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The Cochrane Database of Systematic... 2003It is thought that approximately 6% of children have speech and language difficulties of which the majority will not have any other significant developmental... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
It is thought that approximately 6% of children have speech and language difficulties of which the majority will not have any other significant developmental difficulties. Whilst most children's difficulties resolve, children whose difficulties persist into primary school may have long-term problems concerning literacy, socialisation, behaviour and school attainment.
OBJECTIVES
To examine the effectiveness of speech and language interventions for children with primary speech and language delay/disorder.
SEARCH STRATEGY
The following databases were searched: The Cochrane Controlled Trials Register (Cochrane Library, CENTRAL: 2002/3), CINAHL (1982 - July 2002), EMBASE (1980 - Sept Week 4 2002), ERIC (1965 - 2002), MEDLINE (1966 - Sept Week 3 2002), PsycINFO (1872 - 2002/10 Week 2), The National Research Register (2002/3). In addition to this references were taken from reviews of the literature and reference lists from articles.
SELECTION CRITERIA
The review considered randomised controlled trials of speech and language therapy interventions for children or adolescents with primary speech and language delay/disorder.
DATA COLLECTION AND ANALYSIS
Titles and abstracts were identified and assessed for relevance, before the full text version was obtained of all potentially relevant articles. The data were categorised depending on the nature of the control group and considered in terms of the effects of intervention on expressive and receptive phonology, syntax and vocabulary. The outcomes used in the analysis were dependent on the focus of the study with only the primary effects of therapy being considered in this review.
MAIN RESULTS
The results of twenty-five studies were used in the meta-analysis. The results suggest that speech and language therapy is effective for children with phonological (SMD=0.44, 95%CI: 0.01,0.86) or vocabulary difficulties (SMD=0.89, 95%CI: 0.21,1.56), but that there is less evidence that interventions are effective for children with receptive difficulties (SMD=-0.04, 95%CI: -0.64,0.56). Mixed findings were found concerning the effectiveness of expressive syntax interventions (n=233; SMD=1.02, 95%CI: 0.04-2.01). No significant differences were shown between clinician administered intervention and intervention implemented by trained parents, and studies did not show a difference between the effects of group and individual interventions (SMD=0.01, 95%CI: -0.26,1.17). The use of normal language peers in therapy was shown to have a positive effect on therapy outcome (SMD=2.29, 95%CI: 1.11,3.48).
REVIEWER'S CONCLUSIONS
The review shows that overall there is a positive effect of speech and language therapy interventions for children with expressive phonological and expressive vocabulary difficulties. The evidence for expressive syntax difficulties is more mixed, and there is a need for further research to investigate intervention for receptive language difficulties. There is a large degree of heterogeneity in the results, and the sources of this need to be investigated.
Topics: Adolescent; Aphasia; Child; Dysarthria; Humans; Language Development Disorders; Language Therapy; Randomized Controlled Trials as Topic; Speech Disorders; Speech Therapy
PubMed: 12918003
DOI: 10.1002/14651858.CD004110 -
American Family Physician May 2011Speech and language delay in children is associated with increased difficulty with reading, writing, attention, and socialization. Although physicians should be alert to...
Speech and language delay in children is associated with increased difficulty with reading, writing, attention, and socialization. Although physicians should be alert to parental concerns and to whether children are meeting expected developmental milestones, there currently is insufficient evidence to recommend for or against routine use of formal screening instruments in primary care to detect speech and language delay. In children not meeting the expected milestones for speech and language, a comprehensive developmental evaluation is essential, because atypical language development can be a secondary characteristic of other physical and developmental problems that may first manifest as language problems. Types of primary speech and language delay include developmental speech and language delay, expressive language disorder, and receptive language disorder. Secondary speech and language delays are attributable to another condition such as hearing loss, intellectual disability, autism spectrum disorder, physical speech problems, or selective mutism. When speech and language delay is suspected, the primary care physician should discuss this concern with the parents and recommend referral to a speech-language pathologist and an audiologist. There is good evidence that speech-language therapy is helpful, particularly for children with expressive language disorder.
Topics: Age Factors; Child, Preschool; Counseling; Evidence-Based Medicine; Humans; Infant; Language Development; Language Development Disorders; Mass Screening; Parents; Physician's Role; Physicians, Primary Care; Prevalence; Preventive Health Services; Prognosis; Speech Disorders; Speech Therapy; United States
PubMed: 21568252
DOI: No ID Found -
Continuum (Minneapolis, Minn.) Feb 2019This article reviews two of the primary progressive aphasias (PPAs), disorders characterized by the early and predominant impairment of language, and primary progressive... (Review)
Review
PURPOSE OF REVIEW
This article reviews two of the primary progressive aphasias (PPAs), disorders characterized by the early and predominant impairment of language, and primary progressive apraxia of speech, a degenerative motor speech disorder that is closely related to PPA. An outline of the history and controversy surrounding how these disorders are classified is provided before the article focuses on each disorder's clinical and imaging features.
RECENT FINDINGS
Over the past decade, the classification of degenerative speech and language disorders has been refined. Clinical, imaging, and pathologic evidence suggests that primary progressive apraxia of speech is a distinct degenerative disorder. Furthermore, multiple lines of evidence have highlighted issues with nonfluent/agrammatic variant PPA, which complicates the diagnosis, prognosis, and study of this disorder. Semantic variant PPA, while not without controversy, remains one of the most well-defined disorders, with good clinicopathologic correlation.
SUMMARY
Accurate classification and diagnosis of these degenerative speech and language disorders is crucial in clinical practice and ongoing research efforts. For nonfluent/agrammatic variant PPA, the authors suggest emphasizing agrammatism as the core inclusion criterion and taking care not to include patients with isolated or predominant apraxia of speech. Isolated apraxia of speech can be the manifestation of a degenerative disease and, based on the different prognosis, should be recognized as distinct from PPA. Finally, it is important to recognize that some patients with semantic dementia, despite sharing the same pathologic associations, may not meet criteria for PPA.
Topics: Aged; Aphasia, Primary Progressive; Apraxias; Brain; Female; Fluorodeoxyglucose F18; Frontotemporal Dementia; Humans; Magnetic Resonance Imaging; Neurologic Examination; Neuropsychological Tests; Positron-Emission Tomography; Speech
PubMed: 30707189
DOI: 10.1212/CON.0000000000000699 -
Seminars in Speech and Language Feb 2018Apraxia of speech (AOS) is a motor speech disorder that disrupts the planning and programming of speech motor movements. In the acute stage of stroke recovery, AOS... (Review)
Review
Apraxia of speech (AOS) is a motor speech disorder that disrupts the planning and programming of speech motor movements. In the acute stage of stroke recovery, AOS following unilateral (typically) left hemisphere stroke can occur alongside dysarthria, an impairment in speech execution and control, and/or aphasia, a higher-level impairment in language function. At this time, perceptual evaluation (the systematic, although subjective, description of speech and voice characteristics) is perhaps the only "gold standard" for differential diagnosis when it comes to motor speech disorders. This poses a challenge for speech-language pathologists charged with the evaluation of poststroke communication abilities, as distinguishing production impairments associated with AOS from those that can occur in aphasia and/or dysarthria can be difficult, especially when more than one deficit is present. Given the need for more objective, reliable methods to identify and diagnose AOS, several studies have turned to acoustic evaluation and neuroimaging to supplement clinical assessment. This article focuses on these recent advances. Studies investigating acoustic evaluation of AOS will be reviewed, as well as those that have considered the extent that neuroimaging can guide clinical decision making. Developments in the treatment of AOS will also be discussed. Although more research is needed regarding the use of these methods in everyday clinical practice, the studies reviewed here show promise as emerging tools for the management of AOS.
Topics: Apraxias; Diagnosis, Differential; Humans; Neuroimaging; Speech; Speech Acoustics; Speech Disorders; Speech Production Measurement; Stroke
PubMed: 29359303
DOI: 10.1055/s-0037-1608853 -
Revista de Neurologia Sep 2013The study reviews language disorders in children. Taking their normal development as the starting point, the work puts forward a differential diagnosis based on the... (Review)
Review
AIMS
The study reviews language disorders in children. Taking their normal development as the starting point, the work puts forward a differential diagnosis based on the symptoms presented in the moment the patient visited the physician. It also suggests an approach for children with language disorders from the neuropaediatric point of view while also updating the management of some of its forms.
DEVELOPMENT
The acquisition of language is one of the key milestones in the development of children. A child's social and intellectual development is affected by delayed acquisition of language and this can give rise to a ongoing effect involving isolation and regression, which tends towards poor academic achievement and, eventually, leads to the development of learning and social problems. There are studies that evidence a close relationship in children between the development of spoken language and written language, as well as the importance of acquiring language as the basis for writing skills. These problems cause a great deal of anxiety in parents.
CONCLUSIONS
Knowledge of the problem allows the specialist to detect these children early on in the preschool stage and to ensure they receive the right attention. If treated in time, language learning can be modified to a significant degree, thereby avoiding the complications that affect its development. The specialist working with children must recognise these problems and channel them towards the most suitable therapy.
Topics: Agraphia; Aphasia; Autistic Disorder; Child; Child, Preschool; Diagnosis, Differential; Dyslexia; Female; Humans; Infant; Infant, Newborn; Landau-Kleffner Syndrome; Language Development; Language Development Disorders; Language Disorders; Language Therapy; Male; Mutism; Prevalence; Psychosocial Deprivation; Speech Disorders
PubMed: 23897160
DOI: No ID Found -
Movement Disorders : Official Journal... Nov 2018As many as 89% of people with Parkinson's disease (PD) develop speech disorders. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
As many as 89% of people with Parkinson's disease (PD) develop speech disorders.
OBJECTIVES
This randomized controlled trial evaluated two speech treatments for PD matched in intensive dosage and high-effort mode of delivery, differing in subsystem target: voice (respiratory-laryngeal) versus articulation (orofacial-articulatory).
METHODS
PD participants were randomized to 1-month LSVT LOUD (voice), LSVT ARTIC (articulation), or UNTXPD (untreated) groups. Speech clinicians specializing in PD delivered treatment. Primary outcome was sound pressure level (SPL) in reading and spontaneous speech, and secondary outcome was participant-reported Modified Communication Effectiveness Index (CETI-M), evaluated at baseline, 1, and 7 months. Healthy controls were matched by age and sex.
RESULTS
At baseline, the combined PD group (n = 64) was significantly worse than healthy controls (n = 20) for SPL (P < 0.05) and CETI-M (P = 0.0001). At 1 and 7 months, SPL between-group comparisons showed greater improvements for LSVT LOUD (n = 22) than LSVT ARTIC (n = 20; P < 0.05) and UNTXPD (n = 22; P < 0.05). Sound pressure level differences between LSVT ARTIC and UNTXPD at 1 and 7 months were not significant (P > 0.05). For CETI-M, between-group comparisons showed greater improvements for LSVT LOUD and LSVT ARTIC than UNTXPD at 1 month (P = 0.02; P = 0.02). At 7 months, CETI-M between-group differences were not significant (P = 0.08). Within-group CETI-M improvements for LSVT LOUD were maintained through 7 months (P = 0.0011).
CONCLUSIONS
LSVT LOUD showed greater improvements than both LSVT ARTIC and UNTXPD for SPL at 1 and 7 months. For CETI-M, both LSVT LOUD and LSVT ARTIC improved at 1 month relative to UNTXPD. Only LSVT LOUD maintained CETI-M improvements at 7 months. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
Topics: Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Male; Middle Aged; Parkinson Disease; Speech Disorders; Speech Therapy; Treatment Outcome
PubMed: 30264896
DOI: 10.1002/mds.27460 -
CoDAS 2019Apraxia of speech is defined as the inability to sequence the movements required for accurate articulatory production, traditionally involving a deficit in speech motor...
Apraxia of speech is defined as the inability to sequence the movements required for accurate articulatory production, traditionally involving a deficit in speech motor programming. Language clinicians often confront about speech inconsistency clinical cases, which raise questions concerning the differential diagnosis between apraxia and language disorders. Such problem often results in the difficulty to establish an adequate treatment decision. In this work, we discuss a clinical report in which both diagnosis and treatment raise questions about the apraxic speech condition in childhood. We start from the recognition that, in apraxia, it seems imperative to consider that the body to be considered is the one that surpasses its organic functions and structure. Clinical consequences are drawn from the premise that the human body is one whose ear can listen, and mouth can speak, i.e., the organic structure is a material realm open to the incidence of language and its "music", which creates the speaking body.
Topics: Apraxias; Child, Preschool; Diagnosis, Differential; Female; Humans; Language Development Disorders; Language Therapy; Speech Disorders; Speech Production Measurement
PubMed: 31691745
DOI: 10.1590/2317-1782/20192018121 -
European Journal of Human Genetics :... Aug 2021Expressive communication impairment is associated with haploinsufficiency of SETBP1, as reported in small case series. Heterozygous pathogenic loss-of-function (LoF)...
Expressive communication impairment is associated with haploinsufficiency of SETBP1, as reported in small case series. Heterozygous pathogenic loss-of-function (LoF) variants in SETBP1 have also been identified in independent cohorts ascertained for childhood apraxia of speech (CAS), warranting further investigation of the roles of this gene in speech development. Thirty-one participants (12 males, aged 0; 8-23; 2 years, 28 with pathogenic SETBP1 LoF variants, 3 with 18q12.3 deletions) were assessed for speech, language and literacy abilities. Broader development was examined with standardised motor, social and daily life skills assessments. Gross and fine motor deficits (94%) and intellectual impairments (68%) were common. Protracted and aberrant speech development was consistently seen, regardless of motor or intellectual ability. We expand the linguistic phenotype associated with SETBP1 LoF syndrome (SETBP1 haploinsufficiency disorder), revealing a striking speech presentation that implicates both motor (CAS, dysarthria) and language (phonological errors) systems, with CAS (80%) being the most common diagnosis. In contrast to past reports, the understanding of language was rarely better preserved than language expression (29%). Language was typically low, to moderately impaired, with commensurate expression and comprehension ability. Children were sociable with a strong desire to communicate. Minimally verbal children (32%) augmented speech with sign language, gestures or digital devices. Overall, relative to general development, spoken language and literacy were poorer than social, daily living, motor and adaptive behaviour skills. Our findings show that poor communication is a central feature of SETBP1 haploinsufficiency disorder, confirming this gene as a strong candidate for speech and language disorders.
Topics: Adolescent; Carrier Proteins; Child; Female; Haploinsufficiency; Humans; Language Development; Male; Nuclear Proteins; Phenotype; Speech Disorders; Young Adult
PubMed: 33907317
DOI: 10.1038/s41431-021-00894-x -
Tremor and Other Hyperkinetic Movements... 2017Hyperkinetic dysarthria is characterized by abnormal involuntary movements affecting respiratory, phonatory, and articulatory structures impacting speech and... (Review)
Review
BACKGROUND
Hyperkinetic dysarthria is characterized by abnormal involuntary movements affecting respiratory, phonatory, and articulatory structures impacting speech and deglutition. Speech-language pathologists (SLPs) play an important role in the evaluation and management of dysarthria and dysphagia. This review describes the standard clinical evaluation and treatment approaches by SLPs for addressing impaired speech and deglutition in specific hyperkinetic dysarthria populations.
METHODS
A literature review was conducted using the data sources of PubMed, Cochrane Library, and Google Scholar. Search terms included 1) hyperkinetic dysarthria, essential voice tremor, voice tremor, vocal tremor, spasmodic dysphonia, spastic dysphonia, oromandibular dystonia, Meige syndrome, orofacial, cervical dystonia, dystonia, dyskinesia, chorea, Huntington's Disease, myoclonus; and evaluation/treatment terms: 2) Speech-Language Pathology, Speech Pathology, Evaluation, Assessment, Dysphagia, Swallowing, Treatment, Management, and diagnosis.
RESULTS
The standard SLP clinical speech and swallowing evaluation of chorea/Huntington's disease, myoclonus, focal and segmental dystonia, and essential vocal tremor typically includes 1) case history; 2) examination of the tone, symmetry, and sensorimotor function of the speech structures during non-speech, speech and swallowing relevant activities (i.e., cranial nerve assessment); 3) evaluation of speech characteristics; and 4) patient self-report of the impact of their disorder on activities of daily living. SLP management of individuals with hyperkinetic dysarthria includes behavioral and compensatory strategies for addressing compromised speech and intelligibility. Swallowing disorders are managed based on individual symptoms and the underlying pathophysiology determined during evaluation.
DISCUSSION
SLPs play an important role in contributing to the differential diagnosis and management of impaired speech and deglutition associated with hyperkinetic disorders.
Topics: Deglutition Disorders; Humans; Hyperkinesis; Speech Disorders; Speech-Language Pathology
PubMed: 28983422
DOI: 10.7916/D8Z32B30 -
Journal of Magnetic Resonance Imaging :... Jan 2016Real-time magnetic resonance imaging (RT-MRI) is being increasingly used for speech and vocal production research studies. Several imaging protocols have emerged based... (Review)
Review
Real-time magnetic resonance imaging (RT-MRI) is being increasingly used for speech and vocal production research studies. Several imaging protocols have emerged based on advances in RT-MRI acquisition, reconstruction, and audio-processing methods. This review summarizes the state-of-the-art, discusses technical considerations, and provides specific guidance for new groups entering this field. We provide recommendations for performing RT-MRI of the upper airway. This is a consensus statement stemming from the ISMRM-endorsed Speech MRI summit held in Los Angeles, February 2014. A major unmet need identified at the summit was the need for consensus on protocols that can be easily adapted by researchers equipped with conventional MRI systems. To this end, we provide a discussion of tradeoffs in RT-MRI in terms of acquisition requirements, a priori assumptions, artifacts, computational load, and performance for different speech tasks. We provide four recommended protocols and identify appropriate acquisition and reconstruction tools. We list pointers to open-source software that facilitate implementation. We conclude by discussing current open challenges in the methodological aspects of RT-MRI of speech.
Topics: Computer Systems; Humans; Larynx; Magnetic Resonance Imaging, Cine; Pharynx; Practice Guidelines as Topic; Reproducibility of Results; Sensitivity and Specificity; Speech; Speech Disorders; Speech Production Measurement; United States
PubMed: 26174802
DOI: 10.1002/jmri.24997