National University of Singapore (NUS) offers the Master of Science (Speech and Language Pathology), which is a 2-year full-time programme offered jointly by the Yong Loo Lin School of Medicine (SoM) and the Faculty of Arts and Social Sciences (FASS) under the administration of the Division of Graduate Medical Studies (DGMS).
This programme, which started in January 2007, is an entry-level training for the profession of Speech and Language Pathology. The biennial intake typically comprises about 24 candidates and includes mid-career graduates with relevant work experience, as well as some overseas candidates. Students will graduate with a Master of Science (Speech and Language Pathology) degree from the National University of Singapore (NUS).
The current batch of students (2015-2016) are now in their final semester, and will officially graduate in July 2017. They have recently completed their final thesis projects, and NUS has kindly shared their research topics and abstracts with the SLP community. For more information on individual projects, please contact the individual authors directly.
The NUS SLP programme will also be updating the SLP community on the next cohort that will join them in 2017-2018. Keep a lookout for this segment as we work closely with NUS to support the incoming speech therapy students!
MSc(SLP) SLP 5116: Abstracts for Research Projects
|Abstract No||Student||Title of Project|
|Abstract 1||Anuja Varaprasad||The Efficacy of Literacy Intervention in Deaf Bilingual-Bicultural Children: Two Case Studies|
|Abstract 2||Carline Tan Ching Teng||Effectiveness of Phonological Therapy for Naming in Mandarin-Speaking People with Aphasia|
|Abstract 3||Charmaine Ong Shuwen||Nurse-Led Infant Feeding Pathway: Factors Affecting Pathway and Caregiver Perceptions|
|Abstract 4||Chloe Lim Hui||Evaluating the Usefulness of a Functional Communication Checklist for Teachers of Children with Autism Spectrum Disorder|
|Abstract 5||Connie Sohn Chaird||Effects of Language Treatment for Semantic Dementia: A Single Case Study|
|Abstract 6||Dickman Sharon Charmaine||Normal Disfluencies in Typically Developing English-Mandarin Bilingual Children|
|Abstract 7||Koh Kai Hui, Grace||Language Dominance and Phonological Development of English-Mandarin Bilingual Preschoolers|
|Abstract 8||Kwan Kah Mei, Rhoda||Effects of Nasogastric Tube on Swallowing Function in Patients with Dysphagia Following Stroke: Case Studies|
|Abstract 9||Lam Xin Yi||Prompt Hierarchy Training for Teachers Implementing Augmentative Alternative Communication (AAC) with Children with Autism|
|Abstract 10||Lee Yan, Bobbie Jen||Cross-Language Transfer Effects with a Modified Semantic Feature Analysis Therapy for English-Mandarin Bilinguals with Aphasia|
|Abstract 11||Leong Shi Yun||Cross-Language Transfer Effects of Verb Therapy for Mandarin-English Bilinguals with Aphasia|
|Abstract 12||Low Lixian, Alena||English Cognitive-Communication Screener for Acquired Brain Injury Impairments in Singapore|
|Abstract 13||Low Ye-Tong, Alberta||Effect of Dialect on Phonological Analysis: Evidence from Singapore English Speaking Bilingual Children|
|Abstract 14||Ng Wan Ting, Josie||Measurement of Muscle Activity During Swallow with Chin Tuck and Chin Tuck Against Resistance Using Surface Electromyography|
|Abstract 15||Ong Pei Yu, Mabel||Development of a Mobile Application with Spectral Biofeedback Features|
|Abstract 16||Phoebe Elizabeth Lim Pei Jun||Oral Feeding Outcomes on a New Nurse-Led Semi-Cue-Based Feeding Pathway for Healthy Preterm Infants|
|Abstract 17||Sun Yanhui, Felicia||Language Recovery and Oral Narrative Performance in Children with Acquired Brain Injury|
|Abstract 18||Tan Han Lin, Louisa||Efficacy of Music for Improving Language in Children with Special Needs|
|Abstract 19||Tan Jia Xin Danica||Oral Narratives of English-Dominant Singaporean Preschoolers|
|Abstract 20||Tan Xue Er, Cheryl||Utility of the Children’s Communication Checklist for Bilingual Singaporean Preschoolers|
|Abstract 21||Tang Hui Min||Language Outcome and Written Narrative Performance in School-Aged Children Post Traumatic Brain Injury|
The Efficacy of Literacy Intervention in Deaf Bilingual-Bicultural Children: Two Case Studies
Background: Literacy acquisition is problematic for deaf signing children. An earlier study on 11 students at the Singapore School for the Deaf found significant underperformance and heterogeneity in literacy skills given the complex factors that impact literacy outcomes in this population. The aim of this study was to determine the type of intervention strategies that would support positive literacy outcomes for two 14 year old students in Primary 4 (Student A and Student B) from the earlier study.
Method: Intervention strategies were based on theoretical underpinnings of literacy acquisition in the deaf signing population as well as clinical evidence such as earlier study results, classroom observations and teacher reports. Intervention for Student A targeted increasing verb vocabulary and sentence length, which were identified areas of deficit, through cultivating links between sign and English. Student B had severe spelling difficulties, and intervention introduced a strategy that facilitated visual sequencing to support spelling accuracy.
Results: Baseline assessments were administered before and after the period of intervention. Quantitative and qualitative analysis of results showed positive and significant outcomes with some generalisation to untreated items.
Conclusion: The results suggest that intervention planning must be individually tailored and the heterogeneity in language processing in this population must be taken into account.
Key words: Deaf, Sign Language, Literacy, Intervention
Effectiveness of Phonological Therapy for Naming in Mandarin-Speaking People with Aphasia
Background: The efficacy of phonological therapy for naming deficits in people with aphasia has been widely reported. The aim of this study was to develop and test a phonological cueing therapy in Mandarin for naming problems based on language-specific components (onset, rime, tone, syllable), and thereby determine the most salient phonological feature for word retrieval.
Method: Two Mandarin-speaking participants with moderate-severe aphasia (LLK: 65, male; TKF: 51, male) were recruited. Participants were assessed at three baselines and post-therapy assessments. Intervention involved between 5 and 10 weekly 1.5-hour therapy sessions targeting 21 nouns and 21 verbs. Phonological cues were provided (rime-tone related cue, onset-tone related cue, rime-onset related cue) to aid word retrieval. The presentation order of cues was counterbalanced, and an additional tonal syllabic cue was provided for disyllabic target words.
Results: Participants showed improved naming of treated items following therapy. Follow-up testing with LLK (10 sessions) indicated maintenance of treatment gains over a five-week period. The most effective cue for monosyllabic words and disyllabic words was a rime-onset related cue and tonal syllabic cue respectively.
Conclusions: These results demonstrated the effectiveness of a Mandarin phonological therapy in producing long-lasting benefits in naming target words. The findings also established the most efficient cue for monosyllabic and disyllabic Mandarin words.
Key words: Anomia, Rehabilitation, Error Analysis
Nurse-Led Infant Feeding Pathway: Factors Affecting Pathway and Caregiver Perceptions
Oral feeding is a complex motor task that preterm infants must master. The transition from tube to oral feeding is thus a crucial period to avoid delays in hospital discharge. The aim of this study was to investigate the trends in the feeding outcomes of 17 preterm infants on a new nurse-led semi-cue-based feeding pathway in advancing preterm infants towards full oral feeding. Data on the progress of 17 infants, born at less than 33 weeks gestation, placed on the feeding pathway were collated and analysed. Using phenomenological analysis, caregivers of these infants were also interviewed on their perceptions towards the caregiver training provided to them as part of the feeding pathway protocol. Findings suggest that infants’ gestational age, age at commencement of oral feeding and the number of hours of ventilation at birth were negatively correlated to the duration taken for full oral feeding attainment. The usage of the slower-flow Pigeon ‘S’ teat also appeared to result in a reduction in the time taken to achieve full oral feeding. Additionally, three out of six infants who were referred to speech therapy services did not require intervention. Caregiver perceptions suggest that training is an essential and indispensable component of the feeding pathway. These findings indicate that changes to the pathway protocol may result in more appropriate referrals to speech therapy services, thereby reducing the cost of care and optimising progression of the infants on the pathway. Consideration should be given to enforce that caregiver training is provided before discharge.
Keywords: Preterm, Oral Feeding, Feeding Pathway, Perceptions, Caregiver Training
Evaluating the Usefulness of a Functional Communication Checklist for Teachers of Children with Autism Spectrum Disorder
Background: There is a paucity of easily comprehensible tools designed to aid both teachers and speech and language pathologists (SLPs) in selecting goals for students with autism spectrum disorder (ASD) in the field of special education. The aim of this pilot study was to create and evaluate the usefulness of a functional communication (FC) checklist that may aid teachers and STs in working together to serve the communication needs of students with ASD.
Method: A pre-test post-test design was used in the study. In the pre-test phase, three participants (2 teachers, 1 SLP) viewed three video clips of children with autism and selected FC goals for them. Participants also self-rated their confidence levels during their goal selection for the children in the video clips. Participants were then trained to use the newly designed FC checklist. In the post-test phase, participants viewed three additional video clips and the pre-test procedure was repeated.
Results: While goal selection by each participant remained varied pre-test and post-test, all participants expressed that the FC checklist gave them a common vocabulary and framework for systematic goal selection. All participants also rated their post-test confidence levels as higher or the same as pre-test levels.
Conclusion: The results suggest that the FC checklist was useful in aiding teachers and SLPs in selecting functional communication goals for students with ASD and may facilitate more robust interdisciplinary discussions in goal selection for students.
Keywords: ASD, Developmental Disorders, Special Education, Teacher-SLP Collaboration
Effects of Language Treatment for Semantic Dementia: A Single Case Study
Primary progressive aphasia (PPA) is a neurological syndrome associated with a slow, gradual decline in language abilities. Word finding difficulties (WFD) are a clinical feature of two variants of PPA; semantic dementia (svPPA) and logopenic aphasia (lvPPA). Language treatment for PPA is known to improve naming of treated words. However, limited generalisation of such treatment has been so far reported. Two participants, the first with svPPA and mild WFD, the second with lvPPA and minimal WFD, received intensive naming treatment bolstered by autobiographical discourse production and written homework over four weeks. Following treatment, participants submitted homework for a further four weeks. Treatment benefits were observed for both participants, including reduced WFD in oral discourse production, maintenance of treatment gains with written homework, reduced impact of disability, improved overall confidence in communication and improved self-awareness of disability. These extensive functional gains highlight the potential use of autobiographical discourse in language treatment as an optimal method of behavioral intervention for individuals with early stage svPPA and lvPPA.
Keywords: Treatment; Generalisation; Primary Progressive Aphasia; Semantic Dementia; Logopenic
Normal Disfluencies in Typically Developing English-Mandarin Bilingual Children
The aim of the research was to describe the frequency and type of speech disfluencies produced by typically-developing, English-dominant, English-Mandarin bilingual children. Specifically, we investigated whether frequency and type of stuttering-like disfluencies (SLD), non-stuttering-like disfluencies (NSLD) varied across language and task. Fourteen typically-developing, English-Mandarin bilingual children, aged between 5 to 7 years old participated in the study. Each child completed three tasks in both English and Mandarin: receptive and expressive language assessment, structured conversation, and a “Tell-Retell” narrative task using a wordless book. Each participant’s parent also completed a Language Background Questionnaire seeking information about the child’s language. Audio-recorded narrative samples were transcribed and analysed for number of SLD, NSLD, and other linguistic variables using the Computerised Language ANalysis program (CLAN). The bilinguals produced more SLDs than monolingual standards. However, no differences in disfluency behaviours across tasks and languages were found. The study’s focus on English and Mandarin bilingual children would help inform clinical practice in the local context.
Keywords: Normal Disfluency, Narratives, English-Mandarin Bilingual
Language Dominance and Phonological Development of English-Mandarin Bilingual Preschoolers
Presently, there exists preliminary normative data (Gn, Brebner, & McCormack, 2014; Yeo, 2010) on the English phonology of bilingual children in Singapore. The aims of this study were to investigate the effects of language dominance on English phonology in English-Mandarin bilingual children raised in Singapore, and extend on the existing studies. The Articulation and Phonology assessments of the Diagnostic Evaluation of Articulation and Phonology (Dodd, Hua, Crosbie, Holm, & Ozanne, 2002) were used to collect normative speech data in English from 96 children, matched for age and language dominance. The children were aged 3;6 to 4;11, and divided into either the English-dominant (ED) or Mandarin-dominant (MD) group. Data were rated against Singapore English targets to measure for phonological accuracy. The type and number of error patterns produced, and error frequency within each error pattern were considered qualitatively as well. Results showed that language dominance influenced the development of English phonology. ED children presented with greater phonological accuracy than MD children, and the two groups used different error patterns. ED children presented with a lower frequency of errors within each error pattern than MD children. In line with findings by Gn et al. (2014) and Yeo (2010), results confirmed that language dominance influences the English phonological development of English-Mandarin children in Singapore. However, current findings differ from previous studies by showing an acceleration effect in the English phonological development of MD children as compared with ED children. The study contributes to better understanding of bilingual phonological development in Singapore accounting for the current local linguistic context.
Key words: Bilingual, Cross-Linguistic Processes, Speech Development
Effects of Nasogastric Tube on Swallowing Function in Patients with Dysphagia Following Stroke: Case Studies
Background: There currently exist mixed findings in the literature on the effects of nasogastric tube (NGT) on the swallowing function of people with dysphagia. The aim of this study was to address whether NGT does indeed affect the swallowing function of people with acquired dysphagia post-stroke.
Method: Four individuals within three months of having had their first stroke and were on NGT feeding were recruited. Four measures of swallowing function during videofluoroscopy were taken – epiglottic retroflexion, triggering of the swallowing reflex in relation to the position of the bolus, presence of valleculae and pyriform sinus residue, and penetration and aspiration.
Results: Three of the four participants showed increased epiglottic retroflexion without NGT. One participant showed a more delayed swallow and increased valleculae and pyriform sinus residue without NGT while another participant showed a decrease in penetration and aspiration status without NGT.
Conclusion: The difference in the changes in epiglottic retroflexion and its sequelae between the participants was probably affected by NGT placement and the sensation of discomfort caused by NGT. There is a possibility of a ceiling effect since all four participants displayed epiglottic retroflexion and sequelae that were close to a normal swallow. Future work with a larger sample is recommended to explore the effect of NGT placement on epiglottic retroflexion and its sequelae.
Keywords: Deglutition Disorders, Nasogastric Tube
Prompt Hierarchy Training for Teachers Implementing Augmentative Alternative Communication (AAC) with Children with Autism
Background: Many children with autism demonstrate a lack of independence when using their Augmentative Alternative Communication (AAC) systems to communicate in naturalistic settings. Using three case studies, the effectiveness of teachers’ training on prompt hierarchy – four cases of cues, provided in a least-to-most approach – to promote independence in AAC use in children with autism was explored. Spillover effects of teachers’ training in prompt hierarchy on decreasing socially inappropriate communicative behaviours were also examined.
Method: Participants were 2 males and 1 female, ages 8-10, who had insufficient functional speech, were using a photo/picture communication book and had an ongoing communication goal. Independence in AAC use and frequency of inappropriate communicative behaviours were measured at baseline and post-training phases over three standardized activities (Art, Snack, Work with Teacher).
Results: Analyses showed that all three participants demonstrated incremental shifts in their level of independence in AAC use in at least one standardized activity. However, the improvements in participants’ independence in AAC use were not consistently seen across all three activities. No observable changes in the frequency of inappropriate communicative behaviours were observed following teachers’ training.
Conclusion: Training teachers to systematically provide and fade off cues were helpful in promoting independence in students’ AAC use. Factors such as students’ activity specific motivation, teachers’ quality of prompt and knowledge on creating communication opportunities influence the efficacy of prompt hierarchy training on improving independence in students’ AAC use.
Keywords: Special Education Setting, Developmental Disorders, Cues, Instruction
Cross-Language Transfer Effects with a Modified Semantic Feature Analysis Therapy for English-Mandarin Bilinguals with Aphasia
Background: Differences between monolingual and bilingual language representation suggest there may be dissimilarities in rehabilitation patterns in patients with aphasia and the possibility of cross-language transfer during therapy. The Spreading Activation Model, the basis of Semantic Feature Analysis (SFA), describes the conceptual network as inter-connected nodes. During retrieval, activation spreads, attenuating from a concept along network links based on semantic likeness, suggesting that patients need not generate all six SFA features for semantically-related words. The aims of this study included exploring (1) the efficacy of a modified SFA in English and Mandarin on the target language, and (2) possible crossover effects to a linguistically contrasting non-target language.
Method: The 21-week study involved a multiple baselines single-case design with two pre-morbidly proficient male English-Mandarin bilinguals (PKK, age 71, and CYS, age 64) with word-finding difficulties. Both were more than three years post stroke-onset at the time of the study, and had been receiving speech therapy in English for more than three years. The therapy method required treatment items to be sorted into sets of five based on semantic relation. In each set, the initial item was taught as in traditional SFA but subsequent ones were treated based on their similarities and differences in relation to the first item.
Results: Both participants showed positive and lasting within-language effects for (1) treated items and (2) untreated items in English. Only CYS showed effects for items treated in Mandarin though this was not maintained. Neither showed cross-language transfer.
Conclusion: The modified SFA therapy produced positive and long-lasting within-language effects in treated and untreated English items that merit further research with a different pool of participants. Taking into account results of a previous study with similar participants, outcomes indicate that age of second language acquisition may be a crucial factor in determining the possibility of cross-language transfer.
Keywords: Bilingualism, Language Therapy, Stroke Rehabilitation
Cross-Language Transfer Effects of Verb Therapy for Mandarin-English Bilinguals with Aphasia
Background: Limited research has been conducted on the cross-language generalisation of verb therapy effects in bilinguals with aphasia (BWA), especially those who speak languages with greater linguistic differences (i.e., English and Mandarin). To maximise treatment efficacy within constraints of clinical resources, it is important to determine which language of treatment would be more beneficial in bilingual aphasia rehabilitation therapy.
Method: A Mandarin-English BWA (TSH: 48, male) was recruited 22 months post-stroke. Three baseline assessments were conducted prior to an English treatment block. Then, a post-therapy assessment (PT) was conducted before the Mandarin treatment block. A second PT and a maintenance testing were conducted thereafter. All assessments were conducted in both languages. Each therapy session consisted of a 90-minute Semantic Feature Analysis (SFA) verb therapy (Wambaugh & Ferguson, 2007) per week for eighteen items in the respective language.
Results: Treatment led to improvements in verb retrieval in the target language. Positive cross-language transfer of treatment effects was observed when treated in Mandarin, his premorbid more proficient language. Generalisation to untreated items and discourse production was not observed in the target language.
Conclusion: These findings suggest that semantic therapy can be conducted in the premorbid more proficient language to obtain benefits in both languages.
Keywords: Confrontation Naming, Translation Equivalents, Vocabulary
English Cognitive-Communication Screener for Acquired Brain Injury Impairments in Singapore
Background: The prevalence of stroke and vascular cognitive impairment no dementia (VCIND) in Singapore is increasing rapidly. Patients with VCIND are at-risk of conversion to dementia hence detection of VCIND could facilitate appropriate intervention and support positive outcomes. For this study, a culturally and linguistically appropriate screener was modified and normed (1) to facilitate early identification of cognitive-communication deficits in English-speaking adults, and (2) to better understand the progression of cognitive impairment in patients following stroke.
Method: 60 neurologically-intact participants: 30 aged 40-59 years (18 females, 12 males), 30 aged 60-78 years (11 females, 19 males) were assessed using the modified Cognitive-communication Screener which included visuospatial and visuomotor subtests. Preliminary normative data were obtained for two age groups. Using the modified screener, three case studies of English-speaking patients (aged 51, 58 and 62 years) with stroke were then conducted to track the progression of cognitive impairment from the acute to sub-acute stage of stroke.
Results: Normative data by age group based on neurologically intact participants can provide an accurate reference for clinicians. The modified Cognitive-communication screener for detection of VCI appears to have good criterion validity as changes to patients’ performance were supported by their Montreal Cognitive Assessment results.
Conclusion: The Cognitive-communication Screener appears to be a sensitive tool that provides clinically useful information about changes to patient’s performance.
Keywords: Mild Cognitive Impairment, Geriatric Assessment, Language Screening
Effect of Dialect on Phonological Analysis: Evidence from Singapore English Speaking Bilingual Children
Dialect and language background largely influence a speaker’s articulation and phonology. As Singapore is home to various cultures and languages, establishing local speech norms will provide a more accurate reference for assessing phonological disorders in the local population. Normative data using the Articulation and Phonology subtests of the Diagnostic Evaluation of Articulation and Phonology – UK (Dodd, Zhu, Crosbie, Holm, & Ozanne, 2002) were collected from 146 English-Mandarin bilingual preschoolers in Singapore, aged 3;6 to 4;5 (years;months). Responses were scored against two standards – British Standard English (BSE) and Singapore English (SGE), in terms of speech sound accuracy, and the frequency and type of error patterns present. The effect of language dominance on the children’s English phonological abilities was also explored. The results showed that the preschoolers’ speech sound accuracy increased significantly when scored against SGE versus BSE targets. The number of children identified to be using several error patterns was reduced when SGE targets were used instead of BSE targets. English-dominant children scored significantly higher than their Mandarin-dominant peers, in measures of speech sound accuracy. The identification of error patterns also differed between the two language groups. It is important to take dialectal variation and language dominance into account in the assessment of speech. Speech and language pathologists need to identify whether a bilingual child’s speech characteristics are related to a speech sound disorder, or are just normal variations of speech, to ensure more accurate assessment and diagnosis.
Keywords: Bilingual, Dialect, Phonology, Speech Sound Disorder
Measurement of Muscle Activity During Swallow with Chin Tuck and Chin Tuck Against Resistance Using Surface Electromyography
Background: Chin Tuck Against Resistance (CTAR) is a therapeutic exercise for people with swallowing problems. It incorporates the concepts of intensity and muscle-specificity, but does not include task-specificity. In order to include task-specificity, CTAR has to be performed with swallowing. In this study, the impact of carrying out CTAR with swallow was evaluated on healthy adults. Thus, the objective was to measure and compare submental muscle activity under 6 conditions: resting state, normal swallow, Chin Tuck, Chin Tuck swallow, CTAR and CTAR swallow, in a within-participants design.
Method: 36 healthy male and female participants, aged 21-50 years old, performed three trials each of the six conditions in counterbalanced orders. The angle of head flexion for Chin Tuck, Chin Tuck swallow, CTAR and CTAR swallow tasks was standardized at 20° from vertical plane and 5 ml of water was used for each swallow. Surface electromyography (sEMG) was used to collect readings of muscle activity of the submental muscles.
Results: Significantly greater mean and maximum sEMG values were observed during CTAR swallow as compared to normal swallow and CTAR.
Conclusion: CTAR swallow is a more effective exercise than CTAR alone and could be developed into a functional therapy exercise for people with dysphagia.
Keywords: Deglutition Disorders, Swallowing Intervention, Submental Muscles
Development of a Mobile Application with Spectral Biofeedback Features
Spectral biofeedback has been studied in the field of speech-language pathology as a complementary tool in articulation therapy for individuals who have been resistant to traditional articulation therapy. The aim of this study is to evaluate the reliability of a mobile application with spectral biofeedback features in providing accuracy ratings of users’ /s/ productions in various syllable positions. Seven participants aged 6;9 to 11;9 with disordered consonant /s/ productions were recorded imitating 60 nonsense syllables on an iPhone 5C. The syllables had /s/ in syllable initial, syllable initial within word, and syllable final positions. Participants’ productions of /s/ in each syllable were rated by a certified SLP for accuracy (accurate vs. inaccurate). The same syllables were then rated with the mobile application (accurate vs. inaccurate). The mobile application achieved at least satisfactory agreement with a certified Speech and Language Pathologist when rating 5 out of 7 participants’ productions of the /s/ consonant in different syllable positions. The use of the mobile application for providing feedback regarding the accuracy of /s/ consonant productions is promising. However, more studies will be needed to evaluate the mobile application’s reliability with a larger number of participants.
Keywords: Articulation, Spectral Biofeedback, Mobile Application
Oral Feeding Outcomes on a New Nurse-Led Semi-Cue-Based Feeding Pathway for Healthy Preterm Infants
Background: The aims of this study were to investigate the (1) outcome of a new, standardised nurse-led semi-cue-based feeding pathway for healthy preterm infants at a Special Care Nursery in an acute hospital, and (2) evaluate attitudes and perceptions of nurses implementing the pathway towards cross-disciplinary infant feeding training conducted by Speech-Language Therapists.
Method: A matched-pairs design was employed to compare feeding milestones of infants on the pathway (n = 10) with retrospective controls (n = 10). Nurses’ (N = 10) infant feeding knowledge was evaluated through pre- and post-training theory tests; attitudes and perceptions were captured using (1) Likert scale ratings, and (2) semi-structured interviews analysed through a general inductive approach.
Results: The age at attainment of full oral feeding was not significantly different between infant groups but pathway infants were discharged significantly earlier by 4.48 days (p = .05). Nurses demonstrated significantly higher post-test scores (p = .011), and a significant increase in confidence ratings of performing infant feeding post-training. Semi-structured interviews with nurses revealed themes relating to the benefits of cross-disciplinary training, and challenges to pathway implementation.
Conclusion: Early introduction of oral feeding in combination with a systematic framework provided by the new feeding pathway may facilitate earlier hospital discharge for healthy preterm infants, with positive implications on healthcare cost savings for caregivers. Cross-disciplinary training facilitated an upgrading of nurses’ knowledge base and clinical skills, and was deemed a positive experience overall. Recommendations are provided for the refinement of pathway implementation.
Keywords: Prematurity, Oral Feeding, Nurse-Led, Semi-Cue-Based, Feeding Pathway, Cross-Disciplinary Training, Attitudes, Perceptions
Language Recovery and Oral Narrative Performance in Children with Acquired Brain Injury
Background: For children with acquired brain injury (ABI), studies have highlighted the presence of persistent deficits in complex language skills. The first aim of this study was to examine the presence of these persistent deficits using the Pediatric Test of Brain Injury (PTBI). As these persistent deficits are often observed in discourse tasks, the second aim was to explore the oral narrative performance of children with ABI compared to matched typically developing (TD) children. The third aim was to compare the oral and written narrative performance in children with ABI to obtain a holistic picture of their narrative discourse abilities and guide intervention planning.
Method: The study involved a pair-wise case-matched design where three Singaporean children with ABI (aged 10;0 to 14;0) were matched to TD children. All participants were administered the same test battery: PTBI, Raven’s Standard Progressive Matrices and narrative task.
Results: Children with ABI demonstrated persistent deficits in complex language skills as shown from their PTBI performance. They also demonstrated poorer oral narrative performance compared to TD children. Additionally, children with ABI demonstrated poorer oral than written narrative performance.
Conclusion: Results suggest the need for detailed assessment using school-based tasks and have implications in the clinical setting for intervention planning.
Keywords: Language Recovery, Discourse, Cognitive-Linguistic Impairment, School-Age
Efficacy of Music for Improving Language in Children with Special Needs
Background: The efficacy of music for improving speech and language has been shown across ages and diagnoses. Locally, the wide range of therapy settings and increasing number of children with special needs demand more cost and time effective service delivery. Research exploring co-treatment models on children other than those with Autism Spectrum Disorder remains sparse. The aim of this research was to determine the efficacy of music for improving language in children with special needs, and generalizability of therapy effects.
Method: 25 children (7 to 12 years) were split into three groups – A, B and control. A cross-over design with direct therapy (storytelling) with or without music, and indirect therapy was applied with two therapy phases lasting 6 sessions each. Therapy targeted three prepositions in each phase. Baseline language abilities were assessed, with re-assessment after each phase.
Results: Introduction of music in therapy led to significantly greater improvement (p=.046, r=.53) in associated language abilities, with case studies showing greater effectiveness in developmentally appropriate target prepositions. However, improvements were not maintained once direct therapy ceased.
Conclusion: Incorporation of music could lead to greater efficiency and effectiveness of language therapy in children with special needs, but sustainability and generalizability of therapy effects both require further exploration.
Keywords: Music, Language Therapy, Special Needs
Oral Narratives of English-Dominant Singaporean Preschoolers
Background: Narrative assessment has been shown to be a sensitive tool in identifying children with persistent and subtle language difficulties. Many standardized narrative assessments available for preschoolers were normed on Standard English speaking monolingual populations. Due to exposure to bilingualism and Singapore Colloquial English, the narrative development of local bilingual children will differ from their monolingual Standard English speaking counterparts. The purpose of this research was thus to establish normative data which would accurately reflect the oral narrative ability of typically developing Singaporean English-dominant bilingual preschoolers.
Method: 17 typically developing English-dominant bilingual preschoolers (eight males, nine females), aged 4;4 to 5;4 years (M = 4;10 years, SD = 3 months), were recruited from five local preschools. Each child was asked to retell a story in English using a wordless picture book, “Frog, Where Are You?”. The oral narratives collected were then evaluated at the macrostructural and microstructural levels using the Systematic Analysis of Language Transcripts software.
Results: Percentiles for Narrative Scoring Scheme (NSS) components and linguistic measures were computed. There was a positive correlation observed between the NSS composite score and several microstructural measures. The atypical oral narrative samples obtained from two out of three participants, whose data were excluded from the normative sample, were also analyzed and discussed.
Conclusion: The normative data obtained for oral narratives could be used to support clinicians in identifying local English-dominant preschoolers with language difficulties.
Keywords: Oral Narrative, Discourse, Macrostructure, Microstructure, Story Retell
Utility of the Children’s Communication Checklist for Bilingual Singaporean Preschoolers
Background: The Children’s Communication Checklist (CCC-2) is used to screen for language and pragmatic problems in children. The aims of this project were (1) to establish Singapore norms for the CCC-2 in order to extend assessment options for local speech-language therapists and (2) to further our understanding of how bilingualism and language dominance affects language and pragmatic development.
Method: Participants were 59 typically-developing (TDL) preschoolers and two children with autism, aged 5-6 years, and their respective English teachers were recruited as participants. The TDL children were split into English-dominant and Mandarin-dominant groups. The children were rated on the CCC-2 by their English teachers and scores for each group were compared. Scores of English-dominant children were also compared to monolingual (UK) normative data for CCC-2.
Results: Generally, the English-dominant children had lower scores in comparison to the monolingual norms on language scales. On two of four pragmatic scales, the English-dominant children were rated lower than the monolingual norms for the UK. The English-dominant children were rated significantly higher than the Mandarin-dominant children on the language scales but equally on the pragmatic scales overall. When scored using local percentiles, the two children with autism had borderline performances.
Conclusions: Results suggest that bilingualism and language dominance do affect CCC-2 ratings for language and pragmatic development. These preliminary investigations also suggest that CCC-2 can be a viable option for local speech therapists if the new norms are adopted, item reliability is enhanced and translations to other local languages, such as Mandarin, are done.
Keywords: Children’s Communication Checklist, Bilingualism, Language Dominance, Pragmatics, Autism
Language Outcome and Written Narrative Performance in School-Aged Children Post Traumatic Brain Injury
Background: Children with traumatic brain injury (TBI) typically present with wide-ranging language impairments, spanning from deficits in basic to complex language skills. This study explored language recovery in children post-TBI, through the use of the Pediatric Test of Brain Injury (PTBI), a US standardized tool that assesses neurocognitive-linguistic skills that are often deficient in this population. The secondary aim of this study was to determine if deficits in written language production, which is crucial for school-aged children, persist more than 6 months post-injury.
Method: Two children who sustained severe TBI at least 6 months previously (Case 1: 12;5, female; Case 2: 12;7, male) were recruited. PTBI performance at two time points was compared at initial testing, and more than 6 months post-injury. Participants were instructed to write a narrative based on a picture stimulus within 45 minutes. A comparison on the written narrative performance of both cases and their typically developing (TD) matched peers was made. Comparison between written and spoken narratives were also made within the TBI children.
Results: The PTBI revealed (i) variable recovery patterns of complex language skills, (ii) poorer performance in measures of cohesion on written narratives compared to TD peers, (iii) poorer performance in measures of cohesion on written narratives compared to spoken narratives within the TBI children.
Conclusion: Findings provide insight into the variability in language recovery in children post-TBI, and hold implications for assessing and monitoring written language production.
Keywords: Traumatic Brain Injury, Language Recovery, Written Language Production