The role of Augmentative and Alternative Communication in Speech and Language Therapy: A mini review.

Augmentative and Alternative Communication is an aided or unaided means of communication which supports existing communication abilities of an individual or replaces natural speech due to any speech and language disorder. The deficit could be developmental or acquired such as autism spectrum disorder, cerebral palsy, learning difficulties, dysarthria, dyspraxia or due to any acquired neurological condition such as aphasia and other degenerative disorders. Furthermore, it may be due to surgical procedures such as laryngectomy. Alternate means of communication have also been successfully used with COVID-19 patients. These tools may include pictures, symbols, signs or voice output devices. Parents of children with special needs and medical professionals have been reluctant in implementing the approach due to certain misconceptions. The aim of this review is to summarize the current evidence for the use of Augmentative and Alternative Communication with a range of disorders in relation to in relation to Pakistan.

Improving Hands-free Speech Rehabilitation in Patients With a Laryngectomy: Proof-of-Concept of an Intratracheal Fixation Device.

Permanent hands-free speech with the use of an automatic speaking valve (ASV) is regarded as the optimal voice rehabilitation after total laryngectomy. Due to fixation problems, regular ASV use in patients with a laryngectomy is limited. We have developed an intratracheal fixation device (ITFD) composed of an intratracheal button augmented by hydrophilic foam around its shaft. This study evaluates the short-term effectiveness and experienced comfort of this ITFD during hands-free speech in 7 participants with a laryngectomy. We found that 4 of 7 participants had secure ASV fixation inside the tracheostoma during hands-free speech for at least 30 minutes with the ITFD. The ITFD's comfort was perceived positively overall. The insertion was perceived as being mildly uncomfortable but not painful. This proof-of-concept study demonstrates the feasibility of the ITFD that might improve stomal attachment of ASVs, and it provides the basis for further development toward a prototype suitable for long-term daily use.

Effects of an iPad-based Speech-Generating Device Infused into Instruction with the Picture Exchange Communication System for Adolescents and Young Adults with Severe Autism Spectrum Disorder.

This study used a multiple baseline, single-subject research design to investigate the efficacy of an iPad®-based speech-generating device (SGD). The iPad was equipped with the SPEAKall!® application to function as a SGD. SGDs are a form of aided augmentative and alternative communication (AAC) allowing a user to communicate using digitized and/or synthesized speech. Instruction followed a modified version of the intervention phases from the Picture Exchange Communication System (PECS). This modified PECS protocol was implemented with two adolescents and one young adult between the ages of 14 and 23. All three participants were diagnosed with severe autism spectrum disorder and little to no functional speech. Dependent measures included the ability to request for edible and tangible items as the primary measure, and the ability to engage in natural speech production as an ancillary measure to determine simultaneous, additive effects on speech acquisition. Results indicated increases in requesting behaviors for all three participants across intervention and maintenance phases. Once participants mastered requesting of edible items, they were able to generalize the skill to tangible items. However, mixed results were found when targeting natural speech production. Based on the current findings, the infusion of an iPad-based SGD into PECS instruction may be effective in increasing initial requesting skills; however, a facilitative effect on increasing speech acquisition cannot necessarily be expected for every participant.

Teaching mands for information using speech generating devices: A replication and extension.

Approximately 30% of individuals diagnosed with autism spectrum disorder (ASD) fail to develop vocal communication and, therefore, use some form of augmentative or alternative communication system. The current study replicates and extends previous research on teaching "Who?" and "Which?" mands for information to 3 young children diagnosed with ASD using a speech generating device. Procedures were evaluated using a multiple baseline across participants design. All participants learned to mand for information and, subsequently, used the information to access preferred items.

Implementing Aided Augmentative Communication Systems With Persons Having Complex Communicative Needs.

Augmentative and alternative communication (AAC) systems can support communication skills for people with significant developmental disabilities who experience complex communication needs (CCNs). There is a need to tailor best practices in AAC assessment and intervention to create individualized communication systems with this population. In this article, we outline the important components of AAC systems that can be implemented in authentic settings. However, given the limited evidence on AAC interventions specific to people with CCNs, we also identify some priority areas for future inquiry. Among these involve strategies to enhance decision making regarding (a) matching communication mode(s) to learner skills and contextual demands, (b) identifying communicative opportunities and obligations, (c) individualizing aided communication display features, (d) selection of vocabulary specificity, and (e) considering dosage parameters needed to acquire and maintain a communicative repertoire. In addition, we briefly discuss the use of telehealth to enhance intervention capability.

Addition of Kinesio Taping of the orbicularis oris muscles to speech therapy rapidly improves drooling in children with neurological disorders.

OBJECTIVE: To evaluate the effects of Kinesio Taping (KT) of the orbicularis oris muscles as an adjunct to standard therapy for drooling. METHODS: Fifteen children with neurological disorders and drooling received speech therapy and twice-weekly KT of the orbicularis muscles over a 30-day period. Drooling was assessed by six parameters: impact on the life of the child and caregiver; severity of drooling; frequency of drooling; drooling volume (estimated by number of bibs used); salivary leak; and interlabial gap. Seven markers of oral motor skills were also assessed. RESULTS: KT of the orbicularis oris region reduced the interlabial gap. All oral motor skills and almost all markers of drooling improved after 15 days of treatment. CONCLUSION: In this sample of children with neurological disorders, adding KT of the orbicularis oris muscles to speech therapy caused rapid improvement in oral motor skills and drooling.

Physiological and clinical outcomes associated with use of one-way speaking valves on tracheostomised patients: A systematic review.

BACKGROUND: The one way speaking valve was first engineered in 1985 to allow patients with tracheostomies to communicate. The research has indicated alternative physiological benefits of using a speaking valve, however this literature has not yet been evaluated. The purpose of this systematic review was to evaluate the evidence for one-way speaking valve in a range of physiological domains, including vital signs, aspiration, olfaction, ventilation and tracheostomy weaning, length of stay, and quality of life. METHODS: A literature search was conducted in September 2017. Studies were eligible if they compared the use of a one-way speaking valve against no speaking valve, across any physiological or clinical parameter. RESULTS: 16 eligible studies were included in this review. A meta-analysis random-effect model (I2 = 71.96, p = 0.006) found reduced instances of aspiration with a speaking valve in situ, compared to without a speaking valve in situ (OR 0.122; 95% confidence interval, 0.031-0.479; p = 0.003). Statically significant results were also found across the domains of olfaction, secretion management and ventilation. CONCLUSION: There is emerging evidence of additional benefits for using speaking valves. Further studies should focus on clinical outcomes that have the potential to reduce healthcare costs as well as patient outcomes.

Paediatric tracheostomy tubes: recent developments and our current practice.

OBJECTIVE: A variety of paediatric tracheostomy tubes are available. This article reviews the tubes in current use at Great Ormond Street Hospital for Children and Evelina London Children's Hospital. METHODS: This paper outlines our current preferences, and the particular indications for different tracheostomy tubes, speaking valves and other attachments. RESULTS: Our preferred types of tubes have undergone significant design changes. This paper also reports further experience with certain tubes that may be useful in particular circumstances. An updated sizing chart is included for reference purposes. CONCLUSION: The choice of a paediatric tracheostomy tube remains largely determined by individual clinical requirements. Although we still favour a small range of tubes for use in the majority of our patients, there are circumstances in which other varieties are indicated.

Speech-driven mobile games for speech therapy: User experiences and feasibility.

Purpose: To assist in remote treatment, speech-language pathologists (SLPs) rely on mobile games, which though entertaining, lack feedback mechanisms. Games integrated with automatic speech recognition (ASR) offer a solution where speech productions control gameplay. We therefore performed a feasibility study to assess children's and SLPs' experiences towards speech-controlled games, game feature preferences and ASR accuracy. Method: Ten children with childhood apraxia of speech (CAS), six typically developing (TD) children and seven SLPs trialled five games and answered questionnaires. Researchers also compared the results of ASR to perceptual judgment. Result: Children and SLPs found speech-controlled games interesting and fun, despite ASR-human disagreements. They preferred games with rewards, challenge and multiple difficulty levels. Automatic speech recognition-human agreement was higher for SLPs than children, similar between TD and CAS and unaffected by CAS severity (77% TD, 75% CAS - incorrect; 51% TD, 47% CAS, 71% SLP - correct). Manual stop recording yielded higher agreement than automatic. Word length did not influence agreement. Conclusion: Children's and SLPs' positive responses towards speech-controlled games suggest that they can engage children in higher intensity practice. Our findings can guide future improvements to the ASR, recording methods and game features to improve the user experience and therapy adherence.

The Potential Effect of Forbrain as an Altered Auditory Feedback Device.

Purpose: The purpose of this study was to run a proof of concept on a new commercially available device, Forbrain® (Sound For Life Ltd/Soundev, Luxemburg, model UN38.3), to test whether it can modulate the speech of its users. Method: Participants were instructed to read aloud a text of their choice during 3 experimental phases: baseline, test, and posttest, while wearing a Forbrain® headset. Critically, for half of the participants (Forbrain group), the device was turned on during the test phase, whereas for the other half (control group), the device was kept off. Voice recordings were analyzed to derive 6 quantitative measures of voice quality over each of the phases of the experiment. Results: A significant Group × Phase interaction was obtained for the smoothed cepstral peak prominence, a measure of voice harmony, and for the trendline of the long-term average spectrum, a measure of voice robustness, this latter surviving Bonferroni correction for multiple comparisons. Conclusions: The results of this study indicate the effectiveness of Forbrain® in modifying the speech of its users. It is suggested that Forbrain® works as an altered auditory feedback device. It may hence be used as a clinical device in speech therapy clinics, yet further studies are warranted to test its usefulness in clinical groups.

Exploring the learnability and usability of a near field communication-based application for semantic enrichment in children with language disorders.

Recently, a few software applications (apps) have been developed to enhance vocabulary and conceptual networks to address the needs of children with language impairments (LI), but there is no evidence about their impact and their usability in therapy contexts. Here, we try to fill this gap presenting a system aimed at improving the semantic competence and the structural knowledge of children with LI. The goal of the study is to evaluate learnability, usability, user satisfaction and quality of the interaction between the system and the children. The system consists of a tablet, hosting an app with educational and training purposes, equipped with a Near Field Communication (NFC) reader, used to interact with the user by means of objects. Fourteen preschool children with LI played with the device during one 45-minute speech therapy session. Reactions and feedbacks were recorded and rated. The system proved to be easy to understand and learn, as well as engaging and rewarding. The success of the device probably rests on the integration of smart technology and real, tangible objects. The device can be seen as a valuable aid to support and enhance communication abilities in children with LI as well as typically developing individuals.

Resonance Tube Phonation in Water-the Effect of Tube Diameter and Water Depth on Back Pressure and Bubble Characteristics at Different Airflows.

OBJECTIVES: Resonance tube phonation with tube end in water is a voice therapy method in which the patient phonates through a glass tube, keeping the free end of the tube submerged in water, creating bubbles. The purpose of this experimental study was to determine flow-pressure relationship, flow thresholds between bubble types, and bubble frequency as a function of flow and back volume. METHODS: A flow-driven vocal tract simulator was used for recording the back pressure produced by resonance tubes with inner diameters of 8 and 9 mm submerged at water depths of 0-7 cm. Visual inspection of bubble types through video recording was also performed. RESULTS: The static back pressure was largely determined by the water depth. The narrower tube provided a slightly higher back pressure for a given flow and depth. The amplitude of the pressure oscillations increased with flow and depth. Depending on flow, the bubbles were emitted from the tube in three distinct types with increasing flow: one by one, pairwise, and in a chaotic manner. The bubble frequency was slightly higher for the narrower tube. An increase in back volume led to a decrease in bubble frequency. CONCLUSIONS: This study provides data on the physical properties of resonance tube phonation with the tube end in water. This information will be useful in future research when looking into the possible effects of this type of voice training.

Effectiveness of speech language therapy either alone or with add-on computer-based language therapy software (Malayalam version) for early post stroke aphasia: A feasibility study.

CONTEXT AND AIMS: This study aimed to assess the feasibility of professional based conventional speech language therapy (SLT) either alone (Group A/less intensive) or assisted by novel computer based local language software (Group B/more intensive) for rehabilitation in early post stroke aphasia. SETTINGS AND DESIGN: Comprehensive Stroke Care Center of a tertiary health care institute situated in South India, with the study design being prospective open randomised controlled trial with blinded endpoint evaluation. MATERIAL AND METHODS: This study recruited 24 right handed first ever acute ischemic stroke patients above 15years of age affecting middle cerebral artery territory within 90days of stroke onset with baseline Western Aphasia Battery (WAB) Aphasia Quotient (AQ) score of <93.8 between September 2013 and January 2016.The recruited subjects were block randomised into either Group A/less intensive or Group B/more intensive therapy arms, in order to receive 12 therapy sessions of conventional professional based SLT of 1h each in both groups, with an additional 12h of computer based language therapy in Group B over 4weeks on a thrice weekly basis, with a follow up WAB performed at four and twelve weeks after baseline assessment. The trial was registered with Clinical trials registry India [2016/08/0120121]. STATISTICAL ANALYSIS: All the statistical analysis was carried out with IBM SPSS Statistics for Windows version 21. RESULTS: 20 subjects [14 (70%) Males; Mean age: 52.8years±SD12.04] completed the study (9 in the less intensive and 11 in the more intensive arm). The mean four weeks follow up AQ showed a significant improvement from the baseline in the total group (p value: 0.01). The rate of rise of AQ from the baseline to four weeks follow up (ΔAQ %) showed a significantly greater value for the less intensive treatment group as against the more intensive treatment group [155% (SD: 150; 95% CI: 34-275) versus 52% (SD: 42%; 95% CI: 24-80) respectively: p value: 0.053]. CONCLUSIONS: Even though the more intensive treatment arm incorporating combined professional based SLT and computer software based training fared poorer than the less intensive therapy group, this study nevertheless reinforces the feasibility of SLT in augmenting recovery of early post stroke aphasia.

The Use of Speaking Valves in Children With Tracheostomy Tubes.

One-way speaking valves have been successfully used to restore audible meaningful speech in adult patients after tracheostomy tube placement. One-way speaking valves have also been used in pediatric patients after tracheostomy tube placement with promising results. We conducted a scoping review to synthesize and summarize the current evidence on the use of one-way tracheostomy tube speaking valves in the pediatric population to identify knowledge gaps that could inform future research programs and facilitate evidence-based clinical decision making. The Arksey and O'Malley 5-step methodological framework was used for this scoping review. We searched OVID MEDLINE, EMBASE, PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google Scholar to locate articles published between January 1, 1946 and May 26, 2016. Our search resulted in a total of 524 articles. After removing 270 duplicates, we screened 254 abstracts, and 50 articles were identified for full text review. We excluded 38 references. A total of 12 articles met our inclusion criteria. Details of all studies were charted. Application of the Sackett levels of evidence to evaluate the qualitative strength of the evidence provided by the 12 articles selected for study found that 6 studies were level 5, 4 were level 4, and 2 studies were categorized as level 3 evidence. Eligibility criteria for trials of speaking valves were inconsistent across all studies and included a combination of clinical assessment coupled with published indications. Much of the literature has focused on tolerance/successful use of speaking valves in children with a tracheostomy with limited evidence on its impact on verbal communication. Current evidence on the use of speaking valves in children with a tracheostomy, its indication, and its impact on verbal communication is inadequate, mandating further research in this area.

Cutting-Edge Technology for Speech Rehabilitation.

Purpose: The authors of this article introduce the technical reports of this special issue.

Electropalatography and its correlation to tongue movement ultrasonography in speech analysis. / Eletropalatografia e sua correlação à ultrassonografia do movimento de língua nas análises da fala.

PURPOSE: To analyze the use of electropalatography and ultrasonography regarding speech therapy through literature narrative review. RESEARCH STRATEGIES: A literature review was conducted at PubMed and Scielo databases, using descriptors as electropalatography, electropalatography AND evaluation, electropalatography AND therapy, electropalatography AND ultrasonography, electropalatography AND speech. SELECTION CRITERIA: The research criteria selected in the database were: studies in the past five years and studies in humans. In the pre-selection, studies that were duplicate, not fully available, and have shown no direct relation with electropalatography in speech-language therapy were discarded. DATA ANALYSIS: Data analysis was performed descriptively, following subdivisions: title, area, year, subject, implementation, and conclusion of the study. RESULTS: Twenty one papers were selected, eight of them using the term electropalatography, two with the keywords electropalatography AND evaluation, six with the keywords electropalatography AND therapy, three of them with the keywords electropalatography AND ultrasonography, and two papers with the keywords electropalatography AND speech. CONCLUSION: Different types of research involving the use of electropalatography in the field of speech-language therapy were found and analyzed. Few researches have concomitantly used electropalatography and ultrasonography.

Prototype app for voice therapy: a peer review. / Protótipo de aplicativo para terapia vocal: análise por pares.

PURPOSE: Voice speech therapy promotes changes in patients' voice-related habits and rehabilitation. Speech-language therapists use a host of materials ranging from pictures to electronic resources and computer tools as aids in this process. Mobile technology is attractive, interactive and a nearly constant feature in the daily routine of a large part of the population and has a growing application in healthcare. To develop a prototype application for voice therapy, submit it to peer assessment, and to improve the initial prototype based on these assessments. METHODS: a prototype of the Q-Voz application was developed based on Apple's Human Interface Guidelines. The prototype was analyzed by seven speech therapists who work in the voice area. Improvements to the product were made based on these assessments. RESULTS: all features of the application were considered satisfactory by most evaluators. All evaluators found the application very useful; evaluators reported that patients would find it easier to make changes in voice behavior with the application than without it; the evaluators stated they would use this application with their patients with dysphonia and in the process of rehabilitation and that the application offers useful tools for voice self-management. Based on the suggestions provided, six improvements were made to the prototype. CONCLUSION: the prototype Q-Voz Application was developed and evaluated by seven judges and subsequently improved. All evaluators stated they would use the application with their patients undergoing rehabilitation, indicating that the Q-Voz Application for mobile devices can be considered an auxiliary tool for voice speech therapy.

Eletropalatografia e sua correlação à ultrassonografia do movimento de língua nas análises da fala / Electropalatography and its correlation to tongue movement ultrasonography in speech analysis

RESUMO Objetivo Analisar o uso da eletropalatografia e ultrassonografia na área da Fonoaudiologia por meio de revisão narrativa de literatura. Estratégia de pesquisa Foi realizada pesquisa bibliográfica nas bases de dados PubMed e Scielo, utilizando como descritores electropalatography, electropalatography AND evaluation, electropalatography AND therapy, electropalatography AND ultrasonography, electropalatography AND speech. Critérios de seleção Como critério da pesquisa em base de dados, foram selecionados: estudos dos últimos cinco anos e estudos em humanos. Na pré-seleção, foram descartados estudos duplicados, não disponibilizados na íntegra e que não apresentassem relação direta da eletropalatografia para a área da Fonoaudiologia. Análise dos dados A análise de dados foi realizada de forma descritiva, seguindo as subdivisões: título, área, ano, tema, aplicação e conclusão do estudo. Resultados Foram selecionados vinte e um artigos, oito deles utilizando o termo electropalatography, dois com os descritores electropalatography AND evaluation, seis artigos com os descritores electropalatography AND therapy, três artigos com os descritores electropalatography AND ultrasonography e dois artigos com os descritores electropalatography AND speech. Conclusão Foram encontrados e analisados diferentes tipos de pesquisas envolvendo o uso da eletropalatografia na área da Fonoaudiologia. Poucas pesquisas utilizaram concomitantemente a eletropalatografia e a ultrassonografia.

ABSTRACT Purpose To analyze the use of electropalatography and ultrasonography regarding speech therapy through literature narrative review. Research strategies A literature review was conducted at PubMed and Scielo databases, using descriptors as electropalatography, electropalatography AND evaluation, electropalatography AND therapy, electropalatography AND ultrasonography, electropalatography AND speech. Selection criteria The research criteria selected in the database were: studies in the past five years and studies in humans. In the pre-selection, studies that were duplicate, not fully available, and have shown no direct relation with electropalatography in speech-language therapy were discarded. Data analysis Data analysis was performed descriptively, following subdivisions: title, area, year, subject, implementation, and conclusion of the study. Results Twenty one papers were selected, eight of them using the term electropalatography, two with the keywords electropalatography AND evaluation, six with the keywords electropalatography AND therapy, three of them with the keywords electropalatography AND ultrasonography, and two papers with the keywords electropalatography AND speech. Conclusion Different types of research involving the use of electropalatography in the field of speech-language therapy were found and analyzed. Few researches have concomitantly used electropalatography and ultrasonography.