ACQ Vol 13 No1 2011

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Language disorders
ACQ Volume 13, Number 1 2011 53
settings, and urges further and better designed studies
to be undertaken in the future. The authors conclude that
“clinicians have little research evidence on which to base
decisions about service delivery options” (p. 248). We in the
field must therefore continue to seek convergent findings
to assist us to make clinical judgements, and to seriously
consider all opportunities to contribute to the current body of
evidence in terms of effective service delivery in schools. The
comprehensive appendix and bibliography of this review will
be useful to the school-based SPs for both purposes.
Speech production in primary progressive aphasia
Wilson, S.M., Henry, M.L., Besbris, M., Ogar, J.M., Dronkers,
N.F., Jarrold, W., Miller, B.L., & Gorno-Tempini, M.L. (2010).
Connected speech production in three variants of primary
progressive aphasia. Brain , 133, 2069–2088.
Rhonda Holmes
The neurodegenerative syndrome of primary progressive
aphasia (PPA) can be classified into three distinct clinical
syndromes depending on the linguistic and cognitive
features present. These are progressive non-fluent aphasia
(PNFA), semantic dementia (SD) and logopenic progressive
aphasia (LPA). Previously fluent and non-fluent dichotomies
have been applied to these dementia types; however, the
authors point out that the notion of fluency depends on the
particular dimension of verbal expression being considered
and furthermore, that the concept is applied inconsistently.
This study firstly aimed to characterise the connected
speech of each PPA variant by considering motor speech
and linguistic features, and secondly, to determine the
neuroanatomical correlates associated with the verbal
expression deficits.
The researchers recruited 70 participants: 50 patients
with mild to moderate aphasia from the populations of
interest and 20 controls. The sample of interest included 14
participants with PNFA, 25 with SD, 11 with LPA, and the
control sample included 10 participants with behavioural
variant frontotemporal dementia (the neurodegenerative
control group), and 10 normal controls. An extensive battery
of linguistic, motor speech, and cognitive assessments
were undertaken and connected speech samples for all
participants were recorded, transcribed and analysed.
Patients underwent MRI and had areas of atrophy mapped
and correlated with each speech/language measure.
Results indicated participants with PNFA had the slowest
speech rate with distortions, syntactic errors and markedly
reduced complexity, but did not have the agrammatism of
a “classic” Broca’s dysphasia. Participants with SD showed
normal speech rate with few speech or syntactic errors,
but demonstrated lexical retrieval difficulties evidenced by
their high usage of closed class words, pronouns, verbs,
and high frequency nouns. Those with LPA had a speech
rate between the other two groups, which, in the authors’
opinion, explained the variable results from other studies
in describing this variant as both non-fluent and fluent.
Effects of service delivery models on outcomes for
school-age children
Cirrin, F., Schooling, T., Nelson, N., Diehl, S., Flynn, P.,
Staskowski, M., Torrey, T., & Adamczyk, D. (2010). Evidence-
based systematic review: Effects of different service delivery
models on communication outcomes for elementary
school-age children. Language, Speech and Hearing
Services in Schools , 41 , 233–264.
Rosemary Roberts
Given the consistently high demand, along with the low
supply of speech pathology services within education
settings, speech language pathologists (SPs) working in
schools aim to provide high quality, evidence based
interventions. In seeking to identify best practice in terms of
service delivery models, these authors note that the 2008
American Speech Hearing Association (ASHA) Schools
Survey data indicated that the traditional “pullout” model (1:1
intervention outside the classroom) is still the most common
practice used by SPs in US elementary schools. Since both
classroom-based interventions and indirect-consultative
service delivery models are also used, the effectiveness of all
methods warrants investigation.
The rigour required of an evidence-based systematic
review (EBSR) resulted in a comprehensive search being
conducted of 27 relevant electronic databases along with
electronic searches of all ASHA journals; references from all
relevant articles found were investigated. Once the inclusion
criteria were applied, only 5 studies from the original 255
abstracts considered could be included in the systematic
review.
The main question addressed in the review was the
influence of the type and dosage of speech-language
pathology service delivery models on nine outcomes,
which included those related to the child (e.g., vocabulary,
functional communication, literacy), the environment (e.g.,
language facilitation techniques of significant adults) and
system-related outcomes (e.g., curriculum standards and
rates of referral to special education).
While the authors conclude that comparisons between the
effectiveness of direct services delivered in the classroom
and pullout intervention were favourable, and that “highly
trained” SP assistants following clear guidelines from SPs
can be effective in some cases, the authors remind SPs
to interpret their findings with caution, given the limitations
of the EBSR. For example, this review did not capture the
range and scope of available research for services provided
to preschool or secondary students, suggesting the
probability that “some evidence that could be quite useful to
school clinicians did not meet the inclusion criteria for this
review” (p. 249). Fortunately, the paper includes an extensive
appendix containing abstracts which were not included in
the current review, but which have the potential to inform
clinical practice with regard to models of service delivery.
This paper makes us acutely aware of the difficulty of
attempting high-quality experimental research in school
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