Shane Erickson

The social and communication impact of stuttering on adolescents and their families

PURPOSE Stuttering can cause wide ranging psychosocial impact. This is particularly the case for adolescents who may face additional physical, emotional and personality changes as they become adults. This study reports the findings of an investigation into the social and communication impacts of stuttering on Australian adolescents seeking treatment for stuttering and their families. METHOD A cross-sectional design utilising questionnaires assessed the self-perceived communication competence and apprehension, stigma and disclosure, and experiences of teasing and bullying of 36 adolescents who stutter. Additionally, the impact of stuttering on the families of these adolescents was investigated. RESULTS Adolescents who stutter have below average self-perceived communication competence, heightened communication apprehension, are teased and bullied more often than fluent peers, and they try to keep their stuttering secret. The families of the adolescents in the study reported high levels of emotional strain, family conflict and difficulty managing their childs frustrations. CONCLUSION The findings from this study emphasise the wide-ranging impact of stuttering beyond the surface level behaviours. Clinicians working with adolescents who stutter should take note of both the outcomes of this study and the suggestions for more effectively coping with the condition in this population. EDUCATIONAL OBJECTIVES The reader will be able to: (a) summarise findings with regards to the impact of stuttering on an adolescents social and communication skills; (b) summarise areas of impact on the families of adolescents who stutter; (c) compare these findings with previous reported data for this population; (d) discuss the clinical implications of the results for working with adolescents who stutter and their families.

Systematic review of virtual speech therapists for speech disorders

A systematic review on virtual speech therapists (VSTs) was presented.The comparison of VSTs and traditional speech therapy was discussed.We analyzed intervention methods used in VSTs such as articulation therapy.Hearing impairments was observed as the most frequent disorder targeted by VSTs.We explored 3D virtual heads and games as efficient therapy delivery approaches. In this paper, a systematic review of relevant published studies on computer-based speech therapy systems or virtual speech therapists (VSTs) for people with speech disorders is presented. We structured this work based on the PRISMA framework. The advancements in speech technology and the increased number of successful real-world projects in this area point to a thriving market for VSTs in the near future; however, there is no standard roadmap to pinpoint how these systems should be designed, implemented, customized, and evaluated with respect to the various speech disorders. The focus of this systematic review is on articulation and phonological impairments. This systematic review addresses three research questions: what types of articulation and phonological disorders do VSTs address, how effective are virtual speech therapists, and what technological elements have been utilized in VST projects. The reviewed papers were sourced from comprehensive digital libraries, and were published in English between 2004 and 2014. All the selected studies involve computer-based intervention in the form of a VST regarding articulation or phonological impairments, followed by qualitative and/or quantitative assessments. To generate this review, we encountered several challenges. Studies were heterogeneous in terms of disorders, type and frequency of therapy, sample size, level of functionality, etc. Thus, overall conclusions were difficult to draw. Commonly, publications with rigorous study designs did not describe the technical elements used in their VST, and publications that did describe technical elements had poor study designs. Despite this heterogeneity, the selected studies reported the effectiveness of computers as a more engaging type of intervention with more tools to enrich the intervention programs, particularly when it comes to children; however, it was emphasized that virtual therapists should not drive the intervention but must be used as a medium to deliver the intervention planned by speech-language pathologists. Based on the reviewed papers, VSTs are significantly effective in training people with a variety of speech disorders; however, it cannot be claimed that a consensus exists in the superiority of VSTs over speech-language pathologists regarding rehabilitation outcomes. Our review shows that hearing-impaired cases were the most frequently addressed disorder in the reviewed studies. Automatic speech recognition, speech corpus, and speech synthesizers were the most popular technologies used in the VSTs.

Standalone Internet speech restructuring treatment for adults who stutter: A phase I study

Abstract Purpose: This Phase I trial reports the results of a clinician-free Internet speech restructuring treatment for adults who stutter. The program consists of nine phases with concepts loosely based on the Camperdown Program. Method: Twenty adults who stutter were recruited. They were given unlimited access to the program for 6 months. Primary outcome measures were the percentage of syllables stuttered and self-reported severity ratings. Result: Five participants accessed all phases of the program, while another five accessed more than half the phases. The remaining 10 accessed between one and four phases. Four of five participants who accessed all phases reduced their stuttering frequency by more than 50% and an additional two participants who accessed more than half the phases also achieved similar reductions. These results were confirmed by self-reports of stuttering severity. Stuttering reductions were largely commensurate with the amount of the program accessed. Conclusion: As with other clinician-free programs in related health areas, maintaining adherence to the program’s procedures was a significant issue. Nonetheless, this novel approach to treating stuttering has the potential to be a viable alternative for some clients and may help to address the significant access and relapse issues that affect treatment provision for adults who stutter.

The role of augmentative and alternative communication for children with autism: current status and future trends

Background Augmentative and alternative communication (AAC) interventions are used for children with autism, often as stand-alone communication interventions for those who are minimally verbal. Our aim was to synthesize the evidence for AAC interventions for children (up to 21 years), and then consider the role of AAC within established, comprehensive, evidence-based autism interventions targeting learning across multiple developmental domains. Design We completed a systematic search of three databases (OVID Medline, PsycINFO, ERIC) as well as forward citation and hand searches to identify systematic reviews of AAC intervention efficacy research including children with autism, published between 2000 and March 2016 in peer-reviewed journals. Data pertaining to the quality indicators of included studies, effect sizes for intervention outcomes, and evidence for effectiveness were extracted for descriptive analysis. Results The search yielded 17 systematic reviews. Most provided indicators of research quality for included studies, of which only relatively few provided conclusive results. Communication targets tended to be focused on teaching children to make requests. Still, effect size measures for included studies indicated that AAC was effective to highly effective. Conclusion There is growing evidence for the potential benefits of AAC for children with autism, but there is a need for more well-designed studies and broader, targeted outcomes. Furthermore, a lack of evidence for the role of AAC within comprehensive intervention programs may account for a tendency by autism researchers and practitioners to neglect this intervention. Attempts to compare evidence for AAC with other interventions for children with autism, including those in which the use of AAC is delayed or excluded in pursuit of speech-only communication, must take into account the needs of children with the most significant learning needs. These children pose the greatest challenges to achieving large and consistent intervention effects, yet stand to gain the most from AAC interventions.

Translating research into practice in low-resource settings: An Australian case study of early autism service provision in a regional town

ABSTRACT Background We investigated the context for translating evidence-based early intervention for autism spectrum disorders (ASD) into real world settings through a case study of a regional town characterised as disadvantaged. Methods Data were from interview surveys of five managers reporting on 15 services, and surveys from 19 practitioners and 15 mothers of young children with ASD. Results The 15 services were multidisciplinary, offering diagnostic assessments (n = 2) and interventions delivered in the home and centres. Children were diagnosed at a mean age of 3 years; access to intervention was delayed and mostly limited to one session every two weeks. Some families travelled substantial distances to services, driving on average 50 minutes each way. Practitioners described intervention strategies in broad terms, rather than name interventions. Conclusions Services available to young children with ASD in this town were far removed from good practice in terms of early diagnosis, and intervention frequency and intensity.

Mobile apps for treatment of speech disorders in children: An evidence-based analysis of quality and efficacy

Background Recently there has been exponential growth in mobile health (mHealth) applications (apps) for children with speech disorders. A challenge for health professionals and families is knowing how to find high quality apps that are therapeutically beneficial. We systematically search and critique the quality of mobile apps for childhood speech disorders. An evidence-based method for identifying suitable apps in the Google Play and Apple iTunes stores is also proposed. Methods and findings A systematic search of the Google Play and Apple iTunes app stores was conducted from November 2016 to May 2017. Twelve pre-defined search terms were applied, identifying 5076 apps. Systematic screening resulted in 132 unique apps for full appraisal. These were appraised by two raters using the Mobile Application Rating scale. None were of excellent quality. Twenty-five were of good quality, 105 average and 2 were poor or very poor. Discussion It can be challenging for consumers to locate high quality speech therapy apps for children. Although we found more than 5000 apps, less than 3% met criteria for evaluation. Difficulties sourcing valid apps included: (i) Boolean operators were not available and therefore only one search term could be used each time (ii) the order of app listings in online stores continually changed (iii) apps were organised in online stores according to relevance and popularity (iv) there was no easy way to extract app titles and eliminate duplicates (v) app cost did not always correlate with therapeutic quality. Conclusions The rapid growth of mHealth heightens the need to develop rigorous and efficient systems to search and retrieve apps and evaluate their therapeutic benefits. Given the difficulty accessing speech therapy services worldwide, mHealth promises therapy benefits when apps are reliable, valid and easily found.

Effect of control samples and listener attributes on speech naturalness ratings of people who stutter

PURPOSE Speech restructuring treatment can effectively reduce stuttering but the resultant speech may sound unnatural. Martin et al. (1984) speech naturalness scale is widely used by clinicians and researchers, yet little is known about whether including normally fluent speech samples alters the judgement of the naturalness of speech samples of people who stutter, and whether attributes of listeners - specifically training and sex - influence ratings. METHODS In this study 20 untrained listeners (male and female) and 19 speech language pathology students (female only) rated either the naturalness of 21 speech samples from adults who stutter obtained post-treatment, or the same 21 post-treatment samples randomly mixed with samples of 21 samples from normally fluent speakers matched for age and sex. The independent variables were sample composition (addition of fluent controls) and listener training. The dependent variable was listener naturalness rating. RESULTS A two-factor ANOVA with listener training and sample composition as independent variables and naturalness ratings as the dependent variable was performed. Untrained listeners rated samples as significantly less natural than trained listeners. The addition of control samples did not significantly impact scores assigned to post-treatment samples. A comparison of male and female listeners was completed using the Mann Whitney U Test. A significant group difference was observed with female listeners rating the samples more leniently (more natural) than male listeners. CONCLUSION Based on this preliminary research, the addition of controls does not appear necessary in evaluating speech naturalness, however the composition of the listener group may affect results.

Computer-based speech therapy for childhood speech sound disorders

BACKGROUND With the current worldwide workforce shortage of Speech-Language Pathologists, new and innovative ways of delivering therapy to children with speech sound disorders are needed. Computer-based speech therapy may be an effective and viable means of addressing service access issues for children with speech sound disorders. AIM To evaluate the efficacy of computer-based speech therapy programs for children with speech sound disorders. METHOD Studies reporting the efficacy of computer-based speech therapy programs were identified via a systematic, computerised database search. Key study characteristics, results, main findings and details of computer-based speech therapy programs were extracted. The methodological quality was evaluated using a structured critical appraisal tool. MAIN CONTRIBUTION 14 studies were identified and a total of 11 computer-based speech therapy programs were evaluated. The results showed that computer-based speech therapy is associated with positive clinical changes for some children with speech sound disorders. CONCLUSIONS There is a need for collaborative research between computer engineers and clinicians, particularly during the design and development of computer-based speech therapy programs. Evaluation using rigorous experimental designs is required to understand the benefits of computer-based speech therapy. LEARNING OUTCOMES The reader will be able to 1) discuss how computerbased speech therapy has the potential to improve service access for children with speech sound disorders, 2) explain the ways in which computer-based speech therapy programs may enhance traditional tabletop therapy and 3) compare the features of computer-based speech therapy programs designed for different client populations.

Comparing alternate learning pathways within a problem-based learning speech-language pathology curriculum

Abstract Purpose: This qualitative study investigated the learning process for speech-language pathology (SLP) students engaging in a problem-based learning (PBL) curriculum and compared the perspectives of students from two pathways. Method: Sixteen final-year SLP students participated in one of four focus groups. Half the participants entered the course directly via an undergraduate pathway and the other half entered via a graduate entry pathway. Each focus group comprised two students from each pathway. Data were generated via a semi-structured interview and analysed thematically. Result: Regardless of participants’ pathway, many similar themes about factors that influenced their expectations prior to PBL commencing as well as their actual PBL experiences were raised. Participants believed that PBL was a productive way to learn and to develop clinical competencies. Many were critical of variations in PBL facilitation styles and were sensitive to changes in facilitators. The majority of participants viewed experiential opportunities to engage in PBL prior to commencement of semester as advantageous. Conclusion: Combining students with different backgrounds has many advantages to the PBL learning process. Regardless of prior experiences, all students must be sufficiently prepared. Furthermore, the facilitator has a crucial role with the potential to optimise or detract from the learning experience.

Computer-Based Rehabilitation for Developing Speech and Language in Hearing-Impaired Children: A Systematic Review

Abstract The purpose of this systematic review was to examine whether online or computer-based technologies were effective in assisting the development of speech and language skills in children with hearing loss. Relevant studies of children with hearing loss were analysed with reference to (1) therapy outcomes, (2) factors affecting outcomes, and (3) publication and methodological quality. The study quality was assessed using the 11-point PEDro scale. The review identified ten studies of relevance to the question of interest. All studies had relatively low PEDro quality scores with only four studies scoring in the mid-range on the scale. For these four studies, computer-based training appeared favourable at the group level. However, the small number of studies found significantly limits the generalizations and indicates the usage of these technologies in this population as an area requiring further rigorous research.