Received Speech Therapy Research Articles

Subjective outcomes after treatment for velopharyngeal dysfunction

Background: Velopharyngeal dysfunction (VPD) can have various causes and may be a significant disability for the affected patient. Treatment options include surgery and speech therapy, but the success rates are often inconsistent. Methods: In this study, self-assessment questionnaires were sent out to 222 Swedish patients with VPD. The questionnaire included questions about satisfaction with speech, perceived speech quality, perceived improvement from VPD-surgery, and/or speech therapy. Out of 117 (52.7%) respondents, 114 (51.4%) patients were included in the study. The participants were 7–71 years of age (median = 14 years), diagnosed with cleft palate, neurological/developmental delay, congenital hypernasality, or acquired VPD. All patients had previously undergone videofluoroscopy, and 61.4% had undergone VPD-surgery. Results: Seventy-one per cent of the patients perceived their speech to be normal or slightly deviant, but only 55% were satisfied with their speech. Sixty per cent of the operated on patients felt that the treatment had improved their speech much or very much, 10% thought that they had moderate improvement, and 30% stated that they had no or little improvement. Out of the patients that had received speech therapy, 41% felt that the treatment had improved their speech much or very much, 21% thought that they had moderate improvement, and 33% stated that they had no or little improvement. Conclusion: In conclusion, most patients with VPD in this study who underwent evaluation and treatment felt that surgery and speech therapy had improved their speech, but only about half of them were in the end satisfied with the quality of their speech.

Clinical Outcomes of Primary Palatal Surgery in Children with Nonsyndromic Cleft Palate with and without Lip.

This study presents clinical outcomes of primary cleft palate surgery, including rate of oronasal fistula development, rate of velopharyngeal insufficiency (VPI) requiring secondary surgery, and speech outcomes. We examined the effect of cleft type on the clinical outcomes. Retrospective analysis was performed using clinical records of all patients who received a primary palatoplasty at the Cleft Palate Clinic at Seoul Asan Medical Center, South Korea, between 2007 and 2012. The study included 292 patients with nonsyndromic overt cleft palate (±cleft lip). The results revealed that the rate of oronasal fistula was 7.9% and the incidence of VPI based on the rate of secondary palatal surgery was 19.2%. The results showed that 50.3% of all the patients had received speech therapy and 28.8% and 51.4% demonstrated significant hypernasality and articulatory deficits, respectively. The results of the rate of VPI and speech outcomes were significantly different in terms of cleft type. Except for the rate of oronasal fistula, patients with cleft palate generally exhibited better clinical outcomes compared to those with bilateral or unilateral cleft lip and palate. This study suggests that several factors, including cleft type, should be identified and comprehensively considered to establish an optimal treatment regimen for patients with cleft palate.

Effect of Repetitive Transcranial Magnetic Stimulation on Patients With Dysarthria After Subacute Stroke.

ObjectiveTo evaluate whether repetitive transcranial magnetic stimulation (rTMS) could improve dysarthria in stroke patients at the subacute stage.MethodsThis study was a prospective, randomized, double-blind controlled trial. Patients who had unilateral middle cerebral artery infarction were enrolled. In patients in the rTMS group, we found hot spots by searching for the evoked motor potential of the orbicularis oris on the non-affected side. We performed rTMS at a low frequency (1 Hz), 1,500 stimulations/day, 5 days a week for 2 weeks on the hotspots. We used the same protocol in the sham stimulation group patients as that in the rTMS group, except that the angle of the coil was perpendicular to the skull rather than tangential to it. The patients in both groups received speech therapy for 30 minutes, 5 days a week from a skilled speech therapist. The speech therapist measured the Urimal Test of Articulation and Phonology, alternative motion rates, sequential motion rates, and maximal phonation time before and after intervention sessions.ResultsForty-two patients were enrolled in this study and 20 completed the study. Statistical analysis revealed significant improvements on the dysarthria scales in both groups. The sequential motion rate (SMR)-PǝTǝKǝ showed significantly greater improvement in the rTMS group patients than in the sham stimulation group.ConclusionPatients in the rTMS group showed greater improvement in articulation than did patients in the sham rTMS group. Therefore, rTMS can have a synergistic effect with speech therapy in treating dysarthria after stroke.

112. Low frequency repetitive transcranial magnetic stimulation in early phase of rehabilitation of patients with post-stroke aphasia

About 50% of post-stroke patients remain aphasic a condition that greatly impede their reintegration to society. Results of Repetitive Transcranial Magnetic Stimulation (rTMS) as supplementary treatment for sub-acute post-stroke aphasia are controversial. We assessed the efficacy of inhibitory rTMS with conventional speech therapy to help recovery language performance in sub-acute stroke aphasia.In a randomised case-control double-blind study 12 non-fluent aphasic were consecutively enrolled. All patients suffered a first-ever stroke in the sub-acute stage defined as time since lesion onset from 1 month post-stroke. Patients were randomized either to receive real (low frequency on right-hemisphere homologue of Broca’s area) or sham rTMS, to a 3-week (5 day in a week). Immediately after each rTMS all patients received speech therapy. The speech performance was evaluated with Italian version of Aachener Aphasia Test (AAT), before (T0) and after (T1) treatments.Seven patients were treated with real rTMS and 5 patients with sham rTMS. Total and sub totals AAT scores showed a similar improvement in real and in sham rTMS groups between T0 and T1.In early phase of rehabilitation (< 1 month) inhibitory rTMS over the right posterior inferior frontal gyrus, in combination with speech therapy, did not seem significantly to improve language recovery respect to conventional speech therapy only.

Program to diagnose probability of aspiration pneumonia in patients with ischemic stroke.

Introduction Stroke is a major cause of death and disability worldwide, with a strong economic and social impact. Approximately 40% of patients show motor, language, and swallowing disorders after stroke. Objective To evaluate the use of software to infer the probability of pneumonia in patients with ischemic stroke. Methods Prospective and cross-sectional study conducted in a university hospital from March 2010 to August 2012. After confirmation of ischemic stroke by computed axial tomography, a clinical and flexible endoscopic evaluation of swallowing was performed within 72 hours of onset of symptoms. All patients received speech therapy poststroke, and the data were subsequently analyzed by the software. The patients were given medical treatment and speech therapy for 3 months. Results The study examined 52 patients with a mean age of 62.05 ± 13.88 years, with 23 (44.2%) women. Of the 52 patients, only 3 (5.7%) had a probability of pneumonia between 80 and 100% as identified by the software. Of all patients, 32 (61.7%) had pneumonia probability between 0 and 19%, 5 (9.5%) between 20 and 49%, 3 (5.8%) between 50 and 79%, and 12 (23.0%) between 80 and 100%. Conclusion The computer program indicates the probability of patient having aspiration pneumonia after ischemic stroke.

Long-term follow-up in primary progressive aphasia: Clinical course and health care utilisation

Background: Primary progressive aphasia (PPA) is a rare disorder. Data on health care utilisation and care-relevant symptoms are scarce.Aims: The study aimed at finding out how patients with PPA are cared for, the extent of professional support utilised by family caregivers, and which care-relevant clinical symptoms and signs occur with advanced disease.Method & Procedures: Forty-three family caregivers of patients with PPA were interviewed with a standardised questionnaire.Outcomes & Results: A majority of caregivers cared for the patients at home without any support. More than 40% of the patients were treated with cholinesterase inhibitors or memantine. Only 9% of the patients received speech therapy. In advanced PPA, the majority of patients were unable to communicate and almost all needed 24-hr care. Other neurological symptoms appeared, and a considerable number of patients suffered from moderate or severe somatic illnesses.Conclusion: Future studies are necessary to investigate the reasons why the PPA caregivers hardly utilise informal and formal support, what their specific needs are, and which kind of support and interventions prove to be useful.

P 126. Righthemispheric inhibitory rTMS in patients with letfsided brain infarcts: Effect on cerebral blood flow using PET and speech performance

Several small studies suggest that non-invasive repetitive transcranial magnetic stimulation (rTMS) of the non-dominant right Brodmann area might support recovery from aphasia in patients with leftsided stroke during conventional speech therapy.We evaluated the effect of this therapeutic regimen in patients with subacute stroke on cerebral blood flow (rCBF) and speech performance. 21 subjects have been included in this randomized, double blind, placebo controlled study. The intervention group was treated daily for 2 weeks with rTMS (1 Hz) for 20 min directly prior to speech therapy. The magnetic coil was placed over the right sided gyrus frontalis inferior, as indentified by T1 MRI. In the control group, the protocol was the same but the coil was placed over the vertex. Prior to the 2 weeks protocol, a PET (H 2 O 15 ) was performed during rest and during verb generation to calculate the rCBF change by this activation. The PET was repeated at the end of the protocol to identify a possible shift of cortical activation during verb generation. The Aachener Aphasia test (AAT) and the Amsterdam-Nijmegen Everyday Language Test (ANELT) were used for tests of the language performance. CBF measurement revaled a significant shift of activated language related cortex towards the left hemisphere in the group treated with rTMS compared to the control group. We calculated a significant difference in the pre-and posttreatment values of the global AAT scores between verum treated patients and control patients. The mean scores post treatment was significantly higher in the verum patients, predominantly in the subtest picture naming. rTMS with inhibitory effect on the rightsided homologous speech area plus speech therapy in patients with left sided brain infarcts and aphasia results in better recovery of language performance compared to patients who received speech therapy only.

Utilidad de la logopedia en la mejora del lenguaje en el tratamiento del síndrome del cromosoma X frágil en niños preescolares

Fragile X syndrome (FXS) is the most common cause-and the second genetic cause-of intellectual disability. There is wide variability in the behavioral phenotype associated with this syndrome and consequently evaluation should be individualized. We report the exhaustive initial evaluation, follow-up and achievements of two children (aged 16 and 27months) with FXS with a full mutation. One child received speech therapy, while the other did not. Children with FXS should be individually assessed to determine their specific developmental impairments. Although the literature predicts that affected individuals will show cognitive and language deficits, we found that the two children assessed in this study required interventions aimed at improving motor skills and autonomy, especially the second child.

Categories of Auditory Performance and Speech Intelligibility Ratings of Early-Implanted Children without Speech Training

ObjectiveTo assess whether speech therapy can lead to better results for early cochlear implantation (CI) children.PatientsA cohort of thirty-four congenitally profoundly deaf children who underwent CI before the age of 18 months at the Sixth Hospital affiliated with Shanghai Jiaotong University from January 2005 to July 2008 were included. Nineteen children received speech therapy in rehabilitation centers (ST), whereas the remaining fifteen cases did not (NST), but were exposed to the real world, as are normal hearing children.MethodsAll children were assessed before surgery and at 6, 12, and 24 months after surgery with the Categories of Auditory Performance test (CAP) and the Speech Intelligibility Rating (SIR). Each assessment was given by the same therapist who was blind to the situation of the child at each observation interval. CAP and SIR scores of the groups were compared at each time point.ResultsOur study showed that the auditory performance and speech intelligibility of trained children were almost the same as to those of untrained children with early implantation. The CAP and SIR scores of both groups increased with increased time of implant use during the follow-up period, and at each time point, the median scores of the two groups were about equal.ConclusionsThese results indicate that great communication benefits are achieved by early implantation (<18 months) without routine speech therapy. The results exemplify the importance of enhanced social environments provided by everyday life experience for human brain development and reassure parents considering cochlear implants where speech training is unavailable.

“I Can Hear the Noise, But Not the Voice”—A Case of Bilateral Sylvian Fissure Infarct in a 52-Year-Old Man

“I Can Hear the Noise, But Not the Voice”—A Case of Bilateral Sylvian Fissure Infarct in a 52-Year-Old Man

Tempo médio para a alta fonoaudiológica a partir de três modelos com base fonológica

OBJETIVO: comparar o tempo médio para a alta fonoaudiológica entre três modelos de terapia para os desvios fonológicos. MÉTODO: os dados deste estudo são provenientes do banco de dados pertencente a uma instituição de ensino superior. Adotaram-se os seguintes critérios de inclusão: idade entre 5:0 e 6:11; ter autorização para participar da pesquisa; apresentar diagnóstico de desvio fonológico classificado como desvio leve ou desvio levemente-moderado e ter recebido terapia fonoaudiológica através de um dos modelos terapêuticos: Ciclos Modificado (; ABAB-Retirada e Provas Múltiplas ou Pares Mínimos/Oposições Máximas ; além de ter adquirido alta fonoaudiológica. A amostra constou de 38 crianças, oito tratadas pelo Modelo de Ciclos Modificado, 18 pelo ABAB-Retirada e Provas Múltiplas, e 12 pelo de Pares Mínimos/Oposições Máximas. Para análise dos dados foi contabilizado o número de sessões em que houve intervenção fonoaudiológica direta. Para análise estatística utilizou-se o programa Statistical Analysis System, versão 8.02, teste Kruskal-Wallis com p&lt;0,05. RESULTADOS: verificou-se que para o modelo de Ciclos Modificado, o número de sessões em média foi de 23.0, para o modelo ABAB-Retirada e Provas Múltiplas, foi de 18.5, e para o modelo de Pares Mínimos/Oposições Máximas foi de 20,6. Não houve diferença estatística significante em relação ao número de sessões entre os três modelos de terapia. CONCLUSÃO: os três modelos de terapia mostraram-se eficazes na mesma proporção, uma vez que promoveram a alta fonoaudiológica e não apresentaram diferença significante quanto ao tempo médio de terapia para os casos de desvio fonológico.

Dificultades en la afasia progresiva primaria. A propósito de un caso

A 45 year-old woman, right handed, with no medical history of interest, and a good level of education was seen in the clinic due to subjective complaints of memory and language problems. She was diagnosed with primary progressive aphasia (PPA) three years ago and had received speech therapy for a year. The psychopathological examination was normal, with categorical verbal fluency impairment, although with good comprehension and speaking ability, normal praxis and normal performance in the cognitive screening test. The subjective complains of memory were assessed by test of verbal memory. Furthermore, behaviour changes, particularly irritability, were reported by family. These problems did not affect her activities of daily living. The present case shows the difficulties in classifying cases into different subtypes of PPA and the problems in making a possible prognosis.

Blind randomized controlled study of the efficacy of cognitive training in Parkinson's disease

The aim of this study was to analyze the efficacy of a cognitive training program on cognitive performance and quality of life in nondemented Parkinson's disease patients. Participants who met UK Brain Bank diagnosis criteria for Parkinson's disease, with I-III Hoehn & Yahr, aged 50-80, and nondemented (Mini-Mental State Examination ≥ 23) were recruited. Patient's cognitive performance and functional and quality-of-life measures were assessed with standardized neuropsychological tests and scales at baseline and after 4 weeks. Subjects were randomly and blindly allocated by age and premorbid intelligence (Vocabulary, Wechsler Adult Intelligence Scale-III) into 2 groups: an experimental group and a control group. The experimental group received 4 weeks of 3 weekly 45-minute sessions using multimedia software and paper-and-pencil cognitive exercises, and the control group received speech therapy. A total of 28 patients were analyzed. Compared with the control group participants (n = 12), the experimental group participants (n = 16) demonstrated improved performance in tests of attention, information processing speed, memory, visuospatial and visuoconstructive abilities, semantic verbal fluency, and executive functions. There were no observable benefits in self-reported quality of life or cognitive difficulties in activities of daily living. We concluded that intensive cognitive training may be a useful tool in the management of cognitive functions in Parkinson's disease. © 2011 Movement Disorder Society.

The Factors Associated with Good Responses to Speech Therapy Combined with Transcranial Direct Current Stimulation in Post-stroke Aphasic Patients

ObjectiveTo determine factors associated with good responses to speech therapy combined with transcranial direct current stimulation (tDCS) in aphasic patients after stroke.MethodThe language function was evaluated using Korean version of Western aphasia battery (K-WAB) before and after speech therapy with tDCS in 37 stroke patients. Patients received speech therapy for 30 minutes over 2 to 3 weeks (10 sessions) while the cathodal tDCS was performed to the Brodmann area 45 with 1 mA for 20 minutes. We compared the improvement of aphasia quotient % (AQ%) between two evaluation times according to age, sex, days after onset, stroke type, aphasia type, brain lesion confirmed by magnetic resonance image and initial severity of aphasia. The factors related with good responses were also checked.ResultsAQ% improved from pre- to post-therapy (14.94±6.73%, p<0.001). AQ% improvement was greater in patients with less severe, fluent type of aphasia who received treatment before 30 days since stroke was developed (p<0.05). The adjusted logistic regression model revealed that patients with hemorrhagic stroke were more likely to achieve good responses (odds ratio=4.897, p<0.05) relative to infarction. Initial severity over 10% in AQ% was also found to be significantly associated with good improvement (odds ratio=8.618, p<0.05).ConclusionSpeech therapy with tDCS was established as a treatment tool for aphasic patients after stroke. Lower initial severity was associated with good responses.

Bilingual aphasia and language control: A follow-up fMRI and intrinsic connectivity study

In a world that is becoming more multilingual, bilingual aphasia is a clinical problem with a major clinical impact. However, at present we lack causal explanations of the many features of recovery patterns and there is no consensus about the language in which the patient should receive speech therapy. Further advance requires an understanding of the dynamics of recovery. In a novel longitudinal, single-case study, we combine fMRI and dynamic causal modeling to examine the effects of specific language treatment for picture naming on the representation and control of language areas during the course of recovery. Improved performance in the treated language was associated with increased activation in language areas. Consistent with theoretical expectations, causal modeling indicated increased connectedness of the control and language networks for the treated language. This functional approach holds great promise for investigating recovery patterns and the effects of specific language treatment in bilingual aphasic patients.

Hyperbilirubinemia and Language Delay in Premature Infants

Our goal was to evaluate whether language delay at 3 years in premature infants is associated with previous exposure to hyperbilirubinemia during the first 2 weeks after birth. We performed a retrospective case-control study of infants admitted to the NICU between January and October 2003. Inclusion criteria included a birth weight of < or =1500 g and follow-up to age 3 years. Exclusion criteria included genetic disorders and hearing loss or recurrent ear infections. Peak total serum bilirubin levels during the first 2 weeks and duration of hyperbilirubinemia (days with total serum bilirubin level at >8 mg/dL) were determined. Infants with language delay and who were receiving speech therapy by 3 years were identified through developmental clinic charts and a tracking program and compared with infants who had normal language development. A total of 125 infants with birth weight of < or =1500 g were admitted to the NICU between January and October 2003. Fifteen infants died, and 110 were discharged from the hospital. A total of 102 (93%) of 110 infants had follow-up to the age of 3 years. Four infants were excluded (1 genetic disorder, 3 delayed hearing loss or recurrent ear infections). Twenty-four infants had a language delay and received speech therapy, whereas 74 infants had normal language development. There was no significant difference in peak total serum bilirubin level and duration of hyperbilirubinemia between the 2 groups. On logistic regression, only bronchopulmonary dysplasia was associated with language delay. Hyperbilirubinemia, defined as peak total serum bilirubin level or duration of elevated bilirubin in days, is not associated with language delay in premature infants. However, this issue deserves investigation, because other measures of bilirubin, such as unbound bilirubin, may be associated with language delay.

Serving bilingual patients with aphasia: challenges, foundations, and procedures

Bilingualism and multilingualism are a common occurrence in today's world. Many bilinguals (speakers of two languages) and multilinguals or polyglots (speakers of more than two languages) in multilingual population centers receive speech therapy for acquired language problems or aphasia as a result of neurological damage. Serving these bilingual and multilingual aphasic patients involves theoretical and clinical challenges for speech therapists. This article proposes a multidisciplinary framework as a strategy to overcome such difficulties. Particularly, the proposed approach, guided by the possible interactions among culture, cognition, and language in adult bilinguals, draws from various disciplines, such as sociolinguistics, neurolinguistics, psycholinguistics, and ethnopsychology, to formulate procedures that would increase diagnostic accuracy and therapeutic effectiveness with bilingual and multilingual aphasic patients. Because aphasia is considered a social rather than a purely linguistic phenomenon, this approach ultimately aims to enhance linguistic and communicative skills to support social readaptation.

Hoarseness in Children with Cleft Palate

Objective 1) To determine the rate of hoarseness in children with cleft palate (CP). 2) To understand the relationship between velopharyngeal insufficiency (VPI) and hoarseness in children with CP. Methods Retrospective chart review of 98 patients treated for CP by a tertiary care Children's Hospital Cleft Team and born between 1990 and 2001. Results Of the 98 patients, 59 were male and 39 female. All types of CP were represented. 89% received speech therapy. 41.6% had VPI. The overall rate of hoarseness was 22.4% and of dysphonia was 55.9%. The presence of VPI did not correlate with the presence of hoarseness or dysphonia. However, while VPI decreased when comparing ages 3–4 (58.1%) with ages 6–7 (32.1%) (p &lt;0.001), the hoarseness rates did not change as children got older. Additionally, there was a trend toward higher hoarseness and dysphonia rates in children with Pierre Robin Syndrome (PRS). Conclusions Both VPI and hoarseness are common findings in patients with CP. VPI improves as children get older in the setting of a tertiary care cleft team and a high rate of speech therapy. However, hoarseness and dysphonia do not appear to improve. These findings suggest that the theory that VPI causes hoarseness due to compensatory speech mechanisms may be incorrect. Even when resonance problems have improved, CP patients should continue to be evaluated by speech therapists for voice disturbances, as well as evaluated by otolaryngologists for treatable causes of hoarseness. Further, patients with PRS may be at additional risk for voice disturbances and should be treated accordingly.

Neurofibromatosis type 2 and auditory brainstem implantation

Neurofibromatosis type 2 and auditory brainstem implantation

Efetividade da intervenção fonoaudiológica no tempo de alta hospitalar do recém-nascido pré-termo

OBJETIVO: verificar a efetividade da intervenção fonoaudiológica na diminuição do tempo de alta hospitalar do recém nascido pré-termo. MÉTODOS: coleta de dados em 96 prontuários de recém-nascidos hospitalizados no Berçário Intermediário (BI) da Maternidade Marly Sarney no ano de 2000 a 2002 quando não havia atendimento fonoaudiológico e no ano de 2002 a 2004 quando ocorreu a implantação dos serviços fonoaudiológicos. RESULTADOS: os recém-nascidos que tiveram intervenção fonoaudiológica tiveram o tempo de internação mais curto do que os que não receberam. Os que receberam: 88% de 1 a 10 dias, 8% de 11 a 20 dias, 2% de 41 a 50 dias e 2% de 61 a 70 dias. Os que não receberam: 47,9% de 1 a 10 dias, 17,7% de 11 a 20 dias, 10,4% de 21 a 30 dias, 9,4% de 31 a 40 dias, 9,4% de 41 a 50 dias, 3,1% de 51 a 60 dias e 2,1% de 61 a 70 dias. Esse aspecto foi estatisticamente significante (p-valor &lt; 0.000). CONCLUSÃO: os dados obtidos apontam para a efetividade da intervenção fonoaudiológica em recém-nascidos pré-termos. Houve associação entre menor tempo de internação hospitalar e presença de intervenção fonoaudiológica.