Dysphagia, Dysarthria, Voice, & Apraxia

Intervention

Ballard, K. J. (2001). Response generalization in apraxia of speech treatments: Taking another look. Journal of Communication Disorders. Special Issue: Clinics Issue: Peering into the Future, 34, 3-20.

Usefulness to Clinical Practice
  • Treatment approaches for AOS
  • Factors that influence the
       generalization of AOS treatments
    		•

    Characteristics of Review
    Population Apraxia
    Review Type Narrative
    Country USA
    Number of studies 40 referenced               

     

     

     


    The purpose of the present paper is to present a critical review and reanalysis of response generalization effects in studies of treatment efficacy in apraxia of speech (AOS). Response generalization takes two forms: generalization of treatment effects to untrained exemplars of trained behaviors and generalization to untrained (i.e., novel) behaviors. In the past, response generalization has not been extensive and typically has been restricted to untrained exemplars of trained behaviors. Reasons for these findings are discussed with reference to recent advances in our understanding of the nature of AOS and to theories of speech motor control and learning. The discussion focuses on the influence of the theoretical basis used to develop hypotheses and select behaviors to test predictions, the complexity of the treatment task/s, and patient characteristics. Suggestions for future directions in treatment efficacy research are offered. Learner outcomes: (1) An understanding of the nature of AOS, based on recent experimental analyses. (2) An understanding of the efficacy of current treatments for AOS in the area of response generalization. (3) An understanding of how theories of speech motor control might be applied to develop hypotheses for testing and increase effectiveness in treatment studies. (4) An understanding of how theories of speech motor control might guide selection of behaviors to test treatment effects and response generalization.      (Journal Abstract).

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    Clark, H. M. (2003). Neuromuscular treatments for speech and swallowing: A tutorial. American Journal of Speech-Language Pathology, 12, 400-415.

    Usefulness to Clinical Practice
  • Lists treatment strategies for
       neuromuscular impairments
  • Research findings on the efficacy of
       each strategy
    		•

    Characteristics of Review
    Population Dysarthria & dysphagia
    Review Type Narrative
    Country USA
    Number of studies 17 included

     

     

     

     

    Despite the proliferation of oral motor therapies, much controversy exists regarding the application and benefit of neuromuscular treatments (NMTs) such as strength training for alleviating dysarthria and/or dysphagia. Not only is limited empirical support available to validate the use of NMTs, but clinicians may also lack the foundational information needed to judge the theoretical soundness of unstudied treatment strategies. This tutorial reviews the theoretical foundations for several NMTs, including active exercises, passive exercises, and physical modalities. It highlights how these techniques have been used to address neuromuscular impairments in the limb musculature and explores potential applications to the speech and swallowing musculature. Key issues discussed in relation to active exercise are the selection of treatment targets (e.g., specificity of training, progression, and recovery. Factors influencing the potential effectiveness of passive exercises and physical modalities are presented, along with discussion of additional issues contributing to the controversy surrounding oral motor therapies.  (Journal Abstract).

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    Dworkin, J. P., Marunick, M. T., & Krouse, J. H. (2004). Velopharyngeal dysfunction: Speech characteristics, variable etiologies, evaluation techniques, and differential treatments. Language, Speech, & Hearing Services in Schools, 35, 333-352.

    Usefulness to Clinical Practice
  • Table of possible causes of VP
       dysfunction
  • Screening & assessment
       techniques; scoring forms
  • Review of surgical, prosthetic, &
       behavioural treatments
    		•

    Characteristics of Review
    Population Hypernasal resonance & articulation disorders
    Review Type Narrative
    Country USA
    Number of studies 45 referenced

     

     

     

      
    This tutorial addresses the complex patho-physiology, various structural and neurologic causes, methods of clinical appraisal, and alternative behavioral, prosthetic, and medicosurgical treatments of velopharyngeal dysfunction. To balance the primary focus of this review on hypernasal resonance and articulation disorders, discussions concerning hyponasal speech characteristics and underlying etiologies are also rendered.      (Journal Abstract).

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    Hooper, C. R. (2004). Treatment of voice disorders in children. Language, Speech, & Hearing Services in Schools, 35, 320-326.

    Usefulness to Clinical Practice
  • Describes characteristics of children
       with voice disorders
  • Compares voice therapies for
       children versus adults
  • Reviews treatment programs for
       children with voice disorders
    		•

    Characteristics of Review
    Population Voice disorders
    Review Type Narrative
    Country USA
    Number of studies 42 included

     

     

     

     

    Children with voice disorders do respond to treatment, with vocal hyperfuction being the predominant disorder on the caseload of the pediatric voice clinician. This article reviews the literature in describing what is known about these children and typical disorders, prevention of voice disorders, the need for treatment, the referral patterns of teachers and others, and typical management programs and their settings. Good online resources are offered and brief highlights about voice therapy with children are reviewed.  (Journal Abstract).

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    Pederson, M., & McGlashan, J. (2001). Surgical versus non-surgical interventions for vocal cord nodules. The Cochrane Database of Systematic Reviews, Issue 2. Art. No.:CD001934. DOI: 10.1002/14651858.CD001934.

    Usefulness to Clinical Practice
  • Compares the effectiveness of two
       treatments for vocal cord nodules
  • Lists studies that were included &
       excluded from the review
    		•

    Characteristics of Review
    Population Vocal nodules
    Review Type Systematic
    Country Denmark
    Number of studies None met inclusion criteria

     

     

     

     

     
    Background: Vocal cord nodules are bilateral swellings of the mid-portion of the membranous vocal folds. They are of variable size and are characterised histologically by thickening of the epithelium with a variable degree of inflammatory action in the underlying superficial lamina propria. They     characteristically produce hoarseness. Treatment of vocal cord nodules aims to eliminate or reduce this hoarseness.
    Objectives: To assess the effectiveness of surgery versus non-surgical interventions for vocal cord nodules.
    Search strategy: We searched the Cochrane Controlled Trials Register (CCTR) and Medline (1966-2000), Embase (1974-2000), Biological Abstracts (1970-2000), Biological Abstracts RRM (Reports, Reviews and Meetings) on CD-ROM (1989-2000) and review articles.
    Selection criteria:     Randomised and quasi-randomised tr    ials comparing any surgical intervention for vocal cord nodules with non-surgical treatment or no treatment. Data collection and analysis: No suitable trials were identified
    Main results: No studies fulfilled the inclusion criteria
    Authors’ conclusions: There is a need for high quality randomised controlled trials to evaluate the effectiveness of surgical and non-surgical treatment of vocal cord and nodules.      (Journal Abstract).

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    Steele, C. M. (2004). Electrical stimulation of the pharyngeal swallow: Does the evidence support application in clinical practice? Journal of Speech-Language Pathology and Audiology, 28, 78-84.

    Usefulness to Clinical Practice
  • Describes neurophysiology of the
       swallow initiation
  • Reviews evidence for pharyngeal
       swallowing treatments
    		•

    Characteristics of Review
    Population Swallowing disorders
    Review Type Narrative
    Country Canada
    Number of studies 15 referenced

     

     

     

      

     In recent years there has been a proliferation of interest in the use of electrical stimulation for the treatment of swallowing disorders. This review explores both the rationale and existing evidence for different therapeutic swallow stimulation techniques, including electrical stimulation methods. For each technique, the method and presumed mechanism of therapeutic benefit will be described. Criteria from the University of Alberta Evidence Based Medicine Toolkit (U of A EBMT) will be considered in evaluating the current evidence for use of these techniques. A critical analysis of this literature will be presented to support the argument that implementation of electrical stimulation in clinical swallowing rehabilitation settings remains premature.  (Journal Abstract).

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