[The S3 Guideline on the Treatment of Language Development Disorders: Summary of Recommendations]. / Die S3-Leitlinie zur Therapie von Sprachentwicklungsstörungen.

The S3 Guideline on the Treatment of Language Development Disorders: Summary of Recommendations Abstract: The German S3 Guidelines on the Treatment of Developmental Speech and Language Disorders (AWMF: No. 049-015) were published on the AWMF homepage at the end of 2022. The German Society for Phoniatrics and Paedaudiologie coordinated the work and developed the guideline text together with linguists and speech and language therapists. Many scientific medical societies consented to the respective recommendations. For the first time in the German-speaking area, the guideline group reviewed international research results on the treatment of various speech and language disorders and formulated evidence- or consensus-based recommendations for clinical care. The present article summarizes these recommendations and evaluates the guidelines from the perspective of child and adolescent psychiatry and psychotherapy.

The Effectiveness of Individualized Morphosyntactic Target Identification and Explicit Intervention Using the SHAPE CODING System for Children With Developmental Language Disorder and the Impact of Within-Session Dosage.

PURPOSE: We investigated the effectiveness of a highly individualized morphosyntactic intervention using the SHAPE CODING™ system delivered at different dosages. METHOD: Eight children with developmental language disorder aged 8;0-10;10 (years;months) received 10 hr of explicit individualized intervention for morphosyntax delivered in 30-min individual sessions once per week for 20 weeks. Following at least four baseline probe tests, two grammatical targets per session received explicit instruction until they reached criterion (90%), when the next target was introduced. To control for session length and teaching episode density, either both targets received 20 teaching episodes per session or one target received 10 teaching episodes and the other 30. Maintenance testing of completed targets was also carried out. RESULTS: Scores on probe tests post-intervention were significantly higher than during the baseline phase (d = 1.6) with no change during the baseline or maintenance phases. However, progress during the intervention phase was highly significant. One participant showed significantly faster progress with intervention, while one (with the lowest attention score) made little progress. When considering progress relative to cumulative intervention sessions, progress was faster with 30 teaching episodes per session and slower with 10. However, when cumulative teaching episodes were used as the predictor, all three within-session dosages showed very similar rates of progress, with the odds of a correct response increasing by 3.9% for each teaching episode. The targets that were achieved required an average of 40-60 teaching episodes. CONCLUSIONS: With the exception of one participant, the individualized intervention was highly effective and efficient. Thus, the individualized target identification process and intervention method merit further research in a larger group of children. The cumulative number of teaching episodes per target provided across sessions appeared to be key. Thus, clinicians should aim for high teaching episode rates, particularly if the number of sessions is constrained. Otherwise, intervention scheduling can be flexible. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25996168.

The Efficacy of Story Champs for Improving Oral Language in Third-Grade Spanish-English Bilingual Students With Developmental Language Disorder.

PURPOSE: We investigated the efficacy of Story Champs for improving oral language in third-grade Spanish-English bilingual children with developmental language disorder (DLD). METHOD: We implemented a concurrent multiple-baseline across-participants single-case design with four bilingual Spanish-English third-grade students with DLD. Treatment was carried out over 12 sessions with approximately two sessions per week. Maintenance sessions were conducted 1, 2, and 4 weeks postintervention. Participants were explicitly taught story grammar elements, causal and temporal connections, and modifiers within story retells and personal narratives. Dependent variables were story grammar, grammatical complexity, modifiers and listening comprehension within story retells, and story grammar and grammatical complexity within personal narratives. Outcome measures were assessed at the end of every baseline, intervention, and maintenance session using the Narrative Language Measures-Listening (NLM-L). RESULTS: Visual analyses for outcome measures suggested slight increases in scores on the NLM-L during intervention accompanied by marked variability. Within-case analyses of story retell performance suggested an intervention effect on story grammar for two participants and on grammatical complexity and modifier use for one participant. For personal narratives, within-case analyses of personal narrative performance suggested an intervention effect on story grammar for one participant. CONCLUSIONS: Overall, Story Champs demonstrated efficacy for improving story grammar use in story retells for three out of four participants. It did not show efficacy for improving grammatical complexity, modifier use, or listening comprehension within story retells, nor did it show efficacy for improving story grammar and grammatical complexity within personal narratives. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.26053033.

The Feasibility of an Online Language Program Delivered Through Music and the Impact of Dosage on Vocabulary Outcomes in Young Children With Down Syndrome.

BACKGROUND: Few studies have explored the feasibility of online language interventions for young children with Down syndrome. Additionally, none have manipulated dose frequency or reported on the use of music as a medium through which language and sign can be learned. PURPOSE: The purpose of this study was to (a) examine the feasibility and acceptability of an online language through music intervention for young children (1-3;6 years) with Down syndrome and (b) compare effectiveness at two intervention dose frequencies. METHOD: The study was carried out in two phases using a mixed-methods design. Phase 1: Qualitative data were gathered from parents to examine feasibility when implementing a video-based language intervention. Phase 2: Seventy-six families participated in an online language intervention at home. Effectiveness was examined comparing two groups, randomly assigned to a high and low dose frequency. The Down Syndrome Education (DSE) checklists (combined) were the primary outcome measure. Process data were gathered to determine intervention acceptability in practice and to identify factors that would improve successful future implementation. Acceptability data were analyzed with reference to the theoretical framework of acceptability (Version 2). RESULTS: Forty-three parents completed the Phase 1 scoping questionnaire, five of whom took part in focus groups. Once weekly morning sessions were indicated as the preferred scheduling choice. Phase 2 quantitative data were analyzed using beta regression adjusted for baseline scores and indicated no additional benefit to receiving the higher dose. However, exploratory interaction models suggested that the efficacy of the high-dose intervention was higher (than low-dose intervention) in participants with higher baseline DSE performance. Parents perceived the intervention to be effective and positive for the family. CONCLUSION: The results add to our knowledge of real-world effective online interventions and suggest that a critical minimum language level is required for children with Down syndrome to benefit optimally from a higher intervention dose frequency. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25979704.

A feasibility randomised waitlist-controlled trial of a personalised multi-level language treatment for people with aphasia: The remote LUNA study.

BACKGROUND: Stroke survivors with aphasia want to improve their everyday talking (discourse). In current UK practice, 90% of speech and language therapists believe discourse assessment and treatment is part of their role but are hampered by barriers in resources, time and expertise. There is a clinical need for well-articulated discourse assessment and treatments. LUNA is a multi-level treatment targeting words, sentences and discourse macrostructure in personal stories that addresses this clinical need. OBJECTIVES: This study aimed to assess the feasibility and acceptability of LUNA trial procedures in a randomised waitlist-controlled trial; and to evaluate preliminary efficacy. METHODS: This paper reports a phase II, waitlist-controlled, proof-of-concept feasibility trial. Participants with chronic aphasia (n = 28) were recruited from the community and randomised to an Immediate (n = 14) or Delayed (n = 14) group. LUNA treatment was delivered twice weekly for 10 weeks via the videoconferencing technology, Zoom. Feasibility was assessed in terms of participant recruitment and retention, adherence, missing data, and treatment fidelity. Preliminary treatment efficacy was assessed in terms of between group differences in outcome measures relating to discourse, language, and psychosocial state. RESULTS: The remote LUNA trial was feasible: 85% of those eligible consented to the trial; trial retention was 86%; 87% of treatment sessions were delivered as scheduled, and 79% of participants completed 80%+ of the treatment programme; data was missing only for participants who withdrew; treatment fidelity was high at 92% adherence; and only one clinical outcome measure demonstrated ceiling effects. ANCOVA analysis of the clinical outcome measures revealed group differences with medium and large effect sizes, indicating, improvements in the production of words, sentences, discourse macrostructure, overall language functioning (WAB-R), and psychosocial state (VAMS) following LUNA treatment. For most outcomes measured, similar treatment benefits were suggested in a secondary, non-parametric analysis. CONCLUSIONS: Large-scale evaluation of the clinical efficacy and cost-effectiveness of LUNA is warranted and supported by these findings. TRIAL REGISTRATION: Clinical trials registration: NCT05847023 (clinical trials.gov).

Does SLT combined with NIBS enhance naming recovery in post-stroke aphasia? A meta-analysis and systematic review.

BACKGROUND: Non-invasive brain stimulation has been widely used as an adjunctive treatment for aphasia following stroke. OBJECTIVE: The aim of this study was to investigate the effect of non-invasive brain stimulation as an adjunctive treatment on naming function in aphasia following stroke. METHODS: This review included randomized controlled trials (RCTs) involving 5 databases (Web of Science, Embase, Cochrane Library, OVID and PubMed) that investigated the effects of electrical stimulation on stroke patients. The search included literature published up to November 2023. RESULTS: We identified 18 studies, and the standardized mean differences (SMDs) showed that the effect sizes of TMS and tDCS were small to medium. Moreover, the treatment effects persisted over time, indicating long-term efficacy. CONCLUSION: This study suggested that NIBS combined with speech and language therapy can effectively promote the recovery of naming function in patients with post-stroke aphasia (PSA) and that the effects are long lasting.

Group Size: An Active Ingredient of School-Based Language Therapy.

PURPOSE: This study explored the relation between therapy group size and language outcomes for children receiving school-based language therapy through an implementation science lens. METHOD: Data for the current study were gathered as part of the Speech-Language Therapy Experiences in Public Schools study. Participants included 273 English-speaking kindergarten through second-grade children with language impairment receiving business-as-usual therapy on the caseloads of 75 speech-language pathologists. Data were collected over an academic year, including weekly therapy logs, speech-language pathology questionnaires, and pre- and post-language measures. RESULTS: Descriptive analysis revealed that children primarily experienced small-group therapy sessions (two to four children); however, there was considerable variability in group size. Hierarchical general linear modeling indicated that caseload size did not explain group size variability. However, the number of student cancellations was positively associated with receipt of large-group sessions. Notably, a significant negative association was found between receipt of large-group sessions (i.e., five to 10 children) and language outcomes. Children who received more than the average number of sessions in large groups (i.e., more than 5% of total sessions) experienced 0.18 SD less language gain over the academic year compared to the mean (0.54 SD). No other group size configurations (i.e., individual, small group, and extra large) yielded significant associations with language outcomes. CONCLUSIONS: The findings suggest that young children receiving language-based therapy in large groups make substantially fewer language gains over an academic year. These results have considerable implications for educational policy and clinical practice, which are discussed through an implementation science frame.

Study protocol for Hear Me Read (HMR): A prospective clinical trial assessing a digital storybook intervention for young children who are deaf or hard of hearing.

Since the early 2000's, digital reading applications have enhanced the language and literacy skills of typically hearing young children; however, no digital storybook intervention currently exists to scaffold the early language and literacy skills of their peers who are deaf or hard of hearing. To address this gap, our research team developed a novel digital storybook intervention called Hear Me Read with the aim of enhancing the therapeutic, language, and literacy benefits of speech-language therapy. This prospective clinical trial (registered at clinicaltrials.gov, NCT#: 05245799) aims to determine the efficacy of adding Hear Me Read to in-person speech-language therapy for children aged three to five years who are deaf or hard of hearing. Fifty caregivers, their child, and their child's treating speech-language pathologist participate in the trial for 12 months. In the first six months, children attend standard-of-care speech-language therapy sessions. In the second six months, children continue to attend standard-of-care speech-language therapy sessions and use the Hear Me Read application, via a study supplied iPad. The primary outcome of this trial is that, compared to in-person speech-language therapy alone, in-person speech-language therapy with Hear Me Read will improve vocabulary, speech, and language outcomes in children aged three to five years who are deaf or hard of hearing. The secondary outcome is that, compared to in-person speech-language therapy alone, in-person speech-language therapy with Hear Me Read will improve literacy outcomes in children aged three to five years who are deaf or hard of hearing. The goal of this intervention is to help children who are deaf or hard of hearing achieve their vocabulary, speech, language, and literacy goals through interactive digital storybook reading.

Functional neuroimaging and behavioral correlates of multisite tDCS as an add-on to language training in a person with post-stroke non-fluent aphasia: a year-long case study.

Mary, who experienced non-fluent aphasia as a result of an ischemic stroke, received 10 years of personalized language training (LT), resulting in transient enhancements in speech and comprehension. To enhance these effects, multisite transcranial Direct Current Stimulation (tDCS) was added to her LT regimen for 15 sessions. Assessment using the Reliable Change Index showed that this combination improved her left inferior frontal connectivity and speech production for two months and significantly improved comprehension after one month. The results indicate that using multisite transcranial direct current stimulation (tDCS) can improve the effectiveness of language therapy (LT) for individuals with non-fluent aphasia.

The effectiveness of interprofessional peer-led teaching and learning for therapeutic radiography students and Speech and Language Therapy students.

BACKGROUND: Therapeutic Radiographers (RT) and Speech and Language Therapists (SLT) work closely together in caring for people with head and neck cancer and need a strong understanding of each others' roles. Peer teaching has been shown to be one of the most effective methods of teaching; however, no studies to date, have involved RT and SLT students. This research aims to establish the effectiveness and perceptions of peer-led teaching between undergraduate RT and SLT students in Ulster University. METHODS: Twenty SLT students and 14 RT students participated. Knowledge tests were taken online before the peer-led teaching session (T1), after the session (T2) and 3 months later (T3). Students' perceptions of the experience were collected at the end of the session. Wilcoxon signed-rank tests were used to analyse the impact of the intervention on knowledge scores. Qualitative content analysis was used for open text response data. RESULTS: RT students' own professional knowledge score at T2 was statistically significantly higher than the score at T1; the score at T3 was not deemed to be statistically significantly higher. RT students' SLT knowledge score at T2 and T3 was found to be statistically significantly higher than the score at T1. SLT students' own professional knowledge score was not statistically significantly higher at T2 or T3 than T1. They did have a statistically significantly higher score at T2 on the RT test, but score at T3 was not deemed to be statistically significantly higher. The majority of students across both professions agreed or strongly agreed that the peer-led teaching experience had a positive impact on their learning. CONCLUSION: This investigation highlights the benefits of an interprofessional peer-led teaching intervention for RT and SLT students and the findings add to the evidence of more objective study of knowledge gain as a result of interprofessional peer teaching.

Non-pharmacological interventions for improving language and communication in people with primary progressive aphasia.

BACKGROUND: Primary progressive aphasia (PPA) accounts for approximately 43% of frontotemporal dementias and is mainly characterised by a progressive impairment of speech and communication abilities. Three clinical variants have been identified: (a) non-fluent/agrammatic, (b) semantic, and (c) logopenic/phonological PPA variants. There is currently no curative treatment for PPA, and the disease progresses inexorably over time, with devastating effects on speech and communication ability, functional status, and quality of life. Several non-pharmacological interventions that may improve symptoms (e.g. different forms of language training and non-invasive brain stimulation) have been investigated in people with PPA. OBJECTIVES: To assess the effects of non-pharmacological interventions for people with PPA on word retrieval (our primary outcome), global language functions, cognition, quality of life, and adverse events. SEARCH METHODS: We searched the Cochrane Dementia and Cognitive Improvement Group's trial register, MEDLINE (Ovid SP), Embase (Ovid SP), four other databases and two other trial registers. The latest searches were run on 26 January 2024. SELECTION CRITERIA: We included randomised controlled trials (RCTs) evaluating the effects of non-pharmacological interventions in people with PPA. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: There were insufficient data available to conduct the network meta-analyses that we had originally planned (due to trial data being insufficiently reported or not reported at all, as well as the heterogeneous content of the included interventions). Therefore, we provide a descriptive summary of the included studies and results. We included 10 studies, with a total of 132 participants, evaluating non-pharmacological interventions. These were: transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) as stand-alone treatments (used by two and one studies, respectively); tDCS combined with semantic and phonological word-retrieval training (five studies); tDCS combined with semantic word-retrieval training (one study); and tDCS combined with phonological word-retrieval training (one study). Results for our primary outcome of word retrieval were mixed. For the two studies that investigated the effects of tDCS as stand-alone treatment compared to placebo ("sham") tDCS, we rated the results as having very low-certainty evidence. One study found a significant beneficial effect on word retrieval after active tDCS; one study did not report any significant effects in favour of the active tDCS group. Five studies investigated tDCS administered to the dorsolateral prefrontal cortex, inferior frontal cortex, left frontotemporal region, or the temporoparietal cortex, combined with semantic and phonological word-retrieval training. The most consistent finding was enhancement of word-retrieval ability for trained items immediately after the intervention, when behavioural training was combined with active tDCS compared to behavioural training plus sham tDCS. We found mixed effects for untrained items and maintenance of treatment effects during follow-up assessments. We rated the certainty of the evidence as very low in all studies. One study investigated tDCS combined with semantic word-retrieval training. Training was provided across 15 sessions with a frequency of three to five sessions per week, depending on the personal preferences of the participants. tDCS targeted the left frontotemporal region. The study included three participants: two received 1 mA stimulation and one received 2 mA stimulation. The study showed mixed results. We rated it as very low-certainty evidence. One study investigated tDCS combined with phonological word-retrieval training. Training was again provided across 15 sessions over a period of three weeks. tDCS targeted the left inferior frontal gyrus. This study showed a significantly more pronounced improvement for trained and untrained words in favour of the group that had received active tDCS, but we rated the certainty of the evidence as very low. One study compared active rTMS applied to an individually determined target site to active rTMS applied to a control site (vertex) for effects on participants' word retrieval. This study demonstrated better word retrieval for active rTMS administered to individually determined target brain regions than in the control intervention, but we rated the results as having a very low certainty of evidence. Four studies assessed overall language ability, three studies assessed cognition, five studies assessed potential adverse effects of brain stimulation, and one study investigated quality of life. AUTHORS' CONCLUSIONS: There is currently no high-certainty evidence to inform clinical decision-making regarding non-pharmacological treatment selection for people with PPA. Preliminary evidence suggests that the combination of active tDCS with specific language therapy may improve impaired word retrieval for specifically trained items beyond the effects of behavioural treatment alone. However, more research is needed, including high-quality RCTs with detailed descriptions of participants and methods, and consideration of outcomes such as quality of life, depressive symptoms, and overall cognitive functioning. Moreover, studies assessing optimal treatments (i.e. behavioural interventions, brain stimulation interventions, and their combinations) for individual patients and PPA subtypes are needed. We were not able to conduct the planned (network) meta-analyses due to missing data that could not be obtained from most of the authors, a general lack of RCTs in the field, and heterogeneous interventions in eligible trials. Journals should implement a mandatory data-sharing requirement to assure transparency and accessibility of data from clinical trials.

We Have to Talk About Something: Why NOT Talk About the Curriculum? A Guide to Embedding Language Interventions in Curricular Content.

PURPOSE: Children with developmental language disorder frequently have difficulty with both academic success and language learning and use. This clinical focus article describes core principles derived from a larger program of research (National Science Foundation 1748298) on language intervention combined with science instruction for preschoolers. It serves as an illustration of a model for integrating language intervention with curricular content delivery. METHOD: We present a five-step model for a speech-language pathologist and other school professionals to follow to (a) understand the grade-level core curriculum objectives; (b) align intervention targets with the curriculum; (c) select a therapy approach that aligns with both goals and curricular content, and (d) methods for implementing the intervention; and (e) verify that both the intervention and the curriculum have been provided in accordance with best practices. We apply this model to the Next Generation Science Standards, a science curriculum popular in the United States, and to grammar and vocabulary interventions, two areas of difficulty for children with developmental language disorders, though it would be possible to extend the steps to other curricular areas and intervention targets. CONCLUSIONS: We conclude by discussing the barriers and benefits to adopting this model. We recognize that both speech-language pathologists and teachers may have limited time to implement language intervention within a general education curriculum, but we suggest that the long-term benefits outweigh the barriers.

Contextualized, Multicomponent Language Instruction: From Theory to Randomized Controlled Trial.

PURPOSE: Clinicians address a wide range of oral language skills when working with school-age students with language and literacy difficulties (LLDs). Therefore, there is a critical need for carefully designed, rigorously tested, multicomponent contextualized language interventions (CLIs) that have a high likelihood of successful implementation and measurable academic impacts. This clinical focus article summarizes the development and testing of a CLI entitled Supporting Knowledge in Language and Literacy (SKILL), which is a supplementary narrative intervention program for elementary school-age children. Our aims are to (a) to review the foundational theoretical models that are the foundation of SKILL; (b) describe the iterative process used to develop the phases, lessons, procedures, materials, and progress monitoring tool; (c) summarize recent findings of the randomized controlled trial that was conducted to test its efficacy; and (d) discuss factors that may contribute to successful implementation of multicomponent language interventions. METHOD: A total of 357 students in Grades 1-4 with LLDs were randomized to a treatment group or to a business-as-usual control group. The treatment group received the SKILL curriculum in small groups during 30-min lessons by trained speech-language pathologists, teachers, and special educators. RESULTS: Students who received SKILL significantly outperformed those who did not on oral and written measures of storytelling and comprehension immediately after treatment and after 5-months at follow-up. Gains were similar among students with different levels of language ability (at-risk, language impaired) and language status (monolingual, bilingual) at pretest. CONCLUSIONS: There is growing support for the use of multicomponent CLIs to bring about educationally relevant outcomes for students with LLDs. The authors present this review of how SKILL was designed, manualized, and rigorously tested by a team of researchers and practitioners with the hope that this approach will serve as a springboard for the development of future multicomponent CLIs that may meaningfully improve communicative and educational outcomes for students with LLDs.

Quantifying Dosage in Self-Managed Speech-Language Therapy: Exploring Components of Cumulative Intervention Intensity in a Real-World Mobile Health Data Set.

PURPOSE: Cumulative Intervention Intensity (CII) is a proposed framework for conceptualizing and calculating dose that has been used to quantify intensity of speech-language therapy (SLT) in highly controlled laboratory studies and clinical trials. However, it is unknown whether CII can be applied to characterize the practice patterns of patients undertaking at-home, self-managed SLT. The current study leverages real-world mobile health data to investigate the applicability of CII parameters to self-managed SLT, including the interrelationships between individual CII parameters and their utility for identifying naturally occurring subgroups of patient users. METHOD: Anonymized data from 2,223 poststroke survivors who used the Constant Therapy application were analyzed. Four quantitative CII parameters-dose, session frequency, session duration, and total intervention duration-were calculated per user over a 3-month analysis period using raw session-level data. We conducted correlation analyses at the level of the individual and group to examine the degree of relatedness between each of the CII parameters. CII parameter measures were additionally used as inputs to a k-mean clustering analysis to identify practice pattern subgroups. RESULTS: Results demonstrate the feasibility of calculating components of CII based on available usage statistics from a commercial app for self-managed SLT. Specifically, results suggest that, although CII parameters are related, session frequency offers complementary and nonoverlapping information (cf. dose, session duration, total intervention duration) about dosage. Clustering results show that practice patterns can be broadly differentiated according to the (a) amount and (b) frequency of practice. CONCLUSIONS: The calculation of CII may provide both users and clinicians with a fuller picture of at-home, self-managed practice habits than looking at any one dosage component alone. The study represents a first step toward more comprehensive and theoretically grounded dose reporting for self-managed SLT. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25511191.

Evidence-based practice - implementation level and attitude among physical, occupational, and speech and language therapists in Germany: status quo.

INTRODUCTION: Evidence-based practice (EBP) is an important component of clinical practice in public health. Its implementation involves interpreting scientific studies and then applying this knowledge to clinical decision-making. In Germany, the therapy professions are often trained in non-academic medical schools, and only a small number of therapists are university graduates. AIMS: This study assessed the current status of EBP among physiotherapists, occupational therapists, and speech and language therapists and to determine whether academization influences the implementation of EBP in Germany. METHODS: To assess the EBP implementation level and therapists' attitudes toward EBP, a cross-sectional study was conducted using the German version of the Evidence-Based Practice Inventory (EBPI), which consists of five dimensions: attitude; subjective norm; perceived behavioral control; decision-making; and intention and behavior. The structural validity and internal consistency of the EBPI survey were also tested. RESULTS: Of the 2,412 responses, only 557 were eligible. There were statistically significant differences between academically educated vs. non-academically educated therapists in four of the five EBPI dimensions. Furthermore, four of the five dimensions had sufficient unidimensionality and internal consistency. CONCLUSION: There are differences between academically educated and non-academically educated therapists regarding EBP knowledge, attitudes, and implementation. Academically educated therapists are more likely to use EBP than non-academically educated therapists. There are still barriers to clinical application that need to be addressed. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A195.

A Meta-Analysis of Anomia Treatment in Bilingual Aphasia: Within- and Cross-Language Generalization and Predictors of the Treatment Outcomes.

PURPOSE: The present meta-analysis investigated the efficacy of anomia treatment in bilingual and multilingual persons with aphasia (BPWAs) by assessing the magnitudes of six anomia treatment outcomes. Three of the treatment outcomes pertained to the "trained language": improvement of trained words (treatment effect [TE]), within-language generalization of semantically related untrained words (WLG-Related), and within-language generalization of unrelated words (WLG-Unrelated). Three treatment outcomes were for the "untrained language": improvement of translations of the trained words (cross-language generalization of trained words [CLG-Tx]), cross-language generalization of semantically related untrained words (CLG-Related), and cross-language generalization of unrelated untrained words (CLG-Unrelated). This study also examined participant- and treatment-related predictors of these treatment outcomes. METHOD: This study is registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42023418147. Nine electronic databases were searched to identify word retrieval treatment studies of poststroke BPWAs of at least 6 months postonset. Pre- and posttreatment single-word naming scores were extracted for each eligible participant and used to calculate effect sizes (within-case Cohen's d) of the six treatment outcomes. Random-effects meta-analyses were conducted to assess weighted mean effect sizes of the treatment outcomes across studies. Multiple linear regression analyses were used to examine the effects of participant-related variables (pretreatment single-word naming and comprehension representing poststroke lexical processing abilities) and treatment-related variables (type, language, and duration). The methodological quality of eligible studies and the risk of bias in this meta-analysis were assessed. RESULTS: A total of 17 published studies with 39 BPWAs were included in the meta-analysis. The methodological quality of the included studies ranged from fair (n = 4) to good (n = 13). Anomia treatment produced a medium effect size for TE (M = 8.36) and marginally small effect sizes for WLG-Related (M = 1.63), WLG-Unrelated (M = 0.68), and CLG-Tx (M = 1.56). Effect sizes were nonsignificant for CLG-Related and CLG-Unrelated. TE was significantly larger than the other five types of treatment outcomes. TE and WLG-Related effect sizes were larger for BPWAs with milder comprehension or naming impairments and for treatments of longer duration. WLG-Unrelated was larger when BPWAs received phonological treatment than semantic and mixed treatments. The overall risk of bias in the meta-analysis was low with a potential risk of bias present in the study identification process. CONCLUSIONS: Current anomia treatment practices for bilingual speakers are efficacious in improving trained items but produce marginally small within-language generalization and cross-language generalization to translations of the trained items. These results highlight the need to provide treatment in each language of BPWAs and/or investigate other approaches to promote cross-language generalization. Furthermore, anomia treatment outcomes are influenced by BPWAs' poststroke single-word naming and comprehension abilities as well as treatment duration and the provision of phonological treatment. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25595712.

Self-Reported Home Program Adherence by People With Aphasia: Exploring Construct Validity.

PURPOSE: The study purpose was to compare the practice patterns captured by self-reported logbook data and those recorded by a computerized home program application. The current study is part of a larger single-case research design study aimed at investigating the effect of logbook use on home program adherence in people with aphasia poststroke. METHOD: Data from six adults with chronic aphasia with interest in improving their reading were used in this secondary analysis. Participants completed reading comprehension therapy tasks using a mobile application and tablet. The activities were self-directed and designed for people with aphasia to complete independently. We created an aphasia-friendly logbook based on best practices to allow participants to record their estimated total minutes practiced. Participants received instructions to practice the reading therapy application 80 min a day 7 days a week for the duration of the study. We calculated the difference in the total time per day recorded by each participant to the application data collected. RESULTS: All participants used the logbook to record their practice. There was a strong relationship between self-reported logbook practice and application-recorded practice for four of the six participants. Individual differences were noted and explored. CONCLUSION: These results suggest that some people with aphasia can use logbooks with aphasia-friendly modifications to accurately estimate the amount of practice completed outside of therapy sessions.

Invaluable Benefits of 10 Years of the International Collaboration of Aphasia Trialists (CATs).

Aphasia research has traditionally been considered a (unidisciplinary) niche topic in medical science. The international Collaboration of Aphasia Trialists (CATs) is a global collaboration of multidisciplinary aphasia researchers. Over the past 10 years, CATs has collectively taken a rigorous approach to systematically address persistent challenges to aphasia research quality. This article summarizes the achievements over the past decade. CATs' achievements include: standardizing terminology, advancing aphasia research design by aphasia expert consensus recommendations, developing a core data set and intervention descriptors, facilitating the involvement of people with the language impairment aphasia in the research process, translating, and adapting assessment tools into global languages, encouraging data sharing, developing innovative secondary data analysis methodologies and promoting the transparency and accessibility of high quality aphasia research reports. CATs' educational and scientific achievements over the past 10 years far exceed what individual researchers in the field could have ever achieved.

Resting-state brain network connectivity is an independent predictor of responsiveness to language therapy in chronic post-stroke aphasia.

Post-stroke aphasia recovery, especially in the chronic phase, is challenging to predict. Functional integrity of the brain and brain network topology have been suggested as biomarkers of language recovery. This study sought to investigate functional connectivity in four predefined brain networks (i.e., language, default mode, dorsal attention, and salience networks), in relation to aphasia severity and response to language therapy. Thirty patients with chronic post-stroke aphasia were recruited and received a treatment targeting word finding. Structural and functional brain scans were acquired at baseline and resting state functional connectivity for each network was calculated. Additionally, graph measures quantifying network properties were calculated for each network. These included global efficiency for all networks and average strength and clustering coefficient for the language network. Linear mixed effects models showed that mean functional connectivity in the default mode, dorsal attention, and salience networks as well as graph measures of all four networks are independent predictors of response to therapy. While greater mean functional connectivity and global efficiency of the dorsal attention and salience networks predicted greater treatment response, greater mean functional connectivity and global efficiency in the default mode network predicted poorer treatment response. Results for the language network were more nuanced with more efficient network configurations (as reflected in graph measures), but not mean functional connectivity, predicting greater treatment response. These findings highlight the prognostic value of resting-state functional connectivity in chronic treatment-induced aphasia recovery.

Tube feeding in advanced dementia: Insights from South African speech-language therapists.

BACKGROUND:  Speech-language therapists (SLTs) may recommend tube feeding even with minimal research evidence of its effectiveness, and an understanding of SLTs' perceived practices is warranted. OBJECTIVES:  To qualitatively describe a sample of South African SLTs' perceived practices regarding feeding tube placement in people with advanced dementia. METHOD:  Semi-structured online interviews were conducted via Microsoft Teams. Eight South African SLTs with a particular interest in advanced dementia, in public and private settings, were recruited. Data were analysed using inductive reflexive thematic analysis. RESULTS:  Three main themes were identified: (1) factors influencing SLTs' decisions for feeding tube placement in people with advanced dementia; (2) nature of clinical setting and SLTs' decision-making and (3) SLTs' considerations to improve management of people with advanced dementia. Existing local palliative care guidelines were not employed in decisions about tube feeding. Most participants did not recommend tube feeding during end-of-life care. Perceived burden of care influenced participants' decisions about tube feeding. CONCLUSION:  Speech-language therapists in South Africa likely have an increased reliance on clinical experience rather than recent research and guidelines for decisions about feeding tube placement. Findings accentuate the importance of clinical supervision, mentoring and continuous professional development in the workplace. The findings are an urgent call to action to improve SLTs' overall practices and ethical service delivery for people with advanced dementia and their families.Contribution: Factors and needs regarding SLTs' decision-making about feeding tubes in people with advanced dementia are highlighted.