Learning to spell for children 5-8 years of age: The importance of an integrated approach to ensure the development of phonic, orthographic and morphemic knowledge at compatible levels.

This paper considers samples of independent writing highlighting the integral role of phonology, orthography and morphology in spelling development for children from 5-6 years to 7-8 years (3 years of formal schooling). It also introduces an approach to monitoring spelling development by considering the sources of knowledge that are evident in children's attempts to spell when writing independently. Synthetic phonics can be a powerful and effective strategy for both reading and spelling; however when the development of a synthetic phonics strategy fails to take account of the importance of compatibility with orthographic and morphemic knowledge its predominant use can lead to long term spelling difficulties for children who cannot acquire this knowledge from implicit learning when reading. Furthermore, this paper proposes that there may be an optimum period for ensuring the interaction between phonemic, orthographic and morphemic knowledge (5-6 years to 7-8 years; 3 years of formal schooling) during which time significant gains can be made for all children. This optimum period is particularly important for children who are at risk of long-term spelling difficulties because they spell by sounds alone as a result of insensitivity to orthographic and ortho-morphemic patterns.

The effect of vitamin D auxiliary rehabilitation therapy in children with cerebral palsy and language dysfunction.

BACKGROUND: The aim of the present study was to observe the clinical efficacy of vitamin D auxiliary rehabilitation therapy in children with cerebral palsy and language dysfunction. METHODS: Eighty-two cases of children with cerebral palsy and language dysfunction in our hospital from March 2011 to June 2014 were selected for this study. They were divided into two groups: the rehabilitation treatment group (simple group, N.=39) and the vitamin D auxiliary rehabilitation therapy group (combination group, N.=43). After three months of treatment, language development, Gesell Child Development Scale, Bayley Infant Development Scale score and vitamin D and calcium levels were compared. RESULTS: The language development, Gesell Child Development Scale, Bayley Infant Development Scale score and vitamin D and calcium levels for two of the groups, after treatment, are improved compared to before treatment. The difference was statistically significant (P<0.05). The total efficiency of the language development in the combination group was obviously higher than the simple group. The difference was significant (95.3% vs. 74.4%, χ2=2.486, P=0.032). The Gesell Child Development Scale improved in the combination group compared to the simple group. The difference was statistically significant (70.4±11.3 vs. 53.3±10.5, t=3.127, P=0.026). The proportion of normal children was significantly higher than the rehabilitation treatment group, and the difference was statistically significant (30.2% vs. 20.5%, χ2=3.016, P=0.029). In the combination group, the vitamin D and calcium levels were statistically increased compared to the rehabilitation treatment group. It had statistical differences between the two groups (P<0.05). CONCLUSIONS: Vitamin D auxiliary rehabilitation therapy could improve the language function and the language development status in children with cerebral palsy and language dysfunction.

Language and language disorders: neuroscience to clinical practice.

Language disorders are common in neurological practice but their accurate recognition and description can be challenging. In this review, we summarise the major landmarks in the understanding of language disorders and the organisation of language in the brain. We describe approaches to assessing language disorders at the bedside or in the clinic as well as the treatment and rehabilitation of aphasia. Finally, we describe how the field of neuroscience is providing new computational and neuroscientific approaches to study the mechanisms of recovery and rehabilitation of aphasia.

Evidence- and Consensus-Based Guidelines for the Management of Communication and Swallowing Disorders Following Pediatric Traumatic Brain Injury.

OBJECTIVE: Evidence-based management guidelines for communication and swallowing disorders following pediatric traumatic brain injury (TBI) are scarcely available, potentially resulting in suboptimal outcomes. To improve clinical care of this population, a multidisciplinary guideline development committee was formed to develop evidence-based recommendation (EBR) and consensus-based recommendation (CBR) for the management of speech, language, and swallowing disorders during the first year of recovery. METHODS: A 3-round Delphi survey was completed by the committee to reach agreement (80% consensus) for the CBRs. Systematic review evidence guided development of EBRs, devised using the National Health and Medical Research Council statement form. RESULTS: Altogether, 30 recommendations (5 EBRs and 25 CBRs) were developed to guide management of speech, language, and swallowing disorders, including prediction of these disorders; health team required, optimal timing of assessment; assessment tools; intervention strategies and commencement of treatment; and key information to support parents. CONCLUSION: The developed recommendations provide a basis for the systematic management of communication and swallowing disorders to be refined as new evidence emerges. Key recommendations include screening of children with moderate/severe TBI for these disorders acutely using specified measures. Patients with severe TBI and prolonged ventilation are a particular at-risk group and should be considered for early referral to speech-language pathology to support timely diagnosis and management. No evidence was identified to support an EBR for treatment, highlighting a key area for research.

Stakeholders' qualitative perspectives of effective telepractice pedagogy in speech-language pathology.

BACKGROUND: Academic programmes in speech-language pathology are increasingly providing telehealth/telepractice clinical education to students. Despite this growth, there is little information describing effective ways to teach it. AIMS: The current exploratory study analyzed the perceptions of speech-language pathology/therapy (SLP/SLT) faculty, student and SLP/SLT clinicians to ascertain effective pedagogical approaches for telepractice service delivery, rank the relative importance of telepractice skills and knowledge competencies, and define any pedagogical challenges to teaching them. METHODS & PROCEDURES: Qualitative data were collected from two sources: three open-ended questions within an online survey (SLP/SLT faculty n = 31, graduate students n = 16, telehealth ('telepractice') clinicians n = 16); and follow-up telephone interviews (n = 22). Data were analyzed with a grounded theory approach followed by a summative rank-order analysis of themes. OUTCOMES & RESULTS: All three groups agreed the most effective telepractice instructional approach was telepractice demonstrations (such as students role playing or watching a supervisor). Professional development approaches such as workshops or training manuals were less effective and didactic approaches such as lecture-only were ineffective. Skills and knowledge competencies students needed before entering the workforce were, in order of implied importance: telepractice clinical skills, telepractice technology skills, legal knowledge pertinent to telepractice and knowledge of telepractice literature. The most important telepractice clinical skills students needed to acquire were appropriate selection of telepractice materials and engaging the client over the internet. Many participants said teaching and learning telepractice was more challenging than in-person service delivery because of the difficulties in selecting appropriate telepractice clinical materials, managing technology problems and engaging with clients over the internet. CONCLUSIONS & IMPLICATIONS: Despite substantial limitations to this investigation, findings imply that telepractice instruction, like other methods of SLP/SLT clinical education, may be most effective when students engage in critical thinking and problem-solving issues through intense practice. Because the skills and competencies associated with telepractice appear to vary in their perceived value, academic programmes may wish to consider prioritizing how they are taught, giving students additional instruction in the selection of telepractice clinical materials and development of online interpersonal communication skills. For some clinical educators, the challenges associated with telepractice may necessitate additional educator training.

Inter-professional education of prospective speech-language therapists and primary school teachers through shared professional practice placements.

BACKGROUND: Preliminary studies of inter-professional education (IPE) among student speech-language therapists (SLTs) and student teachers suggest that workshop-based applications are beneficial in preparing participants for elements of collaborative practice. Situating IPE within the students' professional practice placements may provide another useful avenue to develop attitudes, knowledge and skills for inter-professional collaboration. Research examining the impact of different approaches to IPE is required to advance our understanding of effective design and evaluation of such initiatives. AIMS: To understand how student SLTs and student teachers develop competency for collaborative practice when co-working during professional practice placements to support children's speech and literacy development. METHODS & PROCEDURES: A case study design was used to monitor the impact of the IPE. Student SLTs (n = 4) were paired with student teachers (n = 4) to participate in shared professional practice placements in junior school classrooms. An inductive thematic analysis of interviews conducted with participants after the IPE was employed to explore the development of competencies in collaborative practice. Change in inter-disciplinary knowledge and perceptions over the IPE was evaluated via survey to further explore the development of collaborative competencies. OUTCOMES & RESULTS: Integration of qualitative and quantitative findings suggested that participants began to develop four broad areas of collaborative competency: understanding of professional roles and expertise, communication skills to support shared decision-making, inter-dependency in supporting children's learning, and flexibility to implement alternative instructional practices. Interview analysis also revealed factors related to the facilitators and learning contexts that supported and/or limited the collaboration between participants. CONCLUSIONS & IMPLICATIONS: Shared placement experiences between student SLTs and student teachers may be an effective method for building participants' competencies in multiple aspects of collaborative practice. Active facilitation by both SLT and classroom teacher supervisors alongside careful consideration of learning contexts (e.g., classroom structure) will help to ensure that learning is maximized for prospective professionals.

A qualitative case study in the social capital of co-professional collaborative co-practice for children with speech, language and communication needs.

BACKGROUND: Effective co-practice is essential to deliver services for children with speech, language and communication needs (SLCN). The necessary skills, knowledge and resources are distributed amongst professionals and agencies. Co-practice is complex and a number of barriers, such as 'border disputes' and poor awareness of respective priorities, have been identified. However social-relational aspects of co-practice have not been explored in sufficient depth to make recommendations for improvements in policy and practice. Here we apply social capital theory to data from practitioners: an analytical framework with the potential to move beyond descriptions of socio-cultural phenomena to inform change. AIMS: Co-practice in a local authority site was examined to understand: (1) the range of social capital relations extant in the site's co-practice; (2) how these relations affected the abilities of the network to collaborate; (3) whether previously identified barriers to co-practice remain; (4) the nature of any new complexities that may have emerged; and (5) how inter-professional social capital might be fostered. METHODS & PROCEDURES: A qualitative case study of SLCN provision within one local authority in England and its linked NHS partner was completed through face-to-face semi-structured interviews with professionals working with children with SLCN across the authority. Interviews, exploring barriers and facilitators to interagency working and social capital themes, were transcribed, subjected to thematic analysis using iterative methods and a thematic framework derived. OUTCOMES & RESULTS: We identified a number of characteristics important for the effective development of trust, reciprocity and negotiated co-practice at different levels of social capital networks: macro-service governance and policy; meso-school sites; and micro-intra-practitioner knowledge and skills. Barriers to co-practice differed from those found in earlier studies. Some negative aspects of complexity were evident, but only where networked professionalism and trust was absent between professions. Where practitioners embraced and services and systems enabled more fluid forms of collaboration, then trust and reciprocity developed. CONCLUSIONS & IMPLICATIONS: Highly collaborative forms of co-practice, inherently more complex at the service governance, macro-level, bring benefits. At the meso-level of the school and support team network there was greater capacity to individualize co-practice to the needs of the child. Capacity was increased at the micro-level of knowledge and skills to harness the overall resource distributed amongst members of the inter-professional team. The development of social capital, networks of trust across SLCN support teams, should be a priority at all levels-for practitioners, services, commissioners and schools.

The PLORAS Database: A data repository for Predicting Language Outcome and Recovery After Stroke.

The PLORAS Database is a relational repository of anatomical and functional imaging data that has primarily been acquired from stroke survivors, along with standardized scores on a wide range of sensory, motor and cognitive abilities, demographic details and medical history. As of January 2015, we have data from 750 patients with an expected accrual rate of 200 patients per year. Expansion will accelerate as we extend our collaborations. The main aim of the database is to Predict Language Outcome and Recovery After Stroke (PLORAS) on the basis of a single structural (anatomical) brain scan that indexes the stereotactic location and extent of brain damage. Predictions are made for individual patients by indicating how other patients with the most similar brain damage, cognitive abilities and demographic details recovered their language skills over time. Predictions are validated by longitudinal follow-ups of patients who initially presented with speech and language difficulties. The PLORAS Database can also be used to predict recovery of other cognitive abilities on the basis of anatomical brain scans. The functional imaging data can be used to understand the neural mechanisms that support recovery from brain damage; and all the data can be used to understand the main sources of inter-subject variability in structure-function mappings in the human brain. Data will be made available for sharing, subject to: funding, ethical approval and patient consent.

Intermittent Theta-Burst Stimulation of the Right Dorsolateral Prefrontal Cortex to Promote Metaphor Comprehension in Parkinson Disease: A Case Study.

This single-case research-designed study explored whether intermittent theta-burst stimulation (iTBS) of the right dorsolateral prefrontal cortex (DLPFC) could improve metaphor comprehension in people with Parkinson disease (PD) and language impairments. A right-handed participant with PD diagnosed 9 years ago, receiving long-term treatment with levodopa, and with metaphor comprehension impairment was recruited to undergo 10 sessions of sham stimulation (in 2wk), a washout period (6wk), and then 10 sessions of iTBS (in 2wk). Clinical scores of metaphor comprehension and motor evaluation (Unified Parkinson Disease Rating Scale part III) and transcranial magnetic stimulation to test the excitability of the primary motor cortex (M1) were used at baseline, postsham, post-iTBS, and at 3 follow-ups (8, 14, and 20wk post-iTBS). Metaphor comprehension was improved after iTBS, and the highest scores were obtained 8 weeks later (P=.01). This improvement was correlated with the increase of the right M1 excitability (r=-.86, P=.03) and with the decrease of transcallosal inhibition latency from the left to the right hemisphere (r=-.88, P=.02). Sham yielded no effect (P>.05). Administration of iTBS over the right DLPFC improved metaphor comprehension likely by a long-term influence on brain synaptic plasticity, including improvement of interhemispheric dialogue. More studies are warranted to confirm these findings in larger samples of participants with PD.

The proportion of minimally verbal children with autism spectrum disorder in a community-based early intervention programme.

BACKGROUND: Estimates of the proportion of children with autism spectrum disorder (ASD) who are minimally verbal vary from 25%to 35%. However, there is a lack of consensus in defining minimally verbal and few detailed reports of communication outcomes for these children following intervention. The aim of this study was to explore how minimally verbal children have been defined and to document the proportion of minimally verbal children in a group of children with ASD receiving a community based early intervention programme. METHOD: A longitudinal cohort design was used to examine the proportion of children who met criteria for minimally verbal in 246 children with ASD when they entered and exited an early intervention programme. RESULTS: Overall, 26.3% of the children in this study exited the programme using 'fewer than five spontaneous and functional words' and 36.4% exited not using 'two word phrases' as indicated by direct assessment. However, our findings were mixed depending on measures and definitions used, with parent report indicating that as many as 29.4% of children were not 'naming at least three objects' consistently, and 43.3% not using 'phrases with a noun and verb' consistently at exit. More than half of the children who entered the programme with minimal speech exited the programme with a similar language profile. A small percentage of children (1.2%-4.7%) regressed in their language level over time. CONCLUSIONS: Despite advances in early intervention, and access to services at a younger age, around a quarter of individuals with ASD in this study exited early intervention with significant communication needs. Our findings are considered in relation to the literature and clinical implications, and future research directions are discussed.

[New aspects of neurorehabilitation: motor and language]. / Neues zur Neurorehabilitation: Motorik und Sprache.

Advancements in medical care over the last decades have contributed to a continuous decline in immediate post-stroke mortality. The flipside of this development is that patients surviving the initial stroke are forced to live with sometimes extreme functional motor and/or language limitations for the remaining life span. The following overview presents evidence-based neurorehabilitative interventions to promote motor and language recovery in the acute and chronic post-stroke stages. Therapeutic approaches comprise intensive training, neuropharmacological drugs and non-invasive brain stimulation techniques, such as transcranial magnetic stimulation (TMS) or direct current stimulation (tDCS). Additionally, an outlook on promising future interventions for stroke neurorehabilitation is provided.

Intervening to alleviate word-finding difficulties in children: case series data and a computational modelling foundation.

We evaluated a simple computational model of productive vocabulary acquisition, applied to simulating two case studies of 7-year-old children with developmental word-finding difficulties across four core behavioural tasks. Developmental models were created, which captured the deficits of each child. In order to predict the effects of intervention, we exposed the computational models to simulated behavioural interventions of two types, targeting the improvement of either phonological or semantic knowledge. The model was then evaluated by testing the predictions from the simulations against the actual results from an intervention study carried out with the two children. For one child it was predicted that the phonological intervention would be effective, and the semantic intervention would not. This was borne out in the behavioural study. For the second child, the predictions were less clear and depended on the nature of simulated damage to the model. The behavioural study found an effect of semantic but not phonological intervention. Through an explicit computational simulation, we therefore employed intervention data to evaluate our theoretical understanding of the processes underlying acquisition of lexical items for production and how they may vary in children with developmental language difficulties.

Rule-based learning of regular past tense in children with specific language impairment.

The treatment of children with specific language impairment was used as a means to investigate whether a single- or dual-mechanism theory best conceptualizes the acquisition of English past tense. The dual-mechanism theory proposes that regular English past-tense forms are produced via a rule-based process whereas past-tense forms of irregular verbs are stored in the lexicon. Single-mechanism theories propose that both regular and irregular past-tense verbs are stored in the lexicon. Five 5-year-olds with specific language impairment received treatment for regular past tense. The children were tested on regular past-tense production and third-person singular "s" twice before treatment and once after treatment, at eight-week intervals. Treatment consisted of one-hour play-based sessions, once weekly, for eight weeks. Crucially, treatment focused on different lexical items from those in the test. Each child demonstrated significant improvement on the untreated past-tense test items after treatment, but no improvement on the untreated third-person singular "s". Generalization to untreated past-tense verbs could not be attributed to a frequency effect or to phonological similarity of trained and tested items. It is argued that the results are consistent with a dual-mechanism theory of past-tense inflection.

Contextual Constraint Treatment for coarse coding deficit in adults with right hemisphere brain damage: generalisation to narrative discourse comprehension.

Coarse coding is the activation of broad semantic fields that can include multiple word meanings and a variety of features, including those peripheral to a word's core meaning. It is a partially domain-general process related to general discourse comprehension and contributes to both literal and non-literal language processing. Adults with damage to the right cerebral hemisphere (RHD) and a coarse coding deficit are particularly slow to activate features of words that are relatively distant or peripheral. This manuscript reports a pre-efficacy study of Contextual Constraint Treatment (CCT), a novel, implicit treatment designed to increase the efficiency of coarse coding with the goal of improving narrative comprehension and other language performance that relies on coarse coding. Participants were four adults with RHD. The study used a single-subject controlled experimental design across subjects and behaviours. The treatment involved pre-stimulation, using a hierarchy of strong and moderately biased contexts, to prime the intended distantly related features of critical stimulus words. Three of the four participants exhibited gains in auditory narrative discourse comprehension, the primary outcome measure. All participants exhibited generalisation to untreated items. No strong generalisation to processing non-literal language was evident. The results indicate that CCT yields both improved efficiency of the coarse coding process and generalisation to narrative comprehension.

The Same Fish: Creating Space for Therapeutic Relationships, Play, and Development in a School for Children with Special Needs.

This paper represents and attempts to describe psychoanalytically informed work applied in a school setting with children with special needs. While many therapists at the Parkside School are trained in analytic techniques and principles, these ideas have not traditionally been applied to children with language-based learning difficulties. Over the years, we have found that analytic ideas such as transference, countertransference, projective identification, containment, and attachment are especially salient to our understanding of these very complex children. Despite being in a school--a nontraditional setting for psychoanalysis--children are seen in individual and group therapy, often more than once a week. We believe that therapeutic relationships and play (sometimes bringing a child to a place of being able to play) are especially mutative with children with language-based learning challenges. Play and relationship provide a holding environment that, over time, allows for the reorganization of a child's often immature developmental capacities into a sense of agency that captures more clearly a child's innate potential. This article includes case studies of children with complex language-based learning difficulties, including autism spectrum disorders.

Content validity of the Comprehensive ICF Core Set for multiple sclerosis from the perspective of speech and language therapists.

BACKGROUND: The Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Multiple Sclerosis (MS) is a comprehensive framework to structure the information obtained in multidisciplinary clinical settings according to the biopsychosocial perspective of the International Classification of Functioning, Disability and Health (ICF) and to guide the treatment and rehabilitation process accordingly. It is now undergoing validation from the user perspective for which it has been developed in the first place. AIMS: To validate the content of the Comprehensive ICF Core Set for MS from the perspective of speech and language therapists (SLTs) involved in the treatment of persons with MS (PwMS). METHODS & PROCEDURES: Within a three-round e-mail-based Delphi Study 34 SLTs were asked about PwMS' problems, resources and aspects of the environment treated by SLTs. Responses were linked to ICF categories. Identified ICF categories were compared with those included in the Comprehensive ICF Core Set for MS to examine its content validity. OUTCOMES & RESULTS: Thirty-four SLTs named 524 problems and resources, as well as aspects of environment. Statements were linked to 129 ICF categories (60 Body-functions categories, two Body-structures categories, 42 Activities-&-participation categories, and 25 Environmental-factors categories). SLTs confirmed 46 categories in the Comprehensive ICF Core Set. Twenty-one ICF categories were identified as not-yet-included categories. CONCLUSIONS & IMPLICATIONS: This study contributes to the content validity of the Comprehensive ICF Core Set for MS from the perspective of SLTs. Study participants agreed on a few not-yet-included categories that should be further discussed for inclusion in a revised version of the Comprehensive ICF Core Set to strengthen SLTs' perspective in PwMS' neurorehabilitation.

Training a new generation of speech-language pathologists with competences in the management of literacy disorders and learning disabilities in Hong Kong.

One of the recent developments in the education of speech-language pathology is to include literacy disorders and learning disabilities as key training components in the training curriculum. Disorders in reading and writing are interwoven with disorders in speaking and listening, which should be managed holistically, particularly in children and adolescents. With extensive training in clinical linguistics, language disorders, and other theoretical knowledge and clinical skills, speech-language pathologists (SLPs) are the best equipped and most competent professionals to screen, identify, diagnose, and manage individuals with literacy disorders. To tackle the challenges of and the huge demand for services in literacy as well as language and learning disorders, the Hong Kong Institute of Education has recently developed the Master of Science Programme in Educational Speech-Language Pathology and Learning Disabilities, which is one of the very first speech-language pathology training programmes in Asia to blend training components of learning disabilities, literacy disorders, and social-emotional-behavioural-developmental disabilities into a developmentally and medically oriented speech-language pathology training programme. This new training programme aims to prepare a new generation of SLPs to be able to offer comprehensive support to individuals with speech, language, literacy, learning, communication, and swallowing disorders of different developmental or neurogenic origins, particularly to infants and adolescents as well as to their family and educational team.

Speech comprehension and emotional/behavioral problems in children with specific language impairment (SLI).

This research aims to investigate differences in speech comprehension between children with specific language impairment (SLI) and their developmentally normal peers, and the relationship between speech comprehension and emotional/behavioral problems on Achenbach's Child Behavior Checklist (CBCL) and Caregiver Teacher's Report Form (C-TRF) according to the DSMIV The clinical sample comprised 97preschool children with SLI, while the peer sample comprised 60 developmentally normal preschool children. Children with SLI had significant delays in speech comprehension and more emotional/behavioral problems than peers. In children with SLI, speech comprehension significantly correlated with scores on Attention Deficit/Hyperactivity Problems (CBCL and C-TRF), and Pervasive Developmental Problems scales (CBCL)(p<0.05). In the peer sample, speech comprehension significantly correlated with scores on Affective Problems and Attention Deficit/Hyperactivity Problems (C-TRF) scales. Regression analysis showed that 12.8% of variance in speech comprehension is saturated with 5 CBCL variables, of which Attention Deficit/Hyperactivity (beta = -0.281) and Pervasive Developmental Problems (beta = -0.280) are statistically significant (p < 0.05). In the reduced regression model Attention Deficit/Hyperactivity explains 7.3% of the variance in speech comprehension, (beta = -0.270, p < 0.01). It is possible that, to a certain degree, the same neurodevelopmental process lies in the background of problems with speech comprehension, problems with attention and hyperactivity, and pervasive developmental problems. This study confirms the importance of triage for behavioral problems and attention training in the rehabilitation of children with SLI and children with normal language development that exhibit ADHD symptoms.

Can individuals with Down syndrome improve their grammar?

Morphosyntax constitutes one of the most complex areas of language. It takes into account the structure of the word and that of the sentence, and its development allows one to establish adequately agreements both within the nominal phrase and in the rest of the sentence. Morphosyntax is particularly impaired in individuals with Down syndrome. To improve their morphosyntactic skills, an intervention programme was designed and carried out with a total of 20 Spanish-speaking children with Down syndrome; half of them composed the experimental group and the other half the control group. The results obtained show that the children in the experimental group improved more than the children in the control group in the areas of syntax, morphology and semantics, but not in pragmatics, where both groups improved to the same extent. Overall, the results obtained support the effectiveness of the programme implemented as a clinical and educational tool for intervention in individuals with Down syndrome.

The effects of medication on cognition in long-term care.

This article emphasizes the need to consider the role of medications when providing speech-language pathology services to a person with cognitive decline. This is particularly true when working with older adults. Many older adults take multiple medications that may have a direct effect on cognitive ability and as a result, on the success of rehabilitation efforts.