Peer reviewers for International Journal of Speech-Language Pathology December 2011–September 2012

Abstract

Purpose: This study aimed to explore if dysphonic voice quality affects children's performance on a language comprehension test, the Test for Reception of Grammar-2 (TROG-2), performed in simultaneous background noise (non-semantic babble). A further aim was to investigate the role of Working Memory Capacity (WMC) and Executive Functioning (EF) in coping with the voice against a background of babble conditions.

Method: Ninety-three mainstreamed 8 year old children with typical language development were tested for WMC and EF. Two groups of children (n = 47/46) were formed and presented with recordings of TROG-2 instructions read by one female speaker: one group was presented with recordings with induced dysphonic voice quality, the other with recordings of typical voice. Both groups listened to the voice recordings in competing babble noise at a Signal-to-Noise Ratio of + 10 dB.

Result: Significant differences were found for the interaction between cognitive capacity and the TROG-2 results in relation to the voice conditions. In the dysphonic voice condition, children with better WMC results scored higher at the easier comprehension tasks. In the typical voice condition, children with better WMC and EF results scored higher on the more difficult tasks. Seventeen per cent of the variance for the TROG-2 results was explained by the WMC and EF results. There was no overall effect on the children's performance depending of voice condition.

Conclusion: The effect of the speaker's voice quality on children's performance varies depending on the prevalence of background babble noise and on the task demands. The dysphonic voice and babble noise seem to demand allocation of cognitive capacities at the cost of language comprehension.     

Relationship between social interaction bids and language in late talking children

Abstract

Purpose: The aim of this paper is to explore the relationship between language development and the frequency of social interaction (SI) behaviours during language acquisition in late-talking (LT) children who exhibit delays in expressive vocabulary development but have age-appropriate cognitive skills.

Method: The research consists of a longitudinal study with a first test followed by two re-tests 5 months apart, in which LT children were compared to 5-months-younger typically-developing (TD) children.

Result: Data showed that LT children performed significantly fewer initiation of SI behaviours, but no differences between groups in responding to SI behaviours were observed. Furthermore, LT children who have lower language comprehension scores initiate social interaction more frequently.

Conclusion: The results showed that LT children seem to be less active in starting social interaction and participation, but, once they get involved, they respond similarly to TD children of comparable expressive language competence. Additionally, the correlation pattern between the frequency of SI behaviours and language functions showed that LT toddlers with more prominent receptive language delay are more interested in initiating interaction with their partner, thus suggesting that they need a partner's “scaffolding” to overcome this lack.     

The effect of voice disorders on lexical tone variation: Exploratory study in an African language

Abstract

Purpose: The aim was to determine if the presence of a voice disorder in speakers of Setswana, an African tone language, will negatively impact the accuracy of identification by typical first language judges of words belonging to tonal minimal pairs.

Method: A quasi-experimental between-group comparison and individual case studies were conducted. Five participants with different types and degrees of voice disorders and nine control participants produced 10 tonal minimal word pairs. Five judges had to identify which of a pair was produced.

Result: The mean scores of the control and experimental speakers as groups differed, but the difference was not statistically significant. Control participants scored between 19.6/20 and 14.2/20 words correctly identified. Individual data revealed that four of the nine control participants attained at least one perfect score across judges and six had mean scores of 18.0/20 and higher. The highest scoring experimental participant, presenting with a mild voice disorder, attained a mean of 18.0/20. The lowest scoring participant, presenting with the most severe dysphonia, had a mean of 12.2/20 words correctly identified.

Conclusion: These preliminary results appear to suggest that a severe voice disorder could compromise lexical tone variation and by implication the intelligibility of a message.     

“Dream On:” Awaking the Dream

Abstract

When there is a death in the family, adults, desirous of shielding the children from grief, frequently exclude them from participation in related activities and are reluctant to share with children important family experiences and feelings. Children, on the other hand, even very young ones, have a genuine interest in knowing what death is and have the emotional stamina to survive loss and grief—provided the loved adults are attentive to the children's queries and responsive to their feelings.

Incidents from the author's experiences and from literature illustrate the nature of a child's comprehension and humanity when encountering death of a sibling, a parent, a great-grandmother. Children have the strength also to live through the greatest loss of all—the death of young parents.

Adults should recognize the young child's need for protection against grief and fear of death at the time when it is expressed, but they must be truthful about facts and not use euphemisms such as “going to sleep,” which may lead to serious confusions.

Being truthful in sharing feelings of sorrow with children helps build a trusting relationship between children and adults and enables both to endure “the saddest day of my life.”     

Voice problems in the fitness industry: Factors associated with chronic hoarseness

Abstract

Purpose: To determine factors associated with chronic hoarseness in Australian group fitness instructors (GFIs).

Method: A total of 361 GFIs (81 males, 280 females), aged between 18–67 years currently active in the Australian fitness industry, completed a 65-item self-completion questionnaire distributed via SurveyMonkey. Demographic, lifestyle and voice use variables thought to influence vocal health and voice production in the GFI population were examined using logistic regression analyses. GFIs’ chronic hoarseness with response options “positive” and “negative” was considered as the outcome variable of interest.

Result: Approximately 39% of the study participants reported having chronic hoarseness. Multivariable logistic regression modelling revealed a set of statistically significant factors associated with chronic hoarseness. These include: younger age, partial voice loss while instructing, partial voice loss after instructing and using vocal volume louder than normal speaking voice whilst instructing.

Conclusion: This study has identified factors associated with the presentation of chronic hoarseness in the Australian GFI population. Prospective studies are required to validate the findings of this study in order to better understand predictive factors of chronic hoarseness among GFIs.     

Comprehension: An overlooked component in augmented language development

Purpose. Despite the importance of children's receptive skills as a foundation for later productive word use, the role of receptive language traditionally has received very limited attention since the focus in linguistic development has centered on language production. For children with significant developmental disabilities and communication impairments, augmented language systems have been devised as a tool both for language input and output. The role of both speech and symbol comprehension skills is emphasized in this paper.

Method. Data collected from two longitudinal studies of children and youth with severe disabilities and limited speech serve as illustrations in this paper. The acquisition and use of the System for Augmenting Language (SAL) was studied in home and school settings. Communication behaviors of the children and youth and their communication partners were observed and language assessment measures were collected.

Results. Two patterns of symbol learning and achievement – beginning and advanced – were observed. Extant speech comprehension skills brought to the augmented language learning task impacted the participants' patterns of symbol learning and use.

Conclusions. Though often overlooked, the importance of speech and symbol comprehension skills were underscored in the studies described. Future areas for research are identified.     

Cognitive predictors of sentence comprehension in children with and without developmental language disorder: Implications for assessment and treatment

Abstract

Purpose: This paper summarises the clinical ramification of a large-scale study of the direct and indirect (mediated) influences of four cognitive mechanisms that are relevant to the comprehension of syntactic structure by school-age children with and without developmental language disorder (DLD).

Method: A total of 117 children with DLD and 117 propensity-matched typically-developing (TD) children completed sentence comprehension tasks and cognitive tasks related to fluid reasoning, controlled attention, speed of processing, phonological short-term memory (pSTM), complex working memory (cWM) and language knowledge in long-term memory (LTM).

Result: Results of confirmatory factor analysis (CFA) indicated that the most salient characteristics of cognitive processing in children with and without DLD were represented by a measurement model that included four latent variables: fluid reasoning, controlled attention, complex WM and language knowledge in LTM. Structural equation modelling (SEM) indicated that complex WM mediated the relationship between sentence comprehension and fluid reasoning, controlled attention and long-term memory for language knowledge.

Conclusion: Our research suggests that the most salient characteristics of cognitive processing in children with and without DLD can be condensed to four cognitive factors: fluid reasoning, controlled attention, complex WM and language knowledge in LTM. We suggest a few measures that clinicians can use to reliably assess these factors, and we summarise a functional intervention programme that is designed to promote the strategic organisation of information in ways that challenge verbal complex WM and LTM processes that support language comprehension and use.     

Strategies that facilitate participation in family activities of children and adolescents with profound intellectual and multiple disabilities: parents’ and personal assistants’ experiences

Abstract

Purpose: Participation throughout one’s life plays a significant role for development and emotional well-being. For this reason, there is a need to identify ways to facilitate participation in family activities for children and adolescents with profound intellectual and multiple disabilities (PIMD). Methods: The study design was qualitative and explorative, based on semi structured interviews with 11 parents and 9 personal assistants of children with PIMD. Results: The interviews revealed participation-facilitating strategies relating to the children’s/adolescent’s proximal environment, such as “Availability and acceptability of the activity”, “Good knowledge about the child” and a “A positive attitude of people close to the child”, as well as strategies related to the children/adolescents themselves: “Sense of belonging”, “Possible for the child/adolescent to understand”, “Opportunities to influence” and “Feeling of being needed”. Conclusions: Children and adolescents with PIMD are dependent on support obtained through their environment. The identified strategies, individually adapted through awareness and knowledge by the parents and the personal assistants, provide important evidence to assist our understanding in gaining understanding about how to improve participation in family activities of children and adolescents with PIMD.

• Implications for Rehabilitation

• Participation-facilitating strategies related to the child/adolescent and his or her proximal environments are identified to improve participation in children and adolescents with profound intellectual and multiple disabilities (PIMD).

• Examples of strategies for the child’s/adolescents’ proximal environment include “good knowledge about the child/adolescent”, and, for the child/adolescent, include creating “sense of belonging” and “opportunities to influence”.

• Identifying and making these strategies explicit may assist in enhancing the participation of children and adolescents with PIMD in family activities.

• People in the child’s/adolescent’s proximal environment need to set the scene for participation.

     

A systematic review of resonant voice therapy

Purpose: The purpose of this study is to systematically review the literature on resonant voice therapy and to evaluate the level of evidence on the effectiveness of using resonant voice therapy in treating dysphonia.

Method: Refereed journal papers from 1974 to 2014 were retrieved and reviewed by two independent reviewers using the keywords “Humming, Resonance, Resonant Voice, Semi-occluded or closed tube phonation” using available database systems. Quality of evidence was evaluated by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Result: Thirteen papers met the search criteria. Nine papers were selected by the two reviewers. Two of the papers were randomised-controlled studies and the other seven were observational studies. At least four types of resonant voice therapies were described. They included the Lessac-Madsen Resonant Voice Therapy, Y-Buzz, Resonance Therapy and Humming. The overall level of quality of evidence was graded as “moderate”.

Conclusion: There were limited studies that investigated the effectiveness of resonant voice therapy. Most studies were small-scale uncontrolled observational studies with the inclusion of only small samples or specific populations. There is clearly a need for more large-scale randomised controlled studies with a wider range of populations to provide further evidence on the effectiveness of resonant voice training for different populations.     

Simplified bipartite concepts of functioning and disability recommended for interdisciplinary use of the ICF

Abstract

Purpose: To argue for and propose bipartite concepts of functioning and disability, to tally with the structure of the ICF classification list, concepts of social models and clinical needs. Method: The ICF concepts are discussed in relation to the history of ideas regarding disability concepts and the needs for such concepts in interdisciplinary rehabilitation. Results: Bipartite concepts are presented; they refer to actual functioning, simply body functions/structures and participation, including functioning in standardized environments. Participation refers to actually performed “activities”, with “activities” simply denoting things that people may do. Bipartite concepts are congruent with the ICF classification and the structure of social models of disability, suitable for clinical and interdisciplinary use and easy to understand. The issue of standardized environments represents a methodological issue rather than the conceptual issue of defining functioning and disability. An individual perspective on activity and activity limitations, i.e. the middle part of the tripartite ICF concept, is somewhat similar to concepts of traditional language that were regarded as too generalizing already in 1912, when the interactional concept of “disability in a social sense” was introduced in rehabilitation practices. Conclusion: Bipartite concepts of functioning and disability are recommended for interdisciplinary use of the ICF.

• Implications for Rehabilitation

• The ICF classification is useful, but the ICF concept of activities in an individual perspective is confusing.

• We suggest a use of the term “activities” simply to denote things that people may do and “participation” to denote actually performed activities.

• Estimations of ability should be explicit about how they are related to environmental factors.

     

Associations between self-perceived voice disorders in teachers,perceptual assessment by speech-language pathologists,and instrumental analysis

Purpose: The three aims of this study were to assess agreement between self-perceived voice disorders, perceptual and instrumental assessment; to determine factors associated with perceptual voice assessment; and to determine which associated factors would serve as an initial screening tool for ascertainment of the presence or absence of voice disorders among teachers.

Method: A cross-sectional study was conducted among 574 Colombian teachers. Participants filled in a questionnaire and recorded a voice sample. The voice samples were perceptually evaluated by a speech-language pathologist with the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale and objectively with an automated voice analysis for fundamental frequency, jitter, shimmer and maximum phonation time. Agreements between GRBAS scale, self-reported voice disorders and instrumental analysis were determined by unweighted Coheńs Kappa coefficients and receiver operating characteristic curves. Multivariate logistic regression analysis was used to identify variables associated with the perceptual assessment. Diagnostic performance of these variables was assessed by the area under the curve.

Result: There was no agreement between self-reported voice disorders and GRBAS assessments. Maximum phonation time showed a slight agreement with perceptual assessment of voice disorders.

Conclusion: Since these three methods offer different information, it is advisable to include all methods in ascertainment of voice disorders among teachers at work.     

Native voice,self-concept and the moral case for personalized voice technology

Purpose (1) To explore the role of native voice and effects of voice loss on self-concept and identity, and survey the state of assistive voice technology; (2) to establish the moral case for developing personalized voice technology. Methods This narrative review examines published literature on the human significance of voice, the impact of voice loss on self-concept and identity, and the strengths and limitations of current voice technology. Based on the impact of voice loss on self and identity, and voice technology limitations, the moral case for personalized voice technology is developed. Results Given the richness of information conveyed by voice, loss of voice constrains expression of the self, but the full impact is poorly understood. Augmentative and alternative communication (AAC) devices facilitate communication but, despite advances in this field, voice output cannot yet express the unique nuances of individual voice. The ethical principles of autonomy, beneficence and equality of opportunity establish the moral responsibility to invest in accessible, cost-effective, personalized voice technology. Conclusions Although further research is needed to elucidate the full effects of voice loss on self-concept, identity and social functioning, current understanding of the profoundly negative impact of voice loss establishes the moral case for developing personalized voice technology.

• Implications for Rehabilitation

• Rehabilitation of voice-disordered patients should facilitate self-expression, interpersonal connectedness and social/occupational participation.

• Proactive questioning about the psychological and social experiences of patients with voice loss is a valuable entry point for rehabilitation planning.

• Personalized voice technology would enhance sense of self, communicative participation and autonomy and promote shared healthcare decision-making.

• Further research is needed to identify the best strategies to preserve and strengthen identity and sense of self.

     

Oral literal and inferential narrative comprehension in young typically developing children and children with developmental language disorder

Abstract

Purpose: The Squirrel Story Narrative Comprehension Assessment (NCA) was used to investigate the literal and inferential comprehension skills of young typically developing (TD) children aged between 4 and 6 years and to compare the performance of 5-year-old TD children and those with developmental language disorder (DLD).

Method: A total of 132 typically developing children across three age groups between 4 to 6 years (4;0–4;11, 5;0–5;11, 6;0–6;11, years;months), and 94 children with DLD aged 5 years, were assessed using the NCA.

Result: There was a significant increase in both literal and inferential scores for TD children from 4 to 6 years. The TD children aged 4;0 to 4;11 scored significantly lower than the two older age groups for both literal and inferential comprehension, while there was no significant difference between the 5;0 to 5;11 and 6;0 to 6;11 TD groups. The 5;0 to 5;11 TD group scored significantly higher than the age-matched DLD group for literal and inferential comprehension.

Conclusion: The findings indicate that the Squirrel Story NCA is a clinically useful task which is sensitive to developmental improvement in literal and inferential comprehension in young typically developing children and confirm previous research findings of poor narrative comprehension in children with DLD.     

Psychiatric Symptoms and Psychosocial Problems in Primary Health Care as Seen by Doctors

Abstract

Objectives. Parents of sick children frequently visit their general practitioners (GPs). The aim was to explore parents' interpretation of their child's incipient signs and symptoms when falling ill and their subsequent unsatisfactory experience with the GP in order to make suggestions for improvements in the medical encounter. Design. Semi-structured interviews. Setting and subjects. Twenty strategically selected families with a child from a birth cohort in Frederiksborg County, Denmark were interviewed. Results. Parents wanted to consult their GP at the right time, i.e. neither too early nor too late. Well-educated parents experienced a discrepancy between their knowledge about their child, the information they had sought about the illness and the consultation with the GP, when they were dismissed with phrases such as “it will disappear” or “it is just a virus”. The parents went along with the GP's advice if the child only occasionally became sick. However, parents of children with recurrent illnesses seemed very frustrated. During the course of several consultations with their GP, they started to question the GP's competence as the child did not regain health. Conclusions. Parents want to be acknowledged as competent collaborators. The GP's failure to acknowledge the parents' knowledge of their child's current illness, and the parents' attempt to identify what is wrong with the child and make the child feel better before the encounter may have consequences for the GP's credibility. It is therefore recommended that parents of children with recurrent illnesses receive extra attention and information.     

Social participation of children age 8–12 with SLI

Purpose: Two objectives are being pursued: (1) to describe the level of social participation of children aged 8–12 presenting a specific language impairment (SLI) and (2) to identify personal and family factors associated with their level of social participation. Method: This cross-sectional study was conducted among 29 children with SLI and one of their parents. Parental stress and family adversity were measured as risk factors. The measure of life habits (LIFE-H) adapted to children aged 5-3 was used to measure social participation. Results: The assumption that social participation of these children is impaired in relation to the communication dimension was generally confirmed. The statements referring to the “communication in the community” and “written communication” are those for which the results are weaker. “Communication at home” is made easier albeit with some difficulties, while “telecommunication” is totally preserved. A high level of parental stress is also confirmed, affecting the willingness of parents to support their child’s autonomy. Conclusions: The achievement of a normal lifestyle of children with SLI is upset in many spheres of life. Methods of intervention must better reflect the needs and realities experienced by these children in their various living environments, in order to optimize social participation, and consequently, to improve their well-being and that of their families. The need to develop strategies to develop children's independence and to reduce parental stress must be recognized and all stakeholders need to be engaged in the resolution of this challenge.

• Implications for Rehabilitation

• The realization of life habits of SLI children is compromised at various levels, especially in the domain related to “communication in the community” and “written communication”.

• Speech-language pathologists must consider providing ongoing support throughout the primary years of these children and during adolescence, to promote and facilitate the continued realization of life habits of SLI persons.

• Providing ongoing support throughout the primary years and thereafter is needed to facilitate the continuing realization of life habits of SLI persons.

• Parents of children with SLI experience considerable stress in relation to the exercise of their parental roles.

• It is important to intervene and to support parents to promote autonomy for their SLI children.

     

Coding of meaningful concepts in lymphedema-specific questionnaires with the ICF

Abstract

Purpose: To identify and quantify the meaningful concepts within questionnaires focusing on lymphedema using the International Classification of Functioning, Disability and Health (ICF). Methods: Electronic searches of Medline, EMBASE, CINAHL, CENtral and Pedro (2005–2010) were conducted. The concepts in the questionnaires were retrieved from the included studies and linked to the ICF. Results: Of the 2381 abstracts retrieved, 136 studies were included. The study population suffered from lymphedema in the upper limb (65%), in the lower limb (25%), in the midline (3%) and in combinations of these areas (7%). In total, 12 lymphedema-specific questionnaires were found (nine for the upper limb, two for the lower limb and one for lymphedema in general). A total of 301 concepts were extracted from the questionnaires, of which 271 (90%) could be linked to the ICF. There were 45 two-level ICF categories linked to concepts in ≥2 questionnaires; 13 in Body Functions, 6 in Body Structures, 16 in Activities and Participation and 10 in Environmental Factors. The most frequently measured categories were “Structure of upper extremity”, “Immunological system functions”, “Looking after one’s health”, “Sensation of pain”, “Touch functions”, “Dressing” and “Health services, systems and policies”. Conclusion: The ICF provides a valuable reference to identify concepts in questionnaires focusing on individuals with lymphedema.

• Implications for Rehabilitation

• Lymphedema is a chronic condition and the problems in physical functioning related to lymphedema can result in distress and loss of quality of life.

• ICF Core Sets for lymphedema consist of a lymphedema-specific selection of ICF categories, which makes it easier to implement the use of the ICF in medical and allied health care.

• ICF Core Sets for lymphedema can act as a framework for more unity in questionnaires concerning consequences of lymphedema.

• Part of the development process of ICF Core Sets for lymphedema is the linking of items from lymphedema-specific clinical questionnaires to ICF codes. The ICF codes most frequently used to link the items in the reviewed questionnaires were “Structure of upper extremity”, “Immunological system functions”, “Looking after one’s health”, “Sensation of pain”, “Touch functions”, “Dressing” and “Health services, systems and policies”.

     

Waiting for speech-language pathology services: A randomised controlled trial comparing therapy,advice and device

Abstract

Purpose: To compare children’s speech, language and early literacy outcomes, and caregivers' empowerment and satisfaction following provision of 12 sessions of direct intervention (therapy), or face-to-face advice or a purpose-built website (device) while waiting for therapy.

Method: A four-stage randomised controlled trial was undertaken involving three- to six-year-old children referred to speech-language pathology waiting lists at two Australian community health centres over eight months (n?=?222). Stage 1 (screening): 149 were eligible to participate. Stage 2 (pre-assessment): 117 were assessed. Stage 3 (intervention): 110 were randomised to advice (33), device (39) or therapy (38). Stage 4 (post-assessment): 101 were re-assessed by a speech-language pathologist blinded to the intervention condition.

Result: After controlling for baseline levels, children’s speech (percentage of consonants correct) was significantly higher in the therapy group compared to the advice and device conditions. Caregivers' satisfaction was also significantly higher in the therapy condition compared to the device condition. There were no significant differences between the three conditions for children’s intelligibility, language and early literacy or caregivers' empowerment.

Conclusion: Therapy resulted in significantly higher speech outcomes than the advice and device conditions and was associated with significantly greater caregiver satisfaction. Provision of a website containing evidence-based material or a single session of advice may be a viable alternative while children wait for therapy targeting intelligibility, language and early literacy, and to empower caregivers.