ACQ Vol 13 No1 2011

Language disorders

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settings, and urges further and better designed studies to be undertaken in the future. The authors conclude that “clinicians have little research evidence on which to base decisions about service delivery options” (p. 248). We in the field must therefore continue to seek convergent findings to assist us to make clinical judgements, and to seriously consider all opportunities to contribute to the current body of evidence in terms of effective service delivery in schools. The comprehensive appendix and bibliography of this review will be useful to the school-based SPs for both purposes. Speech production in primary progressive aphasia Wilson, S.M., Henry, M.L., Besbris, M., Ogar, J.M., Dronkers, N.F., Jarrold, W., Miller, B.L., & Gorno-Tempini, M.L. (2010). Connected speech production in three variants of primary progressive aphasia. Brain , 133 , 2069–2088. Rhonda Holmes The neurodegenerative syndrome of primary progressive aphasia (PPA) can be classified into three distinct clinical syndromes depending on the linguistic and cognitive features present. These are progressive non-fluent aphasia (PNFA), semantic dementia (SD) and logopenic progressive aphasia (LPA). Previously fluent and non-fluent dichotomies have been applied to these dementia types; however, the authors point out that the notion of fluency depends on the particular dimension of verbal expression being considered and furthermore, that the concept is applied inconsistently. This study firstly aimed to characterise the connected speech of each PPA variant by considering motor speech and linguistic features, and secondly, to determine the neuroanatomical correlates associated with the verbal expression deficits. The researchers recruited 70 participants: 50 patients with mild to moderate aphasia from the populations of interest and 20 controls. The sample of interest included 14 participants with PNFA, 25 with SD, 11 with LPA, and the control sample included 10 participants with behavioural variant frontotemporal dementia (the neurodegenerative control group), and 10 normal controls. An extensive battery of linguistic, motor speech, and cognitive assessments were undertaken and connected speech samples for all participants were recorded, transcribed and analysed. Patients underwent MRI and had areas of atrophy mapped and correlated with each speech/language measure. Results indicated participants with PNFA had the slowest speech rate with distortions, syntactic errors and markedly reduced complexity, but did not have the agrammatism of a “classic” Broca’s dysphasia. Participants with SD showed normal speech rate with few speech or syntactic errors, but demonstrated lexical retrieval difficulties evidenced by their high usage of closed class words, pronouns, verbs, and high frequency nouns. Those with LPA had a speech rate between the other two groups, which, in the authors’ opinion, explained the variable results from other studies in describing this variant as both non-fluent and fluent.

Effects of service delivery models on outcomes for school-age children Cirrin, F., Schooling, T., Nelson, N., Diehl, S., Flynn, P., Staskowski, M., Torrey, T., & Adamczyk, D. (2010). Evidence- based systematic review: Effects of different service delivery models on communication outcomes for elementary school-age children. Language, Speech and Hearing Services in Schools , 41 , 233–264. Given the consistently high demand, along with the low supply of speech pathology services within education settings, speech language pathologists (SPs) working in schools aim to provide high quality, evidence based interventions. In seeking to identify best practice in terms of service delivery models, these authors note that the 2008 American Speech Hearing Association (ASHA) Schools Survey data indicated that the traditional “pullout” model (1:1 intervention outside the classroom) is still the most common practice used by SPs in US elementary schools. Since both classroom-based interventions and indirect-consultative service delivery models are also used, the effectiveness of all methods warrants investigation. The rigour required of an evidence-based systematic review (EBSR) resulted in a comprehensive search being conducted of 27 relevant electronic databases along with electronic searches of all ASHA journals; references from all relevant articles found were investigated. Once the inclusion criteria were applied, only 5 studies from the original 255 abstracts considered could be included in the systematic review. The main question addressed in the review was the influence of the type and dosage of speech-language pathology service delivery models on nine outcomes, which included those related to the child (e.g., vocabulary, functional communication, literacy), the environment (e.g., language facilitation techniques of significant adults) and system-related outcomes (e.g., curriculum standards and rates of referral to special education). While the authors conclude that comparisons between the effectiveness of direct services delivered in the classroom and pullout intervention were favourable, and that “highly trained” SP assistants following clear guidelines from SPs can be effective in some cases, the authors remind SPs to interpret their findings with caution, given the limitations of the EBSR. For example, this review did not capture the range and scope of available research for services provided to preschool or secondary students, suggesting the probability that “some evidence that could be quite useful to school clinicians did not meet the inclusion criteria for this review” (p. 249). Fortunately, the paper includes an extensive appendix containing abstracts which were not included in the current review, but which have the potential to inform clinical practice with regard to models of service delivery. This paper makes us acutely aware of the difficulty of attempting high-quality experimental research in school Rosemary Roberts

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ACQ Volume 13, Number 1 2011

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