6.15Speech difficulties

SRs
Review detailsInterventionPopulationResultsQuality assessment+
Author (year)
Deane (2002)[429]

Objective
To compare the efficacy of speech and language therapy versus placebo or no interventions in patients with Parkinson's disease.

Number of included studies
3 RCTs (n=63). Numerical data was only available in two of the trials (n=41)
Speech and language therapy: individual therapy with the emphasis on the prosodic feaures of pitch and volume (n=1); group therapy with emphasis on pitch and volume but respiration and voice production also addressed (n=1); individual Lee Silverman Voice Therapy (LSVT) (n=1). (3 RCTs)Patients with Parkinson's disease who had a speech deficit; 45 males and 18 females; all patients were on a stable drug regime.All the trials claimed a significant positive effect of speech and language therapy on dysarthria in Parkinson's disease on a number of outcome measures including volume, the mean loudness of a monologue, mean loudness of patients reading a standard passage, maximum pitch range, maximum volume range and fundamental frequency. In the one trial that folowed patients up to 6 months, the benefits were still evident at this time.

Considering the small number of patients examined and the methodological flaws in the studies, it is unsafe to draw firm conclusions regarding the efficacy of speech and language therapy.
1: Good
2: Good
3: Good
4: Good
5: Good
Author (year)
Deane (2002)[430]

Objective
To compare the efficacy and effectiveness of novel speech and language therapy (S & LT) techniques versus standard S & LT to treat dysarthria in patients with Parkinson's disease.

Number of included studies
2 RCTs (n=71)
Prosodic exercises versus prosodic exercises with visual clues.

Lee Silverman Voice Therapy (increases vocal adduction and respiratory effort) versus respiratory therapy using a 'Respigraph'.
Patients with Parkinson's disease who had a speech deficit.When the two trials were examined individually there was a trend in the intelligibility results favouring prosodic exercises without visual feedback over those with feedback. There was also a trend favouring the Lee Silerman Voice Therapy technique over respiration therapy, in outcomes measuring increases in loudness and decreases in monotonicity. However, considering the serious metholdological flaws in the studies, the small number of patients examined, and the possiblity of publication bias, it is unsafe to draw any conclusions regarding the efficacy of one form of S & LT over another.1: Good
2: Good
3: Good
4: Good
5: Good
Author (year)
Greener (2002)[427]

Objective
To assess the effects of formal speech and language therapy and non-professional types of support from untrained providers for people with aphasia after stroke.

Number of included studies
12 RCTs (n = 1179)
Speech and Language Therapy (SLT) compared to no support at all.
(2 RCTs) (n=405)

S & L from trained S & L therapist compared to informal support from volunteer, trained or untrained. (4 RCTs) (n = 361)

Untrained support from volunteer compared to no support of any kind.
(2 RCTs) (n = 178)

Formal S & LT from trained therapist compared to supportive counselling, also from trained S & L therapist. (1 RCT) (n = 60)

Comparisons of different types of S & LT.
(6 RCTs) (n=175)
Adults with acquired aphasia due to stroke (WHO criteria).Most of the trials were relatively old with poor or unassessable methodological quality. None of the trials were detailed enough for a complete description and analysis to be undertaken. It was therfore impossible for the review to determine whether formal speech and language therapy is more effective than informal support.1: Good
2: Good
3: Good
4: Good
5: Good

From: Appendix I, Evidence tables

Cover of Multiple Sclerosis
Multiple Sclerosis: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care.
NICE Clinical Guidelines, No. 8.
National Collaborating Centre for Chronic Conditions (UK).
Copyright © 2004, Royal College of Physicians of London.

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