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The paper seeks to describe the way in which changes were brought about in the delivery of speech therapy to children in special schools. Changes were necessary in order to make most use of existing staff resources and to investigate the effects of treatment. Both aims were achieved, but improvements to practice are continuing. A change in service organisation across the two state services of Health and Education takes time to bring about.
Four chronic global aphasics were treated with Blissymbols (C. K. Bliss, 1965, Semantography-Blissymbolics, Sydney: Semantography Pub.). As soon as possible the therapeutic communication was based solely on the use of the symbols. Three patients seemed to benefit from therapy. In one case therapy had to be discontinued because of massive perseveration. In one patient expression of needs relied solely on the use of the symbols. In another, expressive speech could be restored to such an extent that communication by the use of symbols was discontinued.
People with jargon aphasia have severely disordered and incomprehensible speech that may be resistant to therapeutic intervention. In this study, we treated written output and examined whether it assisted communication for these clients. In stage one of the study, anagram sorting, delayed copying and lexical decision tasks were used to investigate the residual knowledge of written words in a group of ten people with jargon aphasia. Evidence of the presence of orthographic knowledge was taken as an indication that writing might be a useful focus for therapy. This hypothesis was explored in stage two with six clients. A personally useful vocabulary was selected for each, and copying, word completion and written picture-naming tasks were used in therapy to improve written production of these words. The clients made progress in written naming. However, they showed little change on a 'message' assessment that tested their ability to use the written words to convey messages. Stage three targeted communicative writing. Here, three of the clients received 'message therapy', which encouraged them to relate treated words to functional messages and to communicate them to a partner. The clients improved on the message assessment and observation of their communication and reports from relatives suggested that they made functional use of writing in a range of communication settings.
Five nonfluent aphasics were presented English phrases with three syllable durations; a regular speech, non-intoned duration less than 1 sec per syllable, and two modified Melodic Intonation Therapy (MIT) intoned durations of 1.5 sec per syllable and 2.0 sec per syllable. All subjects had the greatest number of correct phrase productions at the longest MIT duration (p less than 0.001) and the greatest number of failures at the regular non-intoned duration. Therefore, syllable duration is an important acoustic parameter to consider when using an MIT technique with severe nonfluent aphasics.
We present a preliminary report on a study of the treatment of word finding difficulties in aphasia using phonological and orthographic cues. These techniques although often used to cue word finding in the immediate term have been little evaluated in terms of therapy designed to improve word retrieval in the long term. The first phase using cued word retrieval in a picture naming task was followed by a second phase designed to facilitate use of treated words in real-life contexts. The results from both phases were encouraging with improved word retrieval for three out of the four participants. The implications for clinical practice are discussed.
A 5-year-old boy presented with very deviant phonological production, as well as some delay in acquisition of vocabulary for comprehension. Investigations showed that, in contrast to his very limited phonological system in word production and naming, he was able to repeat a variety of non-words with reasonable accuracy using a variety of syllable structures. A period of therapy aimed at improving his phonological segmentation skills resulted in dramatic improvement in real word production to the same level that he showed with non-words. This improvement was specific to the domain of treatment--real word phonology--demonstrating that the effects were a result of the therapy regimen. The reasons for this dissociation between the phonology of real words and non-words are discussed. It is concluded that the child's pattern of performance is incompatible with theories which assume that a single phonological representation is used both for word recognition and for output. His deficit appears to lie in a failure to update the underlying phonological representations used to drive spoken output as his phonological abilities develop--his lexical phonology was 'frozen'.
Sixty-one children, aged 3.6-5.0, with developmental phonological disorders (PD) participated in a study comparing the effects of metaphonologically (MET) or articulation-based (ART) therapy. Maturational effects were controlled for by the inclusion of 59 normally speaking control children of the same age range. Measures of phonological (speech) output and phonological awareness were taken before and after therapy for all subjects and at 3 months post-therapy for PD children. Results showed that PD children improved significantly in both phonological output and awareness skills across the intervention period compared with control children, but that there was no significant difference on the awareness measure between ART and MET groups. ART and MET groups differed from each other on one measure of speech improvement only, with the ART group making more change than the MET group on individual probe scores. Follow-up measures for both therapy groups indicated that there was little difference between the groups on phonological awareness change or speech development 3 months after intervention, though there was a trend for MET children to continue to make more long-term change than the ART group on one output measure. Additional analysis showed that there were generally few significant implications for outcome between PD children with good initial phonological awareness skills and those who initially had poor phonological awareness skills.
Twelve weeks of therapy emphasizing functional communication content was conducted twice weekly in a group setting for seven chronic aphasic patients whose average post-onset time was 97.9 months. Porch Index of Communicative Abilities (PICA) test scores did not change significantly as a result of this treatment. Communicative Abilities in Daily Living (CADL) test scores, however, revealed statistically significant improvement in post-treatment performances. A final administration of CADL tests six weeks after cessation of functional communication treatment indicated that the positive change in CADL scores had been maintained.
OBJECTIVE: The objective of this article was to evaluate the results of a prevention campaign on the access to early speech therapy for 4-year-old children. POPULATION AND METHODS: A prevention campaign of speech disorders was conducted in Gironde area in 1999, offering a systematic screening by ERTL4 test and free speech therapy. The campaign results were evaluated by quality and efficiency indicators. RESULTS: In 1999, 14037 children born in 1995 were included and 1363 children randomly selected from the schools benefited from the campaign. One child out of four failed in the screening test by ERTL4. The percentage of the assessment and speech therapy in the children of the campaign (16.0 and 8.2%) were significantly higher than the other children of the area (8.9 and 6.7%). CONCLUSION: The campaign evaluation has demonstrated its capacity to access to speech therapy for children language disorders, allowing gains of frequency and earlier treatment.
This paper looks at the content, methods and evaluation of training in communication therapy developed in Vietnam over a two year period using a wider approach to treatment than a medical one. It argues that training to institution staff needs to combine the needs of a community and principles of community based rehabilitation with a more traditional medical model. It examines the need to develop training programmes for trainers based on a sharing of attitudes and awareness between institutions and communities as well as some more prescriptive and activity-based training. It examines the selection and role of trainees who attend such training courses and skills required by the trainers. It also relates these skills to possible approaches to service delivery in this country.
The purpose of this article is to discuss a cognitive approach to therapy with a language impaired adult. Two types of productive thinking are explored in this research: concept awareness and problem solving. These are dynamic and creative processes underlying the development and use of cognition and language. This single subject study follows an ABAB design and describes techniques used in therapy and methods for measuring productive thinking in a 66-yr-old moderately language impaired adult. Results indicate a sharp increase in the subject's thought productivity in a variety of contexts. A critical appraisal of reasons for therapy effectiveness are given.
This study investigated a new treatment in which sentence production abilities were trained in a small group of individuals and nonfluent aphasia. It was based upon a mapping therapy approach which holds that sentence production and comprehension impairments are due to difficulties in mapping between the meaning form (thematic roles) and the syntactic form of sentences. We trained production of both canonical and noncanonical reversible sentences. Three patients received treatment and two served as control participants. Patients who received treatment demonstrated acquisition of all trained sentence structures. They also demonstrated across-task generalisation of treated and some untreated sentence structures on two tasks of constrained sentence production, and showed some improvements on a narrative task. One control participant improved on some of these measures and the other did not. There was no noted improvement in sentence comprehension abilities following treatment. Results are discussed with reference to the heterogeneity of underlying impairments in sentence production impairments in nonfluent patients, and the possible mechanisms by which improvement in sentence production might have been achieved in treatment.
Aphasic patients who met stringent selection criteria were assigned randomly to three groups: clinic treatment by a speech pathologist for 12 weeks, followed by 12 weeks of no treatment; home treatment by a trained volunteer for 12 weeks, followed by 12 weeks of no treatment; or deferred treatment for 12 weeks, followed by 12 weeks of treatment by a speech pathologist. At 12 weeks after entry, language measures indicated that the clinic-treatment patients made significantly more improvement than did the deferred-treatment patients, and improvement in home-treatment patients did not differ significantly from either clinic- or deferred-treatment patients. At 24 weeks after entry, after deferred-treatment patients had received clinic treatment, there were no significant differences among the groups. These results suggest that clinic treatment for aphasia is efficacious, and delaying treatment for 12 weeks does not compromise ultimate improvement.
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We argue that researchers interested in language and communication problems in mental retardation or any other developmental disorder should view such problems as emerging within the broader context of the behavioral profile, or phenotype, associated with a particular genetic condition. This will require understanding the direct and indirect effects of genes on the development of language and communication and thereby an understanding of the complex relations that exist between language and other dimensions of psychological and behavioral functioning as well as an understanding of the environments in which the developing person acts and is acted upon. We believe that the dominant model for understanding language and communication problems--the nativist approach, which emphasizes the child's innate capacity for acquiring language and characterizes language as consisting of a set of context-free deterministic rules that operate on abstract representations--is inconsistent with an emphasis on indirect genetic effects. We review recent evidence that undermines the nativist approach--evidence concerning the initial state of the language-learning child, the role of environmental input, the competence-performance distinction, and modularity. In place of nativism, we argue for Emergentism, which is a model in which language is seen to emerge from the interaction between the child's biological abilities to map statistical properties of the language input into a distributed representation and the characteristics of the language learning environment and for the purpose of engaging in real-time, meaningful language use.
In this article, we consider the theoretical debates and frameworks that have shaped research on language development and intervention in persons with mental retardation over the past four decades. Our starting point is the nativist theory, which has been espoused most forcefully by Chomsky. We also consider more recent alternatives to the nativist approach, including the social-interactionist and emergentist approaches, which have been developed largely within the field of child language research. We also consider the implications for language development and intervention of the genetic syndrome-based approach to behavioral research advocated by Dykens and others. We briefly review the impact and status of the debates spurred by the nativist approach in research on the course of language development in individuals with mental retardation. In addition, we characterize some of the achievements in language intervention that have been made possible by the debates spurred by nativism and the various alternatives to it. The evidence we consider provides support for all three alternatives to the nativist approach. Moreover, successful interventions appear to embody elements of several of these approaches as well as other theoretical approaches (e.g., behaviorism). We conclude that language intervention must be theoretically eclectic in its approach, with different strategies appropriate for teaching different features of language, at different points in development, and for children displaying different characteristics or learning histories.
This issue of MRDD research reviews is dedicated to treatment efficacy research. The treatment of MRDD conditions has long been a central question, but the clinical science of treatment efficacy has not yet been systematically applied to many MRDD typologies. The purpose of this paper is to provide an overview of this special issue and to provide a rationale for including treatment efficacy research as a tool for studying selected neurological development and genetic correlates of MRDD. Existing treatment efficacy paradigms should be applied systematically to relevant populations (and theoretical questions) and new, objectively tested paradigms should be developed in order to integrate ongoing discovery in MRDD.
The purpose of this review is to discuss the importance of treatment efficacy research in language comprehension in MR/DD populations. Although receptive language deficit is an integral part of most MR/DD typologies, there have been relatively few studies evaluating the effectiveness or efficacy of treatment for this condition. Recently, there has been increased attention placed on auditory processing in children with disabilities, an aspect of cognition related to receptive language, but there have also been few studies investigating the effectiveness or efficacy of training designed to improve auditory processing. In addition to arguing that additional studies in this area are needed, the review includes several theoretical frameworks for addressing the treatment of receptive language deficits in MR/DD.