Impact case study database

Newcastle research found a substantial benefit of breath control therapy on the intelligibility of young people with CP affected by dysarthria. Since breath control is fundamental to clear, intelligible speech, Newcastle recommended this as the first line of therapy before, for example, improving articulation.

Impact on NICE guidance

At the outset of research, there was little guidance on effective therapies. Newcastle research underpinned the chapter on improving speech intelligibility in the January 2017 full NICE guideline NG62 (EV1). For example, R2 and R3 are cited on pages 232-5 as the only studies that investigated improvement of speech production and intelligibility for both single words and connected speech when rated by both familiar and unfamiliar listeners. The guideline also highlighted the finding of R3 that treatment improved children’s communicative participation in interactions at home and school. This evidence led to the following recommendation in the accompanying concise guideline on assessment and management (EV2, page 20):

1.9.6: “Offer interventions to improve speech intelligibility, for example targeting posture, breath control, voice production and rate of speech, to children and young people with cerebral palsy…”

Impact on practice

In 2019, a survey was distributed via the Royal College of Speech and Language Therapists with the same question set as the initial survey (R4, carried out in 2012) to assess change in practice (EV3). Overall, the results suggest a reduction in provision of two types of therapy that Newcastle found to be ineffective or inappropriate (R1-3). The first type is non-speech oromotor interventions (e.g. blowing, moving the tongue in different directions on command); since neural control is specific, this therapy should not improve speech production. The second is articulation therapy, which can only be provided once breath control is sufficient to support speech. Specifically, there was a significant reduction in the proportion of therapists providing these interventions compared to 2012: from 70% to 43% for non-speech oromotor interventions and from 87% to 77% for articulation interventions, indicating a reduction in the use of interventions with limited effectiveness. The proportion of therapists stating that they targeted the speech functions specified by NICE was over 90% in both 2012 and 2019, indicating that therapists now focus their limited time on more effective methods.

In addition, the therapy has been found to improve children’s confidence, allowing them to have more successful conversations, with a wider range of partners in more environments, thereby increasing their social participation (EV4).

Impact on Australian online guidance

In June 2016, the Australian Cerebral Palsy Alliance included R1-3 as evidence on their webpage “Speech therapy for children with dysarthria” (EV5), which has around 250 hits/month, with the recommendation:

“Intensive dysarthria therapy appears to be effective for children with cerebral palsy… the studies concluded that these children’s speech was easier to understand after the therapy.”

Impact on textbook resources

Newcastle research (R1-3) extensively informed the widely-used 2016 textbook “Children’s Speech: An Evidence-Based Approach to Assessment and Intervention” by McLeod and Baker. As of July 2020, this had Amazon sales rankings in the top 5% across Anatomy, Pre-clinical Medicine and Family, and Lifestyle Paediatrics; and sales of over 800 in Europe and over 3,500 in the US (EV6). Citations of Newcastle work include:

• Page 379 “[R2] found that intensive intervention… using the systems approach… was associated with improvements in speech intelligibility for older children with cerebral palsy and dysarthria.”

• Page 514 “Across the evidence on a systems approach to intervention, procedures involving practice of a particular motor skill are usually based on principles of motor learning e.g.… [R2, R3].

• Page 515: “[R2] reported that… intervention sessions 3 times per week for 6 weeks resulted in improvements in both word level and conversational speech intelligibility in children aged 12 to 18 years. A similar finding was reported for younger children aged 5 to 11 years [R3].

Impact on undergraduate teaching

The research (particularly R1-4) has informed national and international university speech therapy courses. For example, at Manchester Metropolitan University the research was crucial in developing their courses and has been adopted on publication into undergraduate teaching to 50 students per year since 2015 (EV7). The University of Strathclyde has included the research into undergraduate teaching since 2017, and R4 is compulsory reading for all 35 students as preparation for class-based discussion (EV8).

Internationally, the University of Sydney confirmed (EV9) that undergraduate teaching has included R1-4 as they have been published since 2014, including specific reference to the systems approach. The course is undertaken by around 90 students per year. At the University of Melbourne, R1-4 were crucial to developing the course, which is undertaken by up to 90 students per year (EV10). The papers also informed a two-year Masters of Speech Pathology degree. Finally, Radboud University Medical Center (Netherlands) confirmed that R1-4 have been included into their undergraduate teaching to 50 students a year since 2013 (EV11).

In summary, Newcastle research found a substantial effect of breath control therapy on the intelligibility of children with CP who are affected by dysarthria. The results informed UK guidance, worldwide use in textbooks and international teaching practice.