Speech Therapy Intervention Research Articles

Logopēda darbs pirmsskolā Covid-19 pandēmijas laikā

In March 2020, World Health Organization announced that Covid-19 (SARS-CoV-2) has become a worldwide pandemic. Trying to curb the spread of the disease many countries, including Latvia, announced emergency measures, including lockdowns. As the situation surrounding Covid-19 developed, Ministry of Education and Science created various suggestions on how to organise the education process during a coronavirus pandemic, however, these did not cover the work of speech therapists. Language is an important indicator of quality of life and helps to achieve personal and social goals. Therefore, it is especially important to provide speech therapy assistance to children with speech and language disorders at preschool and it is offered in vast majority of preschool educational institutions in Latvia. At present, the course of speech therapy work has been significantly affected by the restrictions that are being implemented in the field of education in Latvia to reduce the spread of Covid-19. In order to understand the effects of Covid-19 restrictions on the work of speech therapists in Latvia, a study Speech therapy intervention in preschool education institutions during Covid-19 pandemic was conducted in April 2021. The questions of the study covered various aspects of managing and performing day to day activities such as conducting speech therapy sessions and communicating with parents before and during the pandemic. Additionally, the study enquired about the use of epidemiological measures and social distancing in preschool speech therapy classes during Covid-19 pandemic. The Covid-19 pandemic, which created an unprecedented situation, has had a significant impact on society, including most families with children, through both distance learning and various epidemiological constraints. In order to provide preschool children with speech and language skills, timely, individualized and high-quality assistance from a speech therapist is required, however, the current situation has necessitated continuous adaption. Therefore, speech therapists in Latvia have used a variety of creative solutions to keep providing preschool children with the assistance they require to thrive.

Complex speech-language therapy interventions for stroke-related aphasia: the RELEASE study incorporating a systematic review and individual participant data network meta-analysis

Complex speech-language therapy interventions for stroke-related aphasia: the RELEASE study incorporating a systematic review and individual participant data network meta-analysis

The effect of bi-hemispheric transcranial direct current stimulation on verbal function in Broca's aphasia

Aphasia is one of the most common deficits occurring after stroke that remains, at least in part, even after speech therapy and medication treatment. Non-invasive direct current transcranial stimulation (tDCS) is used to improve brain function by induction of neural plasticity. This study investigated the effect of bi-hemispheric tDCS on verbal function in patients with stroke-induced Broca's aphasia. Thirty patients with Broca's aphasia due to ischemic stroke, referred to an academic hospital in Guilan Province, Iran, in 2019-20, were studied. Patients were divided into two groups receiving seven sessions of either active or sham tDCS. The tDCS sessions began 10–20 days after stroke onset. The severity of aphasia before and after the intervention and a 3-month follow-up were assessed by the Persian version of the Western Battery-1 test (P-WAB-1). T-test, ANOVA, and Repeated Measurement were used for data analyses. The mean P-WAB-1 score was significantly higher in the intervention group both early after tDCS (P ≤ 0.0001) and on the 3-months follow-up (P ≤ 0001). Linear regression analysis indicated that tDCS had a positive effect on verbal performance scores independent of age, sex, and lesion volume (Regression coefficient = −33.3). Bi-hemispheric tDCS effectively improves verbal function in Broca's aphasia in the sub-acute phase of ischemic stroke.

Sialorrhea in patients with Parkinson's disease: A case report

Introduction: Sialorrhea is a common disorder in neurodegenerative diseases, being one of the most frequent signs resulting from the progress of Parkinson’s disease (PD). It consists of the excessive production of saliva and its accumulation in the oral cavity and oropharynx, compromising the quality of life and health and increasing the development of diseases. Case Report: A 66-year-old female patient, diagnosed with Parkinson’s disease 13 years ago, complained of hypersalivation and xerostomia, with consequent depletion of her quality of life, and underwent botulinum toxin application to the parotid glands and radiotherapy irradiation of the submandibular glands and 2/3 of the parotids, as well as physiotherapeutic and speech therapy intervention. Conclusion: Considering the high incidence and prevalence of sialorrhea in patients with Parkinson’s disease, the methods of treatment and rehabilitation available in order to re-establish the patients’ well-being will be discussed. The negative implications generated by sialorrhea on the quality of life and health of patients with PD are evident, which justifies the present study and its approaches within the field of treatments and interventions for the rehabilitation of these patients.

Better conversations: a language and communication intervention for aphasia in posterior cortical atrophy

ABSTRACT Posterior cortical atrophy (PCA) describes a neurodegenerative syndrome characterized by progressive difficulties in cortical visual and other posterior cortical functions consistent with parieto-occipital and occipito-temporal involvement. It is increasingly recognized that many patients develop difficulties with other aspects of daily living, in particular, with language and communication. We present a case emphasizing how language difficulties may emerge in PCA. Difficulties are interpreted as arising from interacting effects of linguistic deficits and impaired detection of nonverbal (particularly, visual) turns that normally facilitate, schedule, and disambiguate the exchange of verbal messages between speakers. We propose that relatively simple speech and language therapy interventions may hold promise in addressing language and communication difficulties as secondary features of PCA by targeting the behaviors of both the person with PCA and their communication partners.

Trastornos de la deglución en niños menores de 3 años con condiciones médicas complejas, abordaje interdisciplinario

Children with swallowing disorders (SD) may manifest symptoms at all times during feeding. This clinical entity can present itself in different grades and forms. ObjectiveTo diagnose and intervene in SD and/or eating behavior (EB) in children with complex chronic medical conditions referred to an interdisciplinary team, during 2017, in a high complexity hospital. Material and methodsAnalytical, prospective and longitudinal study with the intervention of an interdisciplinary team. Clinical phonoaudiological evaluation of swallowing was performed, offering guidelines for stimulation and consistency modification. Results139 patients, between 2 month and 3 years old, 38% women, 77% with enteral nutritional support (ENS) were evaluated, 73% presented SD exclusively or associated with an EB. The 38% who entered with ENS achieved weaning (without significant difference between those who had or not SD, P=.85, and those who had or not tracheotomy, P=.88), and of the group that did not achieve weaning, oral contribution increased in 54% of cases. A statistically significant difference was observed in weaning of patients who attended the interdisciplinary space with respect to those who did not (P=.016) and longer intervention time between those who achieved weaning and those who did not, 5.2±3.1 vs 3.45±3.1 months (P=.0099). And 70% off patients continued follow with the speech therapist. ConclusionInterdisciplinary and specialized work in this subject is essential in children with complex medical conditions. In cases of SD, speech therapy intervention, it is assumed as essential for early detection and correct approach to dysphagia.

Mucopolysaccharidosis Type I, Hematopoietic Cell Transplantation and Neurodevelopmental Profile: A Case Report

Type I mucopolysaccharidosis is caused by an alpha-L-iduronidase deficit and has three phenotypic expressions. Hurler syndrome includes dysmorphias, hirsutism, hepatosplenomegaly, hydrocephalus, skeletal deformities, recurrent infections, heart abnormalities, and global developmental delay. Hematopoietic cell transplantation provides a continuous source of alpha-L-iduronidase throughout the body, including the central nervous system and, currently, appears to be the gold-standard therapy for this pathology. We present the case of a six-years-old child with the diagnosis of Hurler syndrome, submitted to hematopoietic cell transplantation and integrated in a structured support plan with special education, speech therapy and early home intervention, who presents a trend of convergence with the normality in all the development areas, except for locomotor skills and eye-hand coordination. These findings highlight the positive impact of the hematopoietic cell transplantation together with the early and structured intervention of a multidisciplinary team in the neurodevelopmental profile of children affected by Hurler syndrome.

AWARENESS REGARDING SPEECH-LANGUAGE PATHOLOGIST DOMAIN AMONG GENERAL PHYSICIANS

We examine the extent to which General Practitioners (GPs) have knowledge of the speech language pathology field. This was pilot research where 20 pilots were selected through convenience sampling techniques because it is suitable for both. Another study it was a structured questionnaire-based study for general physicians about awareness regarding Speech-Language Pathologist (SLP) domain. This pilot study found mixed results that, All the doctors have an understanding of the speech therapy requirements and no doctor (0%) were in the category of “No to Little Knowledge” Most of these general physicians have enough knowledge about SLPs field, about 60% of the doctors required further updated knowledge and education about the best practice speech therapy requirements/treatment. The general practitioners are merely aware that this specialty indeed exists but still do not know what sort of cases that are dealt with by the professionals of this field. 25% of the doctors classified under the Reasonable knowledge, these doctors have knowledge about all the basic requirement of the speech therapy patient requirements but no referring to Speech-language pathologist. However, the need refresher courses/knowledge to be an expert in the field. 15% of the doctors have expert level knowledge and they have clear concept and requirement of the best practices for the speech therapy treatment. Although they all suggested that a health care provider SLP should perform the main role in health domain collaboration with general physicians. The study results showed that in Pakistan, the medicines curriculum (MBBS) has been updated with any chapter regarding the rehabilitation / habitation of this sort. So, most of the general practitioners are unaware about SLP domain, which is basically the key point that plays a significant role in rehabilitation. So, the researcher suggested Pakistan health council to review the official MBBS curriculum and government sector health ministry to work on this specificity.

Developmental language disorders in Cyprus

The term developmental language disorder (DLD) refers to the condition in which a child fails to achieve the speech and language milestones that are expected for his/her chronological age. The disorder is often linked to a series of add-on effects such as learning difficulties, trouble with socializing, problematic behaviour and low self-esteem. According to the international literature, DLD affects approximately 7% of school children in mainstream education. This paper reports on research conducted in Cyprus aiming to map the services provided by speech and language therapists (SLTs) to children with DLD. A questionnaire containing key areas of enquiry was developed and distributed to professionals working with DLD in Cyprus. A total of 44 responses were submitted by SLTs who provide services to individuals with DLD. The findings showed that the majority of children with DLD are diagnosed with a mixed receptive/expressive language disorder and are, on average, 7 years of age. The speech therapy interventions provided by professionals were twice a week and were most often on an individual basis. The maximum number of sessions was not pre-determined. Findings underscored the need for further research in defining service provision issues for children with DLD in Cyprus.

Speech therapy intervention in patients diagnosed with attention deficit hyperactivity disorder: integrative review

Attention Deficit Hyperactivity Disorder (ADHD) can be characterized as a neurobiological disorder, with genetic causes, presenting, among the main symptoms, inattention, restless behaviors, as well as impulsivity problems. This disorder appears during childhood and can accompany humans throughout their life cycle. The treatment can be carried out through the association of drugs, psychotherapy and speech therapy, especially when speech disorders or writing problems are observed. In this context, the present article has as its guiding question: how can speech therapy act to reduce the problems caused by attention deficit hyperactivity disorder? Thus, the main objective of this research is to analyze, through the already published literature, the intervention of speech therapy in patients diagnosed with attention deficit hyperactivity disorder. For the foundation of the research, it was necessary to carry out an integrative bibliographical research, analyzing several theories related to the intervention of speech therapy in people with ADHD. For this, searches were carried out in the databases: Scielo, Pubmed, Lilacs and Medline. It is concluded through this research that the performance of speech therapists in individuals diagnosed with ADHD provides a significant reduction in multiple behaviors, significantly helping with regard to combating the main difficulties of these individuals, such as attention and impulsiveness problems, in addition to assistance to parents or guardians of people with ADHD.

Speech and language therapy interventions for speech problems in Parkinson's disease

Speech and language therapy interventions for speech problems in Parkinson's disease

The BioVisualSpeech Serious Game with Voice Exercises for People with Parkinson's Disease with Hypokinetic Dysarthria.

People with Parkinson's disease (PD) can have dysarthria, a voice disorder that affects speech intelligibility. To fight this disorder people may resort to speech and language therapy. Unfortunately, weekly speech therapy sessions may not be enough, because to achieve and maintain good voice quality, intensive training is required. Additionally, the COVID-19 pandemic brought attention to the need for alternative speech therapy treatments that complement face-to-face appointments. Here, we propose a serious therapy game to improve voice loudness that can be used for intensive therapy or when face-to-face appointments are not possible. The game integrates three voice exercises used in speech therapy sessions for people with PD and aims to provide motivation for patients to perform the exercises on a daily basis. This application evaluates the vocal intensity, vocal frequency and maximum phonation time, offering real-time visual feedback. It also allows pathologists to customize the exercises difficulty to the needs of each patient.

Rehabilitation in atypical neurological disease: a case report

The rehabilitative management of neurological diseases such as Parkinson's disease (PD) and multiple sclerosis (MS) is complex; drug treatment alone is generally insufficient. Multidisciplinary rehabilitation programs can fundamentally contribute to the management of neurological patients and have important positive repercussions on their quality of life. We describe the unusual case of a 70-year-old man with a diagnosis of both MS and PD, who presented with motor and cognitive impairments. He was admitted to our institute for a rehabilitation program. Motor, cognitive, and linguistic abilities were evaluated at admission and 60 days after the multidisciplinary rehabilitation, which included motor exercises, speech therapy, and cognitive interventions. The multidisciplinary rehabilitation improved the patient’s functional status and exerted positive effects on his mood, autonomy in activities of daily life, perception of quality of life, cognitive performance, and speech skills. It is important to find new methods for treating neurological patients to better manage the social and economic implications of neurological disease, and to ensure a long course of treatment and rehabilitation.

Ранняя комплексная реабилитация пациента с постоперационной дисфагией

Postoperative paresis and paralysis of the larynx, associated with breathing, voice and swallowing disorders, are actual problem of surgical treatment of the thyroid and mediastinal diseases. Traditionally, more attention is paid to phonation disorders treatment. Swallowing recovery methods are not described sufficiently. The paper reports a clinical case of early speech therapy intervention aimed at alleviating postoperative dysphagia caused by the limited flexibility of the larynx. Detailed swallowing disorder diagnosis in patient was carried out before and after the logopaedic correction of dysphagia. The main directions and results of the correctional and pedagogical work with psychological support within comprehensive rehabilitation are described. The findings confirm the need for correctional impact during the early stages of rehabilitation in case of dysphagia in surgical patients with the paresis or paralysis of the larynx.

Precision rehabilitation for aphasia by patient age, sex, aphasia severity, and time since stroke? A prespecified, systematic review-based, individual participant data, network, subgroup meta-analysis.

Stroke rehabilitation interventions are routinely personalized to address individuals' needs, goals, and challenges based on evidence from aggregated randomized controlled trials (RCT) data and meta-syntheses. Individual participant data (IPD) meta-analyses may better inform the development of precision rehabilitation approaches, quantifying treatment responses while adjusting for confounders and reducing ecological bias. We explored associations between speech and language therapy (SLT) interventions frequency (days/week), intensity (h/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database. MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including ⩾ 10 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori. Data were dichotomized by age (⩽/> 65 years), aphasia severity (mild-moderate/ moderate-severe based on language outcomes' median value), chronicity (⩽/> 3 months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (> 50%), results were reported for completeness. 959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h/week; overall-language and comprehension > 9 h/week); older participants' greatest gains occurred alongside low-intensity SLT (⩽ 2 h/week) except for auditory comprehension (> 9 h/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants ⩽ 3 months post-onset demonstrated greatest overall-language gains for SLT at low intensity/moderate dosage (⩽ 2 SLT-h/week; 20-to-50 h); for those > 3 months, post-stroke greatest gains were associated with moderate-intensity/high-dosage SLT (3-4 SLT-h/week; ⩾ 50 hours). For moderate-severe participants, 4 SLT-days/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for ⩾ 4 SLT-days/week; mild-moderate participants' greatest functional communication gains were associated with similar frequency (⩾ 4 SLT-days/week) and greatest overall-language gains with higher frequency SLT (⩾ 6 days/weekly). Males' greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h/weekly) or high intensity (overall-language and auditory comprehension; (> 9 h/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (< 2 SLT-h/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT > 9 h over ⩾ 4 days/week. We observed a treatment response in most subgroups' overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild-moderate, and male subgroups experienced their greatest language gains alongside high-frequency/intensity SLT. In contrast, older, moderate-severely impaired, and female subgroups within 3 months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.

Digital Assessment of Acquired Alexia and Agraphia: On the Relevance of Written Discourse

The digital revolution has created challenges as well as opportunities for people with acquired reading (= alexia) and writing (= agraphia) impairments. Although it is difficult to validly assess written discourse, it is imperative that people with alexia and agraphia (PwAA) receive reliable diagnostics for the following reasons: (1) discourse in written and oral forms is highly relevant to daily interaction and participation, but there are no established tests or diagnostic procedures to assess written discourse; (2) reliable diagnostic measures are a prerequisite for any language rehabilitation, especially for the complex skills needed for written discourse; and (3) the continuing trend in digitalization offers new opportunities for easily collecting and assessing written discourse via digital means. In our manuscript, we highlight the relevance of written discourse for social participation and in the digital world and argue that in order to improve social participation in general and digital participation in particular for PwAA, remote assessment of written discourse abilities can be the basis for speech and language therapy treatment focused on communicative abilities.

Applying evidence to practice by increasing intensity of intervention for children with severe speech sound disorder: a quality improvement project.

Speech sound disorder (SSD) affects up to 25% of UK children and may impact on: effective communication; the development of relationships; school progression and overall well-being. The evidence base shows that intervention for children with SSD is more effective and efficient when provided intensively in relation to the number of target sounds elicited in sessions (dose) and number of sessions per week (frequency). Southern Health and Social Care (HSC) Trust's baseline intensity of speech and language therapy (SLT) intervention was similar to that often found in current practice across the UK, where ~30 target sounds were elicited (dose) in once weekly sessions (frequency) over a 6-week block, followed by a break from therapy. This quality improvement (QI) project aimed to increase intensity of intervention for children with severe SSD within Southern HSC Trust’s community SLT service to improve outcomes for children and their parents. QI methods supported accurate identification of ten 4–5 year olds with severe SSD and increased the intensity of their intervention over a 12-week period by measuring a range of data and speech outcomes. Findings showed a sustainable increase of dose (number of targets elicited per session) to levels recommended in the research (≥70). However, it was difficult to sustain increased frequency of appointments (to twice weekly) because of contextual factors such as sickness, etc. Accommodating this, measuring days between appointments captured an overall increase in the number of appointments attended across time. Child speech outcomes improved for direct speech measures and parent ratings of intelligibility. The intensive model of intervention has been implemented for children identified with severe SSD across Southern HSC Trust's community service with ongoing audit and development, and findings have been disseminated.

Principles and philosophies for speech and language therapists working with people with primary progressive aphasia: an international expert consensus

Purpose Primary progressive aphasia (PPA) is a language-led dementia associated with Alzheimer’s pathology and fronto-temporal lobar degeneration. Multiple tailored speech and language interventions have been developed for people with PPA. Speech and language therapists/speech-language pathologists (SLT/Ps) report lacking confidence in identifying the most pertinent interventions options relevant to their clients living with PPA during their illness trajectory. Materials and methods The aim of this study was to establish a consensus amongst 15 clinical-academic SLT/Ps on best practice in selection and delivery of speech and language therapy interventions for people with PPA. An online nominal group technique (NGT) and consequent focus group session were held. NGT rankings were aggregated and focus groups video recorded, transcribed, and reflexive thematic analysis undertaken. Results The results of the NGT identified 17 items. Two main themes and seven further subthemes were identified in the focus groups. The main themes comprised (1) philosophy of person-centredness and (2) complexity. The seven subthemes were knowing people deeply, preventing disasters, practical issues, professional development, connectedness, barriers and limitations, and peer support and mentoring towards a shared understanding. Conclusions This study describes the philosophy of expert practice and outlines a set of best practice principles when working with people with PPA. Implications for rehabilitation Primary progressive aphasia (PPA) describes a group of language led dementias which deteriorate inexorably over time. Providing speech and language therapy for people with PPA is complex and must be person centred and bespoke. This study describes the philosophy of expert practice and outlines a set of best practice principles for speech and language therapists/pathologists working with people with people with PPA.

789 Role of Speech Therapy (SLP) in the rehabilitation of a complicated case of glossoparesis (GP)

IntroductionGlossoparesis is defined as a neurodegenerative process resulting in progressive dysphagia and dysarthria. The deinervation of the tongue and related structures results in flaccid muscle function unilaterally and bilaterally, this process is difficult to treat and rehabilitate and prognosis is considered poor. We encountered this in a patient that had a complicated case of necrotizing fasciitis (NF) that arose from an abscessed tooth.The purpose of this case report is to summarize the overall approach to a rehabilitation plan which resulted in successful return to speech and partial swallow.MethodsThe patient was diagnosed with an abscessed tooth which resulted in Necrotizing fasciitis of the face, neck and chest. Multiple surgical interventions resulted in removal of necrotic tissue and reconstructive interventions were implemented. Initial prognosis of return of function was noted as “poor” per ENT services. Ear, Nose and Throat (ENT) specialist noted that prognosis for recovery of function is unknown but was low.Speech Therapy was also consulted and an individualized plan of care to address the deficits assessed was developed. Initial prognosis of return of functional speech / swallow was guarded. It was felt to be highly appropriate to provide the patient with therapeutic options.Speech Therapy sessions included use of Neuromuscular Electrical Stimulation, Thermal Stimulation, Tactile Stimulation, Therapeutic Massage to affected regions, Deep Pharyngeal Neuromuscular Stimulation, finger occlusion trials for speech production attempts to ready patient for use of Passy Muir Valve, Oral Motor Exercises, Laryngeal Elevation Tasks, Vocal Stretching / Relaxation tasks and oral trials of ice chips as musculature function improved.ResultsThrough the use of these multiple modalities of skilled speech therapy intervention, the patient had return of functional verbal communication prior to discharge to a skilled rehabilitation program.ConclusionsUpon initial evaluation, the true potential for return of function was questioned. It is paramount that patient be given an opportunity to succeed - to be included in the plan of care - to be provided with opportunities to return to their prior level of function or as close as possible. There is little to no research regarding return of function for patients affected by glossoparesis.

Fonoaudiologia e Psicanálise: estudo de casos com crianças com atraso na linguagem oral

ABSTRACT The present research aims to study the effects of interdisciplinary interventions of Speech Therapy and Psychoanalysis in children with language delay. This is a comparative case study between two groups with quantitative and qualitative analysis, with four children, through the application of the Protocol of Behavioral Observation Protocol pre and post intervention, interviews with parents, records of children's filming during playing and interdisciplinary dialogues among the professionals. The pre-intervention evaluations showed that underage children obtained similarity in aspects that related to communicative skills and functions, cognitive development and toy level. Both groups presented difficulties regarding the alternation of turns. The assessments of older children, in the pre-intervention phase, also indicated similarities in the results. One subject presented a greater difficulty when waiting for his turn in dialogic activity. The results post-interdisciplinary intervention showed a superior improvement compared to the two cases followed only by the speech therapist. The interdisciplinary dialogue made it possible to effectively evolve in the cases of group 2. A psychoanalytic look over the cases that received only speech therapy intervention would allow intervention along with parents, children and school.