Telepractice in service delivery: A survey of perspectives and practices of speech and language therapists in Ireland during COVID-19

BACKGROUND: COVID-19 accelerated telepractice implementation in speech and language therapy (SLT) in Ireland. OBJECTIVE: This study documents the service delivery changes that took place in the SLT profession in Ireland during the public health crisis. METHODS: An online survey of speech and language therapists (SLTs) in Ireland was conducted from June-September 2020 to investigate their perceptions of telepractice. Data were analysed using descriptive and inferential statistics and frequency distribution. RESULTS: 173 SLT responses were analysed. Over half of the participants worked in urban locations. Respondents’ years of experience varied from less than four years to over 20 years. Slightly over half the participants reported using telepractice, with 85% starting to use telepractice in the six months prior to the survey. Telepractice uptake was not influenced by participants’ professional experience or geographical location (p > 0.05). Almost all participants who used telepractice were trained informally (92%,). Telepractice was most commonly used with school-aged children with developmental language and speech sound disorders. Respondents perceived that telepractice was not suitable for all individuals who need SLT, including those with complex needs. Clinicians reported that telepractice facilitated access to therapy for clients and opportunities to see clients in their own environments. Technology barriers were the biggest hurdle to telepractice use. CONCLUSIONS: Uptake of telepractice by the SLT profession in Ireland was widespread during COVID-19, highlighting the profession’s flexibility and innovation. Respondents indicated they are likely to continue to use telepractice as a complementary service delivery model post-COVID due to the distinct benefits for clinicians and clients.

Risk Factors for Subtypes of Children with Speech Sound Disorders Classified by Linguistic Symptoms

Objectives: The purpose of this study is to investigate 22 risk factors for speech sound disorders (SSDs) and to find out whether there are differences in risk factors for each subtype of SSDs of Dodd’s model.Methods: Sixty-two children with SSDs aged 3-9 years participated in the study, and 22 risk factors reported in literature were investigated through parental interviews and a nonverbal intelligibility test. Children with SSDs were divided into children with articulation disorders, phonological delays, and consistent/inconsistent phonological disorders.Results: As a result of the principal component analysis, 22 risk factors were classified into 1) language and gross motor development, 2) gender and early development, 3) otitis media with effusion, 4) socioeconomic status, and 5) family history. Among all risk factors, only general developmental delay around 2 years of age showed a significantly different frequency among subtypes of SSDs.Conclusion: This study directly investigated the risk factors of children with SSDs and classified a number of risk factors into five categories. This study suggests that if children show early general developmental delays, they should be closely monitored and early evaluation and interventions should be planned.

The Effectiveness of an Integrated Treatment for Functional Speech Sound Disorders—A Randomized Controlled Trial

Background: The treatment of functional speech sound disorders (SSDs) in children is often lengthy, ill-defined, and without satisfactory evidence of success; effectiveness studies on SSDs are rare. This randomized controlled trial evaluates the effectiveness of the integrated SSD treatment program PhonoSens, which focuses on integrating phonological and phonetic processing according to the Integrated Psycholinguistic Model of Speech Processing (IPMSP). Methods: Thirty-two German-speaking children aged from 3.5 to 5.5 years (median 4.6) with functional SSD were randomly assigned to a treatment or a wait-list control group with 16 children each. All children in the treatment group and, after an average waiting period of 6 months, 12 children in the control group underwent PhonoSens treatment. Results: The treatment group showed more percent correct consonants (PCC) and a greater reduction in phonological processes after 15 therapy sessions than the wait-list control group, both with large effect sizes (Cohen’s d = 0.89 and 1.04). All 28 children treated achieved normal phonological abilities: 21 before entering school and 7 during first grade. The average number of treatment sessions was 28; the average treatment duration was 11.5 months. Conclusion: IPMSP-aligned therapy is effective in the treatment of SSD and is well adaptable for languages other than German.

Speech-Language Pathologists' Ratings of Speech Accuracy in Children With Speech Sound Disorders

Purpose: Forming accurate and consistent speech judgments can be challenging when working with children with speech sound disorders who produce a large number and varied types of error patterns. Rating scales offer a systematic approach to assessing the whole word rather than individual sounds. Thus, these scales can be an efficient way for speech-language pathologists (SLPs) to monitor treatment progress. This study evaluated the interrater reliability of an existing 3-point rating scale using a large group of SLPs as raters. Method: Utilizing an online platform, 30 SLPs completed a brief training and then rated single words produced by children with typical speech patterns and children with speech sound disorders. Words were closely balanced across the three rating categories of the scale. The interrater reliability of the SLPs ratings to a consensus judgment was examined. Results: The majority of SLPs (87%) reached substantial interrater reliability to a consensus judgment using the 3-point rating scale. Correct productions had the highest interrater reliability. Productions with extensive errors had higher agreement than those with minor errors. Certain error types, such as vowel distortions, were especially challenging for SLPs to judge. Conclusions: This study demonstrated substantial interrater reliability to a consensus judgment among a large majority of 30 SLPs using a 3-point rating. The clinical implications of the findings are discussed along with proposed modifications to the training procedure to guide future research.

Expansion Points Intervention in Young Children with Speech Sound Disorders: A Multiple Baseline Design

The purpose of this investigation was to evaluate the efficacy of expansion points (EXP) intervention with a modified criterion for preschool children with speech sound disorders (SSD). Three preschool-aged children were enrolled in a single-subject multiple baseline intervention study. Intervention took place over 16 sessions. Pre- and post-intervention data are provided. Three outcome measures (generalization to probe words and gains in percent consonants correct, PCC, in words and in conversation) were evaluated to measure the effectiveness of the EXP intervention. All three of the participants demonstrated gains by the end of the intervention phase when measuring PCC in single words. Two of the three participants demonstrated gains in PCC in conversational speech. Progress on individual phonemes was variable across participants. Utilizing the EXP approach, two of the three children showed gains in all three outcome measures. One child showed variable performance in one outcome measure, improvement in one, and a decrease in one. Findings suggest that EXP should be further explored to evaluate intervention efficacy.

Comparing the Informativeness of Single-Word Samples and Connected Speech Samples in Assessing Speech Sound Disorders

Purpose Speech-language pathologists (SLPs) are faced with the challenge of quickly and accurately identifying children who present with speech sound disorders (SSD) compared to typically developing (TD) children. The goal of this study was to compare the clinical relevance of two speech sampling methods (single-word vs. connected speech samples) in how sensitive they are in detecting atypical speech sound development in children, and to know whether the information obtained from single-word samples is representative enough of children's overall speech sound performance. Method We compared the speech sound performance of 37 preschool children with SSD ( M age = 4;11 years) and 37 age-sex-matched typically developing children ( M age = 5;0 years) by eliciting their speech in two ways: (a) a picture-naming task to elicit single words, and (b) a story-retelling task to elicit connected speech. Four speech measures were compared across sample type (single words vs. connected speech) and across groups (SSD vs. TD): intelligibility, speech accuracy, phonemic inventory, and phonological patterns. Results Interaction effects were found between sample type and group on several speech sound performance measures. Single-word speech samples were found to differentiate the SSD group from the TD group, and were more sensitive than connected speech samples across various measures. The effect size of single-word samples was consistently higher than connected speech samples for three measures: intelligibility, speech accuracy, and phonemic inventory. The gap in sample type informativeness may be attributed to salience and avoidance effects, given that children tend to avoid producing unfamiliar phonemes in connected speech. The number of phonological patterns produced was the only measure that revealed no gap between two sampling types for both groups. Conclusions On measures of intelligibility, speech accuracy, and phonemic inventory, obtaining a single-word sample proved to be a more informative method of differentiating children with SSD from TD children than connected speech samples. This finding may guide SLPs in their choice of sampling type when they are under time pressure. We discuss how children's performance on the connected speech sample may be biased by salience and avoidance effects and/or task design, and may, therefore, not necessarily reveal a poorer performance than single-word samples, particularly in intelligibility, speech accuracy, and the number of phonological patterns, if these task limitations are circumvented. Our findings show that the performance gap, typically observed between the two sampling types, largely depends on which performance measures are evaluated with the speech sample. Our study is the first to address sampling type differences in SSD versus TD children and has significant clinical implications for SLPs looking for sampling types and measures that reliably identify SSD in preschool-aged children.

INTERVENÇÕES FONOLÓGICAS EM CRIANÇAS COM DESVIO FONOLÓGICO: UMA REVISÃO SISTEMÁTICA

Introdução: Dentre os distúrbios dos sons da fala, tem-se o desvio fonológico, sendo este caracterizado por erros na produção de fala. A partir dos achados da avaliação fonológica, o terapeuta deverá selecionar a proposta de intervenção mais adequada para cada caso dentre os diversos modelos elaborados a partir de teorias linguísticas que buscam alcançar a reorganização fonológica. Objetivo: Avaliar a intervenção fonológica para os casos de desvios fonológicos no Português Brasileiro Método: a revisão sistemática foi conduzida conforme as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A busca por artigos científicos foi conduzida por dois pesquisadores independentes nas bases de dados Medline (Pubmed), LILACS, SciELO, Cochrane Library e Scopus. A pesquisa foi realizada com os descritores [(Phonological disorders) or (Phonological impairment) or (Speech sound disorders) or (Articulation Disorders) or (Language and Hearing Sciences) and (Speech Therapy) or (Speech Intervention) or (Phonological treatment) or (Phonological Intervention)] e compreendeu o período de janeiro de 2015 a maio de 2020. Resultados: Todas as crianças apresentaram evolução e ampliação no sistemas fonológicos, independente da intervenção fonológica escolhida para o caso. Entretanto, os estudos que aliaram a terapia tradicional com outros recursos alternativos (exemplo, softwares) obtiveram resultados promissores. Conclusão: Apesar dos resultados terem sido eficazes nos estudos analisados, não foi possível sistematizar a escolha da intervenção com o quadro clínico dos sujeitos em decorrência da falta de uniformização dos sujeitos e ao delineamento metodológico. Não é possível realizar conclusões sistemáticas com relação à intervenção fonológica de crianças brasileiras.