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PubMed2005

Speech and language therapists in palliative care: what do we have to offer?

Speech and language therapists (SLTs) are specialists in the management of communication and swallowing disorders (dysphagia); however, few are members of acute and community specialist palliative care teams in the UK. Although numbers of SLTs working in palliative care are increasing, there is a need for education and research to support service development and promote understanding of their role. This profile piece outlines what SLTs have to offer patients with palliative care needs and describes how their role in palliative care is increasing in the UK.

Deglutition Disorders↗
PubMed2000

(Re-) constructing pre-linguistic interpersonal processes to promote language development in young children with deviant or delayed communication skills.

BACKGROUND: Approaches to intervention with young children with delayed or deviant communication skills have tended to focus directly on the production and comprehension of linguistic forms. Research in developmental psychology, however, has highlighted the role of joint attention and action within a mutually negotiated frame in early communicative development. AIMS: An approach to intervention was developed which uses graded participation in such 'formats' to promote language development in 3- to 5-year-olds with significant delays or deviance in communication skills. This study was designed to evaluate this in comparison with a more conventional approach. SAMPLE: The sample comprised twenty 3- to 5-year-olds attending a diagnostic nursery or a speech and language support centre attached to a mainstream primary school. METHOD: In the intervention, developmentally ordered sequences of exchange games provided predictable ruled-based and structured joint contexts of action, within which verbal and non-verbal exchanges between an adult and child could be meaningfully used. In the control condition, participants received more conventional intervention focusing more directly on language per se. Level of participation in dyadic play was assessed in terms both of role and cognitive complexity, and for the present study language development was assessed using the verbal subtests of the WPPSI. The study entailed both a between- and a within-subjects design. RESULTS: Cross-sectional and longitudinal comparisons confirmed that this form of intervention was significantly more effective than the control condition in increasing children's level of participation in social game formats and in promoting their language development; moreover, these were significantly correlated. CONCLUSIONS: The results indicate that the development of language skills can be promoted more effectively through (re-) constructing the interpersonal framework of pre-linguistic communicative development than through conventional intervention focusing directly upon language per se.

Adult↗
PubMed2001

Intentional communication elicits language-facilitating maternal responses in dyads with children who have developmental disabilities.

An experimental test of whether intentional communication elicits maternal responses purported to facilitate language development is presented. Fifty-eight prelinguistic children with disabilities and their mothers participated. Children were randomly assigned to two staff-implemented treatments that were designed to experimentally increase intentional communication ability. We predicted that treatment effects on maternal responses would vary by maternal education level and maternal responsive interaction style at the pretreatment period. We predicted any treatment effect on maternal responses would be mediated by posttreatment intentional communication. Results indicated that treatment effects on maternal responses varied by pretreatment maternal education level. A pattern of results also supports the conclusion that posttreatment intentional communication to mother was, at least in part, responsible for the effect on posttreatment maternal responses.

Child, Preschool↗
PubMed2000

"A good future for deaf children": a five-year sign language intervention project.

Deaf preschoolers and hearing family members learned sign language in a 5-year intervention project. Once weekly, each child met with a teacher who was deaf. Parents, siblings, and other relatives met about once monthly to study sign language, and all families in the project signed together about twice yearly. The present study addressed four questions asked of parents about the project: (a) How did the children learn to sign? (b) Did both the parents and the children benefit from the project? (c) What was the position of sign language in the family? (d) Did the project have some impact on the family's social network? The families indicated satisfaction with the project; they learned to sign and their social networks expanded. Parents favored bilingual education: Sign language was the main language but learning Finnish was also important. Learning sign language was not easy, especially for the fathers. The families that were most actively involved in the lessons learned the most.

Adult↗
PubMed1995

The effectiveness of an interactive instructional context. Principles from the parent-child interaction literature.

In the present study, the effectiveness of embedding a targeted linguistic structure within an interactive instructional context is examined. Ten subjects participated in a communication-games intervention which contained seven interactive elements drawn from the parent-child interaction literature. Ten subjects were assigned to a control group. A comparison of student performance before and after intervention supports the effectiveness of adopting instructional strategies that are consistent with a social-interaction perspective on language development. Qualitative results are presented that illustrate each of the interactional characteristics of the intervention. Implications for practice are discussed.

Child↗
PubMed2006

Screening for speech and language delay in preschool children: systematic evidence review for the US Preventive Services Task Force.

BACKGROUND: PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Published in the public domain by the American Academy of Pediatrics. Speech and language development is a useful indicator of a child's overall development and cognitive ability and is related to school success. Identification of children at risk for developmental delay or related problems may lead to intervention services and family assistance at a young age, when the chances for improvement are best. However, optimal methods for screening for speech and language delay have not been identified, and screening is practiced inconsistently in primary care. PURPOSE: We sought to evaluate the strengths and limits of evidence about the effectiveness of screening and interventions for speech and language delay in preschool-aged children to determine the balance of benefits and adverse effects of routine screening in primary care for the development of guidelines by the US Preventive Services Task Force. The target population includes all children up to 5 years old without previously known conditions associated with speech and language delay, such as hearing and neurologic impairments. METHODS: Studies were identified from Medline, PsycINFO, and CINAHL databases (1966 to November 19, 2004), systematic reviews, reference lists, and experts. The evidence review included only English-language, published articles that are available through libraries. Only randomized, controlled trials were considered for examining the effectiveness of interventions. Outcome measures were considered if they were obtained at any time or age after screening and/or intervention as long as the initial assessment occurred while the child was < or =5 years old. Outcomes included speech and language measures and other functional and health outcomes such as social behavior. A total of 745 full-text articles met our eligibility criteria and were reviewed. Data were extracted from each included study, summarized descriptively, and rated for quality by using criteria specific to different study designs developed by the US Preventive Services Task Force. RESULTS: The use of risk factors for selective screening has not been evaluated, and a list of specific risk factors to guide primary care physicians has not been developed or tested. Sixteen studies about potential risk factors for speech and language delay in children enrolled heterogeneous populations, had dissimilar inclusion and exclusion criteria, and measured different risk factors and outcomes. The most consistently reported risk factors included a family history of speech and language delay, male gender, and perinatal factors. Other risk factors reported less consistently included educational levels of the mother and father, childhood illnesses, birth order, and family size. The performance characteristics of evaluation techniques that take < or =10 minutes to administer were described in 24 studies relevant to screening. Studies that were rated good to fair quality reported wide ranges of sensitivity and specificity when compared with reference standards (sensitivity: 17-100%; specificity: 45-100%). Most of the evaluations, however, were not designed for screening purposes, the instruments measured different domains, and the study populations and settings were often outside of primary care. No "gold standard" has been developed and tested for screening, reference standards varied across studies, few studies compared the performance of > or =2 screening techniques in 1 population, and comparisons of a single screening technique across different populations are lacking. Fourteen good- and fair-quality randomized, controlled trials of interventions reported significantly improved speech and language outcomes compared with control groups. Improvement was demonstrated in several domains including articulation, phonology, expressive language, receptive language, lexical acquisition, and syntax among children in all age groups studied and across multiple therapeutic settings. Improvement in other functional outcomes such as socialization skills, self-esteem, and improved play themes were demonstrated in some, but not all, of the 4 studies that measured them. In general, studies of interventions were small and heterogeneous, may be subject to plateau effects, and reported short-term outcomes based on various instruments and measures. As a result, long-term outcomes are not known, interventions could not be compared directly, and generalizability is questionable. CONCLUSIONS: Use of risk factors to guide selective screening is not supported by studies. Several aspects of screening have been inadequately studied to determine optimal methods, including which instrument to use, the age at which to screen, and which interval is most useful. Trials of interventions demonstrate improvement in some outcome measures, but conclusions and generalizability are limited. Data are not available addressing other key issues including the effectiveness of screening in primary care settings, role of enhanced surveillance by primary care physicians before referral for diagnostic evaluation, non-speech and language and long-term benefits of interventions, and adverse effects of screening and interventions.

Child, Preschool↗
PubMed1998

[Prevention for speech-hearing therapists from the University of Valle in Cali, Colombia].

INTRODUCTION: Preventive activities in communication disorders treated by speech-hearing therapists of the Universidad del Valle in Cali Colombia, between January and April, 1995, are described. METHODOLOGY: Forty-five professionals to whom a self administered questionnaire with 13 questions was applied, were included in the study. RESULTS: For 67% the program of graduation is basic as source of their preventive knowledge. 47% used only one of nine strategic options and 29% report the use of only two of these preventive interventions. For all communication areas, on average nearly 60% of speech-hearing therapists never use preventive actions. CONCLUSION: The alumni of the Universidad del Valle do not exercise the practice of prevention in a systematic way it has been claimed by the curriculum of the school. Some determinants of social context and demand of professional services are suspected to induce a great reduction in the proportion and frequency of preventive practice in the professional role.

Colombia↗
PubMedDate not supplied

[Alphabetization and rehabilitation of reading/writing disorders through a phonetic-visual-articulatory method].

BACKGROUND: Alphabetization and rehabilitation of reading/writing disorders through a phonetic-visual-articulatory method (Método das Boquinhas - Jardini, 1997). This methodology combines neuropsychological inputs, such as sounds/phonemes, letters/graphemes to the visual representation of mouth position/articulemes. AIM: To alphabetize and/or rehabilitate children who presented reading/writing disorders, of varied etiologies, with consistent short-term results, in a combined intervention with a speech-language pathologists and a psycho-pedagogue. METHOD: Participants of this study were 30 children, with the diagnoses of dyslexia, ADHA, mild cognitive retardation, infant psychoses and borderline behavior, some of which presented comorbidities. Children ranged between 7 and 10 years of age, all presenting at least a six-month delay in regular schooling. The children along with their parents and teachers took part in the research. Parents and teachers assessed the children through a multiple choice questionnaire at the beginning of treatment (T0), three (T1) and six months after intervention (T2), according to parameters of reading, reading comprehension, spelling, blackboard copying, attention, concentration and confidence for learning. The questionnaire qualified children as incapable, intermediate and capable for learning in each of the assessed parameter. The adopted therapeutic approach was the application of a phonetic-visual-articulatory method, with two weekly sessions with a speech-language pathologist and a psycho-pedagogue. Besides the therapeutic interventions, children continued to attend regular school. RESULTS: An expressive development was observed for all of the assessed parameters, according to parents and teachers. After the first 3 months of intervention, the performance of the children was classified at an intermediate level of learning and after 6 months they were considered as being capable for learning in each of the assessed parameters. These results not only favored a better performance at school, but also raised the children's self-esteem in terms of learning. CONCLUSION: After 6 months of intervention with the phonetic-visual-articulatory methodology children were able to continue with their learning process in a regular school, following the performance of the other members of class.

Child↗
PubMed1991

Accuracy of information reported by parents and children evaluated by a cleft palate team.

Children with palatal clefts and their parents were interviewed to determine what information they had about the cleft and its management. Their responses were compared with the standards of 17 team members from seven disciplines. Both parent and child were consistently provided information about clefts that they were expected to remember. The children's responses met the standards 67 percent of the time. Their parents' responses met the standards 80.6 percent of the time. Parents accurately predicted their children's responses 92 percent of the time.

Adolescent↗
PubMed1979

Acquisition of adjectives and adverbs in sentences written by hearing impaired and aphasic children.

The effect of an instructional package, which included modeling, reinforcement, and remedial feedback on the rate, accuracy, and topography of sentences composed by four hearing impaired and aphasic children, was examined. In a specially designed classroom, students wrote sentences describing a stimulus picture on acetate sheets placed on the stage of an overhead projector which was built into each student's desk. This arrangement provided the teacher and other students immediate and continuous visual access to each student's sentences. In a multiple baseline design across behaviors, model sentences were projected and token reinforcment and remedial feedback were made contingent upon writing correct sentences containing prenominal adjectives only, then adverbs only, then prenomial adjectives plus adverbs. During baseline all student displayed poor written language skills and seldom wrote sentences containing modifiers. When the instructional package was implemented, all students demonstrated significant increases in response rate, accuracy, and percentage of correct sentences including prenominal adjectives and adverbs.

Aphasia↗
PubMed1981

Evaluating a supervision program for developing and maintaining therapeutic staff-resident interactions during institutional care routines.

This study evaluated a program to teach and maintain language training interactions between institutional staff and profoundly handicapped children during a routine care task. Following baseline observations of bath sessions, staff were sequentially taught in multiple baseline fashion to vocalize more during the bath, praise child vocalizations, imitate sounds, and provide sound prompts. Procedures included a brief in-service meeting followed by a series of supervisory prompts and feedback. Results indicated that staff acquired the interaction skills in the bath sessions and that the skills generalized to another direct care task, dressing. The number of days on which components of supervision were implemented decreased from 47% of all days during the experimental conditions to 19% of the days during a 19-week maintenance period with no decrease in staff behavior. The interactions were shown not to interfere with the quality of the direct care task nor to increase the amount of time necessary to complete it. Also, some increases were noted for child vocalization frequencies. The advantages of providing therapeutic interactions during care routines are discussed along with the need for staff management techniques with long-term maintenance value.

Child↗
PubMed1983

A modified incidental-teaching procedure for autistic youth: acquisition and generalization of receptive object labels.

A modified incidental-teaching procedure was used to increase the receptive language skills of autistic youth who had previously experienced lengthy institutionalization. At the time of the study, the two severely language-delayed children had recently been transitioned to a community-based group home. Receptive-labeling skills were taught for four sets of objects typically used in school lunch preparation. The percentage of correct, unprompted object identifications displayed by Youth 1 increased when the incidental-teaching package (gestural prompts, behavior-specific praise, and contingent access to lunch-making supplies) was sequentially introduced in a multiple-baseline design across sets of objects. These results were replicated with Youth 2. The youths' newly acquired language skills also generalized to a different setting (the dining room of the group home) and to a different activity occurring later in the day (a traditional sit-down, discrete-trial session). This research indicates that the linguistic skills of severely developmentally delayed autistic children can be accelerated by incidental instruction that is provided in the course of shaping other home-living skills.

Adolescent↗
PubMed1984

Establishing generative yes/no responses in developmentally disabled children.

We evaluated the effects of two procedures for teaching four developmentally disabled children to respond yes/no appropriately. During baseline, tutoring was conducted in which five known items were individually presented with the question, "Is this a ----?", followed either by access to requested items or by remedial prompting contingent on responding. When tutoring did not improve performance, instruction was embedded in the regular classroom activities. In this condition, items requested by students were either presented or withheld on the basis of their response to the question, "Do you want ----?". Increases in correct responding were confirmed by a multiple-baseline design across all four students and were maintained with the introduction of new items. However, generalization to "Is this a ----?" questions did not occur in the tutoring setting until specifically programmed. Subsequently, students also demonstrated appropriate yes/no responding to questions involving actions, possession, and spatial relations.

Child↗
PubMed1989

Facilitating generalized requesting behavior in Broca's aphasia: an experimental analysis of a generalization training procedure.

The effects of a generalization training procedure on requesting by 4 subjects with chronic Broca's aphasia were examined using a multiple baseline design across behaviors and subjects. Subjects were trained to request information on three topics sequentially. Generalization across topics and persons was assessed in weekly probe sessions consisting of 5-min conversational interactions with trainers and unfamiliar volunteers in a nontreatment setting. Results revealed generalization effects were greatest when trainers, as opposed to unfamiliar volunteers, served as conversational participants. Nevertheless, subjects' requests increased with all conversational participants to a level comparable to a normal comparison group assessed under conditions identical to the experimental probes. Social validation of treatment effects using a subjective evaluation procedure revealed significant improvement on the parameters of talkativeness, inquisitiveness, and conversational success.

Aphasia↗