Conclusions: The available evidence does not support strong claims concerning the diagnostic accuracy of these measures, but a number appear promising. Several steps are suggested for strengthening future investigations of diagnostic accuracy.
Identification and nursing management of dysphagia in individuals with acute neurological impairment (update)
Results Forty-two quantitative studies were retrieved and, of these, 17 met the inclusion and quality criteria, representing a wide range of quantitative research methodologies. The evidence from this updated review indicates that nurses are well placed to conduct dysphagia screening and that there are several tools available that may be suitable for them to use. It is important that formal dysphagia screening protocols are in place and that nurses are trained to use them. If nurses screen patients with an acute neurological impairment within 24 h of admission, it may reduce the time that patients spend without appropriate methods of nutrition and hydration and improve clinical outcomes. Dysphagia screening by nurses does not replace assessment by other health professionals; instead it enhances the provision of care to patients at risk by allowing for early recognition and intervention to occur. Dysphagia screening by nurses is an important initial step in the care of patients with acute neurological impairment, but in order to achieve the best outcomes, it needs to be followed up with careful, consistent management of food and fluid intake.
Conclusion: Collaborative research reflecting higher levels of evidence using rigorous experimental designs is needed to compare the relative benefits of different intervention approaches.
Evidence-Based Practice for Children With Speech Sound Disorders: Part 2 Application to Clinical Practice
Conclusion: SLPs need to use their clinical expertise to integrate research findings with the constraints and complexities of everyday clinical practice and client factors, values, and preferences in their management of SSDs in children.
This article looks back over the years and identifies some of the most influential thinkers, writers, and researchers who have had a profound effect on the way the therapy at the Michael Palin Centre for Stammering Children in London has evolved. It tracks the changes that have occurred in theoretical perspective, treatments offered, and the delivery of therapy. In particular this author is interested in the changing nature of the therapeutic relationship between professionals and people who stutter (PWS), and describes the way it has developed from the “expert professional” towards a more collaborative relationship that recognises the “expert patient”. It was inspired by a book written in 1902 by Mr Beasley, a person who stammered. After several unsuccessful attempts to find a ’cure’ he found his own solution to his stuttering and then used what he had learned to help many others. Much of what he wrote was well ahead of his time and reminds us, the professionals, of the importance of listening to and taking account of the views of PWS in therapy and designing treatment that meets the needs of the individual. This article also looks briefly at evidence based practice (EBP) and the issues involved in measuring outcomes that reflect the complex and individual nature of the problem. Finally the importance of the research in developing the knowledge and skill base of clinicians as well as PWS is acknowledged and discussed and the way ahead signposted.
This paper reviews the evidence on sight word instruction as a method of teaching students with autism and significant cognitive and verbal limitations to read printed words. Nine single-subject studies were rated using Reichow et al.’s (J Autism Dev Disord 38:1311–1319, 2008) evaluative method for identifying evidence-based practice, and studies with at least adequate methodology were analyzed to identify common intervention features. Results yielded evidence in support of a massed trials approach featuring student response to a succession of items, differential positive reinforcement, systematic prompting, and use of visual supports. Across studies, students learned to identify printed words, even those with limited oral language and no prior reading instruction. However, no studies addressed the effects of sight word instruction on broad literacy outcomes.
Conclusion: Treatment fidelity is a neglected construct in the EBP literature; however, fidelity is a crucial construct for documenting intervention effectiveness and engaging in EBP.
An introduction to the speechBITE database: Speech pathology database for best interventions and treatment efficacy
This paper describes the development of the Speech Pathology Database for Best Interventions and Treatment Efficacy (speechBITE) at The University of Sydney. The speechBITE database is designed to provide better access to the intervention research relevant to speech pathology and to help clinicians interpret treatment research. The challenges speech pathologists face when locating research to support evidence-based practice have been well documented and include inadequate time resources and difficulties in navigating and using a multiplicity of electronic databases. These barriers are addressed by speechBITE by providing the first open-access database on the internet that solely indexes treatment in the area of communication and swallowing disorders. The database includes the bibliographic details from systematic reviews, randomized controlled trials, nonrandomized controlled trials, case series, and single-case experimental design studies. At present, randomized and nonrandomized controlled trials are rated with the Physiotherapy Evidence Database (PEDro) scale to assist clinicians with interpreting the methodological quality of the clinical studies of relevance to speech pathologists.
Purpose: A systematic review was conducted to summarize and evaluate the literature on the effectiveness of speech pathology interventions in adults with neuromuscular diseases. Method: Databases searched included the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, EMBASE, PsycINFO and PubMed. A total of 1,772 articles were independently screened on title and abstract by 2 reviewers. Results: No randomized controlled trials or clinical controlled trials were found. Four other designs were included. Only one study on oculopharyngeal muscle dystrophy (OPMD) appeared to have sufficient methodological quality. There is evidence indicating that correction of head position in patients with OPMD improves swallowing efficiency (level III evidence). Conclusion: Despite 1,772 studies, there is only evidence of level III regarding the effectiveness of speech pathology interventions in patients with OPMD. Recommendations for future research are given.
Evidence Based Practice requires that clinical decisions be based on evidence from rigorously controlled research studies. At this time, very few studies have directly examined the efficacy of clinical intervention methods for bilingual children. Clinical decisions for this population cannot, therefore, be based on the strongest forms of research evidence, but must be inferred from other sources. This article reviews the available intervention research on bilingual children, the current clinical recommendations for this population, and the strength of the empirical and theoretical support on which these recommendations are based. Finally, future directions are suggested for documenting current methods of intervention and developing optimal methods for different groups of bilingual children. Although the current research base is limited, the few studies available to date uniformly suggest that interventions that include a focus on both languages are superior to those that focus on only one language. The available research offers little guidance, however, as to the particular treatment methods that may be most appropriate. Further research is required to examine efficacy with larger numbers of children and children of various bilingual backgrounds. It is suggested that efforts to develop and test intervention methods for bilingual children must carefully consider the linguistic heterogeneity of bilingual children and the cultural variation in communication styles, child rearing practices, and child rearing beliefs. This will lead to the development of methods that may involve treatment methods that are more suitable for other languages and cultures.
from the Journal of Communication Disorders
Evidence-Based Systematic Review: Effects of Different Service Delivery Models on Communication Outcomes for Elementary School–Age Children
Lacking adequate research-based evidence, clinicians must rely on reason-based practice and their own data until more data become available concerning which service delivery models are most effective. Recommendations are made for an expanded research agenda.
Replicated evidence of satisfactory 1- and 2-year post-treatment outcomes has been reported for the Comprehensive Stuttering Program (CSP). However, little is known about longer-term outcomes of the CSP. Yearly follow-up measures were obtained from 18 participants for 5 consecutive years. At 5-years follow-up, participants were maintaining clinically and statistically significant reductions in stuttering and increases in rates of speech relative to pre-treatment measures. Standardized effect sizes were large. There were no significant differences among the immediate post-treatment and five follow-up measures, indicating that speech gains achieved by the end of the treatment program were stable over the 5-year follow-up period. Insufficient return rates for self-report data for the third to fifth follow-up measurement occasions prohibited analyzing these data. However, non-significant differences among the immediate post-treatment and two follow-up measures indicated that improvements achieved by the end of treatment in speech related confidence, and perceptions of struggle, avoidance, and expectancy to stutter were stable over the 2-year follow-up period. Significant differences among the speech related communication attitudes scores indicated that improvements in attitudes made at the end of the treatment program were less stable. Taken together, these results provide further and longer-term evidence of the effectiveness of the CSP.
Epidemiological research was used to develop the Speech Disorders Classification System (SDCS). The SDCS is an important speech diagnostic paradigm in the field of speech-language pathology. This paradigm could be expanded and refined to also address treatment while meeting the standards of evidence-based practice. The article assists that process by initiating a clinical exchange of ideas on the topic of speech treatment. It explores: (a) the treatment of children with speech oral placement disorders (OPD; a new term suggested by the authors), (b) the various types of speech oral placement therapy (OPT) used to treat OPD, (c) the relationships of OPT to current motor learning theories and oral motor treatment, as well as (c) the critical need for appropriately designed, systematic research on OPT.
Data Recycling: Using Existing Databases to Increase Research Capacity in Speech-Language Development and Disorders
Conclusion: Researchers invested in addressing basic and applied problems of relevance to speech and language services in schools can make use of a variety of extant databases to increase research capacity.
Building speech-language pathologist capacity for evidence-based practice: A unique graduate course approach
A speech-language pathology graduate-level course using the systematic review and meta-analytic process as a learning tool is described. The course design, content, activities, and pedagogical methods are discussed in depth. Three groups of students worked collaboratively to produce three systematic reviews in the area of language and literacy. This course provided a framework for the completion of the reviews and the development of the students as expert consumers of research. It is suggested that this course framework be used as a tool for building speech-language pathologist capacity in the use of evidence-based decision making.