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PubMed2001

Providing intensive therapy in schools for children with no identified provision.

The provision of a speech and language therapy service to a school-age child with little home support and no identified provision for extra help in school has always proved challenging to service providers and causes many services to make hard choices in terms of best use of limited resources. These children commonly at stage three of the Code of Practice (Department for Education 1994) fall between two stools: a school which cannot provide extra help in order to carry out a speech and language therapy programme; and a speech and language therapy service which cannot effect change without back up in the home or school. In this paper a project which provides therapy programmes to this group of children via a student clinical placements initiative is reported. The project is discussed in terms of client outcomes data and offers suggestions as to how findings may be interpreted.

Child↗
PubMed1994

Parental-based intervention with pre-school language-delayed children.

Mothers of children randomly allocated to an experimental group attended fortnightly group parental language training sessions, over a 6-month period. Mothers of children allocated to a matched no intervention control group received no special attention. The results showed significantly greater gains in the expressive language skills of the experimental group compared to the control group. A second experiment was designed to compare the parental involvement approach with direct, individual treatment and to clarify the role of non-specific 'Hawthorne-type' effects. The experimental group mothers attended parental language training sessions, as above. The parental control group mothers also attended training sessions, with the emphasis on general learning skills rather than language. A third group of children received individual, direct speech and language therapy. Results showed significantly greater language gains in the parental language training group and in the individual group in comparison with the non-specific training group. The two former groups did not differ significantly, indicating that, for these groups and this methodology, parental language training is as effective as individual speech and language therapy. The results also indicate that the effectiveness of the parental involvement approach cannot be accounted for by non-specific factors. The research findings are discussed, together with the professional implications of the study and recommendations for further research.

Adult↗
PubMed2001

Pharmacological treatment for aphasia following stroke.

BACKGROUND: Aphasia describes language impairment associated with a brain lesion. OBJECTIVES: The objective of this review was to assess the effects of drugs on language abilities when given to people with aphasia following stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group Register (last searched: May 2001), and reference lists of relevant articles to December 1998. We also contacted academic institutions and other researchers to identify further published and unpublished trials. MEDLINE was searched from 1966-1998, and CINAHL from 1982-1998. We searched the International Journal of Disorders of Communication by hand (known by other names in the past), from 1969 to 1998. SELECTION CRITERIA: Randomised controlled trials comparing: ~bullet~Any drug given to improve language, versus no treatment, or versus placebo ~bullet~Any drug given to improve language versus speech and language therapy ~bullet~One drug given to improve language versus another drug given with the same aim DATA COLLECTION AND ANALYSIS: The principal reviewer collected the data, and assessed the quality of the trials with independent data checking and methodological advice. If we could not perform a statistical combination of different studies, we sought missing data. Failing that we provided a description. We sought missing data from authors, or where appropriate, a drug company. MAIN RESULTS: We considered fifty two studies in detail, from which we identified ten trials suitable for the review. In most cases the methodological quality was unassessable, and only one trial reported sufficient detail for us to complete a description and analysis. This study did lose a large number of patients during its course. Drugs used in the trials identified were piracetam, bifemalane, piribedil, bromocriptine, idebenone, and Dextran 40. We found weak evidence that patients were more likely to have improved on any language measure at the end of the trial if they had received treatment with piracetam (odds ratio 0.46, 95% confidence interval 0.3 to 0.7). The evidence is considered weak because of the large numbers of drop outs from the trials identified, who were lost to follow up. Patients who were treated with piracetam were no more likely (considering statistical significance) than those who took a placebo to experience unwanted effects, including death (odds ratio 1.29, 95% confidence interval for difference 0.9 to 1.7). However, the differences in death rates between the two groups, even though not not statistically significant, do give rise to some concerns that there may be an increased risk of death from taking piracetam. We could not determine if drug treatment is more effective than speech and language therapy. We could not determine whether one drug is more effective than another. REVIEWER'S CONCLUSIONS: The main conclusion of this review is that drug treatment with piracetam may be effective in the treatment of aphasia after stroke. Further research is needed to explore the effects of drugs for aphasia, in particular piracetam. If a trial is done, this must be large enough to have adequate statistical power. The safety of the drug should be of primary interest. Researchers should examine the long term effects of this treatment, and whether it is more effective than speech and language therapy.

Aphasia↗
PubMed1998

Is anyone speaking my language?

This paper describes an on-going three-phase action research project undertaken by members of the Norwich Community Trust speech and language therapy adult services team. With the support of the Clinical Audit department the project was set up in order to: 1) investigate the characteristics, needs and aspirations of the population of dysphasic people in the community; 2) examine how dysphasic people and their families perceive the speech and language therapy service; 3) implement specific changes to the speech and language therapy service to dysphasic people and their families. These changes are based on proposals developed through a working partnership between the speech and language therapy department and dysphasic people and their families.

Adult↗
PubMedDate not supplied

Children with speech and language disability: caseload characteristics.

BACKGROUND: There has been no previous incidence survey of children referred to a speech and language therapy service in the UK. Previous studies of prevalence of specific communication difficulties provide contradictory data from which it is difficult to plan speech and language therapy service provision. Reliable data are needed concerning the nature and severity of impairments as well as the age and source of referral and the effects of cultural and socio-economic profiles of the population served. AIMS: To describe referrals received between January 1999 and April 2000 by the paediatric speech and language therapy service of Middlesborough Primary Care Trust, an area of social deprivation. METHODS & PROCEDURES: All referrals were offered an initial assessment appointment within 8 weeks of referral. Standardized tests and quantitative measures of communication difficulties, determined by age, were undertaken. Population and case history information was also gathered. OUTCOMES & RESULTS: The incidence rate of referrals who attended for assessment in a single year was calculated as 16.3% for primary communication disability and 14.6% for speech/language disability. Of the 1100 referrals, 14.9% failed to attend and 9.8% had normal functioning. The distribution of disorder type was dysfluency 5.3%, voice or nasality disruption 2.0%; receptive language difficulties 20.4%, expressive language difficulties 16.9% and speech difficulties 29.1%. A further 0.7% had special educational needs and 0.9% had speech and language impairment but refused consent. The majority of referrals were between 2 and 6 years old, more boys than girls were referred, and socio-economic status matched that of the local population. Both gender and socio-economic status affected diagnosis. CONCLUSIONS: Based on the Middlesborough data, the estimated national incidence rate of referrals who attend for assessment and who have speech and language disability is 85 000-90 000 children per year (14.6% of births). While findings from only one Primary Care Trust must be treated cautiously, they provide paediatric speech and language therapy services managers with information that might guide service planning.

Child↗
PubMedDate not supplied

The implications of different approaches to evaluating intervention: evidence from the study of language delay/disorder.

There is a pressure to both identify and expand the evidence base with regard to the treatment of speech and language disorders in children, as there is in other areas of speech and language therapy. This paper addresses two sources of evidence, a systematic review and meta-analysis of early language interventions and the monitoring of an early language target for socially disadvantaged children in Sure Start programmes in England. There is a growing number of efficacy studies in the field of speech and language disorders in children. For example, in a recent review for the Cochrane Collaboration in the UK 36 articles reporting a total of 33 different trials. Twenty-five of these articles provided sufficient information for use in a series of meta-analyses. The results indicate that speech and language therapy may be effective for children with phonological or expressive vocabulary difficulties. There is mixed evidence concerning the effectiveness of intervention for children with expressive syntax difficulties and little evidence available considering the effectiveness of intervention for children with receptive language difficulties. No significant differences were found between interventions administered by trained parents and clinicians. A number of gaps in the evidence base are identified. But such reviews are essentially retrospective and, while the results may be interesting for practitioners, they do not provide the whole picture. The paper then turns to a very different data set and the role of population monitoring, an approach to assessing the value of interventions which has not hitherto been used in any area of speech and language therapy. The data are derived from a year-on-year monitoring of the language output of 2-year-olds in Sure Start programmes in England. This is a programme funded by central government in the UK to reduce the impact of social disadvantage on children, parents and their communities. The practice and policy implications of these two different sources of information are considered. Who is the consumer of such information and what can they do with it once they have it?

Child↗
PubMed1996

Audit in the therapy professions: some constraints on progress.

AIMS: To ascertain views about constraints on the progress of audit experienced by members of four of the therapy professions: physiotherapy, occupational therapy, speech and language therapy, and clinical psychology. METHODS: Interviews in six health service sites with a history of audit in these professions. 62 interviews were held with members of the four professions and 60 with other personnel with relevant involvement. Five main themes emerged as the constraints on progress: resources; expertise; relations between groups; organisational structures; and overall planning of audit activities. RESULTS: Concerns about resources focused on lack of time, insufficient finance, and lack of access to appropriate systems of information technology. Insufficient expertise was identified as a major constraint on progress. Guidance on designing instruments for collection of data was the main concern, but help with writing proposals, specifying and keeping to objectives, analysing data, and writing reports was also required. Although sources of guidance were sometimes available, more commonly this was not the case. Several aspects of relations between groups were reported as constraining the progress of audit. These included support and commitment, choice of audit topics, conflicts between staff, willingness to participate and change practice, and concerns about confidentiality. Organisational structures which constrained audit included weak links between heads of professional services and managers of provider units, the inhibiting effect of change, the weakening of professional coherence when therapists were split across directorates, and the ethos of regarding audit findings as business secrets. Lack of an overall plan for audit meant that while some resources were available, others equally necessary for successful completion of projects were not. CONCLUSION: Members of four of the therapy professions identified a wide range of constraints on the progress of audit. If their commitment to audit is to be maintained these constraints require resolution. It is suggested that such expert advice, but also that these are directed towards the particular needs of the four professions. Moreover, a forum is required within which all those with a stake in therapy audit can acknowledge and resolve the different agendas which they may have in the enterprise.

Allied Health Occupations↗
PubMedDate not supplied

Ask a silly question: two decades of troublesome trials.

BACKGROUND: Randomized control trials and the use of meta-analysis in systematic reviews are the basis of evidence-based practice. The paper reviews their use in the development of evidence-based practice in speech and language therapy. AIMS: It is accepted that clinical outcome research should develop in a sequence of phases. A model of this process is described. Examples of outcome research in speech and language therapy are used to illustrate the use of the model and the problems that result when it is not followed. MAIN CONTRIBUTION: Existing research has largely ignored the agreed procedures for outcome research. Particular problems have arisen when randomized control trials are used to examine therapy provision for a client group. Clients are often a heterogeneous group and receive different therapies. Consequently, it is unlikely that trials can obtain significant results, nor, if they do, can they provide clinicians with useful information about the choice of treatment. Systematic reviews are equally uninformative. Many of the studies on which they are based have methodological problems and their frequent failure adequately to describe the therapies used mean that reviews cannot evaluate or compare different types of therapy. CONCLUSIONS: Researchers in speech and language therapy have given too little attention to the basics of clinical outcome research. This requires that clinical and theoretical insights are used to identify specific therapies for well-defined groups of clients. These therapies must be tested first in efficacy, then in effectiveness studies, and their results should be disseminated to clinicians. Only then is it meaningful to carry out large-scale trials of the effectiveness of therapy provision for a client group or to conduct systematic reviews of existing research.

Child↗
PubMed1998

Encouraging speech and language development in exceptional circumstances.

An evaluation of the accessibility of the speech and language therapy service within Down Lisburn Trust and a needs assessment of the levels of speech and language difficulties in preschool children was conducted between October 1996 and March 1997. Results highlighted that 42% of preschool children had speech and language difficulties, however only 17.8% were able to access the speech and language therapy service for remediation of their difficulties. A further 2-3 year project is now planned. This aims to tackle the high levels of speech and language difficulties in children through prevention, early identification and remediation programmes. It also aims to ensure equitable access to the speech and language therapy service for all children.

Child, Preschool↗
PubMed2002

Stammering and therapy views of people who stammer.

UNLABELLED: This study used a postal questionnaire to seek the views of adults who stammer concerning the effect of stammering on their lives, the speech and language therapy and other remedies they have tried, and their hopes for speech and language therapy in the future. The 332 returned questionnaires indicated that stammering had the greatest adverse effect on school life and occupation. Speech and language therapy had been helpful to many, but the nature of the benefits and specific therapies used were not cited in many responses. An emergent theme in unhelpful therapy was the dissatisfaction that arises when individual needs are not met. In the future, people want help in controlling stammering and in developing coping strategies. The desire for timely and effective therapy for children, ongoing help and for group or intensive work has implications for service organization and therapist's skills. The survey highlights the need for therapists and clients to negotiate therapy aims and procedures that are clearly defined, appropriate to individual needs, achievable, and, if possible, recorded and measured. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to list (1) the areas most and least affected by stammering, (2) the therapy approaches respondents had found helpful, and (3) other remedies that tried to help stammering.

Adolescent↗
PubMed2007

Increasing print awareness in preschoolers with language impairment using non-evocative print referencing.

PURPOSE: This study examined the extent to which using non-evocative, explicit referencing of print concepts during shared storybook reading in the context of language therapy facilitated print concept knowledge in children with language impairment. METHOD: Five children, ages 4 to 5 years, were provided scripted input on 20 print concepts during shared storybook reading that was incorporated into individualized 30-min language intervention sessions that were conducted in the children's classroom twice weekly. The children were not required to make any response to the input on print concepts, and the input was secondary to instruction in the language targets during the 10-min shared storybook reading activity. RESULTS: Using a single-subject, multiple probe design across subjects, results indicated that children's knowledge of print concepts improved markedly when the procedure was incorporated into shared storybook reading and that they continued to learn and maintain knowledge of print concepts with repeated input. CLINICAL IMPLICATIONS: These findings suggest that children with language impairment may benefit from simple non-evocative, explicit referencing strategies that can be easily incorporated into the context of storybook reading during language therapy, thus providing speech-language pathologists with an additional tool for facilitating children's literacy skills.

Awareness↗
PubMed1976

[Recovery processes in 2 cases of bilingual aphasia].

Recovery processes of two English-Japanese bilingual aphasics were investigated with special emphasia on the effect of language therapy. Although the two patients had different types of aphasia (one Broca's aphasia and the other Wernicke's aphasia), the degree of the language impairment initially manifested in English and Japanese was almost equivalent in each case with the pattern of impairment corresponding to the respective types of aphasia. In either case, language therapy was conducted in English, and the course of recovery during the first six months was analyzed. The results indicated that auditory comprehension improved almost simultaneously in both treated (English) and untreated (Japanese) languages regardless of the type of the patients' aphasia. In contrast, oral language production in Broca's aphasia improved only for the treated language while that in Wernicke's aphasia improved simultaneously for both languages. Writing ability seemed to improve as a function of language therapy in both cases. The implications for the relationship between spontaneous recovery and the effects of treatment were discussed.

Aged↗
PubMed2004

Drug treatment of poststroke aphasia.

Impairment of language function (aphasia) is one of the most common neurological symptoms after stroke. Approximately one in every three patients who have an acute stroke will suffer from aphasia. The estimated incidence and prevalence of stroke in Western Europe is 140 and 800 per 100,000 of the population. Aphasia often results in significant disability and handicap. It is a major obstacle for patients to live independently in the community. When recovery from aphasia occurs, it is usually incomplete and patients are rarely able to return to full employment and other social activities. Currently, the main treatment for aphasia is conventional speech and language therapy. However, the effectiveness of this intervention has not been conclusively demonstrated and empirical observations suggest that spontaneous biological recovery may explain most of the improvement in language function that occurs in aphasics. The generally poor prognosis of the severe forms of poststroke language impairment (Broca, Wernicke and global aphasia), coupled with the limited effectiveness of conventional speech and language therapy has stimulated the search for other treatments that may be used in conjunction with speech and language therapy, including the use of various drugs. Dopamine agonists, piracetam (Nootropil), amphetamines, and more recently donepezil (Aricept), have been used in the treatment of aphasia in both the acute and chronic phase. The justification for the use of drugs in the treatment of aphasia is based on two types of evidence. Some drugs, such as dextroamphetamine (Dexedrine), improve attention span and enhance learning and memory. Learning is an essential mechanism for the acquisition of new motor and cognitive skills, and hence, for recovery from aphasia. Second, laboratory and clinical data suggest that drug treatment may partially restore the metabolic function in the ischemic zone that surrounds the brain lesion and also has a neuroprotective effect following acute brain damage. An example of this is the nootropic agent piracetam. Extensive animal studies have demonstrated the beneficial effects of this and other drugs on neural plasticity, but data on humans are still sparse. This review provides a critical analysis of the current evidence of the effectiveness of these drugs in the treatment of acute and chronic aphasia.

Amphetamine↗
PubMed2001

The gender imbalance among speech and language therapists and students.

Speech and language therapy is still a predominantly female profession. This paper reports the numbers and percentages of males among the population of student speech and language therapists in the UK in 1999-2000. The numbers imply that there is no prospect of redressing the gender imbalance in the near future. Information was gathered by means of a questionnaire to male speech and language therapy students and male therapists on the reasons for their career choice and their occupation-related experience concerning their gender. Most therapists reported advantages from their gender but a minority reported difficulties arising from being a man in the speech and language therapy profession. The issue of working alone with children is identified as being in urgent need of resolution.

Career Choice↗
PubMed1998

Aspects of voice quality: display, measurement and therapy.

One approach to outcome measures for speech and language therapy is to display measures of the physical, acoustic, correlates of the perceptually salient features of the structure of speech. A difficulty with this approach is that there is no simple mapping of physical correlates onto speech percepts. In this workshop the physical measures of voice fundamental frequency and larynx contact quotient are explored in relation to the perception, analysis and treatment of aspects of voice quality in a speech and language therapy clinic. A fundamental principle is to analyse samples of continuous speech. The workshop will focus on clients with unilateral vocal fold paralysis.

Humans↗
PubMedDate not supplied

Instrumental assessment and treatment of hypernasality, following maxillofacial surgery, using SNORS: a single case study.

The super nasal oral ratiometry system (SNORS) is a commercially available system which measures both nasal and oral airflow during speech, allowing the very rapid movement of the velum to be measured. SNORS uses a modified oxygen mask, which houses the airflow sensors and microphones, and a standard personal computer. By calculating nasalance (the percentage of airflow that is nasal), an estimation of velopharyngeal closure, which is independent of speech intensity, is achieved. SNORS can be used for objective assessment, where the subject is required to speak a number of words selected to demonstrate velopharyngeal function. SNORS also provides biofeedback, using a simple realtime display of nasal and oral airflow. Velopharyngeal insufficiency (VPI) is the inability to make adequate velpharyngeal closure, and may be the result of either neurological or, as in this case, structural abnormalities. It results in abnormal speech characteristics, such as omissions, substitutions or weak articulation of consonants, and hypernasality. T.W., a 52 year old male, had very hypernasal speech following extensive maxillofacial surgery, for the removal of a tonsillar carcinoma. SNORS was successfully used as both an assessment and a therapy tool in the treatment of this patient. The effectiveness of conventional speech and language therapy vs. SNORS biofeedback therapy was compared. Initially, while there was some movement of the velum, the patient could not achieve velopharyngeal closure. Conventional therapy aimed to strengthen and improve the function of the velum and following this there was some minimal improvement: the patient could now achieve, but not maintain, closure. Reassessment, following a non-treatment period, showed little further change. SNORS biofeedback therapy was then given. This raised the patient's awareness of his velopharyngeal function, thus helping him to maintain closure, thereby reducing hypernasality. SNORS therapy proved significantly more effective than conventional speech and language therapy, in this case. Further intervention is outlined, and the benefits of multiparameter assessment of speech are discussed.

Biofeedback, Psychology↗