Views of children with cerebral palsy and their parents on the effectiveness and acceptability of intensive speech therapy

Quantitative results of SonoSpeech Cleft Pilot: a mixed-methods pilot randomised control trial of ultrasound visual biofeedback versus standard intervention for children with cleft palate ± cleft lip

BACKGROUND

Despite its growing popularity, there is limited evidence of the effectiveness of ultrasound visual biofeedback speech therapy for children with cleft palate ± cleft lip (CP ± L). This study reports on the findings of a pilot feasibility study of ultrasound visual biofeedback versus standard care. Results will be used to determine if a full-scale randomised controlled trial (RCT) is feasible.

METHODS

We used a mixed-methods pilot RCT. Participants were children aged 5-16 with repaired CP ± L and at least one compensatory articulation. Participants were randomised, stratified for age, to receive six sessions of either articulation therapy (standard care) or ultrasound visual biofeedback (U-VBF) therapy. Outcome indicators for progression to full trial were measured as percentage targets achieved including the following: participants recruited and retained; outcome measure completion; and therapy protocol adherence. Due to the nature of treatment, the treating Speech and Language Therapists (SLTs) and families were not blinded; however, the assessing SLTs were blinded to treatment allocation until the end of the trial.

RESULTS

Eight participants were randomised to articulation therapy and eleven to ultrasound. All participants' data was included for analysis. All but one of the pre-determined criteria for moving to full trial were fully met and the remaining indicator was partially met. At least 75% of the following were achieved: outcome measure completion; therapy protocol adherence; participant retention in each arm of the study. The target number of participants, 20 per treatment arm, was not reached.

CONCLUSION

Most feasibility measures were successful. This study suggests that a full RCT comparing articulation therapy to U-VBF therapy would be possible if the current recruitment strategy is addressed.

TRIAL REGISTRATION

ISRCTN, ISRCTN17441953. Registered 22 March 2021.

"It's not that bad but it's not so fun either"- A qualitative study on school-aged children's perceptions of speech and language therapy for developmental language disorders

INTRODUCTION

Different studies have explored the experiences and perspectives of parents on developmental language disorders (DLD). Recently, different authors also called for more research hearing the children's voices. Unfortunately, this topic is under-researched. Therefore, this study investigated how school-aged Flemish children with DLD experience speech and language therapy for DLD.

METHODS

Seven Flemish children with DLD, aged between 6 and 12 years, were included in this study. Child-friendly semi-structured interviews were conducted to investigate their perceptions of speech and language therapy. Data derived from these interviews were analysed using an descriptive thematic content analysis. Trustworthiness of the data was achieved by applying researcher triangulation and use of narrative autobiographies.

RESULTS

During the analyses, six major teams were identified: (1) mixed emotions towards therapy, (2) challenges and difficulties in therapy, (3) impact of therapy context and timing, (4) social reactions and peer awareness, (5) engagement through play, and (6) learning and therapy goals. Each theme was divided into different subthemes. The theme 'mixed emotions towards therapy' was divided into the subthemes positive feelings, mixed feelings, and shame and embarrassment. Confronting difficulties and task focus were the subthemes of the major theme 'challenges and difficulties in therapy'. The theme 'impact of therapy context and timing' consisted of two subthemes, namely after-school therapy and in-school therapy. Reactions from peers was the subtheme of 'social reactions and peer awareness'. Engagement through play was divided into enjoyment of games and rewards. And the theme 'learning and therapy goals' was divided into the subthemes value of learning and collaboration with teachers.

CONCLUSION

While most children had positive attitudes on speech hand language therapy, some reported embarrassment or discomfort. The timing of therapy sessions, whether during or outside school hours, influenced engagement, as did the use of games and rewards. Children generally valued a playful approach, though variety in activities was important. Understanding the goals and benefits of speech and language therapy also increased intrinsic motivation for some children. SLTs should consider these factors and minimize biases to improve therapy outcomes. Future research should explore ways to better align therapy with children's preferences and developmental needs.

A mixed-methods pilot randomized control trial of ultrasound visual biofeedback versus standard intervention for children with cleft palate ± cleft lip: Parents' and children's perspectives

BACKGROUND

Ultrasound visual biofeedback (UVBF) has the potential to be useful for the treatment of compensatory errors in speakers with cleft palate ± lip (CP±L), but there is little research on its effectiveness, or on how acceptable families find the technique. This study reports on parents' and children's perspectives on taking part in a pilot randomized control trial of UVBF compared with articulation intervention.

AIMS

To determine the acceptability of randomization, UVBF and articulation intervention to families. We set feasibility criteria of at least 75% of responses rated as acceptable or positive in order to determine progression from a pilot to a full randomized control trial.

METHODS & PROCEDURES

A total of 19 families who received UVBF therapy (11 families) and articulation intervention (eight families) were invited to participate. Mixed methods were employed: two questionnaires to determine the acceptability of UVBF and articulation intervention, respectively; and semi-structured focus groups/interviews. Questionnaires were analysed for frequency of positive versus negative acceptability and the focus groups/interviews were analysed using thematic analysis and coded using the theoretical framework of acceptability.

OUTCOMES & RESULTS

More than 75% of families rated randomization as acceptable and more than 75% of families rated both interventions as acceptable, with the caveat that half of the participants did not wish to continue articulation intervention after the study. For some families, this was because they felt further intervention was not required. Six families (three in each intervention) volunteered to take part in the focus groups/interviews. Results showed more positive than negative themes regarding acceptability, particularly affective attitude where high levels of enjoyment were expressed, although some participants found the articulation intervention 'boring'. In both groups, there was a considerable burden involved in travelling to the hospital location.

CONCLUSIONS & IMPLICATIONS

Randomization in a clinical trial is acceptable to families; UVBF and articulation intervention are acceptable and indeed enjoyable. The burden of the additional outcome measures required for a clinical trial is manageable, although there is a travel burden for participants. Future studies should seek to mitigate the travel burden by considering additional locations for intervention.

WHAT THIS PAPER ADDS

What is already known on the subject UVBF shows potential for teaching children with speech sound disorders new articulations. Previous studies looking at the acceptability of using ultrasound in speech intervention have only asked for the drawbacks of the intervention: finding the ultrasound gel to be cold and sticky and the probe to be uncomfortable. SLTs, however, believe that the technique offers advantages due to its ability to visualize tongue movements. What this paper adds to the existing knowledge This study asks parents and children for their full views about using ultrasound in speech intervention and compared this to articulation intervention. We also asked parents how they feel about being randomized to one of these interventions. Results were positive for both interventions, with parents highlighting the importance of intelligible speech to their child. Children enjoyed both interventions, though the articulation intervention could be 'boring' or 'repetitive'. For all families, there was a considerable burden travelling to clinics. What are the potential or actual clinical implications of this work? Clinicians can be assured that both articulation therapy and ultrasound therapy are acceptable to families. Efforts could be made to ensure that articulation intervention is not repetitive and that appointments are offered at locations which are accessible to families where possible.

Child, family and professional views on valued communication outcomes for non-verbal children with neurodisability: A qualitative meta-synthesis

BACKGROUND

There are many children with neurodisability who are unable to rely on speech to communicate and so use a range of augmentative and alternative communication (AAC) methods and strategies to get their message across. Current instruments designed to measure the outcomes of speech and language therapy interventions lack specific attention to communication outcomes that are valued by non-verbal children with neurodisability, their families and support networks. This qualitative meta-synthesis was conducted to identify valued communication outcomes to inform the next stage of developing a novel outcome measure.

AIMS

To systematically identify and synthesise the qualitative evidence about which communication outcomes non-verbal children with neurodisability, their family members, healthcare professionals and educators think are important to achieve, specifically which communication outcomes are most valued by: (1) non-verbal children with neurodisability; (2) parents or other family members of non-verbal children with neurodisability; and (3) professionals who work with non-verbal children with neurodisability.

METHODS & PROCEDURES

A systematic search of bibliographic databases and the grey literature was undertaken to identify qualitative studies that included evidence of views expressed by children, family members, healthcare professionals and educators on outcomes in relation to the communication of non-verbal children with neurodisability. All papers meeting the inclusion criteria were quality appraised using the Critical Appraisal Skills Programme Qualitative checklist, although none were excluded on this basis. The data synthesis involved organising coded data into descriptive themes which were then synthesised into analytical themes.

MAIN CONTRIBUTION

We found 47 papers containing qualitative data meeting the inclusion criteria from research situated in 14 countries. The views of 35 children, 183 parents, six other family members, 42 healthcare professionals and 18 educators are represented in the review. The included studies contained very few data reported by children themselves; most data were provided by adults, especially parents. Three main analytical themes were identified: Experiences of communication and expectations; adapting to and acceptance of AAC; and becoming an autonomous communicator.

CONCLUSIONS & IMPLICATIONS

This meta-synthesis brings together the limited qualitative research findings about what parents, professionals and children consider are important communication outcomes for non-verbal children with neurodisability. The synthesis identifies key gaps in our knowledge about the perspectives of children and their siblings. This synthesis will inform primary research to understand valued communication outcomes in this group, and ultimately the development of a patient-reported outcome measure (PROM) that can be used to demonstrate the effect of interventions, at both clinical and service levels.

WHAT THIS PAPER ADDS

What is already known on the subject Studies of children with cerebral palsy and autism spectrum disorder indicate that at least 25% of children with these conditions are non-verbal. Studies on the health outcomes of children with neurodisability have identified that communication is rated as important by parents and health professionals. There is an evidence gap about which communication outcomes are important to non-verbal children, their families and the people who work with them. What this paper adds to the existing knowledge This is the first synthesis of data that relates to communication outcomes for non-verbal children with neurodisability. This qualitative meta-synthesis identifies from previous research studies the communication outcomes valued by children who are non-verbal, their parents or other family members, and the professionals who work with them. The findings will be used to shape further primary research and the development of a novel patient-reported communication outcome measure for non-verbal children with neurodisability. It is anticipated that this will be used by clinicians to measure the effect of their interventions. What are the practical and clinical implications of this work? Clinicians should reflect on parents' experiences of communication with their child before discussing potential outcomes with them. Gaining insight into the lived experience of communication for non-verbal children and their families will help healthcare professionals to understand which goals are important to them and why. Few studies have specifically asked which communication outcomes are important for non-verbal children with neurodisability. Further exploration is needed to determine which communication outcomes non-verbal children and their families would like to see included in outcome measures used by clinicians.

Speech treatment for Hebrew-speaking adolescents and young adults with developmental dysarthria: A comparison of mSIT and Beatalk

BACKGROUND

Individuals with developmental dysarthria typically demonstrate reduced functioning of one or more of the speech subsystems, which negatively impacts speech intelligibility and communication within social contexts. A few treatment approaches are available for improving speech production and intelligibility among individuals with developmental dysarthria. However, these approaches have only limited application and research findings among adolescents and young adults.

AIMS

To determine and compare the effectiveness of two treatment approaches, the modified Speech Intelligibility Treatment (mSIT) and the Beatalk technique, on speech production and intelligibility among Hebrew-speaking adolescents and young adults with developmental dysarthria.

METHODS & PROCEDURES

Two matched groups of adolescents and young adults with developmental dysarthria participated in the study. Each received one of the two treatments, mSIT or Beatalk, over the course of 9 weeks. Measures of speech intelligibility, articulatory accuracy, voice and vowel acoustics were assessed both pre- and post-treatment.

OUTCOMES & RESULTS

Both the mSIT and Beatalk groups demonstrated gains in at least some of the outcome measures. Participants in the mSIT group exhibited improvement in speech intelligibility and voice measures, while participants in the Beatalk group demonstrated increased articulatory accuracy and gains in voice measures from pre- to post-treatment. Significant increases were noted post-treatment for first formant values for select vowels.

CONCLUSIONS & IMPLICATIONS

Results of this preliminary study are promising for both treatment approaches. The differentiated results indicate their distinct application to speech intelligibility deficits. The current findings also hold clinical significance for treatment among adolescents and young adults with motor speech disorders and application for a language other than English.

WHAT THIS PAPER ADDS

What is already known on the subject Developmental dysarthria (e.g., secondary to cerebral palsy) is a motor speech disorder that negatively impacts speech intelligibility, and thus communication participation. Select treatment approaches are available with the aim of improving speech intelligibility in individuals with developmental dysarthria; however, these approaches are limited in number and have only seldomly been applied specifically to adolescents and young adults. What this paper adds to existing knowledge The current study presents preliminary data regarding two treatment approaches, the mSIT and Beatalk technique, administered to Hebrew-speaking adolescents and young adults with developmental dysarthria in a group setting. Results demonstrate the initial effectiveness of the treatment approaches, with different gains noted for each approach across speech and voice domains. What are the potential or actual clinical implications of this work? The findings add to the existing literature on potential treatment approaches aiming to improve speech production and intelligibility among individuals with developmental dysarthria. The presented approaches also show promise for group-based treatments as well as the potential for improvement among adolescents and young adults with motor speech disorders.

Protocol for SonoSpeech Cleft Pilot: a mixed-methods pilot randomized control trial of ultrasound visual biofeedback versus standard intervention for children with cleft lip and palate

Background

Children with cleft lip and palate can continue to have problems producing clear speech after surgery. This can lead to social, emotional, and educational challenges. Typical treatment involves teaching children the correct tongue movements to produce speech sounds. This is known as articulation intervention. However, this intervention is challenging because the tongue is hidden from view and movements are difficult to see and describe. This pilot randomized control trial will try a new treatment, ultrasound visual biofeedback (U-VBF) versus standard articulatory intervention for children with cleft lip and palate, as comparison. Feasibility outcomes will be determined.

Methods/design

The Sonospeech project will enroll up to 40 children with cleft lip and palate aged 4;6 to 16 in a mixed-methods randomized controlled trial with blinded assessors. Children will receive either six sessions of U-VBF or articulation intervention. The primary goals of this pilot are to assess the feasibility and inform the design of a full-scale RCT of U-VBF for children with cleft speech characteristics. This will be achieved by determining the following outcome measures: recruitment/attrition rates; measures of pre-post follow-up completion; and acceptability of the randomization and interventions to families.

Discussion

Larger trials of speech interventions for children with cleft lip and palate are needed. This pilot/feasibility study will determine whether a larger randomized control trial comparing ultrasound and articulation interventions is feasible.

Trial registration

ISRCTN, ISRCTN17441953. Registered 22 March 2021. See Table 2 in Appendix 1 for all items.

Intensive Voice Treatment (Lee Silverman Voice Treatment [LSVT LOUD]) for Children With Down Syndrome: Phase I Outcomes

PURPOSE

This study examined the effects of an intensive voice treatment Lee Silverman Voice Treatment (LSVT LOUD) on children with Down syndrome (DS) and motor speech disorders.

METHOD

A Phase I, multiple baseline, single-subject design with replication across nine participants with DS was used. Single-word intelligibility, acoustic measures of vocal functioning, and parent perceptions of pre- and posttreatment communication function were used as treatment outcome measures.

RESULTS

All participants completed the full dose of LSVT LOUD and showed gains on one or more of the outcome measures. Patterns of posttreatment improvements were not consistent across participants but were more frequently observed on trained maximum performance tasks compared to tasks reflecting generalization of the treatment skillset. Some participants exhibited a stronger response to treatment, whereas others showed a mixed or weaker response. Parents liked the treatment protocol, perceived benefits from intensive intervention, and indicated they would strongly recommend LSVT LOUD to other parents who have children with DS and motor speech disorders.

CONCLUSIONS

These preliminary results show that children with DS tolerated intensive voice treatment without adverse effects and made select meaningful therapeutic gains. The treatment evidence from this study warrants Phase II treatment studies using LSVT LOUD with a larger group of children with DS.

Effects of an intensive voice treatment on articulatory function and speech intelligibility in children with motor speech disorders: A phase one study

Producing speech that is clear, audible, and intelligible to others is a challenge for many children with cerebral palsy (CP) and children with Down syndrome (DS). Previous studies have demonstrated the effectiveness of using the Lee Silverman Voice Treatment (LSVT LOUD®) to increase vocal loudness and improve speech intelligibility in individuals with dysarthria secondary to Parkinson's disease (PD), and some research suggests that it also may be effective for individuals with dysarthria secondary to other conditions, including CP and DS. Although LSVT LOUD targets healthy vocal loudness, there is some evidence of spreading effects to the articulatory system. Acoustic data from two groups of children with secondary motor speech disorders [one with CP (n = 17) and one with DS (n = 9)] who received a full dose of LSVT LOUD and for whom post-treatment intelligibility gains have been previously reported, were analyzed for treatment effects on: 1) vowel duration, 2) acoustic vowel space and 3) the ratio of F2/i/ to F2/u/. Statistically significant changes in vowel duration and acoustic vowel space occurred pre-treatment to 12 weeks post-treatment in the CP group, and increased acoustic vowel space was observed in 5 of the DS participants. The present study provides preliminary evidence of intensive voice treatment spreading effects to the articulatory system in some children with CP and children with DS consistent with previous findings in other populations.

Communication Modes and Functions in Children With Cerebral Palsy

Purpose This study seeks to determine how speech-language impairments relate to the frequency and diversity of communication modes and functions produced by children with cerebral palsy (CP) during interactions with their mothers. Method We studied 40 children with CP (M age = 62 months) comprising three groups: those who were unable to speak and had anarthria (n = 15), those with speech motor impairment and language comprehension impairment (SMI-LCI; n = 15), and those with speech motor impairment and typical language comprehension (SMI-LCT; n = 10). Mother-child play interactions were coded for child modes and functions. Generalized linear regression models were used to examine the relationship between profile group and frequencies of communication modes and functions. Results Results indicated groups SMI-LCI and SMI-LCT had significantly higher mean frequencies of vocalizations, vocalizations + gestures, comments, initiations, and requests than the group of those who were unable to speak and had anarthria. All children used vocalizations primarily, though these vocalizations were often not understood. SMI-LCI and SMI-LCT differed on two measures: frequency of gestures and frequency of initiations. The majority of children in this sample did not have access to augmentative and alternative communication devices. Conclusion Results of this study highlight the need for parent-mediated interventions for children with CP that emphasize multimodal communication tailored to impairment profiles. Supplemental Material https://doi.org/10.23641/asha.12354704.