7/7/2011 Peer Review Process Updating Evidence Against NSOME for Speech Sound Production I nterested in Becom ing a Peer Review er? APPLY TODAY! Presenter: 3 + years SLP Professional Experience Gregory Lof, Ph.D., CCC-SLP Required Moderated by: Contact: Am y Natho at Amy Hansen, M.A., CCC-SLP, Managing Editor, SpeechPathology.com anatho@speechpathology.com Live Expert eSem inar Sending Questions ATTENTI ON! SOUND CHECK! Unable to hear anything at this tim e? Please contact Speech Pathology for technical support at Type question or Type question or 8 0 0 2 4 2 5 1 8 3 8 0 0 2 4 2 5 1 8 3 com m ent and click the send button TECHNI CAL SUPPORT Need technical support during event? Please contact Speech Pathology for technical support at 8 0 0 2 4 2 5 1 8 3 OR Submit a question using the Q&A Pod - please include your phone number. Earning CEUs Dow nload Handouts EARNI NG CEUS • Must be logged in for full time requirement • Must pass 10-question multiple-choice exam Post-event em ail w ithin 2 4 hours regarding the CEU exam Post event em ail w ithin 2 4 hours regarding the CEU exam Cli k t Click to highlight hi hli ht ( ceus@speechpathology.com ) handout • Log in to your account and go to Pending Courses under the Continuing Education tab. Click Save to My • The test for the Live Event w ill be available after attendance Com puter records have been processed, approxim ately 1 hour after the event ends • Must pass exam within 7 days of today • Two opportunities to pass the exam 1
7/7/2011 Some Practical Questions About Oral Updating Evidence Against Updating Evidence Against Motor Exercises Nonspeech Oral Motor Exercises Nonspeech Oral Motor Exercises • Do SLPs routinely use oral motor (NSOME) for Speech Sound (NSOME) for Speech Sound Are SLPs using exercises? Evidence Based Productions Productions • Why do SLPs use them? Practice? • What exercises do SLPs use? • What proof do SLPs have that they July, 2011 are effective in bringing about changes in speech-sound Gregory L. Lof, PhD , CCC-SLP productions? Department Chair/Professor Boston, MA A special thanks to… Outline of Talk Practice Dr. Maggie Watson Dr Maggie Watson Trends University of Wisconsin- Stevens Point (using survey data) Outline of Talk Why not Nonspeech Oral Motor Exercises Logical Reasons (NSOME) to change (NSOME) to change Not to Use Not to Use speech sound Oral Motor productions? Exercises 2
7/7/2011 Nonspeech Oral Motor Outline of Talk Exercises Defined Theoretical Reasons Any technique that does not require the child to produce q p Not to Use Not to Use a speech sound but is used Oral Motor to influence the development Exercises of speaking abilities. Lof & Watson (2008) Nonspeech Oral Motor Outline of Talk Exercises Defined A collection of nonspeech methods Evidence Why and procedures that are purported to influence tongue, lip, and jaw to influence tongue lip and jaw Not to Use Not to Use resting postures, increase strength, Oral Motor improve muscle tone, facilitate range of motion, and develop Exercises muscle control. (Ruscello, 2008) Nonspeech Oral Motor Definitions Exercises Defined Oral-motor exercises (OMEs) are nonspeech activities that involve sensory stimulation to or Nonspeech Oral p actions of the lips, jaw, tongue, soft palate, larynx, and respiratory muscles which are intended to and respiratory muscles which are intended to influence the physiologic underpinnings of the Motor Exercises oropharyngeal mechanism and thus improve its functions. They include active muscle exercise, muscle stretching, passive exercise, and sensory stimulation. McCauley, Strand, Lof, et al. (2009) 3
7/7/2011 Nonspeech Oral Motor Do SLPs Use NSOME? Exercises Defined Nationwide Survey Note that I will be talking about procedures and techniques that do not use speech. NSOME NSOME Lof & Watson (2008) Nonspeech Oral Motor Do SLPs Use NSOME? Exercises Defined Not about: Not about: Nationwide survey of 537 SLPs feeding, swallowing, drooling feeding, swallowing, drooling g g g g g g 85% use NSOME to 85% use NSOME to change speech sound productions S p e e c h Lof & Watson (2008) Do SLPs Use NSOME? Nationwide survey of 535 SLPs in Canada Do SLPs Use NSOME? Hodge, Salonka, & Kollias, (2005) 4
7/7/2011 Do SLPs Use NSOME? Do SLPs Use NSOME? How did clinicians learn How did clinicians learn Nationwide survey of 535 SLPs in Canada about NSOME? about NSOME? 85% use NSOME to 85% use NSOME to 87% from CE change speech sound 87% offerings, productions! workshops, In-services Hodge, Salonka, & Kollias, (2005) Lof & Watson (2008) Do SLPs Use NSOME? Do SLPs Use NSOME? How did clinicians learn How did clinicians learn Survey of SLPs in Kentucky about NSOME? about NSOME? Approximately 79% use 79% use 25% 25% of university f i it NSOME to professors who 75% change speech teach speech sound productions sound disorders teach NSOME Cima, Mahanna-Boden, Brown, & Cranfill (ASHA, 2009) Watson & Lof (2009) Do SLPs Use NSOME? Do SLPs Use NSOME? Survey of SLPs in South Carolina Rank order of most frequently used exercises: Rank order of most frequently used exercises: Approximately 1. Blowing 6. Tongue-to-nose-to chin 81% believe 2. Tongue push-ups 7. Cheek puffing NSOME are at least somewhat 3. Pucker-smile 8. Blowing kisses effective in 4. Tongue wags 9. Tongue curling bringing about speech sound 5. Big smile improvements Lemmon, Harrison, Woods-McKnight, Bonnette, & Jackson, (ASHA, 2010) Lof & Watson (2008) 5
7/7/2011 Do SLPs Use NSOME? Evidence-Based Practice Rank order of most frequently identified Rank order of most frequently identified “benefits” of these exercises: “benefits” of these exercises: 1. Tongue elevation 6. Jaw stabilization 2. Awareness of articulators 7. Lip/tongue protrusion 3. Tongue strength 8. Drooling control 4. Lip strength 9. VP competence 5. Lateral tongue movements 10.Sucking ability Lof & Watson (2008) Do SLPs Use NSOME ? Evidence-Based Practice • The conscientious, explicit, and unbiased Clinicians Clinicians USUALLY USUALLY use these use these use of current best research results in exercises for children with… exercises for children with… making decisions about the care of individual clients. i di id l li t 1. Dysarthria • Treatment decisions should be 2. Childhood Apraxia of Speech (CAS) administered in practice only when there is 3. Structural anomalies (e.g., clefts) a justified (evidence-based) expectation of 4. Down syndrome benefit. Lof & Watson (2008) Sackett et al., (1996) Do SLPs Use NSOME? Evidence-Based Practice Clinicians Clinicians FREQUENTLY FREQUENTLY use these use these Research Evidence exercises for children with… exercises for children with… 1. In early intervention EBP 2. Late talkers 3. Phonologically impaired 4. Hearing impaired Clinical Experience Client Values 5. Functional misarticulators Lof & Watson (2008) 6
7/7/2011 Evidence-Based Practice Evidence-Based Practice EBP is the integration of best research The Purpose of EBP evidence along with clinical expertise and the client values and the client values Prevent EBP uses the best evidence available, in consultation with the client or parents to the adoption of decide upon the options that suits the ineffective interventions client best. Evidence-Based Practice Evidence-Based Practice Levels of Evidence from Studies The Purpose of EBP Most of the evidence on the efficacy of th ffi f P Promote t NSOME is on the the adoption of effective somewhat weaker interventions side, but… Evidence-Based Practice Evidence-Based Practice Levels of Evidence from Studies The Purpose of EBP LEVEL Ia : STRONGEST Well-designed meta-analysis of >1 RCT LEVEL Ib: LEVEL Ib: STRONG STRONG Well designed randomized controlled study Well-designed randomized controlled study Delay LEVEL IIa: MODERATE Well-designed controlled study without randomization LEVEL IIb: MODERATE Well-designed quasi-experimental study the adoption of LEVEL III: LIMITED Nonexperimental studies (i.e., correlational and case studies) unproved interventions LEVEL IV: WEAK Opinion of authorities, based on clinical experience 7
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