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Background Despite the compelling case for engaging parents in speech and language therapy, research indicates that speech and language therapists (SLTs) currently have a leading role in the goal-setting process of therapy for children with developmental language disorder (DLD). Therefore, we set out to develop a tool that aims to support the dialogue between SLTs and parents and enhance shared decision-making about children's communicative participation goals. We used co-design techniques with SLT–practitioners to include their perspectives throughout the design process. Although co-design has been used for some years in healthcare research, it is still a relatively new research methodology in the field of speech and language therapy. Aims To provide a detailed description of the co-design process that led to the development of a physical artefact that can support SLTs to engage parents of children with DLD in collaborative goal-setting. Methods & Procedures The Design Council's Double Diamond model was used to develop a tool in co-design, together with eight SLTs, who participated in all stages of the development process. Usability was tested in actual goal-setting conversations between four SLTs and 11 parents of a child with DLD resulting in stepwise improvements. In addition, usability of the first and final prototypes was tested with five usability criteria that were rated on a 10-point scale by 64 SLTs. Outcomes & Results The co-design process resulted in the development of a physical prototype of the tool called ‘ENGAGE’, consisting of a metal ‘tree trunk’ on which parents can stick magnetic ‘leaves’ containing potential participation goals for their child. The ‘tree’ shape represents a child's development and opportunities for growth. This first prototype received marks between 7.0 and 8.0 out of 10 on attractiveness, user-friendliness, safety, functionality and affordability. After several iterations, ther

Dit artikel beschrijft de bevindingen uit een explorerend literatuuronderzoek naar de grammaticale ontwikkeling van Nederlandstalige kinderen tussen 7 en 10 jaar met en zonder een taalontwikkelingsstoornis (TOS). De resultaten worden ook in een klinische context geplaatst, met als doel logopedisten te ondersteunen in de behandeling van grammaticale problemen bij kinderen met TOS in deze leeftijdsgroep. Grammaticale problemen zijn een kernprobleem van kinderen met TOS en behandeling van deze grammaticale problemen is daarmee een kerntaak van de logopedist. De verwervingsvolgorde van grammaticale structuren bij Nederlandstalige kinderen met een normale taalontwikkeling is redelijk duidelijk tot een leeftijd van 5 á 6 jaar. Voor oudere kinderen is dit veel minder het geval. Deze informatie is echter wel van belang om passende grammaticale behandeldoelen te kunnen selecteren en prioriteren.

Purpose: Most speech-language pathologists (SLPs) working with children with developmental language disorder (DLD) do not perform language sample analysis (LSA) on a regular basis, although they do regard LSA as highly informative for goal setting and evaluating grammatical therapy. The primary aim of this study was to identify facilitators, barriers, and needs related to performing LSA by Dutch SLPs working with children with DLD. The secondary aim was to investigate whether a training would change the actual performance of LSA. Method: A focus group with 11 SLPs working in Dutch speech-language pathology practices was conducted. Barriers, facilitators, and needs were identified using thematic analysis and categorized using the theoretical domain framework. To address the barriers, a training was developed using software program CLAN. Changes in barriers and use of LSA were evaluated with a survey sent to participants before, directly after, and 3 months posttraining. Results: The barriers reported in the focus group were SLPs' lack of knowledge and skills, time investment, negative beliefs about their capabilities, differences in beliefs about their professional role, and no reimbursement from health insurance companies. Posttraining survey results revealed that LSA was not performed more often in daily practice. Using CLAN was not the solution according to participating SLPs. Time investment remained a huge barrier. Conclusions: A training in performing LSA did not resolve the time investment barrier experienced by SLPs. User-friendly software, developed in codesign with SLPs might provide a solution. For the short-term, shorter samples, preferably from narrative tasks, should be considered.

Item does not contain fulltext, Mastication problems can have a negative impact on the intake of food and quality of life. This cross-sectional study characterizes mastication problems using clinical and instrumental assessments in patients with spinal muscular atrophy (SMA) types 2 and 3 with self-reported bulbar problems. We included 27 patients (aged 13-67 years), 18 with SMA type 2 and 9 patients with SMA type 3 (of whom three were still ambulant) and applied a questionnaire, clinical mastication tests (TOMASS and 6-min mastication test), and muscle ultrasound of the mastication muscles. Non-ambulant patients demonstrated inefficient mastication as reflected by median z scores for masticatory cycles (z = 1.8), number of swallows (z = 4.3) and time needed to finish the cracker (z = 3.4), and limited endurance of continuous mastication as demonstrated by the median z scores of the 6-min mastication test (z = - 1.5). Patients reported increased fatigue directly after the 6-min mastication test as well as 5 min after completing the test (p < 0.001; p = 0.003). Reduced maximal mouth opening was associated with mastication problems (p < 0.001). Muscle ultrasound of the mastication muscles showed an abnormal muscle structure in 90% of both ambulant and non-ambulant patients. This study aims to understand the nature and underlying mechanisms of mastication problems in patients with SMA types 2 and 3 with reported bulbar problems.

Background: There is a lack of suitable language tests for multilingual children to distinguish a developmental language disorder from a language delay, caused by insufficient input in the second language. Therefore, the Language Impairment Testing in Multilingual Settings (LITMUS) test has been developed and adapted into an online version. To implement the Dutch version, LITMUS_NL, the test must be user-friendly and valuable for speech and language therapists. Therefore, the usability needs to be investigated. Aim: To investigate the degree of usability, usability issues, added value, clinical first impression and duration of the digital version of LITMUS_NL for identifying developmental language disorders in multilingual children. Method: This study was a descriptive usability study. The sample consisted of speech and language therapists working with multilingual children in speech and language therapy practices or speech hearing centres. The degree of usability was measured with the system usability scale. Secondary parameters were usability issues, measured with a think-aloud protocol, added value, clinical first impression and time to complete LITMUS_NL, measured with an online-questionnaire. Results: The 24 participants assessed the degree of usability as good, with a mean score of 72/100. 337 usability issues were found in the categories of ‘Instructions’, ‘Technical’, ‘Pronunciation of items’, ‘Spelling errors’, and ‘Development of tests’. The added value was rated 5.60/7. The mean duration was 45 minutes and all domains of clinical first impression were scored 7/10 or higher. Conclusion: This evaluation of usability of LITMUS_NL found a good degree of usability and a positive clinical first impression. A range of usability issues was identified; technical issues that can be solved, but also issues related to the construct of the test which are difficult to adapt. Recommendations: We recommend adapting LITMUS_NL to the feedback of the users and to investigat

Contains fulltext : 220780.pdf (Publisher’s version ) (Closed access), BACKGROUND: Infantile hereditary proximal spinal muscular atrophy (SMA) type 1 is characterized by onset in the first 6 months of life and severe and progressive muscle weakness. Dysphagia is a common complication but has not been studied in detail. OBJECTIVE: To study feeding and swallowing problems in infants with SMA type 1, and to explore the relation between these problems and functional motor scores. METHODS: We prospectively included 16 infants with SMA type 1 between September 2016 and October 2018. Eleven infants received palliative care and five infants best supportive care in combination with nusinersen. We compiled and used an observation list with feeding related issues and observed feeding sessions during inpatient and outpatient visits. The Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) was used as a measure of motor function. RESULTS: All infants in the palliative care group (median onset of disease 14 days (range 1-56); median inclusion in the study 52 days (range 16-252) demonstrated symptoms of fatigue during feeding and unsafe swallowing. Symptoms were short nursing sessions (10-15 minutes), and not being able to finish the recommended feeding volumes (72%); increased frequency of feeding sessions (55%); coughing when drinking or eating (91%), and wet breathing during and after feeding (64%).Two out of five infants in the nusinersen group (median onset of disease 38 days (range 21-90); inclusion in the study at 63 days (range 3-218) were clinically pre-symptomatic at the start of treatment. The other three infants showed symptoms of fatigue and unsafe swallowing at inclusion in the study. These symptoms initially decreased after the start of the treatment, but (re)appeared in all five infants between the ages of 8 to 12 months, requiring the start tube of feeding. In the same period motor function scores significantly improved (median increase CHOP INTEND 16 points). CONCLUSION: Impaired feeding and swall

Background: Early detection and remediation of language disorders are important in helping children to establish appropriate communicative and social behaviour and acquire additional information about the world through the use of language. In the Netherlands, children with (a suspicion of) language disorders are referred to speech and hearing centres for multidisciplinary assessment. Reliable data are needed on the nature of language disorders, as well as the age and source of referral, and the effects of cultural and socioeconomic profiles of the population served in order to plan speech and language therapy service provision. Aims: To provide a detailed description of caseload characteristics of children referred with a possible language disorder by generating more understanding of factors that might influence early identification. Methods & Procedures: A database of 11,450 children was analysed consisting of data on children, aged 2–7 years (70% boys, 30% girls), visiting Dutch speech and hearing centres. The factors analysed were age of referral, ratio of boys to girls, mono- and bilingualism, nature of the language delay, and language profile of the children. Outcomes & Results: Results revealed an age bias in the referral of children with language disorders. On average, boys were referred 5 months earlier than girls, and monolingual children were referred 3 months earlier than bilingual children. In addition, bilingual children seemed to have more complex problems at referral than monolingual children. They more often had both a disorder in both receptive and expressive language, and a language disorder with additional (developmental) problems. Conclusions & Implications: This study revealed a bias in age of referral of young children with language disorders. The results implicate the need for objective language screening instruments and the need to increase the awareness of staff in primary child healthcare of red flags in language development of girls and mu

Item does not contain fulltext, BACKGROUND: Spinal muscular atrophy (SMA) is hereditary motor neuron disorder, characterised by the degeneration of motor neurons and progressive muscle weakness. It is caused by the homozygous loss of function of the survival motor neuron (SMN) 1 gene. SMA shows a wide variability of disease severity. OBJECTIVE: To investigate self-reported bulbar problems in patients with SMA, and their relationship to age, functional motor scores and active maximum mouth opening. METHODS: We used the Diagnostic List of Dysphagia and Dysarthria in (pediatric) patients and relevant recent clinical data from the national SMA database. RESULTS: The 118 included patients with SMA frequently reported jaw problems (34%), fatigue associated with mastication (44%), choking (56%) and intelligibility problems (27%). Jaw, mastication and swallowing problems frequently occurred in combination with each other. There was an increase of reported bulbar problems in patients with SMA type 3a, older than 30 years of age, compared to younger patients of this SMA type.The Hammersmith Functional Motor Scale Expanded scores showed a negligible correlation with jaw and mastication problems, a low negative correlation with swallowing problems and a moderate negative correlation with intelligibility problems. Reduced mouth opening showed a significant, but low correlation with bulbar complaints in patients with SMA type 2. CONCLUSIONS: Fatigue associated with mastication and swallowing problems were frequently reported complaints. Patients 30 years and older with milder forms of SMA showed an increase of self-reported bulbar problems.

Background Language sample analysis (LSA) is seen as the gold standard for diagnosis and documentation of oral language skills in children with developmental language disorders (DLD). In the Netherlands, 'Taal Analyse Remediëring en Screening Procedure' (TARSP) is one of the methods used for spontaneous LSA. A limitation of this method is that it lacks the ability to detect and evaluate small changes when a child makes progress in morphosyntactic structures. For that reason, in 2016 Van Oorschot and Bruisman developed a new measure: 'Taal Analyse Remediëring en Screening Procedure met Punten' (TARSP-P). Aim This study aims to determine whether TARSP-P is more sensitive to small changes in morphosyntactic development than traditional TARSP. Methods Repeated measures at three time points in a four month period were conducted in a group of twelve children with DLD, age 4 and 5 years old. Language samples were collected and analysed and a sentence repetition task was performed. Results Significant differences in TARSP-P scores for all time points were found. This indicates that TARSP-P is more sensitive to small morphosyntactic changes at both group level and age group level than traditional TARSP, which is limited to measuring seven phases in language development. Significant strong positive correlations of TARSP-P with one other language measure were observed. No significant correlations between TARSP-P, TARSP and a sentence repetition task were found. Inter Rater Reliability of TARSP-P outcomes showed good agreement. Conclusion TARSP-P is more sensitive to small morphosyntactic changes when compared with the traditional TARSP and is therefore a better indicator for assessing treatment effects in children with DLD. Implications of key findings For use in clinical practice, both the practical feasibility and time-commitment involved in using TARSP-P should be further evaluated. A computerised method of speech recognition and automated analysis are recommended.

Deze studie beschrijft de relatie tussen de indicatiecriteria voor Voor- en Vroegschoolse Educatie (VVE) en taalachterstanden bij peuters. Het doel van VVE is het stimuleren van de taalontwikkeling bij kinderen die risico lopen op een achterstand, omdat ze in hun opvoedomgeving te weinig taal of taal van onvoldoende kwaliteit krijgen aangeboden. In gemeenten worden verschillende indicatiecriteria gehanteerd om de doelgroep voor VVE te selecteren. Het is op dit moment onduidelijk of de criteria daadwerkelijk een achterstand in de taalontwikkeling voorspellen. Deze studie onderzoekt welk gehanteerde indicatiecriterium de beste voorspeller is voor een achterstand in de taalontwikkeling. Er hebben 42 kinderen van VVE-peuterspeelzalen in de gemeente Apeldoorn deelgenomen aan dit onderzoek. In Apeldoorn zijn de kinderen geselecteerd op basis van de gewichtenregeling, een omgevingsanalyse, het van Wiechenschema of een combinatie van deze criteria. Bij alle deelnemende kinderen is bepaald of er sprake is van een achterstand in de taalontwikkeling en of er voldoende blootstelling aan het Nederlands is in de opvoedomgeving. Ten eerste is de uitkomstmaat taalachterstand vergeleken met de indicatiecriteria. Uit de logistische regressieanalyse blijkt dat kinderen met een achterstand in de taalontwikkeling significant (p < 0.05) vaker op basis van de omgevingsanalyse een indicatie hebben gekregen voor VVE dan op basis van de gewichtenregeling. Ten tweede is de uitkomstmaat blootstelling aan het Nederlands vergeleken met de indicatiecriteria. Er wordt geen verschil gevonden tussen de indicatiecriteria omgevingsanalyse en gewichtenregeling wanneer er wordt gekeken naar de mate van blootstelling aan het Nederlands. Een analyse van de kwaliteit en kwantiteit van het taalaanbod in de opvoedomgeving lijkt een betrouwbare voorspeller voor een achterstand in de taalontwikkeling. Vervolgonderzoek met een grotere onderzoeksgroep is nodig om een helder beeld van de relatie tussen de indi

Meertalige kleuters in Nederland lopen hoger risico op over- en onderdiagnose van een specifieke taalontwikkelingsstoornis dan eentalige kleuters. De beschikbare diagnostische taaltests zijn door testbias onvoldoende valide voor meertalige kinderen. De huidige studie onderzoekt of dynamische diagnostiek - door taalleerpotentieel te meten - een bruikbaar en valide alternatief biedt. Vijf logopedisten hebben samen met tien eentalige en twee meertalige kleuters (4 t/m 6 jaar) met specifieke taalontwikkelingsstoornissen aan deze studie deelgenomen. Om taalleerpotentieel te meten, is er een cue-continuüm ontwikkeld, dat kinderen kan ondersteunen in de subtest Zinnen Herhalen in Context (ZHC) van de Celf Preschool-2-NL. Het cue-continuüm transformeert de reguliere subtest ZHC in een dynamische ZHC en levert een hulpscore op. Er is onderzocht of er een relatie is tussen de hulpscore en twee statische uitkomstmaten op de Celf Preschool-2-NL, te weten de ruwe kernscore en de ruwe score op de statische ZHC. Verwacht wordt, dat kinderen met lagere statische scores meer cues gebruiken op de dynamische ZHC en zodoende een hogere hulpscore behalen. Middels een enquête achteraf is onderzocht of de deelnemende logopedisten de dynamische ZHC nuttig en bruikbaar vinden. Bij de eentalige kleuters is, zoals verwacht, een matige negatieve correlatie zichtbaar tussen de ruwe kernscore en de hulpscore, echter niet significant. Daarnaast is er, anders dan verwacht, geen relatie gevonden tussen de ruwe score op de statische ZHC en de hulpscore. Correcte zinsimitaties op de dynamische ZHC komen voornamelijk tot stand bij herhaald auditief aanbod van de doelzin. Uit de enquête blijkt dat de logopedisten de dynamische ZHC hanteerbaar vinden, maar er rijst twijfel over het nut van de cues. Hoewel de correlatie tussen de ruwe kernscore en de hulpscore correspondeert met voorgaande studies, levert het cue-continuüm te weinig en onvoldoende valide inzicht in taalleerpotentieel. Het aantal correcte

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Purpose: This study investigated whether a uniform vocabulary intervention protocol enhances the number of new words learned by preschoolers with SLI within 4 weeks. A vocabulary intervention protocol was developed. Method: For this study the developed vocabulary intervention protocol was implemented at the Dutch Foundation for the Deaf and Hard of Hearing Child (NSDSK). Children in the age of 2 to 4 years with SLI (n = 22) of 3 different young intervention groups from the NSDSK were randomly assigned to vocabulary intervention according to the protocol (n =12) or a control condition (n =10). The speech and language therapists (n =3) executed the vocabulary intervention protocol for 4 weeks, 3 times a week and 15 minutes sessions. Expressive word knowledge was tested by illustrations of a set of 50 words at pre- and posttest. Results: The children in the experimental group produced more target words provided with the protocol than the matching words, not provided by the protocol. The control group did not show a difference in the number of these target words and matching words learned. On average 6 new theme words out of 50, were learned by the participating children. The number of verbs learned out of 14, was on average 2. Conclusions: The results suggest that this vocabulary intervention protocol enhances the number of new words learned in preschoolers with SLI. This vocabulary intervention protocol showed not to be as evidently beneficiary for children with SLI with a language level below 1;11 years. In this study learning new verbs were not enhanced by the vocabulary intervention protocol. Thus, vocabulary intervention according to this protocol is improving the number of expressive words in preschoolers with SLI. However, a revision of this protocol is recommended, because the children with a young language level, i.e. under the 1;11 years, do not benefit as clearly as the rest of the children in word learning. Splitting the group into subgroups (children with