Abstract

Introduction

Children's early language and communication skills are efficiently measured using parent report, for example, communicative development inventories (CDIs). These have scalable potential to determine risk of later language delay, and associations between delay and risk factors such as prematurity and poverty. However, there may be measurement difficulties in parent reports, including anomalous directions of association between child age/socioeconomic status and reported language. Findings vary on whether parents may report older infants as having smaller vocabularies than younger infants, for example.

Methods

We analysed data from the UK Communicative Development Inventory (Words and Gestures); UK-CDI (W&G) to determine whether anomalous associations would be replicated in this population, and/or with gesture. In total 1204 families of children aged 8–18 months (598 girls, matched to UK population for income, parental education and ethnicity as far as possible) completed Vocabulary and Gesture scales of the UK-CDI (W&G).

Results

Overall scores on the Gesture scale showed more significant relationships with biological risk factors including prematurity than did Vocabulary scores. Gesture also showed more straightforward relationships with social risk factors including income. Relationships between vocabulary and social risk factors were less straightforward; some at-risk groups reported higher vocabulary scores than other groups.

Discussion

We conclude that vocabulary report may be less accurate than gesture for this age. Parents have greater knowledge of language than gesture milestones, hence may report expectations for vocabulary, not observed vocabulary. We also conclude that gesture should be included in early language scales partly because of its greater, more straightforward association with many risk factors for language delay.

WHAT THIS PAPER ADDS

What is already known on the subject

We already know that it is possible to measure children's early communicative skills using parent-completed inventories (Communicative Development Inventories, CDIs) and that some aspects of early communication can predict which children are likely to go on to have long-lasting communicative development difficulties. We also know that most uses of CDIs include only vocabulary, not early gesture. In addition, child-related and family-related variables such as prematurity, family history of language disorder and socioeconomic status may be related to communication development.

What this paper adds to existing knowledge

We looked at a large sample (N = approx. 1200) of families representative of the UK population with an infant aged 8 through 18 months and asked them about their infant's comprehension and production vocabulary as well as their early gesture skills. Gesture was more closely related to possible risk factors for communication development difficulties, for example, family history of communication difficulties, prematurity and multiple birth status. Vocabulary was only related in a straightforward way to family history and had complex relationships to socioeconomic differences. Families with different economic backgrounds may approach questions about their child's development in different ways.

What are the potential or actual clinical implications of this work?

We suggest that clinicians need to ensure that not only vocabulary but also gesture ability is assessed when looking at very early communication skills. We also suggest that gesture may be more predictive of later communicative development difficulties, and that clinicians need to be sure that parents are clear on how vocabulary questions are asked and what exactly is required of them in answering these types of questions.

Abstract

Background

Children born with cleft palate ± lip (CP ± L) are at risk of speech sound disorder (SSD). Up to 40% continue to have SSD at age 5–6 years. These difficulties are typically described as articulatory in nature and often include cleft speech characteristics (CSC) hypothesized to result from structural differences. In non-CP ± L SSD comorbidity with language difficulties is often reported. There is growing evidence of concomitant language difficulties in children with CP ± L and of a higher prevalence of developmental speech errors in children compared with non-CP ± L peers. The impact of underlying phonological and language skills on speech production in children with CP ± L is poorly understood.

Aims

To investigate language outcomes in children with CP ± L and the relationship to speech production, by answering the following research questions: (1) Does the profile of language skills in children with CP ± L differ from normative samples? (2) Do children with CP ± L and SSD have poorer language skills than those with typically developing speech? (3) Is there an association between language skills and speech profile in children with CP ± L at age 5–8 years?

Methods & Procedures

In this prospective cross-sectional, observational study, 95 participants were recruited from regional cleft lip and palate services in the UK. They were aged 5;0–7;11 with non-syndromic CP ± L. Those with a syndromic diagnosis, global learning disability, sensorineural hearing loss and first language other than English were excluded. Assessments of speech (Diagnostic Evaluation of Articulation and Phonology—DEAP) and language (Clinical Evaluation of Language Fundamentals—5th UK edition—CELF) were completed. Language outcomes were analysed and compared with normative samples and according to speech error analysis.

Outcomes & Results

Average language scores were within the expected range. For those presenting with SSD, language scores were significantly lower than those with typically developing speech. Analysis of speech errors showed four distinct speech profiles: typical speech, CSC only, developmental speech characteristics (DSC), and combined CSC + DSC. Language scores were lower for participants with DSC (±CSC). A significant association was found between the presence of CSC + DSC and expressive language outcomes (odds ratio (OR) = 10.82; 95% confidence interval (CI) = 2.42, 48.32, p = 0.002).

Conclusions & Implications

An association between language skills and speech production was observed. The distribution of speech errors in children with CP ± L varied with a high level of DSC as well as CSC. Those with CSC + DSC had significantly lower language scores than those with typically developing speech or CSC only. Speech and language therapists working with this caseload should be alerted to potential ongoing phonological and language difficulties in children presenting with this profile.

WHAT THIS PAPER ADDS

What is already known on this subject

Children born with CP ± L are known to be at risk of SSD. There is also evidence of language delay in the early years. Evidence for persistent language difficulties is equivocal but some studies have shown a higher than average prevalence of developmental phonological errors in addition to cleft articulation errors in speech production.

What this paper adds to the existing knowledge

This study investigates links between speech development and language skills in children aged 5–8 years with non-syndromic CP ± L. It adds to our understanding of the nature of SSD in children with CP ± L and in particular the relationship between language skills and speech production. It shows that children with CP ± L have varied speech profiles and that those presenting with delayed phonological processes are also at risk of language difficulties.

What are the potential or actual clinical implications of this work?

Speech and language therapists working with children with CP ± L should be aware of the varied nature of SSD in this population. They should be alert to the need for additional assessment of language for those presenting with delayed phonological processes and the implications this has for educational attainment.

Abstract

Background

There is a growing body of evidence showing the value of community singing-based rehabilitation on psychosocial well-being and communication for people with post-stroke communication impairment (PSCI). However, there has been little consideration of the potential value an inpatient aphasia-friendly choir may have through the perspective of the stroke multidisciplinary team (MDT).

Aims

To explore the experiences and views of the MDT on the role an established inpatient aphasia-friendly choir, at a stroke rehabilitation centre in South Wales, UK, may play in the rehabilitation of people with PSCI.

Methods & Procedures

Eight participants were recruited from the stroke rehabilitation centre's MDT. Semi-structured interviews were conducted and the verbatim transcripts were analysed using thematic analysis according to Braun and Clark's work of 2006.

Outcomes & Results

Four main themes were identified: (1) breaking down social isolation barriers; (2) patient voice and patient choice; (3) collective well-being and engagement; and (4) the therapeutic benefits across the MDT. The experiences and perceptions overlap, highlighting the wide-reaching therapeutic benefits of singing collaboratively.

Conclusions & Implications

This research enables us to discover more about how the inpatient aphasia-friendly choir may enhance an individual's well-being, communication and confidence, and their overall rehabilitation from the MDT's perspective. By increasing our understanding of which aspects of the aphasia-friendly choir are most valued, future choir sessions can be better tailored to patients’ needs. Additionally, the findings presented here could be taken forward and included in future speech and language therapy interventions, leading to increased patient ownership, not only of the choir but also of their other therapy goals.

WHAT THIS PAPER ADDS

What is already known on this subject

Previous research suggests positive implications for therapeutic collaborative singing on psychosocial well-being and communication for people with PSCI. There has been little consideration of the potential value an inpatient aphasia-friendly choir may have through the lens of the stroke MDT. The aim of this research was to explore the experiences and views of the MDT on the role an established inpatient aphasia-friendly choir may play in the rehabilitation of people with PSCI.

What this paper adds to the existing knowledge

This research highlights the benefits of an inpatient aphasia-friendly choir for an individual's well-being, communication and confidence. An increased understanding enables future choir sessions to be better tailored to patients’ needs.

What are the potential or actual clinical implications of this work?

Participating in the choir was felt to offer an increased opportunity for functional therapy goals in an inpatient setting. The MDT frequently discussed the choir's ability to ‘normalise’ therapeutic approaches for the patients. A greater understanding of the choir participants empowers therapists to personalise therapy plans further, facilitating effectiveness, efficiency and holistic practice.

Abstract

Background

Global aphasia is a severe communication disorder affecting all language modalities, commonly caused by stroke. Evidence as to whether the functional communication of people with global aphasia (PwGA) can improve after speech and language therapy (SLT) is limited and conflicting. This is partly because cognition, which is relevant to participation in therapy and implicated in successful functional communication, can be severely impaired in global aphasia. Cognitive treatments that aim to improve functional communication for people with aphasia do exist, but few have been trialled with PwGA and no studies have robustly demonstrated gains.

Aim

This study aimed to explore the effect of a novel non-linguistic cognitive intervention on the functional communication skills of PwGA.

Method

A non-linguistic intervention, developed to target cognitive skills underpinning functional communication, was delivered to six participants three times weekly for up to 6 weeks (depending on the rate of progression through the intervention programme). All participants met the criteria for global aphasia following screening with the Western Aphasia Battery Bedside Record Form. A multiple baseline case series design was employed to investigate changes in functional communication using the American Speech and Hearing Association Functional Assessment of Communication (ASHA-FACS). Secondary outcome measures were auditory comprehension and informal tests of non-verbal cognition. Statistical analyses of change after intervention were performed using the Wilcoxon signed-ranks test and weighted statistics.

Results

Participants completed the intervention programme in an average of nine sessions. Four out of six participants made statistically significant gains in functional communication as measured by communication independence (amount of assistance or prompting required) on the ASHA-FACS. Five of six participants made statistically significant gains in non-verbal semantics, two in non-verbal reasoning and two in auditory comprehension.

Conclusion

The findings provide preliminary evidence that a non-linguistic cognitive intervention delivered with a dose replicable in clinical practice can improve functional communication and non-verbal cognition in some PwGA. This finding contrasts with much existing evidence suggesting that improvements in global aphasia can be achieved only after intensive or prolonged input over many years.

WHAT THIS PAPER ADDS

What is already known on the subject

People with global aphasia (PwGA) have the potential to make impairment level gains after intensive or prolonged speech and language therapy (SLT). However, evidence of functional communication gains is limited. Cognition plays an important role in functional communication, particularly the ability to switch to alternative means of communication and switch modalities.

What this study adds

Contrary to many previous studies, the findings indicate that PwGA can benefit from SLT and make functional communication gains with a relatively low dose of intervention. The findings highlight cognitive skills that appear relevant to basic functional communication abilities in PwGA. These are: attention, visual perception, semantics and non-verbal problem solving.

What are the clinical implications of this work?

This work suggests that clinicians should offer cognitive, non-linguistic interventions to PwGA and consider delivering intervention using little to no verbal language.

Abstract

Background

There is a global need for synthetic speech development in multiple languages and dialects, as many children who cannot communicate using their natural voice struggle to find synthetic voices on high-technology devices that match their age, social and linguistic background.

Aims

To document multiple stakeholders’ perspectives surrounding the quality, acceptability and utility of newly created synthetic speech in three under-resourced South African languages, namely South African English, Afrikaans and isiXhosa.

Methods & Procedures

A mixed methods research design was selected. After the creation of naturalistic synthetic child speech which matched the vocal identity of three children with expressive communication difficulties, those three children answered questions about the quality, acceptability and utility of the synthetic voices using a pictographic three-point scale. A total of 11 adults who are known to the children participated in subjective quality assessments in the form of mean opinion scores, intelligibility tests and focus group discussions.

Outcomes & Results

Despite the synthetic adult voices appearing more natural, stakeholders were accepting of all the synthetic voices. Although personalization of the voices is important, intelligibility is prioritized and standard dialects are often preferred. When communication partners have adequate training and are willing to model and support children in all environments, children with expressive communication difficulties thrive, but when augmentative and alternative communication (AAC) use is inconsistent, there is reduced vocabulary development and poor system transitioning, and AAC abandonment is greater.

Conclusions & Implications

This research suggests that stakeholders from low- and middle-income countries are interested in the development of synthetic voices in their home languages. Our research highlights that children would prefer to incorporate these voices on their high-tech devices, and adults would prefer them for their children, learners and/or clients’ devices, rather than using British or US English voices.

WHAT THIS PAPER ADDS

What is already known on this subject

Caregivers, service providers, peers and other communication partners play a substantial role in a child AAC user's early communicative success, and their acceptance of AAC ultimately influences the effectiveness of the intervention. When communication partners advocate and support the inclusion of specific speech-generating devices, AAC applications, and suitable synthetic voices, children are more willing to consistently utilize the technology.

What this paper adds to the existing knowledge

As literature focusing on stakeholder perspectives from low- and middle-income countries is less common than research from high-income countries, and often lacks input from multi-perspective stakeholders, our study offers a unique perspective from South African children with expressive communication difficulties, caregivers of those children, their speech–language pathologists and teachers, about the quality, acceptability and utility of synthetic speech in under-resourced languages.

What are the potential or clinical implications of this work?

Our research highlights that stakeholders would prefer South African languages and dialects on South African speech-generating devices, rather than relying on devices that only incorporate British or US English voices. The development of synthetic speech in under-resourced languages has the potential to support marginalized AAC communities. Children with expressive communication difficulties would finally be able to participate in class and do so with a voice that matches their age, gender and social and linguistic background. This paper highlights the importance of providing a variety of synthetic voice options and emphasizes the significance of introducing novel voices for high-tech AAC to children in a manner that respects and aligns with their linguistic and cultural backgrounds.

Abstract

Background

Late side effects of head and neck cancer treatment commonly affect swallowing function. Late radiation-associated dysphagia (late-RAD) often presents years post-treatment when patients have been discharged from their multidisciplinary team. Timely symptom management may provide important physical and emotional support, potentially reducing the overall healthcare burden. Speech and language therapists (SLTs) are key in the assessment and management of dysphagia but there is no current guidance in the late-RAD setting.

Aims

The primary objective was to establish how late-RAD is assessed in both existing literature and by UK SLT. The study also aimed to explore UK SLT approaches to management.

Methods

A dual methodology approach was taken. A scoping review (SR) of PubMed, Scopus, CINAHL, Web of Science and Embase databases was conducted between November and December 2022. Eligibility criteria included studies reporting dysphagia outcomes >2 years post-treatment with narrative data synthesis. Also, a survey of SLTs working in the United Kingdom was conducted between November 2023 and February 2024. Respondents were questioned about their current pathways and service provision for patients with late-RAD.

Main Contribution

The SR included 39 studies. Dysphagia was assessed using three different toxicity grades; five patient-reported outcome measures (PROMs) and five clinical assessments. Five studies were multidimensional in their approach to data collection, whilst nine used PROMs alone and four used a toxicity grade alone. The survey received 56 responses. Only six respondents reported an existing late effect clinic (all tumour sites) in their region. A wide range of measures were used to assess dysphagia including 12 different PROMs. Instrumental assessments were used by most (98% Videofluoroscopy; 82% Fibreoptic Endoscopic Evaluation of Swallowing). Rehabilitation was offered by 86% and this was intensive in 34%. Late-RAD patient information was routinely provided by 35 respondents and usually within 1 year of treatment completion.

Conclusion

A wide range of assessment methods and outcome measures were used to report dysphagia in existing literature but often in a unidimensional approach. In the United Kingdom, SLTs also use a variety of assessment tools and regularly offer intensive rehabilitation. Without consensus on how we measure late-RAD, synthesising evidence to guide service provision is challenging.

WHAT THIS PAPER ADDS

What is already known on the subject

Late-RAD significantly affects swallowing function, often necessitating enteral feeding which in turn impacts emotional and health-related quality of life. There is no existing guidance on optimum pathways, assessment methods or effective treatment options.

What this paper adds to existing knowledge

This study highlights the lack of consensus in the evidence base regarding how to assess and measure late-RAD. In the United Kingdom, referral pathways are not well defined and there is wide variation on provision of information and specialist assessment and management of late-RAD.

What are the potential or clinical implications of this work?

Challenges in synthesising existing studies translate to variations in practice due to a lack of guidelines. Without a robust evidence base, patients will experience geographical variation in how they are supported with their late-RAD symptoms.

Abstract

Background

Individuals with dementia have communication limitations resulting from cognitive impairments that define the syndrome. Whereas there are numerous cognitive assessments for individuals with dementia, there are far fewer communication assessments. The Profiling Communication Ability in Dementia (P-CAD) was developed to address this gap.

Aims

The purpose of this study was to examine the concurrent validity, longitudinal validity and inter- and intra-rater reliability of the P-CAD in a population of people with dementia and their communication partners.

Method

The P-CAD was administered to 122 people with dementia and their communication partners in Ireland (n = 100) and Canada (n = 22), over a 12-month period. To establish concurrent validity of the P-CAD, scores were compared to scores obtained from existing standardized instruments including the Functional Linguistic Communication Inventory (FLCI), the Mini-Mental State Examination (MMSE-2) and Global Deterioration Scale (GDS). Inter-rater reliability and responsiveness (longitudinal validity) were analysed using data from a subgroup of participants.

Outcomes & Results

Overall P-CAD test scores were significantly correlated with FLCI (n = 122; r = 0.875; p < 0.001) and MMSE-2 total scores (n = 122; r = 0.857; p < 0.001). Levels of communication support categories on the P-CAD correlated with GDS rankings (n = 122; rho = −0.539; p < 0.001) and MMSE-2 total scores (n = 122; rho = 0.680, p < 0.001). Inter-rater reliability tested for 20 participants in the Irish sample revealed high levels of agreement between raters in scoring the GDS (n = 20; ICC = 0.969, p < 0.001), MMSE-2 (n = 20; ICC = 0.997, p < 0.001), FLCI (n = 20; ICC = 0.999, p < 0.001) and P-CAD (n = 20; ICC = 0.981, p < 0.001). To establish longitudinal validity to examine if the P-CAD was responsive to changes in cognitive-communication function over time, 12 participants in the Irish sample repeated all tests 3 months after the initial testing. No statistically significant differences in test scores were found for the 12 participants who completed follow-up measures at this time point in any of the three scales. It was not possible to determine sufficient responsiveness as correlations between the change in P-CAD scores over 3 months were insignificant for both the change in MMSE-2 scores (rho = −0.130, p = 0.704) and the FLCI scores (rho = 0.221, p = 0.513).

Conclusions & Implications

In this study, P-CAD has demonstrated good concurrent validity and inter-rater reliability in samples collected in two countries with English-speaking participants. The P-CAD is appropriate for use to evaluate communication abilities of people with dementia, including during conversational interactions with caregivers.

WHAT THIS PAPER ADDS

What is already known on the subject

Dementia alters the communication function of the person with dementia and impacts interactions with others. Speech and language therapists (SLTs) provide specific recommendations on communication function and support. However, they have limited access to comprehensive communication assessments to guide intervention.

What this paper adds to the existing knowledge

This validation study has confirmed that Profiling Communication Ability in Dementia (P-CAD) is a valid and reliable tool for SLTs to profile the communication abilities of people with dementia. It identifies the type and levels of communication support required as dementia progresses. The inclusion of communication partners in the study confirms their important role in providing conversation support to people with dementia.

What are the potential or clinical implications of this work?

The P-CAD is a clinical resource for dynamic communication assessment, which identifies key areas of retained ability to guide communication support and individualised intervention. It can be used with people at different stages and severity of dementia across a range of clinical settings. The P-CAD summary, which is part of the P-CAD, can be shared with family members and healthcare teams to enhance communication access for the person as dementia progresses.