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Intervention for dysarthria associated with acquired brain injury in children and adolescents

  • Review
  • Intervention

Authors

  • Angela T Morgan,

    Corresponding author
    1. Murdoch Childrens Research Institute, Healthy Development [Theme], Language & Literacy, Melbourne, Victoria, Australia
    • Angela T Morgan, Healthy Development [Theme], Language & Literacy, Murdoch Childrens Research Institute, Parkville, Melbourne, Victoria, 3052, Australia. angela.morgan@mcri.edu.au.

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  • Adam P Vogel

    1. The University of Melbourne, Centre for Neuroscience, Melbourne, Victoria, Australia
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Abstract

Background

The term 'acquired brain injury' (ABI) incorporates a range of aetiologies including cerebrovascular accident, brain tumour and traumatic brain injury. ABI is a common cause of disability in the paediatric population, and dysarthria is a common and often persistent sequelae associated with ABI in children.

Objectives

To assess the efficacy of intervention delivered by Speech and Language Pathologists/Therapists targeting dysarthric speech in children resulting from acquired brain injury.

Search methods

We searched CENTRAL (Issue 4, 2006), MEDLINE (1966 to 02/2007), CINAHL (1982 to 02/2007), EMBASE (1980 to 02/2007), ERIC (1965 to 02/2007), Linguistics Abstracts Online (1985 to 02/07), PsycINFO (1872 to 02/2007). Additional references were also sought from reference lists studies. 

Selection criteria

The review considered randomised controlled trials (RCTs) and quasi-experimental design studies of children aged 3-16 years with acquired dysarthria grouped by aetiology (e.g., brain tumour, traumatic brain injury, cerebrovascular accident).

Data collection and analysis

Each author independently assessed the titles and abstracts for relevance (100% inter-rater reliability) and the full text version of all potentially relevant articles was obtained. No studies met inclusion criteria.

Main results

Of 2091 titles and abstracts identified, full text versions of only three  (Morgan 2007; Murdoch 1999; Netsell 2001) were obtained. 2088 were excluded, largely on the basis of not including dysarthria, being diagnostic or descriptive papers, and for concerning adults rather than children. Morgan 2007 and Murdoch 1999 were excluded for not employing RCT or quasi-randomised methodology; Netsell 2001 on the basis of being a theoretical review paper, rather than an intervention study. Five references were identified and obtained from the bibliography of the Murdoch 1999 paper. All were excluded due to including populations without ABI, adults with dysarthria, or inappropriate design. Thus, no studies met inclusion criteria.

Authors' conclusions

The review demonstrates a critical lack of studies, let alone RCTs, addressing treatment efficacy for dysarthria in children with ABI. Possible reasons to explain this lack of data include i) a lack of understanding of the characteristics or natural history of dysarthria associated with this population; ii) the lack of a diagnostic classification system for children precluding the development of well targeted intervention programs; and iii) the heterogeneity of both the aetiologies and resultant possible dysarthria types of paediatric ABI. Efforts should first be directed at modest well-controlled studies to identify likely efficacious treatments that may then be trialed in multi-centre collaborations using quasi-randomised or RCT methodology.

摘要

背景

孩童及成人後天性腦傷造成之發音困難的介入

‘後天性腦傷’ 這個詞包含多樣病因,包括腦血管意外、腦腫瘤和腦創傷。後天性腦傷是孩童失能的常見原因之一,而發音困難是孩童後天性腦傷後常見且持續的後遺症。

目標

評估語言病理師/治療師針對孩童後天性腦傷造成之發音困難,給予介入的效果。

搜尋策略

搜尋的資料庫包括: CENTRAL (Issue 4,2006) ,MEDLINE (1966至02/2007) ,CINAHL (1982至02/2007) ,EMBASE (1980至02/2007) ,ERIC (1965至02/2007) ,Linguistics Abstracts Online (1985至02/07) ,PsycINFO (1872至02/2007) 。從參考文獻清單中搜尋額外的資料。

選擇標準

這篇回顧選擇3到16歲,針對有後天性腦傷 (例如,腦瘤、腦創傷、腦血管意外) 造成的發音困難的孩童的隨機對照試驗和半實驗設計的文獻。

資料收集與分析

每位作者分別藉由標題和摘要,評估文章的相關性 (100% 評量者間的信度) ,瀏覽所有可能相關文章的全文。沒有試驗是符合選擇標準的。

主要結論

在2091篇找到的標題和摘要中,只瀏覽3篇完整的內容 (Morgan 2007年;Murdoch 1999年;Netsell 2001) 。另外2088篇被排除在外,主要是因為不包含發音困難、為診斷性或描述性的文章、或放更多重點在成人而非孩童上。Morgan 2007年和Murdoch 1999年這2篇因為沒有使用隨機對照試驗或半隨機試驗方法而被排除。Netsell 2001年這篇因為是理論回顧,非介入相關的文章而被排除。從Murdoch 1999年這篇文章的參考文獻中,共找出5篇有相關性的文章。所有文章後來都被排除,原因包括沒有後天性腦傷的族群、發音困難的成人、或不適合的試驗設計。因此,沒有文章符合選擇標準。

作者結論

這篇文獻回顧顯示,關於後天性腦傷造成發音困難的孩童之治療效果的研究相當欠缺,更遑論隨機對照試驗。缺乏相關資料的可能原因包括: 1. 對於這個族群發音困難的自然病程或特徵仍缺乏了解 2. 缺乏對於孩童的診斷分類系統,阻礙了介入計劃的發展 3. 孩童後天性腦傷造成之發音困難,其病因和種類之異質性。應該先努力設計出有良好控制的試驗,以找出可能有效果的治療方式,才可能將治療方式,以多中心、隨機試驗或半隨機試驗的方法,來進一步試驗其有效性。

翻譯人

本摘要由成功大學附設醫院紀美宏翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

發音困難是一種語言形成的疾患,會使個案在被人理解上產生困難。發音困難是孩童腦傷 (也稱作後天性腦傷) 常見且常慢性化的後遺症。這篇研究檢視對孩童後天性腦傷造成之發音困難,其治療的效果。雖然本研究報告了以個案報告為主,因腦傷 (特別是腦創傷) 造成發音困難的正面治療效果,這個領域相關的試驗仍太少,以至於無法做出關於孩童和青少年治療效果的結論。本文獻回顧呼籲,這個領域的語言病理師/治療師,應針對此族群自然病程和治療效果進行相關研究。

Plain language summary

Controlled studies for treatment of dysarthia associated with acquired brain injury in childhood urgently required

Dysarthria is a disorder of speech production that can make it harder for people to be understood by others.  Dysarthria is a common and often chronic outcome associated with brain injury suffered in childhood (also known as paediatric acquired brain injury (ABI) ).

This research examines the efficacy of treatment for dysarthria in children following ABI.

Although this research reports that  positive gains have been reported from a case-based study of a child with dysarthria following ABI (specifically with traumatic brain injury), there are currently too few studies performed in this area to draw any conclusions about the efficacy of treatment for dysarthria in children and teenagers. This review therefore calls for Speech Language Pathologists/Speech Language Therapists (SLPs/SLTs) working in this area to perform studies of the natural history and treatment efficacy of this group.

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