BACKGROUND: Oropharyngeal dysphagia is a common and disabling consequence of stroke. Transcranial direct current stimulation (tDCS) has shown potential in promoting swallowing recovery, although evidence remains limited. OBJECTIVE: To determine whether bilateral anodal tDCS combined with intensive speech-language therapy (SLT) improves swallowing outcomes compared with sham stimulation in patients with post-stroke dysphagia. Exploratory analyses examined the influence of treatment phase, sex, lesion site, and baseline severity. METHODS: This multicenter, randomized, double-blind, sham-controlled trial enrolled patients with supratentorial or infratentorial ischemic stroke and oropharyngeal dysphagia. Participants received either bilateral anodal tDCS or sham stimulation (1.5 mA, 20 min/day, 5 days/week for 2 weeks) combined with intensive SLT over 6 weeks. Swallowing outcomes were assessed at baseline, 2 weeks, and 6 weeks using the Dysphagia Outcome and Severity Scale (DOSS, primary outcome), Penetration-Aspiration Scale (PAS), Mann Assessment of Swallowing Ability (MASA), and Swallowing Quality of Life questionnaire (SWAL-QoL). RESULTS: Forty-six patients (24 active, 22 sham) completed the protocol. Both groups showed significant improvement across all outcomes (p < 0.001), with no significant difference between active and sham stimulation. The DOSS was the most sensitive measure, showing sustained improvement over time. Exploratory analyses indicated greater MASA gains with active tDCS in infratentorial strokes (p = 0.04). Correlation analyses showed that greater baseline dysphagia severity was associated with larger functional gains. CONCLUSIONS: Intensive SLT was associated with meaningful recovery in post-stroke dysphagia, regardless of stimulation condition. Exploratory findings suggest that bilateral tDCS may confer additional benefit in selected lesion subgroups.
Children born with cleft palate, with or without cleft lip (CP ± L), are at high risk for speech and resonance disorders that can significantly impact communication and quality of life. Causes of cleft-related speech disorders include velopharyngeal insufficiency, malocclusion, dental anomalies, and airway obstruction. Accurate differential diagnosis is critical, as mismanagement can result in unnecessary surgery or ineffective therapy. Nonetheless, many children do not receive specialist evaluation or targeted intervention. Optimal outcomes require coordinated multidisciplinary care, with speech-language pathologists (SLPs) playing a central role in the assessment and treatment of feeding, articulation, resonance, and velopharyngeal function. However, a global shortage of trained SLPs has created major barriers to care, particularly in low- and middle-income countries, where geographic, financial, and infrastructure constraints further limit access. This article reviews the effects of CP ± L on speech, the essential contributions of SLPs, and the systemic challenges restricting service delivery, and proposes practical strategies for optimizing outcomes in resource-constrained settings. Service gaps are driven by workforce shortages, excessive caseloads, training deficits in cleft-specific care, and poor integration of speech services into healthcare systems. Promising strategies to mitigate these barriers include expanding cleft-specific training within university curricula and continuing education, implementing mentorship and "train-the-trainer" programs, and adopting task-shifting models that equip paraprofessionals, teachers, and caregivers to support therapy under SLP supervision. Telehealth provides opportunities for remote assessment, therapy, and professional supervision, whereas group therapy and structured parent-led home practice extend the impact of limited sessions. Standardized protocols for assessment and outcome reporting are essential for quality improvement and international data comparability. Policy initiatives that prioritize funding, workforce development, and integration of speech services into national health frameworks are critical for ensuring equitable, sustainable access to care. By adopting innovative, evidence-based approaches, including telehealth, mentorship, and parental involvement, healthcare providers can expand cleft speech services worldwide and improve long-term communication outcomes for children affected by CP ± L.
Medical sciences (Basel, Switzerland)Carmela De Domenico, Margherita La Fauci, Noemi Mancuso, Mariarita Caputo, Marcella Di Cara, Adriana Piccolo, Alessia Fulgenzi, Daniele Borzelli, Caterina Impa…
BACKGROUND/OBJECTIVES: Digital technologies are increasingly explored as complementary tools in speech and language therapy for children with neurodevelopmental disorders. However, evidence on virtual reality-based interventions for children with developmental language disorder (DLD) remains limited. This study aimed to evaluate the effects of a Virtual Reality Rehabilitation System (VRRS)-based language intervention combined with standard speech therapy in preschool children with DLD. Secondary objectives included assessing the feasibility, usability, and safety of the VRRS-integrated intervention. METHODS: A randomized controlled pilot study was conducted in preschool children diagnosed with DLD. Participants were allocated to an experimental group receiving VRRS-based language intervention integrated with conventional therapy or to a control group receiving standard speech therapy alone. Both groups attended two 60 min sessions per week for six months. Clinical language outcomes were assessed at baseline (T0) and post-intervention (T1). Feasibility was evaluated through adherence and retention rates, usability through a therapist-completed questionnaire, and safety through monitoring of adverse events during sessions. RESULTS: All participants in the experimental group completed the intervention (100% retention). No adverse events were observed. Therapists reported good usability of the VRRS system, highlighting ease of exercise customization, intuitive monitoring of progress, and good integration into routine therapy. CONCLUSIONS: VRRS-based activities integrated into conventional speech therapy appear feasible, safe, and well accepted in preschool children with DLD. Further controlled studies with larger samples are needed to confirm these findings. TRIAL REGISTRATION: ClinicalTrials.gov (NCT07438639).
JPMA. The Journal of the Pakistan Medical AssociationRamma Inam, Saleh Shah, Muhammad Sana Ullah, Tahreem Tariq, Hira Ashraf
The study was conducted to evaluate the effects of Ayres sensory integration therapy versus conservative treatment in autism spectrum disorder. In a prospective randomised controlled trial, we assessed pre- and post-intervention scores of both the intervention group (A) that took ASI and the control group (B) that received conservative treatment-only behaviour therapy, speech therapy, and educational activities of children with Autism Spectrum Disorder (ASD) -using sensory profile from Jan 2024 to July 2024. Thirty diagnosed ASD cases, age range 2-8 years, were randomly enrolled in both groups (n=15/group) at the RICCER Institute of Faisalabad. The intervention group (A) was noted to be significantly better in mean change as compared with the control group (B). Independent and paired t-test results showed significant relationship between ASI intervention group (A) and sensory integration dysfunction, while non-significant relationship between sensory integration dysfunction and conservative group (B) treatment (p> 0.05). Ayres Sensory Integration, an Occupational Therapy Approach, was significantly effective in developing socialisation, self-care, and aim accomplishment in comparison to conservative treatment in ASD.
International journal of language & communication disordersSione Twilt, Karin Neijenhuis, Rick de Graaff, Jan Ten Thije
BACKGROUND: Collaboration with parents is essential in speech and language therapy to achieve therapeutic goals for children. However, linguistic and cultural differences can complicate communication and collaboration with multilingual parents. This study offers insight into the perspectives, experiences, and needs of multilingual parents who share little or no common language with the Speech and Language Therapist (SLT) supporting their child. AIMS: This study aims to provide an in-depth understanding of the perspectives of multilingual parents on the perceived communication and collaboration with SLTs. METHODS: Individual in-depth interviews were conducted with 12 multilingual parents whose children were involved in SLT. The oral interviews were supported by a visual and tactile method, the Yucel method, which had not previously been applied in this context. The data were analysed using reflexive thematic analysis. RESULTS: Reflexive thematic analysis revealed six key themes: 1) Language barriers affect the equity within parent-SLT partnerships, 2) Inclusive communication in speech and language therapy is not self-evident, 3) Child-centred communication simplifies the complexity of the message, 4) There is a discrepancy between the desire and the possibilities for collaboration in therapy, 5) Contextual factors influence the interaction between parents and SLTs and 6) Empowerment of multilingual children and their parents enhances through speech and language therapy CONCLUSION: This study provides a unique view into the perspectives of multilingual parents regarding communication and collaboration with SLTs. The identified themes underscore the importance of increasing awareness of the complex multilingual interactions between SLTs, parents, and children. The findings highlight the vulnerable position of parents and advocate for the conscious and appropriate use of inclusive communication strategies in SLT practice. Furthermore, the study emphasizes that the impact of SLT extends beyond child empowerment, contributing to the broader support and inclusion of multilingual families. WHAT THIS PAPER ADDS: What is already known on this subject Speech and language therapists (SLTs) often face challenges when collaborating with multilingual parents due to linguistic and cultural differences. While some previous studies have explored parental perspectives on partnership with SLTs, little research has focused specifically on multilingual parents and their views on communication and partnership in speech and language therapy. What this study adds to existing knowledge This study offers a unique perspective of parents who share little or no common language with the SLTs supporting their children. It provides insight into the experiences, needs, and viewpoints of multilingual parents, a group often underrepresented in research. The findings emphasise the importance of raising awareness among SLTs of inclusive communication and collaboration with multilingual parents. What are the clinical implications of this study? This study underscores the importance of increasing awareness of the complex multilingual interactions between SLTs, parents, and children. It highlights the vulnerable position of parents and advocates for the adequate and conscious use of inclusive communication strategies when language barriers are significant. Moreover, speech and language therapy hold substantial value for multilingual families, contributing to their communicative self-efficacy. KEY POINTS: There is a discrepancy between parents' willingness to act as partners and the actual opportunities to collaborate in an equitable way in the absence of a shared language. Despite language differences, parents report increased empowerment in their family's communicative participation through speech and language therapy, underscoring its broader value. The use of complementary visual and tactile methods, such as Yucel, enables a more inclusive approach in both research and practice by facilitating access to parental perspectives that might otherwise remain underexplored.
International journal of language & communication disordersDaichi Iimura, Takuma Yamamoto, Osamu Ishida
PURPOSE: This systematic review and meta-analysis evaluated the fluency- enhancing effect of DAF alone in individuals with developmental stuttering. METHODS: Following PRISMA 2020 guidelines, we searched multiple databases for studies published between 2000 and 2024. Eligible studies examined DAF conditions applied to speech tasks with stuttering-related outcomes. Meta-analyses were conducted using a random-effects model, with subgroup analyses by disfluency type, delay time, speech task, stuttering severity, and participant age. RESULTS: Of the 194 records screened, eight studies involving a total of 98 participants in total met the inclusion criteria, and five studies involving 61 participants were eligible for quantitative synthesis. Each study included 8-20 participants ranging from school-age children to adults. Most participants were male, and stuttering severity ranged from mild to severe. DAF conditions were evaluated using oral reading and spontaneous speech/monologue tasks. Meta-analysis revealed no significant overall benefit of DAF compared with normal auditory feedback (NAF; mean difference = -1.46, 95% CI [-4.83, 1.91]). CONCLUSION: DAF alone does not consistently reduce disfluencies; however, specific populations and conditions may derive greater benefits from it. Larger, well-controlled studies are needed to clarify its therapeutic potential and clinical applications. WHAT THIS PAPER ADDS: What is already known on this subject Delayed auditory feedback (DAF) has been reported to improve fluency in people who stutter and is used in several assistive devices. However, its independent effect remains unclear because DAF is often combined with other altered auditory feedback conditions. What this study adds to existing knowledge This systematic review and meta-analysis evaluated the exclusive effect of DAF on stuttering. The results indicate that DAF alone does not consistently reduce disfluency compared with NAF, although certain conditions (e.g., shorter delays or reading tasks) may show greater benefits. What are the potential or actual clinical implications of this work? Clinicians should interpret the fluency-enhancing effects of DAF cautiously when used alone. Further well-controlled studies are needed to determine which individuals and speech contexts may benefit most from DAF-based interventions.
International journal of language & communication disordersFien Allemeersch, Kristiane Van Lierde, Cassandra Alighieri, Kim Bettens, Tara Mouton, Greet Hens, Nick Verhaeghe
PURPOSE: This paper aims to provide speech and language pathologists and researchers with practical, educational guidance on designing health economic evaluations (HEEs) to assess the cost-effectiveness of high-intensity speech intervention (HISI) for children with cleft palate with or without cleft lip (CP±L). METHOD: Key methodological considerations for designing HEEs of HISI for children with CP±L were identified by drawing on established frameworks. The foundational framework by Drummond et al. (2015) and the CHEERS reporting standards served as guiding structures for organizing and synthesizing principles relevant to conducting rigorous and transparent HEEs. Based on this conceptual synthesis, this paper provides practical recommendations to support researchers in implementing high-quality HEEs in the context of HISI for children with CP±L. CONCLUSIONS: Despite growing interest in HISI, rigorous evidence on its cost-effectiveness is still lacking. Well-designed HEEs are needed to inform policymakers about the efficient allocation of healthcare resources. Clear evidence on cost-effectiveness is essential to ensure that implementation and reimbursement decisions are based on interventions that are both clinically effective and economically justified. WHAT THIS PAPER ADDS: What is already known on this subject High-intensity speech intervention (HISI) is increasingly used in the management of speech sound errors in children with cleft palate with or without cleft lip (CP±L), with growing evidence supporting its clinical effectiveness. However, despite rising healthcare costs and pressure on effective service delivery, evidence on the cost-effectiveness of HISI remains limited. Health economic evaluations (HEEs) are well established in health research but are underutilised in speech and language therapy, and existing studies often show considerable methodological variability and limited transparency in reporting. What this study adds to existing knowledge This paper provides structured, practical guidance for designing rigorous HEEs of HISI for children with CP±L. Drawing on established frameworks and the CHEERS reporting standards, it synthesises key methodological considerations tailored to speech and language therapy research. The study clarifies how HEEs can be systematically integrated into intervention research in this field and offers concrete recommendations to improve methodological quality, transparency, and comparability of future economic evaluations of speech interventions for children with CP±L. What are the clinical implications of this study? By supporting the design of high-quality HEEs, this paper enables speech and language pathologists and researchers to generate evidence on the economic value of HISI. Such evidence can inform service planning and reimbursement decisions, supporting efficient allocation of resources in cleft care. Ultimately, improved economic evidence may facilitate wider, equitable implementation of effective interventions while ensuring sustainability of speech and language therapy services for children with CP±L.
International journal of language & communication disordersKatherine Pritchard, Vesna Stojanovik, Jill Titterington, Emma Pagnamenta
BACKGROUND: Speech sound disorder (SSD) is broadly defined as difficulty producing speech sounds in childhood. It can have a lasting impact on academic outcomes and well-being, making effective early intervention vital. Speech and language therapists (SLTs) consider parental involvement-particularly supporting their child with home practice-as essential to a child's progress. Relationships between SLTs and parents are known to facilitate this engagement. However, there is a significant gap in the literature regarding parents' perspectives, and little is known about what parents perceive to be most effective in supporting home practice. Understanding these perspectives is crucial for designing interventions that are both feasible and meaningful for families. AIM: To explore the perspectives of parents of children with SSD aged ≤5;11, about their experiences with speech and language therapy intervention sessions and home practice. METHODS AND PROCEDURES: This study used qualitative methodology. Nine parents, recruited via social media, professional networks and a university clinic, participated in focus groups or 1:1 interviews. A group of children, aged 4-6, who had lived experience of SSD, speech and language therapy and home practice were consulted to design the topic guide and inform data analysis. Discussions were recorded, transcribed verbatim and analysed using Reflexive Thematic Analysis. OUTCOMES AND RESULTS: Four main themes were constructed as follows: (1) Building positive therapeutic relationships is fundamental to families' experiences and creates the foundation for successful home practice. (2) SLTs need to employ a wide range of skills and knowledge, including a multi-modal approach to empower parents and develop their capability. (3) Clear communication is key for shared power, understanding of roles, active involvement and effective home practice. (4) Factors outside an individual's control can impact parents' attitudes towards, and engagement with, home practice. CONCLUSIONS AND IMPLICATIONS: We conclude that relationships between SLTs and parents, and the skills required to build these, underpin parental motivation to engage in home practice. To maximise parental capability, SLTs ensure that parents understand not only what to do but why they are doing it, utilising a variety of methods. Whilst some barriers for home practice are out of the SLT's control, using all opportunities to develop the motivation and capability of the parents is required. To achieve this, service delivery models may need to be reconsidered. WHAT THIS PAPER ADDS: What is already known on this subject SSD that persists into school years can have lasting implications for a child's academic outcomes and well-being. Effective and efficient early intervention is essential. SLTs and parents agree that working together, including parental delivery of home practice, is important for a child's progress. Little is known about how parents experience and perceive what SLTs do within intervention sessions to ensure parents feel confident and capable of delivering effective home practice. What this paper adds to existing knowledge This is the first study to explore parents' perceptions and experiences of what SLTs do within direct intervention sessions for young children with SSD and how this supports parents to become implementors of intervention for their child at home. Findings suggest that parents benefit from SLTs using a range of teaching and coaching approaches, including clear instructions and active involvement, to ensure parents feel confident and capable at home. Relationships between the parent, SLT and the child are highly valued by parents, and are fundamental for parental engagement with home practice. What are the potential or actual clinical implications of this work? SLTs prioritising building effective relationships with parents and children can support parental motivation for home practice. SLTs can work with parents to increase opportunities for home practice by building it into their daily lives, including working with other family members. To maximise parental capability, it is important to ensure that parents understand not only what to do but why they are doing it, utilising a variety of methods. To achieve this, service delivery models may need to be reconsidered.