tool for analyzing theory within clinical situations. A Venn model, used to conceptualize the links between general theory, specific theory, and clinical action, is discussed as a conceptual organizer for theory building in communicative sciences and disorders. LEARNING OUTCOMES: As a result of this activity, participants will (1) understand how theory can be used as a tool during clinical action, (2) understand the relationship between general and specific theory, and (3) understand how Bamberg's hexad can be used to analyze clinical action and build theory.

Child↗

The effect of a dopamine agonist on dysarthric speech production: a case study.

UNLABELLED: The effect of Permax (pergolide mesylate), a dopamine agonist, was assessed in an individual with traumatic brain injury. The participant evidenced symptoms of hypokinetic dysarthria. His performance on and off Permax was evaluated in a BABA design. Measures were obtained across physiological systems. There were few differences in the on and off conditions. In the on condition, he evidenced an abnormally large velopharyngeal orifice area, dysfluencies in stimulus sentences, and less precise articulation. However, listeners perceived him to be more animated in the on condition. In addition, he reported better performance in the on condition. The study highlights potential discrepancies among participant report, listener perception, and objective measures. LEARNING OUTCOMES: As a result of this activity, the participant will be able (1) to recognize the effect of dopamine agonists as an adjunct to other pharmacological interventions and (2) to determine potential discrepancies among participant report, listener perception and objective physiological and acoustic measures.

Adult↗