Effectiveness of computerised rehabilitation for long-term aphasia: a case series study.
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Seven participants with long-standing aphasia following cerebrovascular accident were serially recruited to a case series study where language therapy was delivered at home and monitored via the Internet. All participants improved in word finding, and four improved in general communication. (+info)
Relationship between rehabilitation therapies and outcome of stroke patients in Israel: a preliminary study.
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BACKGROUND: The relationship between the amount of rehabilitation therapy and functional outcome in stroke patients has not been established. OBJECTIVES: To evaluate the effectiveness of inpatient rehabilitation for post-acute stroke, and examine the relationship between intensity of therapies and functional status at discharge. METHODS: We evaluated 50 first-stroke patients, average age 63 years, in a prospective descriptive study. The impairment and Functional Independence Measurement were assessed both at admission to rehabilitation and at discharge. Patients were monitored weekly during their stay by means of discipline-specific measures of activity level. Predictor variables included intensity of physical, occupational and speech therapies; demographic characteristics; length of stay; and time since the stroke. RESULTS: A significant reduction in impairment was observed at discharge. The predictors of gains and activity level at discharge as well as motor vs. cognitive components of the FIM were neither consistent nor did they occur in the same trend of functional improvement. Greater FIM motor level at discharge was associated with younger age, higher admission motor and cognitive level, and receipt of any speech therapy, while greater FIM cognitive level was associated with higher cognitive level at admission, shorter interval from onset to admission, and more intense occupational therapy. More intense OT was associated with greater and more cognitive improvement during the hospitalization. CONCLUSION: Since the sample was relatively small and heterogenous in terms of the patients' functional abilities, the findings cannot be generalized to the whole population of stroke patients. Further efforts to identify the best timing, modalities, intensity and frequency of the various treatments are needed to improve the cost-benefit equation of rehabilitation in stroke patients. (+info)
Facilitating speech in the patient with a tracheostomy.
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A tracheostomy tube decreases the ability of the patient to communicate effectively. The ability to speak provides an important improvement in the quality of life for a patient with a tracheostomy. In mechanically ventilated patients, speech can be provided by the use of a talking tracheostomy tube, using a cuff-down technique with a speaking valve, and using a cuff-down technique without a speaking valve. Speech can be facilitated in patients with a tracheostomy tube who are breathing spontaneously by use of a talking tracheostomy tube, by using a cuff-down technique with finger occlusion of the proximal tracheostomy tube, and with the use of a cuff-down technique with a speaking valve. Teamwork between the patient and the patient care team (respiratory therapist, speech-language pathologist, nurse, and physician) can result in effective restoration of speech in many patients with a long-term tracheostomy. (+info)
Improved naming after TMS treatments in a chronic, global aphasia patient--case report.
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We report improved ability to name pictures at 2 and 8 months after repetitive transcranial magnetic stimulation (rTMS) treatments to the pars triangularis portion of right Broca's homologue in a 57 year-old woman with severe nonfluent/global aphasia (6.5 years post left basal ganglia bleed, subcortical lesion). TMS was applied at 1 Hz, 20 minutes a day, 10 days, over a two-week period. She received no speech therapy during the study. One year after her TMS treatments, she entered speech therapy with continued improvement. TMS may have modulated activity in the remaining left and right hemisphere neural network for naming. (+info)
Randomised controlled trial of the Lidcombe programme of early stuttering intervention.
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OBJECTIVES: To evaluate the efficacy of the Lidcombe programme of early stuttering intervention by comparison to a control group. DESIGN: A pragmatic, open plan, parallel group, randomised controlled trial with blinded outcome assessment. SETTING: Two public speech clinics in New Zealand. PARTICIPANTS: Stuttering preschool children who presented to the speech clinics for treatment. Inclusion criteria were age 3-6 years and frequency of stuttering of at least 2% syllables stuttered. Exclusion criteria were onset of stuttering during the six months before recruitment and treatment for stuttering during the previous 12 months. 54 participants were randomised: 29 to the Lidcombe programme arm and 25 to the control arm. 12 of the participants were girls. INTERVENTION: Lidcombe programme of early stuttering intervention. MAIN OUTCOME MEASURES: Frequency of stuttering was measured as the proportion of syllables stuttered, from audiotaped recordings of participants' conversational speech outside the clinic. Parents in both arms of the trial collected speech samples in three different speaking situations before randomisation and at three, six, and nine months after randomisation. RESULTS: Analysis showed a highly significant difference (P = 0.003) at nine months after randomisation. The mean proportion of syllables stuttered at nine months after randomisation was 1.5% (SD 1.4) for the treatment arm and 3.9% (SD 3.5) for the control arm, giving an effect size of 2.3% of syllables stuttered (95% confidence interval 0.8 to 3.9). This effect size was more than double the minimum clinically worthwhile difference specified in the trial protocol. CONCLUSIONS: The results provide evidence from a randomised controlled trial to support early intervention for stuttering. The Lidcombe programme is an efficacious treatment for stuttering in children of preschool age. (+info)
Parent concerns and professional responses: the case of specific language impairment.
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BACKGROUND: GPs and health visitors are usually the first to be approached by parents concerned about their child's speech and language development in the early years. The role health professionals play in early detection of speech and language difficulties is therefore crucial to ensure timely referral for speech and language therapy. AIM: To examine parental accounts of health visitor and GP involvement in the assessment and diagnosis of their children's speech and language impairment. DESIGN OF STUDY: Qualitative retrospective interviews. SETTING: Two Local Education Authorities in Merseyside. METHOD: In-depth interviews were conducted with 40 parents. Interviews were transcribed and thematically analysed. Twenty per cent of interviews were analysed by an independent researcher and consensus reached on thematic content. RESULTS: In many cases, parents were the first to realise that there was something wrong with the speech and language development of their child. Parents reported that health professionals tended to underestimate speech and language problems, and failed to take parental views into account. In some cases, parents found that attending a specialist unit or hospital resulted in the children reaching school age before referral to speech and language therapy was made. In other cases, health professionals appeared to rely on the possibility of spontaneous recovery, and gave inappropriate advice to parents, which resulted in delayed referral to speech and language therapists. CONCLUSIONS: Health professionals failed to use systematic, evidence-based approaches in responding to early parental concerns. For this group of parents, such an approach resulted in long delays in referral for specialist intervention. (+info)
The effects of speech production and vocabulary training on different components of spoken language performance.
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A group of 21 hard-of-hearing and deaf children attending primary school were trained by their teachers on the production of selected consonants and on the meanings of selected words. Speech production, vocabulary knowledge, reading aloud, and speech perception measures were obtained before and after each type of training. The speech production training produced a small but significant improvement in the percentage of consonants correctly produced in words. The vocabulary training improved knowledge of word meanings substantially. Performance on speech perception and reading aloud were significantly improved by both types of training. These results were in accord with the predictions of a mathematical model put forward to describe the relationships between speech perception, speech production, and language measures in children (Paatsch, Blamey, Sarant, Martin, & Bow, 2004). These training data demonstrate that the relationships between the measures are causal. In other words, improvements in speech production and vocabulary performance produced by training will carry over into predictable improvements in speech perception and reading scores. Furthermore, the model will help educators identify the most effective methods of improving receptive and expressive spoken language for individual children who are deaf or hard of hearing. (+info)
Syntactic movement in orally trained children with hearing impairment.
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This study explored the comprehension and production of sentences derived by syntactic movement, in orally trained school-age Hebrew-speaking children with moderate to profound hearing impairment, aged 7;8-9;9 years. Experiments 1 and 2 tested the comprehension of relative clauses and topicalization sentences (with word orders of OVS [object, verb, subject] and OSV [object, subject, verb]) using a sentence-picture matching task. Experiments 3 and 4 tested the production of relative clauses using two elicitation tasks. Experiment 5 tested the comprehension of relative clauses with and without resumptive pronouns. As a group, the children with hearing loss failed to understand object relatives and OVS topicalization sentences. In the production tasks they either avoided producing a sentence with syntactic movement, by using a relative clauses with a resumptive pronoun instead of a gap or by producing a sentence without a relative clause, or produced ungrammatical sentences. They understood correctly object relatives with resumptive pronouns, which are not derived by movement. Both comprehension and production of the hearing-impaired group was significantly different from that of the hearing control group. Individual performance was strongly correlated with the age of intervention: only children who received hearing aids before the age of 8 months performed well in the comprehension tasks. Type of hearing aid, duration of use of a cochlear implant, and degree of hearing loss did not correlate with syntactic comprehension. (+info)