MA-thesis about stuttering guidelines

 

The EST-team is very glad to welcome MA-student Trude Beseth Nordeide to the project. Trude is presenting her project here - and would really appreciate feedback from you concerning existing guidelines.

My name is Trude Beseth Nordeide. I’m a master’s degree student at the speech language therapist study at the University of Oslo. This spring I will write my master’s thesis, and I will write my thesis in collaboration with the EST project.

Through my time at the master program at UiO I’ve got an increased interest for stuttering in preschool children and children in school age. Therefore, I decided to take a closer look at existing national clinical guidelines in other countries for stuttering treatment for these client groups for my master’s thesis.

Through ECSFs (by Mark Pertijs) presentation “Evidence-based Clinical Guidelines in Stuttering Therapy” from 2014 I did find an overview over European countries with national guidelines, and I have chosen to take account for that list http://www.ecsf.eu/userfiles/files/PDF%20M.Pertijs%2020014-03-27.pdf, see page 41). 

However, I have not been able to find an updated list of countries with national guidelines. Therefore, I recently sent out emails to 13 countries with both consensus-based and evidence-based national guidelines (most of them were at that time evidence-based, and some in process of changing from consensus-based to evidence-based). Furthermore, I chose to contact ASHA and the Australian association as well, since both the USA and Australia have been influencing European SLTs practice with their research and guidelines.

Method and analysis 

I will use Appraisal Guidelines Research and Evaluation (AGREE) for analysing the guidelines. AGREE can contribute in evaluating the clinical guidelines through giving rates in the following six domains.

 

1 Scope and purpose	addresses the overall goal with the guideline, specific help questions and the target population.
2 Stakeholder involvement	focuses on the extent to which the guideline has been developed by the appropriate stakeholders, and whether it represents the views of its intended users.
3 Thoroughness in development	deals with the process of collecting and synthesizing the evidence, the methods for formulating the recommendations and updating them.
4 Clarity in the presentation	deals with the language, structure and format of the practice guidelines.
5 Usability	looks at the different variants and facilities, strategies for increasing uptake and source usability for the use of the practice guidelines.
6 Editorial independence	deals with the fact that the recommendations are not exclusively biased with a form of competing interest.

    

                  

The questions and domains in AGREE can contribute to receiving important information on how the guidelines relate to evidence collection and how well they are transferred to clinical implications for the SLTs. 

What is my goal with the project?

The purpose of my master’s project is to address information about the following elements in the guidelines: 

• How evidence-based national guidelines apply holistic implications for clinicians based on the underlying research (e.g., to which degree does the case that a treatment is evidence-based mean that it will be adequate for SLP clients in their environment?)
• If I receive both consensus-based and evidence-based guidelines it would be interesting to discuss the eventual differences.
• Do the authors of the guidelines have any relations with how the implications are presented? (E.g., Ratner et al. (2005) expressed lack of more independent stakeholders in the research of the different stuttering treatments.)
• Do the guidelines implications work as strict procedures or more “loose indicatives” to the clinician’s practice?

If you have any information relevant to my master project, or maybe have any updated information about countries in Europe who are not represented in the mentioned overview from 2014, who do have national guidelines today, I would be very happy hearing from you! You can contact me on this email: trudebno@student.uv.uio.no   

Thank you!  

Kindly, Trude Beseth Nordeide

Half way there- thoughts from a midway assessment

 

The PhD candidate in the EST project, Åse, marked being half way in her PhD this fall. In this blogpost she shares her thoughts from her midway assessment:

The midway assessment in a PhD is a milestone for a PhD candidate, although it is carried out differently across universities and departments. At the Faculty of Educational Sciences here at the University of Oslo, the mid way evaluation is a 90 minutes seminar, often held as part of a research seminars the PhDs candidates partake in. Participants are the candidate, opponent (a senior researcher within the research field), supervisor, coordinator of the organized research seminar and other PhD students.

I had my midway assessment in the end of September with professor Scott Yaruss as the opponent. The seminar begun with a presentation of my work. I talked about the three studies that will be included in my thesis, about the progress I have made, and about how I plan to work the next two years in order to finish the project on time. I also accounted for the courses I have taken and plan to take. Preparing for the seminar really felt like taking a step back and looking at my work from a distance. So much of working with the PhD feels like being on a high-speed rail, and it felt good to pause for a minute and get an overview of the road I have already traveled: The first study, a systematic review and meta- analyses, has been submitted, and the second study of my PhD is currently being drafted. I have finished all courses and the teaching proportion of the job. When did this even happen? It feels like I just started!

Also, preparing the presentation forced me to think ahead. Although I do have a progress plan and a time frame it is nice with a reason to reassess the plans, check in with deadlines and make changes accordingly. Two years is still a long way to go, but at least now, I know more about where I am going.  

The presentation was followed by a discussion about the work, between professor Yaruss and I. We discussed questions such as: what are the mechanisms leading to improvement in children`s stuttering? What are implications of the individuality of programs for treating stuttering in children? Discussing treatment for stuttering in preschool aged children, and the studies included in the EST project and my thesis especially, was very motivating. The discussion illuminated some parts of the projects that wasn’t clear for me, and presented me with many new insights. Thanks for the discussion, Scott!

-Åse 

Happy new year!

 A very special year sees its final days. 

The EST teams wishes all of you and your families a happy new year, may 2021 be the year where we can celebrate to see each other again in real live, both private and professional.

Stay safe!

Picture by Karolina Grabowska from Pexels

Throwback: Open seminar on “Individualization of stuttering treatment”, March 3rd 2020.

 

One of the more recent posts in Norwegian here on the blog was about Hilda Sønsterud’s Ph.D. project titled “What works for whom”. Way back in March we planned to make a post on an open seminar that was hosted by the Departement of Psychology and the Department of Special Needs Education at the University of Oslo in conjunction with the public defense for Dr. Sønsterud’s doctoral dissertation. The members of the scientific committee were invited to present their own research under the heading “Individualization of stuttering treatment” to a wider audience of speech language pathologists, students and other clinicians interested in stuttering. 

The topic of the seminar is still highly relevant, and we decided that it was about time to pull this text out of the file archive.

Dr. Marie-Christine Franken

The first presenter was Clinical researcher Dr. Marie-Christine Franken. The title of her talk was “The long-term outcomes of the RESTART trial”. Dr. Franken started out by talking about the design of the randomized comparative study.18 months post treatment the researchers found comparable effects of the Lidcombe program (LP) and the RESTART Demands and Capacities Model based treatment (DCM) for preschool children who stutter. Results from the trial have been published and are available here. Dr. Franken went on to share some of the preliminary data 5 years post treatment. These outcomes are based on self-reports of stuttering severity from children (N=100) and parents (N=127), as well as ratings of satisfaction with communication in everyday speaking situations from both groups. Analysis were still being carried out and did not include evaluations of speech samples by the researchers at the time. The preliminary results suggested, however, that the outcomes between LP and DCM are still comparable at 5 years post treatment. Fortunately, we can look forward to future publications on long term effects from the research group.

Professor Glen Tellis

Next presenter was Professor Glen Tellis who gave a talk on the topic “Fluency therapy ideas for 21st century clinicians. Apps, Social Networking, and Teletherapy”, based on his own and his former Ph.D-student Erik X. Raj’s work. With illustrative videos from teletherapy, Dr. Tellis showed how different apps that provide us with pictures, audio, memes and emojis can be incorporated into more traditional stuttering therapy for school aged children. He gave strong arguments for using humor and to make use of platforms that children enjoy, when working with affective, behavioral and cognitive components of stuttering. How do you imagine you would feel if you met an alien version of yourself on the street? Would you be nervous, or scared maybe? Together you can explore if there are other situations where you have felt nervous, scared etc. Maybe you can remember a situation where stuttering has made you feel like this? Moreover, consider that the alien comes from a planet where everyone stutters. What would his talking sound like, and what symbols would they have for different stuttering types, like blocks and repetitions on this planet? These are just a few of the creative suggestions for activities Dr. Tellis shared and where visual and audio material play a key role. Norwegian readers can also find some tips and information on this topic at Statped.no here.  

Finally, Dr. Hilda Sønsterud reflected upon the topic “Individualized stuttering therapy - what matters the most”. She highlighted the need for, and importance of, clinical research on stuttering therapy for adults that lead to personally significant changes for the participants. The core focus of Hilda’s Multimodal stuttering therapy (MIST) has been “minding the body in speech”. Participants have been practicing one or a few, strategies they have found helpful in clinic outside the therapy room. Strategies have been tailored to meet individual needs. 

From the right: Dr. Hilda Sønsterud and organizer of the seminar, Melanie Kirmess

We thank all presenters for their time and contribution to make this seminar a success.

For the EST-team, Ane Hestmann Melle

Forskningsformidling til barn

 

Jobber du som logoped, lærer, eller er forelder til et barn som stammer? Eller er du kanskje selv et barn som stammer? Stipendiat i EST prosjektet, Åse Sjøstrand er denne uken intervjuet av Ung.forskning.no om sin forskning. Les intervjuet her!

På ung.forskning.no formidles ny forskning til barn på en forståelig måte. Her kan barn lese forskerportretter og lære om alt fra forskning på klima og mikroplast, til medisin og koronavirus. Å formidle forskning til barn er en strålende øvelse. Det krever et klart språk, og gir en tydelig pekepinn på om vi selv vet hva vi driver med.

Leter du etter informasjon om stamming rettet mot voksne? Post doc i Est-prosjektet snakker om stamming på podcasten BBC Crowd Science. Les om episoden og finn lenke til den, i dette blogginnlegget.

 

A warm welcome to our Swedish collaborators

 

Since spring 2020 Sweden, represented by three researchers, has joined the EST-project. Main Swedish coordinator is Tove Lagerberg, assistant professor with a position as coordinator of the Speech and Language Pathology program at Gothenburg University https://www.gu.se/en/about/find-staff/tovelagerberg, Ineke Samson, doctoral student and SLP, Karolinska Institute and Danderyd Hospital https://medarbetare.ki.se/people/inesam  and Anita McAllister, associate professor and SLP, Karolinska Institute and Karolinska University Hospital https://medarbetare.ki.se/people/anitmc .

So who are we? We are all SLP’s with extensive expertise in different speech and language disorders primarily within children and teenagers. 

Tove Lagerberg has clinical experience and research experience concerning fluency disorders and intelligibility assessment. She has been coordinator of specialist medical care for children and adults who stutter (Intensive Stuttering Therapy). Tove has also been a member of international networks such as European Clinical Specialization in Fluency Disorders (ECSF) and Stuttering Research and education network (STUREN). 

Ineke Samson, is recognized as a specialist in accordance with criteria developed by the ECSF and has clinical experience from almost twenty years in the field of fluency disorders. She also has an ongoing teaching assignment at the Study program in Speech and Language Pathology at Karolinska Institute, responsible for the content and structure of theory, practice and assessment of fluency disorders. 

Anita McAllister has extensive clinical and research experience by supervising doctoral students, leading and participating in research and by clinical patient work. She started and coordinated a multi-professional specialist clinic for patients with oral motor and speech motor disorders. 

 

In addition to the expertise within the field of stuttering, the Swedish researchers contribute knowledge within intelligibility and oral motor and speech motor disorders. By joining the project also Swedish children with stuttering will be included in the up-coming clinical trial. Children will be recruited from different clinics in the larger Stockholm and Gothenburg area. 

We are very excited to be part of this clinically important and valuable project and recognize the important work that has been done to date by the researcher’s in the EST-project. The results from the clinical trial will be looked forward to by many clinicians within the field with great expectations.

The EST team warmly welcomes our Swedish colleagues. 

"Sen hjelp er heller ikke for sent" – Hilda Sønsterud presenterer fra sin doktorgradsavhandling på NIFS’ Høstweekend 2020

 

Tidlig intervensjon framheves som viktig for barn som begynner å stamme. Noen fortsetter å stamme inn i voksenlivet. Hva som er god hjelp for den siste gruppen var tema under Norsk Interesseforening for Stamming og løpsk tale (NIFS) årsmøte og seminar 23.-25. oktober 2020.

Deltakerne var i all hovedsak personer med stamming og/eller løpsk tale og deres pårørende, samt noen fagmedlemmer. Hovedtaler på lørdag var Hilda Sønsterud, som presenterte funn fra sitt avsluttede doktorgradsprosjekt «Stammebehandling – Hva virker for hvem?». 

Hilda Sønsterud engasjerer tilhørerne på NIFS årsmøte. 
Foto: Ciel Waagenes Udbjørg, NIFS

Tre av deltakerne i hennes behandlingsstudien delte av sine erfaringer med å delta i prosjektet, og hva de har tatt med seg videre etter endt behandling. Endringer som ble trukket fram som betydningsfulle var å snakke med mindre strev, å holde presentasjoner på jobb med større trygghet og å tørre ta opp mer taletid blant snakkesalige, utadvendte venner. For noen av deltakerne innebar endringene å snakke med mindre stamming, for andre ikke.

I alt 18 voksne i alderen 21-61 år mottok totalt 10 timer med Multimodal Individuell Stammebehandling (MIST) i løpet av en 6-månedersperiode. Noen av de sentrale funnene fra Hilda studie er:

•         Individuelle mål er viktig for å oppnå personlig betydningsfulle resultater av behandling, i tillegg til statistisk signifikante resultater

•        Arbeidsalliansen, det vil si relasjonen og samarbeidet mellom deltaker og logoped, bidrar til effekten av stammebehandling. Enighet om hvilke oppgaver og aktiviteter man skal utføre peker seg ut som viktig.

•     Et lite antall skreddersydde elementer, innenfor temaene kropp, tanker, pust, stemme og presentasjonsferdigheter ble valgt ut som fokusområde i behandling for hver deltaker. Positiv effekt ble opprettholdt i 12 måneder etter avsluttet behandling for en stor andel av deltakerne. Denne oppfølgingsperioden er lengre enn i mange internasjonale studier. Det er også gjort målinger etter 24 måneder som skal analyseres.

Den interesserte leser kan finne de internasjonale publiserte artiklene i Hildas prosjekt her:

-        What do people search for in stuttering therapy: Personal goal-setting as a gold standard?

-        The working alliance in stuttering treatment: a neglected variable?

-        What works for whom? Multidimensional individualized stuttering therapy (MIST)

Melanie Kirmess, medlem i EST-teamet, har vært en av Hilda Sønsteruds veiledere og er medforfatter av disse artiklene. For mer informasjon om MIST på norsk finner man artikkelen Multimodal Individuell stammeterapi (MIST) – en aktuell tilnærming for flere? på nettsiden til Norsk Tidsskrift for Logopedi.  

Det bør fremheves at NIFS er en del av EST-prosjektets referansegruppe. NIFS er også søkerinstansen som ble tildelt midler fra Stiftelsen Dam, som finansierte Hildas Sønsteruds doktorgradsprosjekt. Dette viser at brukermedvirkning har en plass i forskning og at brukerorganisasjoner kan ha en viktig rolle i kunnskapsutvikling.  

Vi gratulerer NIFS med vel gjennomført Høstweekend, og Hilda Sønsterud med oppnådd doktorgrad!

Skrevet av Ane Hestmann-Melle