Assessment and management of the communication difficulties of children with cerebral palsy: a UK survey of SLT practice

Child, family and professional views on valued communication outcomes for non-verbal children with neurodisability: A qualitative meta-synthesis

BACKGROUND

There are many children with neurodisability who are unable to rely on speech to communicate and so use a range of augmentative and alternative communication (AAC) methods and strategies to get their message across. Current instruments designed to measure the outcomes of speech and language therapy interventions lack specific attention to communication outcomes that are valued by non-verbal children with neurodisability, their families and support networks. This qualitative meta-synthesis was conducted to identify valued communication outcomes to inform the next stage of developing a novel outcome measure.

AIMS

To systematically identify and synthesise the qualitative evidence about which communication outcomes non-verbal children with neurodisability, their family members, healthcare professionals and educators think are important to achieve, specifically which communication outcomes are most valued by: (1) non-verbal children with neurodisability; (2) parents or other family members of non-verbal children with neurodisability; and (3) professionals who work with non-verbal children with neurodisability.

METHODS & PROCEDURES

A systematic search of bibliographic databases and the grey literature was undertaken to identify qualitative studies that included evidence of views expressed by children, family members, healthcare professionals and educators on outcomes in relation to the communication of non-verbal children with neurodisability. All papers meeting the inclusion criteria were quality appraised using the Critical Appraisal Skills Programme Qualitative checklist, although none were excluded on this basis. The data synthesis involved organising coded data into descriptive themes which were then synthesised into analytical themes.

MAIN CONTRIBUTION

We found 47 papers containing qualitative data meeting the inclusion criteria from research situated in 14 countries. The views of 35 children, 183 parents, six other family members, 42 healthcare professionals and 18 educators are represented in the review. The included studies contained very few data reported by children themselves; most data were provided by adults, especially parents. Three main analytical themes were identified: Experiences of communication and expectations; adapting to and acceptance of AAC; and becoming an autonomous communicator.

CONCLUSIONS & IMPLICATIONS

This meta-synthesis brings together the limited qualitative research findings about what parents, professionals and children consider are important communication outcomes for non-verbal children with neurodisability. The synthesis identifies key gaps in our knowledge about the perspectives of children and their siblings. This synthesis will inform primary research to understand valued communication outcomes in this group, and ultimately the development of a patient-reported outcome measure (PROM) that can be used to demonstrate the effect of interventions, at both clinical and service levels.

WHAT THIS PAPER ADDS

What is already known on the subject Studies of children with cerebral palsy and autism spectrum disorder indicate that at least 25% of children with these conditions are non-verbal. Studies on the health outcomes of children with neurodisability have identified that communication is rated as important by parents and health professionals. There is an evidence gap about which communication outcomes are important to non-verbal children, their families and the people who work with them. What this paper adds to the existing knowledge This is the first synthesis of data that relates to communication outcomes for non-verbal children with neurodisability. This qualitative meta-synthesis identifies from previous research studies the communication outcomes valued by children who are non-verbal, their parents or other family members, and the professionals who work with them. The findings will be used to shape further primary research and the development of a novel patient-reported communication outcome measure for non-verbal children with neurodisability. It is anticipated that this will be used by clinicians to measure the effect of their interventions. What are the practical and clinical implications of this work? Clinicians should reflect on parents' experiences of communication with their child before discussing potential outcomes with them. Gaining insight into the lived experience of communication for non-verbal children and their families will help healthcare professionals to understand which goals are important to them and why. Few studies have specifically asked which communication outcomes are important for non-verbal children with neurodisability. Further exploration is needed to determine which communication outcomes non-verbal children and their families would like to see included in outcome measures used by clinicians.

Factors affecting speech-language pathologists' language assessment procedures and tools - challenges and future directions in Sweden

Purpose: National surveys of speech-language pathologists' (SLP) practices play an important role in professional development, and previous research show that many challenges faced by the profession are similar across the globe. This study aims to describe Swedish SLP assessment practices, examine factors that may affect this practice, and discuss the results in the light of international studies. Methods: Data from 584 SLPs were collected through an online questionnaire with multiple choice and open-ended questions. A mixed-method design was deployed where a deductive qualitative analysis of free-text responses complemented quantitative data. Results: In line with previous results from English-speaking countries, both standardized discrete skill tests and contextualized assessments were used by the respondents but fewer used language sample analysis and dynamic assessment procedures, despite international recommendations. There were few differences based on experience, work setting, proportion of multilingual assessments and socio-economic status of the health catchment area. Main challenges reported were lack of time and difficulty prioritizing, and assessment and/or diagnosis of multilingual/L2 children, which is similar to challenges faced by SLPs in other countries. Swedish SLPs also reported lack of national clinical guidelines as a main challenge. Factors contributing to better assessments included experience, and the combination of many sources of information, including professional and interprofessional discussions. Conclusions: The accumulated evidence from this and previous studies show that to address challenges and build on strengths, changes on a systemic level are needed. This includes more time and resources for continuing education and implementation of recommended assessment methods, as well as professional and interprofessional collaborations.

The confidence and competence of speech language pathologists in augmentative and alternative communication: a scoping review

Augmentative and alternative communication (AAC) is a core component of speech pathology practice. However, international literature has highlighted that speech language pathologists (SLPs) may not feel confident or competent in this area. Confidence and competence are critical factors in therapy as they can impact the quality-of-service provision. The purpose of this scoping review was to investigate the confidence/competence of SLPs in AAC. A systematic scoping search was conducted using four databases to identify relevant literature. The first two authors reviewed 30% of abstracts and the remaining 70% were reviewed by the first author. Full-text screening applied the same review approach. Data was then extracted and organized according to the research questions. Thirteen studies were included in the review. All thirteen used self-assessment to measure confidence or competence with one study also using an objective evaluation. Overall, confidence and competence levels varied based on the specific clinical task and etiology of the client in addition to being influenced by prior training, clinician age, workplace and AAC caseload. While current research provides a snapshot of the SLP workforce, it is limited in that the research predominantly uses self-assessment measures, is cross-sectional and is quantitative in nature. Further research into the confidence and competence of SLPs in AAC is required, specifically how confidence and competence can be defined and developed.

Structured observation and informant report assessments in intellectual disability: Reflections of qualified and student speech-language pathologists

PURPOSE

The purpose of this study was to explore the perspectives of qualified and student speech-language pathologists (SLPs) on the clinical utility of informant report and observation tools following a 1-day workshop using a decision tree.

METHOD

Each participant group (qualified [n = 4] or student SLP [n = 8]) attended a 1-day workshop where they engaged with informant report and structured observation tools using video case studies. Each workshop concluded in a focus group conducted by an independent researcher. NVivo 12 software supported inductive coding and subsequent thematic analysis of transcribed data.

RESULT

Thematic analysis revealed that participants' perceptions of tools' clinical utility could be conceptualised as three themes (a) tool characteristics, (b) external clinical work demands, and (c) clinician preparedness.

CONCLUSION

Participants' views on the utility of informant report and structured observation were influenced by tensions between their desires, the realities of clinical practice, and their own capabilities. This has implications for workforce development in the field in providing clinician guidance, training, and support.

Clinical Practice in Childhood Dysarthria: An Online Survey of German-Speaking Speech-Language Pathologists

PURPOSE

This survey study aimed to establish current clinical practices of German-speaking speech-language pathologists (SLPs) regarding their assessment and treatment of communication disorders in children with neurological conditions, with a particular focus on the management of childhood dysarthria.

METHOD

A 23-question cross-sectional online survey was disseminated to practicing SLPs in Germany, Austria, and Switzerland via relevant professional bodies. SLPs were invited to provide information on their current assessment and treatment practices. Demographic data including case load and clinical settings were also gathered to contextualize practices.

RESULTS

One hundred two SLPs responded to the survey, of which 68 valid responses were analyzed. German-speaking SLPs comprehensively assess and treat various aspects of overall communication, language, and swallowing functions in children with neurological conditions. Speech motor aspects did not represent a main intervention focus. In cases where the dysarthric component was targeted, specific approaches for childhood dysarthria were rarely used. Instead, SLPs reported using approaches developed for speech disorders other than dysarthria.

CONCLUSIONS

German-speaking SLPs working with children with neurological conditions use various assessment and treatment methods to support children's communication. However, dysarthria-specific approaches were not an established part of clinical practice. Results of the survey highlight the need for access to relevant developments in German and for evaluation of current curricula for speech-language pathology students and continuing education opportunities for practicing clinicians.

Assessment Scales in Cerebral Palsy: A Comprehensive Review of Tools and Applications

Cerebral palsy (CP) is a complex neurological condition characterized by motor dysfunction affecting millions worldwide. This comprehensive review delves into the critical role of assessment in managing CP. Beginning with exploring its definition and background, we elucidate the diverse objectives of CP assessment, ranging from diagnosis and goal setting to research and epidemiology. We examine standard assessment scales and tools, discuss the challenges inherent in CP assessment, and highlight emerging trends, including integrating technology, personalized medicine, and neuroimaging. The applications of CP assessment in clinical diagnosis, treatment planning, research, and education are underscored. Recommendations for the future encompass standardization, interdisciplinary collaboration, research priorities, and professional training. In conclusion, we emphasize the importance of assessment as a compass guiding the care of individuals with CP, issuing a call to action for improved assessment practices to shape a brighter future for those affected by this condition.

Standardized Measures Used Regularly by Speech-Language Pathologists when Assessing the Language Abilities of School-Aged Children: A Survey

INTRODUCTION

This study examined speech-language pathologist (SLP)'s use of standardized language measures when assessing school-aged children.

METHOD

A total of 335 SLPs provided information in a web-based survey regarding the standardized language measures they use for school-aged children. SLPs were asked to identify the domains targeted, purposes of use, and reasons for which regularly used standardized measures were chosen for use.

RESULTS

Findings indicated that SLPs collectively use many standardized measures, although only a small number are used regularly. SLPs reported using standardized measures to assess domains that measures are not ideally designed for and for purposes that the measures are not ideally suited to assessing. SLPs reported selecting diagnostic measures based on psychometric properties but not for screening measures. Reasons for choice varied depending on the particular measure.

CONCLUSION

Overall, findings indicated that SLPs need to place greater focus on evidence-based practice recommendations when selecting standardized measures for use with school-aged children. Implications for clinical practice and future directions are discussed.

Functional impact of augmentative and alternative communication scale: development of an outcome measure for educators of students with complex communication needs

PURPOSE

The study aim was to develop and assess the measurement properties of the Functional Impact of Augmentative and Alternative Communication - Educator (FIAAC-E) scale - an educator-reported measure designed to detect change in factors associated with communicative participation in students who use augmentative and alternative communication (AAC).

METHODS

The study had three phases. In phase 1 (content validity), 22 content specialists independently rated the relevancy of 22 dimensions proposed for the new scale. In phase 2 (item generation, face validity), 8 educators independently completed a preliminary version of the FIAAC-E scale and flagged items that were unclear. Next, these educators adjusted the wording of unclear items during consensus-building sessions. In phase 3 (item reduction, reliability, convergent validity), 62 educators completed an online survey that included the revised FIAAC-E scale. Survey data were used to shorten the scale, estimate its reliability, and evaluate support for its convergent validity.

RESULTS

In phase 1, the 11 dimensions ranked most highly by content specialists were selected for inclusion in the preliminary scale. In phase 2, educators reviewed 113 items and revised 33 to improve clarity. In phase 3, correlational statistics informed the selection of 77 items for the shortened scale. Subsequent data analyses indicated acceptable levels of internal consistency and test-retest reliability and support for convergent validity of the preliminary measure.

CONCLUSION

The study provides emerging evidence that supports the FIAAC-E scale as a reliable way to evaluate communicative participation in children and youth who use AAC systems at school.Implications for rehabilitationUsing a reliable means to measure the effectiveness of AAC for children and youth at school may reveal important factors that influence successful communicative, academic, and social participation in school.The FIAAC-E scale is a promising educator-reported questionnaire to inform the development of communication goals and monitor progress towards meeting these goals for students with complex communication needs.

PROMPT to improve speech motor abilities in children with cerebral palsy: a wait-list control group trial protocol

BACKGROUND

Children with cerebral palsy (CP) often have communication impairments, including speech altered intelligibility. Multiple levels of disrupted speech have been reported in CP, which negatively impact on participation and quality of life, with increase of care needs. Augmentative Alternative Communication (AAC) is an option, with debated benefits and limitations, in particular for its functional use. This is supported by a substantial lack of defined evidences in favor of direct speech articulation intervention in CP. Motor learning-based interventions are effective in CP and are the basis of speech motor interventions such as PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets). The PROMPT speech motor treatment provides tactile-kinesthetic inputs to facilitate articulatory movements by dynamic modelling, resulting in more efficient motor patterns that can be integrated into speech and communication. In CP, exploratory evidences support the feasibility and preliminarily advantages on intelligibility of motor speech treatments, such as PROMPT, with increased speech motor control, also documented by kinematic analyses.

METHODS

A randomized waitlist-control trial will be conducted in children aged between 3- and 10-years having CP and dysarthria (estimated sample size = 60 children). Children will be allocated in the immediate intervention or in the waitlist control group. The intervention consists of an intensive 3 weeks period of twice-a-day administration of PROMPT. Standard care will be administered in the control (waitlist) group. After repeated baseline assessments (T0), the PROMPT treated group will undergo the experimental 3-week intervention period, with T1 assessment at the end. A further T2 assessment will be provided at medium term (3 months after the end of the intervention) for evaluating the stability of intervention. Primary and secondary speech clinical and kinematics outcome measures will be collected at T0, T1 and T2.

DISCUSSION

This paper describes the study protocol consisting of a RCT with two main objectives: (1) to evaluate the or short-term benefits of an intensive speech motor intervention on speech and intelligibility in children with CP and the stability of the intervention at medium term; (2) to describe the kinematic correlates of speech motor control modifications.

TRIAL REGISTRATION

Trial registration date 06/12/2019; ClinicalTrials.gov Identifier: NCT04189159 .

Clinical utilisation of the Infant Monitor of vocal Production (IMP) for early identification of communication impairment in young infants at-risk of cerebral palsy: a prospective cohort study

AIM

To report prospective longitudinal data of early vocaliszations of infants identified "at-risk" of cerebral palsy (CP) for early identification of communication impairment.

METHOD

This case-control longitudinal prospective cohort study reports on the assessment of 36 infants, 18 identified as at-risk of CP at the time of enrolment and 18 typically developing (TD) children, at three time points: 6 months, 9 months and 12 months of age, Data were obtained through criterion and norm referenced assessments of vocaliszation behaviors.

RESULTS

Early vocal behaviors of infants identified as at-risk of CP did not differ from their age matched peers at 6 months of age, however, significant group differences emerged at 9 and 12 months when pre-canonical and canonical babble typically emerge. Generalized linear mixed models analysis showed that the rate of development of early language ability and more complex speech-related vocal behaviors was slower for infants at risk of CP when compared to TD infants, with over 75% of infants with CP showing below normal vocal production and impaired language by 12 months of age.

INTERPRETATION

Our data suggest characteristics of infant vocalizations associated with pre-canonical and canonical babbling provide a strong evidence base for predicting communication outcomes in infants at risk of CP.

Valoración de la Calidad de la Práctica Fonoaudiológica en Atención Primaria de Salud

El estudio de la calidad representa un tema relevante para usuarios, gestores y profesionales del sistema de salud. La incorporación de fonoaudiólogos a la Atención Primaria de Salud (APS) hace necesario indagar los parámetros que configuran una práctica de calidad desde la perspectiva de la provisión de servicios. El objetivo de este trabajo es validar el contenido de una matriz de calidad de la práctica fonoaudiológica en APS a través del juicio de expertos. Se calculó razón de validez de contenido (CVR), coeficiente de concordancia (W) de Kendal e índice de validez de contenido (CVI). La matriz contempló tres dimensiones: estructura, proceso y resultados. El 84% de los reactivos generados presentó una CVR positiva. Las dimensiones proceso y resultado presentaron un W de Kendal estadísticamente significativo (p<0,05). El CVI total de la prueba fue 0,55. La matriz creada explora dominios de contenido vinculados a la calidad de los servicios de fonoaudiología en APS. El estudio y gestión de la calidad representa una oportunidad para mejorar la práctica fonoaudiológica en APS.

Validation of the pediatric Radboud Dysarthria Assessment

PURPOSE

The Radboud Dysarthria Assessment (RDA) was published in 2014. Adaptation into a pediatric version (p-RDA) was required because of relevant differences between children and adults. The purpose of this study was to assess the feasibility of the p-RDA and to test intra-rater and inter-rater reliability as well as the validity of the two severity scales (function and activity level).

METHODS

Video recordings were made of 35 participants with (suspected) dysarthria (age 4 to 17 years) while being assessed using the p-RDA. Intra-rater reliability was assessed by one, and inter-rater reliability by two experiments using the Intraclass Correlation Coefficient (ICC). Validity of the severity scales was tested by correlating the consensus scores with the independently rated scores on four communication scales, three mobility scales, and one self-care scale using Spearman correlation coefficients (rs).

RESULTS

The assessment was applicable for 89% of the tested sample, with good intra-rater and inter-rater reliability (ICC = 0.88-0.98 and 0.83-0.93). The p-RDA severity scales (function and activity level) correlated from substantially to strongly with the communication scales (rs = 0.69-0.82 and 0.77-0.92) and self-care scale (rs = 0.76-0.71) and correlated substantially with the mobility scales (rs = 0.49-0.60).

CONCLUSION

The feasibility, reliability and validity of the p-RDA are sufficient for clinical use.

Evaluation of an intensive voice treatment to reduce anterior drooling in children with cerebral palsy: Protocol for a concurrent multiple-baseline, single case experimental design study

Anterior drooling is common in children with cerebral palsy (CP) and poses significant risks to the child's health. Causes of drooling include oro-motor dysfunction, inefficient swallowing and reduced sensation in the orofacial musculature. Behavioural interventions are frequently recommended to reduce drooling; however, this is in the absence of high-quality research evidence. This paper describes a protocol for evaluating the effectiveness of the Lee Silverman Voice Treatment LOUD (LSVT LOUD®) in reducing drooling; and optimising speech and swallowing in a group of children with CP. A structured and systematic visual analysis supplemented with statistical analyses will be used to analyse the data. The risk of bias in n-of-1 trials (RoBiNT) Scale [1] guided the design and implementation of the study.

Consensus on Terminology for Describing Child Language Interventions: A Delphi Study

Purpose Language intervention for children with language disorder may be effective; however, lack of detailed and consistent terminology for describing language interventions poses barriers for advancement within the field. This study aimed to develop consensus from speech-language pathologists (SLPs) in Australia on a taxonomy with terminology for describing language interventions for school-aged children and investigate SLPs' application of taxonomy terminology when describing child language interventions. Method A taxonomy with terms for describing interventions was developed with reference to contemporary literature and presented to clinicians and researchers with expertise in child language disorders in a three-round Delphi study. We asked Delphi participants to indicate agreement with the taxonomy or propose changes. Application of the taxonomy was investigated by asking participants to use taxonomy terminology to describe interventions presented in two case studies. Results The taxonomy consists of five aspects across which interventions may be described: modality/domain, purpose, delivery, form, and teaching techniques. Consensus on the taxonomy was established in both Round 1 (55 participants) and Round 2 (43 participants), with 100% of SLPs strongly agreeing or agreeing with the overall structure of the taxonomy and at least 87.3% of SLPs strongly agreeing or agreeing with each aspect. In Round 3 (32 participants), consensus was reached on 45/54 taxonomy categories (4/12 of the components) for Case Study 1 and 45/54 taxonomy categories (7/12 of the components) for Case Study 2. Conclusions Consensus on a taxonomy with terminology for describing language interventions represents a significant advancement in the field of child language intervention. Future actions may be needed to facilitate consistent application of taxonomy terms. Supplemental Material https://doi.org/10.23641/asha.16435290.

What Influences Speech-Language Pathologists' Use of Different Types of Language Assessments for Elementary School-Age Children?

Purpose This study reports on data from a survey of speech-language pathologists' (SLPs) language assessment practices for elementary school-age children. The objective was to investigate the regularity with which SLPs use different types of assessments (described across data types, task types, environmental contexts, and dynamic features). This study also investigated factors that influence assessment practice, the main sources from which SLPs obtain information on language assessment and the main challenges reported by SLPs in relation to language assessment. Method A web-based survey was used to collect information from 407 Australian SLPs regarding the types of assessments they use. Factors that influenced the regularity with which different types of assessments were used were investigated using regression analysis. Results Most SLPs regularly used assessments that are norm-referenced, decontextualized, and conducted in a clinical context and less regularly used other types of assessments. Service agency, Australian state, and SLPs' years of experience were found to influence the regularity with which some types of assessments were used. Informal discussions with colleagues were the most frequently identified source of information on assessment practice. Main challenges related to limited time, lack of assessment materials, and lack of confidence in assessing children from culturally and linguistically diverse backgrounds. Conclusions SLPs could improve current language assessment practice for elementary school-age children through more regular use of some types of assessments. Actions to facilitate evidence-based assessment practice should consider the contextual differences that exist between service agencies and states and address challenges that SLPs experience in relation to language assessment. Supplemental Material https://doi.org/10.23641/asha.14378948.

Factors associated with spoken language comprehension in children with cerebral palsy: a systematic review

AIM

To identify factors that are relevant for spoken language comprehension in children with cerebral palsy (CP), following the International Classification of Functioning, Disability and Health - Children and Youth (ICF-CY) framework.

METHOD

A systematic literature search was conducted using the electronic literature databases PubMed, Embase, PsycInfo, and Cochrane Library, from January 1967 to December 2019. Included studies involved children with CP, results regarding spoken language comprehension, and analysis of at least one associated factor. Factors were classified within ICF-CY domains.

RESULTS

Twenty-one studies met inclusion criteria. Factors in the ICF-CY domains of body functions and structure were most frequently reported. White brain matter abnormalities, motor type, functional mobility, and intellectual functioning appear to be relevant factors in spoken language comprehension in CP. Factors in the domain of activities and participation, as well as contextual factors, have rarely been studied in the context of spoken language comprehension in CP.

INTERPRETATION

Most factors known to be important for spoken language comprehension in typically developing children and/or known to be susceptible to change by interventions are understudied in CP.

Application of vocal organ correction combined with language training in the rehabilitation of children with cerebral palsy and language disorder

BACKGROUND

To explore the effect of vocal organ correction combined with language training on the rehabilitation of children with cerebral palsy (CP) and language disorder.

METHODS

A total of 98 children with CP and language disorder were divided into two groups (49 cases in each group) using a random number table: the control group and the test group. The control group was given language training alone, while the test group received vocal organ correction combined with language training. The changes in language function classification, efficacy, and family satisfaction before and after the treatments were compared.

RESULTS

A significant difference was identified in language function classification between the two groups before and after treatment (P<0.05). The language function classification of the two groups was also significantly different after treatment (P<0.05), as was the distribution of clinical efficacy between the two groups (P<0.05). The total effective rate for the test group was 91.84%, which was higher than the 73.47% for the control group (P<0.05). Family satisfaction between the two groups differed significantly (P<0.05), and the total satisfaction rate of families in the test group was 87.76%, which was higher than the 69.39% in the control group (P<0.05).

CONCLUSIONS

Vocal organ correction combined with language training can improve the language function of children with CP and language disorder, has ideal efficacy, and can also enhance family satisfaction during rehabilitation.

Effects of an intensive voice treatment on articulatory function and speech intelligibility in children with motor speech disorders: A phase one study

Producing speech that is clear, audible, and intelligible to others is a challenge for many children with cerebral palsy (CP) and children with Down syndrome (DS). Previous studies have demonstrated the effectiveness of using the Lee Silverman Voice Treatment (LSVT LOUD®) to increase vocal loudness and improve speech intelligibility in individuals with dysarthria secondary to Parkinson's disease (PD), and some research suggests that it also may be effective for individuals with dysarthria secondary to other conditions, including CP and DS. Although LSVT LOUD targets healthy vocal loudness, there is some evidence of spreading effects to the articulatory system. Acoustic data from two groups of children with secondary motor speech disorders [one with CP (n = 17) and one with DS (n = 9)] who received a full dose of LSVT LOUD and for whom post-treatment intelligibility gains have been previously reported, were analyzed for treatment effects on: 1) vowel duration, 2) acoustic vowel space and 3) the ratio of F2/i/ to F2/u/. Statistically significant changes in vowel duration and acoustic vowel space occurred pre-treatment to 12 weeks post-treatment in the CP group, and increased acoustic vowel space was observed in 5 of the DS participants. The present study provides preliminary evidence of intensive voice treatment spreading effects to the articulatory system in some children with CP and children with DS consistent with previous findings in other populations.

Accessible digital assessments of temporal, spatial, or movement concepts for profoundly motor impaired and non-verbal individuals: a pilot study

PURPOSE

Here we present a study of two new Assistive Technology (AT) accessible digital assessments which were developed to address the current paucity of (English) spoken language comprehension assessments accessible to individuals who are both non-verbal and have profound motor impairments. Such individuals may rely heavily upon AT for communication and control. However, many assessments require that responses are given either verbally, by physical pointing or manipulating physical objects. A further problem with many assessments is their reliance upon static images to represent language components involving temporal, spatial or movement concepts. These new assessments aim to address some of these issues.

MATERIALS AND METHODS

The assessments were used with 2 young people who are non-verbal and have profound motor impairments (GMFCS level IV/V) and who use eye gaze as their primary method of communication and access. One assessment uses static images and the other short video clips to represent concepts containing temporal, spatial or movement elements. The assessments were carried out with each participant, both before and after an intervention, as part of a larger study.

RESULTS

The assessments were accessible using AT (eye gaze) for both participants, although assessment scores varied. The design of the assessments particularly suited one participant who scored near maximum, but they appeared less suitable for the other participant.

CONCLUSIONS

Making assessments AT accessible removes a barrier to assessing aspects of the spoken language comprehension abilities of some. Video may be a better medium for representing certain concepts within assessments compared with static images.IMPLICATIONS FOR REHABILITATIONThe new assessments provided a deeper understanding of two members of a group who are traditionally difficult to assess, using two alternative physically accessible methods of assessing the spoken language comprehension of the target group;Accessible assessments are important for assessing complex individuals in order to identify knowledge limitations and set therapy (and education) goals;The alternative access features of communication software can provide a "wrapper" for providing accessibility features to assessments;Video clips may be a better means of representing certain concepts in assessments compared to their static equivalents;Ensuring that assessments are physically accessible is sufficient for the assessment of some individuals, but for some "cognitive" accessibility also needs to be considered.

Views of children with cerebral palsy and their parents on the effectiveness and acceptability of intensive speech therapy

Purpose: To understand children and parents' views of the effectiveness and acceptability of intensive dysarthria therapy.Materials and Methods: Twenty-two children with cerebral palsy and dysarthria joined a pilot RCT comparing intensive therapy and usual care. Children (n = 11) allocated to dysarthria therapy comprising three 40-minute sessions per week for six weeks and their parents (n = 11) were interviewed two weeks before and six weeks after therapy. Interviews were transcribed verbatim and analysed thematically.Results: Analysis revealed five themes: Motivations, My new voice; The new me; I can do more; Success rooted in therapy design. Children had received little therapy for speech and were keen to improve intelligibility. Overall, therapy was viewed as effective. Participants described changes in children's speech production, which they associated with increased speech intelligibility. Children were described as more confident following the therapy, to have more successful conversations, with a wider range of partners in more environments, thereby increasing their social participation. The programme was viewed as acceptable, despite its intensity, due to the short term commitment and wider benefits for the child. Parents valued the organised structure and individualisation of the programme and inclusion in the therapy process.Conclusion: Families found the intervention acceptable and effective. A definitive trial of its clinical effectiveness is warranted.Implications for rehabilitationChildren with cerebral palsy who have dysarthria and their parents reported that intensive speech therapy focussing on creating a stronger voice and a steady speech rate increased the clarity of children's voice and the intelligibility of their speech.Therapy may have additional benefits for children's self-confidence and social participation.The programme of therapy comprising three sessions per week for six weeks was seen as manageable by families in view of the results achieved.

Feasibility of parent communication training with remote coaching using smartphone apps

BACKGROUND

Communication training for parents of young children with neurodisability is often delivered in groups and includes video coaching. Group teaching is problematic when there is wide variation in the characteristics and needs amongst participants.

AIMS

To assess the potential feasibility and acceptability of delivering one-to-one parent training supported by remote coaching using smartphone apps and of conducting further trials of the intervention.

METHODS & PROCEDURES

We aimed to recruit eight children aged 12-48 months with motor disorders and communication difficulties and to provide families with individual parent training in six weekly home visits supplemented by remote coaching via smartphone apps. For outcome measurement, parents recorded their interaction with their child thrice weekly during baseline (3 weeks), intervention, post-intervention (3 weeks) and follow-up (1 week). Measures comprised parent responsiveness and counts of children's communication and vocalization. Research design feasibility was measured through rates of recruitment, attrition, outcome measure completion and agreement between raters on outcome measurement. Intervention feasibility was assessed through the proportion of therapy sessions received, the number of videos and text messages shared using the apps in remote coaching, and message content. Parents were interviewed about the acceptability of the intervention and trial design. Interviews were transcribed and analyzed using inductive thematic analysis.

OUTCOMES & RESULTS

Nine children were recruited over 16 weeks. All fitted the inclusion criteria. Four families withdrew from the study. Five families completed the intervention. No family submitted the target number of video recordings for outcome measurement. Interrater agreement was moderate for child communication (K = 0.46) and vocalization (K = 0.60) and high for The Responsive Augmentative and Alternative Communication Style scale (RAACS) (r_s = 0.96). Parents who completed the intervention reported positive experiences of the programme and remote coaching via the apps. Therapist messages via the app contained comments on parent and child behaviour and requests for parental reflection/action; parental messages contained reflections on children's communication.

CONCLUSIONS & IMPLICATIONS

The intervention and study design demanded high levels of parental involvement and was not suitable for all families. Recording shorter periods of interaction via mobile phones or using alternative methods of data collection may increase feasibility of outcome measurement.

Internet delivery of intensive speech and language therapy for children with cerebral palsy: a pilot randomised controlled trial

OBJECTIVES

To test the feasibility of recruitment, retention, outcome measures and internet delivery of dysarthria therapy for young people with cerebral palsy in a randomised controlled trial.

DESIGN

Mixed methods. Single blind pilot randomised controlled trial, with control offered Skype therapy at end of study. Qualitative study of the acceptability of therapy delivery via Skype.

SETTING

Nine speech and language therapy departments in northern England recruited participants to the study. Skype therapy was provided in a university setting.

PARTICIPANTS

Twenty-two children (14 M, 8 F) with dysarthria and cerebral palsy (mean age 8.8 years (SD 3.2)) agreed to take part. Participants were randomised to dysarthria therapy via Skype (n=11) or treatment as usual (n=11).

INTERVENTIONS

Children received either usual speech therapy from their local therapist for 6 weeks or dysarthria therapy via Skype from a research therapist. Usual therapy sessions varied in frequency, duration and content. Skype dysarthria therapy focused on breath control and phonation to produce clear speech at a steady rate, and comprised three 40 min sessions per week for 6 weeks.

PRIMARY AND SECONDARY OUTCOME MEASURES

Feasibility and acceptability of the trial design, intervention and outcome measures.

RESULTS

Departments recruited two to three participants. All participants agreed to random allocation. None withdrew from the study. Recordings of children's speech were made at all time points and rated by listeners. Families allocated to Skype dysarthria therapy judged internet delivery of the therapy to be acceptable. All families reported that the study design was acceptable. Treatment integrity checks suggested that the phrases practised in one therapy exercise should be reduced in length.

CONCLUSIONS

A delayed treatment design, in which dysarthria therapy is offered at the end of the study to families allocated to treatment as usual, is acceptable. A randomised controlled trial of internet delivered dysarthria therapy is feasible.

Measuring and Training Speech-Language Pathologists' Orofacial Cueing: A Pilot Demonstration

Tactile-kinesthetic-proprioceptive (TKP) input used to facilitate speech motor control is considered an active ingredient within speech motor interventions. Objective metrics identifying skill level differences across speech-language pathologists (S-LP) providing TKP cues are crucial for monitoring treatment delivery fidelity. The study examined three kinematic measures indicating accuracy and consistency of TKP inputs by 3 S-LPs with varying experience levels (S-LP 1: novice; S-LP 2 and S-LP 3: advanced). Confidence interval measures were used to compare the accuracy of jaw movement amplitudes of the vowel /a/ made by a model participant versus S-LPs giving the TKP input. Generalised Orthogonal Procrustes Analysis (GPA) and cyclic Spatial Temporal Index (cSTI) were used to determine movement consistency. Results revealed passive jaw excursions induced by S-LP 2 and 3 to be not statistically significant from the model participant's active jaw movements. cSTI values decreased with advanced level of experience (19.28, 12.14, and 9.33 for S-LP 1, S-LP 2, and S-LP 3, respectively). GPA analyses revealed a similar pattern for S-LPs with more experience demonstrating lower mean RMS values (0.22, 0.03, and 0.11 for S-LP 1, S-LP 2, and S-LP 3, respectively). Findings suggest kinematic measures adapted from the motor control literature can be applied to assess S-LP skill differences in providing TKP cues.

Parent-mediated communication interventions for improving the communication skills of preschool children with non-progressive motor disorders

BACKGROUND

Children with motor disorders can have difficulties in producing accurate and consistent movements for speech, gesture or facial expression (or a combination of these), making their communication difficult to understand. Parents may be offered training to help recognise and interpret their child's signals and to stimulate their children's development of new communication skills.

OBJECTIVES

To assess the effectiveness of parent-mediated communication interventions, compared to no intervention, treatment as usual or clinician-mediated interventions, for improving the communication skills of preschool children up to five years of age who have non-progressive motor disorders.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, 12 other databases and three trials registers in July 2017. We also searched the reference lists of relevant papers and reviews, and contacted experts working in the field to find unpublished studies.

SELECTION CRITERIA

We included studies that used randomised or quasi-randomised designs; compared a parent-mediated communication intervention with no treatment, treatment as usual or clinician-mediated therapy; and included children with non-progressive motor disorders up to five years of age.

DATA COLLECTION AND ANALYSIS

We used the standard methodological procedures expected by Cochrane.

MAIN RESULTS

This review included two randomised controlled trials involving 38 children (20 boys, 18 girls), aged 15 to 96 months, and their mothers. All children had developmental disabilities; 10 had motor disorders, but it was unclear if these motor disorders affected their gestural, vocal or verbal communication. Mothers attended eight group training sessions over 11 to 12 weeks and received two or three home visits. Outcomes were assessed immediately after training. We found no report of longer-term follow-up. One study took place at an intervention centre in Canada and the other in South Korea.Both studies recruited small numbers of participants from single centres. Since it is not possible to blind participants attending or therapists providing training to group allocation, we considered both studies to be at high risk of performance bias. We also rated one study at high risk of attrition bias, and both studies at low risk of reporting bias.There was very low-quality evidence for all outcomes assessed. There was no evidence of an effect of training for children's initiation of conversation or engagement in joint attention during interaction with their mothers. Mothers who received training became more responsive to their children's communication, but there were no differences in the extent to which they controlled conversation by directing their children. Missing data meant that we were unable to evaluate the effects of training on children's frequency of communication, frequency of spoken language in conversation, speech production, or receptive or expressive language development. There were no effects on maternal stress. We found no reports of the effects of parent training on children's use of individual communication skills, such as asking questions or providing information, on their generic participation or adverse outcomes. Neither did we find reports of mothers' satisfaction with treatment, its acceptability or their compliance with it.

AUTHORS' CONCLUSIONS

There is only limited, very low quality evidence that parent-mediated communication interventions may be associated with improvements in interaction between mothers and their preschool children who have motor disorders. The indirectness of the study samples and high risk of bias in the included the studies significantly limits our confidence in the evidence, as do issues with study design and lack of detail in results. It is not clear if training has been tested with children whose motor disorders limit the consistency and accuracy of movements underpinning spoken or gestural communication. Some speech and language therapists currently provide communication training for parents. Further research, with larger numbers of children whose movement disorders affect their speech and gestures, coupled with detailed reporting of children's baseline skills, is needed to test whether communication training for parents can help them to promote the communication development of their young children with movement disorders.

Speech therapy for children with dysarthria acquired before three years of age

BACKGROUND

Children with motor impairments often have the motor speech disorder dysarthria, a condition which effects the tone, strength and co-ordination of any or all of the muscles used for speech. Resulting speech difficulties can range from mild, with slightly slurred articulation and breathy voice, to profound, with an inability to produce any recognisable words. Children with dysarthria are often prescribed communication aids to supplement their natural forms of communication. However, there is variation in practice regarding the provision of therapy focusing on voice and speech production. Descriptive studies have suggested that therapy may improve speech, but its effectiveness has not been evaluated.

OBJECTIVES

To assess whether any speech and language therapy intervention aimed at improving the speech of children with dysarthria is more effective in increasing children's speech intelligibility or communicative participation than no intervention at all , and to compare the efficacy of individual types of speech language therapy in improving the speech intelligibility or communicative participation of children with dysarthria.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015 , Issue 7 ), MEDLINE, EMBASE, CINAHL , LLBA, ERIC, PsychInfo, Web of Science, Scopus, UK National Research Register and Dissertation Abstracts up to July 2015, handsearched relevant journals published between 1980 and July 2015, and searched proceedings of relevant conferences between 1996 to 2015. We placed no restrictions on the language or setting of the studies. A previous version of this review considered studies published up to April 2009. In this update we searched for studies published from April 2009 to July 2015.

SELECTION CRITERIA

We considered randomised controlled trials and studies using quasi-experimental designs in which children were allocated to groups using non-random methods.

DATA COLLECTION AND ANALYSIS

One author (LP) conducted searches of all databases, journals and conference reports. All searches included a reliability check in which a second review author independently checked a random sample comprising 15% of all identified reports. We planned that two review authors would independently assess the quality and extract data from eligible studies.

MAIN RESULTS

No randomised controlled trials or group studies were identified.

AUTHORS' CONCLUSIONS

This review found no evidence from randomised trials of the effectiveness of speech and language therapy interventions to improve the speech of children with early acquired dysarthria. Rigorous, fully powered randomised controlled trials are needed to investigate if the positive changes in children's speech observed in phase I and phase II studies are generalisable to the population of children with early acquired dysarthria served by speech and language therapy services. Research should examine change in children's speech production and intelligibility. It must also investigate children's participation in social and educational activities, and their quality of life, as well as the cost and acceptability of interventions.

A systematic review of evidence-based assessment practices by allied health practitioners for children with cerebral palsy

AIM

The routine use of psychometrically robust assessment tools is integral to best practice. This systematic review aims to determine the extent to which evidence-based assessment tools were used by allied health practitioners for children with cerebral palsy (CP).

METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocols 2015 was employed. A search strategy applied the free text terms: 'allied health practitioner', 'assessment', and 'cerebral palsy', and related subject headings to seven databases. Included articles reported assessment practices of occupational therapists, physiotherapists, or speech pathologists working with children with CP aged 0 to 18 years, published from the year 2000.

RESULTS

Fourteen articles met the inclusion criteria. Eighty-eight assessment tools were reported, of which 23 were in high use. Of these, three tools focused on gross motor function and had acceptable validity for use with children with CP: Gross Motor Function Measure, Gross Motor Function Classification System, and goniometry. Validated tools to assess other activity components, participation, quality of life, and pain were used infrequently or not at all.

INTERPRETATION

Allied health practitioners used only a few of the available evidence-based assessment tools. Assessment findings in many areas considered important by children and families were rarely documented using validated assessment tools.