A systematic scoping review of speech and language therapists' public health practice for early language development.

BACKGROUND: There have been calls for speech and language therapists (SLTs) to work within a public-health framework to support language development. Innovative practice is reported, but the range of services remains unknown. Furthermore, the potential impact of public health practice in speech and language therapy on early child development is also currently unknown. A new method in SLT research, systematic scoping reviews enable greater breadth of focus than traditional systematic reviews when identifying innovative practice. AIM: To report scope and critically appraise evidence of family-focused health-promotion practice for early language development in this area. METHODS & PROCEDURES: Using the Cochrane Public Health Group scoping review framework, data from reports of health-promotion practice with families of children aged 0-3 years were extracted and critically appraised on service delivery, information, reach and evaluation. MAIN CONTRIBUTION: Group-based service delivery was the most popular form of service delivery. There were limited reports on the information given in services and on their reach. Questionnaires were the most popular reported evaluation method. Quality of evaluations was poor due to lack of replicability and experimental control in the studies reported. CONCLUSIONS & IMPLICATIONS: This method of systematic review has highlighted the scope of health-promotion practice in speech and language therapy and also demonstrated the lack of evidence for its effectiveness on child language development. It is argued that systematic scoping reviews are valuable for scoping innovative practice in areas where either there is a lack of robust evidence or there is a high level of heterogeneity in practice or evaluation. To support clinician appraisal of available evidence, recommendations are given for development of questionnaire appraisal and for categorization of evidence levels on summary databases.

Parents and Young Children with Disabilities: The Effects of a Home-Based Music Therapy Program on Parent-Child Interactions.

BACKGROUND: Responsive parenting style and synchronous parent-child interactions have a positive impact on children in terms of language, cognitive, and social-emotional development. Despite widely documented benefits of music therapy on parent-child interactions, empirical evidence for the effects of music therapy on parent-child synchrony is lacking. OBJECTIVE: To examine effects of parent-child dyads' participation in a six-week home-based music therapy program on parent response, child initiation, and parent-child synchrony, as well as parents' daily use of musical activities with their child. METHODS: Twenty-six parent-child dyads participated in this pretest-posttest within-subject single-group design study. Participating dyads included parents and their child with disabilities or developmental delays (ages 1-3 years inclusive). Parent-child dyads participated in a home-based music therapy program that included six weekly 40-minute sessions, and incorporated five responsive teaching strategies (i.e., affect, match, reciprocity, shared control, and contingency). Observational data were recorded for parent-child interactions and parent-child synchrony. RESULTS: Parents' positive physical and verbal responses, as well as children's positive verbal initiations, increased significantly pre- to post-intervention; however, children's positive physical initiations did not increase significantly. Parent-child synchrony also improved significantly pre- to post-intervention. CONCLUSIONS: Findings support the use of home-based music therapy programs to facilitate parent-child interactions in the areas of parental responsiveness and child-initiated communication, as well as parent-child synchrony.

Typical consonant cluster acquisition in auditory-verbal children with early-identified severe/profound hearing loss.

Early-identified severe/profound hearing loss (HL) following universal newborn hearing screening (UNHS) has been associated with improved speech and language outcomes. However, speech outcome reports have typically been based on broad measures of speech intelligibility and/or singleton consonant accuracy, with little known about production of consonant clusters. Using a prospective design, the range and accuracy of consonant clusters produced by a homogenous cohort of 12 children early-identified with severe/profound HL aged 3- and 4-years were examined. All children demonstrated bilateral aided thresholds within a range of 15-25 dB HL across all frequencies, were optimally amplified with cochlear implants (11/12) or hearing aids (1/12), and attended auditory-verbal (AV) early intervention. Standardized speech and language assessments were administered. Consonant clusters were strategically sampled in single-word and conversational speech contexts. All standard scores for speech, receptive, and expressive language were within normal limits. All children produced consonant clusters commensurate with expectations for typically-developing hearing peers at 3- and 4- years-of-age. Children's production of phonetically complex morphophonemes (final consonant clusters marking grammatical morphemes) was also in keeping with developmental expectations. Factors which contributed to these encouraging outcomes require further investigation.

Implementing directives that involve prepositions with children with autism: a comparison of spoken cues with two types of augmented input.

Some children with autism face considerable challenges with comprehension, including difficulties following spoken directives involving prepositional relations. The use of augmented input through visual modalities might be an effective means for supplementing spoken language. The purpose of this preliminary study was to compare spoken input with two augmented input modalities (i.e., speech + visual cues) in terms of children's ability to follow directives involving prepositions. The augmented input modalities consisted of static scene cues (i.e., photographic or pictorial visual scenes that portray relevant concepts and their relationships) and dynamic scene cues (i.e., full-motion video clips that depict the actions underlying relevant concepts and their relationships). A within-subjects design involving nine children with autism or pervasive developmental disorders-not otherwise specified was used to examine the effectiveness of the three input conditions. Results indicated that both static scene cues and dynamic scene cues were more effective than spoken cues, but there were no differences between static scene cues and dynamic scene cues. Results are discussed in terms of appropriate instructional inputs for children with autism. Limitations are noted and directions for future research are posited.

Spatial hearing in a child with auditory neuropathy spectrum disorder and bilateral cochlear implants.

OBJECTIVE: The neural dys-synchrony associated with auditory neuropathy spectrum disorder (ANSD) causes a temporal impairment that could degrade spatial hearing, particularly sound localization accuracy (SLA) and spatial release from masking (SRM). Unilateral cochlear implantation has become an accepted treatment for ANSD but treatment options for the contralateral ear remain controversial. We report spatial hearing measures in a child with ANSD before and after receiving a second cochlear implant (CI). STUDY SAMPLE: An 11-year-7-month old boy with ANSD and expressive and receptive language delay received a second CI eight years after his first implant. DESIGN: The SLA and SRM were measured four months before sequential bilateral CIs (with the contralateral ear plugged and unplugged), and after nine months using both CIs. RESULTS: Testing done before the second CI, with the first CI alone, suggested that residual hearing in the contralateral ear contributed to sound localization accuracy, but not word recognition in quiet or noise. Nine-months after receiving a second CI, SLA improved by 12.76° and SRM increased to 3.8-4.2 dB relative to pre-operative performance. Results were compared to published outcomes for children with bilateral CIs. CONCLUSIONS: The addition of a second CI in this child with ANSD improved spatial hearing.

Early gamma oscillations during rapid auditory processing in children with a language-learning impairment: changes in neural mass activity after training.

Children with language-learning impairment (LLI) have consistently shown difficulty with tasks requiring precise, rapid auditory processing. Remediation based on neural plasticity assumes that the temporal precision of neural coding can be improved by intensive training protocols. Here, we examined the extent to which early oscillatory responses in auditory cortex change after audio-visual training, using combined source modeling and time-frequency analysis of the human electroencephalogram (EEG). Twenty-one elementary school students diagnosed with LLI underwent the intervention for an average of 32 days. Pre- and post-training assessments included standardized language/literacy tests and EEG recordings in response to fast-rate tone doublets. Twelve children with typical language development were also tested twice, with no intervention given. Behaviorally, improvements on measures of language were observed in the LLI group following completion of training. During the first EEG assessment, we found reduced amplitude and phase-locking of early (45-75 ms) oscillations in the gamma-band range (29-52 Hz), specifically in the LLI group, for the second stimulus of the tone doublet. Amplitude reduction for the second tone was no longer evident for the LLI children post-intervention, although these children still exhibited attenuated phase-locking. Our findings suggest that specific aspects of inefficient sensory cortical processing in LLI are ameliorated after training.

Clinical and research perspectives on nonspeech oral motor treatments and evidence-based practice.

PURPOSE: Evidence-based practice (EBP) involves the incorporation of research evidence, clinical expertise, and client values in clinical decision making. One case in which these factors conflict is the use of nonspeech oral motor treatments (NSOMTs) for children with developmental speech sound disorders. Critical reviews of the research evidence suggest that NSOMTs are not valid, yet they are widely used by clinicians based on their expertise/experience. This investigation presents detailed descriptions of clinicians' and researchers' views and opinions on NSOMTs and EBP. METHOD: Individual interviews with 11 clinicians who use NSOMTs and 11 researchers in child phonology were conducted. The interviews were transcribed and organized into themes, following a phenomenological research design. RESULTS: Five themes were identified: (a) NSOMTs are effective, (b) EBP is useful, (c) there is no published research supporting NSOMTs, (d) research evidence may change clinical use of NSOMTs, and (e) researchers and clinicians have separate but shared roles in clinical decision making. CONCLUSIONS: The participants' responses provided detailed and complex insights into each group's decisions regarding NSOMTs. These responses also suggested questions that should be considered when making decisions about approaches that are not fully supported by EBP.

[Exploration of the auditory system in humans: From click to speech auditory brainstem responses]. / Exploration électrophysiologique des voies auditives sous-corticales chez l'humain : du clic au son de parole.

There is a growing and unprecedented interest in the objective evaluation of the subcortical processes that are involved in speech perception, with potential clinical applications in speech and language impairments. Here, we review the studies illustrating the development of electrophysiological methods for assessing speech encoding in the human brainstem: from the pioneer recordings of click-evoked auditory brainstem responses (ABR), via studies of frequency-following responses (FFR) to the most recent measurements of speech ABR (SABR) or ABR in response to speech sounds. Recent research on SABR has provided new insights in the understanding of subcortical auditory processing mechanisms. The SABR test is an objective and non-invasive tool for assessing individual capacity of speech encoding in the brainstem. SABR characteristics are potentially useful both as a diagnosis tool of speech encoding deficits and as an assessment tool of the efficacy of rehabilitation programs in patients with learning and/or auditory processing disorders.

The use of nonspeech oral motor treatments for developmental speech sound production disorders: interventions and interactions.

PURPOSE: The use of nonspeech oral motor treatments (NSOMTs) in the management of pediatric speech sound production disorders is controversial. This article serves as a prologue to a clinical forum that examines this topic in depth. METHOD: Theoretical, historical, and ethical issues are reviewed to create a series of clinical questions that should be considered before one incorporates new methods into clinical practice. CONCLUSION: Speech production disorders are complex and multifaceted. Speech-language pathologists are encouraged to advocate on behalf of clients by adopting the highest standards of clinical practice and by evaluating treatment options in a systematic, critical, and ethical manner.

Nonspeech oral motor treatment issues related to children with developmental speech sound disorders.

PURPOSE: This article examines nonspeech oral motor treatments (NSOMTs) in the population of clients with developmental speech sound disorders. NSOMTs are a collection of nonspeech methods and procedures that claim to influence tongue, lip, and jaw resting postures; increase strength; improve muscle tone; facilitate range of motion; and develop muscle control. In the case of developmental speech sound disorders, NSOMTs are employed before or simultaneous with actual speech production treatment. METHOD: First, NSOMTs are defined for the reader, and there is a discussion of NSOMTs under the categories of active muscle exercise, passive muscle exercise, and sensory stimulation. Second, different theories underlying NSOMTs along with the implications of the theories are discussed. Finally, a review of pertinent investigations is presented. RESULTS: The application of NSOMTs is questionable due to a number of reservations that include (a) the implied cause of developmental speech sound disorders, (b) neurophysiologic differences between the limbs and oral musculature, (c) the development of new theories of movement and movement control, and (d) the paucity of research literature concerning NSOMTs. CLINICAL IMPLICATION: There is no substantive evidence to support NSOMTs as interventions for children with developmental speech sound disorders.

Teaching children with autism to initiate to peers: effects of a script-fading procedure.

A script that was systematically faded from end to beginning was used to teach peer initiations about recently completed, current, and future activities. The effectiveness of the script-fading procedure was assessed via a multiple baseline design across 4 children with autism. During baseline, the children seldom initiated to peers, although all had previously acquired some functional expressive language and sometimes spontaneously addressed adults. When the script was introduced, peer initiations increased, and as the script was faded, unscripted initiations increased. With the minimal written prompts available in the final fading steps, initiations generalized to a different setting, time, teacher, and activity; and for 3 of the 4 children, peer initiations were maintained at a 2-month follow-up. After the script was faded, the participants' levels of peer initiations were within the same range as a normative sample of 3 nondisabled youngsters. The script-fading procedure enabled children with severe social and verbal deficits to practice context-specific, peer-directed generative language that was not prompted by adults or peer confederates.

Effects of a multifaceted training procedure on the social behaviors of hearing-impaired children with severe language disabilities: a replication.

The effectiveness of a training package on the social behaviors of 20 hearing-impaired children with severe language disabilities was assessed. The package consisted of initial instruction in role-play situations, reinforcement of appropriate instances of the behaviors, and a correction procedure following inappropriate instances of the behaviors. Results showed that the training package was effective in increasing greeting, turn waiting, initiating interaction, and giving help and these effects were maintained over several weeks.

[Current status of electrostimulation of auditory nerve fibers with cochlear implants]. / Derzeitiger Stand der Elektrostimulation der Hörnervenfasern mit Cochlearimplantaten.

Under the observance of a few selection criteria electrostimulation of the cochlea nerve with cochlea implants is a suitable method to supply totally deafs with a hearing ability and in about the half of the patients even with speech understanding. The technology of the Vienna Cochlea Implant, selection criteria, surgical technique as well as the rehabilitation procedure and the results are discussed.