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American Journal of Speech-language... May 2015This is a systematic review of assessment and treatment of cognitive and communicative abilities of individuals with acquired brain injury via telepractice versus in...
PURPOSE
This is a systematic review of assessment and treatment of cognitive and communicative abilities of individuals with acquired brain injury via telepractice versus in person. The a priori clinical questions were informed by previous research that highlights the importance of considering any functional implications of outcomes, determining disorder- and setting-specific concerns, and measuring the potential impact of diagnostic accuracy and treatment efficacy data on interpretation of findings.
METHOD
A literature search of multiple databases (e.g., PubMed) was conducted using key words and study inclusion criteria associated with the clinical questions.
RESULTS
Ten group studies were accepted that addressed assessment of motor speech, language, and cognitive impairments; assessment of motor speech and language activity limitations/participation restrictions; and treatment of cognitive impairments and activity limitations/participation restrictions. In most cases, equivalence of outcomes was noted across service delivery methods.
CONCLUSIONS
Limited findings, lack of diagnostic accuracy and treatment efficacy data, and heterogeneity of assessments and interventions precluded robust evaluation of clinical implications for telepractice equivalence and the broader area of telepractice efficacy. Future research is needed that will build upon current knowledge through replication. In addition, further evaluation at the impairment and activity limitation/participation restriction levels is needed.
Topics: Adult; Apraxias; Brain Injury, Chronic; Cognition Disorders; Communication; Humans; Language Disorders; Patient Acceptance of Health Care; Patient Satisfaction; Practice, Psychological; Research; Telerehabilitation; Treatment Outcome
PubMed: 25836020
DOI: 10.1044/2015_AJSLP-14-0028 -
American Journal of Speech-language... May 2015The aim was for the appointed committee of the Academy of Neurological Communication Disorders and Sciences to conduct a systematic review of published intervention...
OBJECTIVES
The aim was for the appointed committee of the Academy of Neurological Communication Disorders and Sciences to conduct a systematic review of published intervention studies of acquired apraxia of speech (AOS), updating the previous committee's review article from 2006.
METHOD
A systematic search of 11 databases identified 215 articles, with 26 meeting inclusion criteria of (a) stating intention to measure effects of treatment on AOS and (b) data representing treatment effects for at least 1 individual stated to have AOS.
RESULTS
All studies involved within-participant experimental designs, with sample sizes of 1 to 44 (median = 1). Confidence in diagnosis was rated high to reasonable in 18 of 26 studies. Most studies (24/26) reported on articulatory-kinematic approaches; 2 applied rhythm/rate control methods. Six studies had sufficient experimental control for Class III rating according to the Clinical Practice Guidelines Process Manual (American Academy of Neurology, 2011), with 15 others satisfying all criteria for Class III except use of independent or objective outcome measurement.
CONCLUSIONS
The most important global clinical conclusion from this review is that the weight of evidence supports a strong effect for both articulatory-kinematic and rate/rhythm approaches to AOS treatment. The quantity of work, experimental rigor, and reporting of diagnostic criteria continue to improve and strengthen confidence in the corpus of research.
PubMed: 25815778
DOI: 10.1044/2015_AJSLP-14-0118 -
OTJR : Occupation, Participation and... 2014The objective was to assess effectiveness of apraxia treatments using a systematic review. In contrast to previous reviews, each study was rated as to its applicability... (Review)
Review
The objective was to assess effectiveness of apraxia treatments using a systematic review. In contrast to previous reviews, each study was rated as to its applicability to occupational therapy practice and its focus on occupational performance using the FAME rating system (defined by four categories: Feasibility, Appropriateness, Meaningfulness, Effectiveness). This systematic review included eight studies: four randomized controlled trials (level 1 evidence) and four pre-post designs (level 3 evidence). Three treatment approaches were reported: errorless learning with training of details; gesture training; and strategy training. FAME scores ranged from A to C. All studies reported significant treatment effects, but only one demonstrated an impact on observed occupational performance that transferred from clinic to home.
Topics: Apraxias; Humans; Occupational Therapy; Treatment Outcome
PubMed: 25347756
DOI: 10.3928/15394492-20141006-02 -
Journal of the American Medical... Jan 2015Fear of falling (FOF) and increased gait variability are both independent markers of gait instability. There is a complex interplay between both entities. The purposes... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Fear of falling (FOF) and increased gait variability are both independent markers of gait instability. There is a complex interplay between both entities. The purposes of this study were (1) to perform a qualitative analysis of all published studies on FOF-related changes in gait variability through a systematic review, and (2) to quantitatively synthesize FOF-related changes in gait variability.
METHODS
A systematic Medline literature search was conducted in May 2014 using the Medical Subject Heading (MeSH) terms "Fear" OR "fear of falling" combined with "Accidental Falls" AND "Gait" OR "Gait Apraxia" OR "Gait Ataxia" OR "Gait disorders, Neurologic" OR "Gait assessment" OR "Functional gait assessment" AND "Self efficacy" OR "Self confidence" AND "Aged" OR "Aged, 80 and over." Systematic review and fixed-effects meta-analysis using an inverse-variance method were performed.
RESULTS
Of the 2184 selected studies, 10 observational studies (including 5 cross-sectional studies, 4 prospective cohort studies, and 1 case-control study) met the selection criteria. All were of good quality. The number of participants ranged from 52 to 1307 older community-dwellers (26.2%-85.0% women). The meta-analysis was performed on 10 studies with a total of 999 cases and 4502 controls. In one study, the higher limits of the effect size's confidence interval (CI) were lower than zero. In the remaining studies, the higher limits of the CI were positive. The summary random effect size of 0.29 (95% CI 0.13-0.45) was significant albeit of small magnitude, and indicated that gait variability was overall 0.29 SD higher in FOF cases compared with controls.
CONCLUSIONS
Our findings show that FOF is associated with a statistically significant, albeit of small magnitude, increase in gait variability.
Topics: Accidental Falls; Aged; Fear; Gait Disorders, Neurologic; Humans
PubMed: 25230892
DOI: 10.1016/j.jamda.2014.06.020 -
American Journal of Speech-language... Aug 2014To present a systematic review of single-case experimental treatment studies for childhood apraxia of speech (CAS). (Review)
Review
PURPOSE
To present a systematic review of single-case experimental treatment studies for childhood apraxia of speech (CAS).
METHOD
A search of 9 databases was used to find peer-reviewed treatment articles from 1970 to 2012 of all levels of evidence with published communication outcomes for children with CAS. Improvement rate differences (IRDs) were calculated for articles with replicated (n > 1), statistically compared treatment and generalization evidence.
RESULTS
Forty-two articles representing Phase I and II single-case experimental designs (SCEDs; n = 23) or case series or description studies ( n = 19) were analyzed. Six articles showed high CAS diagnosis confidence. Of the 13 approaches within the 23 SCED articles, treatments were primarily for speech motor skills ( n = 6), linguistic skills ( n = 5), or augmentative and alternative communication ( n = 2). Most participants responded positively to treatment, but only 7 of 13 approaches in SCED studies reported maintenance and/or generalization of treatment effects. Three approaches had preponderant evidence (Smith, 1981). IRD effect sizes were calculated for Integral Stimulation/Dynamic Temporal and Tactile Cueing, Rapid Syllable Transition Treatment, and Integrated Phonological Awareness Intervention.
CONCLUSIONS
At least 3 treatments have sufficient evidence for Phase III trials and interim clinical practice. In the future, efficacy needs to be established via maintenance and generalization measures.
Topics: Apraxias; Awareness; Child; Combined Modality Therapy; Generalization, Psychological; Humans; Longitudinal Studies; Phonetics; Speech Production Measurement; Speech Therapy; Treatment Outcome; Vocabulary
PubMed: 24686844
DOI: 10.1044/2014_AJSLP-13-0035