A five-phase model for clinical-outcome research
ABSTRACT Through a variety of approaches, speech-language pathologists and audiologists have produced strong evidence that treatments are generally potent. However, we have largely ignored the accepted standards for clinical-outcome testing used throughout the broader research community (e.g., by other clinical disciplines, federal regulators, and third-party payers). Several clinical professions recognize a comprehensive model for organizing and scaffolding the many forms of clinical-outcome research. An adaptation of this five-phase model of clinical-outcome research is examined as a means for structuring forms of clinical research throughout audiology and speech-language pathology. Within the organizing structure, relationships become apparent between types and grades of scientific evidence and the processes underpinning evidence-based practice which ultimately lead to decisions on the status of intervention protocols. LEARNING OUTCOMES: Readers will be able to distinguish the phases of clinical-outcome research in a comprehensive model. Readers will be able to identify relationships between the structure of the model and broadly recognized concepts associated with the terms 'efficacy' and 'effectiveness.' Readers will be able to identify indicators of quality for controlled clinical trials.
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ABSTRACT: The ultimate goal of aphasia therapy should be to achieve gains in function that generalize to untrained exemplars and daily conversation. Anomia is one of the most disabling features of aphasia. The predominantly lexical/semantic approaches used to treat anomia have low potential for generalization due to the orthogonality of semantic and phonologic representations; this has been borne out in a meta-analysis of treatment studies. The intensive, neurally distributed, phonologic therapy reported here can, in principle, generalize to untrained phonologic sequences because of extant regularities in phonologic sequence knowledge, and should, in principle, generalize to production of words trained as well as those untrained. Twenty-six persons with chronic aphasia due to stroke were treated, in a staggered (immediate vs. delayed treatment) open trial design, with 60 hours of intensive, multi-modal therapy designed to enhance access to and efficiency of phonemes and phonologic sequences. There was an absolute increase of 5% in confrontation naming of untrained nouns at three months and there were 9-10% increases on measures of generalization of phonologic processes. The results of this trial demonstrate generalization of training effects on laboratory measures, which were sustained at three months, and provide support for the theories that motivated the treatment.Journal of Speech Language and Hearing Research 03/2015; DOI:10.1044/2015_JSLHR-L-14-0131 · 1.93 Impact Factor
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ABSTRACT: Abstract We explored the suitability of perceptual and acoustic outcome measures to prepare E-learning based Speech Therapy (EST) efficacy tests regarding speech intelligibility in dysarthric speakers. Eight speakers with stroke (n = 3), Parkinson's disease (n = 4) and traumatic brain injury (n = 1) participated in a 4 weeks EST trial. A repeated measures design was employed. Perceptual measures were (a) scale ratings for "ease of intelligibility" and "pleasantness" in continuous speech and (b) orthographic transcription scores of semantically unpredictable sentences. Acoustic measures were (c) "intensity during closure" (ΔIDC) in the occlusion phase of voiceless plosives, (d) changes in the vowel space of /a/, /e/ and /o/ and (e) the F0 variability in semantically unpredictable sentences. The only consistent finding concerned an increased (instead of the expected decreased) ΔIDC after EST, possibly caused by increased speech intensity without articulatory adjustments. The importance of suitable perceptual and acoustic measures for efficacy research is discussed.Clinical Linguistics & Phonetics 07/2014; DOI:10.3109/02699206.2014.936627 · 0.78 Impact Factor
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ABSTRACT: Successful acquisition of literacy depends on adequate development of decoding skills as well as broader, meaning-related knowledge and skills for text comprehension. Children from low socioeconomic status (SES) backgrounds are often challenged in both domains, relative to peers who are not economically disadvantaged. The efficacy of code-focused instructional programs for at-risk preliterate children is well supported, but less evidence is available regarding interventions to improve broader language and comprehension skills. This preliminary study tested the feasibility of a new intervention, "structured narrative retell instruction" (SNRI), and explored its potential to enhance meaning-related knowledge and skills, including vocabulary, listening comprehension, and narrative skills, in pre-literate, low SES children. SNRI used authentic children's books to model comprehension processes, explicitly teach story grammar, and implicitly target microstructural aspects of narratives. Participants included 9 children with a mean age of 60 months, who were randomly assigned to SNRI or to code-focused literacy instruction (CFLI). Each group received 12, 40-min instructional sessions over 6 weeks. Pre- and post-tests were administered to assess vocabulary, listening comprehension, narrative macrostructure and narrative microstructure, as well as alphabet knowledge, phonological awareness, and concepts of print. The feasibility of SNRI was demonstrated by completion of the designed study, moderately high treatment fidelity, and qualitative feedback from interventionists. The SNRI group also made significant gains on 4 of the 7 meaning-related measures (p < 0.10). In comparison, the CFLI group made significant gains on 2 of 7 meaning-related measures. We conclude that SNRI is feasible and shows potential for improving language skills related to comprehension and that further research investigating its efficacy is warranted.Frontiers in Psychology 05/2014; 5:391. DOI:10.3389/fpsyg.2014.00391 · 2.80 Impact Factor