Efficacy of Problem-Solving Interventions for Improving Executive Functioning Outcomes in Patients with Acquired Brain Injuries: A Systematic Review
Rebecca Booth, Emily Heckler, and Molly Reese
Background and Objective(s): Individuals with acquired brain injury (ABI) often demonstrate executive functioning (EF) impairments that impact their ability to identify and solve problems within their daily lives. This systematic review attempts to consolidate available research supporting problem-solving interventions as effective, evidence-based practice for addressing EF deficits in individuals with ABI.
Methods: A systematic review was conducted using the databases Ovid Medline, CINAHL, and PsycINFO. Studies met the following inclusion criteria: 1) problem-solving intervention, 2) EF outcomes, 3) individuals with acquired brain injuries. Studies were excluded based on the following criteria: 1) single case study design, 2) family-centered interventions and outcomes. All studies were then quality assessed using components of the Assessment of the Quality and Applicability of Systematic Reviews.
Results: A total of 531 studies were identified and 14 met inclusion criteria. The overall quality of the studies was ‘moderate.’ Interventions identified include problem-solving skills training, analogical problem-solving approach, explicit problem-solving training, Attention and Problem Solving, Interactive Strategy Modelling Training, Short-Term Executive Plus, Counselor Assisted Problem-Solving Training, Teen Online Problem Solving-Teen Only, and Teen Online Problem Solving-Family.
Conclusions: Problem-solving interventions are effective for use as management strategies for individuals with problem-solving deficits following ABI. The available evidence does not support the use of these interventions as remediation for EF deficits. Explicit teaching of problem-solving frameworks has been found to improve individuals’ abilities to recognize solutions to daily problems and determine a plan to reach an appropriate solution. Variables such as age, injury severity, and cognitive reserve may contribute to the level of success of the problem-solving interventions. More research is warranted to support the use and generalization of explicit problem-solving interventions to improve EF in individuals with ABI.
Efficacy of Electrical Stimulation Intervention in Treating Adults with Dysphagia: A Systematic Review
Virginia N. Cheng, Jenna N. Dalton, and Kathryn R. Howrigan
Purpose: Dysphagia is a term used for a swallowing disorder resulting from problems with the oral cavity, pharynx, esophagus, or gastroesophageal junction. Dysphagia can have significant impacts on an individual’s quality of life and statistics suggest that nearly 15 million adults in the United States present with swallowing disorders. Common medical complications associated with dysphagia are malnutrition, dehydration, aspiration pneumonia, and even death. Traditional dysphagia treatment (TDT) for adults currently consists of diet modification, compensatory strategies involving postural adjustments, and swallowing exercises to strengthen musculature. The objective of this systematic review is to determine whether electrical stimulation (ES) improves swallowing function in adults with dysphagia.
Methodology: Four indexed databases were searched to obtain studies pertaining to the use of ES in dysphagia treatment and its success. Application of inclusionary and exclusionary criteria narrowed the results and relevant studies were selected for this systematic review. Studies were also hand-selected and appraised for validity to ensure minimal bias.
Results: Results of the selected studies revealed varying statistically significant effects of ES as a treatment for adults with dysphagia. However, many studies suggest ES is most effective in producing positive outcomes when coupled with TDT.
Conclusion: The results of the systematic review suggest efficacy of ES is highest when it is used in conjunction with TDT. Studies with statistically significant results reported on only a minor improvement with ES. None of the studies reported negative outcomes related to ES. Additional research is needed to determine overall efficacy of ES as an evidence-based intervention for adults with dysphagia resulting from various etiologies.
The Efficacy of Telepractice in the Assessment and Treatment of Speech Disorders: A Systematic Review
Elizabeth Cooley, Jillian Thompson, and Emily Glover
Purpose: Children and adults with speech disorders face numerous barriers in accessing traditional face-to-face services with a speech-language pathologist. Telepractice may be a feasible solution. The aim of this systematic review was to investigate the efficacy of telepractice in the assessment and treatment of speech disorders in children and adults.
Methods: Research articles were ascertained from Ovid MEDLINE, PsychInfo, and CINAHL using an established and consistent search strategy that utilized both medical subject headings and subject terms related to telepractice. The predetermined inclusion criteria included diagnosis of a speech disorder, participants across the lifespan, direct comparison of both delivery methods (i.e., telepractice to face-to-face), and objective outcome measures. Articles were excluded due to lack of speech disorder diagnosis, use of purely subjective outcome measures, and lack of direct comparison of delivery methods. Quality assessment was established by the authors using the criteria in the Assessing the Quality and Applicability of Systematic Reviews and a rating scale (i.e., 'poor,' 'fair,' 'good,' 'strong').
Results: Electronic searches of the databases resulted in the acquisition of 16 full-text research studies, which were used in this systematic review. The quality of the studies ranged from 'poor' to 'strong' with a majority of the articles rated as 'good.' The studies explored telepractice efficacy in speech sound disorders, fluency disorders, dysarthria, apraxia, and voice disorders.
Conclusions: Generally, the quality of intervention delivered via telepractice is comparable to traditional face-to-face therapy. Additional research involving diverse populations with varied levels of severity in natural environments is required to confirm the efficacy of the delivery method. It is imperative the use of telepractice is considered by each clinician on a per case basis.
The Effects of Early Intervention on the Expressive Language Outcomes of Children with Autism Spectrum Disorder: A Systematic Review
Alyssa G. Jones, Emily M. Mailloux, and Emme L. O'Rourke
Background: Autism Spectrum Disorder (ASD) is characterized by persistent challenges in social communication as well as restricted and repetitive behaviors and is often observable in early childhood. Expressive language delays are common in young children diagnosed with ASD. Expressive language includes any form of communicative output, such as verbal language, sign language, and the use of alternative and augmentative communication (AAC). Early intervention, for the purpose of this systematic review, is defined as speech and language services provided before a child is 5 years (60 months) of age. Evidence suggests that early intervention can lead to positive outcomes in the symptoms of children with ASD.
Objective: To determine whether early intervention of ASD in children between 0-59 months of age has positive effects on expressive language development.
Methods: A systematic search of the PsychINFO, PubMED, CINAHL, ERIC, and LLBA database was conducted, followed by a qualitative analysis of relevant articles. Studies included monolingual (i.e., English) children who were diagnosed with ASD. Studies were systematically graded and processed using inter-rater procedures.
Results: Fourteen articles were included based upon inclusionary criteria. The overall quality of the studies was moderate. The most widely used early intervention techniques included the Early Start Denver Model (ESDM) and Pivotal Response Training (PRT).
Conclusions: Consistent high-interval (i.e., 25 hours per week), behaviorally-based early intervention (i.e., before 40 months) may lead to positive outcomes in expressive language development. Clinicians working with young children with ASD should implement behaviorally-based, empirically-supported interventions, such as ESDM or PRT. Future research should prioritize high-quality study designs (e.g., randomized control trials) with larger sample sizes of children diagnosed with ASD, which is necessary to discern a direct relationship between behaviorally-based early intervention and expressive language outcomes for children with ASD.
Carson Leon-Gambetta, Ruth Huttner, and Amanda Matyas
Purpose: Transgender individuals often seek to alter their vocal characteristics. For Male to Female (MtF) transgender individuals, attaining a feminine voice may be particularly challenging. The objective of this systematic review is to determine whether MtF transgender individuals who receive voice feminization therapy alone or Wendler’s Glottoplasty (WG) surgical intervention with subsequent voice therapy yield greater outcomes in frequency and self-perception.
Method: A systematic review of the literature was conducted by using PubMed and Ovid to search terms pertaining to voice feminization. The articles were reviewed and appraised by the authors for inclusionary criteria, exclusionary criteria, and quality. Inclusionary criteria included: 1) adult MtF Transgender individuals, 2) pre and post measures of fundamental frequency (fo), 3) post puberty age, 4) measure of perception of femininity, and 5) patients who underwent WG (articles pertaining to surgical intervention only).
Results: A total of 82 articles were identified and 12 met inclusionary criteria for this systematic review. Overall, the quality of the studies was moderate. Outcome measures included frequency range and frequency gain. The authors were unable to compare measurements of self-perception and perception of femininity due to the variability in assessments.
Conclusions: Patients who opted for surgical intervention experienced a greater increase in fo but a decrease in frequency range. Conversely, patients who participated in voice feminization therapy alone were found to exhibit smaller gains in fo and an increase in frequency range. This implies that both voice feminization therapy and surgical intervention are effective methods for increasing the frequency of voice. Limitations of this research include the subjective nature of self-perception measures, variability in measurements of perception of femininity, and overall limited research regarding this population.
The Effects of Altered Auditory Feedback (AAF) on Fluency in Adults Who Stutter: A Systematic Review
Sarah A. Romeiser, Sullivan J. Kiley, and Nicholas J. Nocella
Background and Objectives: Stuttering affects 70 million people worldwide, which is about 1% of the population. Altered auditory feedback (AAF) is a process by which an individual’s auditory speech signal is electronically changed to temporarily increase the fluency of a person who stutters. For the purpose of this systematic review, AAF includes delayed auditory feedback (DAF) and frequency-altered feedback (FAF). This systematic review examines fluency enhancement in adults who stutter when using AAF devices.
Methods: A review of the literature was searched using PubMed, Ovid MEDLINE, PsycINFO, and CINAHL databases with key search terms related to stuttering and AAF. Inclusion criteria included: 1) adults ages ≥ 18 years old who stutter, 2) comparison of altered auditory feedback forms and/or no altered auditory feedback forms in the treatment of stuttering, 3) inclusion of DAF or FAF, 4) outcomes related to aspects of stuttering or people who stutter (e.g., fluency level, speech naturalness, speech rate), and 5) experimental research. Studies were quality assessed and rated by the authors.
Results: A total of 16 articles were included in this review. Articles were of ‘moderate’ quality.
Conclusions: AAF devices are generally effective in reducing stuttering frequency, with most notable fluency enhancement occurring during oral reading. The degree of fluency enhancement between individuals who stutter is variable and is influenced by factors such as stuttering severity. While research generally supports the use of AAF devices in reducing stuttering frequency, there are inconsistent findings regarding speech naturalness. AAF is likely most effective when used in conjunction with traditional speech therapy. Further research is needed to better understand the relationship between AAF and stuttering, particularly regarding unstructured speaking tasks and speech naturalness.
The Efficacy of Joint Attention Interventions on Play Skills in Children with Autism Spectrum Disorder: A Systematic Review
Flinn Esselstyn, Emilie Hall, and Alexandra Winkel
Purpose:The aim of this study is to determine if joint attention interventions have an effect on general play skills in individuals with Autism Spectrum Disorder (ASD) aged birth to five years.
Method: The reviewers examined various databases and selected research based on predetermined inclusion/exclusion criteria. This included peer-reviewed research articles that assessed children with a formal diagnosis of ASD between the ages of birth to five years, examined joint attention interventions, included outcome measures related to play, and were published after the year 2000. The articles reviewed consisted of 581 participants. Research designs included primarily pre-post randomized clinical trials, one single subject multiple baseline design, and one case study design.
Results: The collective results suggest that joint attention interventions may be effective in increasing play skills in children with ASD. While some studies report no change to either functional or symbolic play skills, other studies report improvements in only one type. No study reports a decrease in play skills.
Conclusion: While there is evidence that joint attention interventions may improve play skills in children with ASD, overall, the results of this systematic review are inconclusive. Future research will help to clarify if joint attention interventions have a measurable impact on either symbolic or functional play skill development.
Erin Fifield, Morgan Bailey, and Lauren Burningham
Access to skilled speech and language intervention can be difficult for individuals residing in rural areas as well as for individuals with complex health and mobility issues. Telehealth (including therapy and rehabilitation) can provide effective services in the context of one’s home, allowing clinicians to reach a wider population of individuals.
Purpose: To determine whether tele-practice service delivery produces positive expressive language outcomes that are comparable to direct service delivery for adults with aphasia.
Method: A variety of databases were searched utilizing systematic inclusionary and exclusionary criteria. Research focused on adults over the age of 18 with a formal diagnosis of aphasia who engaged in telehealth intervention. Various research designs were identified and analyzed. Identified articles included a total of 235 participants.
Results: The identified studies supported the implementation of tele-practice as a means of providing individuals with aphasia access to services that produce positive expressive language outcomes. Several studies indicated that tele-practice produces similar outcomes when compared to traditional direct therapy. Several studies also included qualitative data regarding patient satisfaction and quality of life, much of which produced positive outcomes.
Conclusion: The chosen studies were found to largely support the inclusion of tele-practice as an effective option for producing positive expressive language outcomes for individuals with aphasia. Potential limitations include variability in treatment times and programs, assessment tools used, clinical training of individuals providing treatment, small sample sizes, and variable patient characteristics. Future research should focus on implementing research designs using larger numbers of individuals to increase generalizability.
Systematic Review: Comparative Efficacy of the Picture Exchange Communication System (PECS) to Other Augmentative Communication Systems in Increasing Social Communication Skills in Children with Autism Spectrum Disorder
Brittany Mahoney, Alyssa Johnson, Maggie McCarthy, and Cameron White
Purpose: This systematic review aims to compare the efficacy of the Picture Exchange Communication System (PECS) to other forms of Augmentative and Alternative Communication (AAC) in increasing social communication skills in children with Autism Spectrum Disorder (ASD).
Methods: A systematic review of the literature on PECS and other forms of AAC written between 2007 and 2018 was conducted. Studies were selected based on the established inclusionary and exclusionary criteria. The inclusionary criteria incorporated subjects with a formal diagnosis of ASD under the age of 18. Exclusionary criteria included individuals with severe sensory, motor, and/or other medical conditions that may have affected their use of PECS. 25 articles of varying study designs were critically appraised for validity and reliability to minimize bias.
Results: Results suggest that both PECS and other forms of AAC are conducive to improving social communication in children (<18>years) with ASD. Advancements in conversation initiation, requesting behaviors and joint attention were noted, resulting in a global increase in communication interactions. However, studies demonstrated mixed results with specific consideration of rate of acquisition, modality preference, and overall effectiveness of the system.
Conclusion: Synthesis of results from the 25 studies suggest that both PECS and other AAC systems show favorable outcomes for encouraging social-communicative behavior. The clinical implications of these results suggest the implementation of an AAC system may be client dependent. Single design designs were included in this review due to the lack of research in the areas of ASD and AAC. Further research of this comparison should be conducted on larger populations of children with ASD to improve clinical decision making to target social communication and increase generalizability.
Examining the Effects of AAC Intervention on Oral Language in Children with Autism Spectrum Disorders: A Systematic Review
Alexandra F G Patch, Emily V. Mortner, and Alison R. Joseph
This systematic review researched the efficacy of augmentative and alternative communication (AAC) in increasing oral communication in children with Autism Spectrum Disorder (ASD). It may be used to inform best practice when working with children with ASD. The search strategy reviewed medical, social science, and communication databases. Inclusionary criteria consisted of peer-reviewed, quantitative research published after 2007 regarding children with ASD under age 18. The included studies used AAC interventions and measured spoken language outcomes. After conducting an initial database search with these criteria, a manual search was performed using references from the found articles. Results varied across studies. Although the trend demonstrates increases in verbal language with AAC intervention, few studies show statistically significant outcomes. The studies indicate that additional factors, such as verbal communication at baseline, may affect outcomes. AAC use did not decrease verbal language. Limitations included few randomized control trial designs, few study replications, and varied outcome measures. Based on the studies analyzed, implementation of AAC may increase the number of communicative acts, but may not reliably increase verbal language. Further research is needed to understand the most effective implementation of AAC intervention to increase verbal language. Higher quality research in the form of randomized control trials, and the replication of studies to confirm results is necessary to inform evidence-based practice. The findings are consistent with those of previous systematic reviews and meta analyses. Future considerations should include type of AAC, communicative act being measured, longitudinal studies, and increased use of formal measures.
Printing is not supported at the primary Gallery Thumbnail page. Please first navigate to a specific Image before printing.