Article

Intervention for dysarthria associated with acquired brain injury in children and adolescents

Healthy Development [Theme], Language & Literacy, Murdoch Childrens Research Institute, Parkville, Melbourne, Victoria, Australia, 3052.
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 01/2008; DOI: 10.1002/14651858.CD006279.pub2
Source: PubMed

ABSTRACT The term 'acquired brain injury' (ABI) incorporates a range of aetiologies including cerebrovascular accident, brain tumour and traumatic brain injury. ABI is a common cause of disability in the paediatric population, and dysarthria is a common and often persistent sequelae associated with ABI in children.
To assess the efficacy of intervention delivered by Speech and Language Pathologists/Therapists targeting dysarthric speech in children resulting from acquired brain injury.
We searched CENTRAL (Issue 4, 2006), MEDLINE (1966 to 02/2007), CINAHL (1982 to 02/2007), EMBASE (1980 to 02/2007), ERIC (1965 to 02/2007), Linguistics Abstracts Online (1985 to 02/07), PsycINFO (1872 to 02/2007). Additional references were also sought from reference lists studies.
The review considered randomised controlled trials (RCTs) and quasi-experimental design studies of children aged 3-16 years with acquired dysarthria grouped by aetiology (e.g., brain tumour, traumatic brain injury, cerebrovascular accident).
Each author independently assessed the titles and abstracts for relevance (100% inter-rater reliability) and the full text version of all potentially relevant articles was obtained. No studies met inclusion criteria.
Of 2091 titles and abstracts identified, full text versions of only three (Morgan 2007; Murdoch 1999; Netsell 2001) were obtained. 2088 were excluded, largely on the basis of not including dysarthria, being diagnostic or descriptive papers, and for concerning adults rather than children. Morgan 2007 and Murdoch 1999 were excluded for not employing RCT or quasi-randomised methodology; Netsell 2001 on the basis of being a theoretical review paper, rather than an intervention study. Five references were identified and obtained from the bibliography of the Murdoch 1999 paper. All were excluded due to including populations without ABI, adults with dysarthria, or inappropriate design. Thus, no studies met inclusion criteria.
The review demonstrates a critical lack of studies, let alone RCTs, addressing treatment efficacy for dysarthria in children with ABI. Possible reasons to explain this lack of data include i) a lack of understanding of the characteristics or natural history of dysarthria associated with this population; ii) the lack of a diagnostic classification system for children precluding the development of well targeted intervention programs; and iii) the heterogeneity of both the aetiologies and resultant possible dysarthria types of paediatric ABI. Efforts should first be directed at modest well-controlled studies to identify likely efficacious treatments that may then be trialed in multi-centre collaborations using quasi-randomised or RCT methodology.

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    • "As regards the clinical effectiveness of treatment , whilst case studies do suggest that change in speech function is possible following treatment for acquired dysarthria in childhood ( Morgan et al . , 2007 ; Murdoch , Pitt , Theodoros , & Ward , 1999 ) , there is no high level evidence available to suggest that treatment is effective ( Morgan & Vogel , 2008 ) . Future studies should deter - mine whether participants had considered treatment , and explore the child and families ' perspective on the impact of their dysarthria on everyday functioning and quality of life . "
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    • "SLT input was variable for each patient, but occurred no more intensively than one session per week or fortnight. It should be noted that there is currently no high level evidence available to support the efficacy of any dysarthria treatments in children (Morgan & Vogel, 2008, 2009; Pennington, Miller, & Robson, 2009). "
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