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Encino, CA, United States

De Lamo White C.,Speech Kingdom | Jin L.,De Montfort University
International Journal of Language and Communication Disorders | Year: 2011

Background: British society is multicultural and multilingual, thus for many children English is not their main or only language. Speech and language therapists are required to assess accurately the speech and language skills of bilingual children if they are suspected of having a disorder. Cultural and linguistic diversity means that a more complex assessment procedure is needed and research suggests that bilingual children are at risk of misdiagnosis. Clinicians have identified a lack of suitable assessment instruments for use with this client group. Aims: This paper highlights the challenges of assessing bilingual children and reviews available speech and language assessment procedures and approaches for use with this client group. It evaluates different approaches for assessing bilingual children to identify approaches that may be more appropriate for carrying out assessments effectively. Methods & Procedures: This review discusses and evaluates the efficacy of norm-referenced standardized measures, criterion-referenced measures, language-processing measures, dynamic assessment and a sociocultural approach. Outcomes & Results: When all named procedures and approaches are compared, the sociocultural approach appears to hold the most promise for accurate assessment of bilingual children. Research suggests that language-processing measures are not effective indicators for identifying speech and language disorders in bilingual children, but further research is warranted. The sociocultural approach encompasses some of the other approaches discussed, including norm-referenced measures, criterion-referenced measures and dynamic assessment. Conclusions & Implications: The sociocultural approach enables the clinician to interpret results in the light of the child's linguistic and cultural background. In addition, combining approaches mitigates the weaknesses inherent in each approach. © 2011 Royal College of Speech and Language Therapists.

Code C.,University of Exeter | Petheram B.,Speech Kingdom
International Journal of Speech-Language Pathology | Year: 2011

Providing a quality service for people with aphasia is a primary goal of speech-language pathologists working with neurogenic communication disorders. This paper reviews what is known about the incidence and prevalence of aphasia and what services are provided for people with aphasia. On the basis of the stroke data, the incidence of aphasia in the developed world ranges between 0.02-0.06% with prevalence ranging between 0.1-0.4%. Average hours of treatment for aphasic people in the developed world ranges between 1-5 hours per week, with a great deal of variability, although recent research suggests that intense treatment of ∼ 9 hours per week over a relatively short period is needed in order to be effective. It is concluded that there is a significant gap between what the research suggests is the appropriate amount of treatment and actual provision throughout the English-speaking world. © 2011 The Speech Pathology Association of Australia Limited.

Hayhow R.,Speech Kingdom
International Journal of Language and Communication Disorders | Year: 2011

Background: Within medicine there is an agreed hierarchy of levels of research evidence with randomized controlled trials at the top and expert opinion at the bottom. When randomized controlled trials are the final stage in testing a treatment for which there is a sound theoretical basis both the 'Does it work?' and 'How does it work?' questions may be answered. However, when the theoretical basis is underdeveloped or contentious, then randomized controlled trials will provide only partial answers and other methods or methodologies may be needed to understand more about the mechanisms involved in the treatments. Aims: This paper aims to contribute to the debate about the nature of the evidence that is required in order to feel confident that people with communication difficulties will benefit from the treatments offered. The aim is not to discuss the relative merits of one methodology over another, but rather, by referring to one particular treatment, to show how knowledge gained from a range of research studies, using different methodologies, can be synthesized to increase one's understanding. Methods & Procedures: The initial discussion focuses on two frameworks that have been developed specifically for the evaluation of healthcare interventions. This is followed by discussion of the research evidence for the Lidcombe Program of early stuttering intervention to illustrate some issues relevant to treatment development and evaluation in the field of communication difficulty. The evidence from randomized controlled trails is related to clinicians' needs. Finally, the potential value of an iterative approach is illustrated with reference to verbal contingencies, which are an essential component of the Lidcombe Program. Main Contribution: This paper considers different sorts of evidence and their contribution to one's knowledge and practice. The content provides a practical example of how knowledge and understanding of a treatment approach can develop through a synthesis of knowledge from a programme of systematic research, from research outside the field of communication difficulty, and from the process of making sense of the experiences of both clinicians and clients who use the approach. Conclusions & Implications: The questions 'Does it work?' and 'How does it work?' are important and require different methods of investigation. Particular treatments may be viewed as better suited to one research methodology over another, but limiting research to one fails to provide the information that practitioners need in order to justify what they do and effectively to solve problems encountered in the application of particular approaches. © 2010 Royal College of Speech & Language Therapists.

Roulstone S.,Speech Kingdom
International Journal of Speech-Language Pathology | Year: 2015

Purpose: This paper examines the relationship between components of evidence-based practice (clinical expertise, patient perspective and research evidence). Method: Findings are examined from two research programs: the Better Communication Research Program and Child Talk, including exploratory studies of the views of parents and children regarding speech-language pathology and studies of current practice by SLPs in England. Systematic reviews of the research literature were also undertaken. The paper analyses relationships between outcomes valued by children and parents and those reported in the literature and in practice, parents' perspectives regarding intervention in comparison with clinicians' reports of practice and the extent to which research evidence underpins current practice is examined. Result: Parents and children value functional outcomes and positive experiences; these are not routinely measured in research or practice. Therapy is perceived positively by most parents; however, some are ambivalent and less clear about the rationale. Commonly used interventions are supported by evidence, but there are gaps regarding some critical therapy components. Conclusion: The paper discusses four challenges to evidence-based practice: the consistency and clarity of descriptions of interventions; consensus based models of practice; understanding of the mechanisms of change; and, finally, the operationalization of client preferences within an evidence-based practice framework. © 2015 The Speech Pathology Association of Australia Limited.

Deary V.,Northumbria University | Miller T.,Speech Kingdom
Current Opinion in Otolaryngology and Head and Neck Surgery | Year: 2011

Purpose of review: Functional dysphonia, defined as alteration or loss of voice in the absence of physical pathology, is known to be associated with a variety of psychosocial factors including anxiety, depression and reduced quality of life. Models of functional dysphonia have tended to conceptualize the voice disorder as being the result of a failure to acknowledge and/or express this associated distress. The current literature was reviewed to identify psychosocial factors that predispose to, precipitate and perpetuate functional dysphonia and to assess the evidence for these models. Recent findings: Recent studies have identified evidence of genetic susceptibility, occupational susceptibility, a history of sexual and/or physical abuse and perfectionism as being predisposing factors. Precipitants include life events, frequency of vocal use and infections. General fatigue is identified as being a potential perpetuating factor. A recent novel theoretical model of functional dysphonia is reported, which proposes deficits in emotional processing as the core process in voice loss. Summary: Current research confirms that functional dysphonia is associated with multiple psychosocial factors. However, these findings are shown to be true of other medically unexplained symptoms in which vocal problems are absent. It is argued that, whilst intuitively appealing, there is insufficient evidence to support the popular notion that the loss of voice is the consequence of unexpressed emotion. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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