Tim Pring

The use of picture/word matching tasks to assist word retrieval in aphasic patients

Three single case studies and a small group study were undertaken to examine the effects of using picture to word matching tasks as a therapeutic technique in aiding word retrieval in aphasic patie...

Calling a salad a federation: An investigation of semantic jargon. Part 1—nouns

Abstract This paper describes an individual with semantic jargon aphasia (RG). His output was largely composed from real words, but in very anomalous combinations. Preliminary investigations suggested severe word finding and comprehension problems for nouns, which were underpinned by a semantic deficit. Despite this, his speech often featured abstract terms. Subsequent tests showed that his comprehension and production were either unaffected by abstractness or aided by it. For example, when naming from definitions, he performed best when those definitions were abstractly phrased. It was hypothesized that RGs deficit lay in the visual domain of the semantic system. This was supported by a number of tasks showing that his knowledge about the appearance of objects and animals was disproportionately impaired. Naming was also influenced by the semantic characteristics of items, in that objects which are largely defined by function were named well, whereas items defined largely by their appearance were named poorly. RGs performance is interpreted against a distributed model of semantic processing.

Speech therapy and Parkinson's disease: A review and further data

A review is undertaken of recent experimental studies of the effects of speech therapy offered to patients with Parkinsons disease. In contrast to earlier opinions based upon clinical impressions, the results of these studies indicate that the immediate gains from therapy measured within the clinical setting are readily detected, that these are perceived by patients relatives and that there is reasonable evidence that benefits persist for some period after treatment. A further study is reported which tests the effects of a less intensive treatment regimen. This also gave positive results. Although questions remain regarding the most efficient form of treatment and the extent of its benefits outside the clinic, the existing results warrant greater optimism about the benefits of speech therapy offered to patients with Parkinsons disease.

Ask a silly question: two decades of troublesome trials

BACKGROUND Randomized control trials and the use of meta-analysis in systematic reviews are the basis of evidence-based practice. The paper reviews their use in the development of evidence-based practice in speech and language therapy. AIMS It is accepted that clinical outcome research should develop in a sequence of phases. A model of this process is described. Examples of outcome research in speech and language therapy are used to illustrate the use of the model and the problems that result when it is not followed. MAIN CONTRIBUTION Existing research has largely ignored the agreed procedures for outcome research. Particular problems have arisen when randomized control trials are used to examine therapy provision for a client group. Clients are often a heterogeneous group and receive different therapies. Consequently, it is unlikely that trials can obtain significant results, nor, if they do, can they provide clinicians with useful information about the choice of treatment. Systematic reviews are equally uninformative. Many of the studies on which they are based have methodological problems and their frequent failure adequately to describe the therapies used mean that reviews cannot evaluate or compare different types of therapy. CONCLUSIONS Researchers in speech and language therapy have given too little attention to the basics of clinical outcome research. This requires that clinical and theoretical insights are used to identify specific therapies for well-defined groups of clients. These therapies must be tested first in efficacy, then in effectiveness studies, and their results should be disseminated to clinicians. Only then is it meaningful to carry out large-scale trials of the effectiveness of therapy provision for a client group or to conduct systematic reviews of existing research.

Sentence processing therapy: Working at the level of the event

Abstract This paper describes the assessment and treatment of a dysphasic subject with severe impairments in sentence production. Investigations revealed poor verb production and reduced access to the verb argument information. Further investigations suggested additional problems at the level of event processing. Errors were elicited on a verb/picture matching task and on a video assessment which required the identification of participant roles from interactive events. Therapy aimed to improve event processing. The subject was asked to identify the agent and theme in video events by selecting relevant photographs. Photo selection was also used to focus on the nature of the verb. Evaluation showed that therapy improved the subjects ability to produce two argument descriptions of action pictures. The structural skills generalized to representations of events which had not been targeted in therapy. The gains in speech production were reflected in a second evaluation procedure in which naive and familiar obs...

Delivering the Lee Silverman Voice Treatment (LSVT) by Web Camera: A Feasibility Study.

BACKGROUND Speech disorders are a feature of Parkinsons disease, typically worsening as the disease progresses. The Lee Silverman Voice Treatment (LSVT) was developed to address these difficulties. It targets vocal loudness as a means of increasing vocal effort and improving coordination across the subsystems of speech. AIMS Currently LSVT is not widely available, and there are practical difficulties associated with the delivery of an intensive treatment in an environment of resource constraints in the National Health Service (NHS). Delivery of LSVT over the World-Wide Web may address some of these difficulties. METHODS & PROCEDURES A feasibility study is reported in which three individuals with speech disorders resulting from Parkinsons disease received LSVT over the Internet, using broadband connection and a web camera. Participants were seen face to face for every fourth session in order to build a personal relationship, measure vocal sound pressure level (SPL) during treatment, and to review and prepare homework tasks. All other sessions were delivered over the Internet. OUTCOMES & RESULTS Broadly similar treatment gains were found between individuals treated over the Internet and those treated face to face. Gains were maintained or improved at an assessment two months after the treatment. CONCLUSIONS & IMPLICATIONS This study demonstrates that delivery of LSVT over the Internet is feasible, and that a larger trial would be appropriate to establish cost and treatment effectiveness.

Phonological naming therapy in jargon aphasia: Positive but paradoxical effects

This article is a single-case investigation of phonological naming therapy. The individual involved had fluent jargon speech, with neologisms, verbal paraphasias, and paragrammatisms. The jargon was underpinned by a severe anomia. Content words were rarely accessed either in spontaneous speech or naming. Single word investigations highlighted some preserved skills. Auditory comprehension, at least for concrete words, was relatively intact and although nonwords could not be repeated, words could, and at a level which was far superior to naming. The patient also had some ability to respond to phonological cues. These results suggested that phonological representations were preserved and that there were some intact semantic abilities. It seemed that the naming disorder was primarily due to an inability to access phonology from semantics. Therapy took a phonological approach. The patient was encouraged to reflect upon the syllabic structure and first phoneme of pictured targets. Subsequently, she was required to use this partial phonological knowledge as a self-cue. It was hypothesized that this therapy might equip the subject with a self-cuing naming strategy. Posttherapy investigations of naming demonstrated dramatic improvements, which generalized to untreated items. However, there was little evidence that these were due to a self cuing strategy. Performance on phonological judgment and discrimination assessments, which required conscious phonological reflection, was unchanged, and there were no signs that the patient was self-cuing during naming. Reasons for these paradoxical results are discussed.

Treating children with expressive phonological disorders: does phonological awareness therapy work in the clinic?

BACKGROUND Recent research has shown that phonological awareness therapy can improve speech production in children with expressive phonological disorders. This approach may be appealing to clinicians as the therapy may also benefit the childrens general phonological abilities and lead to gains in their literacy skills. AIMS To examine the effectiveness of phonological awareness therapy under conditions more similar to those prevailing in many speech and language therapy clinics. Children were treated in small groups and less intensive therapy was offered than in previous studies. METHODS & PROCEDURES Twenty children were randomly assigned to treated and untreated groups. A pre-/post-test design was used to monitor their progress in phonological awareness, literacy and speech production. Children were treated in groups of three. They received 12 hours of therapy. OUTCOMES & RESULTS Comparisons of the groups showed that the treated group made significantly greater gains in phonological awareness. However, differences between the groups in the measures of literacy and speech production were smaller and non-significant. Considerable variation was detected in the response of individual children to the therapy. CONCLUSIONS The results show the effectiveness of phonological awareness therapy in benefiting childrens general phonological skills. However, the comparison of these and previous findings suggest that children may require more therapy than is often available if literacy and speech production are also to benefit. Further research is required to confirm the duration and intensity of therapy required. Until such information is available, clinicians might want to take a cautious approach and combine therapies that target phonological awareness with more traditional approaches, that target speech production more directly.

Pitch change in male-to-female transsexuals: has phonosurgery a role to play?

Male-to-female transsexuals, who have undergone gender reassignment surgery, may continue to have low pitched voices. Voice therapy may assist them to use their voice in a manner more likely to be perceived as female but, if this approach is unsuccessful, a laryngeal framework operation may be necessary to raise vocal pitch. This study assessed the effects of crico-thyroid approximation surgery in 14 transsexuals. Modal pitch was significantly increased by surgery but with substantial variation across speakers. Modal pitch was significantly correlated with judgements of gender by speech and language therapists who listened to tapes of the subjects. The results suggest that crico-thyroid approximation may be used to raise the pitch of voices of male-to-female transsexuals. Further research is needed to clarify the reasons for the variability in outcome, to monitor the longer-term changes in voice and the impact for clients of their modified voice in real life situations.

Speech perception in noise by monolingual, bilingual and trilingual listeners

BACKGROUND There is strong evidence that bilinguals have a deficit in speech perception for their second language compared with monolingual speakers under unfavourable listening conditions (e.g., noise or reverberation), despite performing similarly to monolingual speakers under quiet conditions. This deficit persists for speakers highly proficient in their second language and is greater in those who learned the language later in life. These findings have important educational implications because the number of multilingual children is increasing worldwide, and many of these children are being taught in their non-native language under poor classroom acoustic conditions. AIMS The performance of monolingual, bilingual and trilingual speakers on an English speech perception task was examined in both quiet and noisy conditions. Trilingual performance was compared with that of monolingual and bilingual speakers. METHODS & PROCEDURES Monolingual speakers of English and early bilingual and trilingual speakers (i.e., acquired English as a second/third language before the age of 6 years) were recruited. Their fluency in English was tested by interview and by a questionnaire assessing their knowledge and use of the language. Audiological evaluation confirmed normal hearing in all participants. English speech perception was tested in quiet and in different levels of noise (50, 55, 60, 65 and 70 dB SPL) using the Speech Perception in Noise (SPIN) Test. OUTCOMES & RESULTS Bilingual and trilingual listeners performed similarly to monolingual listeners in quiet conditions, but their performance declined more rapidly in noise and was significantly poorer at 65 and 70 dB SPL. Trilingual listeners performed less well than bilinguals at these noise levels, but not significantly so. A subgroup of five bilingual speakers who learned Arabic and English simultaneously since birth were poorer at higher levels of noise than monolinguals, but not significantly so. CONCLUSIONS & IMPLICATIONS The results replicate previous findings of poorer speech perception in noise with bilingual speakers compared with monolinguals and extend the findings to trilingual speakers.