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PubMed1999

Speech and language therapy caseloads in seven districts in the UK.

This paper provides managers and clinicians with an analysis of routine data collected by seven speech and language therapy services in the UK. Managers in seven districts in the UK of varying size and location were asked to provide information on referrals, waiting times and attendances during the six month period, and to give a breakdown of the types of intervention offered and type of clients seen. These data were aggregated and comparisons were made with existing data on speech and language therapy services. The results revealed considerable variations in prevalence, staffing ratios and client management practices. The implications for service planning are discussed.

Adult↗

PubMed2002

A multimethod approach to the evaluation of community preschool speech and language therapy provision.

OBJECTIVES: The paper presents a research study investigating the effectiveness and acceptability of community speech and language therapy provision for preschool children with early speech/language delays. As a 'worked example', it demonstrates the value of a multimethod approach to evaluation. METHODS: The paper examines how the research findings of a pragmatic randomized controlled trial (RCT), a survey questionnaire and qualitative in-depth interviews, which were the methods used in the evaluation, overlap and complement each other. RESULTS: There was little evidence to establish the effectiveness of the speech and language therapy provided in the trial. This lack of difference was reflected in responses of parents to items on the questionnaire. The findings of the RCT, questionnaire and interviews all cast considerable doubt on the prospect of spontaneous resolution of the children's difficulties. Although the RCT showed few differences between the children allocated to immediate therapy or 'watchful waiting', the questionnaire and interviews revealed the circumstances in which the parents felt that these intervention strategies had been acceptable and unacceptable. CONCLUSIONS: Although the trial provided information about the progress of the children, the questionnaire and interview components highlighted the advantages and limitations of the intervention from the viewpoint of parents, thereby helping to explain the RCT findings. Thus, the study demonstrates how a multimethod approach to evaluation can yield useful information to explain the findings of RCTs.

Child Welfare↗

PubMed1980

Language therapy for pure word deafness in children.--A case report.

A follow-up study has been made on a girl with pure word deafness, the onset of which was surmised to be when she was nearly four years old. In the present paper, a course of language therapy for the patient during the period from five years and three months to seven years and five months was presented and the advantage of the training program using written language as a communicaiton modality was described. The program has been employed for language training of deaf children in the authors' hospital. During the course of the training, improvement in comprehension and expression was noted as far as the cards with written words were concerned, but the patient continued to have limited ability in auditory perception even at the end of the training period and never regained usable language ability by speech. It was suggested that the language difficulty in this particular case was due to the lesions in the bilateral temporal lobes. We discuss the relation between prognosis of this disability and language therapy.

Aphasia↗

PubMedDate not supplied

An analysis of referrals to speech and language therapy in 11 centres, 1987-95.

This retrospective study analyses data collected on an information system developed specifically for the use of speech and language therapists in the management of their services. Eleven healthcare providers have used the system since 1985. This paper reflects data on 73,000 clients referred to these speech and language therapy services between 1987 and 1995. The annual referral rate to these 11 trusts in 1987 was 4129, rising to 11,944 in 1995. The percentage referrals per head of population per year varies between 0.32 and 0.58% of the population. Of referrals to speech and language therapy, 96% comes from 24 different sources, including self referrals and referrals from other agencies, such as education. The top five referrers in 1987 were health visitors, educational service, general medicine/geriatrics, general practitioners (GPs), and other speech and language therapists. In 1995 ear, nose and throat (ENT) services replaced speech and language therapists in the top five referrers.

Computer Systems↗

PubMed2006

Recovery from aphasia as a function of language therapy in an early bilingual patient demonstrated by fMRI.

Knowledge about the recovery of language functions in bilingual aphasic patients who suffer from left-hemispheric stroke is scarce. Here, we present the case of an early bilingual patient (German/French) with chronic aphasia. Functional magnetic resonance imaging (fMRI) was used to investigate neural correlates of language performance during an overt picture naming task in German and French (a) 32 months after stroke to assess differential recovery of both languages as a function of the preceding language therapy that was provided exclusively in German and (b) after additional short-term intensive (German) language training. At the first investigation behavioral performance confirmed selective recovery of German naming ability which was associated with increased functional brain activation compared to the French naming condition. Changes in behavioral performance and brain activation pattern as disclosed by fMRI after an additional experimental treatment were confined to the trained (German) language and indicate bilateral neuroplastic reorganization. No generalization to the untrained (French) language was observed. The present case results demonstrate use and/or training-dependent differential recovery of expressive language functions and an enhanced pattern of brain activation as a function of the rehabilitation efforts that were focussed exclusively on the patient's German language abilities.

Adult↗

PubMed2003

Relation of orientation, verbal aggression, and physical aggression to compliance in speech-language therapy for adults with traumatic brain injury.

20 subjects with traumatic brain injury were tested over a 4-wk. period for aggressive behaviors; orientation to place, person, and time; and compliance in speech-language therapy sessions. Analysis showed significant correlations from .63 to .75 over the four sessions between orientation and compliance in speech-language therapy and suggest that orientation training could be a prerequisite to the formal treatment of other behavioral or communication disorders.

Adolescent↗

PubMed1991

The internal validity of efficacy studies: design and statistical power in studies of language therapy for aphasics.

In this study the internal validity of efficacy studies of language therapy for aphasic patients is discussed. The lack of sufficient internal validity is demonstrated with respect to research designs used in these studies and the statistical power of their statistical significance tests. The internal validity problems are viewed as the major cause of the conflicting conclusions in the efficacy studies in the past three decades.

Aphasia↗

PubMedDate not supplied

Speech and language therapy services to education in England and Wales.

Services for children with speech and language needs in England and Wales are in a period of change. The context is subject to major systemic pressures deriving from government policies. These include the development of inclusive education and encouragement of multiprofessional collaboration in policy development and practice ('joined up thinking'). In addition, structures at local level are changing with the establishment of unitary authorities and the change from Health Trusts to Primary Care Trusts. Professional practice is also changing with a shift from clinical to community settings for speech and language therapists working with children. The present study reports on a survey sponsored by the Department for Education and Employment, Department of Health and the Welsh Assembly to identify the nature of speech and language therapy (SLT) services provided to education in England and Wales. The sample comprised all SLT service managers (n = 133, response rate 74%). The results indicate that services vary greatly in size and in their SLT: child ratio, with a mean of one SLT to 4257 child population. The caseload was highest for the 5-10 age group, and service delivery was targeted at these children, with low levels of work with secondary aged pupils. Most provision in educational settings was made to mainstream schools, but the provision of SLT time per child was substantially higher in specialist language resources. Apart from the preschool phase, most SLT provision was for children with statements of special educational needs. Prioritization of service delivery was usually by severity of need. The provision of bilingual SLT services was very limited, with only 14.0 full-time equivalents SLTs fluent in a community language, other than Welsh, where proportionately availability was much greater. Most LEAs funded SLT posts, although these were usually employed as part of the SLT service, with only about 10% of LEAs employing SLTs direct. However, 55.5% of SLT managers reported that recruitment and retention were problematic, resulting in gaps in the service. These findings are discussed with respect to changes driven by professional judgements on the nature of optimal service delivery, and government policy, with particular reference to inclusion and equity of service delivery.

Adolescent↗

PubMed2004

Speech and language therapy to improve the communication skills of children with cerebral palsy.

BACKGROUND: The production of speech, language and gesture for communication is often affected by cerebral palsy. Communication difficulties associated with cerebral palsy can be multifactorial, arising from motor, intellectual and / or sensory impairments, and children with this diagnosis can experience mild to severe difficulties in expressing themselves. They are often referred to speech and language therapy (SLT) services, to maximise their communication skills and help them to take an independent a role as possible in interaction. This can include introducing augmentative and alternative communication (AAC) systems, such as symbol charts or speech synthesizers, as well treating children's natural forms of communication. Various strategies have been used to treat the communication disorders associated with cerebral palsy but evidence of their effectiveness is limited. OBJECTIVES: To determine the effectiveness of SLT that focuses on the child or their familiar communication partners, as measured by change in interaction patterns. To determine if individual types of SLT intervention are more effective than others in changing interaction patterns. SEARCH STRATEGY: Searches were conducted of MEDLINE, CINAHL, EMBASE, PSYCH INFO, LLBA, ERIC, WEB of SCIENCE, NRR, BEI, SIGLE up to December 2002. References from identified studies were examined and relevant journals and conference reports were hand-searched. SELECTION CRITERIA: Any experimental study containing an element of control was included in this review. This includes non-randomised group studies and single case experimental designs in which two interventions were compared or two communication processes were examined. DATA COLLECTION AND ANALYSIS: L Pennington searched for and selected studies for inclusion. J Goldbart and J Marshall independently assessed separate random samples each comprising 25% of all identified studies. Two reviewers independently abstracted data from each selected study. Disagreements were settled by discussion between the three reviewers. MAIN RESULTS: Eleven studies were included in the review. Seven studies evaluated treatment given directly to children, four investigated the effects of training for communication partners. Subjects in the studies varied widely in age, type and severity of cerebral palsy, cognitive and linguistic skills. Studies focusing directly on children suggest that this model of therapy delivery has been associated with increases in treated communication skills by individual children. However, methodological flaws prevent firm conclusions being made about the effectiveness of therapy. In addition, maintenance of these skills was not investigated thoroughly. The studies targeting communication partners describe small exploratory group projects which contain insufficient detail to allow replication, have very low power and cannot provide evidence of effectiveness of this type of treatment. REVIEWERS' CONCLUSIONS: Firm evidence of the positive effects of SLT for children with cerebral palsy has not been demonstrated by this review. However, positive trends in communication change were shown. No change in practice is recommended from this review. Further research is needed to describe this client group, and its possible clinical subgroups, and the methods of treatment currently used in SLT. Research is also needed to investigate the effectiveness of new and established interventions and their acceptability to families. Rigour in research practice needs to be extended to enable firm associations between therapy and communication change to be made.

Adolescent↗

PubMed1998

Case weighting in a speech and language therapy service.

This study present an approach designed to calculate input provided by a speech and language therapy service. A case weighting system was developed in order to evaluate the cost of services, predict the need for intervention, balance and prioritise the caseload among therapists. It is suggested that this approach can be use widely in clinical practice.

Cerebrovascular Disorders↗

PubMed2006

Online learning in speech and language therapy: Student performance and attitudes.

CONTEXT: Behavioural studies form an essential component of the Speech and Language Therapy (SLT) undergraduate degree. AIMS: This study aimed to produce online teaching material in behavioural studies suitable for undergraduate SLT students, explore students' views on the online material, record their performance when taught through this innovative method and compare their performance to a group taught through the traditional lecture based method. Finally, it aimed to explore the relationship between engagement with the module and performance. METHODS: SLT students completed an online health psychology/sociology module and their performance was compared to students who completed a traditional lecture based course. Student evaluations of the online course were also recorded as was their engagement with the online module. FINDINGS: Results suggested that there was no significant difference between students taught through an online medium compared to those taught through "traditional lectures". An evaluation survey suggested that students appeared to enjoy the material although there was some reluctance to develop an independent learning style. CONCLUSION: Online learning has a great deal to offer SLT education. However, material has to be developed that can both engage and motivate learners, thereby enhancing student independent learning.

Attitude↗

PubMed1992

A meta-analysis of studies carried out between 1946 and 1988 concerned with the efficacy of speech and language therapy treatment for aphasic patients.

An examination of the empirical evidence for the efficacy of speech and language therapy treatment for adult aphasic patients is undertaken with the aid of meta-analysis which affords a statistical method of systematic data summary and synthesis. Patient characteristics and treatment outcomes are correlated to identify factors that contribute to the demonstration of a treatment effect. One of the most striking results of this retrospective study was the identification of the overwhelming failure to report data or include, in experimental controls, variables that might crucially affect outcome.

Aphasia↗

PubMed1998

Prioritisation in speech and language therapy departments in Scotland and Malaysia.

This study investigates how prioritisation in health services have influenced speech and language therapy (SLT) services in Scotland in prioritising their caseload. Additionally, it evaluates how current prioritisation systems may contribute towards the development of the SLT service in Malaysia. Health, education and social agencies in Malaysia were contacted and a literature review was conducted. Information on prioritisation systems used in Malaysia was unavailable. Prioritisation systems from seven SLT departments within Scotland were investigated, of which three SLT managers took part in semi-structured interviews. The findings show that prioritisation is influenced by a combination of factors and that the principles could only be applied to the Malaysian SLT service if consideration is given to the political, economical, social, geographical and cultural factors.

Health Priorities↗

PubMed1998

The use of a paediatric speech and language therapy outcome measurement scale.

This research aimed to evaluate the inter- and intra-rater reliability of a locally developed paediatric speech and language therapy (SLT) outcome measure, the NBOM (Northern Birmingham Outcome Measures), immediately after 15 speech and language therapists (SLTs) had taken part in training then after a period of time. It was found that SLTs who had received more than the basic orientation training achieved a higher level of reliability than those who had not but after 5 months training effects were fading. It seems that as well as requiring training and practice on the scales, SLTs also needed increased scaling definition, protocols and anchor stimuli to help with the interpretation of information and the assigning of rating points. Finally, scales were apparently used more reliably within an 'overt' rating session than in everyday clinical settings.

Adolescent↗

PubMed1998

Efficacy of speech and language therapy for particular speech sounds in children.

At the present time there is a demand for research into the efficacy of speech and language therapy. This study aims to assess the efficacy of therapy provided in South Tees for children who do not use word-initial velar plosives. The study is in progress at the time of writing and it is expected that therapy will be completed by July 1998. Subjects are split randomly into an 'immediate treatment' and a 'deferred treatment' group. All subjects are reassessed after treatment of each group. It is of course possible that analysis of the results will not show a significant difference between pre- and post-treatment scores. Some children may acquire target sounds before entering therapy, whilst others may fail to learn them within the treatment period. Various factors are being noted to determine whether they appear to correlate with the outcome of therapy.

Child, Preschool↗

PubMed1997

A comparison of three approaches to delivering a speech and language therapy service to people with learning disabilities.

This research aimed to compare three different approaches to delivering a speech and language therapy service to people with learning disabilities, in order to make recommendations for future service delivery. The three approaches all involved working with key communication partners in the environment. They were: (i) working directly on a one-to-one basis with the person and partner; (ii) working indirectly by providing teaching for partners; and (iii) a combination of these two approaches. A teaching course called 'Talkabout' was used. Talkabout aims for staff to reach a recognised level of knowledge and competence in communication skills, thus facilitating the communication skills of their service users. The results indicated that whilst communication changed in all three approaches, overall changes were greater in the combination approach. Only the combination approach demonstrated statistically significant differences following intervention, in terms of staff initiations, service user responses, and their use of additional modalities.

Delivery of Health Care↗

PubMed1998

Changes in referral to speech and language therapy.

This is a retrospective study of data collected on an information system, developed specifically for the use of speech and language therapists and used by eleven health care providers since 1985. Information prior to 1987 contain the artefacts of new technology and backload logging. Thus this paper reflects data from 1987 to 1995. Information on 70,000 clients amalgamated from these trusts allow us to reflect upon the changes in speech and language therapy over that period. The annual referral rate to these eleven trusts in 1987 was 4,129. The annual referral rate for the same trusts in 1995 had risen to 11,945. The percentage referrals per head of population per year varies between 0.32% and 0.58% of the population.

Adolescent↗

PubMed2006

Functional imaging before and after constraint-induced language therapy for aphasia using magnetoencephalography.

Five patients with chronic aphasia underwent functional imaging using magnetoencephalography (MEG) before and after constraint-induced language therapy (CILT). Patients who responded well to CILT exhibited a greater degree of late MEG activation in posterior language areas of the left hemisphere and homotopic areas of the right hemisphere prior to therapy than those who did not respond well. Response to CILT, however, was positively correlated with the degree of pre-therapy MEG activity within posterior areas of the right hemisphere only on an individual basis.

Aged↗