A Phase II Trial of Telehealth Delivery of the Lidcombe Program of Early Stuttering Intervention

from the American Journal of Speech-Language Pathology

PURPOSE: The aims of this study were to evaluate the efficacy of telehealth delivery of the Lidcombe Program of Early Stuttering Intervention, compared with a control group, and to determine the number of children who could be regarded as “responders.” METHOD: A speech-language pathologist provided telehealth delivery of the Lidcombe Program during telephone consultations with parents in their homes, remote from the clinic. The study design was an open plan, parallel group, randomized controlled trial with blinded outcome assessment. Children in the no-treatment control group who were still stuttering after 9 months then received the same treatment. The primary outcome measure was frequency of stuttering, gathered from audiotape recordings of participants’ conversational speech in everyday, nontreatment situations, before and after treatment. RESULTS: Analysis of covariance showed a 73% decrease in frequency of stuttering at 9 months after randomization in the treatment group, as compared with the control group (95% confidence interval = 25%-90%, p = .02). Measures of treatment time showed that telehealth delivery of the Lidcombe Program requires around 3 times more resources than standard presentation. CONCLUSIONS: Telehealth delivery of the Lidcombe Program is an efficacious treatment for preschool children who cannot receive the standard, clinic-based Lidcombe Program. Avenues for improving efficiency are considered.

Assessing the microstructure of written language using a retelling paradigm

from the American Journal of Speech-Language Pathology

PURPOSE: The primary goal of this study was to document the progression of the microstructural elements of written language in children at 4 grade levels. The secondary purpose was to ascertain whether the variables selected for examination could be classified into valid categories that reflect the multidimensional nature of writing. METHOD: Written language samples were collected and transcribed from 120 children in Grades 3 through 6 using an expository text-retelling paradigm. Nine variables at various levels of language were analyzed. RESULTS: Using a text-retelling paradigm, measures of productivity (e.g., total number of words and ideas) improved steadily with age, whereas measures of complexity (e.g., mean length of T-unit) did not. Results for measures of accuracy (e.g., spelling and writing conventions) were mixed, with some showing improvement across grades. Grade 3 students showed consistently poorer performance than students in Grades 4, 5, and 6. Grade 4 students showed poorer performance than students in Grades 5 and 6. Exploratory factor analysis suggests that writing can be represented by 3 factors: Productivity, Complexity, and Accuracy. CONCLUSIONS: Clinicians can use this multidimensional scheme for examining writing skills using text-retelling formats with children from Grades 3 through 6. This empirically based framework for measuring microstructural variables of writing provides clinicians with a 3-prong conceptual framework for determining children’s strengths and weaknesses within the translational stage of writing.

Comparison of personal versus fictional narratives of children with language impairment

from the American Journal of Speech-Language Pathology

PURPOSE: Personal narratives are common in children’s conversations, recommended as the appropriate genre for early writing by educators, and part of many high-stakes tests, possibly because they tend to be better formed than fictional narratives. However, current practice in the field of speech-language pathology employs fictional narratives in assessment, intervention, and study of children with impaired language development. This article explored performance on personal versus fictional narratives by children with language impairment (LI), hypothesizing that performance on the former would be better and a minimal relationship between performances in the 2 genres. METHOD: Twenty-seven children age 7;0-9;9 (years;months) with LI orally produced personal and fictional narratives (responses to a wordless picture book). Narratives were analyzed by raters blind to experimental hypotheses using high-point analysis and an analysis derived from scoring of a high-stakes composition for 4th grade. RESULTS: High-point ratings of personal significantly exceeded those of fictional narratives. Disproportionate fictional stories did not meet minimal narrative criteria. However, more personal narratives than would be expected by chance did. The analyses were significantly correlated. Quality of a child’s performance of personal was minimally related to that of fictional narratives. CONCLUSIONS: Clinicians may want to consider functional aspects of personal narratives.

Comparisons of audio and audiovisual measures of stuttering frequency and severity in preschool-age children

from the American Journal of Speech-Language Pathology

PURPOSE: To determine whether measures of stuttering frequency and measures of overall stuttering severity in preschoolers differ when made from audio-only recordings compared with audiovisual recordings. METHOD: Four blinded speech-language pathologists who had extensive experience with preschoolers who stutter measured stuttering frequency and rated overall severity from audio-only and audiovisual recordings of 36 preschool children who were stuttering. Stuttering frequency (percentage of syllables stuttered [%SS]) was based on counts of perceptually unambiguous stutterings, made in real time, and overall severity was measured using a 9-point rating scale. RESULTS: Stuttering frequency was statistically significantly lower by around 20% when made from audio-only recordings. This was found to be directly attributable to differences in the counts of stuttered syllables, rather than to differences in the total numbers of syllables spoken. No significant differences were found between recording modalities for the ratings of overall severity. Correlations between %SS scores in the 2 modalities and severity rating scores in the 2 modalities were high, indicating that observers agreed on data trends across speech samples. CONCLUSIONS: Measures of %SS made from audio-only recordings may underestimate stuttering frequency in preschoolers. Although audio-only %SS measures may underestimate stuttering frequency at the start of a clinical trial to a clinically significant extent, posttreatment scores at or below 1.0%SS are likely to underestimate by 0.2%SS or less, which is clinically insignificant.

Expected test scores for preschoolers with a cochlear implant who use spoken language.

from the American Journal of Speech-Language Pathology

PURPOSE: The major purpose of this study was to provide information about expected spoken language skills of preschool-age children who are deaf and who use a cochlear implant. A goal was to provide “benchmarks” against which those skills could be compared, for a given age at implantation. We also examined whether parent-completed checklists of children’s language were correlated with results of standardized language tests and whether scores increased linearly with decreasing age of implantation and increasing duration of cochlear implant use. METHOD: Participants were a nationwide sample of 76 children who were deaf and orally educated and who received an implant by 38 months of age. Formal language tests were administered at age 4.5 years. The MacArthur-Bates Communicative Development Inventories (CDI) instrument was completed by parents when children were ages 3.5 and 4.5 years. RESULTS: Based on regression analyses, expected scores for each age at implant were provided for 2 commonly administered language tests at 4.5 years of age and CDI subscale scores at 3.5 and 4.5 years. Concurrent test scores were significantly correlated on all measures. A linear relation was found that predicted increasing test scores with younger ages at implantation for all scales administered. CONCLUSIONS: While the expected scores reported here should not be considered as normative data, they are benchmarks that may be useful for evaluating spoken language progress of children with cochlear implants who are enrolled in spoken language-based programs.

Oral and written language development of children adopted from China

from the American Journal of Speech-Language Pathology

PURPOSE: The sharp increase in the number of international adoptions in the United States has prompted a heightened interest in the language development of internationally adopted children. Although recent studies have investigated the early language development of adoptees, little is known about the school-age language and literacy skills of internationally adopted children. The focus of this study was the oral and written language skills of school-age adoptees from China. METHOD: The participants were 24 children between the ages of 7;0 (years;months) and 8;8. Oral and written language skills were assessed using standardized measures and a narrative retell task. RESULTS: As a group, the majority of children exhibited scores in the average to above average range for all oral and written standardized language measures. Narrative analysis indicated that an increase in the number of grammatical errors was moderately correlated with lower reading comprehension scores. Age at adoption was negatively correlated with several measures, including a narrative measure of grammatical errors per T-unit. CONCLUSION: These findings provide an encouraging outlook on the oral and written language outcomes of internationally adopted children from China through the early elementary grades. Moreover, these findings support earlier research that speaks to the resiliency and robustness of language acquisition abilities in children.

The role of color cues in facilitating accurate and rapid location of aided symbols by children with and without down syndrome

from the American Journal of Speech-Language Pathology

PURPOSE: This research examined how the color distribution of symbols within a visual aided augmentative and alternative communication array influenced the speed and accuracy with which participants with and without Down syndrome located a target picture symbol. METHOD: Eight typically developing children below the age of 4 years, 8 typically developing children over the age of 4 years, and 10 children with Down syndrome participated. Participants were asked to find a target line drawing among an array of 12. Line drawings represented either foods (e.g., grapes, cherries), clothing (e.g., a red shirt, a yellow shirt), or activities (e.g., soccer, swimming). In one condition, symbols that shared a color were clustered together, creating a subgroup within which to search. In another condition, symbols that shared a color were distributed across the display, allowing each to appear individually. Dependent measures were accuracy and speed of finding the target symbol. RESULTS: Clustering same-color symbols facilitated the speed of locating the target for all participants, and facilitated search accuracy in the younger preschool children and participants with Down syndrome. These effects held when targets were foods, clothing, or activities. CONCLUSION: Clinicians should consider the internal color of visual symbols when constructing aided symbol displays, at least for children with Down syndrome. Further research is needed on a number of dimensions, however, including visual processing in other etiological categories, the role of background color, and the relation of color to other stimulus dimensions.

Using semantic feature analysis to improve contextual discourse in adults with aphasia

from the American Journal of Speech-Language Pathology

PURPOSE: Semantic feature analysis (SFA) was used to determine whether training contextually related words would improve the discourse of individuals with nonfluent aphasia in preselected contexts. METHOD: A modified multiple-probes-across-behaviors design was used to train target words using SFA in 3 adults with nonfluent aphasia. Pretreatment, posttreatment, and follow-up sessions obtained language samples for the preselected contexts. Contexts included 4 story retellings and 4 procedure explanations. RESULTS: All participants improved naming ability for treated words. No generalization to untrained items was found. Within discourse samples, participants increased number of target words produced from pretreatment to posttreatment sessions but did not increase lexical diversity across samples. Participants maintained performance on standardized measures from the beginning to the end of the study. CONCLUSIONS: Results support and extend previous research by indicating that SFA improves confrontational naming ability and may benefit word retrieval in discourse production of closed-set contexts.

Deaf Child Worldwide Launches Family Friendly Resource

from Medical News Today.com

Deaf Child Worldwide, the only UK-based international development agency dedicated to enabling deaf children to overcome poverty and isolation, has launched a new action learning resource to help organisations working with deaf children and families throughout the world.

Sequential bilateral hearing loss in multiple sclerosis

from Annals of Otology, Rhinology, and Laryngology

OBJECTIVES: We describe a case of multiple sclerosis presenting with sequential bilateral hearing loss. METHODS: A 46-year-old woman underwent a series of audiological and neurologic evaluations for sequential bilateral hearing losses that occurred 6 months apart. RESULTS: Initially, the patient suffered from sudden left hearing loss, and magnetic resonance imaging documented an enhancing lesion in the left middle cerebellar peduncle. Six months later, another episode of sudden vertigo, right hearing loss, and right facial palsy developed. Magnetic resonance imaging disclosed a new lesion in the right middle cerebellar peduncle. CONCLUSIONS: Sequential bilateral hearing loss may be a manifestation of multiple sclerosis. In younger patients with sudden hearing loss, multiple sclerosis should be included in the differential diagnosis.

Bilateral stapedectomy: association between first- and second-ear surgical findings and their effects on the second-ear outcome

from Annals of Otology, Rhinology, and Laryngology

OBJECTIVES: We assessed the association between first-ear and second-ear surgical findings in patients undergoing second-ear stapedectomy for bilateral otosclerosis and the impact of such findings on the audiometric outcome of the second ear. METHODS: A retrospective chart review of all stapedectomy patients who underwent stapes surgery by one of two surgeons in a single tertiary referral institution from 1962 to 2001 was performed, and those patients who underwent bilateral stapedectomy were identified. Patient demographic data, surgical findings, procedure performed, and preoperative and postoperative audiometric data were recorded. RESULTS: A total of 459 patients (918 ears) underwent bilateral stapedectomy for bilateral otosclerosis during the study period, of whom 426 had complete data for analysis. The finding of a white or obliterated footplate in the second ear was significantly higher if the first ear had this disease manifestation (p < .001, chi2 test). The association between a second drill-out’s being performed and a drill-out in the first operation was significant (p < .001, chi2 test). Statistical analysis identified that those who underwent a drill-out procedure had a 2.9-fold increase in unsuccessful outcome in comparison to those who did not have a drill-out (odds ratio, 2.89; 95% confidence interval, 1.41 to 5.89). Facial nerve anomalies were infrequently encountered, affecting only 23 patients, of whom 3 had bilateral abnormalities. The finding of an overhanging or dehiscent facial nerve in the second ear was significantly more likely if such an abnormality was identified during the first procedure (23% versus 2.5%; p = .005, Fisher’s exact test). CONCLUSIONS: Second-ear hearing results are poorer in those who require a drill-out of this ear, and this is more likely to be required if a drill-out was required in the first ear, regardless of a successful outcome of the first procedure. Patients should be aware of the reduced likelihood of success in these cases and be counseled regarding risks and benefits of second-ear surgery based, in part, on the findings from the first ear. This study confirms that bilateral advanced footplate obliteration and overhanging or dehiscent facial nerves may be anticipated in patients found to have these abnormalities during first-ear stapedectomy.

Clinical Training Course: Vocal, Pulmonary and Olfactory Rehabilitation After Total Laryngectomy

from the National Library for Health

For further information contact:

Frans J M Hilgers
Event Tel: Tel: +31 20 512 2550
Event Fax: Fax: +31 20 512 2554
Event Website:
Event Email: Email: kno@nki.nl

Where:Amsterdam, The Netherlands
When:27 Nov 2008 10:00 – 28 Nov 2008 16:00

Outcomes in clinical research – whose responsibility?

from the National Library for Health

A seminar organised jointly by the James Lind Alliance and the Social Science Research Unit, Institute of Education, Thursday 20th November 2008, 10am – 4.15pm, Venue: Institute of Education, University of London.

Aims of the seminar:

Promote debate about the role of patients, clinicians and researchers in determining clinical research outcomes
Provide examples of Patient Reported Outcome programmes, and Patient Important Outcome programmes
Explore how best to progress patient engagement in influencing clinical research outcomes
Promote networking of researchers, patient groups, clinicians, charities, and other funders of health research

For further information contact:

Marty Kilby, Mutfords, Hare Street, Buntingford, Herts, SG9 0ED marty.kilby@virgin.net, Tel: +44 (0)1763 289191, Fax: +44 (0)1763 289888

Where:London
When:20 Nov 2008 10:00 – 16:15

Pilot study of universal newborn hearing screening in Japan: district-based screening program in Okayama

OBJECTIVES: Newborn hearing screening was started in Okayama Prefecture in 2001 as part of a nationwide pilot study in Japan. Nearly 50,000 infants have been screened to date, and an observational study and more than 2 years of follow-up of this population are described in this report. METHODS: Between June 2001 and March 2005 (45 months), 47,346 neonates were screened with automated auditory brain stem response systems and followed up for at least 2 years. This total corresponds to 95% of the infants born in the 44 gynecologic institutions in this district. RESULTS: After undergoing the screening process twice, 248 infants (0.52%) received referrals; 108 of them had apparent bilaterally affected hearing, and 140 had apparent unilaterally affected hearing. Among the bilateral cases, hearing impairment was diagnosed in 40 infants, for a total prevalence of hearing impairment of 0.08%. In 3 additional infants who received a bilateral pass result and 1 infant who received a unilateral pass result, hearing impairment that was progressive or of late onset was subsequently diagnosed. The positive and negative predictive values were calculated as 40% and 99.993%, respectively. CONCLUSIONS: The screening program was carefully designed to work in the Japanese society and to be well managed in Okayama Prefecture.

Reliability of the perceptual evaluation of adductor spasmodic dysphonia

from Annals of Otology, Rhinology, and Laryngology

OBJECTIVES: Although perceptual assessment by experienced voice clinicians remains the gold standard for the diagnosis and assessment of severity of adductor spasmodic dysphonia (ADSD), the interrater reliability of voice experts for this task has not been assessed. In addition, it is unknown whether telephone-recorded or -transmitted voice samples could be used for this task. The aims of this study were (1) to assess the reliability of perceptual analysis of ADSD severity by voice experts and (2) to compare the results between digitally recorded voice samples and those recorded over the telephone. METHODS: Five laryngologists randomly selected voice samples from 46 ADSD patients and rated the severity of ADSD on a 5-point rating scale. A set of digital voice recordings and a set of telephone voice recordings made from filtering the digital set via the telephone were rated, and each voice set was rated twice. Measures of intrarater and interrater reliability, as well as a measure of the probability of agreement among the raters, were calculated. RESULTS: There was a high level of agreement on ADSD severity, with excellent interrater and intrarater reliability (Cronbach’s alpha, .93 to .96). The probabilities of rater agreement on the digitally recorded and telephone-filtered voice samples were similar (chi2, p = .07). The ratings of digital versus telephone voice samples were highly correlated (Pearson r, 0.99; p < .001). CONCLUSIONS: These results demonstrate that voice experts are reliably able to judge and agree on the severity of ADSD. Telephone-filtered voices appear to convey adequate ADSD perceptual cues for expert listeners to judge the severity of spasmodic dysphonia.