2009 Adult Language Group NSW Speech Pathology Evidence Based Practice NETWORK

1. 2009 Adult Language Group NSW Speech Pathology Evidence Based Practice NETWORK Janine Mullay, Kate Schuj and Anika Roseby (Group Co-Leaders) Lyndsey Nickels - Academic Member Clare McCluskey (nee Owens) – 2009 Extravaganza Presenter

2. TIPS FOR ANSWERING A CLINICAL QUESTION? • Ask a question that can be answered • Ask a question that is relevant to clinical decision making • Ask a question that is specific • Use the 4 key components in the question: 1. The patient/problem 2. Intervention 3. Comparison intervention/test 4. Outcome • Search broadly at first before specifying the question • Consider ‘how and in what circumstances a treatment improves a certain impairment’

3. CLINICAL QUESTION 2009 What are the effective therapy techniques currently being used to improve auditory comprehension deficits in people with aphasia?

4. 2009 CAPS (CRITICALLY APPRAISED PAPERS) • 12 possible articles were found • Only 3 answered our clinical question and were included in the CAT • Remediation of auditory comprehension deficits needed to be addressed by the study to be included and all study subjects had auditory comprehension deficits as a result of stroke

5. Behrmann & Lieberthal (1989) • All treated items showed increased semantic comprehension both intra- and post- therapy compared with pre-therapy • Multimodal approach was used (auditory semantic cues, spoken, written and picture form of the treated words) • Therapy tasks included: - teaching meaning/semantics of treated categories and items within categories - written and verbal word to picture matching - auditory semantic feature to picture matching - matching spoken and written words to each other - locating items/target words in dictionary

6. Grayson, Hilton & Franklin (1997) • Specific therapy targeting auditory, semantic and sentence processing resulted in significant improvements in these areas on specific tests. • Therapy cues included repetition, gesture, semantic and orthographic cues. • Specific therapy tasks included spoken word-picture matching, categorizing pictures into separate groups, matching written word associates and auditory sentence-picture matching.

7. Maneta, Marshall & Lindsay (2001) • Impairment-based therapy for word sound deafness may not be effective treatment for chronic aphasia • Therapy targeting the use of effective compensatory strategies with primary communication partners can lead to significant functional gains and decreased communication breakdowns in conversation.

8. Applying the results to clinical practice • Aim to increase your confidence in critically evaluating a paper; • Trust that evidence based practice will improve your skills as a clinician; • Test yourself and your boundaries; • Try it out and share your success!

9. Applying the 2009 results to clinical practice • Small number of studies (three) • And small ‘n’ • BUT Speech Pathology = single case studies! • No ‘right answer’ or single solution

10. 2009 CAT (Critically appraised Topic) • Clinical bottom line: Auditory comprehension deficits may benefit from specific speech therapy treatment techniques. Direct therapy using a multimodal approach may be beneficial in improving comprehension of treated items. Family training regarding the use of compensatory strategies can lead to significant functional gains, including decreased number of communication breakdowns in conversation.

11. REFERENCES • Behrmann, M. & Lieberthal, T. (1989). Category-specific treatment of a lexical-semantic deficit: A single case study of global aphasia. British Journal of Disorders of Communication, 24, 281-299. • Grayson E, Hilton R & Franklin S. (1997). Early intervention in a case of jargon aphasia: efficacy of language comprehension therapy. European Journal of Disorders of Communication, vol. 32, pp. 257-276. • Maneta A, Marshall J, Lindsay J. (2001). Direct and indirect therapy for word sound deafness. International Journal of Language & Communication Disorders, 36(1): 91-106. • Tate, R.L; McDonald, S; Perdices, M; Togher, L; Schultz, R; & Savage, S. (2008). Rating the methodological quality of single-subject designs and n-of-1 trials: Introducing the Single-Case Experimental Design (SCED) Scale. Neuropsychological Rehabilitation An International Journal, Vol 18 (4), pp. 385-401.