The University of New Mexico Speech and Hearing Center, Albuquerque.
University of Texas at Austin.
Am J Speech Lang Pathol. 2018 Aug 6;27(3):1073-1090. doi: 10.1044/2018_AJSLP-17-0128.
This article presents a systematic review that aimed to synthesize single-subject-design studies that have examined naturalistic interventions for teaching the expressive use of speech-generating devices (SGDs) to children with complex communication needs. Specifically, this review describes what intervention strategies are most commonly applied in studies with positive effects and minimal methodological flaws and examines the populations and outcomes for which these strategies have been effective.
A systematic approach was used to qualitatively code variables of interest to this review. Results were summarized via both visual analysis and effect size methods, and a certainty of evidence methodology was adopted to describe the quality of the evidence.
Thirty-two unique studies met inclusion criteria, with 19 having consistent positive results and meeting minimum requirements for certainty of evidence. Although studies used a variety of titles to describe intervention packages (e.g., milieu teaching, interaction strategies), certain strategies were common across studies. These included (a) creating and capturing communication opportunities via methods such as time delay and questioning; (b) providing feedback via methods such as reinforcement of requests, praise, or expansions; (c) prompting (verbal, physical, gestural); (d) modeling; and (e) training communication partners.
Findings regarding these intervention components help to provide practical guidelines for naturalistic SGD intervention. Limitations of the current body of research (e.g., need to include more home-based studies and more intermediate to advanced SGDs, need to critically analyze the most critical intervention components) provide suggestions for future research.
本文呈现了一项系统综述，旨在综合研究使用自然教学干预策略来教授有复杂沟通需求的儿童使用言语产生设备（SGD）进行表达性言语的单被试设计研究。具体来说，本综述描述了哪些干预策略在具有积极效果和最小方法缺陷的研究中最常应用，并考察了这些策略有效的人群和结果。
采用系统方法对本综述感兴趣的变量进行定性编码。结果通过视觉分析和效应量方法进行总结，并采用证据确定性方法来描述证据的质量。
32 项独特的研究符合纳入标准，其中 19 项研究具有一致的积极结果，并符合证据确定性的最低要求。尽管研究使用了各种标题来描述干预方案（例如，环境教学、互动策略），但某些策略在研究中是常见的。这些策略包括：（a）通过时间延迟和提问等方法创造和捕捉沟通机会；（b）通过强化请求、表扬或扩展等方法提供反馈；（c）提示（口头、身体、手势）；（d）模仿；以及（e）培训沟通伙伴。
这些干预组件的发现有助于为自然的 SGD 干预提供实用指南。当前研究领域的局限性（例如，需要纳入更多基于家庭的研究和更中级到高级的 SGD，需要批判性地分析最关键的干预组件）为未来的研究提供了建议。
