Communication intervention in Rett syndrome: a survey of speech language pathologists in Swedish health services

Abstract

Purpose: To investigate communication intervention that speech language pathologists (SLPs) provide to people with Rett syndrome. Methods: A web-based survey targeting all Swedish SLPs working with people currently receiving support from habilitation services. Results: The SLPs reportedly followed recommended practice in the following aspects: (1) Information on communicative function was collected from several sources, including observation in well-known settings and reports from the client s social network, (2) Multimodal communication was promoted and, (3) Responsive partner strategies were largely targeted in the intervention. However, few instruments or standard procedures were used and partner instruction was given informally. Most SLPs used communication aids in the intervention and their general impression of using communication aids was positive. Further, augmentative and alternative communication (AAC) was estimated to increase and clarify communicative contributions from the person. Conclusions: Communication aids were reported to have a positive influence on communicative functions. Swedish SLP services followed best practice in several aspects, but there are areas with potential for development. Tools and best practice guidelines are needed to support SLPs in the AAC process for clients with Rett syndrome.

• Implications for Rehabilitation

• Communication aids were reported to increase and clarify communicative contributions from people with Rett syndrome.

• Systematic procedures and instruments for assessment, evaluation and partner instruction were used to a small extent.

• A limited range of communicative functions were targeted in the interventions.

• There is a need for developing best practice guidelines to support SLPs in the AAC process for this population should be clients with Rett syndrome.

     

Impact of aided AAC interventions on speech comprehension of children with neurodevelopmental disabilities: A critically appraised topic

Abstract

A critically appraised topic (CAT) is one form of rapid review that can be particularly useful for informing practice. The purpose of this CAT was twofold: to determine (a) the impact of aided augmentative and alternative communication interventions on speech and graphic symbol comprehension in children, aged birth-18 years with neurodevelopmental disabilities and (b) whether there are any potential learner characteristics that serve as moderators or mediators regarding intervention outcomes. In addition to the methodology, the authors present and discuss the findings of this CAT. The authors propose an update to this CAT in January 2022.     

Performing mathematics activities with non-standard units of measurement using robots controlled via speech-generating devices: three case studies

Purpose To examine how using a Lego robot controlled via a speech-generating device (SGD) can contribute to how students with physical and communication impairments perform hands-on and communicative mathematics measurement activities. This study was a follow-up to a previous study. Method Three students with cerebral palsy used the robot to measure objects using non-standard units, such as straws, and then compared and ordered the objects using the resulting measurement. Their performance was assessed, and the manipulation and communication events were observed. Teachers and education assistants were interviewed regarding robot use. Results Similar benefits to the previous study were found in this study. Gaps in student procedural knowledge were identified such as knowing to place measurement units tip-to-tip, and students’ reporting revealed gaps in conceptual understanding. However, performance improved with repeated practice. Stakeholders identified that some robot tasks took too long or were too difficult to perform. Conclusions Having access to both their SGD and a robot gave the students multiple ways to show their understanding of the measurement concepts. Though they could participate actively in the new mathematics activities, robot use is most appropriate in short tasks requiring reasonable operational skill.

• Implications for Rehabilitation

• Lego robots controlled via speech-generating devices (SGDs) can help students to engage in the mathematics pedagogy of performing hands-on activities while communicating about concepts.

• Students can “show what they know” using the Lego robots, and report and reflect on concepts using the SGD.

• Level 1 and Level 2 mathematics measurement activities have been adapted to be accomplished by the Lego robot. Other activities can likely be accomplished with similar robot adaptations (e.g., gripper, pen).

• It is not recommended to use the robot to measure items that are long, or perform measurements that require high operational competence in order to be successful.

     

Combined aphasia and apraxia of speech treatment (CAAST): Systematic replications in the development of a novel treatment

Purpose: The purpose of this investigation was to examine the effects of a modified version of a newly developed therapy for aphasia and acquired apraxia of speech (AOS), Combined Aphasia and Apraxia of Speech Treatment (CAAST).

Method: Four speakers with chronic AOS and aphasia received CAAST in the context of multiple baseline designs. Dependent variables included language measures (i.e. production of correct information units (CIUs)) and speech production measures (i.e. speech intelligibility and percent correct consonants (PCC) in sentence repetition).

Result: Three of the participants demonstrated improved CIU production with treated picture sets and two also demonstrated generalization to untreated sets. All participants achieved substantially increased CIU production in an untrained discourse context. Speech intelligibility increased for three of the participants and increases in PCC were observed for all of the participants at two weeks post-treatment. However, PCC improvements were maintained for only two of the speakers at six weeks post-treatment.

Conclusion: The revised CAAST protocol was associated with improved changes in speech and generalization across contexts in comparison to the previous iteration of CAAST. However, focus on sentence production in generalization practice may have been detrimental to CIU production for one participant.     

Access to hands-on mathematics measurement activities using robots controlled via speech generating devices: three case studies

Abstract

Purpose: To examine how using a robot controlled via a speech generating device (SGD) influences the ways students with physical and communication limitations can demonstrate their knowledge in math measurement activities. Method: Three children with severe physical disabilities and complex communication needs used the robot and SGD system to perform four math measurement lessons in comparing, sorting and ordering objects. The performance of the participants was measured and the process of using the system was described in terms of manipulation and communication events. Stakeholder opinions were solicited regarding robot use. Results: Robot use revealed some gaps in the procedural knowledge of the participants. Access to both the robot and SGD was shown to provide several benefits. Stakeholders thought the intervention was important and feasible for a classroom environment. Conclusions: The participants were able to participate actively in the hands-on and communicative measurement activities and thus meet the demands of current math instruction methods.

• Implications for Rehabilitation

• Current mathematics pedagogy encourages doing hands-on activities while communicating about concepts.

• Adapted Lego robots enabled children with severe physical disabilities to perform hands-on length measurement activities.

• Controlling the robots from speech generating devices (SGD) enabled the children, who also had complex communication needs, to reflect and report on results during the activities.

• By using the robots combined with SGDs, children both exhibited their knowledge of and experienced the concepts of mathematical measurements.

     

Lexical stress in childhood apraxia of speech: acoustic and kinematic findings

Abstract

Purpose: This study investigated the acoustic and articulatory movement parameters underlying lexical stress production in children with apraxia of speech (CAS), children with articulation/phonological delay (i.e. speech delay, SD), and children with typical speech-language development (TD). We examined whether there were group differences in these instrumental measures of stress production.

Method: Participants were 24 children (seven CAS, eight SD, nine TD) between three and seven years of age. Acoustic and kinematic measures, including acoustic duration, peak and average fundamental frequency, and jaw movement duration and displacement, were taken from perceptually accurate productions of a strong-weak form. Relative stress analyses were conducted using the Pairwise Variability Index (PVI).

Result: There was a significant difference between the CAS and TD groups in the PVI for movement duration, with the CAS group showing a smaller movement duration contrast between stressed and unstressed syllables. There were no significant group differences for displacement or any of the acoustic variables.

Conclusion: The kinematic findings suggest reduced temporal control for lexical stress production in children with CAS. This finding surfaced during analyses of perceptually accurate productions but suggests a possible basis for lexical stress errors in CAS that could be explored in future studies.     

Effects of speech and print feedback on spelling performance of a child with cerebral palsy using a speech generating device

Purpose. The aim of the study was to investigate the effectiveness of three feedback conditions, using a speech-generating device, on spelling performance of Tom, an 11-year-old boy with cerebral palsy and complex communication needs.

Method. Tom was taught to spell 12 words under three feedback conditions. In the SPEECH condition, he received only speech feedback from the device and in the PRINT condition he received only the orthographic feedback on the display of the device. In the SPEECH – PRINT condition, Tom received both speech output and orthographic feedback. An adapted alternating treatment design was used to investigate the effects of the three-feedback conditions. To strengthen the reliability and increase the internal validity of the findings, an intrasubject direct replication was carried out using the same procedure, but teaching 12 different spelling words to Tom.

Results. Tom reached criterion with the PRINT feedback condition first, followed by SPEECH and SPEECH – PRINT conditions simultaneously for the first 12 words, and the same order for the second set of 12 words.

Conclusions. Overall, the PRINT condition was most efficient for Tom. The results are discussed in terms of evidence for learning style preferences within spelling instruction for a child with complex communication needs. Furthermore, the implications for targeting intervention to optimise spelling achievement amongst this group are considered.     

Clinical management of childhood apraxia of speech: A survey of speech-language pathologists in Australia and New Zealand

Abstract

Purpose: A number of studies have been published that have investigated the practices of speech-language pathologists in relation to speech sound disorder intervention; however, specific research about the treatment of childhood apraxia of speech is not available. This study aimed to describe the treatment approaches being used by speech-language pathologists, explore their perspectives of evidence-based practice and identify perceived barriers to implementing empirical research recommendations.

Method: An online survey was distributed to speech-language pathologists in Australia and New Zealand. In total, 109 valid surveys were completed by participants who answered a series of multiple choice, yes/no, short answer and Likert-scaled questions.

Result: Speech-language pathologists demonstrated a strong preference for eclectic interventions to treat childhood apraxia of speech. When asked to identify the primary treatment approach they used (whether as a stand-alone; or as the primary approach within an eclectic intervention), the most frequently used intervention was the Nuffield Dyspraxia Programme. Many speech-language pathologists reported valuing empirical research evidence, despite identifying a range of barriers that impact their ability to implement evidence-based practice in childhood apraxia of speech treatment.

Conclusion: Although many speech-language pathologists use the Nuffield Dyspraxia Programme as their primary intervention, most clinicians use it as part of an eclectic/hybrid intervention. The effectiveness of eclectic interventions for childhood apraxia of speech has not been empirically evaluated.     

The views of people who use speech generating devices on mentoring new learners

Purpose.?This study explored the perspectives of adults who use a speech generating device (SGD) on the development of a mentoring programme to improve device use. Adults who are competent SGD communicators would mentor new learners. The aims were to investigate the participants' views on peer mentoring to improve SGD use, the critical components of an SGD mentoring programme and the issues that might facilitate the likelihood of a programme's success.

Method.?Semi-structured interviews were conducted with 14 adults who use an SGD. These interviews were analysed for content themes.

Results.?Thematic analysis revealed that participants perceived that new SGD learners would benefit from mentoring by experienced SGD communicators. Participants considered benefits for new learners would include the opportunity to see successful use of an SGD and the opportunity to receive support and guidance from someone who has a shared experience of learning to use an SGD. Participants considered benefits for mentors to include the satisfaction gained from helping new learners. Participants suggested guidelines for establishing a programme and areas in which SGD mentors would require training.

Conclusions.?Participants indicated a need for a mentoring programme to improve SGD use. Such a programme might help address challenges that those new to learning an SGD encounter.     

Alternative service delivery models for families with a new speech generating device: Perspectives of parents and therapists

Abstract

Purpose: Research has revealed limitations in the provision of in-person services to families with a new speech generating device (SGD), both in Australia and overseas. Alternative service models such as parent training, peer support and telepractice may offer a solution, but their use with this population has not been researched to date.

Method: Using interviews and focus groups, this study explored the experiences and opinions of 13 speech-language pathologists and seven parents regarding alternatives to in-person support and training for families with a new SGD. Data were analysed using grounded theory. Themes explored in this paper include the benefits and drawbacks of alternative service models as well as participants’ suggestions for the optimal implementation of these approaches.

Result: Participants confirmed the utility of alternative service models, particularly for rural/remote and underserviced clients. Benefits of these models included reduced travel time for families and therapists, as well as enhanced information access, support and advocacy for parents.

Conclusion: Participants viewed the provision of ongoing professional support to families as critical, regardless of service modality. Additional issues arising from this study include the need for development of organizational policies, resources and training infrastructure to support the implementation of these alternative service models.     

The use of a digital voice output device to facilitate language development in a child with developmental apraxia of speech: a case study

Purpose : The study aimed at describing the language and communication abilities of a child diagnosed with Developmental Apraxia of Speech (DAS), who used a Macaw Digital voice output device.

Method : This case study describes the training of a mother in the use of a Macaw digital voice output device to give her child with DAS access to higher levels of language functioning. It also provides longitudinal information pertaining to the child's school progress in the three years following the implementation of the device.

Results : Results indicate that the use of a digital device is useful in facilitating communication and language development in a young child with DAS. Specific evidence of an increase in the cognitive complexity of questions directed at the child is provided, as well as an increase in the number of questions directed to the child. Regarding the child's responses, it was noted that appropriate answers increased, as did the number of communication modalities and communication attempts. Longitudinal data indicates that the child was able to maintain these positive impacts.

Conclusions : Digital voice output devices can be used as a method to facilitate higher cognitive functioning and has various positive impacts on the functioning of a child with DAS. These devices need to be considered as a tool to facilitate the development of communication and speech development for this population.     

The use of a digital voice output device to facilitate language development in a child with developmental apraxia of speech: a case study

Purpose : The study aimed at describing the language and communication abilities of a child diagnosed with Developmental Apraxia of Speech (DAS), who used a Macaw Digital voice output device. Method : This case study describes the training of a mother in the use of a Macaw digital voice output device to give her child with DAS access to higher levels of language functioning. It also provides longitudinal information pertaining to the child's school progress in the three years following the implementation of the device. Results : Results indicate that the use of a digital device is useful in facilitating communication and language development in a young child with DAS. Specific evidence of an increase in the cognitive complexity of questions directed at the child is provided, as well as an increase in the number of questions directed to the child. Regarding the child's responses, it was noted that appropriate answers increased, as did the number of communication modalities and communication attempts. Longitudinal data indicates that the child was able to maintain these positive impacts. Conclusions : Digital voice output devices can be used as a method to facilitate higher cognitive functioning and has various positive impacts on the functioning of a child with DAS. These devices need to be considered as a tool to facilitate the development of communication and speech development for this population.     

Accommodative speech and terms of endearment: elements of a language mode often experienced by older adults

AIM: To discuss the use of patronizing patterns of speech and modified forms of address in conversations between nurses and other health workers, and older people. RATIONALE: The impetus for this paper was the publication of the National Service Framework for Older People, which draws attention to the prevalence of age discrimination and the need to provide individualized care. APPROACH: The literature between 1990 and 2001 was reviewed in a systematic way. Certain key, older texts were also identified. Twenty-four publications were found, which examine the ways in which nurses and other health workers modify their speech when conversing with older people, discuss what older people think about this practice, or otherwise contribute to this issue. RESULTS: The paper uses speech accommodation theory to explain how the language addressed to older people is sometimes modified. The practice of over-accommodation is also described. This happens when older people are addressed in a simplified vocabulary with a high-pitched tone of voice and slow speech. The extent of over-accommodation is discussed, and its impact on older people is considered in terms of fostered dependence and lowered self-esteem. CONCLUSION: The findings of the review in the context of current policy related to older people and implications for nursing education are discussed.     

Technology-assisted language intervention for children who are deaf or hard-of-hearing; a pilot study of augmentative and alternative communication for enhancing language development

Purpose: Pilot study to assess the effect of augmentative and alternative communication technology to enhance language development in children who are deaf or hard-of-hearing.

Materials and methods: Five children ages 5–10 years with permanent bilateral hearing loss who were identified with language underperformance participated in an individualized 24-week structured program using the application TouchChat WordPower on iPads^®. Language samples were analyzed for changes in mean length of utterance, vocabulary words and mean turn length. Repeated measures models assessed change over time.

Results: The baseline median mean length of utterance was 2.41 (range 1.09–6.63; mean 2.88) and significantly increased over time (p?=?0.002) to a median of 3.68 at final visit (range 1.97–6.81; mean 3.62). At baseline, the median total number of words spoken per language sample was 251 (range 101–458), with 100 (range 36–100) different words spoken. Total words and different words significantly increased over time (β?=?26.8 (7.1), p?=?0.001 for total words; β?=?8.0 (2.7), p?=?0.008 for different words). Mean turn length values also slightly increased over time.

Conclusions: Using augmentative and alternative communication technology on iPads^® shows promise in supporting rapid language growth among elementary school-age children who are deaf or hard-of-hearing with language underperformance.     

Predictors of unmet needs for communication and mobility assistive devices among youth with a disability: the role of socio-cultural factors

Purpose.?Despite the importance of ensuring access to assistive technology, high rates of underutilization remain. Relatively little is known about the characteristics of young people reporting unmet needs for assistive devices, so our study examined this further.

Method.?Data were analyzed using the 2006 Participation and Activity Limitation Survey. Youth aged 15–24 were selected to explore the characteristics associated with those currently using or reporting unmet needs for communication or mobility devices (n?=?15,817).

Results.?Family structure and language spoken influenced the likelihood of using a communication device for two age subgroups. Meanwhile, language spoken influenced the likelihood of reporting unmet needs for communication assistive devices. The following factors influenced the likelihood of using a mobility device: age, gender, language spoken, income, family structure, and severity of impairment. Gender, geographic location, language spoken, family structure, duration and severity of impairment and presence of other impairments influenced the likelihood of reporting unmet needs for mobility devices.

Conclusions.?Clinicians need to pay particular attention to the socio-cultural factors of young clients transitioning to adult care.     

Phonological awareness development in children with and without spoken language difficulties: A 12-month longitudinal study of German-speaking pre-school children

Purpose: There is strong empirical evidence that English-speaking children with spoken language difficulties (SLD) often have phonological awareness (PA) deficits. The aim of this study was to explore longitudinally if this is also true of pre-school children speaking German, a language that makes extensive use of derivational morphemes which may impact on the acquisition of different PA levels.

Method: Thirty 4-year-old children with SLD were assessed on 11?PA subtests at three points over a 12-month period and compared with 97 four-year-old typically developing (TD) children.

Result: The TD-group had a mean percentage correct of over 50% for the majority of tasks (including phoneme tasks) and their PA skills developed significantly over time. In contrast, the SLD-group improved their PA performance over time on syllable and rhyme, but not on phoneme level tasks. Group comparisons revealed that children with SLD had weaker PA skills, particularly on phoneme level tasks.

Conclusion: The study contributes a longitudinal perspective on PA development before school entry. In line with their English-speaking peers, German-speaking children with SLD showed poorer PA skills than TD peers, indicating that the relationship between SLD and PA is similar across these two related but different languages.     

The cognitive competence of speakers with acquired dysarthria: Judgements by doctors and speech and language therapists

Background.?Studies have shown that listeners make negative attributions towards people with communication impairments. This appears to be the case for healthcare professionals as well as non-professional listeners.

Aims.?This study extends this line of research to speakers with acquired dysarthria. These clients often complain that listeners treat them differently after the onset of their speech impairment. The study examines judgements of the cognitive status of speakers with acquired dysarthria made by health care professionals.

Methods and procedures.?Doctors, speech and language therapists and speech and language therapy students viewed videos of speakers with acquired dysarthria and of controls matched for age and gender who had acquired neurological deficits that did not affect their speech. Listeners judged whether speakers could carry out a number of everyday tasks. All the tasks were known to be within the speakers' competence.

Outcomes and results.?Doctors were significantly less confident of the competence of speakers with dysarthria than of the controls. No difference was found for speech and language therapists or speech and language therapy students.

Conclusions Although caution is required in generalizing these results to other speakers, the results lend some support to the complaints of clients with acquired dysarthria that their speech leads others, in this case doctors, to misjudge their cognitive competence.     

The cognitive competence of speakers with acquired dysarthria: judgements by doctors and speech and language therapists

Background. Studies have shown that listeners make negative attributions towards people with communication impairments. This appears to be the case for healthcare professionals as well as non-professional listeners.

Aims. This study extends this line of research to speakers with acquired dysarthria. These clients often complain that listeners treat them differently after the onset of their speech impairment. The study examines judgements of the cognitive status of speakers with acquired dysarthria made by health care professionals.

Methods and procedures. Doctors, speech and language therapists and speech and language therapy students viewed videos of speakers with acquired dysarthria and of controls matched for age and gender who had acquired neurological deficits that did not affect their speech. Listeners judged whether speakers could carry out a number of everyday tasks. All the tasks were known to be within the speakers' competence.

Outcomes and results. Doctors were significantly less confident of the competence of speakers with dysarthria than of the controls. No difference was found for speech and language therapists or speech and language therapy students.

Conclusions Although caution is required in generalizing these results to other speakers, the results lend some support to the complaints of clients with acquired dysarthria that their speech leads others, in this case doctors, to misjudge their cognitive competence.