A Technology-Assisted Language Intervention for Children Who Are Deaf or Hard of Hearing: A Randomized Clinical Trial.

BACKGROUND AND OBJECTIVES: Children who are deaf or hard of hearing (DHH) often have persistent language delays despite early identification and interventions. The technology-assisted language intervention (TALI), which incorporates augmentative and alternative communication technology into a speech-language therapy model, was designed to support language learning. The study objective was to evaluate the impact of the TALI on spoken language outcomes in DHH children. METHODS: Children aged 3 to 12 years with mild to profound bilateral hearing loss were enrolled in a single-site randomized controlled trial. Children were randomly assigned to receive the TALI or treatment as usual (TAU) (with no change in current care) and were followed for 24 weeks. Primary outcomes included spoken language measures elicited from language samples. Secondary outcomes included standardized assessments. Intention-to-treat analyses were used. RESULTS: Analyses focused on 41 children randomly assigned to TALI (n = 21) or TAU (n = 20). Among all participants, mean age was 6.3 years (SD 2.5). Over 24 weeks, children in the TALI group, compared with those in the TAU group, had significantly greater increases in the length of phrases they used to express themselves (ß = .91 vs .15, respectively; P< .0001). Similar findings were seen with conversational turn-taking and number of different words spoken. CONCLUSIONS: Providing visual supports for language concepts that are typically challenging for DHH children to acquire allowed children to process and comprehend spoken language more fully. Such strategies can mitigate persistent language delays with the goal of improving lifelong outcomes and independence across settings.

Short-term and sustained effects of a three-week neuro-developmental treatment intensive: A case series report.

BACKGROUND: Neuro-Developmental Treatment (NDT) currently embraces evidence-based concepts of motor control, motor learning and neuroplasticity. However, most research has been performed on outdated models of NDT. OBJECTIVE: This case series examines the short- and long-term outcomes of a three-week intensive using contemporary NDT interventions. METHODS: Six children, 2-10 years old with neurologic disorders and Gross Motor Function Classification System (GMFCS) levels I-III participated in the intervention. The three-week intensive included 60 minutes of physical, occupational and speech therapy 3-5 times weekly. RESULTS: All children demonstrated Gross Motor Function Measure-66 gains of medium to large effect sizes. These gains were maintained or improved upon 3 months' post conclusion of the intensive intervention. CONCLUSIONS: This study supports emerging research regarding the effectiveness of intensive intervention and further study of current NDT interventions.

COVID-19 and ENT SLT services, workforce and research in the UK: A discussion paper.

BACKGROUND: The COVID-19 pandemic and the UK government's subsequent coronavirus action plan have fundamentally impacted on every aspect of healthcare. One area that is severely affected is ear, nose and throat (ENT)/laryngology where speech and language therapists (SLTs) engage in a diverse range of practice with patients with a range of conditions, including voice disorders, airway problems, and head and neck cancers (HNCs). A large majority of these patients are in high-risk categories, and many specialized clinical practices are vulnerable. In addition, workforce and research issues are challenged in both the immediate context and the future. AIMS: To discuss the threats and opportunities from the COVID-19 pandemic for SLTs in ENT/laryngology with specific reference to clinical practice, workforce and research leadership. METHODS & PROCEDURES: The relevant sections of the World Health Organisation's (WHO) health systems building blocks framework (2007) were used to structure the study. Expert agreement was determined by an iterative process of multiple-group discussions, the use of all recent relevant policy documentation, and other literature and shared documentation/writing. The final paper was verified and agreed by all authors. MAIN CONTRIBUTION: The main threats to ENT/laryngology SLT clinical services include increased patient complexity related to COVID-19 voice and airway problems, delayed HNC diagnosis, reduced access to instrumental procedures and inequitable care provision. The main clinical opportunities include the potential for new modes of service delivery and collaborations, and harnessing SLT expertise in non-instrumental assessment. There are several workforce issues, including redeployment (and impact on current services), training implications and psychological impact on staff. Workforce opportunities exist for service innovation and potential extended ENT/SLT practice roles. Research is threatened by a reduction in immediate funding calls and high competition. Current research is affected by very limited access to participants and the ability to conduct face-to-face and instrumental assessments. However, research opportunities may result in greater collaboration, and changes in service delivery necessitate robust investigation and evaluation. A new national set of research priorities is likely to emerge. CONCLUSIONS & IMPLICATIONS: The immediate impact of the pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. It is unclear when any of these areas will resume operations and whether permanent changes to clinical practice, professional remits and research priorities will follow. However, significant opportunity exists in the post-COVID era to re-evaluate current practice, embrace opportunities and evaluate new ways of working. What this paper adds What is already known on the subject ENT/laryngology SLTs manage patients with a range of conditions, including voice disorders, airway problems and HNCs. The diverse scope of clinical practice involves highly specialized assessment and treatment practices in patients in high-risk categories. A large majority of active research projects in this field are patient focused and involve instrumental assessment. The COVID-19 pandemic has created both opportunities and threats for ENT SLT clinical services, workforce and research. What this paper adds to existing knowledge This study provides a discussion of the threats and opportunities from the COVID-19 pandemic for ENT/laryngology SLT with specific reference to clinical practice, workforce and research leadership. What are the potential or actual clinical implications of this work? The COVID-19 pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. Changes to clinical practice, professional remits and research priorities are of indeterminant duration at this time, and some components could be permanent. Significant clinical practice, workforce and research opportunities may exist in the post-COVID era.

Speech and language therapy approaches to managing primary progressive aphasia.

The term primary progressive aphasia (PPA) describes a group of neurodegenerative disorders with predominant speech and language dysfunction as their main feature. There are three main variants - the semantic variant, the nonfluent or agrammatic variant and the logopenic variant - each with specific linguistic deficits and different neuroanatomical involvement. There are currently no curative treatments or symptomatic pharmacological therapies. However, speech and language therapists have developed several impairment-based interventions and compensatory strategies for use in the clinic. Unfortunately, multiple barriers still need to be overcome to improve access to care for people with PPA, including increasing awareness among referring clinicians, improving training of speech and language therapists and developing evidence-based guidelines for therapeutic interventions. This review highlights this inequity and the reasons why neurologists should refer people with PPA to speech and language therapists.

Evaluación de la dimensión semántica y fonológica en pacientes con esquizofrenia / Evaluation of the semantic and phonological dimension in patients with schizophrenia

Antecedentes y objetivo: La esquizofrenia se caracteriza por una distorsión del pensamiento, las percepciones, las emociones, el lenguaje, la conciencia de sí mismo y la conducta. Afecta a más de 21 millones de personas en todo el mundo y es una de las 10 enfermedades más incapacitantes según la Organización Mundial de la Salud; sin embargo, existe escasa evidencia sobre el déficit lingüístico con el que cursa la enfermedad. Metodología: Se trata de un estudio transversal y cuasi-experimental donde se analizan los datos de diferentes pruebas lingüísticas de las áreas de semántica y fonología en una muestra compuesta por 96 sujetos, de los cuales 48 (50%) tienen esquizofrenia y componen el grupo experimental y otros 48 (50%) no tienen ninguna enfermedad mental y componen el grupo control. Según la clasificación de Crow, el 56,2% de los participantes con esquizofrenia (27 sujetos) presentaba sintomatología positiva y el 43,8% (21 sujetos) presentaba sintomatología negativa. Resultados: Se observa un patrón de déficit según la sintomatología, así como una afectación de las áreas lingüísticas evaluadas (semántica y fonología). Conclusiones: La esquizofrenia cursa con déficit lingüístico en la semántica y en la fonología, siendo necesario evaluar dichas áreas lingüísticas para poder intervenir logopédica y multidisciplinarmente sobre ellas

Background and objective: Schizophrenia is characterized by a distortion of thin-king, perceptions, emotions, language, self-awareness, and behaviour. It affects more than 21 million people worldwide and is one of the 10 most disabling diseases according to the World Health Organization. However, there is little evidence of language deficits in patients with schizophrenia. Method: This is a cross-sectional and quasi-experimental study in which the data of the evaluation of different linguistic tests in the areas of semantics and phonology are analysed. The sample consisted of 96 subjects, 48 of whom (50%) had schizophrenia and made up the experimental group and other 48 (50%) had no mental illness and made up the control group. According to the classification of Crow, 56.2% (27 subjects) presented with positive symptomatology and 43.8% (21 subjects) presented with negative symptoms. Results: A deficit pattern according to the symptomatology was observed, as well as an affectation of all the areas examined in the study (semantics and phonology). Conclusions: Schizophrenia involves a linguistic deficit in semantics and phonology. It is necessary to assess these linguistic areas in order to intervene from a multidisciplinary approach, including speech therapy

Congruence in Research Question, Design, and Analysis: A Tutorial on the Measurement of Change in Clinical Speech and Language Research.

Purpose Measuring change is a common goal in clinical research, and comparing nonequivalent groups is sometimes a necessity in this context. Yet, evaluating change in this way can be problematic, and little consensus is reported on the best way to conduct such an evaluation. This tutorial presents the process of planning a clinical study designed to measure change in the context of a therapeutic intervention. Method This article presents a hypothetical clinical research scenario and follows the process of study design from question formulation to interpretation of results. The presentation focuses on the use of gain score analysis in the context of nonequivalent participant groups, methods that may be particularly relevant to the clinical context. Conditions that are favorable to gain score use, as well as situations that are problematic for gain score use, are presented. Conclusions In this article, the clinical research process is presented, following a logical process from formulation of a clear research question to selection of an appropriate research design to implementation of an effective analysis method. Gain score analysis is presented as an effective tool to measure change in clinical research, even with nonequivalent groups, given the correct conditions.

¿Cuál es la relación entre el síndrome de burnout, el sentido de la vida y el proyecto de vida laboral en los médicos residentes?: una perspectiva logoterapéutica / What is the relationship between burnout syndrome, the meaning of life and the project of working life in resident physicians ?: a logotherapeutic perspective

Introducción: el síndrome de burnout (BO) suele afectar a médicos residentes, debido al estrés laboral crónico. Desde un marco logoterapéutico, la pérdida de un sentido de la vida (SV) es el denominador más común de todas las formas de perturbación emocional, y el BO podría enmarcarse dentro de un proyecto de vida laboral (PVL) con enrolamiento enajenante. El objetivo principal del trabajo es evaluar la relación entre el BO, el SV y el PVL, en los programas de residencia del Hospital Italiano de Buenos Aires. Población y métodos: se evaluaron residentes de 6 programas de residencia del Hospital Italiano de Buenos Aires, a través de un cuestionario. El BO se midió con el "Maslach Burnout Inventory" (MBI). El SV se midió con el "Purpose in Life Test" (PIL Test). El PVL se midió con la Escala de PVL de la Dra. Isabel Pérez Jáuregui. Resultados: participaron 104 residentes. El 28,8% de los evaluados mostraron BO, el 18,3% falta de SV y el 30,8% un PVL inauténtico con sobreadaptación. Tanto la falta de SV como el PVL inauténtico con sobreadaptación se asociaron en forma estadísticamente significativa con BO (p < 0,01), y la presencia de cualquiera de estas alteraciones aumentó en casi 18 veces (odds ratio [OR] crudo) la probabilidad de presentar el síndrome. Los OR ajustados de falta de SV (6,28) y PVL inauténtico (9,57) para la presencia de BO continuaron siendo estadísticamente significativos. Por último, en esta investigación pudimos determinar que las subescalas del MBI agotamiento y despersonalización se correlacionaron negativamente con el PIL Test (r=-0,41 y r=-0,53, respectivamente) y la Escala de PVL (r=-0,45 y r=-0,42, respectivamente), mientras que la subescala de realización se correlacionó positivamente en forma significativa con estas dos últimas (r=0,63 y r=0,61, respectivamente). Conclusiones: se encontró una relación estadísticamente significativa entre BO, falta de SV y PVL inauténtico, en la residencia. (AU)

Introduction: The Burnout Syndrome (BO) usually affects medical residents because they are exposed to chronic labour stress. From a logotherapeutic view, the loss of meaning and purpose in life (ML) is the common denominator of all types of emotional distress, and the BO could belong to an altered labour life project (LLP) with overadaptation. The objective of this study was to evaluate the relationship between the BO, the ML, and the LLP, in residency programs at a university hospital. Population and methods: residents from six programs at Hospital Italiano de Buenos Aires were evaluated. The BO was measured with the Maslach Burnout Inventory (MBI). The ML was measured with the Purpose in Life Test (Pil Test). The LLP was measured with the LLP Scale created by Doctor Isabel Pérez Jáuregui. Results: one hundred and four residents participated. Out of the evaluated residentes, 28.8% showed BO. The loss of ML was observed in 18.3%, and an altered LLP with overadaptation affected the 30.8% of the sample. Loss of ML and altered LLP with overadaptation were associated in a statistically significant way with BO (p<0.01), and the presence of any of this alterations increased the odds ratio almost 18 times to suffer BO. The adjusted odds ratio of loss of ML (6.28) and altered LLP (9.57) to suffer BO, were also statistically significant. Finally, a negative correlation was observed between exhaustion and despersonalization (MBI) and the Pil Test (r=-0.41 and r=-0.53, respectively) and the LLP Scale (r=-0.45 and r=-0.42, respectively), while a positive significant correlation was observed between the personal accomplishment (MBI) and the Pil Test and LLP Scale (r=0.63 and r=0.61, respectively). Conclusions: in the residency, we found a statistically significant relationship between BO, loss of ML and altered LLP. (AU)

Take Home Points: How to Use Statistical Learning.

Purpose: The purpose of this epilogue is to synthesize the main points of the articles in this issue on statistical learning for clinicians. These points can be used to guide practice.

A survey of speech-language therapy provision for people with post-stroke dysarthria in the UK.

BACKGROUND: A large number of people who experience a stroke are affected by dysarthria. This may be in isolation or in association with aphasia and/or dysphagia. Despite evidence highlighting the psychological and social impact of having post-stroke dysarthria and a number of clinical guidelines that make recommendations for appropriate management, little is known currently about UK service delivery issues relating to speech and language therapy (SLT) assessment and treatment for this group. Such evidence is necessary in order to plan, develop and research services for people with post-stroke dysarthria. AIMS: To gain an overview of SLT practices in the management of people with dysarthria after stroke in the UK. METHODS & PROCEDURES: SLTs in the UK were asked to complete an online survey addressing referral patterns, caseload profiles, and their assessment and intervention methods for post-stroke dysarthria. In the absence of a national register of clinicians working with people with acquired dysarthria, a snowballing method was used to facilitate participant recruitment. Results were analysed using descriptive statistics. OUTCOMES & RESULTS: A total of 146 SLTs responded. The majority were employed by the National Health Service (NHS). Most patients were referred within 1 week post-stroke. Almost half the respondents did not regularly use formal assessments and the use of instrumentation was rare, including the use of video recording. The focus of therapy for mild, moderate and severe dysarthria did not differ significantly for clinicians. A little under half the respondents endorsed non-verbal oral exercises in rehabilitation. The survey demonstrated some appreciation of the centrality of regular intensive practice to effect change, but this was in a minority. CONCLUSIONS & IMPLICATIONS: Through this research it became clear that basic information regarding post-stroke dysarthria incidence, prevalence and core demographics is currently unavailable. More embedded NHS SLT reporting systems would make a significant contribution to this area. A more in-depth examination is required of the natural history of dysarthria over the months and years following stroke, of SLT practices in relation to post-stroke dysarthria, with investigations to understand more fully the choices SLTs make and how this relates to available evidence to support their clinical decision-making.

Content analysis of the professional journal of the Royal College of Speech and Language Therapists, III: 1966-2015-into the 21st century.

BACKGROUND: Following content analyses of the first 30 years of the UK speech and language therapy professional body's journal, this study was conducted to survey the published work of the speech (and language) therapy profession over the last 50 years and trace key changes and themes. AIM: To understand better the development of the UK speech and language therapy profession over the last 50 years. METHODS & PROCEDURES: All volumes of the professional journal of the Royal College of Speech and Language Therapists published between 1966 and 2015 (British Journal of Communication Disorders, European Journal of Communication Disorders and International Journal of Language and Communication Disorders) were examined using content analysis. The content was compared with that of the same journal as it appeared from 1935 to 1965. OUTCOMES & RESULTS: The journal has shown a trend towards more multi-authored and international papers, and a formalization of research methodologies. The volume of papers has increased considerably. Topic areas have expanded, but retain many of the areas of study found in earlier issues of the journal. CONCLUSIONS & IMPLICATIONS: The journal and its articles reflect the growing complexity of conditions being researched by speech and language therapists and their professional colleagues and give an indication of the developing evidence base for intervention and the diverse routes which speech and language therapy practice has taken over the last 50 years.

Eficacia de los programas de ejercicios de motricidad oral para el tratamiento logopédico de las dificultades de habla / Non-speech oral motor treatment efficacy for children with developmental speech sound disorders

Introducción. En el tratamiento logopédico de las dificultades de habla se practican dos enfoques metodológicos antagó-nicos: los no verbales, basados en ejercicios de motricidad oral (EMO), y los verbales, que se basan en tareas de procesamiento de habla con sílabas, fonemas y palabras. En España, los programas de EMO se llaman ‘programas de praxias’, están muy difundidos y son apreciados por los logopedas. Objetivo. Revisar los estudios sobre la eficacia de los tratamientos basados en EMO aplicados a niños con trastornos de habla y los argumentos teóricos que podrían justificar o no su utilidad. Desarrollo. Durante las últimas décadas se han acumulado pruebas sobre la falta de eficacia de este enfoque en el tratamiento de los trastornos evolutivos del habla y en las dificultades de pronunciación de poblaciones sin alteración neurológica de la función motriz. La American Speech-Language-Hearing Association ha desaconsejado su uso atendiendo a los principios de práctica basada en la evidencia. Los conocimientos acumulados sobre el control motor demuestran que el patrón de movilidad y su correspondiente organización cerebral son diferentes en el habla y en otras funciones no verbales ligadas a la alimentación y la respiración. Conclusiones. Ni los estudios sobre su eficacia ni los argumentos a partir de estudios del control motor aconsejan el uso de los programas basados en EMO para el tratamiento de las dificultades de pronunciación en niños con trastornos evolutivos del lenguaje (AU)

Introduction. In the treatment of speech disorders by means of speech therapy two antagonistic methodological approaches are applied: non-verbal ones, based on oral motor exercises (OME), and verbal ones, which are based on speech processing tasks with syllables, phonemes and words. In Spain, OME programmes are called ‘programas de praxias’, and are widely used and valued by speech therapists. Aim. To review the studies conducted on the effectiveness of OME-based treatments applied to children with speech disorders and the theoretical arguments that could justify, or not, their usefulness. Development. Over the last few decades evidence has been gathered about the lack of efficacy of this approach to treat developmental speech disorders and pronunciation problems in populations without any neurological alteration of motor functioning. The American Speech-Language-Hearing Association has advised against its use taking into account the principles of evidence-based practice. The knowledge gathered to date on motor control shows that the pattern of mobility and its corresponding organisation in the brain are different in speech and other non-verbal functions linked to nutrition and breathing. Conclusions. Neither the studies on their effectiveness nor the arguments based on motor control studies recommend the use of OME-based programmes for the treatment of pronunciation problems in children with developmental language disorders (AU)

[Dysphonia in children: Retrospective and comparative study between the late 1980s and today].

Child dysphonia is a frequent pathological situation which concerns 6 to 38 percent of a school attending population. Thus it demands a specific and adapted treatment. Because of its direct consequences on social, family and school lives, parents often seek advice from a speech specialist. This study focuses on the specificities of those individuals having diagnosed child dysphonia, as well as the treatment which can be given to them. Our work covers a period of twenty years of comparative studies. We have read through dr Coulombeau's files, from 2005 to 2011, and we have made up a series of questions addressed to the speech therapists having speech impaired children in their practice. We have cross-examined these data with those of Dr Cornut's, covering a period of seven years (1985-1991). The qualitative and quantitative studies which have been carried out enabled us to highlight the fact there has been a constant background of child dysphonia and an evolution in the offered treatments. Indeed, we have realised that the number of individuals having diagnosed child dysphonia are less and less operated on. In the same time people tend to ignore the offered treatments. Though the follow-ups to a prior visit at a speech therapist have decreased for twenty years, it still remains the most common treatment. Our analysis does not focus on the effects of the given treatments on a long term basis. It thus appears that a study consisting in analysing the development of these children through adulthood would be greatly accurate.

[Research and professional practice in speech therapy]. / Investigación y práctica profesional en logopedia.

The relationship between research and clinical practice is discussed based on the request of this last on new therapeutic perspectives and empirical confirmations of their decisions. Two examples of a clear and justified relation between theoretical research data and the later development of an intervention program illustrate the achievements and disappointments of these relationships. From this analysis, the proposal of evidence-based practice is discussed, the requirements involved and the difficulties in its practical application, especially in the intervention in aspects such as semantics and pragmatics. It finally points out the lack of research on an item that is considered crucial to the effectiveness of therapy: the characteristics and skills of the therapist.

TITLE: Investigacion y practica profesional en logopedia.Las relaciones entre la investigacion y la practica clinica se analizan a partir de la demanda de esta ultima acerca de nuevas perspectivas terapeuticas y de una confirmacion empirica de sus decisiones. Dos ejemplos de una relacion clara y justificada entre datos de la investigacion teorica y el desarrollo posterior de programas de intervencion sirven para ilustrar los logros y las decepciones de estas relaciones. A partir de dicho analisis, se comenta la propuesta de la practica basada en la evidencia, las exigencias que supone y las dificultades de su aplicacion concreta, sobre todo en la intervencion en aspectos como la semantica y la pragmatica. Se señala, finalmente, la ausencia de investigaciones acerca de un elemento que se estima crucial en la eficacia de una terapia, es decir, las caracteristicas y habilidades del terapeuta.

An overview of managing stuttering in Japan.

PURPOSE: The purpose of this article is to describe the rapid development of speech-language pathology in Japan since governmental licensing started in 1997 and to summarize the current trends in assessing and treating stuttering for preschoolers, school-age children, adolescents, and adults. METHOD: The authors review relevant information about the current assessment and treatment services for people who stutter in Japan and discuss the issues and challenges faced by speech-language pathologists in managing stuttering. CONCLUSION: It is predicted that as expertise in stuttering grows in Japan, the role of stuttering specialists in allied health, school districts, and research will increase.

Investigación y práctica profesional en logopedia / Research and professional practice in speech therapy

Las relaciones entre la investigación y la práctica clínica se analizan a partir de la demanda de esta última acerca de nuevas perspectivas terapéuticas y de una confirmación empírica de sus decisiones. Dos ejemplos de una relación clara y justificada entre datos de la investigación teórica y el desarrollo posterior de programas de intervención sirven para ilustrar los logros y las decepciones de estas relaciones. A partir de dicho análisis, se comenta la propuesta de la práctica basada en la evidencia, las exigencias que supone y las dificultades de su aplicación concreta, sobre todo en la intervención en aspectos como la semántica y la pragmática. Se señala, finalmente, la ausencia de investigaciones acerca de un elemento que se estima crucial en la eficacia de una terapia, es decir, las características y habilidades del terapeuta (AU)

The relationship between research and clinical practice is discussed based on the request of this last on new therapeutic perspectives and empirical confirmations of their decisions. Two examples of a clear and justified relation between theoretical research data and the later development of an intervention program illustrate the achievements and disappointments of these relationships. From this analysis, the proposal of evidence-based practice is discussed, the requirements involved and the difficulties in its practical application, especially in the intervention in aspects such as semantics and pragmatics. It finally points out the lack of research on an item that is considered crucial to the effectiveness of therapy: the characteristics and skills of the therapist (AU)

Child speech, language and communication need re-examined in a public health context: a new direction for the speech and language therapy profession.

BACKGROUND: Historically speech and language therapy services for children have been framed within a rehabilitative framework with explicit assumptions made about providing therapy to individuals. While this is clearly important in many cases, we argue that this model needs revisiting for a number of reasons. First, our understanding of the nature of disability, and therefore communication disabilities, has changed over the past century. Second, there is an increasing understanding of the impact that the social gradient has on early communication difficulties. Finally, understanding how these factors interact with one other and have an impact across the life course remains poorly understood. AIMS: To describe the public health paradigm and explore its implications for speech and language therapy with children. METHODS & PROCEDURES: We test the application of public health methodologies to speech and language therapy services by looking at four dimensions of service delivery: (1) the uptake of services and whether those children who need services receive them; (2) the development of universal prevention services in relation to social disadvantage; (3) the risk of over-interpreting co-morbidity from clinical samples; and (4) the overlap between communicative competence and mental health. OUTCOMES & CONCLUSIONS: It is concluded that there is a strong case for speech and language therapy services to be reconceptualized to respond to the needs of the whole population and according to socially determined needs, focusing on primary prevention. This is not to disregard individual need, but to highlight the needs of the population as a whole. Although the socio-political context is different between countries, we maintain that this is relevant wherever speech and language therapists have a responsibility for covering whole populations. Finally, we recommend that speech and language therapy services be conceptualized within the framework laid down in The Ottawa Charter for Health Promotion.

Stroke: has speech and language therapy been shown not to work?

In a recent trial investigating the effectiveness of speech and language therapy versus a control intervention in poststroke aphasia, patient outcome improved equally in both groups. However, flaws in the study relating to design of the control intervention, inadequate therapy 'dose', and the interpretation of null results should be highlighted.