Educating Clients with speech and language impairments

Speech and language impairments can result in communication disabilities that can affect clients' capacity to read, write and participate in conversations and social situations.

Phonological and articulation treatment approaches in Portuguese children with speech and language impairments: a randomized controlled intervention study

Background: In Portugal, the routine clinical practice of speech and language therapists (SLTs) in treating children with all types of speech sound disorder (SSD) continues to be articulation therapy (AT). There is limited use of phonological therapy (PT) or phonological awareness training in Portugal. Additionally, at an international level there is a focus on collecting information on and differentiating between the effectiveness of PT and AT for children with different types of phonologically based SSD, as well as on the role of phonological awareness in remediating SSD. It is important to collect more evidence for the most effective and efficient type of intervention approach for different SSDs and for these data to be collected from diverse linguistic and cultural perspectives. Aims: To evaluate the effectiveness of a PT and AT approach for treatment of 14 Portuguese children, aged 4.0–6.7 years, with a phonologically based SSD. Methods & Procedures: The children were randomly assigned to one of the two treatment approaches (seven children in each group). All children were treated by the same SLT, blind to the aims of the study, over three blocks of a total of 25 weekly sessions of intervention. Outcome measures of phonological ability (percentage of consonants correct (PCC), percentage occurrence of different phonological processes and phonetic inventory) were taken before and after intervention. A qualitative assessment of intervention effectiveness from the perspective of the parents of participants was included. Outcomes & Results: Both treatments were effective in improving the participants’ speech, with the children receiving PT showing a more significant improvement in PCC score than those receiving the AT. Children in the PT group also showed greater generalization to untreated words than those receiving AT. Parents reported both intervention approaches to be as effective in improving their children’s speech. Conclusions & Implications: The PT (combination of expressive phonological tasks, phonological awareness, listening and discrimination activities) proved to be an effective integrated method of improving phonological SSD in children. These findings provide some evidence for Portuguese SLTs to employ PT with children with phonologically based SSD

An in-depth analysis of real and perceived barriers to speech and language program participation for children with speech and language delays : a question of barriers to service?

The current study investigated the effects that barriers (both real and perceived) had on participation and completion of speech and language programs for preschool children with communication delays. I compared 36 families of preschool children with an identified communication delay that have completed services (completers) to 13 families that have not completed services (non-completers) prescribed by Speech and Language professionals. Data findings reported were drawn from an interview with the mother, a speech and language assessment of the child, and an extensive package of measures completed by the mother. Children ranged in age from 32 to 71 mos. These data were collected as part of a project funded by the Canadian Language and Literacy Research Networks of Centres of Excellence. Findings suggest that completers and non-completers shared commonalities in a number of parenting characteristics but differed significantly in two areas. Mothers in the noncompleting group were more permissive and had lower maternal education than mothers in the completing families. From a systemic standpoint, families also differed in the number of perceived barriers to treatment experienced during their time with Speech Services Niagara. Mothers in the non-completing group experienced more perceived barriers to treatment than completing mothers. Specifically, these mothers perceived more stressors and obstacles that competed with treatment, perceived more treatment demands and they perceived the relevance of treatment as less important than the completing group. Despite this, the findings suggest that non-completing families were 100% satisfied with services. Contrary to predictions, there were no significant differences in child characterisfics and economic characteristics between completers and non-completers. The findings in this study are considered exploratory and tentative due to the small sample size.

Speech therapy after stroke: trial shows only that practice varies

Bowen and colleagues’ methods and conclusions raise concerns.1 At best, the trial evaluates the variability in current practice. In no way is it a robust test of treatment. Two communication impairments (aphasia and dysarthria) were included. In the post-acute stage spontaneous recovery is highly unpredictable, and changes in the profile of impairment during this time are common.2 Both impairments manifest in different forms,3 which may be more or less responsive to treatment. A third kind of impairment, apraxia of speech, was not excluded but was not targeted in therapy. All three impairments can and do co-occur. Whether randomised controlled trial designs can effectively cope with such complex disorders has been discussed elsewhere.4 Treatment was defined within terms of current practice but was unconstrained. Therefore, the treatment group would have received a variety of therapeutic approaches and protocols, some of which may indeed be ineffective. Only 53% of the contact time with a speech and language therapist was direct (one to one), the rest was impairment based therapy. In contrast, all of the visitors’ time was direct contact, usually in conversation. In both groups, the frequency and length of contact time varied. We already know that the transfer from impairment based therapy to functional communication can be limited and varies across individuals.5 However, it is not possible to conclude from this trial that one to one impairment based therapy should be replaced. For that, a well defined impairment therapy protocol must be directly compared with a similarly well defined functional communication therapy, with an attention control.

Neurolinguistic analysis: aspects of language and speech deviations in Palestinian Arabic aphasics

The characteristics of aphasics’ speech in various languages have been the core of numerous studies, but Arabic in general, and Palestinian Arabic in particular, is still a virgin field in this respect. However, it is of vital importance to have a clear picture of the specific aspects of Palestinian Arabic that might be affected in the speech of aphasics in order to establish screening, diagnosis and therapy programs based on a clinical linguistic database. Hence the central questions of this study are what are the main neurolinguistic features of the Palestinian aphasics’ speech at the phonetic-acoustic level and to what extent are the results similar or not to those obtained from other languages. In general, this study is a survey of the most prominent features of Palestinian Broca’s aphasics’ speech. The main acoustic parameters of vowels and consonants are analysed such as vowel duration, formant frequency, Voice Onset Time (VOT), intensity and frication duration. The deviant patterns among the Broca’s aphasics are displayed and compared with those of normal speakers. The nature of deficit, whether phonetic or phonological, is also discussed. Moreover, the coarticulatory characteristics and some prosodic patterns of Broca’s aphasics are addressed. Samples were collected from six Broca’s aphasics from the same local region. The acoustic analysis conducted on a range of consonant and vowel parameters displayed differences between the speech patterns of Broca’s aphasics and normal speakers. For example, impairments in voicing contrast between the voiced and voiceless stops were found in Broca’s aphasics. This feature does not exist for the fricatives produced by the Palestinian Broca’s aphasics and hence deviates from data obtained for aphasics’ speech from other languages. The Palestinian Broca’s aphasics displayed particular problems with the emphatic sounds. They exhibited deviant coarticulation patterns, another feature that is inconsistent with data obtained from studies from other languages. However, several other findings are in accordance with those reported from various other languages such as impairments in the VOT. The results are in accordance with the suggestions that speech production deficits in Broca’s aphasics are not related to phoneme selection but rather to articulatory implementation and some speech output impairments are related to timing and planning deficits.

Publication practices of English language occupational therapy journals

The aim of this study was to determine the characteristics and publication practices of English language occupational therapy journals. An adapted version of the Survey of Editors Regarding Publishing Practices was posted to the editors of English language occupational therapy journals (n = 14) in September 2001. The response rate was 92.9% (n = 13). Journals were published on average 4.77 times per year and comprised 89% text and 10% advertising. The preferred average length of manuscripts was 20 pages using American Psychological Association format. The average acceptance rate of unsolicited manuscripts was 46.6%. All the journals were peer-reviewed publications and 80% were research oriented. The most frequently cited reasons for rejection of manuscripts were methodology problems, poorly developed idea, poorly written and data interpretation problems. The professional focus of published manuscripts was on research and the clinical foci were on paediatrics, gerontology and physical medicine. The study concludes that there are a variety of publishing opportunities available to occupational therapists. It is essential that prospective authors consult the journal guidelines for authors, including the types of manuscript accepted.

Defining a role for the subthalamic nucleus within operative theoretical models of subcortical participation in language

Objective:To investigate the effects of bilateral, surgically induced functional inhibition of the subthalamic nucleus (STN) on general language, high level linguistic abilities, and semantic processing skills in a group of patients with Parkinson’s disease. Methods:Comprehensive linguistic profiles were obtained up to one month before and three months after bilateral implantation of electrodes in the STN during active deep brain stimulation (DBS) in five subjects with Parkinson’s disease (mean age, 63.2 years). Equivalent linguistic profiles were generated over a three month period for a non-surgical control cohort of 16 subjects with Parkinson’s disease (NSPD) (mean age, 64.4 years). Education and disease duration were similar in the two groups. Initial assessment and three month follow up performance profiles were compared within subjects by paired t tests. Reliability change indices (RCI), representing clinically significant alterations in performance over time, were calculated for each of the assessment scores achieved by the five STN-DBS cases and the 16 NSPD controls, relative to performance variability within a group of 16 non-neurologically impaired adults (mean age, 61.9 years). Proportions of reliable change were then compared between the STN-DBS and NSPD groups. Results:Paired comparisons within the STN-DBS group showed prolonged postoperative semantic processing reaction times for a range of word types coded for meanings and meaning relatedness. Case by case analyses of reliable change across language assessments and groups revealed differences in proportions of change over time within the STN-DBS and NSPD groups in the domains of high level linguistics and semantic processing. Specifically, when compared with the NSPD group, the STN-DBS group showed a proportionally significant (p

Hemispheric contributions to lexical ambiguity resolution: Evidence from individuals with complex language impairment following left-hemisphere lesions

Nine individuals with complex language deficits following left-hemisphere cortical lesions and a matched control group (n 5 9) performed speeded lexical decisions on the third word of auditory word triplets containing a lexical ambiguity. The critical conditions were concordant (e.g., coin–bank–money), discordant (e.g., river–bank–money), neutral (e.g., day–bank– money), and unrelated (e.g., river–day–money). Triplets were presented with an interstimulus interval (ISI) of 100 and 1250 ms. Overall, the left-hemisphere-damaged subjects appeared able to exhaustively access meanings for lexical ambiguities rapidly, but were unable to reduce the level of activation for contextually inappropriate meanings at both short and long ISIs, unlike control subjects. These findings are consistent with a disruption of the proposed role of the left hemisphere in selecting and suppressing meanings via contextual integration and a sparing of the right-hemisphere mechanisms responsible for maintaining alternative meanings.

Otolaryngology and Speech Therapy evaluation in the assessment of oropharyngeal dysphagia: a combined protocol proposal

Dysphagia is a symptom associated with an array of anatomical and functional changes which must be assessed by a multidisciplinary team to guarantee optimal evaluation and treatment, preventing potential complications. Aim: The aim of the present study is to present the combined protocol of clinical and swallowing videoendoscopy carried by ENT doctors and speech therapists in the Dysphagia Group of the ENT Department - University Hospital. Materials and Methods: Retrospective study concerning the use of a protocol made up of patient interview and clinical examination, followed by an objective evaluation with swallowing videoendoscopy. The exam was performed in 1,332 patients from May 2001 to December 2008. There were 726 (54.50%) males and 606 (45.50%) females, between 22 days and 99 years old. Results: We found: 427 (32.08%) cases of normal swallowing, 273 (20.48%) mild dysphagia, 224 (16.81%) moderate dysphagia, 373 (27.99%) severe dysphagia and 35 (2.64%) inconclusive exams. Conclusion: The combined protocol (Otolaryngology and Speech Therapy), is a good way to approach the dysphagic patient, helping to achieve early and safe deglutition diagnosis as far as disorder severity and treatment are concerned.