Association between objective measurement of the speech intelligibility of young people with dysarthria and listener ratings of ease of understanding.

PURPOSE: This study aimed to investigate the association between listeners' ratings of how much effort it took to understand the speech of young people with cerebral palsy and the percentage of words listeners actually understood. METHOD: Thirty-one young people with dysarthria and cerebral palsy (16 males, 15 females; mean age = 11 years, SD = 3) were audio recorded repeating single words and producing speech. Objective measures of intelligibility were calculated for multiple familiar and unfamiliar listeners using a forced choice paradigm for single words and verbatim orthographic transcriptions for connected speech. Listeners rated how much effort it took to understand speech in each condition using a 5-point ordinal ease of listening (EOL) scale. RESULTS: Agreement on EOL within rater groups was high (ICC > 0.71). An effect of listener was observed for familiar listeners, but not for unfamiliar listeners. EOL agreement between familiar and unfamiliar listeners was weak-moderate (ICC = 0.46). EOL predicted the percentage of speech actually understood by familiar and unfamiliar listeners (r > 0.56, p < 0.001 for all predictions). Strongest associations between EOL and intelligibility were observed for speakers with mild and profound impairments. CONCLUSIONS: The findings of this study demonstrate that listeners can judge how well they have understood dysarthric speech. EOL is associated with listener familiarity, speech task and speech impairment severity. EOL is appropriate for use in clinical practice as a measure of communication activity.

Educating our patients collaboratively: a novel interprofessional approach.

Providing cancer patients with more information regarding their treatments allows them to feel more in control, increases self efficacy, and can decrease anxiety. The aims of the present study were to develop an interprofessional group education session and to evaluate the usefulness and acceptability of this session. In addition, informational distress levels pre- and post-education were evaluated. A prostate radiation therapy (RT) education session was developed and facilitated by an interprofessional team. Topics discussed included how RT works, side effects and management, and support services available. Prior to the education session, participants reported their informational RT distress levels using the validated Distress Thermometer (DT). Post-education session, the DT was readministered. In addition, participants completed an acceptability survey to assess format, structure, and usefulness of the education session. Participants agreed that the session contained valuable and useful information helping them understand expectations during treatment, including resource availability, side effects and management, as well as procedural expectation during treatment. All stated they would recommend the session to other patients. The interprofessional nature of the sessions was deemed useful. Suggested areas for improvement included addition of a dietitian, information on long-term side effects, statistics of radiotherapy side effects, impact of radiotherapy on sexual function, and overall quality of life. The group education session significantly improved informational distress levels (p = 0.04). Educating prostate cancer patients utilizing an interprofessional group format can decrease anxiety and stress related to their RT treatment. Future development of group education sessions for other disease site groups may be valuable.

Intensive dysarthria therapy for younger children with cerebral palsy.

AIM: The aim of this study was to investigate if intervention targeting breath support, phonation, and speech rate increases speech intelligibility and participation in the conversational interactions of younger children with dysarthria and cerebral palsy (CP). METHOD: Fifteen children with dysarthria and CP (nine males, six females; age range 5-11 y, mean age 8 y, SD 2 y; CP type: eight spastic, four dyskinetic, one ataxia, two Worster Drought syndrome; Gross Motor Function Classification System levels II-IV, median level II) participated in this study. Children received three sessions of individual therapy per week for 6 weeks. Intelligibility of single words and connected speech was compared across five points: 1 and 6 weeks before therapy and 1, 6, and 12 weeks after therapy. Three familiar listeners and three unfamiliar listeners scored each recording. Participation in communicative interactions was measured using the Focus on the Outcomes of Communication Under Six (FOCUS) tool. Analyses of variance and paired t-tests were used to investigate change. RESULTS: Mean speech intelligibility increased after therapy to familiar listeners (single words 10.8%, 95% confidence interval [CI] 7.2-14.4; connected speech 9.4%, 95% CI 4.8-14.1) and unfamiliar listeners (single words 9.3%, 95% CI 6.8-11.8; connected speech 10.5%, 95% CI 7.3-13.8). FOCUS scores increased following therapy for parents (mean increase 30.3, 95% CI 10.2-50.4) and for teachers (28.25, 95% CI 14.4-42.1), but changes did not correlate with intelligibility. A wide variation was seen in individual responses to therapy. INTERPRETATION: Brief intensive therapy is associated with gains in intelligibility and communicative interactions for some younger children with dysarthria.

Changes in voice quality after speech-language therapy intervention in older children with cerebral palsy.

OBJECTIVE: We examined whether perceived voice quality is altered in a group of children with cerebral palsy (CP) following an intervention focusing on respiration and phonation, and whether possible improvements might be associated with increased intelligibility levels. METHODS: Sixteen individuals with CP and dysarthria (9 girls, mean age 14 years, SD = 2; 9 with spastic type CP, 2 dyskinetic, 4 mixed, 1 Worster-Drought syndrome) completed intelligibility assessments on separate days twice before intervention, at termination of treatment and at 6-week follow-up using 50 words from the Children's Speech Intelligibility Measure lists, and describing cartoon strips. Experienced speech-language pathologists rated voice quality employing GRBAS scales. RESULTS: There was no clear evidence that change in voice quality pre-post intervention was large compared with change in the pre-intervention or post-intervention periods. Asthenia demonstrated largest improvement (effect size of 0.4). Intelligibility correlated weakly with Grade, Breathiness and Asthenia, but not with Roughness or Strain. A deterioration of 1 unit on the Grade and Asthenia scales was associated with an approximately 11% decrease in intelligibility. CONCLUSION: Perceived changes in voice quality were small compared to changes in intelligibility. Further investigations must examine other variables potentially associated with intelligibility gain to better understand the links between the respiratory-phonatory intervention and improved intelligibility.

Modern palliative radiation treatment: do complexity and workload contribute to medical errors?

PURPOSE: To examine whether treatment workload and complexity associated with palliative radiation therapy contribute to medical errors. METHODS AND MATERIALS: In the setting of a large academic health sciences center, patient scheduling and record and verification systems were used to identify patients starting radiation therapy. All records of radiation treatment courses delivered during a 3-month period were retrieved and divided into radical and palliative intent. "Same day consultation, planning and treatment" was used as a proxy for workload and "previous treatment" and "multiple sites" as surrogates for complexity. In addition, all planning and treatment discrepancies (errors and "near-misses") recorded during the same time frame were reviewed and analyzed. RESULTS: There were 365 new patients treated with 485 courses of palliative radiation therapy. Of those patients, 128 (35%) were same-day consultation, simulation, and treatment patients; 166 (45%) patients had previous treatment; and 94 (26%) patients had treatment to multiple sites. Four near-misses and 4 errors occurred during the audit period, giving an error per course rate of 0.82%. In comparison, there were 10 near-misses and 5 errors associated with 1100 courses of radical treatment during the audit period. This translated into an error rate of 0.45% per course. An association was found between workload and complexity and increased palliative therapy error rates. CONCLUSIONS: Increased complexity and workload may have an impact on palliative radiation treatment discrepancies. This information may help guide the necessary recommendations for process improvement for patients who require palliative radiation therapy.

Total quality culture in radiotherapy departments across Ontario.

PURPOSE: To investigate the prevalence of total quality culture (TQC) within radiation therapy (RT) departments across Ontario, Canada. METHODS: A prospective quantitative survey was distributed within RT departments across Ontario, Canada using the Miller Consulting Group Quality Culture survey. FINDINGS: Ninety percent of managers (9/10) and 50% of employees (261/519) participated. There was concordance between managers and staff that overall RT departments exhibit a work culture that somewhat resembles TQC. Both groups scored 55% of the categories as somewhat agree with TQC and 9% of categories as no TQC. There was discordance in views for 36% of the categories, where managers scored a higher prevalence of TQC compared to their therapists. Larger RT departments (>50 employees) had more prevalence of discrepancy between group scores. CONCLUSIONS: This is the first study to report on the prevalence of TQC within RT departments. Strategies designed for on-going continuous improvement will benefit staff, RT managers, continuity of patient care and patient safety within RT departments.

Intensive speech and language therapy for older children with cerebral palsy: a systems approach.

AIM: To investigate whether speech therapy using a speech systems approach to controlling breath support, phonation, and speech rate can increase the speech intelligibility of children with dysarthria and cerebral palsy (CP). METHOD: Sixteen children with dysarthria and CP participated in a modified time series design. Group characteristics were as follows: seven males, nine females; age range 12 to 18 years (mean 14y, SD 2); CP type: nine spastic, two dyskinetic, four mixed, one Worster-Drought; Gross Motor Function Classification System levels range I to V (median IV). Children received three 30- to 45-minute sessions of individual therapy per week for 6 weeks. Intelligibility in single words and connected speech was compared across four points: 1 week and 6 weeks before therapy, and 1 week and 6 weeks after its completion. Three familiar listeners and three unfamiliar listeners scored each recording. Mean percentage intelligibility was compared using general linear modelling techniques. RESULTS: After treatment, familiar listeners understood 14.7% more single words and 12.1% more words in connected speech. Unfamiliar listeners understood 15% more single words and 15.9% more words in connected speech after therapy. INTERPRETATION: Therapy was associated with increases in speech intelligibility. Effects of the therapy should be investigated further, in an exploratory trial with younger children and in a randomized controlled trial.

Speech therapy for children with dysarthria acquired before three years of age.

BACKGROUND: Children with motor impairments often have the motor speech disorder dysarthria, a condition which effects the tone, power and coordination of any or all of the muscles used for speech. Resulting speech difficulties can range from mild, with slightly slurred articulation and low-pitched voice, to profound, with an inability to produce any recognisable words. Children with dysarthria are often prescribed communication aids to supplement their natural forms of communication. However, there is variation in practice regarding the provision of therapy focusing on voice and speech production. Descriptive studies have suggested that therapy may improve speech, but its effectiveness has not been evaluated. OBJECTIVES: To assess whether direct intervention aimed at improving the speech of children with dysarthria is more effective than no intervention at all. To assess whether individual types of intervention are more effective than others in improving the speech intelligibility of children with dysarthria. SEARCH STRATEGY: We searched CENTRAL, MEDLINE, EMBASE, CINAHL , LLBA, ERIC, PsychInfo, Web of Science, Scopus, UK National Research Register and Dissertation Abstracts up to April 2009, handsearched relevant journals published between 1980 and April 2009, and searched proceedings of relevant conferences between 1996-2009. SELECTION CRITERIA: We considered randomised controlled trials and studies using quasi-experimental designs in which children were allocated to groups using non-random methods. DATA COLLECTION AND ANALYSIS: L Pennington conducted searches of all databases and conference reports. L Pennington, N Miller and S Robson handsearched journals. All searches included a reliability check in which a second review author independently checked a random sample comprising 15% of all identified reports. We planned that two review authors would independently assess the quality and extract data from eligible studies. MAIN RESULTS: No randomised controlled trials or group studies were identified. AUTHORS' CONCLUSIONS: We found no firm evidence of the effectiveness of speech and language therapy to improve the speech of children with early acquired dysarthria. No change in practice is warranted at the present time. Rigorous research is needed to investigate if the positive changes in children's speech observed in small descriptive studies are shown in randomised controlled trials. Research should examine change in children's speech production and intelligibility. It should also investigate the secondary education, health and social care outcomes of intervention, including children's interaction with family, friends and teachers, their participation in social and educational activities, and their quality of life. Cost and acceptability of interventions must also be investigated.

Results of a Radiation Therapist Opinion Survey Identifying, Measuring and Addressing Radiation Therapy Patient Supportive Care Needs.

BACKGROUND: At Sunnybrook's Odette Cancer Centre, a multidisciplinary research team with expertise in radiation therapy and supportive care embarked on a comprehensive, evidence-based three-phase study, "Identifying, Measuring and Addressing Radiation Therapy Patient Supportive Care Needs at the Odette Cancer Centre." The subject of this paper, a radiation therapist opinion survey, constitutes Phase I of that study. PURPOSE: The goal of Phase I was to provide an opportunity for radiation therapists (RTs) to express their views concerning a wide range of supportive care issues as they relate to patients and their families, and also to themselves as RTs. The aim was to use the findings to create in-service educational sessions for RTs at the Odette Cancer Centre. These sessions would then allow RTs to enact the protocol that will follow in Phase II and III of the larger study. MATERIALS AND METHODS: An online RT opinion survey was created, which used opinion statement questions. Included in the survey were questions regarding RTs' perspectives on supportive care issues and RTs' comfort level in addressing patient supportive care needs. Participants were asked about the barriers to the provision of optimal supportive care, and for suggestions to overcome these barriers. A treatment record audit was conducted simultaneously to augment the survey findings and to establish a baseline for future improvement measurements. RESULTS: Although there appears to be room for improvement in documentation practices, a high level of commitment to the provision of optimal supportive care has been demonstrated. Concerns regarding a range of relevant issues were expressed. RTs' comfort levels addressing specific supportive care needs of patients and their families, and the barriers that they believe hinder the provision of quality supportive care were identified. The following four themes were suggested in overcoming those barriers: staff education and training, system change, more time for the provision of supportive care, and role clarification. CONCLUSIONS: The survey provided information that can be used to promote quality supportive care that extends beyond the aim of the survey; namely, to create in-service education sessions for RTs at the Odette Cancer Centre.