Speech therapy for children with dysarthria acquired before three years of age
Abstract
Background
Children with motor impairments often have the motor speech disorder dysarthria, a condition which effects the tone, power and coordination of any or all of the muscles used for speech. Resulting speech difficulties can range from mild, with slightly slurred articulation and low‐pitched voice, to profound, with an inability to produce any recognisable words. Children with dysarthria are often prescribed communication aids to supplement their natural forms of communication. However, there is variation in practice regarding the provision of therapy focusing on voice and speech production. Descriptive studies have suggested that therapy may improve speech, but its effectiveness has not been evaluated.
Objectives
To assess whether direct intervention aimed at improving the speech of children with dysarthria is more effective than no intervention at all.
To assess whether individual types of intervention are more effective than others in improving the speech intelligibility of children with dysarthria.
Search methods
We searched CENTRAL, MEDLINE, EMBASE, CINAHL , LLBA, ERIC, PsychInfo, Web of Science, Scopus, UK National Research Register and Dissertation Abstracts up to April 2009, handsearched relevant journals published between 1980 and April 2009, and searched proceedings of relevant conferences between 1996‐2009.
Selection criteria
We considered randomised controlled trials and studies using quasi‐experimental designs in which children were allocated to groups using non‐random methods.
Data collection and analysis
L Pennington conducted searches of all databases and conference reports. L Pennington, N Miller and S Robson handsearched journals. All searches included a reliability check in which a second review author independently checked a random sample comprising 15% of all identified reports. We planned that two review authors would independently assess the quality and extract data from eligible studies.
Main results
No randomised controlled trials or group studies were identified.
Authors' conclusions
We found no firm evidence of the effectiveness of speech and language therapy to improve the speech of children with early acquired dysarthria. No change in practice is warranted at the present time. Rigorous research is needed to investigate if the positive changes in children's speech observed in small descriptive studies are shown in randomised controlled trials. Research should examine change in children's speech production and intelligibility. It should also investigate the secondary education, health and social care outcomes of intervention, including children's interaction with family, friends and teachers, their participation in social and educational activities, and their quality of life. Cost and acceptability of interventions must also be investigated.
PICOs
Plain language summary
Speech therapy for children with early acquired dysarthria
Dysarthria is a disorder which reduces the control of movements for speech. Children with dysarthria often have shallow, irregular breathing and speak on small, residual pockets of air. They have low pitched, harsh voices, nasalised speech and very poor articulation. Together, these difficulties make the children's speech difficult to understand. Dysarthria is caused by neurological impairment and can arise early in children's lives, from neurological damage sustained before, during or after birth, such as in cerebral palsy, or in early childhood through traumatic brain injury or neurological disease. Communication difficulties have a profound impact on children’s development. They reduce the quality of life of children with cerebral palsy and place children at risk of social exclusion, educational failure and later unemployment. Speech and language therapy aims to help children to control the movements for breathing and speech and so become more intelligible. Small, observational studies have suggested that for some children therapy might have been associated with positive changes in intelligibility and clarity of children's voices. This review aimed to investigate if therapy is generally effective for children with dysarthria acquired early in life, and if certain types of therapy may be better than others. We found no randomised controlled trials or controlled group studies which investigate the effects of speech and language therapy to improve the speech of children with dysarthria acquired below three years of age. Rigorous research, using randomised controlled trials, is needed to evaluate if therapy can help children to increase the intelligibility of their speech and if enhanced intelligibility increases children's participation in social and educational activities and their quality of life.
