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    ABSTRACT: Historically speech and language therapy services for children have been framed within a rehabilitative framework with explicit assumptions made about providing therapy to individuals. While this is clearly important in many cases, we argue that this model needs revisiting for a number of reasons. First, our understanding of the nature of disability, and therefore communication disabilities, has changed over the past century. Second, there is an increasing understanding of the impact that the social gradient has on early communication difficulties. Finally, understanding how these factors interact with one other and have an impact across the life course remains poorly understood. To describe the public health paradigm and explore its implications for speech and language therapy with children. We test the application of public health methodologies to speech and language therapy services by looking at four dimensions of service delivery: (1) the uptake of services and whether those children who need services receive them; (2) the development of universal prevention services in relation to social disadvantage; (3) the risk of over-interpreting co-morbidity from clinical samples; and (4) the overlap between communicative competence and mental health. It is concluded that there is a strong case for speech and language therapy services to be reconceptualized to respond to the needs of the whole population and according to socially determined needs, focusing on primary prevention. This is not to disregard individual need, but to highlight the needs of the population as a whole. Although the socio-political context is different between countries, we maintain that this is relevant wherever speech and language therapists have a responsibility for covering whole populations. Finally, we recommend that speech and language therapy services be conceptualized within the framework laid down in The Ottawa Charter for Health Promotion.
    International Journal of Language & Communication Disorders 09/2013; 48(5):486-96. DOI:10.1111/1460-6984.12027
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    ABSTRACT: Background: In recent years there has been significant interest in the differential processing of nouns and verbs in people with aphasia, but more limited consideration about whether the differences have implications for therapy. It remains unclear whether verbs can be treated in a similar way to nouns or should be treated using approaches that recognize the relationship between verb retrieval and sentence production. Aims: This paper reviews studies focusing on therapy for spoken verb retrieval, considering the impact of therapy on treated and untreated verbs, sentence production and connected speech. It explores whether there are differential gains across therapy paradigms and whether verbs respond to therapy in the same way as nouns. Method & Procedures: Studies were identified using a systematic search. A total of 26 studies were reviewed and classified under four headings: (1) studies that treated verbs in a single-word context, (2) studies that compared treatment for nouns and verbs, (3) studies that treated verbs in a sentence context, and (4) studies that treated verb retrieval and argument structure. Main Contribution: Findings from the review demonstrate that verb therapy, irrespective of whether verbs are treated within a single-word or sentence context, is effective in improving the retrieval of treated verbs, but with limited generalization to untreated verbs. Verbs respond very similarly to nouns when treated using the same techniques, but improving verb retrieval may be harder to achieve than improving noun retrieval. The impact on sentence production is more varied. The gains in sentence production are discussed in relation to the different therapy types, the rationale for therapy and the presence of co-occurring sentence difficulties. Conclusions: The review highlights the need for more systematic evaluation of different types of verb therapy, measuring the impact of therapy on verb retrieval, sentence production and connected speech. Only through the judicious assessment and monitoring of change across different contexts will an understanding of how verbs respond to therapy be developed and what generalization patterns can be predicted. This will lead to increased confidence in the selection of therapy approaches for people with verb difficulties in aphasia.
    International Journal of Language & Communication Disorders 11/2012; 47(6):619-36. DOI:10.1111/j.1460-6984.2012.00174.x
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    ABSTRACT: It is commonly assumed that boys have poorer language skills than girls, but this assumption is largely based on studies with small, clinical samples or focusing on expressive language skills. This study examines the relationship between gender and receptive vocabulary, literacy, and non-verbal performance at 5 years through to adulthood. The participants were a UK birth cohort of 11,349 children born in one week in March 1970. Logistic regression models were employed to examine the association of gender with language and literacy at 5 and 34 years. Non-verbal abilities were comparable at 5 years, but there were significant differences for both receptive vocabulary and reading, favouring the boys and the girls, respectively. Boys but not girls who had parents who were poor readers were more likely to be not reading at 5 years. Gender was not associated with adulthood literacy. Boys may have a slight advantage over girls in terms of their receptive vocabulary, raising questions about the skills tested and the characteristics of clinical populations. The findings are discussed in terms of the nature of the way that children are assessed and the assumptions underpinning clinical practice.
    International Journal of Speech-Language Pathology 10/2012; DOI:10.3109/17549507.2012.721897
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    ABSTRACT: Abstract Although Warren, Fey and Yoder (2007) have described the key components of "dosage", one needs to go beyond description if one is to understand "optimal" dosage, specifically one needs to relate the characteristics of the intervention to the size of the intervention effect. This study examines the association between dose, intensity, and effect size in 20 randomized controlled studies taken from a few systematic reviews focusing on interventions aiming to ameliorate vocabulary, phonology, and syntax. Reporting of dosage characteristics is an important issue. Our analysis shows that "teaching episodes" and "dose form" are rarely reported in the included studies. The other dosage characteristics are present but not always reported in a transparent fashion. Session length and cumulative intervention intensity is lower for phonology interventions than it is for vocabulary intervention. Dosage, however defined, is not directly associated with outcome, although the level of association varies across the three interventions, for example appearing stronger for vocabulary and phonology than syntax. Taking the three interventions together the dosage components are related to the intervention effects size, but the sample is small and the association is not statistically significant. This study concludes that, while the framework suggested by Baker (2012) and adapted from Warren et al. (2007) is useful but without reference to the effect size of a study, it can only ever tell half the story. One needs to be able to relate dosage to outcome, asking questions about the relationship between the different dosage characteristics and the intervention effect size. Given the available data, it is not, at this stage, possible to make recommendations about optimal dosage.
    International Journal of Speech-Language Pathology 10/2012; 14(5):471-7. DOI:10.3109/17549507.2012.720281
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    ABSTRACT: Background: Sentence repetition (SR) is a reliable clinical marker of specific language impairment (SLI). However, little is known about cognitive processes underpinning SR, or areas of breakdown in children with SLI. Aims: The study investigated which cognitive mechanisms were most closely involved in SR performance: syntactic knowledge, phonological short-term memory (STM) and working memory (WM). Methods & Procedures: Twenty-three children with SLI (mean age = 6;7), 18 age-matched (mean age = 6;5) and 21 language-matched children (mean age = 4;8) repeated 180 sentences of varying length and complexity. Total words omitted, added or substituted were counted. Assessments of syntactic knowledge using a structural priming task, and assessments of WM, and phonological STM, were conducted. Twenty sentences were presented in a delayed repetition condition to investigate the role of phonological STM. Outcomes & Results: The children with SLI made more SR errors than controls and found delayed repetition especially difficult. Their SR errors were qualitatively similar to errors on other production tasks. In the SLI group, all assessments were good predictors, though the priming task was the strongest. In the control groups WM tasks were the best predictors, but the phonological STM task was a poor predictor. Conclusions & Implications: The data support a multifaceted view of SR with a role for syntactic knowledge, WM and STM. 'Redintegration', whereby long-term memory representations are used to maintain information in short-term memory, is likely to be a key process. Specific errors in the SLI group are likely to reflect difficulties with underlying syntactic representations. Children with SLI may be more dependent on phonological STM than typically developing children.
    International Journal of Language & Communication Disorders 09/2012; 47(5):499-510. DOI:10.1111/j.1460-6984.2012.00158.x
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    ABSTRACT: Despite recognition of the need for increased long-term support for people with aphasia following stroke, there remains limited evidence for effective service-level interventions. To evaluate the outcomes and experiences of people participating in the Communication Hub for Aphasia in North Tyneside (CHANT), a 2-year partnership project between health, local authority and third-sector services, shaped by people with aphasia, which provided a coordinated programme of support and interventions for people with long-term aphasia following stroke. Quantitative and qualitative methods were used in the evaluation. Thirty-nine participants with aphasia were recruited to the 12-month study as they became part of CHANT, with 20 completing all measures at the end of the study. Participants had no other speech and language therapy during the study. Quantitative measures (before and after intervention) were used for quality of life, self-report outcomes and goal attainment. Three of the participants with aphasia and three further people involved in the service (carer, volunteer, public sector worker) each agreed to a series of five semi-structured interviews over a 9-month period. A total of 28 interviews were collected using neutral interviewers; these were transcribed and analysed by a team within NVivo8 software, based on interpretive principles from grounded theory. Thematic analysis of the narratives explored the experience of engaging with CHANT, and the barriers and facilitators affecting quality of life. People with aphasia made significant gains in quality of life (in particular, in communication and psychosocial adjustment to stroke) and self-report measures of change. A total of 82% of real-life goals set as part of intervention were fully or partially achieved at follow-up. Five core themes emerged from the narratives: 'Quality of life', 'Barriers', 'Facilitators', 'Types of CHANT activity' and 'Effectiveness'. The intervention was evaluated through the theme of 'Effectiveness' in relation to the other themes, encapsulating emerging participant views (including the type and timeliness of activity, expectations of outcomes, resources and perceived value). The impact of the intervention was also analysed in terms of identifying barriers and providing facilitators. The quantitative and qualitative (narrative) findings were complementary in demonstrating the effectiveness of the CHANT service delivery model. Moreover, the narratives, through a longitudinal perspective, provided evidence about people's experience of intervention for long-term aphasia. The findings provide foundations for further work into long-term recovery, intervention and adjustment to aphasia post-stroke.
    International Journal of Language & Communication Disorders 07/2012; 47(4):398-412. DOI:10.1111/j.1460-6984.2012.00153.x
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    ABSTRACT: Early language delays across the preschool period have important implications for children, parents, and services raising the significance of early identification. Screening tests are an appealing solution but have proved problematic. A combined risk model would seem promising but has yet to be tested. The goal of this study was to examine the factors that predict language change in a nationally representative sample of children between 3 and 5 years when most children are identified as being in need of services. By using data from children (n = 13,016) in the Millennium Cohort Study (a national UK birth cohort), linear regression was used to predict 5-year performance from 3-year test performance data coupled with sociodemographic and within-child factors and indicators of parental concern. Patterns of change were identified and logistic regression was used to predict the difference between children for whom profiles change and those for whom they do not. The final model (predicting 32% of the variance) included maternal education, pattern construction, behavior, language concerns, and 3-year vocabulary. Four change patterns were identified: one consistently low (n = 201), one consistently high (n = 12,066), a group that is resilient (n = 572), and one with a declining profile (n = 177). The models accurately predicted 71% of the declining group and 99% of the resilient group. Maternal education (odds ratio: 0.49) and behavior (odds ratio: 0.9) were significant predictors for the former and maternal education (odds ratio: 0.6) and pattern construction (odds ratio: 1.03) the latter. Early identification of delayed language remains problematic but, once identified, there are key indicators that predict which children are likely to be more or less at risk across time. The implications are discussed in terms of policy and practice.
    PEDIATRICS 06/2012; 130(1):e132-7. DOI:10.1542/peds.2011-1673
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    ABSTRACT: Auditory-verbal short-term memory deficits (STM) are prevalent in aphasia and can contribute to sentence comprehension deficits. This study investigated the effectiveness of a novel STM treatment in improving STM (measured with span tasks) and sentence comprehension (measured with the Token Test and the Test for the Reception of Grammar, TROG) in a person with severe aphasia (transcortical motor). In particular, the research questions were: (1) Would STM training improve STM? (2) Would improvements from the STM training generalise to improvements in comprehension of sentences? STM was trained using listening span tasks of serial word recognition. No other language or sentence comprehension skills were trained. Following treatment, STM abilities improved (listening span, forward digit span). There was also evidence of generalisation to untreated sentence comprehension (only on the TROG). Backward digit span, phonological processing and single word comprehension did not improve. Improvements in sentence comprehension may have resulted from resilience to rapid decay of linguistic representations within sentences (words and phrases). This in turn facilitated comprehension.
    Neuropsychological Rehabilitation 02/2012; 22(3):428-48. DOI:10.1080/09602011.2012.656460
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    ABSTRACT: Although economic evaluation has been widely recognized as a key feature of both health services and educational research, for many years there has been a paucity of such studies relevant to services for children with speech, language and communication needs (SLCN), making the application of economic arguments to the development of services difficult. The study has two aims, namely to review systematically the cost-effectiveness literature related to services for children with SLCN and to highlight key issues that need to be included in future economic effectiveness studies. A comprehensive search of the international literature for the last 30 years was completed and the studies were evaluated against the 'gold standard' criteria developed by Drummond and colleagues in 1996 and 2005. Five studies met the review inclusion criteria. All focused on young (2-11 years) children with SLCN and most compared clinic-based and parent-administered interventions. The studies provide variable levels of detail on the key elements needed, but few provided sufficient details of costs to draw comparisons across studies. Only two studies attempted to bring together costs and effectiveness data. The studies point to the importance of home-based and indirect intervention and, in many cases, emphasize the parental perspective. There is a need for intervention studies to include a cost dimension based on readily comparable methods of establishing unit costs and for greater use to be made of cost-effectiveness analysis more generally.
    International Journal of Language & Communication Disorders 01/2012; 47(1):1-10. DOI:10.1111/j.1460-6984.2011.00084.x
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    ABSTRACT: Previous studies have highlighted the level of communication difficulty experienced by children from socially disadvantaged backgrounds, but the pattern of difficulties remains unclear. The study asks whether the performance of a community sample of children from one of the most socially disadvantaged neighbourhoods in Scotland is best characterized by a general delay in all areas of development, by difficulties across the more formal structural aspects of language or in phonological skills. The study included 138 monolingual English-speaking children: 63 (45.7%) boys and 75 (54.3%) girls aged between 5 and 12 years. All children were assessed blind to educational attainment in the school. Nearly 40% of children had delayed language development with 10% having severe difficulties. The children presented with an uneven profile with much lower structural language scores than reading, general communication skills or non-verbal performance. Although service use was high in the group as a whole, the proportion who met criteria for specific language impairment on discrepancy criteria were not those who were being referred to speech and language therapy. Although many children were performing well within the normal range, a substantial proportion were not, having considerable implications for the way that services are delivered to these children. Given the high prevalence of delayed structural language difficulties in this group, there is a clear need for a more universal 'population'-based approaches to service delivery.
    International Journal of Language & Communication Disorders 11/2011; 46(6):657-64. DOI:10.1111/j.1460-6984.2011.00036.x
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