SLP Capstone Projects are listed below, by publication year and alphabetically by the author’s last name.
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Bellom-Rohrbacher, Kristen H. A Sensory Integration Program Versus Escape Extinction in Pediatric Feeding Disorders
The purpose of this investigation was to determine if the use of sensory integration plus positive reinforcement would be more beneficial than the use of escape extinction plus positive reinforcement to increase overall acceptance of food and decrease negative mealtime behaviors in preschoolers with pediatric feeding disorders. Two preschool males participated in this investigation. The behavior being measured included the percentage of acceptance of undesired foods, duration of negative mealtime behaviors and the percentage of following sensory demands. The investigation took place at a pediatric multidisciplinary clinic in Bronx, New York. The investigation employed an alternating treatment design. Ultimately, the participants demonstrated positive changes in both conditions compared to the baseline. Both participants experienced higher acceptance of undesired foods in the escape extinction condition, and a decrease in negative mealtime behaviors, however, with several spikes and variability throughout. In the sensory integration condition, both participants experienced an increase in acceptance by the end of the investigation with very low negative mealtime behaviors. These findings support previous studies, which indicate that the use of sensory integration plus positive reinforcement is beneficial in treating children with pediatric feeding disorders to improve acceptance and decrease negative mealtime behaviors. This research also indicates the need for continued research with this population.
Galic, Meggan E. Effectiveness of Therapy Conducted with a Tablet Application on Individuals with Memory Impairment
The overall purpose of this research was to determine if individuals with dementia would benefit from cognitive/memory therapy interventions being provided by a tablet-based application. Two individuals with dementia participated in this research. The behaviors measured included overall cognitive function that was measured with a pre and post-test of cognition. In addition, percentages obtained on a memory task via a tablet-based therapy application were documented daily for each participant. The research was completed at a 120-bed skilled nursing facility in Houston, Texas. The design utilized for this research was a changing criterion design. Overall, in Phase A of the therapy intervention, both participants demonstrated positive changes. In Phase B when the therapy task became more difficult, the participants did not show a statistically significant difference between Phases A and Phase B, which was expected due to the increasing difficulty with the task. Both participants demonstrated positive statistically significant changes from the pre-test at the beginning of the therapy intervention to the post-test at the completion of the therapy intervention. These findings agree with previous studies that suggest there is evidence that individuals with dementia can demonstrate new learning. This research indicates the need for continued research in individuals with dementia.
Heape, Amber Berry Effect of Structured Training on Graduate Student Self-Efficacy in Medical Settings
Medical offsite placements for graduate students in communication sciences and disorders (CSD) are increasingly difficult for speech-language pathology (SLP) programs to attain. Some suggest that may be, in part, due to the perception of student ambiguity, clinical skill deficits, and poor overall self-efficacy (Brown, 2007). This leads to difficulty for universities, which are required to provide diverse clinical placements prior to graduation. The purpose of this investigation was to determine the effect of structured training on the self-efficacy of graduate students in medical settings, in order to determine if training would have a significant effect on selfefficacy. Most empirical research supports a relationship between self-efficacy and performance. Although much remains to be learned about self-efficacy, evidence now available in healthcare sciences suggests that it is possible to teach strategies to improve self-efficacious behavior (Bobo et al, 2012). Stress was also rated as a component of self-efficacy. This study used a single subject (small n) comparison design with A, B, and C phases. After baseline, the primary intervention phase (training) was measured, then the secondary intervention phase (medical offsite) to see the effects on self-reported efficacy ratings of students. Five of six participants in this investigation demonstrated significant improvement in self-efficacy levels after the provision of a structured training program. Pre-placement self-efficacy was increased, as well maintenance or further improvement during offsite placements. The potential implications of this type of structured training could theoretically change the focus of university courses in clinical methodology and theory, or warrant preplacement workshops to achieve the desired improvement.
Keywords: self-efficacy, medical, graduate student, training
La Bella, Renee Effect of Video Modeling with Picture Exchange Communication on Spontaneous Requesting in Children with Autism
Children with autism present with unique communication needs. The children who are nonverbal present speech-language pathologists with the challenge of finding and establishing an effective means of communication, often in the form of an augmentative and alternative communication (AAC) system. This investigation explored the use of video modeling (VM) for training three 6 year-old children with autism to use the Picture Exchange Communication System (PECS) to spontaneously request highly desired items. An alternating treatment research investigation was conducted by alternating two intervention conditions, PECS alone and PECS with VM. Each child received 10 sessions of each condition with no more than two consecutive sessions of the same condition. The dependent variable was the percentage of correct picture exchanges out of 10-20 opportunities. A correct trial involved the participant picking up the picture, reaching for the communication partner, and releasing the picture into the communication partner’s hand without prompting from the silent trainer at any stage of the exchange. Event recording took place at each session and the percentages of non-overlapping data (PND) and slopes were calculated for each participant. Both intervention types (i.e., PECS alone and PECS with VM) resulted in increases in the number of independent requesting for all three participants. There was an increase in levels from stable baselines with no spontaneous picture exchanges to 35-53% with PECS only and 40-58% with PECS and VM. Two participants performed 60% of the paired sessions better when the PECS was paired with the VM versus with the PECS only sessions. One participant performed 70% of the PECS only sessions better than the PECS with VM sessions. The slopes led to different insights than the PND. This investigation supported previous literature. However, results have limited generalization due to the small sample size and decreased interest in the videos for two of the participants.
Lewis, Christine Richard Effect of Multiple Oppositions Approach on Intervention Progress for Speech Sound Disorders
Speech sound disorder (SSD) is the most common diagnosis made by speech-language pathologists with a pediatric caseload (ASHA, 2014). An estimated 2% to 25% of children ages 5 to 7 years have a SSD diagnosis (Law, Boyle, Harris, Harkness, & Nye, 2000). This investigation examined the effects of the multiple oppositions therapy approach, contrastive method of phonological intervention administered by a speech-language pathologist to children with moderate-to-severe phonological disorders. Previous investigations supports that children with moderate-to-severe phonological disorders benefit from the multiple oppositions approach (Cathelle & Ruscello, 2004; Liles & Williams, 2006; Williams 2000a, 2000b). Multiple oppositions approach has been introduced and researched in recent years showing an efficient and effective way to remediate moderate-to-severe phonological disorders through contrasting multiple sounds simultaneously (Williams, 2000). Unlike other phonological treatment methods, the multiple opposition approach homonymy is a central theoretical tenant (Williams, 2010). The purpose of this research investigation is (a) to confirm previous claims regarding the effectiveness of the use of the multiple oppositions approach for improving sound errors with children with SSD, and (b) to improve understanding of the importance of the proper phonological analysis and selecting appropriate sound targets. A single-subject A-B research design was used to determine the effectiveness of the multiple oppositions approach. Research was conducted using three preschool age participants in the public school setting. The data were analyzed using visual inspection and the Two Standard Deviation Band method. The results revealed slight improvement in production of speech sound targets in all participants.
Keywords: speech sound disorder, phonological treatments, multiple opposition approach, minimal pairs
Means, Ebony Thompson Effect of Phonemic Awareness Training on Phonemic Awareness and Oral Reading Fluency
Studies evaluating the acquisition of phonemic awareness and learning to decode print have typically focused on preschool and primary school years. There is limited research of phonemic awareness skills in language-impaired readers post-elementary (Scarborough et al., 1998; Swanson, 2008; Ukrainetz, Cooney, Dyer, Kysar, & Harris, 2000). There are several studies that evaluate the benefit and efficacy of phonemic training with individuals who are hard of hearing, limited English learners, and primary age students (Castles, Wilson, & Coltheart, 2011; Krashen, 1999; Messier & Jackson, 2014); however, limited research is available on the efficacy of phonemic awareness training with secondary age students who continue to exhibit poor phonemic awareness and reading disability. A single subject A-B design was conducted to determine the effectiveness of explicit phonemic awareness training to improve adolescent students phonemic awareness deficits who are struggling readers and the ability to improve phonemic blending and segmenting skills, and reading fluency. The investigation included three adolescent students who completed eight intervention sessions. The baseline and 45-minute intervention sessions took place in a middle school in South Carolina. Ability to segment and blend sounds was assessed at each baseline session and at the beginning of each intervention session. The data were analyzed by a visual inspection and Two Standard Deviation Band method. The outcomes revealed improvement in percentage of accuracy in completion of phonemic awareness tasks for all participants, indicating that explicit phonemic awareness training had a positive effect on phonemic awareness skills and a slight increase in reading fluency words read per minute.
Keywords: phonemic awareness, segmentation, phonemic blending, reading, literacy program
Mentor, Kennetha Sheeti’La Effects of Spaced Retrieval Training and External Memory Aids on Individuals with Dysphagia and Dementia
Two adults with dementia and dysphagia were taught to recall a compensatory swallow strategy using the spaced retrieval training method combined with external memory aids. Ten intervention sessions were administered over a four-week period with two weeks of baseline sessions with external memory aids only. On each trial, participants were provided a 5×8 note card with the compensatory swallow strategy and asked to recall a compensatory strategy by verbally responding to the question and executing the compensatory swallow strategy at increasingly longer retention intervals up to 3 minutes. Results yielded a positive effect of spaced-retrieval training combined with external memory aids for recall of compensatory swallow strategies. Both participants were able to recall the compensatory swallow strategy over longer periods of time across training sessions. These data provided initial evidence that spaced-retrieval training combined with external memory aids can aid individuals with dementia and dysphagia in recall of compensatory swallow strategies.
Keywords: dysphagia, dementia, spaced retrieval training, external memory aids
Parker, Elizabeth D. Effect of the Earobics Computerized Literacy Program on Segmentation Performance in Young Children
A single subject A-B design was conducted to determine the effect of the Earobics Computerized Literacy Program on ability of kindergarten children to segment sounds in words. Earobics was invented as supplementary literacy program to increase reading skills by focusing on phonological awareness abilities. The investigation included seven kindergarten children. The baseline and intervention sessions took place in a small elementary school in New Mexico. Six of the participants were able to activity participate in the investigation and were provided 12 intervention sessions. The participants were randomly assigned to one of two baseline phases: a three-data-point baseline or a sixdata-point baseline. Ability to segment sounds was assessed at each baseline session and at the beginning of each intervention session. The data were analyzed by a visual inspection, Binomial Test, and Two Standard Deviation Method. The data demonstrated significance for a positive change from baseline to intervention; in addition, it demonstrated that the variation of change was due to a special cause. These results indicated that the Earobics Literacy Program had a positive effect on the segmenting skills for the kindergarten children in this investigation. Segmenting involves only one area of phonological awareness and future research should expand to include additional areas of phonological awareness.
Keywords: phonological awareness, segmentation, reading, literacy program
Peterson, Susie Bartolome Effect of Interactive Metronome on Understanding Spoken Language in Adults with Auditory Comprehension Impairments
The ability to understand spoken language involves mechanisms beyond the linguistic level of comprehension. People with acquired auditory comprehension impairments due to a brain injury have differences in neural speed and timing that impair their ability to comprehend. This single subject research study investigated the effect of Interactive Metronome (IM) on processing and understanding spoken language that varied by length, complexity and/or speech rate, on different modalities that demonstrate comprehension (writing to dictation, repetition, following spoken commands and identifying the written word), and on the speed of response for following commands. In this A-B-A design, 15 sessions of IM training were provided to a 55-year-old male participant, 3 years post CVA with persisting symptoms of mild receptive aphasia and mild anomia, and was evaluated to have concomitant acquired auditory processing disorder. Results found improvement in auditory processing and comprehension in each of the modalities, in understanding spoken words with increased complexity and length, an improvement in temporal processing, and in the ability to comprehend faster rates of speech, as well as in faster abilities to respond to spoken commands. Findings contribute to the research that positive improvements in timing and synchronicity improve auditory processing and comprehension.
Rau, Elaine The Effect of Instruction Using the Expanding Expression Tool on the Number and Type of Attributes in Verbal Descriptions Produced by Children with Language Impairment
Verbal descriptions are important for academic success and are included in the 2010 Common Core State Standards; however, children with language impairment (LI) often have limitations in this area. The Expanding Expression Tool™ (EET) is a multisensory program designed to teach children with LI a conceptual strategy to produce comprehensive verbal or written descriptions. The EET learning tool is a toy made of large, color-coded beads on a thick cord. Users are taught a chant in which each colored bead corresponds to a specific component of a comprehensive description. Instruction is supported by a variety of color-coded materials, worksheets, and suggested activities. The effects of the EET program on the verbal descriptions produced by two children with LI were investigated using a single case research design. The participants were two boys, ages 6.7 and 9.9 years respectively. Each received 15 half-hour sessions of instruction in the EET program. The dependent variable was a probe, adapted from an investigation by Dudek (2014) to elicit verbal descriptions of six common nouns, administered at the beginning of each session. Responses to the six nouns were scored using rubrics adapted from Dudek; these scores were averaged to yield a Giving Verbal Descriptions score for each probe. Results indicated that the positive changes in each participant’s scores from baseline to completion of the intervention were significant and reflected an increase in the number and type of attributes produced by both participants.
Scott, Courtney G. The Effect of Real-Time Feedback Using a Smartwatch on the Clinical Behavior of Novice Student Clinicians
There is an identified need to investigate supervisory instructional practices that can effectively manage the cognitive load and needs of student clinicians (SCs) during various stages of clinical development (Young, Van Merrienboer, Durning, & Ten Cate, 2014). This investigation aimed to study an interactive, technology-based method for providing feedback to promote the transfer of knowledge from clinical supervisors to SCs. A substantial body of empirical evidence supports the use of Bluetooth technology to provide real-time feedback during clinical sessions, known as “bug-in-the-ear” (BITe) feedback (Gallant & Thyer, 1 989; Goodman, Brady, Duffy, Scott, & Pollard, 2008; Rock et al., 2009; Rosenberg, 2006; Scheeler & Lee, 2002). The use of computer monitors to provide real-time written feedback, referred to as “bug-in-the-eye” (BITi) feedback, recently emerged in the literature with preliminary evidence to support its effectiveness (Carmel, Villatte, Rosenthal, Chalker & Comtois, 2015; Weck, 2015). All participants in this investigation were students enrolled in a clinical practicum at an American Speech-Language-Hearing Association (ASHA) accredited communication disorders and sciences (CDS) program housed within a state-funded university in the midwestern United States. This investigation employed a single subject, sequential A-B design with two participants to observe the effects of implementing real-time feedback using a smartwatch on the clinical behavior of SCs. The use of a smartwatch to deliver real-time BITi feedback has not been previously considered for BITi feedback. A celeration trend line, descriptive statistics and a stability band were used to analyze the data by slope, trend and variability (Gast & Ledford, 2014). Results demonstrated a significant correlative relationship between BITi feedback with a smartwatch and an increase in positive clinical behaviors.
Keywords: Clinical feedback, speech-language pathology, real-time, smartwatch
Shigetomi-Toyama, Sandra C. The Effect of Rapid Syllable Transition Treatment on Childhood Apraxia of Speech
In the literature, there are various treatments for children with childhood apraxia of speech (CAS) but few discuss treating CAS with a concomitant disorder. CAS can be a challenging disorder to treat and likely to be seen in conjunction with a disorder like autism spectrum disorder (ASD) (Tierney et al., 2015) thus making the treatment more challenging. The purpose of this case study was to evaluate the efficacy of an evidence-based instructional program for CAS, Rapid Syllable Transition (ReST) treatment using the principles of motor learning (PML), and determine if the program would increase natural sounding speech in a boy eight years old with dual diagnoses of mild ASD and moderate CAS by improving the ability to vary the prosodic contours with appropriate intonation and rate in three-to-four syllable pseudo words and generalizing that ability to real words. The treatment, in this A-B single subject design, was intensive in both production (>75) and session frequency (four times per week for 3 weeks). The outcome revealed improvement in the ability to produce variable stress patterns with appropriate rate in three and four syllable pseudo words. Treatment effects generalized to untreated multisyllabic real words. The results supported the use of ReST to address speech naturalness in a child with dual diagnoses of ASD and CAS. Adherence to the PML appear to be a positive component to this approach.
Keywords: speech disorder, autism spectrum disorder, prosody, principles of motor learning, generalization, pseudo words, speech naturalness
Sims, Niqueka S. A Comparison of Traditional Phonetic Placement-Production in Electropalatograpy: Performance of School-Age Children with Persistent Speech Disorder
Pascoe, Stackhouse, and Wells (2006) define persisting speech difficulties (PSD) as “… difficulties in the normal development of speech that do not resolve as the child matures or even after they receive specific help for these problems (p. 2).” Lohman, Fucci, and Marinellie (2001), indicated that in traditional articulation therapy, children are given verbal instruction to improve sound production by altering lingual positioning in the oral cavity; however, some children may not conceptually understand verbal instruction alone and may require additional types of feedback (Ruscello, 1995). This additional feedback could be visual, because visual feedback may facilitate correct placement, thereby aiding correct speech production. One form of visual bio-feedback is electropalatography (EPG) is a computerized bio-feedback system that tracks and visually displays tongue-to-palate contact by u se of a pseudo-palate. This investigation sought to determine the effectiveness of traditional phonetic placement articulation therapy as compared to electropalatography for increasing correct production of target phonemes in school age children with a persistent speech sound disorder. The investigation was an experimental single-subject mixed method A-B-A-B and B-A-B-A design, with six participants. The outcomes revealed improvement in percentage of accuracy for all participants, indicating that electropalatography had a positive effect on treating phoneme errors.
Keywords: electropalatography, articulation, articulation disorder, speech disorder, persistent speech disorder, smart palate
Staley Sr., Carlos The Effects of Neuromuscular Electrical Stimulation and Traditional Dysphagia Treatments on Swallow Initiation Times in Individuals with Oral-Pharyngeal Dysphagia Secondary to Stroke
Recent investigations have posited that greater than 42% of individuals who have experienced stroke have been diagnosed with dysphagia (Crisan, Shaban, Boehme, Dubin, Jeungling, Schulter, Albright, Beasley, & Schild-Martin, 2013). In addition, these individuals have required either short term or long term interventions to compensate for the various levels of dysphagia they have experienced. Traditional interventions for the various phases of dysphagia (swallow dysfunction) have consisted of oral motor exercises (e.g., oral-labial and tongue resistance exercises), compensatory swallow strategies (e.g., Mendelsohn Maneuver), diet modifications, and airway protections (Heijen, Speyer, Baijens, & Bogaardt, 2012). Most recently, neuromuscular electrical stimulation (NMES), has appeared as an adjunctive intervention for dysphagia resulting from various diagnoses including stroke. This modality involves electrical stimulation of the various muscles involved in swallowing. The NMES modality has not been without controversy and there are those who believe that NMES is not beneficial for treatment of dysphagia of any kind (Biber & Barrera, 2012). The purpose of this investigation was to determine the effect of NMES, when combined with traditional dysphagia interventions, on swallow initiation duration of individuals with stroke and subsequent oral/pharyngeal dysphagia characterized by delayed swallow initiation. The single subject (small n) design was utilized with an A (baseline) and a B (intervention) phase. Traditional dysphagia treatments (oral motor movements, e.g. tongue protrusion and lateralization) were utilized during Phase A of the investigation. NMES was added and utilized simultaneously with the traditional treatments within the intervention phase (Phase B) of the investigation to determine if this combination of interventions had an effect on the targeted swallow initiation duration. A speech language pathologist (SLP) collected the pre-treatment and post-treatment swallow initiation times of the participants during each phase of the investigation. Results of the one participant who completed the investigation revealed that while the traditional dysphagia intervention positively impacted the swallow initiation durations of this individual, there was a statistically significant positive impact on the swallow initiation durations of this same participant when NMES was utilized simultaneously with the traditional dysphagia therapeutic approach within the intervention phase. The potential implications of this investigation are that it provides additional information for future research that may further confirm that NMES is a relevant mode of treatment, and should therefore be considered a viable recommendation for intervention of dysphagia in patients with dysphagia secondary to stroke.
Keywords: neuromuscular electrical stimulation (NMES), dysphagia, oral motor exercises
Bell, Joy The Effect of a Sensory-Motor Approach to Feeding in Children with Pediatric Dysphagia
The purpose of this investigation was to determine the efficacy of a sensory- motor approach to feeding in children with pediatric dysphagia. Two preschool males participated in this investigation. One of the participants withdrew from the investigation during the initial intervention phase due to an illness not related to the investigation. Inclusion criterion included diagnoses of oral-pharyngeal dysphagia, neurological and/or genetic disorder, postural control (with or without seating adaptive equipment), and the ability to follow two step commands and understand the words open, close, bite, chew, and swallow as determined by a speech-language screening. Exclusion criterion were children with food aversions due to a sensory feeding disorder without oral-motor weakness or coordination impairments, and children deemed unsafe to consume solids per pre-test swallowing and feeding exam results conducted one week prior to the investigation by the speech-language pathologist. The investigation was held at a speech therapy clinic in Lincolnton, NC. Therapy was held during lunchtime three sessions a week for 4 weeks with 30 minutes per session. An Oral-Motor Feeding Assessment was conducted pre- and post- treatment. The Independent variable was the chewing hierarchy-modified (level 3) and food weight consumed was measured as the dependent variable. The design utilized in the investigation was an ABAB design. Overall, the participant demonstrated positive changes during the intervention phases compared to baseline. A slight improvement in food consumption was also observed during the withdrawal phase of the investigation. This improvement appeared to be due to carryover of a learned skill as evidenced by the observance of the participant executing the learned technique independently during this phase. These findings support previous studies, which suggested that the use of a sensory-motor approach might be beneficial in improving swallow function and food consumption in children with pediatric dysphagia. Based on this research, further investigative studies are warranted to analyze the impact of a sensory-motor approach to feeding with the pediatric population.
Bennett, Lauren S. The Effect of a Holistic Treatment Program on Remediation of Phonological Errors in a Preschool Child
A distinctive feature approach to intervention is a treatment technique that targets phonemes absent in a child’s sound inventory, generally focusing on sound substitutions. Comprehension of phonemic contrasts are indicative of phonological complexity; therefore, children that present with phonological disorders are less aware of these contrasts, hindering speech sound development. A preschool-aged child was provided with instruction using a holistic distinctive features program that targeted final consonants. An AB, single subject design was used across eight sessions and measured improvement on presence of final consonants throughout various word lists. The participant engaged in a multi-step process including: auditory discrimination, practice, participant teaching, and elicitation. Results indicated that this contrastive intervention approach aided in increased inclusion of final consonants and suppressing the phonological process of final consonant deletion.
Keywords: Final consonant deletion, phonological process, distinctive features
Buchheit, Amanda Effect of the Developmental Language Preschool Therapy Approach for Preschool Students with Language Disorders
Approximately 8% of preschool students have speech and language difficulties. A significant portion of these preschool students will present with a diagnosis of a primary speech and language disorder. This single subject research study investigated the effectiveness of the Developmental Language Preschool Therapy Approach (DLPTA) for students identified with receptive and expressive language disorders, specifically measuring the participants’ progress in the areas of rate of spontaneous verbalizations, utterance length (e.g., mean length of utterance), and expressive vocabulary growth (e.g., Type Token Ratio). In this A-B design, 20 sessions of DLPTA were provided to three preschool participants, ranging from 3-years, 4 months to 4years, 4-months old, with a mixed receptive-expressive language disorder. Results indicated that the DLPTA indicated statistically and clinically significant increases in spontaneous verbalizations and mean length of utterance (e.g., phrase length) for Participants One, Two and Three. The DLPTA indicated a clinically significant impact on Type Token Ratio for Participants One, Two and Three. In addition, increases were noted in the total number of different words and total number of words that Participants One, Two and Three used. Additionally, expansions were noted in the grammatical tenses, question asking and use of wh-words used by all three participants. Qualitatively, parents reported a decrease in participant tantrum behavior and parent frustration and increases in the ability to understand their child, engage in a reciprocal conversation, and an increase in quality of life due to the DLPTA.
Cantu, Marisa Effects of Teaching Parents to Respond to Their Child’s Communicative Intents
Eighty-five percent of a child’s brain growth occurs during the first three years of age (Bruner, Floyd, & Copeman, 2005). It is important that children with a developmental delay such as a language disorder be seen early to take advantage of the brain maturation. Early childhood intervention programs provide professional services to parents and children in naturalistic environments to increase the child’s communication using a variety of methods. In this investigation, the methods used were a combination of prelinguistic milieu teaching (PMT) and responsive interaction (RI), to determine the effects of a parent-training program on the parent’s verbal responses to the expressions of the child’s communicative intent, and determine if this program influenced the child’s language development. Results indicated that with an educationally rich environment, parent education, and coaching, the mother (JD) was able to increase her verbal responses to her child’s (TC) communicative intents. At baseline, JD’s verbal response rate of improvement was 0x, meaning there was no improvement in her verbal responses over these three session. When treatment was implemented, JD’s rate of improvement was 5.6x, indicating she began increasing her verbal responses after the treatment was introduced. At the maintenance phase, JD demonstrated another rate of improvement of 1.5x over these three sessions indicating that JD was able to maintain what she had learned and continued to improve. Absolute level of change between adjacent conditions and percent of nonoverlapping data (PND) indicated that from baseline to treatment, JD improved 5percentile points in absolute level of change with a PND of 75%. From treatment to maintenance, there was a 2-percentile point improvement in the absolute level of change with a PND of 33%. The child (TC) was also able to increase her receptive and expressive standard scores on the Developmental Assessment of Young Children 2nd edition in pre and post testing. TC’s standard scores in pre and post testing were greater than 22 points in receptive language (25 points), expressive language (33 points), and overall communication (26 points).
Keywords: prelinguistic milieu teaching, responsive interaction, early intervention, language, brain, developmental delay, communicative intents, normal development
Carlo, Edna J. The Use of Palin Parent-Child Interaction Therapy with Spanish-Speaking Children Who Stutter
This is a single-subject research study exploring the use of Palin Parent-Child Interaction Therapy with a Spanish-speaking child who stuttered. Both parents participated with their son in the indirect component of the therapy Program. Results indicated no changes in the level of stuttering frequency from baseline to intervention with the father. In contrast, changes seen with the mother reflect that treatment had an impact on the outcome response in this case. The study also adds findings about changes in the parents’ rating of (a) impact of stuttering on the child, (b) stuttering severity and parental concern, and (c) parents’ knowledge and confidence in dealing with stuttering. Individual variations are also discussed. Considerations for the cultural and linguistic adaption and application of an indirect intervention program for preschool children who stutter are proposed.
Colon, Marina M. The Effect of Minimal Contrast Therapy on the Speech Perception of English Language Learners (ELLs) From Low Socioeconomic Status (SES) Households
English Language Learners (ELLs) are a population at risk for lower literacy skills and are at an even greater risk when they are from low socioeconomic status (SES) households. Research suggests that the speech perception of Spanish speaking ELLs is immature when it comes to English only vowels sounds, which may be a factor contributing to lower literacy skills. Three participants, ages 4;0-4;11 from a Headstart preschool program who are ELLs from bilingual Spanish-speaking low socioeconomic households, took part in this study. A screener was utilized to identify the children that do not perceive the non-native English vowel target /æ/. The participants were seen together in a group as they would be seen in a Tier 2 RTI setting. The intervention continued for ten sessions. Intervention sessions were comprised of three tasks; (1) actively listening to non-native /æ/ stimuli, (2) actively listening to /æ/ and its minimal contrast /ɒ/ immediately following to attempt to discriminate between the two stimuli, and (3) actively listening to combinations of the two sounds and determine if the sounds are the same or different. All three participants showed increased speech perception of the nonnative English vowel phoneme /æ/ after receiving an intervention of minimal contrast therapy.
Cruz, Gloriana Effectiveness of an Instructional Treatment Model for Spanish Verbal Morphology in Spanish Speaking Preschoolers
Verbs are the most important part of speech in a sentence that describes action. They conjugate in three primary tenses (a) present, (b) past, and (c) future. In the Spanish language, the infinite form of the verb occurs in three different endings (a) ar; (b) er; (c) ir. Verb conjugation is a challenge for any new student of the Spanish language, especially for preschoolers who struggle to understand the underlying grammar concepts. Because this subject is of basic importance in the academic context, it requires an in depth review with regular discussion and practice, particularly in the field of speech language pathology. Three participants aged 3.6 to 5.0. years who were Specific Language Impairment SLI exhibiting a deficit in verb conjugation, took part in this study. A screener was utilized to identify individuals with a verb conjugation deficit. The participants had individual sessions twice a week in ten intervention sessions. The intervention sessions include two tasks: (1) introduction of the verb concepts, and (2) interactive learning exercises. Results did not reveal an impact for the three participants who took part in this study. Nevertheless, this investigation supports the notion that children with SLI require more frequent presentations of stimuli to generalize the target verb.
Garcia, Nelia Vanessa Effect of Thickened Liquids on the Hydration and Quality of Life of Patients with Dysphagia
Thickened liquids are the most frequent intervention in the hospital to prevent aspiration in patients with dysphagia (swallowing difficulties) (Garcia & Chambers, 2010a; Robbins, Gangnon, Theis, Kays, Hewitt, & Hind, 2005), however, they are the least recommendation to be adhered to, with a 36% of adherence (Low, Wyles, Wilkinson, & Sainsbury, 2001). Poor compliance with the use of thickeners can result in malnutrition, dehydration, aspiration pneumonia, decreased quality of life (QOL), and even death (Garcia & Chambers, 2010a). Due to the absence of convincing scientific evidence on how to manage these issues and the need of healthcare professionals to emphasize not only longevity of life but also QOL, this investigation was designed. This study examined the effect of two types of thickeners on the fluid intake and QOL of patients with dysphagia in the acute care setting. This investigation was a single-subject alternating treatments design (Atr). Three participants, aged 61-75, with a diagnosis of oropharyngeal dysphagia were recruited in the acute care setting and completed a total of six treatment sessions. Results of this investigation revealed a higher fluid intake with powderthickened beverages (>324mL) than with pre-thickened beverages. The overall QOL revealed the same preference for the taste of both type of thickeners (mean score of 3.9), preference to the texture and thirst-quenching abilities of powder-thickened beverages (mean scores of 3.7 vs. 3.6 and 3.9 vs. 3.6, respectively), and predilection for the appearance of pre-thickened beverages (mean score of 3.8 vs. 3.6). These findings support existing research about decrease oral intake and discontent when consuming thickened liquids.
Keywords: powder-thickened beverages, xanthan gum thickeners, dehydration, swallowing problems
Hawkins, Lourdes Effects of an Individualized Staff Training Program on the Use of Communication Strategies with Adults with Developmental Disabilities
A multiple probe design across participants was used to investigate the effects of individualized staff training on the use of non-verbal communication by staff at a day habilitation program for individuals with developmental disorders. Staff interactions were observed and analyzed to determine the frequency of non-verbal communication strategies prior to training, during the training phase and intermittently during the remainder of the investigation. Each training session was 15-minutes in length and occurred within the staff’s assigned work location. All staff were observed to increase their overall use of non-verbal communication strategies. Pre-post questionnaires revealed that staff felt comfortable communicating with the individuals they served. Post-questionnaire indicated that staff believed they would benefit from an annual training.
Herreras Mercado, Raul Effect of Prompts for Restructuring Oral Muscular Phonetic Targets (Prompt) on Compensatory Articulation in Children with Cleft Palate/Lip
The current investigation researched the effectiveness of the PROMPT method to address compensatory articulation errors in children with cleft palate. The investigation consisted of three participants (ages 4:4 to 12:8) born with bilateral complete cleft lip and palate. Participants underwent several reconstructive surgeries to repair their lips and palates. The PROMPT treatment was provided for 45 minutes three times a week for four weeks (three weeks for Participant 2) after stable data was obtained during three consecutive therapy sessions. Therapy sessions addressed anterior lingual speech motor phonemes across three tiers (syllable combination, initial and final position at words, and phrase levels). Direct visual observation of data obtained throughout this investigation indicate potential positive effects and significant correlation between improvements in sound production at different tiers and the implementation of the PROMPT technique. Speech intelligibility was judged by three blinded listeners who were unfamiliar with children with speech disorders and/or with cleft palate speech. All listeners identified and judged improvement in overall speech intelligibility over the course of this investigation. Listeners examined speech samples selected from sessions 3, 6, 9 and 12. The findings in this investigation provide a potential relationship on the effectiveness of the PROMPT method and attainment of accurate speech productions in children with cleft palate producing compensatory articulation errors, resulting in improvement in overall speech intelligibility.
Hoy, Melissa Effects of Caregiver Training on the Use of an Aided Language Stimulation Program Using Speech-Generating Devices
Aided language stimulation is an intervention strategy used with individuals who use augmentative and alternative communication (AAC). While the current literature supports the use of aided language stimulation when implemented by speech-language pathologists and educators, there is limited research to support the use of aided language stimulation by caregivers, especially when using dynamic display speech-generating devices (SGDs). The purpose of this investigation was to determine if teaching caregivers in the use of aided language stimulation would increase their ability to spontaneously model vocabulary with their children using AAC systems. Two caregivers were taught aided language stimulation during preferred activities with their children, measuring caregiver rate of spontaneously modeled opportunities using a dynamic display SGD. Results showed an increase in rate for both participants using a single-subject, changing criterion design. Data interpretations and directions for future research are discussed.
Keywords: augmentative and alternative communication, AAC, modeling, dynamic display, communication partner
Jackson, Regina Effect of CIAT II on Language Deficit for Individuals with Acute Aphasia
Constraint-Induced Aphasia Therapy (CIAT) has been found to be effective for treating persons with chronic aphasia (Pulvermüller et al., 2001). Modifications to the traditional activities of the CIAT protocol have been found to be successful using Constraint-Induced Aphasia Therapy Plus (CIAT II of CIAT-plus) (Johnson et al., 2014). Current literature lacks information on dosage parameters and feasibility of the CIAT protocol with caregiver participation in the acute phase of aphasia. The purpose of this investigation was to examine the effect of the CIAT II protocol on language deficits in individuals with acute aphasia. This investigation replicated portions of the Johnson et al. (2014) protocol for CIAT II provided in decreased intensity and dosage for persons with acute aphasia. Two participants ranging between 65 to 67 years-old and <12 months’ post stroke onset were recruited for this investigation. The participants received 1 ½ hours of CIAT II for 5 days/2 weeks. Participant A met criteria after five sessions showing no significant intervention effect. Participant B completed all 10 sessions with all data points falling outside the upper 2 SD band analysis indicating a significant intervention effect. Both participants were found to exhibit improvements on all pre- and posttest scores for the quality of life questionnaire, Western Aphasia Battery-Revised (WAB-R), and naming of non-target words. Participant A showed the greatest improvement on the WAB-R although no statistically significant treatment effect was identified. The results of this investigation indicate the CIAT II protocol as effective when provided in reduced dosage and intensity for persons with acute aphasia.
Keywords: aphasia, constraint-induced aphasia therapy plus, CIAT II, CIAT, CIAT Plus, acute stroke, language, naming
Jones, Shaverra Arnette Use of the Multiple Oppositions Approach in Young Children with Moderate to Severe Phonological Disorders
With the many treatment approaches available, deciding which treatment approach is most appropriate for a particular client may be difficult and will require speech-language pathologist awareness of the treatment options and ability to determine which options best serves that particular client’s severity of the phonological disorder. The multiple oppositions approach is a contrastive approach that simultaneously contrasts several target sounds to a comparison sound (Williams 1992, 200a, 200b: Bernthal & Bankson, 2004). This model typically targets the phoneme collapse and homonymy through the use of larger treatment sets (Williams, McCleod, & McClauley, 2010). The use of the larger sets of the multiple oppositions approach includes the child’s rule, or phoneme collapse more systematically when compared to other singular contrastive approaches (Williams, McCleod, & McClauley, 2010). Although there is literature that supports its effectiveness in the university clinics, documentation of its effectiveness in aa public elementary school setting is limited. Using a single subject multiple baseline design across participants, the present investigation investigated the effectiveness of the multiple oppositions approach in increasing accuracy in production of works for young children with moderate to severe phonological disorder s in a public elementary school setting. The investigation included two participants with a moderate to severe phonological disorder. Prior to baseline, comprehensive assessment of the student’s phonological abilities and language were obtains. Additional generalizations probes were collected prior to each session throughout the investigation. The Sessions lasted approximately 30 minutes in length and took place two times per week in the speech therapy room in a public elementary school setting. Boredom and frustration, when present was managed by variety, breaks, and positive feedback.
Jordan, Toupazer L. An Examination of the Effectiveness of a Dysphagia Screening Tool Training Program for Registered Dietitians Working with Stroke Patients
Dysphagia refers to difficulty swallowing and can be potentially life-threatening due to malnutrition, dehydration, aspiration pneumonia, and other complications, including death (Cichero, Heaton, & Bassett, 2009; Johnson, Brody, Marcus, &Touger-Decker, 2015). Proper identification of dysphagia ensures the correct and safe provision of foods and medications. When dysphagia is not recognized, it can result in aspiration of oral contents, which occurs in 15-30% of hospital patients (Cichero et al., 2009). The majority of these patients are aged 65 years and older (Cichero et al., 2009). Persons at greater risk for dysphagia in the hospital setting include those with surgery to the head or neck, progressive neurological conditions, head injury, respiratory disorders, radiation or chemotherapy to the head and neck, autoimmune disorders, cardiac surgery, and psychiatric conditions. Also, those who have suffered a stroke are at high risk of dysphagia (Cichero et al., 2009; Heiss, Goldberg, Dzarnoski, 2010). The consequences of dysphagia can be exacerbated in patients diagnosed with stroke (Massey & Jedlicka, 2002). Stroke diagnosed with dysphagia are more likely to develop other medical conditions and complications, or even death (Wirth, Smoliner, Jager, Warnecke, Leischker, & Dziewas, 2013). An effective dysphagia screening process may aid in the detection of dysphagia in stroke patients in the hospital setting. The National Stroke Foundation in Australia mandated that all stroke patients be screened for dysphagia within 24 hours of the stroke and before given oral intake (Cichero et al., 2009). The American Heart Association and the American Stroke Association have also included screening for dysphagia for stroke patients before administering any food, liquid, or medication (Daniels, Anderson, & Peterson, 2013). When dysphagia is detected early in stroke patients, it increases the likelihood of preventing complications such as aspiration and malnutrition and initiates the treatment process (Massey & Jedlicka, 2002). Screening for dysphagia has primarily been the responsibility of speech-language pathologists; however, researchers have called for training programs that include other staff, such as nurses and dietitians, in the screening process (Cichero et al., 2009; Johnson et al., 2015). This effort has been deemed an interprofessional approach so as to expedite patient referrals to the speech-language pathologist. However, these other healthcare professionals are not necessarily trained to screen for dysphagia; therefore, a need has arisen to develop effective training programs and screening tools to facilitate dysphagia screening by these personnel. As part of a health care team, dietitians can participate in the process of screening stroke patients for dysphagia. In order to do this effectively, they must have an effective screening tool and be trained on how to use the tool. In the proposed investigation, a researcher-developed dysphagia screening tool training program will be evaluated for effectiveness with registered dietitians to screen stroke patients.
Le Gray, Jodi Effect of Coaching on Early Childhood Education Staff in Implementing Expressive Language Strategies for Students with Autism Spectrum Disorder
Speech-Language Pathologists (SLPs) strive to provide evidence-based practices to elicit expressive language in young children with autism spectrum disorder. This single subject, multiple baseline across behaviors investigation was implemented to see if early childhood education (ECE) staff could use expressive language strategies with students with ASD following coaching. The intervention of coaching was defined to include teaching at the beginning of each intervention condition, as well as two weekly coaching cycles that included check-in, embedded practice, and planning. One participant was coached in three independent strategies and demonstrated that coaching produced significant changes in the use of each strategy with students with ASD. The percentage of nonoverlapping data (PND) when baseline conditions were compared to intervention conditions were 87.5% for following the child’s lead and 75% for matched turns and expansions. These findings demonstrate the ECE staff can be coached to implement expressive language strategies for students with ASD and may have future implications for SLP service delivery in educational settings.
Keywords: Preschool, Early Intervention Natural Environments
Miley, Lauren Gongre A Comparison on the Expanding Expression Tool and the iPad Application of Naming Therapy on the Vocabulary Skills of Elementary Students with Language Impairment
Vocabulary difficulties are common occurrences in individuals with identified language impairments; thus, it is important to implement evidence-based interventions that can improve these individuals’ vocabulary skills. This investigation compared two interventions, the Expanding Expression Tool™ (EET) and Naming Therapy application on the iPad, to determine which intervention was more effective for improving vocabulary skills. The EET is a mnemonic device that teaches individuals through visual, auditory, tactile, and kinesthetic strategies, which are designed to increase language skills, while the Naming Therapy application is used on an iPad and helps persons learn strategies to communicate thoughts and needs. The materials used in this study included both independent variables, the EET and the Naming Therapy application, iPad, visual timer on an iPhone, paper and pen for the scoring probes, 6×6 black and white picture cards, tape recorder, and Eetchy. Three participants, two males and one female, ranged in ages from 6:11 to 8:8 years old. The participants were seen individually for five 15-minute sessions per week. The dependent variable was the number of descriptors the participant could provide to define a vocabulary word. The investigation utilized an adapted alternating treatment research design and the data was collected in three phases: a) initial probe, b) intervention, and c) superior treatment phase. A trend line, descriptive statistics, and a stability band were used to analyze the data by slope, trend, and variability. The results of this study indicated that the EET is a more effective tool than the Naming Therapy application for improving vocabulary skills in individuals with language impairments.
Ogundare, Adetutu A. An Inter-School Settings Pilot Study Regarding the Effects of Modified Regulated Breathing on Fluency of Students Who Stutter
Successful fluency treatment requires speech-language pathologists (SLPs) to draw from other fields such as behavioral analysis, psychology, and physiology to increase understanding of this multi•faceted disorder. The modified regulated breathing (MRB) treatment, a stuttering intervention based on behavioral approaches, has yet to be thoroughly explored and utilized in the field of speech language pathology (SLP). Additionally, this treatment strategy has been suggested to be important for generalization and maintenance of stuttering treatment outcomes in schools. The purpose of this single subject, multiple baselines design investigation was to identify effective methods to promote fluency of people who stutter (PWS) across academic settings by facilitating increased respiration through MRB. This investigation aimed to explore methods of diversifying traditional fluency therapy by promoting fluency across different types of academic settings as a larger part of therapy treatment, and increase the confidence and educational performance of students with fluency disorders by making the classroom a more positive setting for them to grow. Additionally, this investigation aimed to explore further education of SLPs and teachers regarding fluency therapy delivery in the classroom. Instruction in MRB was provided to two male participants (P#l age 12:5; P#2 age 12:11) with diagnosed fluency disorders. Treatment was provided in three settings, as follows: (1) traditional speech therapy room with the SLP, (2) therapy room with an unfamiliar visitor, and (3) classroom. Results indicated that increasing respiratory coordination utilizing MRB decreased the percentage of stuttered syllables (percent SS) produced when speaking across settings, versus no intervention. These positive results validate the need for further investigation of the MRB treatment to increase the fluency of PWS in school settings.
Robinson, Kelly LaRue Effect of Using Specific Parent Coaching of Milieu Strategies for Late Talkers in Naturalistic Settings on Parent and Child Outcomes
Although it has not been researched with individuals who only have communication disorders, the coaching model described by Shelden and Rush (2008) is utilized to implement speech-language interventions in early intervention settings. This study evaluated using the Shelden and Rush (2008) coaching model to teach a parent to implement three milieu strategies to her late talking toddler in their natural environments. The milieu strategies included models, mand models, and time delays. The participant was given two different target words to implement across each session. The target words served as a measure of the child’s ability to learn structured word targets. Total words and total different words used by the child were also measured throughout the study. Parent attitudes about the perceptions of child communication needs and the use of coaching were also investigated during this study. This study was a single-subject, A-B design replicated across one parent/child dyad for 4 weeks. The use of the A-B design allowed an examination of the participant’s behaviors in clearly defined coaching conditions. Results indicated that the Shelden and Rush (2008) coaching model can be used to teach parent use of milieu strategies. Although the child did not use target words, there was an increase in the child’s total words and total different words from baseline. At the beginning of the study the child had one spoken word and by the end of the study, she had a total of six spoken words and two gestures. The parent became more aware of her child’s communication difficulties by the end of the study. Parent and child outcomes from this study will add to the growing body of research that supports the use of parent coaching to implement milieu strategies in naturalistic environments for late talking toddlers.
Keywords: Parent Coaching, late talkers, vocabulary, parent perceptions
San Miguel, Patricia Ana The Effects of Storybook Sharing on Speech Sound Production
A single-case A-B-A-B research design investigation explored the effects of storybook sharing on the production of the T/ (“sh”) phoneme in words among three preschool children with a current articulation or phonological process disorder diagnosis. Participants included two males and one female who had similar backgounds. Four specific storybooks were chosen for the high-frequency content of the T/ phoneme and were used sequentially during the intervention phases. Visual analysis data is provided through level, frend, slope, and the two-standard deviation band method. Results demonstrated that all participants improved from pre-test to 2nd post-test, seven weeks from the conclusion of the investigation. All showed on an average accelerated trend across data points during all intervention phases. Clinical implications include the use of a naturalistic and interactive activity such as storybook sharing in an academic, clinical (therapeutic), and home setting with the appropriate training on how to utilize the appropriate storybooks with high concentration of the phoneme to carefully plan the use of reinforcements throughout the task, to use appropriate prosody and inflection during the storytelling, and to choose a topic of story that is relevant to the child for an effective intervention.
Keywords: storybook sharing, reading, arüculation remediation, naturalistic approach
Stanley, Dawn Marie Effectiveness of a Computer Application on Declarative Memory in Persons with Dementia
Despite memory being the hallmark of dementia, there have been attempts to rehabilitate the deficit. The aim of this investigation was to examine the declarative memory system by determining the effectiveness of an iPad application, Constant Therapy. The primary goal of the face-matching task within the application was to train individuals with dementia to recognize facial features on unfamiliar faces. The face-matching task contained five levels of difficulty, in which the participants were expected to master each level with 70% accuracy. This investigation was conducted with two participants. Participant A was an 85-year old African American female with moderate dementia with session conducted at an adult daycare center and participant B was a 65-year-old African American fèmale with mild dementia with sessions conducted at her home. Participant A completed the face-matching task in two weeks, which consisted of nine sessions. Participant B completed the face-matching task in two weeks, which consisted of I I sessions. This research was conducted with the A — B design. The Saint Louis University Mental Status (SLUMS) Exam was administered prior to the investigation to determine the presence/absence of dementia. The Functional Assessment Staging Tool (FAST) was completed by caregivers to stage the dementia. Overall findings suggested that both participants demonstrated a decline in performance as the task difficulty increased.
Storey, Pamela A. Effects of Telepractice Versus Face-to-Face Phonemic Awareness Intervention with Head Start Preschoolers
Speech-language pathologists (SLP) have been slow to adopt Telepractice as a service delivery model, although it has been approved by the American Speech Language and Hearing Association (ASHA, 2013) and an evidence base is evident in the extant literature. Limited investigations exist studying phonemic awareness interventions provided via telepractice. Burgeoning evidence supports the notion that when phonemic awareness, known as the sensitivity to detect the smallest sound structure in language, is targeted in explicit, small group instruction during the preschool years, the likelihood of becoming a good reader increases (Dodd & Gillon, 2001; Koutsoftas, Harmon & Gray, 2009). However, underserved, at-risk for early literacy low SES Head Start preschoolers rarely receive these efficacious SLP interventions due to nation-wide SLP shortages. A four-participant Adapted Alternating Treatment Design investigation was completed with 4-year old Head Start preschoolers using a phonemic awareness intervention targeting CVC word initial phonemes (liquids, nasals, stops) to compare the efficacy and efficiency of Telepractice and Face-to-face models. Twice daily, 20-minute, alternating morning and afternoon sessions were conducted, with percent correct measures of matching pictures with the same initial phonemes in a CVC word within 5 seconds of a verbal antecedent. Results indicate the Telepractice magnitude of improvement matched or exceeded the Face-to-face service delivery model in this study. Thus, Telepractice is as equally efficacious and efficient as Face-to-face, when providing phonemic awareness interventions to the 4-year old Head Start preschoolers. Further research is warranted with larger groups of participants, participants with speech-language impairments and/or other disabilities, to generalize the findings to the greater preschool population.
Keywords: speech-language pathology, telepractice, early literacy, at-risk, phonemic awareness
Townsend, Dorothy A. Effect of a Therapy Dog on Communication and Quality of Life in Adults with Mild to Moderate Dementia
Nearly 5.4 million Americans are affected by dementia (Alzheimer’s Association, 2016). Memory loss, depression, and decreased quality of life often arise from changes in the person with dementia’s (PWD) ability to communicate (Acton et al., 2007). This leads to difficulties for caregivers to communicate with persons with dementia. The purpose of this investigation was to examine the use of dog-assisted therapy as a means for increasing communication by facilitating reminiscence in PWD in order to increase quality of life. Speech language pathologists may be able to implement a therapy dog program to maximize communication efficiency and maintain the PWD’s ability to direct their health care. The effect of dog assisted therapy for PWD has been examined in inpatient and long-term settings in the United States and internationally. Literature supports the link between dog assisted therapy and social communication across geographic areas (Boyer & Mundschenk, 2014; Greer et al., 2001). This study used a single subject (small n) ABAB research design to investigate if a functional relationship exited between reminiscence intervention without a therapy dog (Phase A1 and A2) and reminiscence intervention with a therapy dog (B1 and B2) for communication and quality of life for adults with mild to moderate dementia. Results of this investigation revealed increased overall self-perceived quality of life pre- and post-intervention, indicating that the use of a therapy dog and reminiscence therapy had a positive effect on cognitive disorders. Findings contribute to the existing research base that suggests the use of a therapy dog with reminiscence therapy improves communication and quality of life for PWD.
Key Words: speech therapy, animal assisted therapy, geriatrics, cognition
Treichler, Jaqueline Effect of Music on Reading Comprehension in Patients with Aphasia
This investigation extended findings from Sarkamo et al. (2008, 2010, 2014) and examined the evidence on emotion, music, and language to determine the most effective and efficient method for application to the rehabilitation of participants with aphasia secondary to left middle cerebral artery stroke. A single subject adapted alternating treatment design was used to compare two music conditions, using music with sung lyrics simultaneously with silent reading of the lyrics, and priming with music and sung lyrics followed by reading of the lyrics, with a control condition using reading lyrics without music. Findings, presented for a single participant, demonstrated that the simultaneous and priming conditions were equally effective and efficient. The two music conditions resulted in retention of the trained phrases four weeks later, but the control condition did not. Using the celebration trend split middle line method, findings were significant and resulted in improvement on six out of ten reading subtest outcome measures. The impact of this study was a behavioral demonstration of effectiveness and efficiency of therapy using music directed toward recovery of reading comprehension for this participant with aphasia. Retention of trained reading material was improved using this approach. Outcome measurements showed improvement generalized to untrained reading material. New materials were developed to increase options for treatment.
Keywords: aphasia, emotion, language, music, neuroplasticity, reading, stroke
Benge, Hannah Ruth Effect of Treatment Environment on the Adult Who Stutters
Research indicates that stuttering inherently affects an individual’s communication in social situations, yet no studies appear to have been done on the effect of environment on stuttering therapy. This study sought to investigate the effect of treatment environment on speech fluency and approach to communication behaviors of the adult who stutters. The three participants were adults with persistent developmental stuttering and an interest in improving their communication. An alternating treatment design was used to measure the effect of a traditional clinic environment as compared to community environments. Results indicated that the treatment was effective in reducing situational anxiety associated with stuttering in participants 1 and 2, but not for participant 3. The treatment package also produced positive benefits on multiple outcomes associated with approach to communication. Findings were mixed regarding which treatment setting was the most effective for adults who stutter.
Keywords: persistent developmental stuttering, anxiety, agency, psychosocial
Bridges, LaShawn Thomas Effect of Explicit Storybook Instruction on Narrative Retell in African American Preschool Children
The overall purpose of this investigation was to determine the effect of a narrative retell intervention on African American preschool age children who need support in the area of story grammar elements. Two participants were taught explicit narrative retell instruction using the narrative intervention, Story Champs. Scoring was based upon the most meaningful story grammar parts: problem, attempt, consequence, and ending: however, character, setting, and, feeling were scored as well. Participants’ total score of story grammar elements was documented weekly via a tablet for digital scoring. This single subject multiple baseline design across participants investigation took place in a childcare care center in a metropolitan area in South Carolina. The sessions were held three times per week for a total of eight weeks with follow-up occurring after two weeks without intervention: sessions lasted approximately IS to 20 minutes in length. Results yielded a positive effect of the narrative retell instruction using story grammar elements for both participants. In Phase B, one participant displayed an average change across sessions of +1.1 points/elements, and the other participant displayed an average change across sessions of + 1.3 points/elements. Although both participants displayed a slight decline in the story grammar retell scores between Phase B and Phase C. the outcome of this investigation still indicates an effective intervention. These findings demonstrate that Story Champs appears to be an effective intervention tool to measure growth of African American preschoolers’ narrative skills.
Chaclas, Jeanne Elizabeth Effect of Anomia Treatment Delivered Via Telepractice to Persons with Aphasia (PWA)
Research targeting therapy over-a-distance through the use of technology, or telepractice, encompasses a wide range of communication disorders in adults and children; however, studies that examine online service delivery to individuals diagnosed with aphasia—a neurological disorder caused by damage to the portions of the brain that are responsible for language production or processing—are limited (NINDS, 2017). Unfortunately, once persons with aphasia (PWA) are homebound, the intensive rehabilitation required to restore language skills may not be realistic. As such, Internet technology has the promise of extending frequent treatment to stroke patients in their homes. The purpose of this investigation was to further the evidence base by investigating two evidence-based prompting techniques used in aphasia treatment—semantic versus phonological cueing—via telepractice to one participant. Accordingly, this investigation utilized a single-subject comparison design to measure picture naming accuracy. While the participant demonstrated a minimal increase in performance following baseline for both semantic cueing treatment (SCT) and phonological cueing treatment (PCT) approaches, there was a slightly higher level of accuracy following the PCT approach. In addition, improved response time was observed following intervention for both SCT and PCT.
Keywords: telehealth, telerehabilitation, videoconferencing, stroke
Davis, Denise Faith The Effects of Phonemic Awareness and Word Recognition Training on Oral Reading Fluency in Secondary School Students with Reading and Language Impairments
In recent years, the role and responsibilities of speech-language pathologists with regards to reading have expanded. There has been an impetus for speech-language pathologists to collaborate, advocate, assess, design programs, and provide reading intervention to students with language impairments (ASHA, 2010). This drive is due to the knowledge and skills that speech-language pathologists possess in the area of language development and its effect on reading. However, much of the research has focused on reading in preschool to elementary grades, with limited research of explicit training of basic reading skills in secondary students with language and reading impairments (Scarborough et al., 1989; Swanson, 2008). The purpose of this study was to determine if explicit training in sight word recognition and phonemic awareness affect oral reading fluency (ORF) skills in high school students with language impairments. The primary dependent variable was the measurement of ORF, determined by words read per minute and reading accuracy. The secondary dependent variables were the measurement of phonemic awareness in the areas of vowel blending, sound segmentation, and sound blending skills. The investigation was conducted over a four-week period, for 45 minutes each session, with an A-B single case research design. Participants were explicitly trained in two areas during each session and a skill was discontinued when the participant scored greater than 80% accuracy on probing over two consecutive sessions. The investigation was conducted in a high school setting, with four participants, all diagnosed with a specific learning disability, due to deficits in basic reading and math skills, as their primary disability. Participant A was a 16-year-old African American female with moderate speech-language disability secondary to her specific learning disability. Participant B was a 17-year-old Pacific Islander female, also diagnosed with a moderate speech-language impairment secondary to the specific learning disability. Participant C was a 15-year-old African American male who had a history of speech-language impairment and participant D was a 19-year-old White Hispanic male, who also had a history of speech-language impairment. Although both participant C and D were not currently receiving speech therapy services, both had a history of a moderate speech-language impairment in the area of language comprehension skills. Overall findings revealed increase in percent accuracy during oral reading fluency tasks, suggesting that explicit training in basic reading skills, both in sight words and phonemic awareness skills, may increase oral reading fluency skills in high school students with reading and language impairments.
Keywords: phonemic awareness, sound segmentation, phonemic blending, reading, adolescent language, reading impairments, language impairments, oral reading fluency, vowel blending
Edwards, Dianca The Effect of the Semantic Feature Analysis on Action Word Retrieval in Individuals with Chronic Aphasia
The purpose of this investigation was to examine the effectiveness of Semantic Feature Analysis (SFA) on action-word retrieval with individuals with chronic aphasia. The participants included three women with a history of chronic aphasia as the result of traumatic brain injury, cancer, and mild cognitive impairment. The participants were age 40-80, living at home with moderate to severe chronic aphasia verified by a score of 26-75 on the Western Aphasia Battery-Revised (WAB-R; Kertesz, 2007). The treatment took place in the homes of the three participants three times each week. Treatment consisted of convergent naming of 15 trained, functional action-word photographs without cues, followed by naming of the same untrained action-word photographs using the SFA cueing chart. Semantic feature analysis was applied in the context of a changing criterion research design with a single session baseline with four intervention phases followed by post-testing with the WAB-R (Kertesz, 2007) and all 30 baseline stimulus photographs (trained and untrained) to assess generalization skills following intervention, Results included an increase in naming of the trained words for two of the three participants. The results are consistent with previous research, that included positive results with the use of SFA with individuals with aphasia. Additional studies examining the effect of SFA using action words for individuals with chronic aphasia are warranted.
Keywords: aphasia, semantic feature analysis, action word retrieval
Ferguson, Ellen The Effect of Individual Short Duration, High Intensity Speech Therapy Sessions on Speech Production in Children Ages 5 to 12 Years Old with Mild to Moderate Speech Sound Disorders
Currently, there is no gold standard for the treatment of speech sound disorders (SSDs) in the school setting (Kamhi, 2006). Further research is needed on what treatments will remediate SSDs efficiently and effectively given educational settings’ limitations. Paramount among those limitations is the protection of time spent in academic instruction (Baker, 2012). Large caseloads and the use of low intensity, distributive practice service delivery can result in a student requiring many more hours in speech therapy services above the 17 hours that is reported by the American Speech-Language-Hearing Association’s National Outcomes Measurement System (NOMS) as being necessary to remediate a single sound error. Research in the areas of intensity, therapy approach, and scheduling are limited and lack agreement on the most efficient and effective approach to remediating SSDs in the public education setting. The purpose of this investigation was to evaluate the effect of using individual, short duration, speech therapy sessions for the remediation of the speech of children ages 5-12 with speech sound disorders. The participants’ Individual Education Plan (IEP) goals and service delivery frequency and duration were used to determine the phoneme to target during therapy and were adapted to increase the frequency and shorten the duration of the individual therapy sessions and maintain the service delivery duration dictated by the participants’ IEPs. The outcome revealed improvement in the production of the targeted phoneme at the word level. The results supported the use of short duration, intensive speech therapy sessions in two out of three participants to efficiently address the treatment of speech sound disorders in the educational setting. Maintaining the intensity of both number of repetitions and the number of treatment sessions per week were important components in remediation of a speech sound error at the word level.
Keywords: intensity, augmented feedback, principles of motor learning
Forman, Debra The Effect of Verbal and Written Directives on Listening and Reading Comprehension in High School Students with Down Syndrome
Students with Down syndrome demonstrate challenges executing directives secondary to their difficulties with communication. The deficits in reading and listening comprehension and memory have the most impact on the students’ ability to function daily. A potential solution would be to determine the best method of issuing directives so students can anticipate, comprehend, and complete any directives in a timely manner. Four participants were screened using the Eckwall/Shanker Reading Inventory and completed a ten-directive test with random directives selected from the pool used in the investigation. Following pre-determined criteria, two of four participants passed the screening. Both attend a high school in the Southeast and had a primary diagnosis of Down syndrome. Pseudonyms were issued to each participant to maintain privacy. “Katie” age 17 years and “Tyler” age 15 years. An alternating treatment design was utilized for this investigation. The participants were seen individually for 35 minutes twice weekly over 4 weeks. Over the eight sessions, the participants completed a 5-minute screening followed by alternating treatment of traditional reading and listening comprehension. One session utilized pencil and paper tasks and the other session that week utilized manipulatives. Data was accumulated for both the 5-minute testing sessions, and for the tasks associated with the intervention. Data from the first week indicated both participants scored higher than anticipated based on their prescreening performance. This may be attributed to the newness of the activity and/or participant enthusiasm for a change in routine tasks. While performance varied during subsequent sessions, the data illustrated a positive progression in four out of the six dependent variables during intervention. For the 5-minute screening, Katie demonstrated improvement in both oral and written directives while the trend for combination directives was unchanged. Adam demonstrated improvement in the combination directives, no change in oral, and decreased in written directives. Overall, the intervention provided a positive influence on participant success in following directives. The hypothesis of the investigation failed to show improvement on the combination of oral and written directives. One explanation could be the small sample size of two participants. Even though the testing and intervention sessions were conducted in a small room free of distractions, the busy high school environment containing constant personal interactions among students potentially impacted mood and behavior of the participants. There is limited information in the body of literature regarding this topic. This investigation indicates that with oral and written modalities, improvement can be made with reading and listening comprehension intervention. Further study in this area, with a larger participant base would be beneficial to increasing the amount of information available to those who work with this population.
Keywords: Down syndrome, directives, manipulatives, reading comprehension, listening comprehension
Fullman, Leah I. Comparison of Shaker Exercise and Chin Tuck Against Resistance Exercise in Healthy Pediatric Populations
The purpose of this study was to compare the intensity of suprahyoid muscle contractions for five healthy pediatric participants during two dysphagia exercises: the chin tuck against resistance (CTAR) and the Shaker. There is empirical support for the use of both exercises to strengthen suprahyoid muscles in adult populations; however, there is a marked lack of evidence for use in pediatric populations. In an alternating treatment design, the healthy pediatric participants performed both exercises and the intensity of suprahyoid muscle contraction was measured as peak microvolts using surface electromyography (sEMG). All participants exhibited higher mean and median values of suprahyoid muscle activation during the CTAR exercise when compared to the Shaker exercise. The percentage of non-overlapping data was 75%, demonstrating a meaningful treatment effect. Though these results were for a small number of healthy children, they may be advantageous in future research for children with dysphagia, in that the results may guide researchers in the selection of treatment exercises.
Keywords: pediatric, dysphagia, chin tuck against resistance, Shaker, surface electromyography
Hawley, Janet L. Effects of Using a Voice Treatment Program Including Home Practice Using Mobile Technology on Voice Feminization
Purpose: Motivated by practice and feedback principles of motor learning, an SLP and Mobile app (SAM) protocol for voice feminization was developed to minimize SLP’s role to one of supervision and professional guidance and maximize learning during independent practice outside the session. The purpose of the study was to evaluate the effectiveness and acceptability of the innovative service delivery method. Method: The study used a single-subject changing criterion design. Four trans women completed a 10-week SAM voice intervention program delivered via 30-minute weekly in-clinic sessions and a technology-supported home program. The program was client-centered and incorporated frequent practice with intermittent, knowledge-of-result feedback. Outcome measures included acoustic measures, self and listener ratings of voice femininity and naturalness, and a program evaluation questionnaire. Results: Average F0 of phrases and picture descriptions gradually increased into the feminine range for all participants. Self and listener ratings showed that the trans women were perceived to sound more feminine, yet still natural, following treatment. Participants found the in-clinic sessions useful, the app easy to use, and noted little fatigue or discomfort. Conclusions: The innovative and efficient SAM program for voice feminization was effective relative to the stated aims in terms of acoustic, perceptual and program evaluation measures. There is a need for further studies to elucidate the factors that were key to the success achieved in the current study.
Keywords: male to female transsexual, acoustic voice analysis, perceptual voice analysis, principles of motor learning
Jacobski, Barbara M. Efficacy of Executive Function Training for Young People (Age 18-26) in Recovery from Opioid Use Disorder
A review of the literature supports the theory that individuals with opioid use disorder (OUD) frequently exhibit impaired skills in executive function (EF) which negatively impact treatment retention and efficacy. EF is a higher-level cognitive process that requires interconnected communication throughout the entire brain to function properly. Current research suggests metacognitive strategy instruction and skill generalization may be effective approaches to cognitive rehabilitation in the OUD population. The purpose of this study was to investigate the effect of a multifaceted EF training program for young people in recovery from OUD. Additionally, it is the investigator’s hypothesis that improved EF skills will decrease levels of depression, anxiety, and stress, which have been associated with limited EF skills (Werchan & Amso, 2017). Four young adults (ages18-26) in recovery from OUD were recruited from sober living homes. An A-B single case research design was used to determine if a metacognitive approach to EF skill development with an emphasis on generalization of skills would positively impact performance on measures of executive function and thereby decrease levels of depression, anxiety and stress. The participants completed 30-minute sessions of alternating EF remediation and skill generalization activities using RehaCom®, a computer-based cognitive rehabilitation program, that took place over 12 consecutive days. Visual analysis of the data revealed overall improved performance in EF skills as well as decreased levels of depression, stress, and anxiety. Participants indicated the program was helpful and useful in their recovery.
Keywords: cognitive rehabilitation, substance use disorder, depression, stress, anxiety, impairment, therapy, remediation, prefrontal cortex
Johnson, Sherry Melissa The Effect of the Social Thinking Methodology for Improving the Ability to Sustain Social Interactions in Adolescents with Social Communication Challenges
Adolescents with social communication challenges pose a challenge for clinicians and educators to find evidence-based interventions to support the social needs of their students (Lee et al., 2008; White, Keonig & Scahill, 2007). The existing research on elements of the Social Thinking® methodology has shown promising results. The purpose of this study was to investigate the effectiveness of the Social Thinking® Methodology for improving the ability to sustain social interactions in adolescents with social communication challenges. Two adolescents participated in this multiple baseline design across behaviors. The three dependent variables (DV) measured include the following: asking follow-up questions, adding-a-thought, and supporting comments. Results from the visual and statistical analyses showed an increase in each participant’s ability to sustain social interaction from pre-to-post intervention. Both participants self-reported varying perspectives of their ability to sustain social interactions.
Keywords: autism spectrum disorder (ASD), conversation, social cognition, social skills, Social Thinking
Kearney, Ann The Effects of Tongue Strengthening Exercices in Mild to Moderate Obstructive Sleep Apnea
The aim of this study was to investigate the effects of tongue strengthening exercises on participants with mild to moderate obstructive sleep apnea (OSA). Although there is evidence that myofunctional therapy can have an effect on OSA, isolated tongue strengthening exercises have not been studied. Two participants were asked to complete six weeks of tongue strengthening exercises and participate in a questionnaire and a home sleep study pre and post exercises. Results from the visual analysis concluded that the intervention had a positive therapeutic impact on home sleep study scores and surveys. These findings are limited given the number of participants.
Keywords: Obstructive sleep apnea, myofunctional therapy, tongue strengthening exercises, Iowa Oral Performance Instrument
Ledbetter, Sarah The Effect of Treatment of the Empty Set on Consonant Production in Children
The diagnosis of a speech sound disorder (SSD) in childhood may affect a child’s academic, social, and emotional development. Speech-language pathologists (SLPs) who work with children diagnosed with SSD must select treatment methods that are effective (Gierut, 1998). A phonological approach to treatment of SSDs addresses a child’s underlying phonological system (Bauman-Waengler, 2008; Fey, 1985). This investigation examined Treatment of the Empty Set and its effect on consonant production in children with moderate to severe SSDs. Previous research has demonstrated that treatment of the empty set is an effective contrast treatment for children with SSDs (Gierut, 1992). In this approach, the child is presented with sounds differing in voice, place, and manner, or in place and manner (Gierut, 1989). The sounds contrasted are never produced correctly in the child’s phonetic or phonemic inventory (Gierut, 1989). A multiple baseline across participants design was selected for this investigation and included three participants ranging from 4-years, 9-months to 6-years, 2-months. Following a stable baseline, Participant One entered into treatment of the empty set. Participants Two and Three began intervention at staggered intervals. The intervention took place two times per week over four weeks. Each participant received eight total 30-45 minute sessions of treatment of the empty set. Visual analysis of the data was conducted to determine the effect of the intervention on the production of two target consonants. Visual analysis of the data revealed no change in untreated words containing the target sound for two participants. One participant demonstrated a significant change in the production of one target sound between the baseline and intervention phase.
Keywords: Contrast Treatment, Maximal Opposition, Treatment of Empty Set
Ledée Lozada, Leslie Effects of Lee Silverman Voice Treatment (LSVT LOUD®) with Spanish speaking population: An A-B-A single subject research design
The majority of people with Parkinson’s disease (PD) experience speech and voice disorders at some point during the course of the disease; these deficits may impair their quality of life. Medical and surgical treatments alone have not sufficiently alleviated speech disorders for people with PD, and in some cases have exacerbated or resulted in voice and speech impairment. A speech treatment approach called Lee Silverman Voice Treatment (LSVT LOUD®) has generated efficacy data for successfully treating voice and speech disorder in this population. The LSVT LOUD targets vocal loudness as a means of increasing vocal effort and improving coordination across the subsystems of speech. LSVT LOUD is delivered in a high dose that consists of four consecutive, individual 1-hour treatment sessions per week for 4 weeks (i.e., 16 sessions in 1 month); daily homework practice is assigned. Research has documented that treatment results can last out to two years, making LSVT LOUD the “gold standard” in treating speech disorders for people with Parkinson’s disease. Despite the established efficacy of LSVT LOUD, treatment of speech and voice remains an unmet need for many individuals in Puerto Rico due to lack access of trained and certified clinicians and inability to travel outside the island to receive the services. The objective of this study is to assess the clinical effectiveness of LSVT LOUD in the Spanish speaking population of Puerto Rico for treating voice disorders associated with Parkinson’s disease. A pre-test-post-test design is applied to assess the effectiveness of LSVT LOUD for the improvement of vocal loudness in the Spanish speaking population diagnosed with Parkinson’s disease. This research will provide important information for clinicians about LSVT LOUD treatment efficacy in the Spanish speaking population diagnosed with Parkinson’s disease. The findings from this study will have an important implication for enhancing treatment accessibility for individuals with Parkinson’s disease who seek voice and speech treatment.
Keywords: Lee Silverman Voice Treatment, LSVT LOUD®, Parkinson’s disease, hypokinetic dysarthria, neural plasticity, speech and voice disorder, speech and voice treatment, evidence-based practice
Lightcap, Renee E. Perceived Vocal Improvement Following Semi-Occluded Vocal Fold Exercises in Persons with Muscle Tension Dysphonia
The purpose of this pilot study was to determine the most efficient method to treat muscle tension dysphonia: semi-occluded vocal fold (SOVT) exercises as compared vocal hygiene education (VH) in an alternating treatment design. Previous research has documented a reduction in laryngeal tension with improved mean phonation time, airflow production, and improved Voice Handicap Index (VHI) scores using SOVT exercises. Additional studies have demonstrated improved vocal quality using VH. The results of this pilot study are based on a single female participant, recruited from Madigan Army Medical Center, with muscle tension dysphonia treated with SOVT exercises to the effects of VH alone using pre- and post-measures of perceived vocal effort through utilization of a visual self-rating analog scale. The data for this study are limited but could suggest the implementation of both direct and indirect treatment may improve vocal function. Keywords: Muscle tension dysphonia, semi-occluded vocal track exercises, vocal hygiene, visual analog scale.
Mathews, Shawna G. A Comparison of Treatment Frequency in Elementary Age School Children Diagnosed With Moderate to Severe Speech Sound Disorders
Current literature indicates there is no gold standard for speech sound disorder (SSD) intervention to include frequency of intervention nor duration of the sessions within the public-school setting (Kamhi, 2006). Additional research is warranted in the area of frequency and intensity of delivery of services that could prove a more efficient model of delivery that is also more beneficial for the students involved. This investigation compared speech sound intervention provided weekly in less intensity, high frequency sessions with greater intensity, lower frequency sessions within the public-school setting. Participants recruited for the investigation met inclusion criteria of ages between the age 5-years 0-months and 8-years 1-months who had an eligibility and individualized education plan (IEP) for services for 60 minutes of speech-language services weekly. Additional inclusion criteria indicated a moderate-to-severe speech sound disorder without comorbid disorders, a positive hearing acuity screening and a primary language of English. An A-B-C-B-C design was used to compare session data from intervention provided five times per week for 12 minutes each session with sessions provided two times per week for 30 minutes each session. Data were collected the initiation of each session as participants named 20 randomly selected consonant-vowel-consonant (CVC) pictures specific to phoneme errors indicated in the most current special education IEP. During intervention, participants imitated productions by the interventionist in isolation, in CVC words and in patterned sentences. Four participants completed the investigation. Data analysis was conducted to determine the effect of the frequency and intensity of intervention provided upon the outcomes of the participant productions. Three of four participants showed positive trend in productions across the investigation. Of these four, two participants demonstrated significant increase in correct production and a greater rate of change of the targeted phonemes within the B-phrases of the investigation of five sessions of 12 minutes per week than the C-phases of two sessions of 30 minutes per week. The third participant indicated positive trend in outcomes across all phases with inconsistent patterns between the B-phases and C-phases. The fourth participant demonstrated a zero-celerating trend within the four phases of the investigation.
Keywords: Speech sound disorder, public school, intervention, frequency, intensity
Medved, Michaela A. The Effect of Neuromuscular Electrical Stimulation (NMES) on Dysphagia Severity and the Role of Surface Electromyography (sEMG) in the Assessment and Treatment of Idiopathic Parkinson’s Disease (IPD)
In the literature, there are various investigations assessing the effectiveness of the use of neuromuscular electrical stimulation (NMES) in diverse patient populations diagnosed with dysphagia. To date there is not an extensive amount of literature on the use of NMES in individuals diagnosed with Parkinson’s disease (PD). From the literature that is available few researchers utilized surface electromyography (sEMG) as an outcome measure. The purpose of this case study is to evaluate the efficacy of neuromuscular electrical stimulation (NMES) paired with active swallowing and traditional therapy, to assess if the intervention will result in greater muscle firing as measured by surface electromyography (sEMG) when compared to traditional swallowing therapy in isolation. The primary principle underlying the use of NMES dictates that electrical stimulation can enhance muscle functioning during active swallowing (Toyama et al., 2014), therefore this modality was paired with effortful swallowing and resistance-based exercises. The treatment, in the A-B-A single-subject design, was intensive both from an exercise physiology and session frequency standpoint (three times per week for eight weeks). The outcome revealed improvement in sEMG firing during the intervention phase which remained during withdrawal. Additionally, quality of life measurements, via the SWAL-QOL, improved. Treatment effects were generalized across both participants. The results support the use of NMES in conjunction with active swallowing to improve dysphagia and quality of life in individuals with Parkinson’s disease.
Keywords: dysphagia, neuromuscular electrical stimulation (NMES), Parkinson’s disease, surface electromyography (sEMG), SWAL-QOL, swallowing
McDermott-Winter, Therese The Effectiveness of Combining Neuro-Developmental Treatment and a Speech Systems Intervention Approach in the Treatment of Dysarthria in Children with Cerebral Palsy
Current research exploring treatment of dysarthria in children with diagnoses of cerebral palsy (CP) suggests the importance of prioritizing the respiratory system, rather than isolating treatment to the oral motor or articulatory system alone. The purpose of this investigation was to attempt replication of previous intervention targeting specific respiratory tasks (Speech Subsystems Treatment – SST) in intervention, followed by examination of the effectiveness in use of a more direct respiratory treatment in the use of a specifically developed Neuro-Developmental Treatment (NDT) protocol combined with the respiratory tasks of the SST protocol. Two five-year old participants with diagnoses of spastic/dystonic CP and associated dysarthria completed an intensive course of speech therapy in an investigation structured using single case research design (A1-B-A2-BC). Seven sessions of SST were presented, followed by a two-week no treatment period, and then combined SST/NDT for six therapy sessions. Data were collected regarding performance on respiratory/speech tasks, as well as intermittent measures of single word and connected speech intelligibility. A rating of postural control was also included in this investigation. Each participant responded positively to both the SST and NDT/SST combined treatment, with improved performance on the respiratory/speech tasks of coordination of respiration with phonation, duration of phonation, slowed rate of speech and appropriate pausing for breath. While variable changes in speech intelligibility were identified at the single word level, intelligibility of connected speech improved 15.5-20% over the course of the investigation. Following the combined NDT/SST phase, increased postural control in a seated position was also documented. Short intensive cycles of SST and NDT/SST combined were effective in improving respiratory control and coordination in children with CP/dysarthria, with functional improvement in speech intelligibility achieved.
Moore, Dawn M. The Effect of Anticipatory Coarticulation in Conjunction with Augmented Feedback on Production of Final /r/ Words in People with Speech Sound Disorders
In the literature, /r/ is well documented as the most difficult sound to treat (Byun & Hitchcock, 2012), yet the research devoted to the remediation of this sound is limited. Surveys of school-based clinicians reveal /r/ treatment to be eclectic (Lancaster, Keusch, Levin, Pring, & Martin, 2010), even though Ehern (2010) reports less efficacy using an eclectic approach versus a programed approach. The most recent research for /r/ focuses on the use of ultrasound and biofeedback, but the cost of these technologies prohibits their mainstream use for nearly all clinicians, especially in the schools. The purpose of this study was to evaluate the efficacy of using anticipatory coarticulation with augmented feedback to increase accuracy of final /r/ words in people with speech sound disorders (SSDs). Anticipatory coarticulation in this study involved the addition of the word red after every final /r/ word and then specific augmented feedback was given for the participant to correct their production. A single-subject ABAB withdrawal design was implemented to assess the accuracy of productions of final /r/ words with red in four participants, ranging in age from 8;0 to 13;6 with a diagnosis of SSD. The accuracy of anticipatory coarticulation paired with augmented feedback was assessed in real time by the clinician and two interobservers (IOs) who listened to the audio recordings of the participants’ productions. According to the results, the participants improved their final /r/ productions during intervention phases as a function of anticipatory coarticulation and augmented feedback while returning to baseline level during the withdrawal phase. The data offer preliminary support for the use of anticipatory coarticulation in therapy for final /r/ words. The need for continued research is discussed as are the benefits and limitations encountered using telepractice.
Keywords: articulation disorder, speech sound disorder, persistent speech sound disorder, rhotics, anticipatory coarticulation, telepractice
Ramsey, Wanda The Effects of Dialogic Reading on the Expressive Vocabulary of Children with Moderate to Severely Impaired Expressive Language Skills
The purpose of this study was to investigate the effects of dialogic reading on the expressive vocabulary skills of children with moderate to severe expressive language delays. Previous research has shown positive effects of dialogic reading on the language skills of children who are typically developing and on children who are at-risk for language delays. However, there is limited research indicating the effectiveness of dialogic reading on children with moderate to severely delayed language skills. The participants in this multiple baseline across participants designed study received four weeks of individual dialogic reading intervention which was intended to increase their expressive vocabulary skills of a near-transfer vocabulary word list. The results revealed that all three participants demonstrated a significant increase in expressive vocabulary of the near-transfer vocabulary list. Additionally, dialogic reading increased the mean length of utterance (MLU) of the participants, though to varying degrees. More improvement was noted in the MLU of the participant who was in the earlier stage of language development than the participants in the later stage of language development.
Keywords: dialogic reading, intervention, word knowledge, expressive language
Sagett, Lindy L. Comparing the Effects of Phonemic Perceptual Training with Sensory Motor Therapy With and Without Tucker Signs in Children with Phonological Delays
The purpose of this investigation was to compare the effects of traditional speech therapy with Tucker signs to traditional speech therapy alone on the accuracy of speech production of a five-year old child with a mild to moderate phonological delay. In the literature, phonological delays and disorders are intermingled, making it difficult to determine the most effective intervention. Visual and tactile cueing have been shown to be effective in treating moderate to severe phonological impairments. An alternating treatments design was used to determine if adding multimodality cueing to phonemic perceptual training and sensory motor therapy results in greater improvements in accuracy of speech production than traditional therapy alone. Results indicated the use of Tucker signs was more effective than traditional therapy alone in remediating a mild to moderate phonological delay, without motor deficits. Accuracy of /l/ increased by an average of three words per session following traditional therapy including Tucker signs, as opposed to an average increase of two words per session following traditional therapy without Tucker signs. Percent consonants correct (PCC) increased from 72% preinterventions to 79% post interventions. Results were encouraging but limited to one participant. Results suggest that the use of Tucker signs during speech therapy may improve accuracy of speech production and intelligibility and decrease duration of time enrolled in speech therapy. Remediating phonological delays may also minimize academic and social impact.
Keywords: phonological delay, speech therapy, visual kinesthetic cues, Tucker signs
Tappen, D. Effect of Social Behavior Mapping on Increasing the Perspective Taking and Metacognition of Adolescents with Social Cognitive Learning Challenges
Previous research on the components of the Social Thinking (ST) methodology has shown positive, but preliminary results. One treatment framework within the ST methodology found in both schools and clinics is called Social Behavior Mapping (SBM). While SBM was studied as part of an intervention package, no research to date has measured the effectiveness of SBM as a standalone intervention. The purpose of this investigation was to explore the effectiveness of using SBM as a teaching framework for increasing perspective taking and metacognitive abilities in adolescents with social learning challenges. Four adolescents with Attention Deficit Hyperactivity Disorder (ADHD) participated in this multiple baseline across participants design for a total of eight treatment sessions. Data included both continuous and pre and post measures, and social validity surveys from subjects and parents. The results indicated an increased perspective taking ability in two subjects, with one subject also showing significant increases in metacognitive ability. The remaining two subjects saw varying results, with behavior as a factor in their performance. Clinical implications for the use of SBM with different types of learners is discussed.
Keywords: ADHD, autism, Cognitive Behavior Therapy, social cognition, social skills, Social Behavior Mapping, Social Thinking, Theory of Mind
Torres, Kristen The Effect of CTAR Exercises for Dysphagia in Persons with Oculopharyngeal Muscular Dystrophy
Oculopharyngeal muscular dystrophy is a genetic disease, which causes weakness in the pharyngeal musculature and dysphagia. This investigation presents the relevant literature and describes the swallowing deficits. Four participants with OPMD completed this A-BA-B design study. Primary measures included duration and extent of UES opening, stasis in the valleculae and pyriform sinuses, hyolaryngeal excursion, strength of the chin tuck and tongue to palate pressure strength. Secondary measures included a qualitative measure of eating satisfaction, swallow capacity measured by the Timed Water Swallow, and IDDSI diet rating. Chin tuck against resistance exercises (CTAR) was used to improve swallow function with limited results. Implications for strength training for swallowing in this disease are discussed.
Williamson, Jill The Effect of Aided Language Stimulation on the Expression of Multi-Symbol Messages by Students in High School with Moderate Intellectual Impairment Who Use Augmentative and Alternative Communication
In the literature, there are many investigations pertaining to effective treatment for individuals with intellectual and speech-language impairment with an emphasis on aided language stimulation (ALS) and augmentative and alternative communication (AAC). Verbal speech of these individuals is often difficult to understand especially to unfamiliar listeners (Beck et al., 2009). Implementation of AAC through voice output communication systems with dynamic displays (Uliano et al., 2009) may be used in accordance with ALS pairing verbal language with symbols on AAC devices (Drager et al., 2006) to assist in improving the overall quality of communication. By using ALS, the goal is to increase the length of multi-symbol messages produced for persons who use AAC. There has been successful research on using AAC modeling on the expression of multi-symbol messages by preschoolers (Binger & Light, 2007). However, there appears to be limited research on individuals in the high school setting using ALS and the production of multi-symbol messages using AAC. The purpose of this investigation was to determine if the use of ALS increased the length of the multi-symbol messages produced by students in high school with a moderate intellectual impairment who use AAC. The treatment, in this Multiple Baseline Across Participants (MBAP) single subject design, involved both production: direct imitation of two-word phrases in an action + object structure during 20 trials per session and the frequency of sessions: two times per week for four weeks. The data were analyzed using visual analysis, slope analysis, percentage of nonoverlapping data, and the Two Standard Deviation Band Method. Three out of the four participants indicated a positive change between the baseline and intervention phase with intervention data increasing in comparison to the flat baseline data, upward trend and slope in a positive direction during the intervention phase, and high percentage (75%) of percentage of non-overlapping intervention data points in comparison to the baseline data. The results indicate a significant change from the baseline to the intervention phase. Data of the fourth participant revealed no change when the intervention was presented. The outcome of this study revealed the ability of three students to produce two-word phrases on their Proloqu02Go™ communication application to facilitate verbal communication within the context of this investigation. The results supported that ALS increased the length of multi-symbol messages produced in three out of four participants specific to this investigation.
Wolff, Miranda The Effect of Tactile Cues on Sound Production in Preschoolers with Articulation Impairment Compared with Traditional Phonetic Therapy
The purpose of this investigation was to explore the effects of tactile facial cues used within traditional phonetic articulation therapy approach for preschool aged children with moderate to severe speech sound (articulation) impairment. Previous research using motor based approaches utilizing tactile facial cues for articulation therapy has shown a positive effect on speech sound acquisition and generalization. The majority of these studies included children with significant articulation impairments including children with childhood apraxia of speech and cerebral palsy and targeted sounds in words and phrases. Studies utilizing tactile facial cues are also limited to a few specific programs and not integrated into a traditional phonetic articulation therapy approach used by many speech-language pathologists. There were three participants included in this multiple baseline across behavior study. Each participant received traditional phonetic articulation therapy approach during the baseline sessions. In the intervention phase, tactile facial cues were used when a target was in error. The overall results were mixed. Only two of the participants received tactile facial cues as the third participant reached criterion for all three targets in the baseline phase. Only a total of three out of nine targets reached the intervention phase, however, all three targets for all three participants did reach criterion. Targets improving in the baseline phase indicate the efficacy of a traditional phonetic articulation therapy approach in remediating articulation errors while improvements in the intervention phase indicate a possible benefit in using tactile facial cues when a target does not respond to a traditional phonetic articulation therapy approach alone.