Watson Rose Mary, Pennington Lindsay
Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
Int J Lang Commun Disord. 2015 Mar-Apr;50(2):241-59. doi: 10.1111/1460-6984.12138. Epub 2015 Feb 4.
Communication difficulties are common in cerebral palsy (CP) and are frequently associated with motor, intellectual and sensory impairments. Speech and language therapy research comprises single-case experimental design and small group studies, limiting evidence-based intervention and possibly exacerbating variation in practice.
To describe the assessment and intervention practices of speech-language therapist (SLTs) in the UK in their management of communication difficulties associated with CP in childhood.
METHODS & PROCEDURES: An online survey of the assessments and interventions employed by UK SLTs working with children and young people with CP was conducted. The survey was publicized via NHS trusts, the Royal College of Speech and Language Therapists (RCSLT) and private practice associations using a variety of social media. The survey was open from 5 December 2011 to 30 January 2012.
OUTCOMES & RESULTS: Two hundred and sixty-five UK SLTs who worked with children and young people with CP in England (n = 199), Wales (n = 13), Scotland (n = 36) and Northern Ireland (n = 17) completed the survey. SLTs reported using a wide variety of published, standardized tests, but most commonly reported assessing oromotor function, speech, receptive and expressive language, and communication skills by observation or using assessment schedules they had developed themselves. The most highly prioritized areas for intervention were: dysphagia, alternative and augmentative (AAC)/interaction and receptive language. SLTs reported using a wide variety of techniques to address difficulties in speech, language and communication. Some interventions used have no supporting evidence. Many SLTs felt unable to estimate the hours of therapy per year children and young people with CP and communication disorders received from their service.
CONCLUSIONS & IMPLICATIONS: The assessment and management of communication difficulties associated with CP in childhood varies widely in the UK. Lack of standard assessment practices prevents comparisons across time or services. The adoption of a standard set of agreed clinical measures would enable benchmarking of service provision, permit the development of large-scale research studies using routine clinical data and facilitate the identification of potential participants for research studies in the UK. Some interventions provided lack evidence. Recent systematic reviews could guide intervention, but robust evidence is needed in most areas addressed in clinical practice.
沟通障碍在脑瘫（CP）中很常见，且常常与运动、智力和感觉障碍相关。言语和语言治疗研究包括单病例实验设计和小组研究，这限制了循证干预，并且可能加剧实践中的差异。
描述英国言语治疗师（SLTs）在管理儿童期与脑瘫相关的沟通障碍时的评估和干预实践。
对英国从事脑瘫儿童和青少年治疗工作的言语治疗师所采用的评估和干预措施进行了在线调查。该调查通过英国国家医疗服务体系（NHS）信托机构、皇家言语和语言治疗师学院（RCSLT）以及私人执业协会，利用各种社交媒体进行宣传。调查于2011年12月5日至2012年1月30日开放。
来自英格兰（n = 199）、威尔士（n = 13）、苏格兰（n = 36）和北爱尔兰（n = 17）的265名从事脑瘫儿童和青少年治疗工作的英国言语治疗师完成了调查。言语治疗师报告使用了各种各样已发表的标准化测试，但最常报告的是通过观察或使用他们自己制定的评估表来评估口面运动功能、言语、接受性和表达性语言以及沟通技能。干预的最高优先领域是：吞咽困难、替代和辅助沟通（AAC）/互动以及接受性语言。言语治疗师报告使用了各种各样的技术来解决言语、语言和沟通方面的困难。一些所采用的干预措施没有证据支持。许多言语治疗师无法估计患有脑瘫和沟通障碍的儿童和青少年每年从他们的服务中接受的治疗时长。
在英国，儿童期与脑瘫相关的沟通障碍的评估和管理差异很大。缺乏标准的评估实践阻碍了不同时间或不同服务之间的比较。采用一套商定的标准临床测量方法将能够对服务提供进行基准测试，允许利用常规临床数据开展大规模研究，并有助于在英国确定研究的潜在参与者。一些提供的干预措施缺乏证据。近期的系统评价可以指导干预，但在临床实践涉及的大多数领域都需要有力的证据。
