International Journal of Speech-Language Pathology
ISSN: 1754-9507 (Print) 1754-9515 (Online) Journal homepage: http://www.tandfonline.com/loi/iasl20
Scientific forum topic: Translating knowledge to practice in childhood dysarthria Angela T. Morgan, Megan Hodge & Lindsay Pennington To cite this article: Angela T. Morgan, Megan Hodge & Lindsay Pennington (2014) Scientific forum topic: Translating knowledge to practice in childhood dysarthria, International Journal of Speech-Language Pathology, 16:4, 335-336 To link to this article: http://dx.doi.org/10.3109/17549507.2014.930176
Published online: 11 Jul 2014.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=iasl20 Download by: [University of Cambridge]
Date: 09 November 2015, At: 06:39
International Journal of Speech-Language Pathology, 2014; 16(4): 335–336
EDITORIAL
Scientific forum topic: Translating knowledge to practice in childhood dysarthria
ANGELA T. MORGAN1,2, MEGAN HODGE3 & LINDSAY PENNINGTON4,5 1Language
and Literacy Group, Murdoch Childrens Research Institute, Melbourne,Victoria, Australia, of Paediatrics, University of Melbourne,Victoria, Australia, 3Department of Communication Sciences and Disorders, University of Alberta, Canada, 4Institute of Health & Society, Newcastle University, Newcastle, United Kingdom, and 5Sir James Spence Institute, Newcastle upon Tyne, Newcastle, United Kingdom
Downloaded by [University of Cambridge] at 06:39 09 November 2015
2Department
Dysarthria can have profound effects on children’s quality-of-life and social participation (Dickinson et al., 2007; Fauconnier et al., 2009). Despite such impacts, there has been a critical lack of research investigating the causes, treatment and outcomes of childhood dysarthria compared to other paediatric speech-language disorders. For example, a simple search in Pubmed reveals a literature ratio of ∼1:3.5 for dysarthria treatment compared to speech sound disorder treatments (child* dysarthria treatment, 398 results vs child* articulation treatment and/or phonological treatment, 1441 results) and an even greater ratio (1:41) for dysarthria vs child language treatment literature (child* language treatment, 16 267 results). More importantly, the level of evidence for treating childhood dysarthria is low. No studies were identified that met inclusion criteria for meta-analyses examining treatment efficacy in the Cochrane Database of Systematic Reviews (see Pennington, Miller, & Robson, 2009 for dysarthria acquired under 3 years; Morgan & Vogel, 2008 for dysarthria acquired from 3 years and upwards). In contrast, a number of papers met inclusion criteria for a Cochrane review on efficacy of treatment for developmental speech and language disorders (Law, Garrett, & Nye 2003; updated 2010). There is a clear need to generate robust evidence to support interventions for children with dysarthria and integrated measures to evaluate their outcomes. With this need in mind, we gathered a group of international scholars who share the goal of improving the clinical management of these children to contribute original research studies to this Special Issue, “Translating Knowledge into Practice in Childhood Dysarthria”. It is an exciting time to focus on this population of children because the World Health Organization’s International Classification of Functioning,
Disability and Health (ICF) has given researchers and clinicians a newfound recognition of the need to consider and, where possible, modify how dysarthria impacts an individual’s activity and participation in daily life. This issue is organized so that aspects of impairment, activity and participation are covered by the invited authors. A relative strength of the extant literature is the characterization of speech deficits or speech impairment in children with dysarthria. Our Special Edition builds on this strength. Nordberg, Miniscalco, and Lohmander examined speech impairment, cognitive level and gross motor function in children with Cerebral Palsy (CP) and report that level of non-verbal cognitive impairment, rather than level of gross motor impairment, may be of greatest relevance when considering management of speech treatment in this population. At the level of communication activity, Allison and Hustad investigated the effects of two important linguistic variables—sentence length and phonetic complexity—on the intelligibility of children with CP. They highlight the need for information from measures at levels of both body function and activity to plan treatment for an individual child. Further insights into the complex issue of intelligibility for children with dysarthria are provided by Landa and colleagues who examine the association between listeners’ perceptions of the ease of understanding dysarthric speech and the amount of speech they actually understand. This work provides an important conceptual leap in the field, providing measures of the impact of listener, as well as speaker, factors on intelligibility. A critical issue limiting our ability to measure intelligibility and associated measures of speaking rate in children with dysarthria has been a lack of standard tools for eliciting connected speech. Here
Correspondence: Angela T. Morgan, Language and Literacy Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia. Tel: ⫹ 61 7 3896 3133. Email: [email protected] ISSN 1754-9507 print/ISSN 1754-9515 online © 2014 The Speech Pathology Association of Australia Limited Published by Informa UK, Ltd. DOI: 10.3109/17549507.2014.930176
Downloaded by [University of Cambridge] at 06:39 09 November 2015
336
A.T. Morgan et al.
Hodge and Gotzke report Criterion-related validity data for such a tool, the Test of Children’s Speech Plus, compared to children’s conversational speech samples. Patel and Connaghan’s contribution also augments our ability to assess dysarthric speech by providing the first picture description task; “Park Play”, which is designed specifically for eliciting connected speech in children with motor speech disorders. The work of Mei and colleagues extends the scope of the contributions focused at the impairment and activity levels by describing the impact of motor speech impairment on activity and participation in the home, school and community in a cohort study of children with CP. As anticipated, limitations in activity and participation were found to increase as motor speech ability and speech intelligibility decreased. We’re delighted that three manuscripts are dedicated to treatment of children with dysarthria. For the past two decades, the Lee Silverman Voice Treatment (LSVT) program has been at the forefront of rigorous dysarthria treatments in adults and is increasingly applied to children. In this Special Issue, Boliek and Fox discuss two case studies, described as one weak and one strong responder to LSVT LOUD. In particular, they demonstrate how individual and environmental features may affect immediate and lasting responses to treatment. Levy also presents findings from implementing LSVT LOUD and Speech Systems Intelligibility Treatment in children with CP. She discusses specific strategies for outcome measurement including acoustic analysis of dysarthric speech. Ward, Leitão, and Strauss also discuss a well known speech treatment approach, the Prompts for Restructuring Oral Motor Targets (PROMPT) program, and demonstrate promise for its utility in children with dysarthria. We are proud that this special issue also considers outcomes in paediatric dysarthria at a more global level. Enderby challenges us to account for our practice and improve our clinical outcome measurement. She encourages us to think at a broader level of healthcare service provision, to strive to benchmark our practice within and across services, at and beyond an individual patient level. Her paper describes an important extension of the Therapy Outcome Measures (TOMS) tool that reflects the impact of the range of treatments for childhood dysarthria, with practical real world examples to facilitate our learning. We thank the authors for their valuable contributions. We trust that these papers will increase readers’ awareness and understanding of the multifaceted and complex issues in childhood dysarthria and inspire some to continue to build a much-needed research base on this topic, cast within the ICF framework.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References Allison, K. M., & Hustad, K. C. (2014). Impact of sentence length and phonetic complexity on intelligibility of 5-year-old children with cerebral palsy. International Journal of SpeechLanguage Pathology, 16(4), 396–407. Boliek, C. A., & Fox, C. M. (2014). Individual and environmental contributions to treatment outcomes following a neuroplasticity-principled speech treatment (LSVT LOUD) in children with dysarthria secondary to cerebral palsy: A case study review. International Journal of Speech-Language Pathology, 16(4), 372–385. Dickinson, H. O., Parkinson, K. N., Ravens-Sieberer, U., Schirripa, G., Thyen, U., Arnaud, C., et al. (2007). Selfreported quality of life of 8–12 year old children with cerebral palsy: A cross-sectional European study. The Lancet, 369, 2171–2178. Enderby, P. (2014). Use of the extended therapy outcome measure for children with dysarthria. International Journal of SpeechLanguage Pathology, 16(4), 436–444. Fauconnier, J., Dickinson, H. O., Beckung, E., Marcelli, M., McManus, V., Michelsen, S. I., et al. (2009). Participation in life situations of 8–12 year old children with cerebral palsy: Cross sectional European study. British Medical Journal, 338, 1458–1471. Hodge, M. & Gotzke, C. L. (2014). Criterion-related validity of the Test of Children’s Speech sentence intelligibility measure for children with cerebral palsy and dysarthria. International Journal of Speech-Language Pathology, 16(4), 417–426. Landa, S., Pennington, L., Miller, N., Robson, S., Thompson, V., & Steen, N. (2014). Association between objective measurement of the speech intelligibility of young people with dysarthria and listener ratings of ease of understanding. International Journal of Speech-Language Pathology, 16(4), 408–416. Law, J., Garrett, Z., & Nye, C. (2003). Speech and language therapy interventions for children with primary speech and language delay or disorder. Cochrane Database Systematic Review, (3): CD004110. Levy, E. S. (2014). Implementing two treatment approaches to childhood dysarthria. International Journal of Speech-Language Pathology, 16(4), 344–354. Mei, C., Reilly, S., Reddihough, D., Mensah, F., & Morgan, A. (2014). Motor speech impairment, activity, and participation in children with cerebral palsy. International Journal of SpeechLanguage Pathology, 16(4), 427–435. Morgan, A. T., & Vogel, A. P. (2008). Intervention for dysarthria associated with acquired brain injury in children and adolescents. Cochrane Database Systematic Review, 6(3): CD006279. Nordberg, A., Miniscalco, C., & Lohmander, A. (2014). Consonant production and overall speech characteristics in schoolaged children with cerebral palsy and speech impairment. International Journal of Speech-Language Pathology, 16(4), 386– 395. Patel, R., & Connaghan, K. (2014). Park Play: A picture description task for assessing childhood motor speech disorders. International Journal of Speech-Language Pathology, 16(4), 337–343. Pennington, L., Miller, N., & Robson, S. (2009). Speech therapy for children with dysarthria acquired before three years of age. Cochrane Database Systematic Review, 7(4): CD006937. Ward, R., Leitão, S., & Strauss, G. (2014). An evaluation of the effectiveness of PROMPT therapy in improving speech production accuracy in six children with cerebral palsy. International Journal of Speech-Language Pathology, 16(4), 355–371.
ISSN: 1754-9507 (Print) 1754-9515 (Online) Journal homepage: http://www.tandfonline.com/loi/iasl20
Scientific forum topic: Translating knowledge to practice in childhood dysarthria Angela T. Morgan, Megan Hodge & Lindsay Pennington To cite this article: Angela T. Morgan, Megan Hodge & Lindsay Pennington (2014) Scientific forum topic: Translating knowledge to practice in childhood dysarthria, International Journal of Speech-Language Pathology, 16:4, 335-336 To link to this article: http://dx.doi.org/10.3109/17549507.2014.930176
Published online: 11 Jul 2014.
Submit your article to this journal
Article views: 308
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=iasl20 Download by: [University of Cambridge]
Date: 09 November 2015, At: 06:39
International Journal of Speech-Language Pathology, 2014; 16(4): 335–336
EDITORIAL
Scientific forum topic: Translating knowledge to practice in childhood dysarthria
ANGELA T. MORGAN1,2, MEGAN HODGE3 & LINDSAY PENNINGTON4,5 1Language
and Literacy Group, Murdoch Childrens Research Institute, Melbourne,Victoria, Australia, of Paediatrics, University of Melbourne,Victoria, Australia, 3Department of Communication Sciences and Disorders, University of Alberta, Canada, 4Institute of Health & Society, Newcastle University, Newcastle, United Kingdom, and 5Sir James Spence Institute, Newcastle upon Tyne, Newcastle, United Kingdom
Downloaded by [University of Cambridge] at 06:39 09 November 2015
2Department
Dysarthria can have profound effects on children’s quality-of-life and social participation (Dickinson et al., 2007; Fauconnier et al., 2009). Despite such impacts, there has been a critical lack of research investigating the causes, treatment and outcomes of childhood dysarthria compared to other paediatric speech-language disorders. For example, a simple search in Pubmed reveals a literature ratio of ∼1:3.5 for dysarthria treatment compared to speech sound disorder treatments (child* dysarthria treatment, 398 results vs child* articulation treatment and/or phonological treatment, 1441 results) and an even greater ratio (1:41) for dysarthria vs child language treatment literature (child* language treatment, 16 267 results). More importantly, the level of evidence for treating childhood dysarthria is low. No studies were identified that met inclusion criteria for meta-analyses examining treatment efficacy in the Cochrane Database of Systematic Reviews (see Pennington, Miller, & Robson, 2009 for dysarthria acquired under 3 years; Morgan & Vogel, 2008 for dysarthria acquired from 3 years and upwards). In contrast, a number of papers met inclusion criteria for a Cochrane review on efficacy of treatment for developmental speech and language disorders (Law, Garrett, & Nye 2003; updated 2010). There is a clear need to generate robust evidence to support interventions for children with dysarthria and integrated measures to evaluate their outcomes. With this need in mind, we gathered a group of international scholars who share the goal of improving the clinical management of these children to contribute original research studies to this Special Issue, “Translating Knowledge into Practice in Childhood Dysarthria”. It is an exciting time to focus on this population of children because the World Health Organization’s International Classification of Functioning,
Disability and Health (ICF) has given researchers and clinicians a newfound recognition of the need to consider and, where possible, modify how dysarthria impacts an individual’s activity and participation in daily life. This issue is organized so that aspects of impairment, activity and participation are covered by the invited authors. A relative strength of the extant literature is the characterization of speech deficits or speech impairment in children with dysarthria. Our Special Edition builds on this strength. Nordberg, Miniscalco, and Lohmander examined speech impairment, cognitive level and gross motor function in children with Cerebral Palsy (CP) and report that level of non-verbal cognitive impairment, rather than level of gross motor impairment, may be of greatest relevance when considering management of speech treatment in this population. At the level of communication activity, Allison and Hustad investigated the effects of two important linguistic variables—sentence length and phonetic complexity—on the intelligibility of children with CP. They highlight the need for information from measures at levels of both body function and activity to plan treatment for an individual child. Further insights into the complex issue of intelligibility for children with dysarthria are provided by Landa and colleagues who examine the association between listeners’ perceptions of the ease of understanding dysarthric speech and the amount of speech they actually understand. This work provides an important conceptual leap in the field, providing measures of the impact of listener, as well as speaker, factors on intelligibility. A critical issue limiting our ability to measure intelligibility and associated measures of speaking rate in children with dysarthria has been a lack of standard tools for eliciting connected speech. Here
Correspondence: Angela T. Morgan, Language and Literacy Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia. Tel: ⫹ 61 7 3896 3133. Email: [email protected] ISSN 1754-9507 print/ISSN 1754-9515 online © 2014 The Speech Pathology Association of Australia Limited Published by Informa UK, Ltd. DOI: 10.3109/17549507.2014.930176
Downloaded by [University of Cambridge] at 06:39 09 November 2015
336
A.T. Morgan et al.
Hodge and Gotzke report Criterion-related validity data for such a tool, the Test of Children’s Speech Plus, compared to children’s conversational speech samples. Patel and Connaghan’s contribution also augments our ability to assess dysarthric speech by providing the first picture description task; “Park Play”, which is designed specifically for eliciting connected speech in children with motor speech disorders. The work of Mei and colleagues extends the scope of the contributions focused at the impairment and activity levels by describing the impact of motor speech impairment on activity and participation in the home, school and community in a cohort study of children with CP. As anticipated, limitations in activity and participation were found to increase as motor speech ability and speech intelligibility decreased. We’re delighted that three manuscripts are dedicated to treatment of children with dysarthria. For the past two decades, the Lee Silverman Voice Treatment (LSVT) program has been at the forefront of rigorous dysarthria treatments in adults and is increasingly applied to children. In this Special Issue, Boliek and Fox discuss two case studies, described as one weak and one strong responder to LSVT LOUD. In particular, they demonstrate how individual and environmental features may affect immediate and lasting responses to treatment. Levy also presents findings from implementing LSVT LOUD and Speech Systems Intelligibility Treatment in children with CP. She discusses specific strategies for outcome measurement including acoustic analysis of dysarthric speech. Ward, Leitão, and Strauss also discuss a well known speech treatment approach, the Prompts for Restructuring Oral Motor Targets (PROMPT) program, and demonstrate promise for its utility in children with dysarthria. We are proud that this special issue also considers outcomes in paediatric dysarthria at a more global level. Enderby challenges us to account for our practice and improve our clinical outcome measurement. She encourages us to think at a broader level of healthcare service provision, to strive to benchmark our practice within and across services, at and beyond an individual patient level. Her paper describes an important extension of the Therapy Outcome Measures (TOMS) tool that reflects the impact of the range of treatments for childhood dysarthria, with practical real world examples to facilitate our learning. We thank the authors for their valuable contributions. We trust that these papers will increase readers’ awareness and understanding of the multifaceted and complex issues in childhood dysarthria and inspire some to continue to build a much-needed research base on this topic, cast within the ICF framework.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References Allison, K. M., & Hustad, K. C. (2014). Impact of sentence length and phonetic complexity on intelligibility of 5-year-old children with cerebral palsy. International Journal of SpeechLanguage Pathology, 16(4), 396–407. Boliek, C. A., & Fox, C. M. (2014). Individual and environmental contributions to treatment outcomes following a neuroplasticity-principled speech treatment (LSVT LOUD) in children with dysarthria secondary to cerebral palsy: A case study review. International Journal of Speech-Language Pathology, 16(4), 372–385. Dickinson, H. O., Parkinson, K. N., Ravens-Sieberer, U., Schirripa, G., Thyen, U., Arnaud, C., et al. (2007). Selfreported quality of life of 8–12 year old children with cerebral palsy: A cross-sectional European study. The Lancet, 369, 2171–2178. Enderby, P. (2014). Use of the extended therapy outcome measure for children with dysarthria. International Journal of SpeechLanguage Pathology, 16(4), 436–444. Fauconnier, J., Dickinson, H. O., Beckung, E., Marcelli, M., McManus, V., Michelsen, S. I., et al. (2009). Participation in life situations of 8–12 year old children with cerebral palsy: Cross sectional European study. British Medical Journal, 338, 1458–1471. Hodge, M. & Gotzke, C. L. (2014). Criterion-related validity of the Test of Children’s Speech sentence intelligibility measure for children with cerebral palsy and dysarthria. International Journal of Speech-Language Pathology, 16(4), 417–426. Landa, S., Pennington, L., Miller, N., Robson, S., Thompson, V., & Steen, N. (2014). Association between objective measurement of the speech intelligibility of young people with dysarthria and listener ratings of ease of understanding. International Journal of Speech-Language Pathology, 16(4), 408–416. Law, J., Garrett, Z., & Nye, C. (2003). Speech and language therapy interventions for children with primary speech and language delay or disorder. Cochrane Database Systematic Review, (3): CD004110. Levy, E. S. (2014). Implementing two treatment approaches to childhood dysarthria. International Journal of Speech-Language Pathology, 16(4), 344–354. Mei, C., Reilly, S., Reddihough, D., Mensah, F., & Morgan, A. (2014). Motor speech impairment, activity, and participation in children with cerebral palsy. International Journal of SpeechLanguage Pathology, 16(4), 427–435. Morgan, A. T., & Vogel, A. P. (2008). Intervention for dysarthria associated with acquired brain injury in children and adolescents. Cochrane Database Systematic Review, 6(3): CD006279. Nordberg, A., Miniscalco, C., & Lohmander, A. (2014). Consonant production and overall speech characteristics in schoolaged children with cerebral palsy and speech impairment. International Journal of Speech-Language Pathology, 16(4), 386– 395. Patel, R., & Connaghan, K. (2014). Park Play: A picture description task for assessing childhood motor speech disorders. International Journal of Speech-Language Pathology, 16(4), 337–343. Pennington, L., Miller, N., & Robson, S. (2009). Speech therapy for children with dysarthria acquired before three years of age. Cochrane Database Systematic Review, 7(4): CD006937. Ward, R., Leitão, S., & Strauss, G. (2014). An evaluation of the effectiveness of PROMPT therapy in improving speech production accuracy in six children with cerebral palsy. International Journal of Speech-Language Pathology, 16(4), 355–371.
