Speech and language therapy for dysarthria due to nonprogressive brain damage: a systematic Cochrane review

Development of the Korea Dysarthria Test Following Stroke

Objective

To develop an objective and quantitative clinical evaluation tool that can be used for diagnosis and severity assessment of dysarthria in patients with stroke.

Methods

A prototype test comprising 23 items was developed to test the function of each speech organ. The scoring of the prototype test was based on the analysis of the result values obtained from 50 healthy individuals. The test was performed for 50 patients with stroke who were suspected to have dysarthria. For evaluating the correlation between each prototype test item and the Urimal Test of Articulation and Phonation (U-TAP), the odds ratio was obtained for each result, based on which the final test items for composing the Korea Dysarthria Test (KDT) were selected. The validity of the test was evaluated using the receiver operator characteristic (ROC) curve and the area under the curve. We used the intraclass correlation coefficients to quantify inter- and intra-rater reliability. The Spearman correlation coefficient was used for examining the correlation between the KDT and the Speech Mechanism Screening Test and U-TAP.

Results

Among the 23 prototype test items, 16 exhibiting significant results were finally selected as the KDT. The higher score of the KDT is reflected the better speaking function. The sensitivity and specificity of the KDT were shown to be high at the cutoff value of 76.50 point.

Conclusion

KDT is a useful evaluation tool for dysarthria, showing a significant correlation with SMST and U-TAP.

Substrates of speech treatment-induced neuroplasticity in adults and children with motor speech disorders: A systematic scoping review of neuroimaging evidence

Purpose: Neuroimaging may provide clinical evidence for speech treatment-induced neuroplasticity. This review aimed to report the current scope of evidence relating to brain changes identified using neuroimaging techniques, following effective speech intervention in adults and children with motor speech disorders (MSD).Method: Studies were retrieved from five electronic databases (PubMed, CINAHL, EMBASE (Medline), SCOPUS, and Web of Science) and a general internet search.Result: Seven studies met the inclusion criteria. Using structural or functional neuroimaging techniques, five studies reported on the effects of the Lee Silverman Voice Treatment for dysarthria in adults and children, one study on the outcome of rhythmic-melodic voice training in adults with apraxia of speech, and one study on the effects of Prompts for Restructuring Oral Muscular Phonetic Targets therapy in children with idiopathic apraxia of speech. Identified brain changes included: enhanced white matter tract integrity; normalisation of baseline cortical activity; right-hemisphere shifts in re-organisation; perilesional activations; and cortical thinning.Conclusion: The current review identified preliminary evidence for treatment-dependent brain changes in adults and children with MSD. Although important to interpret within the context of Phase I research, the identification of therapeutic effects across seven heterogeneous studies suggests that treatment-induced improvements in speech performance are underpinned by demonstrable alterations in brain structure and/or function. Future research is required to better define these mechanisms of neuronal re-organisation in individuals receiving treatment for MSD, including their prognostic potential.

A survey of speech-language pathology treatment for non-progressive dysarthria in Australia

Aim:

To identify management practices of Australian speech-language pathologists (SLPs) in the treatment of non-progressive dysarthria using a subsystem approach, and to explore SLPs’ consideration and implementation of the theoretical underpinnings of non-progressive dysarthria management.

Method:

A 39-item online survey was distributed to Australian SLPs, with 80 responses suitable for data analysis.

Results:

Practices of SLPs were variable for the management of the speech subsystems. The Lee Silverman Voice Treatment (LSVT®) was the most commonly used manualised treatment program, and was employed by 63.77% of respondents. Almost all SLPs (>88%) provided strategies to improve functional communication. There was no clear preference for low tech alternative and augmentative communication (AAC) devices. Speech generating devices were the most commonly employed high tech device. Almost two-thirds of respondents used non-speech oral motor exercises (NSOMEs) in treatment. SLPs had varied frequencies and models of service delivery for intervention. SLPs valued interventions targeting the activity and participation domains of the ICF, however this was restricted by the treatment context and resources available. The majority of SLPs (92.06%) were aware of the principles of motor learning, however many were unsure regarding the specifics of implementation.

Conclusion:

There is a clear need for further research into the efficacy of treatment techniques to guide decision-making.

Interventions for dysarthria due to stroke and other adult-acquired, non-progressive brain injury

BACKGROUND

Dysarthria is an acquired speech disorder following neurological injury that reduces intelligibility of speech due to weak, imprecise, slow and/or unco-ordinated muscle control. The impact of dysarthria goes beyond communication and affects psychosocial functioning. This is an update of a review previously published in 2005. The scope has been broadened to include additional interventions, and the title amended accordingly.

OBJECTIVES

To assess the effects of interventions to improve dysarthric speech following stroke and other non-progressive adult-acquired brain injury such as trauma, infection, tumour and surgery.

SEARCH METHODS

We searched the Cochrane Stroke Group Trials Register (May 2016), CENTRAL (Cochrane Library 2016, Issue 4), MEDLINE, Embase, and CINAHL on 6 May 2016. We also searched Linguistics and Language Behavioral Abstracts (LLBA) (1976 to November 2016) and PsycINFO (1800 to September 2016). To identify further published, unpublished and ongoing trials, we searched major trials registers: WHO ICTRP, the ISRCTN registry, and ClinicalTrials.gov. We also handsearched the reference lists of relevant articles and contacted academic institutions and other researchers regarding other published, unpublished or ongoing trials. We did not impose any language restrictions.

SELECTION CRITERIA

We selected randomised controlled trials (RCTs) comparing dysarthria interventions with 1) no intervention, 2) another intervention for dysarthria (this intervention may differ in methodology, timing of delivery, duration, frequency or theory), or 3) an attention control.

DATA COLLECTION AND ANALYSIS

Three review authors selected trials for inclusion, extracted data, and assessed risk of bias. We attempted to contact study authors for clarification and missing data as required. We calculated standardised mean difference (SMD) and 95% confidence interval (CI), using a random-effects model, and performed sensitivity analyses to assess the influence of methodological quality. We planned to conduct subgroup analyses for underlying clinical conditions.

MAIN RESULTS

We included five small trials that randomised a total of 234 participants. Two studies were assessed as low risk of bias; none of the included studies were adequately powered. Two studies used an attention control and three studies compared to an alternative intervention, which in all cases was one intervention versus usual care intervention. The searches we carried out did not find any trials comparing an intervention with no intervention. The searches did not find any trials of an intervention that compared variations in timing, dose, or intensity of treatment using the same intervention. Four studies included only people with stroke; one included mostly people with stroke, but also those with brain injury. Three studies delivered interventions in the first few months after stroke; two recruited people with chronic dysarthria. Three studies evaluated behavioural interventions, one investigated acupuncture and another transcranial magnetic stimulation. One study included people with dysarthria within a broader trial of people with impaired communication.Our primary analysis of a persisting (three to nine months post-intervention) effect at the activity level of measurement found no evidence in favour of dysarthria intervention compared with any control (SMD 0.18, 95% CI -0.18 to 0.55; 3 trials, 116 participants, GRADE: low quality, I² = 0%). Findings from sensitivity analysis of studies at low risk of bias were similar, with a slightly wider confidence interval and low heterogeneity (SMD 0.21, 95% CI -0.30 to 0.73, I² = 32%; 2 trials, 92 participants, GRADE: low quality). Subgroup analysis results for stroke were similar to the primary analysis because few non-stroke participants had been recruited to trials (SMD 0.16, 95% CI -0.23 to 0.54, I² = 0%; 3 trials, 106 participants, GRADE: low quality).Similar results emerged from most of the secondary analyses. There was no evidence of a persisting effect at the impairment (SMD 0.07, 95% CI -0.91 to 1.06, I² = 70%; 2 trials, 56 participants, GRADE: very low quality) or participation level (SMD -0.11, 95% CI -0.56 to 0.33, I² = 0%; 2 trials, 79 participants, GRADE: low quality) but substantial heterogeneity on the former. Analyses of immediate post-intervention outcomes provided no evidence of any short-term benefit on activity (SMD 0.29, 95% CI -0.07 to 0.66, I² = 0%; 3 trials, 117 participants, GRADE: very low quality); or participation (SMD -0.24, 95% CI -0.94 to 0.45; 1 study, 32 participants) levels of measurement.There was a statistically significant effect favouring intervention at the immediate, impairment level of measurement (SMD 0.47, 95% CI 0.02 to 0.92, P = 0.04, I² = 0%; 4 trials, 99 participants, GRADE: very low quality) but only one of these four trials had a low risk of bias.

AUTHORS' CONCLUSIONS

We found no definitive, adequately powered RCTs of interventions for people with dysarthria. We found limited evidence to suggest there may be an immediate beneficial effect on impairment level measures; more, higher quality research is needed to confirm this finding.Although we evaluated five studies, the benefits and risks of interventions remain unknown and the emerging evidence justifies the need for adequately powered clinical trials into this condition.People with dysarthria after stroke or brain injury should continue to receive rehabilitation according to clinical guidelines.

Tyranny of the randomised clinical trial

Researchers and clinicians often disagree about what it means to provide the best possible care. This paper's purpose is to propose ways of resolving the disagreements. The first is to have both groups re-examine the three equal components of evidence-based practice, a re-examination that begins with rejection of the randomised clinical trial's tyranny. The second is for researchers to design rehabilitation research based on a biopsychosocial rather than a biomedical model. The third is for both groups to redefine translational research so that it means both translation from the laboratory to the clinic and from the clinic to the laboratory. The fourth is to advocate for a science of dissemination that is as robust as rehabilitation's present science of discovery. Most examples are drawn from the literature on acquired neurologic speech and language disorders.

Application of systematic reviews in speech-and-language therapy

BACKGROUND

Systematic reviews are increasingly being carried out in speech-and-language therapy and are used by practitioners, service commissioners, policy-makers and researchers to inform decision-making, as the body of evidence available about speech-and-language therapy grows. Although systematic reviewing is developing to incorporate new methods of review and synthesis, there are currently limitations in the use of some types of systematic reviews within speech-and-language therapy.

AIMS

The purpose of this paper is to provide an overview of the steps involved in the systematic review process and the range of options available. It highlights some challenges to using this process in speech-and-language therapy, with examples based in part on the authors' experiences of involvement in two systematic reviews. A number of developments in systematic review methodology will be outlined and several new approaches to reviewing, both within and outside of speech-and-language therapy, are introduced. These include realist synthesis, evidence-based practice briefs, speech BITE™ and the journal Evidence-Based Communication Assessment and Intervention.

MAIN CONTRIBUTION

This paper highlights some of the current benefits and limitations of systematic reviews in speech-and-language therapy. It will facilitate readers to use and carry out systematic reviews in the speech-and-language therapy field.

CONCLUSIONS

Systematic reviews are useful in speech-and-language therapy, but awareness of their limitations is important to practitioners, commissioners, policy-makers and researchers. New developments may further increase the benefits of systematic reviews.

Translating principles of neural plasticity into research on speech motor control recovery and rehabilitation

PURPOSE

To review the principles of neural plasticity and make recommendations for research on the neural bases for rehabilitation of neurogenic speech disorders.

METHOD

A working group in speech motor control and disorders developed this report, which examines the potential relevance of basic research on the brain mechanisms involved in neural plasticity and discusses possible similarities and differences for application to speech motor control disorders. The possible involvement of neural plasticity in changes in speech production in normalcy, development, aging, and neurological diseases and disorders was considered. This report focuses on the appropriate use of functional and structural neuroimaging and the design of feasibility studies aimed at understanding how brain mechanisms are altered by environmental manipulations such as training and stimulation and how these changes might enhance the future development of rehabilitative methods for persons with speech motor control disorders.

CONCLUSIONS

Increased collaboration with neuroscientists working in clinical research centers addressing human communication disorders might foster research in this area. It is hoped that this article will encourage future research on speech motor control disorders to address the principles of neural plasticity and their application for rehabilitation.

The rehabilitation of patients recovering from brainstem strokes: case studies and clinical considerations

An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke. Two case studies are presented to illustrate some of the difficulties encountered in the rehabilitation of these individuals. Unlike hemispheric stroke, the characteristic consequences of brainstem stroke include ataxia, dysarthria, and diplopia. Additionally, individuals with brainstem stroke may suffer from severe dysphagia and may require enteral feedings. Unlike the rehabilitation of patients with hemispheric stroke, where there is an impressive and relatively comprehensive research literature, there has been surprisingly little research published on the rehabilitation of patients with brainstem stroke despite the fact they represent a significant number of patients admitted to stroke rehabilitation units.

La rééducation orthophonique de la dysarthrie parkinsonienne

INTRODUCTION

Dysarthria is frequent in Parkinson's disease and impairs communication.

STATE OF THE ART

Use of levodopa or surgical procedures does not significantly improve speech. Traditional speech therapy can lead to improvement of dysarthria, and intensive programs have recently showed substantial beneficial effects on parkinsonian dysarthria.

PERSPECTIVES

More work is needed to evaluate speech treatment efficacy.

CONCLUSION

Earlier and more frequent speech therapy in parkinsonian dysarthria patients may contribute to better quality of life.

Speech and language therapy for dysarthria due to non-progressive brain damage

BACKGROUND

Dysarthria is a common sequel of non-progressive brain damage (typically stroke and traumatic brain damage). Impairment-based therapy and a wide variety of compensatory management strategies are undertaken by speech and language therapists with this patient population.

OBJECTIVES

To determine the efficacy of speech and language therapy interventions for adults with dysarthria following non-progressive brain damage.

SEARCH STRATEGY

We searched the trials registers of the following Cochrane Groups: Stroke, Injuries, Movement Disorders and Infectious Diseases. We also searched the trials register of the Cochrane Rehabilitation and Related Therapies Field. The trials registers were last searched in September 2004. The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2004), MEDLINE (1966 to September 2004), EMBASE (1980 to September 2004), CINAHL (1983 to September 2004), PsycINFO (1974 to October 2004), and Linguistics and Language Behavior Abstracts (1983 to December 2004) were searched electronically. We handsearched the International Journal of Language and Communication Disorders (1966 to 2005, Issue 1) and selected conference proceedings, and scanned the reference lists of relevant articles. We approached colleagues and speech and language therapy training institutions to identify other possible published and unpublished studies.

SELECTION CRITERIA

Unconfounded randomised controlled trials (RCTs).

DATA COLLECTION AND ANALYSIS

One author assessed trial quality. Two co-authors were available to examine any potential trials for possible inclusion in the review.

MAIN RESULTS

No trials of the required standard were identified.

AUTHORS' CONCLUSIONS

There is no evidence of the quality required by this review to support or refute the effectiveness of speech and language therapy interventions for dysarthria following non-progressive brain damage. Despite the recent commencement of a RCT of optimised speech and language therapy for communication difficulties after stroke, there continues to be an urgent need for good quality research in this area.

Speech and language therapy for dysarthria due to non-progressive brain damage

BACKGROUND

Dysarthria is a common sequel of non-progressive brain damage (typically stroke and traumatic brain damage). Impairment-based therapy and a wide variety of compensatory management strategies are undertaken by speech and language therapists with this patient population.

OBJECTIVES

To determine the efficacy of speech and language therapy interventions for adults with dysarthria following non-progressive brain damage.

SEARCH STRATEGY

This review has drawn on the search strategies developed for the following Cochrane Groups as a whole: Stroke, Injuries, Movement Disorders and Infectious Diseases. Relevant trials were identified in the Specialised Registers of Controlled Trials (see Review Group details for more information). We also searched the trials register of the Cochrane Rehabilitation and Related Therapies Field. The Trials Registers were last searched in December 2001. The Cochrane Controlled Trials Register (Cochrane Library 2002, Issue 1), MEDLINE (1966-December 2001), EMBASE (1980-December 2001), CINAHL (1983-December 2001), PsycINFO (1974-February 2002) and Linguistics and Language Behavior Abstracts (1983-October 2001) were searched electronically. We handsearched the International Journal of Language and Communication Disorders (1966-2002, Issue 1) and selected conference proceedings, and scanned the reference lists of relevant articles. Colleagues were approached to identify other possible published and unpublished studies.

SELECTION CRITERIA

Unconfounded randomised controlled trials.

DATA COLLECTION AND ANALYSIS

One reviewer assessed trial quality. Two co-reviewers were available to examine any potential trials for possible inclusion in the review.

MAIN RESULTS

No trials of the required standard were identified.

REVIEWER'S CONCLUSIONS

There is no evidence of the quality required by this review to support or refute the effectiveness of Speech and Language Therapy interventions for dysarthria following non-progressive brain damage. There is an urgent need for good quality research in this area.