Therapy outcome measures for children with dysarthria

A recent discussion with a parent and a speech and language therapist about how best to measure whether therapy has had an effect made me choose this article for this month’s blog post. 

I am not telling you anything new when I say that speech therapy can have a positive impact on a person’s communication and wellbeing. However, services are under increasing pressure to prove that their therapies are effective – from a clinical as well as cost-effective point of view. According to Pamela Enderby, one of the leading researchers on speech and language therapy and health interventions in the UK, outcome measures are important for evaluating and improving clinical services as they can measure communication changes in individuals, but also allow for comparison across services.  

Outcomes measures try to establish whether an individual has benefitted from therapy. There are several reasons why this is this difficult to find out for an area such speech and language therapy: 1) there are a wide range of therapy options for a child with dysarthria depending on the communication problem; 2) it is one thing to measure improvement in speech e.g. intelligibility, but how do you measure wellbeing, improved coping skills or increased confidence, which can all contribute to improved communication?

According to Enderby, Therapy Outcomes Measures or TOM (Enderby et al., 2006) can capture these more holistic aspects of therapy. TOM allows clinicians to describe the abilities of a child for impairment, communication activity, participation and wellbeing before and after therapy. The four features are rated on an 11 point scale (0 – severe to 5 – normal for age and sex) using the usual assessment procedures. I see TOMs strengths in the fact that they are a set of scales which are based on the International Classification of Functioning, Disability and Health framework (WHO). It is a quick tool that has proved reliable for a range studies, and can be applied irrespective of the various assessment procedures that exist in services. 

On the other hand, I think that in some cases a qualitative analysis of the data would be helpful to better understand results. For instance, no change in the rating could be considered a positive outcome in cases where the dysarthria is due to progressive disorders. Also, training may be needed to ensure consistency in the use of the scale. Being a member of review panels, I know how differently the same work can be viewed, with some judges, for instance, never exhausting the full scoring range available to them. After all, judging is the act or process of forming an opinion or making a decision after careful thought, i.e. it has a subjective element to it. This, however, should not stop us in our endeavour to improve the quality of the services we offer.

Enderby, P. (2014). Use of extended therapy outcome measure for children with dysarthria. International Journal of Speech-Language Pathology, 16(4), 436-444.