Pennington Lindsay, Miller Nick, Robson Sheila
Institute of Health and Society, University of Newcastle, Sir James Spence Institute - Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK, NE1 4LP.
Cochrane Database Syst Rev. 2009 Oct 7(4):CD006937. doi: 10.1002/14651858.CD006937.pub2.
Children with motor impairments often have the motor speech disorder dysarthria, a condition which effects the tone, power and coordination of any or all of the muscles used for speech. Resulting speech difficulties can range from mild, with slightly slurred articulation and low-pitched voice, to profound, with an inability to produce any recognisable words. Children with dysarthria are often prescribed communication aids to supplement their natural forms of communication. However, there is variation in practice regarding the provision of therapy focusing on voice and speech production. Descriptive studies have suggested that therapy may improve speech, but its effectiveness has not been evaluated.
To assess whether direct intervention aimed at improving the speech of children with dysarthria is more effective than no intervention at all. To assess whether individual types of intervention are more effective than others in improving the speech intelligibility of children with dysarthria.
We searched CENTRAL, MEDLINE, EMBASE, CINAHL , LLBA, ERIC, PsychInfo, Web of Science, Scopus, UK National Research Register and Dissertation Abstracts up to April 2009, handsearched relevant journals published between 1980 and April 2009, and searched proceedings of relevant conferences between 1996-2009.
We considered randomised controlled trials and studies using quasi-experimental designs in which children were allocated to groups using non-random methods.
L Pennington conducted searches of all databases and conference reports. L Pennington, N Miller and S Robson handsearched journals. All searches included a reliability check in which a second review author independently checked a random sample comprising 15% of all identified reports. We planned that two review authors would independently assess the quality and extract data from eligible studies.
No randomised controlled trials or group studies were identified.
AUTHORS' CONCLUSIONS: We found no firm evidence of the effectiveness of speech and language therapy to improve the speech of children with early acquired dysarthria. No change in practice is warranted at the present time. Rigorous research is needed to investigate if the positive changes in children's speech observed in small descriptive studies are shown in randomised controlled trials. Research should examine change in children's speech production and intelligibility. It should also investigate the secondary education, health and social care outcomes of intervention, including children's interaction with family, friends and teachers, their participation in social and educational activities, and their quality of life. Cost and acceptability of interventions must also be investigated.
运动功能受损的儿童常常患有运动性言语障碍——构音障碍，这种病症会影响用于言语的部分或全部肌肉的张力、力量及协调性。由此导致的言语困难程度各异，轻者只是发音稍显含糊、嗓音低沉，重者则无法说出任何可辨认的字词。构音障碍儿童常常会被配备沟通辅助工具，以补充其天然的沟通方式。然而，在提供针对嗓音和言语产生的治疗方面，实际操作存在差异。描述性研究表明治疗可能会改善言语，但尚未对其效果进行评估。
评估针对改善构音障碍儿童言语的直接干预是否比不进行干预更有效。评估在改善构音障碍儿童言语清晰度方面，不同类型的干预措施是否比其他措施更有效。
我们检索了截至2009年4月的Cochrane系统评价数据库（CENTRAL）、医学索引数据库（MEDLINE）、荷兰医学文摘数据库（EMBASE）、护理学与健康领域数据库（CINAHL）、语言与语言学行为摘要数据库（LLBA）、教育资源信息中心数据库（ERIC）、心理学文摘数据库（PsychInfo）、科学引文索引数据库（Web of Science）、Scopus数据库、英国国家研究注册库以及学位论文摘要数据库，手工检索了1980年至2009年4月期间出版的相关期刊，并检索了1996 - 2009年期间相关会议的论文集。
我们纳入了随机对照试验以及采用准实验设计的研究，这些研究中儿童通过非随机方法被分配到各个组。
L·彭宁顿对所有数据库和会议报告进行了检索。L·彭宁顿、N·米勒和S·罗布森手工检索了期刊。所有检索都包括一项可靠性检查，即由另一位综述作者独立检查所有已识别报告中15%的随机样本。我们计划让两位综述作者独立评估质量并从符合条件的研究中提取数据。
未识别到随机对照试验或分组研究。
我们没有找到确凿证据表明言语和语言治疗能有效改善早期获得性构音障碍儿童的言语。目前无需改变实践。需要进行严谨的研究，以调查在小型描述性研究中观察到的儿童言语的积极变化在随机对照试验中是否也会出现。研究应考察儿童言语产生和清晰度的变化。还应调查干预对中等教育、健康和社会护理方面的影响，包括儿童与家人、朋友和教师的互动、他们参与社会和教育活动的情况以及他们的生活质量。此外，还必须调查干预措施的成本和可接受性。
