Julie E Marshall

Interaction training for conversational partners of children with cerebral palsy: a systematic review

BACKGROUND Research has shown that children with cerebral palsy have difficulties acquiring communication skills and that conversation with familiar partners follows restricted patterns, which are characterized by high levels of partner control and childrens responsivity. Speech and language therapy often includes training for conversational partners to help to them recognize childrens communicative signals and to create opportunities for children to take a more equal and independent role in conversation. However, the effectiveness of this indirect therapy has not been demonstrated reliably. AIMS To review systematically all experimental research on communication training for conversational partners of children with cerebral palsy and to evaluate the effectiveness of this type of intervention. METHODS & PROCEDURES As part of a wider review, health, psychology and education electronic databases were searched up to December 2002 for reports of experimental studies on the training of conversational partners to facilitate the communication of children with cerebral palsy, which contained an element of control. References from identified studies were followed-up and relevant journals and conference reports were hand-searched. Identified studies were assessed for inclusion by the first author. Two reviewers independently abstracted data on the quality and content of each study. OUTCOMES & RESULTS Four studies were identified from five research reports that met the criteria for inclusion in the review, comprising three group studies and one single case experiment. Common targets for training were observed across the studies. These included positioning of the conversational partner and child for interaction, creating communication opportunities and responding to childrens communicative signals. Changes were observed in the conversation patterns used by conversational partners, which should facilitate the communication of children with cerebral palsy. However, the studies contain methodological flaws and as a result they cannot demonstrate that the changes were definitely a result of the intervention. CONCLUSIONS Research on the effectiveness of interaction training for conversational partners of children with cerebral palsy is in its early stages. Training has incorporated common targets, which are widely acknowledged by clinicians to affect the communication of children with motor disorders. Trends in behaviour change have been suggested by research to date, but further studies that address the methodological inadequacies of the original research are needed to evaluate the effectiveness of this type of intervention. Suggestions of ways to improve the design and reporting of future studies, that will allow the mapping of interventions to clients, are discussed in this review.

Changing practice: Implications of the World Report on Disability for responding to communication disability in under-served populations

Abstract The World Report on Disability provides a major challenge to the conceptualization and delivery of services for people with communication disabilities around the world. Many people, in both Majority and Minority World countries, receive limited or no support in relation to their communication disability. In this paper the prevalence of communication disability across the world (and the challenges to obtaining these data) are discussed, particularly in relation to disability more broadly. Populations that are under-served by speech-language pathology services in both Majority and Minority World countries are described. The paper describes organizational change theory and the potential it has, together with a biopsychosocial model of disability, to assist in understanding and influencing development of relevant services for people with communication disabilities (PWCD), particularly those who are under-served. Aspects of, and influences on, service delivery for PWCD are described. The need for novel ways of conceptualizing development of services, including population-based approaches, is highlighted. Finally, the challenges and opportunities for PWCD and for speech-language pathologists which arise from the nine recommendations of the World Report on Disability are considered and readers are encouraged to consider new and novel ways of developing equitable services for people with communication disabilities, in both majority and minority world settings.

Direct speech and language therapy for children with cerebral palsy: findings from a systematic review

Children with cerebral palsy (CP) often have speech, language, and/or communication disorders and are referred to speech and language therapy (SLT). They may also be referred to SLT services for dysphagia: treatment of which is beyond the scope of this review. Although the exact prevalence of the communication disorders associated with CP is not known, it has been estimated that approximately 20% of children with a diagnosis of CP have severe communication impairment and are classified as non-verbal. Many more will have less severe speech and communication disorders as a consequence of their motor impairment, or disorders arising from speech, language, and cognitive processing deficits associated with CP.

Describing participants in AAC research and their communicative environments: Guidelines for research and practice

Purpose. People who use augmentative and alternative communication (AAC) vary widely in their skills and communication needs. Interventions have been developed to meet different needs, but have met with varied success. Attempts to discover why interventions succeed or fail are hindered by the lack of detailed description of the research participants and the environments in which they communicate. This paper reviews the information commonly given about AAC research participants and presents guidelines for the description of people who use AAC, their conversation partners and their communicative environments. Method. Electronic databases were searched for AAC intervention research reports published between 1990 and 2004. Data on research participants and their communication environments were extracted from reviewed papers. Information given in published papers and variables known to affect communication were presented to an expert group. A modified Nominal Group technique was used to decide what information should be reported in AAC intervention research. Results. Guidelines for participant description that link with the World Health Organization International Classification of Functioning, Disability and Health were developed from the results of the nominal group. Conclusions. Detailed information is needed to demonstrate efficacy of AAC interventions. Guidelines for participant description are presented and discussion of their utility is now needed.

The World Report on Disability: an impetus to reconceptualize services for people with communication disability.

Abstract Challenges to the conceptualization and delivery of services for people with communication disabilities (PWCD) have been described in the lead article in this issue, which was itself a response to the World Report on Disability. A number of commentaries followed the lead article, where authors from around the world responded to the lead article (39), and the World Report on Disability. This paper synthesizes the issues, ideas, and challenges raised in the preceding commentaries. This has been done by addressing each of the four key issues posed in the lead article. A number of proposals for better responding to the needs of PWCD are outlined. These include: engaging with the collection of epidemiological data, consideration of which PWCD are under-served and how this may be changed, the use of documentation, adoption of new roles and strategies for speech-language pathologists, the challenges of community-directed vs individually-focused approaches, and the suggestion of public health communication disability workers and mid-tier workers, who could work alongside more traditional speech-language pathologists.

International and cross-cultural issues: six key challenges for our professions

This paper discusses a number of key challenges facing professionals who work with people who have communication disabilities. The challenges are related to working internationally and in a cross-culturally competent way. Each challenge is discussed, drawing on material from a range of sources, including the papers in the final 2003 edition of Folia Phoniatrica et Logopaedica (‘International and Cross-Cultural Issues’). The challenges discussed cover how experiences from majority world countries can be used to benefit services elsewhere, ‘mainstreaming’ commitment to cross-cultural competence, learning from relationships with other professionals, influencing research practice, responding to requests to work internationally and finally, dealing with cultural differences that challenge working practices. Some solutions are suggested and additional questions posed.

Critical Reflections on the Cultural Influences in Identification and Habilitation of Children with Speech and Language Difficulties.

This paper analyses how and why cultural diversity is relevant to children with speech and language difficulties and the professionals who work with them. The relevance of various aspects of culture including the development of communication skills, language socialisation, adult-child interaction, child care, attitudes, beliefs, and the epidemiology of speech and language difficulties is described and illustrated with examples from the literature in a number of fields. The author encourages all professionals who work with children who have speech and language difficulties to increase their cultural awareness and for training establishments to consider how they may contribute to raising cultural awareness. Further research is needed in this area. A further challenge is to consider whether and how practice should be adapted to take account of cultural diversity.

Implementation of the World Report on Disability: Developing human resource capacity to meet the needs of people with communication disability in Uganda

Abstract The World Report on Disability makes nine recommendations to ensure the inclusion, participation, and emancipation of people with disabilities. As described by Wylie, McAllister, Marshall, and Davidson (2013), the recommendations present a challenge for the development of services for people with communication disability (PWCD) in the Majority World, particularly recommendation 5: “increasing human resource capacity”, since professionals with training in communication disability are often in extremely short supply. In partial answer to this situation in East Africa, a degree-level education programme for speech-language pathologists (SLPs) commenced in Uganda in 2008. This paper describes the establishment of that degree course, the current context of professional education, service development, and delivery, and describes how the World Report on Disability recommendation of increasing human resource capacity could be further addressed using culturally-appropriate, accessible, and innovative models of education. It highlights the need for a multi-strand and long-term approach to addressing communication disability at impairment, activity, and participation levels and offers a vision for the future of services in Uganda.

‘It’s the way you talk to them.’ The child’s environment: Early Years Practitioners’ perceptions of its influence on speech and language development, its assessment and environment targeted interventions

Speech and language delay occurs in approximately 6% of the child population, and interventions to support this group of children focus on the child and/or the communicative environment. Evidence about the effectiveness of interventions that focus on the environment as well as the (reported) practices of speech and language therapists (SLTs) and other Early Years Practitioners (EYPs) in this regard are limited. One-to-one, semi-structured interviews were carried out with 12 EYPs from one city in North England in order to reveal their beliefs about the impact of the child’s environment on language development and how they report assessing and intervening where they have concerns about child language development, in children aged from birth to 5;11 (5 years, 11 months). Interviews were analysed thematically. Results are presented as three themes: (1) environmental influences on language development (people, physical objects, experiences and opportunities, the auditory environment); (2) assessment of the child’s environment, including how and what assessment is carried out; and (3) the interventions provided, including what interventions (interaction with children, the physical environment and play) and how they are carried out (strategies, individualization of intervention, sensitivity and modelling). Implications for services are discussed, including increasing parental awareness of the importance of early language input, the perceived value of home-based assessment, sensitivity in referral and individualized interventions. There remains a need to test out practitioners’ expressed beliefs and practices and their impact on child language outcomes.

Provision for Children with Speech and Language Difficulties in Tanzania

Knowledge about paediatric speech and language difficulties, training for and contact with children with such problems and views on service developments were explored using a written questionnaire, completed by 84 Tanzanian health and education professionals. Additionally, two sets of interviews were carried out, one with a subset of questionnaire respondents and another with a group of 14 health/education planners and administrators. Results showed that whilst only 41 % of respondents had received training about speech and language difficulties, 68% considered themselves to be responsible for assisting children with such problems. Levels of knowledge were significantly higher in the special education group, but were not significantly related to training, exposure to speech and language therapists, or professional responsibility. However, knowledge levels were significantly related to daily contact with children with speech and language difficulties. No evidence of research or planning for children with such difficulties was discovered. Views on service provision favoured educational over health‐based provision. Qualitative information on attitudes and beliefs about speech and language difficulties did not contradict previous data on disabilities. The implications for Tanzania and other similar countries are discussed. Improvements to the questionnaire are discussed. More data are needed in order to facilitate appropriate service development.