Implementing Remote Developmental Research: A Case Study of a Randomized Controlled Trial Language Intervention During COVID-19

Intervention studies with developmental samples are difficult to implement, in particular when targeting demographically diverse communities. Online studies have the potential to examine the efficacy of highly scalable interventions aimed at enhancing development, and to address some of the barriers faced by underrepresented communities for participating in developmental research. During the COVID-19 pandemic, we executed a fully remote randomized controlled trial (RCT) language intervention with third and fourth grade students (N = 255; age range 8.19–10.72 years, mean = 9.41, SD = 0.52) from diverse backgrounds across the United States. Using this as a case study, we discuss both challenges and solutions to conducting an intensive online intervention through the various phases of the study, including recruitment, data collection, and fidelity of intervention implementation. We provide comprehensive suggestions and takeaways, and conclude by summarizing some important tradeoffs for researchers interested in carrying out such studies.

AAC Intervention for Stroke Survivors - An Anomic Aphasic Case Study

Aphasia is an impairment of language that is a consequence of a cerebral insult or damage affecting the speech production and/or comprehension, as well as the ability to read or write. Etiology of Aphasia is multifactorial, most commonly in the form of a stroke (Cerebrovascular Accident), especially in older individuals. The type of aphasia is determined based on multiple factors such as the site of lesion, signs and symptoms and also through patient’s clinical presentation. Rehabilitation for stroke survivors plays a major role in communication effectiveness. Computerized Intervention method provides a prognostic factor in the treatment for adults with aphasia. AAC devices (high-tech) are used to enhance communicative effectiveness of aphasic individuals who are less likely to use strategies/techniques that the caregiver can use to foster interactions between themselves and the aphasic individual outside the treatment setting. Other factors that determine the success of the intervention are the intensiveness and the duration of intervention. This study focuses on one such intervention of an adult Anomic Aphasia patient using a high tech AAC computerized application known as Avaz. The results showed that the client was able to perform much better in terms of the word retrieving abilities and is now able to communicate well. Key words: Augmentative and Alternative Communications; Anomic Aphasia; Language intervention; Avaz; High tech.

Motivating Adolescents to Participate in Literacy Intervention: A Case Example From Telepractice

Purpose: Motivation declines as children reach adolescence. Poor motivation inhibits participation and engagement in language-based interventions. The purpose of this tutorial is to demonstrate how intervention can be designed to increase client motivation to participate while improving language-based literacy skills. Method: Motivation and behavior change techniques based on self-determination theory are presented, as are examples of how to integrate these techniques into contextualized language intervention with adolescent clients. Conclusion: Incorporating motivation and behavior change techniques into contextualized language interventions with adolescents promotes self-determination and motivation through satisfaction of their need for autonomy, relatedness, and competence while simultaneously addressing language-based literacy deficits.

Implementing Remote Developmental Research: A Case Study of an RCT Language Intervention During COVID-19

Intervention studies with developmental samples are difficult to implement, in particular when targeting demographically diverse communities. Online studies have the potential to examine the efficacy of highly scalable interventions aimed at enhancing development, and to address some of the barriers faced by underrepresented communities for participating in developmental research. During the COVID-19 pandemic, we executed a fully remote randomized controlled trial (RCT) language intervention with third and fourth-grade students (N = 255; age range 8.19-10.72 years, mean = 9.41, SD = 0.52) from diverse backgrounds across the United States. Using this as a case study, we discuss both challenges and solutions to conducting an intensive online intervention through the various phases of the study, including recruitment, data collection, and fidelity of intervention implementation. We provide comprehensive suggestions and takeaways and conclude by summarizing some important tradeoffs for researchers interested in carrying out such studies.

Communication Bridge™-2 (CB2): A NIH Stage 2 randomized control trial of a speech-language intervention for communication impairments in individuals with mild to moderate primary progressive aphasia

Background : Primary Progressive Aphasia (PPA) is a clinical dementia syndrome. Impairments in language (speaking, reading, writing, and understanding) are the primary and persistent symptoms. These impairments progress insidiously and devastate communication confidence, participation, and quality of life for persons living with PPA. Currently, there are no effective disease modifying treatments for PPA. Speech-language interventions hold promise for mitigating communication challenges and language symptoms. However, evidence regarding their efficacy in PPA is of low quality and there are currently no rigorous randomized control trials. Method : Communication Bridge™-2 (CB2) is a Stage 2, superiority, single-blind, randomized, parallel group, active-control, behavioral clinical trial delivered virtually within a telehealth service delivery model to individuals with PPA. Ninety carefully characterized participants with clinically confirmed PPA will be randomized to one of two speech-language intervention arms: 1) Communication Bridge™ a dyadic intervention based in communication participation therapy models that incorporates salient training stimuli or 2) the control intervention a non-dyadic intervention based in impairment therapy models addressing word retrieval and language production that incorporates fixed stimuli. The superiority of Communication Bridge™ over the Control arm will be evaluated using primary outcomes of communication confidence and participation. Other outcomes include accuracy for trained words and scripts. Participants complete two therapy blocks over a 12-month period. Outcomes will be measured at baseline, at each therapy block, and at 12-months post enrollment. Discussion : The CB2 trial will supply Level 2 evidence regarding the efficacy of the Communication Bridge™ intervention delivered in a telehealth service delivery model for individuals with mild to moderate PPA. An important by-product of the CB2 trial is that these data can be used to evaluate the efficacy of speech-language interventions delivered in both trial arms for persons with PPA. The impact of these data should not be overlooked as they will yield important insights examining why interventions work and for whom, which will advance effectiveness trials for speech-language interventions in PPA. Trial Registration: The CB2 trial was registered prospectively with ClinicalTrials.gov (NCT03371706) on December 13, 2017. Registered at https://clinicaltrials.gov/ct2/show/NCT03371706

Language Intervention Isn't Just Spoken: Assessment and Treatment of a Deaf Signing Child With Specific Language Impairment

Purpose This case study describes the language evaluation and treatment of a 5-year-old boy, Lucas, who is Deaf, uses American Sign Language (ASL), and presented with a language disorder despite native access to ASL and no additional diagnosis that would explain the language difficulties. Method Lucas participated in an evaluation where his nonverbal IQ, fine motor, and receptive/expressive language skills were assessed. Language assessment included both formal and informal evaluation procedures. Language intervention was delivered across 7 weeks through focused stimulation. Results Evaluation findings supported diagnosis of a language disorder unexplained by other factors. Visual analysis revealed an improvement in some behaviors targeted during intervention (i.e., number of different verbs and pronouns), but not others. In addition, descriptive analysis indicated qualitative improvement in Lucas' language production. Parent satisfaction survey results showed a high level of satisfaction with therapy progress, in addition to a belief that Lucas improved in language areas targeted. Conclusions This study adds to the growing body of literature that unexplained language disorders in signed languages exist and provides preliminary evidence for positive outcomes from language intervention for a Deaf signing child. The case described can inform professionals who work with Deaf signing children (e.g., speech-language pathologists, teachers of the Deaf, and parents of Deaf children) and serve as a potential starting point in evaluation and treatment of signed language disorders. Supplemental Material https://doi.org/10.23641/asha.16725601

Perceived Competence as a Mediator in Parental Engagement in Speech Therapy

Parental engagement has been recognised as a critical factor in providing optimal speech therapy services to children. However, it continues to be challenging for clinicians to effectively engage parents in speech and language intervention for their children. Therefore, this study was conducted to investigate the roles of parental expectation and parent-therapist communication on parental engagement in speech therapy and to determine the contribution of the parent’s perceived competence as a mediator. A total of 389 respondents were selected from government hospitals in Malaysia for this cross-sectional study. Four instruments were administered: Parental Expectation Scale, Therapist-Parent Communication Questionnaire, Perceived Competence Scale, and Parent Home-programme Compliance Questionnaire. In addition, descriptive, bivariate, and mediation analyses were performed using SPSS and Smart-PLS software to address the study objectives. The results showed that perceived competence partially mediated the relationship between communication and expectation on parental engagement. Thus, it can be concluded that to ensure parental engagement in a child’s intervention which is vital for a better outcome. Parents need to be competent and believe strongly in their capabilities to practise in speech and language intervention. Moreover, policymakers and clinicians should focus on strategies that can improve parental expectations and communication.

Consensus on Terminology for Describing Child Language Interventions: A Delphi Study

Purpose Language intervention for children with language disorder may be effective; however, lack of detailed and consistent terminology for describing language interventions poses barriers for advancement within the field. This study aimed to develop consensus from speech-language pathologists (SLPs) in Australia on a taxonomy with terminology for describing language interventions for school-aged children and investigate SLPs' application of taxonomy terminology when describing child language interventions. Method A taxonomy with terms for describing interventions was developed with reference to contemporary literature and presented to clinicians and researchers with expertise in child language disorders in a three-round Delphi study. We asked Delphi participants to indicate agreement with the taxonomy or propose changes. Application of the taxonomy was investigated by asking participants to use taxonomy terminology to describe interventions presented in two case studies. Results The taxonomy consists of five aspects across which interventions may be described: modality/domain, purpose, delivery, form, and teaching techniques. Consensus on the taxonomy was established in both Round 1 (55 participants) and Round 2 (43 participants), with 100% of SLPs strongly agreeing or agreeing with the overall structure of the taxonomy and at least 87.3% of SLPs strongly agreeing or agreeing with each aspect. In Round 3 (32 participants), consensus was reached on 45/54 taxonomy categories (4/12 of the components) for Case Study 1 and 45/54 taxonomy categories (7/12 of the components) for Case Study 2. Conclusions Consensus on a taxonomy with terminology for describing language interventions represents a significant advancement in the field of child language intervention. Future actions may be needed to facilitate consistent application of taxonomy terms. Supplemental Material https://doi.org/10.23641/asha.16435290