Linda Wilson

A Clinical Trial of an Operant Treatment for School-Age Children Who Stutter

The purpose of this investigation was to determine the effectiveness of a nonprogrammed, operant treatment for school-age children who stutter. The treatment was administered by clinicians and pare...

Availability, access, and quality of care: Inequities in rural speech pathology services for children and a model for redress

Equity, with its target of social justice and a fair distribution of health, is an accepted overarching principle in health care. Yet the literature has identified inequities between rural and metropolitan areas. It is not clear to what extent this literature pertains to paediatric speech pathology services, and the purpose of this research was to provide clarifying information. Data were obtained through interviews with 12 speech pathologists who provided services to rural paediatric clients. Findings indicated that (a) local, frequent speech pathology services were not universally available, (b) some rural clients faced significant barriers to accessing frequent speech pathology services, and (c) some rural clients may be receiving services of compromised quality. It was concluded that equity is currently questionable for some paediatric speech pathology clients in rural New South Wales. A conceptual approach to redressing these equity problems is presented.

Distance Intervention for Early Stuttering with the Lidcombe Programme

The Lidcombe Programme is a parent-conducted operant intervention for early stuttering. This article presents a case study of the Lidcombe Programme adapted for distance intervention with a family who were isolated from treatment services. The subject, Matthew, was 5 years 10 months old and had been stuttering severely for nearly 4 years at the start of treatment. The entire treatment occurred by telephone contact and was supplemented by audiotape and videotape recordings of the subjects speech, which were mailed to the clinician by his parents. Matthews mother was taught to implement all aspects of the Lidcombe Programme: control of stuttering with on-line praise and correction, measurement of stuttering severity, and administration of a maintenance programme. Matthew attained near-zero stuttering levels after 25 telephone consultations over a period of 9 months. Data suggest that he maintained those levels for 23 months posttreatment. Plans for further research into distance intervention with the Lidc...

An investigation of equity of rural speech-language pathology services for children: A geographic perspective

The World Health Organizations equity objective states that there should be equal access to healthcare for equal need, regardless of location. Disparities between health services and challenges to achieving the equity objective have been documented both in Australia and around the world. However, little is known about the extent to which this objective has been met in the field of speech-language pathology in Australia. This study used structured interviews with 74 speech-language pathologists working in rural areas of New South Wales and Victoria. The data obtained were used to develop maps to describe the availability of paediatric speech-language pathology services through consideration of location and frequency. The findings show that 98.60% of localities are unserviced at the ideal frequency of weekly or more often. It is important to note that these percentages include all localities in the represented rural areas of New South Wales and Victoria, some of which are minimally populated. The maps also depict travel and distance as barriers to the accessibility of services and have been used to suggest a critical maximum distance for paediatric outpatient speech-language pathology services in rural New South Wales and Victoria. From the data collected, 50 kilometres was suggested as the critical maximum distance past which consumers become unable or unwilling to travel to access weekly rural speech-language pathology services in rural New South Wales and Victoria. Thus, people living in almost one third of rural localities in rural New South Wales and Victoria lie beyond what is considered by rural speech-language pathologists to be a reasonable travel distance to weekly speech-language pathology services. These results highlight barriers to the achievement of equitable services in rural areas. The results also provide an essential foundation to inform policy development and assist health service planning to meet the needs of rural consumers.

Insight vs readiness: Factors affecting engagement in therapy from the perspectives of adults with TBI and their significant others

Introduction: Adults sustain significant, often irreversible impairments following brain injury. The process they go through coming to terms with these impairments can seriously interfere with their readiness to engage in rehabilitation. Aim: This study aimed to look beyond the development of self-awareness and insight in order to explore the concept of readiness as it relates to clients’ experiences of engaging with therapy. Method: Sixteen in-depth interviews were conducted with 14 adults with a moderate–severe traumatic brain injury (TBI) and nine of their significant others. These participants were asked to speak about the continuum of care they experienced and the factors that effected their engagement with care. Results: The results of this study indicated that participants believed their ability to engage in therapy was related to the degree to which they were aware of and accepted their impairments and motivated to engage in rehabilitation. Participants reported that the rate and degree to which they developed awareness varied according to the type of impairments they experienced (i.e. physical vs cognitive). Participants also stated that one way to augment their awareness was to compare their new vs old selves and to compare their recovery to those of others with a similar impairment. Finally, participants reported that it was important to be able to access services when they had accepted their impairment and were ready to engage in therapy. Conclusion: The clinical implications for considering the degree of awareness of impairments and readiness for engagement in care of an adult with a moderate–severe TBI are discussed in relation to future services planning.

The reliability of a severity rating scale to measure stuttering in an unfamiliar language

Abstract With increasing multiculturalism, speech-language pathologists (SLPs) are likely to work with stuttering clients from linguistic backgrounds that differ from their own. No research to date has estimated SLPs’ reliability when measuring severity of stuttering in an unfamiliar language. Therefore, this study was undertaken to estimate the reliability of SLPs’ use of a 9-point severity rating (SR) scale, to measure severity of stuttering in a language that was different from their own. Twenty-six Australian SLPs rated 20 speech samples (10 Australian English [AE] and 10 Mandarin) of adults who stutter using a 9-point SR scale on two separate occasions. Judges showed poor agreement when using the scale to measure stuttering in Mandarin samples. Results also indicated that 50% of individual judges were unable to reliably measure the severity of stuttering in AE. The results highlight the need for (a) SLPs to develop intra- and inter-judge agreement when using the 9-point SR scale to measure severity of stuttering in their native language (in this case AE) and in unfamiliar languages; and (b) research into the development and evaluation of practice and/or training packages to assist SLPs to do so.

Implementing the World Report on Disability in Malaysia: A student-led service to promote knowledge and innovation

Abstract The lead article by 17 puts forward pertinent issues facing the speech-language pathology profession raised by the World Report on Disability. This paper continues the discussion by reporting on a capacity building action research study on the development, implementation, and evaluation of a new approach to early intervention speech-language pathology through clinical education in Malaysia. This research evaluated a student-led service in community-based rehabilitation that supplemented existing and more typical institution-based services. A Malaysian community-based rehabilitation project was chosen due to its emphasis on increasing the equitability and accessibility of services for people with disabilities which was a catalyst for this research. Also, expanding awareness-building, education, and training activities about communication disability was important. The intention was to provide students with experience of working in such settings, and facilitate their development as advocates for broadening the scope of practice of speech-language pathology services in Malaysia. This article focuses on the findings pertaining to the collaborative process and the learning experiences of the adult participants. Through reflection on the positive achievements, as well as some failures, it aims to provide deeper understanding of the use of such a model.

The Lidcombe Program of early stuttering intervention for Malaysian families: Four case studies

PURPOSE This study investigated the outcomes of implementing the Lidcombe Program, an evidence-based early intervention for stuttering, with four preschool children in Malaysia. Early stuttering intervention is currently underdeveloped in Malaysia, where stuttering treatment is often more assertion-based than evidence-based. Therefore, introducing an evidence-based early stuttering intervention is an important milestone for Malaysian preschoolers who stutter. METHOD The participants ranged from 3 years 3 months to 4 years 9 months at the start of the study. Beyond-clinic speech samples were obtained at 1 month and 1 week pretreatment and immediately post-Stage 1, and at 1 month, 3 months, 6 months and 12 months post-Stage 1. RESULTS Two participants, who were bilingual, achieved near-zero levels of stuttering at 12 months posttreatment. Near zero levels of stuttering were also present in their untreated languages. One participant withdrew due to reasons not connected with the research or treatment. The remaining participant, who presented with severe stuttering, completed Stage 1 but had some relapse in Stage 2 and demonstrated mild stuttering 12 months post-Stage 1. CONCLUSIONS The outcomes were achieved without the need to significantly adapt Lidcombe Program procedures to Malaysian culture. Further research to continue evaluation of the Lidcombe Program with Malaysian families and to estimate proportion of those who will respond is warranted.

An investigation of the MLU-age relationship and predictors of MLU in 2- and 3-year-old Australian children

AbstractMean length of utterance (MLU) is widely used as an indicator of language development in the speech-language pathology profession. The literature has presented conflicting evidence regarding the age–MLU relationship and the strength of this relationship has been an issue of debate. Much of the previous research on MLU has been conducted with American children. There is a need to investigate the age–MLU relationship in Australian children. This paper presents the results of an investigation into the age–MLU relationship and factors which influence MLU in 2- and 3-year-old Australian children. Language samples were collected from a longitudinal study group of 75 children. Results indicated a positive relationship between age and MLU at the age of 2 years in this study of Australian children. MLU at 2 years was a significant predictor of MLU at 3 years. These results are discussed in the light of current literature and clinical implications. Limitations of the study and future research directions are...

An investigation of the effects of a speech-restructuring treatment for stuttering on the distribution of intervals of phonation

PURPOSE The purpose of this study was to investigate whether stuttering reductions following the instatement phase of a speech-restructuring treatment for adults were accompanied by reductions in the frequency of short intervals of phonation (PIs). The study was prompted by the possibility that reductions in the frequency of short PIs is the mechanism underlying such reductions in stuttering. METHOD The distribution of PIs was determined for seven adults who stutter, before and immediately after the intensive phase of a speech-restructuring treatment program. Audiovisual recordings of conversational speech were made on both assessment occasions, with PIs recorded with an accelerometer. RESULTS All seven participants had much lower levels of stuttering after treatment but these were associated with reductions in the frequency of short PIs for only four of them. For the other three participants, two showed no change in frequency of short PIs, while for the other participant the frequency of short PIs actually increased. CONCLUSIONS Stuttering reduction with speech-restructuring treatment can co-occur with reduction in the frequency of short PIs. However, the latter does not appear necessary for this reduction in stuttering to occur. Thus, speech-restructuring treatment must have other, or additional, treatment agents for stuttering to reduce.