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PubMed2005

Comparing outcomes of voice therapy: a benchmarking study using the therapy outcome measure.

The quality cycle requires clinicians to assess the outcomes of interventions. Benchmarking is an approach that has been advocated to compare current performance across different services to identify commonalities and significant differences. This article gives the results of a study of outcomes in speech and language therapy (SLT) using the therapy outcome measure (TOM) for patients with voice disorder (dysphonia) comparing outcomes of seven separate speech and language therapy services. The study aimed to identify the similarities and differences in outcomes of care provided by different services. Two hundred and forty patients with dysphonia (age range 3-87.5 years, average 51.9 years) were treated. The results indicated that although there was no significant difference in the profile of the severity of symptomology of patients referred to speech and language therapy in different geographical areas, there was a significant difference in the treatment outcomes across the services and in the stated reason for discharge from treatment. Nevertheless, most patients with dysphonia had a good outcome and this was associated with completion of the course of treatment. There were significant differences in the number of treatment contacts provided by the different services and in the duration (between admission and discharge) of treatment across the services. Benchmarking can provide useful information through use of routinely collected clinical data.

Adolescent↗
PubMed1990

Influence of therapist ethnicity and language on therapy outcomes of Southeast Asian clients.

The purpose of this study was to examine the relationship of Southeast Asian client-therapist ethnicity and language match on three therapy outcomes: number of sessions with primary therapist, dropout from therapy and admission-discharge difference in Global Assessment Scale (GAS) scores. The sample consisted of 543 Southeast Asian client episodes in Los Angeles County mental health facilities between January 1983 and August 1988. Various types of multiple regression analyses were used to investigate the relationship of language and ethnicity match to the three outcome variables and to eight sociodemographic variables. Either therapist-client language or ethnicity match significantly increased the number of client sessions with the primary therapist. Dropout from therapy was significantly affected by a language match in the Cambodian sample only but the effect was to increase dropout. Neither ethnicity nor language match was significantly related to GAS score gain. Several possible explanations for these findings and their clinical significance were explored.

Adult↗
PubMed1997

Early intervention in a case of jargon aphasia: efficacy of language comprehension therapy.

A client with dysphasia was treated during the first six months following onset. A cognitive neuropsychological model of language processing was used to establish the levels of impairment in auditory comprehension. Three separate phases of therapy were administered: a semantic therapy; a period of therapy where both semantics and auditory processing were treated; and therapy designed to enhance the processing of words in a sentence. Four assessments were used to measure changes between each therapy phase and the results demonstrate that improvement occurred in a pattern which suggests specific effects of treatment.

Aphasia↗
PubMed1991

A profile of aphasia services in three health districts.

The study examines language rehabilitation provisions for aphasic people and their families in three health districts, as perceived by speech and language therapists. The study is exploratory. Semi-structured interviews were carried out with each District Speech Therapist and with speech and language therapists whose caseloads regularly included aphasic people, and documentary evidence was used where available. Comparison is made of: speech and language therapy expenditure and staffing in the three districts (West Suffolk, West Essex and Newcastle-upon-Tyne); aphasia therapy staffing; caseloads of aphasic people; patterns of treatment (inpatient/outpatient/community; individual/group) and reasons for these; provision for relatives; relationships between speech and language therapy and other services; volunteer involvement; and speech and language therapists' work situations (support from colleagues, post-qualification training, secretarial support and accommodation). Differences are found in levels of provision, with Newcastle having considerably more resources devoted to aphasia services than the other two districts, and modes of service delivery. Some shared concerns are identified (e.g. relationships with other professions, accommodation and transport). Implications of the findings are discussed and areas for further research identified.

Adolescent↗
PubMed1998

A hidden client group? Communication impairment in hospice patients.

Retrospective research has identified communication impairment in over a quarter of hospice patients (Jackson et al. 1996) but this field has not been investigated using speech and language therapy assessments. The present study assessed a sample of 12 hospice patients using tests of verbal learning and recall, word-finding, sentence comprehension and motor speech. Eleven patients experienced difficulties in one or more areas of assessment. Possible reasons are discussed, including the effects of patients' illness and treatment and changes in mood or cognitive functioning. A role for speech and language therapy is proposed, in terms of assessment, advice and training. Further research is suggested to help establish the extent of impairment and define a role for speech and language therapy.

Aged↗
PubMed2000

The impact of music therapy on language functioning in dementia.

Dementias, such as Alzheimer's disease, include a progressive deterioration of language functioning. While some researchers have reported an increase in patients' self-expression following music therapy, it is not clear whether these changes specifically reflect improved language skills or whether simple interpersonal interaction with a therapist could account for the improvement. In this study, the effects of music therapy were compared to conversational sessions on language functioning in dementia patients. Participants were selected according to the following criteria: (a) residing in a facility specializing in Alzheimer's and related disorders; (b) possessing sufficient verbal ability to answer simple questions and to comply with requests to speak, participate, or sit down; and (c) attaining the written consent of the patient's guardian or representative. All participants had been in music therapy twice per week for at least 3 months prior to the study onset. One week prior to the beginning of the study, subjects were assessed for cognitive functioning using the Mini-Mental State Examination (MMSE), and language ability via the Western Aphasia Battery (WAB). A within-subjects design was used, with order of condition (music or group conversation first) counter-balanced between participants. Subjects participated in groups of 2 to 4, twice per week for 20-30 minutes for a total of 8 sessions (4 music therapy and 4 conversation sessions or vice-versa), and were re-tested on the WAB at the end of each 2 week (4 session) interval. Results from 20 participants revealed that music therapy significantly improved performance on both speech content and fluency dimensions of the spontaneous speech subscale of the WAB (p =.01). While the difference in overall Aphasia Quotient (AQ) for music and conversation sessions (mean AQ = 76 vs. 70, respectively) did not reach statistical significance, data were only available for 10 participants (5 per condition). Hopefully, these findings will stimulate additional research on the use of music therapy interventions with demented patients, as it may offer a noninvasive mechanism to enhance communication between victims and their caregivers.

Aged↗
PubMed2000

Active participation of mothers during speech therapy improved language development of children with cleft palate.

Whole language intervention uses the principles of natural language learning, which consider language not as an independent system but as a system intimately related to other cognitive and social abilities. This paper compares the outcome of speech therapy given in different settings to two groups of children with cleft palate. Those in the first group were treated by the speech pathologist alone (control group), whereas those in the second group were treated by the speech pathologist but were also accompanied by their mothers (experimental group). The purpose of this study was to find out if including the mother as an active participant in speech therapy sessions would improve the language development of children with cleft palate who also had additional language delays. Both groups were evaluated before and after treatment to evaluate the advance of each group. The patients accompanied by their mothers had significantly better language skills compared with patients treated without their mothers. The results support the statement that language development is related to mother-child mode of daily life interaction in children with cleft palate.

Child, Preschool↗
PubMed2001

Day in, day out: the everyday therapy of community clinics.

This paper describes the timing and nature of therapy provided within a recent randomised controlled trial (RCT) of preschool speech and language therapy services. There is literature that describes and evaluates speech and language therapy but there is little indication of how this is translated into everyday practice. The study collected data from 21 speech and language therapists (SLTs) in 16 community clinics. The areas targeted, goals, approaches used, the frequency and timing of contact for the 68 children who received treatment were documented. The data show that several aspects of therapy were frequently targeted simultaneously, that approaches were combined and that the frequency of therapy did not vary with severity. The discussion will consider the gap between published programmes and everyday practice and the implications for effectiveness.

Child, Preschool↗
PubMed2005

Parent concerns and professional responses: the case of specific language impairment.

BACKGROUND: GPs and health visitors are usually the first to be approached by parents concerned about their child's speech and language development in the early years. The role health professionals play in early detection of speech and language difficulties is therefore crucial to ensure timely referral for speech and language therapy. AIM: To examine parental accounts of health visitor and GP involvement in the assessment and diagnosis of their children's speech and language impairment. DESIGN OF STUDY: Qualitative retrospective interviews. SETTING: Two Local Education Authorities in Merseyside. METHOD: In-depth interviews were conducted with 40 parents. Interviews were transcribed and thematically analysed. Twenty per cent of interviews were analysed by an independent researcher and consensus reached on thematic content. RESULTS: In many cases, parents were the first to realise that there was something wrong with the speech and language development of their child. Parents reported that health professionals tended to underestimate speech and language problems, and failed to take parental views into account. In some cases, parents found that attending a specialist unit or hospital resulted in the children reaching school age before referral to speech and language therapy was made. In other cases, health professionals appeared to rely on the possibility of spontaneous recovery, and gave inappropriate advice to parents, which resulted in delayed referral to speech and language therapists. CONCLUSIONS: Health professionals failed to use systematic, evidence-based approaches in responding to early parental concerns. For this group of parents, such an approach resulted in long delays in referral for specialist intervention.

Adolescent↗
PubMed2004

The efficacy of treatment for children with developmental speech and language delay/disorder: a meta-analysis.

A meta-analysis was carried out of interventions for children with primary developmental speech and language delays/disorders. The data were categorized depending on the control group used in the study (no treatment, general stimulation, or routine speech and language therapy) and were considered in terms of the effects of intervention on expressive and receptive phonology, syntax, and vocabulary. The outcomes used in the analysis were dependent on the aims of the study; only the primary effects of intervention are considered in this review. These were investigated at the level of the target of therapy, measures of overall linguistic development, and broader measures of linguistic functioning taken from parent report or language samples. Thirty-six articles reporting 33 different trials were found. Of these articles, 25 provided sufficient information for use in the meta-analyses; however, only 13 of these, spanning 25 years, were considered to be sufficiently similar to be combined. The results indicated that speech and language therapy might be effective for children with phonological or expressive vocabulary difficulties. There was 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 those administered by clinicians. The review identified longer duration (>8 weeks) of therapy as being a potential factor in good clinical outcomes. A number of gaps in the evidence base are identified.

Child↗
PubMedDate not supplied

Emerging issues in speech therapy in Iran.

This report is a short review of the form and content of speech and language therapy services and the trend of their institutionalization in Iran. A summary of formal education in speech and language therapy in Iran as originated by establishing a 4-year BS rehabilitation program in the College of Rehabilitation Sciences in Tehran is given. Since then, speech and language rehabilitation programs have been expanding both in size and quality, resulting in about 1,000 speech therapists practicing in hospitals and rehabilitation centers throughout the country. The expansion of graduate programs at MS level in three different institutions and a prospective PhD program are also adding to the quality of these services. The content of the theory courses and clinical practice courses as well as research on specific speech and language disorders and cross-linguistic studies are briefly described.

Humans↗
PubMed2026

Modulating sentence comprehension in people with aphasia through anodal tDCS: A double-blind randomized cross-over study.

This double-blind randomized cross-over study investigated the effects of perilesional anodal transcranial direct current stimulation (AtDCS) combined with speech-language therapy on sentence comprehension in eight individuals with chronic nonfluent agrammatic aphasia. The behavioral therapy consisted of an intensive comprehension treatment including drilling in sentence-to-picture matching and Mapping Therapy. Each participant underwent both the anodal tDCS and sham stimulation conditions (five received sham first followed by real stimulation, and the remaining three the reverse sequence), with each condition paired with the same behavioral treatment and separated by a four-month washout period. Stimulation was applied over the perilesional area (left BA6) for 20 min during daily 40-min therapy sessions over four consecutive weeks. Sentence comprehension was assessed with the RiComprendo battery and functional communication with the Communicative Effectiveness Index (CETI). Data were analyzed using paired t-tests, Bayesian analyses, and linear mixed-effects models to control for baseline performance and individual variability. Both stimulation conditions produced significant pre-to-post improvements in sentence comprehension, particularly for syntactically complex structures such as passives and center-embedded object relatives. However, gains were overall greater following AtDCS, as reflected in larger effect sizes, stronger Bayes factors, and a significant treatment effect in the mixed-effects models. Only the AtDCS condition yielded significant improvements in self-perceived comprehension abilities on the CETI. These findings suggest that AtDCS over perilesional cortical areas may boost the effects of traditional language therapy on sentence comprehension, supporting its feasibility and potential as an adjuvant intervention in post-stroke aphasia rehabilitation.

Humans↗
PubMed2004

Children with specific language impairment: parental accounts of the early years.

Parent views of specific language impairment have received little attention in the literature, even though speech and language development is the single greatest area of concern for parents. This article examines parental views of events up to, and including, language unit admission for their children. A series of qualitative interviews was conducted with parents. Parents felt that, apart from speech and language difficulties, the children were developing normally. They placed a low value on speech and language therapy, and saw language unit admission as the only intervention that 'worked'. Initially, some children were placed in mainstream school, where their failure to keep up with peers resulted in transfer to a language unit. Parent views provide a unique understanding of the impact of specific language impairment on the child and family. Such information is essential for the early diagnosis and treatment of this condition.

Adaptation, Psychological↗
PubMed2005

Poststroke aphasia : epidemiology, pathophysiology and treatment.

Aphasia, the loss or impairment of language caused by brain damage, is one of the most devastating cognitive impairments of stroke. Aphasia is present in 21-38% of acute stroke patients and is associated with high short- and long-term morbidity, mortality and expenditure. Recovery from aphasia is possible even in severe cases. While speech-language therapy remains the mainstay treatment of aphasia, the effectiveness of conventional therapies has not been conclusively proved. This has motivated attempts to integrate knowledge from several domains in an effort to plan more rational therapies and to introduce other therapeutic strategies, including the use of intensive language therapy and pharmacological agents. Several placebo-controlled trials suggest that piracetam is effective in recovery from aphasia when started soon after the stroke, but its efficacy vanishes in patients with chronic aphasia. Drugs acting on catecholamine systems (bromocriptine, dexamfetamine) have shown varying degrees of efficacy in case series, open-label studies and placebo-controlled trials. Bromocriptine is useful in acute and chronic aphasias, but its beneficial action appears restricted to nonfluent aphasias with reduced initiation of spontaneous verbal messages. Dexamfetamine improves language function in subacute aphasia and the beneficial effect is maintained in the long term, but its use is restricted to highly selected samples. Pharmacological agents operating on the cholinergic system (e.g. donepezil) have shown promise. Data from single-case studies, case series and an open-label study suggest that donepezil may have beneficial effects on chronic poststroke aphasia. Preliminary evidence suggests that donepezil is well tolerated and its efficacy is maintained in the long term. Randomised controlled trials of donepezil and other cholinergic agents in poststroke aphasia are warranted.

Adult↗
PubMed2006

Early speech- and language-impaired children: linguistic, literacy, and social outcomes.

The aim of this study was to follow-up prospectively a cohort of preschool children originally recruited from successive referrals to speech and language therapy community clinics and to investigate their linguistic, literacy, and social outcomes at 7 to 10 years of age. Three hundred and fifty children aged 84 to 113 months (mean age 99.9mo [SD 5.4mo]) were singletons from monolingual backgrounds where there was concern about their speech and language development. Children who had severe learning difficulties, autism, oromotor deficits, dysfluency, or dysphonia were excluded. Altogether 196 (56%), 134 males and 62 females, were seen at follow-up. A control group of children who had never been referred for speech and language therapy, 57% of whom were males, was also recruited (n=94; mean age 104.4mo [SD 6.8mo]). All children were assessed on standardized measures of speech, language, and literacy. Teachers and parents completed questionnaires on educational and social outcomes. In total, 139 children in the cohort were within the normal range on standardized language assessments. About 30% of the original cohort of children continue to struggle with language, literacy, and social difficulties. The study demonstrates the long-term nature of language impairment and reinforces the need for awareness among professionals in child development and education of the ongoing needs of this population of children.

Age Factors↗
PubMedDate not supplied

Exploring the effects of communication intervention for developmental pragmatic language impairments: a signal-generation study.

BACKGROUND: The remediation of pragmatic problems forms a significant part of the caseload for professionals working with children with communication problems. There is little systematic evidence that demonstrates the benefits of speech and language therapy for children whose difficulties lie primarily within the pragmatic domain or which indicates whether changes in pragmatic behaviours, which are a result of a specific intervention, can be measured over time. AIMS: To generate a signal of change in pragmatic and other language behaviours for children with pragmatic language impairments; to gauge the magnitude and nature of the signal and to make recommendations for future studies. METHODS AND PROCEDURES: A case series of six children with pragmatic language impairments without diagnosis of autism received 8 weeks of individual intensive speech and language therapy supported in a mainstream educational setting in the UK. Measures of pragmatic behaviours in conversation were made at seven data points before and after therapy using Bishop's ALICC procedure. Conversation coders were blind to the point of assessment. Inferential comprehension, narrative, sentence formulation and sentence recall skills were also tested before and after therapy. The opinions of teachers and parents were sought regarding any change in communication and social abilities of the children over time. OUTCOMES AND RESULTS: All children showed change in communication behaviour on some conversational measures, even if the child functioned at the ceiling on standardized language testing. Some conversation measures had more utility as outcome measures than others. Most children showed substantial change on standardized language measures, but there are limitations on the use of these due to heterogeneity within the group. Overall, the intervention produced a signal for change in pragmatics and/or language behaviour in all children. Parent/teacher opinion reported demonstrable change in communication behaviour and engagement in the curriculum. CONCLUSIONS: There is a strong signal that change in pragmatic language behaviour can be measured in well-controlled intervention studies but this signal is complex. Outcome measures should take into account changes in language processing skills that are significantly impaired in many children with PLI. For those children within the PLI group who function at ceiling on language tests, conversational measures may have the potential to signal change, but this finding has not been subjected to group study or to testing in generalized settings. Qualitative data regarding behaviour, classroom engagement and generalization of language gains will be an essential supplement to measuring progress in a diverse population.

Child↗
PubMedDate not supplied

Speech and language outcomes of children with bronchopulmonary dysplasia.

UNLABELLED: A prospective follow-up of very low birth weight infants (VLBW) with (n = 89) and without (n = 71) bronchopulmonary dysplasia (BPD) and Term control children (n = 93) was conducted at 8 years of age. Groups were compared on measures of articulation, receptive and expressive language, verbal and performance IQ, oral motor skills and gross and fine motor skills. The BPD group demonstrated reduced articulation, receptive language skills, performance IQ, and overall gross and fine motor skills when compared to VLBW and Term groups. The BPD and VLBW groups did not differ on expressive language, oral motor skills, or verbal IQ. The groups also differed in enrollment in special classes and speech-language therapy, with almost half (48%) of the BPD group enrolled in speech-language therapy compared to 21% of the VLBW group, and 9% of the Term group. These results suggest that BPD may have adverse effects on speech development as well as on performance IQ, motor skills, and receptive language over and above the effects of VLBW. LEARNING OUTCOMES: (1) As a result of this activity the reader will be able to describe what BPD is and how it impacts speech and language. (2) As a result of this activity the reader will be able to discuss how children with VLBW with BPD differ from children with VLBW without BPD in their developmental outcomes.

Bronchopulmonary Dysplasia↗