Speech therapy for children with dysarthria acquired before three years of age.
BACKGROUND
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.


OBJECTIVE
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.


METHODS
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.


METHODS
We considered randomised controlled trials and studies using quasi-experimental designs in which children were allocated to groups using non-random methods.


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.


RESULTS
No randomised controlled trials or group studies were identified.


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.
Pennington
Lindsay
L
Institute of Health and Society, University of Newcastle, Sir James Spence Institute - Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK, NE1 4LP.
Miller
Nick
N
Robson
Sheila
S
D002648:Child; D002675:Child, Preschool; D004401:Dysarthria / Q000628:therapy*; D006801:Humans; D013065:Speech Intelligibility; D013070:Speech Therapy