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communication" /></a></div><div class="bkr_bib"><h1 id="_NBK578077_"><span itemprop="name">Interventions that improve function and participation: communication</span></h1><div class="subtitle">Cerebral palsy in adults</div><p><b>Evidence review D4</b></p><p><i>NICE Guideline, No. 119</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Alliance (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2019 Jan</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-3223-8</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div></div><div class="bkr_clear"></div></div><div id="chd4.s1"><h2 id="_chd4_s1_">Interventions that improve function and participation for adults over 25 with cerebral palsy</h2><div id="chd4.s1.1"><h3>Review question</h3><p>D4 Which interventions (for example augmentative and alternative communication systems) are effective in promoting communication for adults with cerebral palsy who have communication difficulties?</p><div id="chd4.s1.1.1"><h4>Introduction</h4><p>Adults with cerebral palsy can have communication difficulties due to their underlying motor disorder, learning difficulties and problems with medication and equipment. In current practice speech and language therapy assessment is used to identify interventions including alternative augmentative communication systems that can be used to assist communication. The effectiveness of these interventions is analysed in this review question.</p></div><div id="chd4.s1.1.2"><h4>PICO table</h4><p>Please see <a class="figpopup" href="/books/NBK578077/table/chd4.tab1/?report=objectonly" target="object" rid-figpopup="figchd4tab1" rid-ob="figobchd4tab1">Table 1</a> for a summary of the Population, Intervention, Comparison and Outcome (PICO) characteristics of this review.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchd4tab1"><a href="/books/NBK578077/table/chd4.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figchd4tab1" rid-ob="figobchd4tab1"><img class="small-thumb" src="/books/NBK578077/table/chd4.tab1/?report=thumb" src-large="/books/NBK578077/table/chd4.tab1/?report=previmg" alt="Table 1. Summary of the protocol (PICO table)." /></a><div class="icnblk_cntnt"><h4 id="chd4.tab1"><a href="/books/NBK578077/table/chd4.tab1/?report=objectonly" target="object" rid-ob="figobchd4tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">Summary of the protocol (PICO table). </p></div></div><p>For full details see the review protocol in <a href="#chd4.appa">appendix A</a>.</p></div><div id="chd4.s1.1.3"><h4>Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guideline: the manual 2014</a>. Methods specific to this review question are described in the review protocol in <a href="#chd4.appa">appendix A</a> and for a full description of the methods see <a href="/books/n/niceng119erbm3/?report=reader" class="toc-item">supplementary document C</a>.</p><p>Declaration of interests were recorded according to NICE’s 2014 conflicts of interest policy from May 2016 until April 2018. From April 2018 onwards they were recorded according to NICE’s 2018 <a href="https://www.nice.org.uk/About/Who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">conflicts of interest policy</a>. Those interests declared until April 2018 were reclassified according to NICE’s 2018 conflicts of interest policy (see Interests Register).</p></div><div id="chd4.s1.1.4"><h4>Clinical evidence</h4><div id="chd4.s1.1.4.1"><h5>Included studies</h5><p>Three studies (number of participants, N=28) were included in the review (<a class="bibr" href="#chd4.s1.ref2" rid="chd4.s1.ref2">Hustad 2003</a>, <a class="bibr" href="#chd4.s1.ref3" rid="chd4.s1.ref3">Hustad 2004</a> and <a class="bibr" href="#chd4.s1.ref1" rid="chd4.s1.ref1">Pennington 2010</a>).</p><p>One before-and-after study (<a class="bibr" href="#chd4.s1.ref1" rid="chd4.s1.ref1">Pennington 2010</a>; N=16) evaluated an intensive speech and language therapy intervention. Two cross-sectional studies (<a class="bibr" href="#chd4.s1.ref2" rid="chd4.s1.ref2">Hustad 2003</a> and <a class="bibr" href="#chd4.s1.ref3" rid="chd4.s1.ref3">Hustad 2004</a>; N=12) compared speech augmented with alphabet or topic cues with habitual speech. No evidence was found for interventions to improve receptive communication or for training of communication partners.</p><p>The clinical studies included in this evidence review are summarised in <a class="figpopup" href="/books/NBK578077/table/chd4.tab2/?report=objectonly" target="object" rid-figpopup="figchd4tab2" rid-ob="figobchd4tab2">Table 2</a> and evidence from these is summarised in the clinical evidence profiles below (<a class="figpopup" href="/books/NBK578077/table/chd4.tab3/?report=objectonly" target="object" rid-figpopup="figchd4tab3" rid-ob="figobchd4tab3">Table 3</a> and <a class="figpopup" href="/books/NBK578077/table/chd4.tab4/?report=objectonly" target="object" rid-figpopup="figchd4tab4" rid-ob="figobchd4tab4">Table 4</a>).</p><p>See also the literature search strategy in <a href="#chd4.appb">appendix B</a>, study selection flow chart in <a href="#chd4.appc">appendix C</a>, forest plots in <a href="#chd4.appe">appendix E</a> and study evidence tables in <a href="#chd4.appd">appendix D</a>.</p></div><div id="chd4.s1.1.4.2"><h5>Excluded studies</h5><p>Studies excluded from this systematic review, with reasons for their exclusion, are provided in <a href="#chd4.appk">appendix K</a>.</p></div></div><div id="chd4.s1.1.5"><h4>Summary of clinical studies included in the evidence review</h4><p><a class="figpopup" href="/books/NBK578077/table/chd4.tab2/?report=objectonly" target="object" rid-figpopup="figchd4tab2" rid-ob="figobchd4tab2">Table 2</a> provides a brief summary of the included studies</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchd4tab2"><a href="/books/NBK578077/table/chd4.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figchd4tab2" rid-ob="figobchd4tab2"><img class="small-thumb" src="/books/NBK578077/table/chd4.tab2/?report=thumb" src-large="/books/NBK578077/table/chd4.tab2/?report=previmg" alt="Table 2. Summary of included studies." /></a><div class="icnblk_cntnt"><h4 id="chd4.tab2"><a href="/books/NBK578077/table/chd4.tab2/?report=objectonly" target="object" rid-ob="figobchd4tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of included studies. </p></div></div><p>See <a href="#chd4.appd">appendix D</a> for the full evidence tables.</p></div><div id="chd4.s1.1.6"><h4>Quality assessment of clinical studies included in the evidence review</h4><p>The clinical evidence profiles for this review question are presented in <a class="figpopup" href="/books/NBK578077/table/chd4.tab3/?report=objectonly" target="object" rid-figpopup="figchd4tab3" rid-ob="figobchd4tab3">Table 3</a> and <a class="figpopup" href="/books/NBK578077/table/chd4.tab4/?report=objectonly" target="object" rid-figpopup="figchd4tab4" rid-ob="figobchd4tab4">Table 4</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchd4tab3"><a href="/books/NBK578077/table/chd4.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figchd4tab3" rid-ob="figobchd4tab3"><img class="small-thumb" src="/books/NBK578077/table/chd4.tab3/?report=thumb" src-large="/books/NBK578077/table/chd4.tab3/?report=previmg" alt="Table 3. Summary clinical evidence profile: comparison 1: before versus after intensive speech and language therapy." /></a><div class="icnblk_cntnt"><h4 id="chd4.tab3"><a href="/books/NBK578077/table/chd4.tab3/?report=objectonly" target="object" rid-ob="figobchd4tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Summary clinical evidence profile: comparison 1: before versus after intensive speech and language therapy. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchd4tab4"><a href="/books/NBK578077/table/chd4.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figchd4tab4" rid-ob="figobchd4tab4"><img class="small-thumb" src="/books/NBK578077/table/chd4.tab4/?report=thumb" src-large="/books/NBK578077/table/chd4.tab4/?report=previmg" alt="Table 4. Summary clinical evidence profile: comparison 2: supplemented versus habitual speech." /></a><div class="icnblk_cntnt"><h4 id="chd4.tab4"><a href="/books/NBK578077/table/chd4.tab4/?report=objectonly" target="object" rid-ob="figobchd4tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Summary clinical evidence profile: comparison 2: supplemented versus habitual speech. </p></div></div><p>See <a href="#chd4.appf">appendix F</a> for the full GRADE tables.</p></div><div id="chd4.s1.1.7"><h4>Economic evidence</h4><div id="chd4.s1.1.7.1"><h5>Included studies</h5><p>A systematic review of the economic literature was conducted, but no studies were identified which were applicable to this review question.</p></div><div id="chd4.s1.1.7.2"><h5>Excluded studies</h5><p>No studies were identified which were applicable to this review question.</p></div></div><div id="chd4.s1.1.8"><h4>Summary of studies included in the economic evidence review</h4><p>No economic evaluations were included for this review.</p></div><div id="chd4.s1.1.9"><h4>Economic model</h4><p>This question was not prioritised for economic modelling as the committee considered that any intervention would be highly personalised to the person receiving it. Given this it would be difficult to consider alternate interventions in the form of an economic model.</p></div><div id="chd4.s1.1.10"><h4>Resource impact</h4><p>No unit costs were presented to the committee as these were not prioritised for decision making purposes.</p></div><div id="chd4.s1.1.11"><h4>Evidence statements</h4><div id="chd4.s1.1.11.1"><h5>Comparison 1. before versus after intensive speech and language therapy</h5><div id="chd4.s1.1.11.1.1"><h5>Critical outcomes</h5><div id="chd4.s1.1.11.1.1.1"><h5>Participation</h5><ul id="l343"><li id="lt974" class="half_rhythm"><div>No evidence was found for this outcome.</div></li></ul></div><div id="chd4.s1.1.11.1.1.2"><h5>Function (expressive and receptive communication)</h5><ul id="l344"><li id="lt975" class="half_rhythm"><div>Very low quality evidence from 1 before-and-after study including 16 older children (mean age 14 years) with cerebral palsy and moderate to severe dysarthria indicated that an intensive speech and language therapy improved intelligibility (as measured by the familiar listeners scale) by a clinically significant amount.</div></li></ul></div><div id="chd4.s1.1.11.1.1.3"><h5>Independence (communication in different situations)</h5><ul id="l345"><li id="lt976" class="half_rhythm"><div>No evidence was found for this outcome.</div></li></ul></div></div><div id="chd4.s1.1.11.1.2"><h5>Important outcomes</h5><div id="chd4.s1.1.11.1.2.1"><h5>Health related quality of life</h5><ul id="l346"><li id="lt977" class="half_rhythm"><div>No evidence was found for this outcome.</div></li></ul></div><div id="chd4.s1.1.11.1.2.2"><h5>Patient satisfaction</h5><ul id="l347"><li id="lt978" class="half_rhythm"><div>No evidence was found for this outcome.</div></li></ul></div></div></div><div id="chd4.s1.1.11.2"><h5>Comparison 2. supplemented versus habitual speech</h5><div id="chd4.s1.1.11.2.1"><h5>Critical outcomes</h5><div id="chd4.s1.1.11.2.1.1"><h5>Participation</h5><ul id="l348"><li id="lt979" class="half_rhythm"><div>No evidence was found for this outcome.</div></li></ul></div><div id="chd4.s1.1.11.2.1.2"><h5>Function (expressive and receptive communication)</h5><ul id="l349"><li id="lt980" class="half_rhythm"><div>Very low quality evidence from 1 cross-sectional study including 4 adults with cerebral palsy and 1 with traumatic brain injury and dysarthria indicated supplemented speech (using alphabet cues or combined alphabet and topic cues) improved intelligibility by a clinically significant amount compared to habitual speech.</div></li></ul></div><div id="chd4.s1.1.11.2.1.3"><h5>Independence (communication in different situations)</h5><ul id="l350"><li id="lt981" class="half_rhythm"><div>No evidence was found for this outcome</div></li></ul></div></div><div id="chd4.s1.1.11.2.2"><h5>Important outcomes</h5><div id="chd4.s1.1.11.2.2.1"><h5>Health related quality of life</h5><ul id="l351"><li id="lt982" class="half_rhythm"><div>No evidence was found for this outcome</div></li></ul></div><div id="chd4.s1.1.11.2.2.2"><h5>Patient satisfaction</h5><ul id="l352"><li id="lt983" class="half_rhythm"><div>Very low quality evidence from 1 cross-sectional study including 7 adults with cerebral palsy and dysarthria indicated that listeners had more a positive attitude towards communication using supplemented speech (using alphabet cues or combined alphabet and topic cues) than to habitual speech.</div></li></ul></div></div></div></div><div id="chd4.s1.1.12"><h4>The committee’s discussion of the evidence</h4><div id="chd4.s1.1.12.1"><h5>Interpreting the evidence</h5><div id="chd4.s1.1.12.1.1"><h5>The outcomes that matter most</h5><p>Participation, function and independence were critical outcomes because effective communication is central to these. The committee thought that lack of ability to communicate would have a significant effect on health related quality of life and satisfaction, these outcomes were considered important.</p></div><div id="chd4.s1.1.12.1.2"><h5>The quality of the evidence</h5><p>Evidence was available for function as measured by the intelligibility of communication. The quality of this evidence was very low using GRADE. Evidence was downgraded for nonrandomised design and also for applicability – one of the studies included older children and was downgraded for indirectness. There was a lack of evidence about interventions to improve receptive communication (such as optimising hearing) and training of communication partners of people with cerebral palsy. No evidence was found for the outcomes participation, independence or health related quality of life.</p></div><div id="chd4.s1.1.12.1.3"><h5>Benefits and harms</h5><p>The committee recognised the changing nature of communication needs in adults with cerebral palsy. People with cerebral palsy and communication difficulties could experience new onset communication difficulties as a result of neurological deterioration. To mitigate this risk, the committee therefore recommended awareness of the possibility of changing communication needs, and that people with cerebral palsy and their families and carers should be asked at each clinical review about any changes in hearing, speech or communication.</p><p>To identify communication needs and the support that the adult with cerebral palsy may require the committee decided, based on their experience and good practice, that people should be asked at every review whether they have experienced any changes that could impact on their communication. This would facilitate early recognition of problems and prevent them from becoming an obstacle to, for example, participation and access to services.</p><p>Even though no specific evidence was identified for the use of any particular alternative and augmentative communication systems, the committee agreed that communication is a basic human need and that the use of such systems should be considered if problems with communication are highlighted. The committee considered that this recommendation would help meet communication needs, support independence and improve quality of life and the quality of social relationships. Based on their knowledge the committee noted that there is variation in the availability of training in alternative and augmentative communication techniques. To be an effective means of communication the committee agreed that family, carers and people in regular contact with the adult with cerebral palsy need to receive training on how to use such techniques. The evidence suggested moderate benefits of interventions to improve intelligibility and the committee agreed there are effective speech therapy interventions (including augmentative and alternative communication systems), but the optimal choice would depend on the physical, cognitive, language and sensory needs of the individual. For this reason, they recommended referral to speech therapy services for those with new difficulties with verbal communication for a detailed assessment of each individual’s needs.</p><p>The committee discussed that people with cerebral palsy and communication difficulties could experience problems in making themselves understood in unfamiliar social situations or when their regular communication partners change – for example when moving out of the family home. They recommended key communication partners should be trained whenever alternative and augmentative communication techniques were required for adults with cerebral palsy, in addition to asking about changes in hearing, speech or communication at each clinical review.</p><p>The committee discussed one potential harm is the portability of some augmentative and alternative communication devices which might put-off some potential users. They also discussed that the use of language even if hard to understand is a social interaction that people prefer rather than using technology which to some seems to be one step removed from this. For this, and other reasons the committee highlighted than some people with poor intelligibility may still prefer to rely on their natural speech.</p><p>The committee discussed that there was a need for more research in this area. The committee noted that current practice is to offer Alternative and Augmentative Communication (AAC) over intensive speech and language therapy. However, limited evidence has been found to support this treatment. There was very low grade evidence of the use of supplemented speech (augmentative communication) with a combination of alphabet and topic cues to improve the intelligibility of dysarthric speech and also low grade evidence to support the use of intensive speech and language therapy to improve the intelligibility of dysarthric speech. However, this was in children (the mean age for this cohort was 14 years) which is below the age this guideline is concerned with. No evidence was found to support the use of alternative communication with adults with cerebral palsy, therefore further research is necessary to find whether there is support for the use of alternative or augmentative communication aids within this client group.</p></div></div><div id="chd4.s1.1.12.2"><h5>Cost effectiveness and resource use</h5><p>The committee noted that no relevant published economic evaluations had been identified for this topic.</p><p>The committee referred to the NHS England guidance for commissioning augmentative and alternative communication services and equipment that outlines the role of local and specialised augmentative and alternative communication service and the criteria for referral to these services. However, it was noted that such service specifications by NHS England are not evidence based and did not consider resource impact or cost effectiveness of implementation in areas where it currently is not. The committee made recommendations based on the evidence and their clinical expertise and considered that the extent of change in practice will vary according to current practice.</p><p>The committee recognised that speech intelligibility declines with age and if communication difficulties are not identified and managed appropriately, they can negatively affect participation and function. Knowing that speech and communication needs may change with time and social circumstance may lead to better identification and thus more timely management. Therefore, to reduce the high risk of missing emerging problems, the committee agreed healthcare professionals should ask the person with cerebral palsy and their families and carers about any changes in hearing, speech and communication at each review. Asking such questions would not incur any additional training costs according to the committee as healthcare professionals would likely refer adults who have difficulties with verbal communication to a speech. This would likely increase the number of appointments with speech therapists According to NHS Reference Costs 2015/16, the cost per consultantled attendance with a speech and language therapist is £87 (Currency Code, WF01B; Non-Admitted Face to Face Attendance; First Attendance; Service Code, 652).</p><p>The committee were unable to recommend any specific intervention because this would be individualised to the person’s needs, taking into account their skills, aspirations and cognitive ability. However, the committee noted that low-tech and low-cost options would be considered by the local augmentative and alternative communication services, before more costly interventions such as powered communication aids.</p></div><div id="chd4.s1.1.12.3"><h5>Other factors the committee took into account</h5><p>Under the <a href="https://www.legislation.gov.uk/ukpga/2005/9/contents" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Mental Capacity Act 2005</a>, individuals should be given adequate opportunity to participate in any decisions about their care. Lack of effective means of communication could lead a person to be deemed to be incapable of making decisions for themselves. Even though there was a lack of evidence for alternative or augmentative communication systems the committee acknowledged that <a href="https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities/article-21-freedom-of-expression-and-opinion-and-access-to-information.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Article 21</a> in the UN <a href="https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities/convention-on-the-rights-of-persons-with-disabilities-2.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Convention on disability rights</a> relates to freedom of expression and opinion, and access to information. Article 21 states that it should be ensured that people with disabilities can have freedom of expression for example by: ‘<i>Accepting and facilitating the use of sign languages, Braille, augmentative and alternative communication, and all other accessible means, modes and formats of communication of their choice by persons with disabilities in official interactions’</i>.</p></div></div></div><div id="rl.r14"><h3>References</h3><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="chd4.s1.ref1"><p id="p-165">
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<strong>Pennington 2010</strong>
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</p>Pennington, L., Miller, N., Robson, S., Steen, N., Intensive speech and language therapy for older children with cerebral palsy: a systems approach, Developmental Medicine and Child Neurology, 52, 337–344, 2010 [<a href="https://pubmed.ncbi.nlm.nih.gov/19758364" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19758364</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd4.s1.ref2"><p id="p-166">
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<strong>Hustad 2003</strong>
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</p>Hustad, K.C., Jones, T., Dailey, S., Implementing speech supplementation strategies: effects on intelligibility and speech rate of individuals with chronic severe dysarthria, Journal of Speech Language and Hearing Research, 46, 462–474, 2003 [<a href="https://pubmed.ncbi.nlm.nih.gov/14700386" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14700386</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chd4.s1.ref3"><p id="p-167">
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<strong>Hustad 2004</strong>
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</p>Hustad, K.C., Gearhart, K.J., Listener attitudes toward individuals with cerebral palsy who use speech supplementation strategies, American Journal of Speech-Language Pathology, 13, 168–181, 2004 [<a href="https://pubmed.ncbi.nlm.nih.gov/15198635" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15198635</span></a>]</div></p></li></ul></div></div><div id="appendixes.appgroupd4"><h2 id="_appendixes_appgroupd4_">Appendices</h2><div id="chd4.appa"><h3>Appendix A. Review protocols</h3><p>Review protocol for review question D4: Which interventions (for example augmentative and alternative communication systems) are effective in promoting communication for adults with cerebral palsy who have communication difficulties?</p><p id="chd4.appa.et1"><a href="/books/NBK578077/bin/chd4-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 5. Review protocol for interventions to improve communication</a><span class="small"> (PDF, 314K)</span></p></div><div id="chd4.appb"><h3>Appendix B. Literature search strategies</h3><p>Literature search strategies for review question D4: Which interventions (for example augmentative and alternative communication systems) are effective in promoting communication for adults with cerebral palsy who have communication difficulties?</p><p>This appendix is a combined search strategy and will be the same for all the evidence reviews for the D review questions as listed below:
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<ul id="l353" class="simple-list"><li id="lt984" class="half_rhythm"><div>D1: Which interventions (for example, vocational and independent living skills training) promote participation in adults with cerebral palsy?</div></li><li id="lt985" class="half_rhythm"><div>D2: Which interventions are effective for maintaining physical function and mobility in adults with cerebral palsy?
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<ul id="l354"><li id="lt986" class="half_rhythm"><div>Physical activity</div></li><li id="lt987" class="half_rhythm"><div>Strengthening programmes or training</div></li><li id="lt988" class="half_rhythm"><div>Orthotics</div></li><li id="lt989" class="half_rhythm"><div>Task-oriented upper limb training</div></li><li id="lt990" class="half_rhythm"><div>Orthopaedic surgery (including tendon lengthening and orthopaedic bone procedures in adulthood).</div></li></ul></div></li><li id="lt991" class="half_rhythm"><div>D3: What is the effectiveness of electronic assistive technology in promoting independence in adults with cerebral palsy?</div></li><li id="lt992" class="half_rhythm"><div>D4: Which interventions (for example augmentative and alternative communication systems) are effective in promoting communication for adults with cerebral palsy who have communication difficulties?</div></li></ul></p><div id="chd4.appb.s1"><h4>Database: Medlife & Embase (Multifile)</h4><p>Database(s): Embase 1974 to 2018 March 22, Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) 1946 to Present</p><p id="chd4.appb.tab1"><a href="/books/NBK578077/table/chd4.appb.tab1/?report=objectonly" target="object" rid-ob="figobchd4appbtab1" class="figpopup">Table 6. Last searched on 22 March 2018</a></p></div><div id="chd4.appb.s2"><h4>Database: Cochrane Library</h4><p id="chd4.appb.tab2"><a href="/books/NBK578077/table/chd4.appb.tab2/?report=objectonly" target="object" rid-ob="figobchd4appbtab2" class="figpopup">Table 7. Last searched on 22 March 2018</a></p></div><div id="chd4.appb.s3"><h4>Database: Cochrane Library</h4><p id="chd4.appb.tab3"><a href="/books/NBK578077/table/chd4.appb.tab3/?report=objectonly" target="object" rid-ob="figobchd4appbtab3" class="figpopup">Table 8. Last searched on 22 March 2018</a></p></div></div><div id="chd4.appc"><h3>Appendix C. Clinical evidence study selection</h3><p>Clinical evidence study selection for review question D4: Which interventions (for example augmentative and alternative communication systems) are effective in promoting communication for adults with cerebral palsy who have communication difficulties?</p><p id="chd4.appc.fig1"><a href="/books/NBK578077/figure/chd4.appc.fig1/?report=objectonly" target="object" rid-ob="figobchd4appcfig1" class="figpopup">Figure 1. Flow diagram of clinical article selection for interventions to promote communication</a></p></div><div id="chd4.appd"><h3>Appendix D. Clinical evidence tables</h3><p>Clinical evidence tables for review question D4: Which interventions (for example augmentative and alternative communication systems) are effective in promoting communication for adults with cerebral palsy who have communication difficulties?</p><p id="chd4.appd.et1"><a href="/books/NBK578077/bin/chd4-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 9. Clinical studies included in the evidence review for communication</a><span class="small"> (PDF, 451K)</span></p></div><div id="chd4.appe"><h3>Appendix E. Forest plots</h3><p>Forest plots for review question D4: Which interventions (for example augmentative and alternative communication systems) are effective in promoting communication for adults with cerebral palsy who have communication difficulties?</p><div id="chd4.appe.s1"><h4>Comparison 1. before versus after intensive speech and language therapy</h4><p id="chd4.appe.fig1"><a href="/books/NBK578077/figure/chd4.appe.fig1/?report=objectonly" target="object" rid-ob="figobchd4appefig1" class="figpopup">Figure 2. Before versus after intensive speech and language therapy - intelligibility of single words (range of scores: 0 to 100; better indicated by higher values)</a></p><p id="chd4.appe.fig2"><a href="/books/NBK578077/figure/chd4.appe.fig2/?report=objectonly" target="object" rid-ob="figobchd4appefig2" class="figpopup">Figure 3. Before versus after intensive speech and language therapy - intelligibility of connected words (range of scores: 0 to 100; better indicated by higher values)</a></p></div><div id="chd4.appe.s2"><h4>Comparison 2. supplemented versus habitual speech</h4><p id="chd4.appe.fig3"><a href="/books/NBK578077/figure/chd4.appe.fig3/?report=objectonly" target="object" rid-ob="figobchd4appefig3" class="figpopup">Figure 4. Supplemented versus habitual speech – intelligibility (range of scores: 0 to 100; better indicated by higher values)</a></p><p id="chd4.appe.fig4"><a href="/books/NBK578077/figure/chd4.appe.fig4/?report=objectonly" target="object" rid-ob="figobchd4appefig4" class="figpopup">Figure 5. Supplemented versus habitual speech - attitudes of listeners (range of scores: 1 to 7; better indicated by higher values)</a></p></div></div><div id="chd4.appf"><h3>Appendix F. GRADE tables</h3><p>GRADE tables for review question D4: Which interventions (for example augmentative and alternative communication systems) are effective in promoting communication for adults with cerebral palsy who have communication difficulties?</p><p id="chd4.appf.et1"><a href="/books/NBK578077/bin/chd4-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 10. Clinical evidence profile: Comparison 1: before versus after intensive speech and language therapy</a><span class="small"> (PDF, 285K)</span></p><p id="chd4.appf.et2"><a href="/books/NBK578077/bin/chd4-appf-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 11. Clinical evidence profile: Comparison 2: supplemented speech (augmented communication) versus habitual speech</a><span class="small"> (PDF, 276K)</span></p></div><div id="chd4.appg"><h3>Appendix G. Economic evidence study selection</h3><p>Economic evidence study selection for review question D4: Which interventions (for example augmentative and alternative communication systems) are effective in promoting communication for adults with cerebral palsy who have communication difficulties?</p><p>No economic evidence was identified for this review.</p></div><div id="chd4.apph"><h3>Appendix H. Economic evidence tables</h3><p>Economic evidence tables for review question D4: Which interventions (for example augmentative and alternative communication systems) are effective in promoting communication for adults with cerebral palsy who have communication difficulties?</p><p>No economic evidence was identified for this review.</p></div><div id="chd4.appi"><h3>Appendix I. Health economic evidence profiles</h3><p>Health economic evidence profiles for review question D4: Which interventions (for example augmentative and alternative communication systems) are effective in promoting communication for adults with cerebral palsy who have communication difficulties?</p><p>No economic evidence was identified for this review.</p></div><div id="chd4.appj"><h3>Appendix J. Health economic analysis</h3><p>Health economic analysis for review question D4: Which interventions (for example augmentative and alternative communication systems) are effective in promoting communication for adults with cerebral palsy who have communication difficulties?</p><p>No economic analysis was included in this review.</p></div><div id="chd4.appk"><h3>Appendix K. Excluded studies</h3><p>Clinical and economic list of excluded studies for review question D4: Which interventions (for example augmentative and alternative communication systems) are effective in promoting communication for adults with cerebral palsy who have communication difficulties?</p><div id="chd4.appk.s1"><h4>Clinical studies</h4><p id="chd4.appk.et1"><a href="/books/NBK578077/bin/chd4-appk-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 12. Excluded clinical studies for communication</a><span class="small"> (PDF, 291K)</span></p></div><div id="chd4.appk.s2"><h4>Economic studies</h4><p>No economic evidence was identified for this review.</p></div></div><div id="chd4.appl"><h3>Appendix L. Research recommendations</h3><p>Research recommendations for review question D4: Which interventions (for example augmentative and alternative communication systems) are effective in promoting communication for adults with cerebral palsy who have communication difficulties?</p><p>Are augmentative and alternative communication systems effective and cost-effective in promoting communication for adults with cerebral palsy who have communication difficulties?</p><p id="chd4.appl.tab1"><a href="/books/NBK578077/table/chd4.appl.tab1/?report=objectonly" target="object" rid-ob="figobchd4appltab1" class="figpopup">Table 13. Research recommendation rationale</a></p><p id="chd4.appl.tab2"><a href="/books/NBK578077/table/chd4.appl.tab2/?report=objectonly" target="object" rid-ob="figobchd4appltab2" class="figpopup">Table 14. Research recommendation modified PICO table</a></p></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence reviews</p><p>These evidence reviews were developed by the National Guideline Alliance, hosted by the Royal College of Obstetricians and Gynaecologists</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div><div class="small"><span class="label">Bookshelf ID: NBK578077</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/35192273" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">35192273</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobchd4tab1"><div id="chd4.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Summary of the protocol (PICO table)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578077/table/chd4.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd4.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_chd4.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_chd4.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adults aged 25 and over with cerebral palsy and communication difficulties</td></tr><tr><th id="hd_b_chd4.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><td headers="hd_b_chd4.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l337"><li id="lt961" class="half_rhythm"><div>Interventions to improve receptive communication
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<ul id="l338" class="circle"><li id="lt962" class="half_rhythm"><div>Optimise hearing</div></li></ul></div></li><li id="lt963" class="half_rhythm"><div>Interventions to improve expressive communication
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<ul id="l339" class="circle"><li id="lt964" class="half_rhythm"><div>speech and language therapy</div></li><li id="lt965" class="half_rhythm"><div>assisted augmentative therapy</div></li></ul></div></li><li id="lt966" class="half_rhythm"><div>Training for communication partners</div></li></ul></td></tr><tr><th id="hd_b_chd4.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><td headers="hd_b_chd4.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l340"><li id="lt967" class="half_rhythm"><div>Each other</div></li><li id="lt968" class="half_rhythm"><div>No intervention</div></li></ul></td></tr><tr><th id="hd_b_chd4.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcome</th><td headers="hd_b_chd4.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Critical</b>
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<ul id="l341"><li id="lt969" class="half_rhythm"><div>Participation</div></li><li id="lt970" class="half_rhythm"><div>Function (expressive and receptive communication)</div></li><li id="lt971" class="half_rhythm"><div>Independence (communication in different situations)</div></li></ul>
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<b>Important</b>
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<ul id="l342"><li id="lt972" class="half_rhythm"><div>Health related quality of life</div></li><li id="lt973" class="half_rhythm"><div>Patient satisfaction</div></li></ul></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchd4tab2"><div id="chd4.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of included studies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578077/table/chd4.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd4.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chd4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Study</th><th id="hd_h_chd4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Design</th><th id="hd_h_chd4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Participants</th><th id="hd_h_chd4.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Comparison(s)</th><th id="hd_h_chd4.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Outcomes</th></tr></thead><tbody><tr><td headers="hd_h_chd4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#chd4.s1.ref1" rid="chd4.s1.ref1">Pennington 2010</a>
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</td><td headers="hd_h_chd4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Before-and-after study</td><td headers="hd_h_chd4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Older children with cerebral palsy (N=16; mean age 14 years) with moderate to severe dysarthria.</p>
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<p>United Kingdom</p>
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</td><td headers="hd_h_chd4.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Before versus after intensive speech and language intervention.</td><td headers="hd_h_chd4.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Function (intelligibility)</td></tr><tr><td headers="hd_h_chd4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#chd4.s1.ref2" rid="chd4.s1.ref2">Hustad 2003</a>
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</td><td headers="hd_h_chd4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cross-sectional study</td><td headers="hd_h_chd4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Adults with cerebral palsy (N=4) or TBI (N=1) and severe or profound dysarthria.<sup>1</sup></p>
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<p>United States of America</p>
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</td><td headers="hd_h_chd4.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Supplemented speech (using topic and alphabet cues) versus habitual (non-cued) speech</td><td headers="hd_h_chd4.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Function (intelligibility)</td></tr><tr><td headers="hd_h_chd4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#chd4.s1.ref3" rid="chd4.s1.ref3">Hustad 2004</a>
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</td><td headers="hd_h_chd4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cross-sectional study</td><td headers="hd_h_chd4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Adults with cerebral palsy (N=7) and severe or profound dysarthria.</p>
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<p>United States of America</p>
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</td><td headers="hd_h_chd4.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Supplemented speech (using topic and alphabet cues) versus habitual (non-cued) speech</td><td headers="hd_h_chd4.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Patient satisfaction</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">N: number of participants in study; TBI, traumatic brain injury.</p></div></dd></dl><dl class="bkr_refwrap"><dt>1</dt><dd><div id="chd4.tab2_1"><p class="no_margin">No subgroup analysis reported for those with cerebral palsy.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchd4tab3"><div id="chd4.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Summary clinical evidence profile: comparison 1: before versus after intensive speech and language therapy</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578077/table/chd4.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd4.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chd4.tab3_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_chd4.tab3_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_chd4.tab3_1_1_1_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Illustrative comparative risks (95% CI)</th><th id="hd_h_chd4.tab3_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_chd4.tab3_1_1_1_3" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_chd4.tab3_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_chd4.tab3_1_1_1_4" style="text-align:left;vertical-align:bottom;">No of Participants (studies)</th><th id="hd_h_chd4.tab3_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_chd4.tab3_1_1_1_5" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th></tr><tr><th headers="hd_h_chd4.tab3_1_1_1_2" id="hd_h_chd4.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Assumed risk before intensive speech and language therapy (SLT)</th><th headers="hd_h_chd4.tab3_1_1_1_2" id="hd_h_chd4.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Corresponding risk after intensive speech and language therapy</th></tr></thead><tbody><tr><td headers="hd_h_chd4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Participation - not reported</td><td headers="hd_h_chd4.tab3_1_1_1_2 hd_h_chd4.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab3_1_1_1_2 hd_h_chd4.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td></tr><tr><td headers="hd_h_chd4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Function: Intelligibility of single words (%) - Familiar listeners</p>
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<p>Scale from: 0 to 100.</p>
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<p>Function: Follow-up: mean 6 weeks</p>
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</td><td headers="hd_h_chd4.tab3_1_1_1_2 hd_h_chd4.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>The mean intelligibility of single words (%) to familiar listeners before SLT was</p>
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<p>42.1 %</p>
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</td><td headers="hd_h_chd4.tab3_1_1_1_2 hd_h_chd4.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>The mean intelligibility of single words (%) to familiar listeners after SLT was</p>
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<p>14.9 higher</p>
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<p>(0.21 to 29.59 higher)</p>
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</td><td headers="hd_h_chd4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>16</p>
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<p>(1 study)</p>
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</td><td headers="hd_h_chd4.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low<sup>1</sup><sup>,</sup><sup>2</sup></td></tr><tr><td headers="hd_h_chd4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Intelligibility of single words (%) - Unfamiliar listeners</p>
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<p>Scale from: 0 to 100.</p>
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<p>Follow-up: mean 6 weeks</p>
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</td><td headers="hd_h_chd4.tab3_1_1_1_2 hd_h_chd4.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>The mean intelligibility of single words (%) to unfamiliar listeners before SLT was</p>
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<p>34 %</p>
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</td><td headers="hd_h_chd4.tab3_1_1_1_2 hd_h_chd4.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>The mean intelligibility of single words (%) to unfamiliar listeners after SLT was</p>
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<p>18.4 higher</p>
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<p>(4.25 to 32.55 higher)</p>
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</td><td headers="hd_h_chd4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>16</p>
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<p>(1 study)</p>
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</td><td headers="hd_h_chd4.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low<sup>1</sup><sup>,</sup><sup>2</sup></td></tr><tr><td headers="hd_h_chd4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Function: Intelligibility of connected speech (%) - Familiar listeners</p>
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<p>Scale from: 0 to 100.</p>
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<p>Follow-up: mean 6 weeks</p>
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</td><td headers="hd_h_chd4.tab3_1_1_1_2 hd_h_chd4.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>The mean intelligibility of connected speech (%) to familiar listeners before SLT was</p>
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<p>48 %</p>
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</td><td headers="hd_h_chd4.tab3_1_1_1_2 hd_h_chd4.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>The mean intelligibility of connected speech (%) to familiar listeners after SLT was</p>
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<p>13 higher</p>
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<p>(8.45 lower to 34.45 higher)</p>
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</td><td headers="hd_h_chd4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>16</p>
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<p>(1 study)</p>
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</td><td headers="hd_h_chd4.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low<sup>1</sup><sup>,</sup><sup>2</sup></td></tr><tr><td headers="hd_h_chd4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Function: Intelligibility of connected speech (%) - Unfamiliar listeners</p>
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<p>Scale from: 0 to 100.</p>
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<p>Follow-up: mean 6 weeks</p>
|
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</td><td headers="hd_h_chd4.tab3_1_1_1_2 hd_h_chd4.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean intelligibility of connected speech (%) to unfamiliar listeners before SLT was s</p>
|
|
<p>25.9 %</p>
|
|
</td><td headers="hd_h_chd4.tab3_1_1_1_2 hd_h_chd4.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean intelligibility of connected speech (%) to unfamiliar listeners after SLT was</p>
|
|
<p>14.8 higher</p>
|
|
<p>(5.23 lower to 34.83 higher)</p>
|
|
</td><td headers="hd_h_chd4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>16</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_chd4.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low<sup>1</sup><sup>,</sup><sup>2</sup></td></tr><tr><td headers="hd_h_chd4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Independence - not reported</td><td headers="hd_h_chd4.tab3_1_1_1_2 hd_h_chd4.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab3_1_1_1_2 hd_h_chd4.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td></tr><tr><td headers="hd_h_chd4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Health related quality of life - not reported</td><td headers="hd_h_chd4.tab3_1_1_1_2 hd_h_chd4.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab3_1_1_1_2 hd_h_chd4.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td></tr><tr><td headers="hd_h_chd4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Satisfaction - not reported</td><td headers="hd_h_chd4.tab3_1_1_1_2 hd_h_chd4.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab3_1_1_1_2 hd_h_chd4.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">CI: confidence interval; MID: minimally important difference; SLT: speech and language therapy.</p></div></dd></dl><dl class="bkr_refwrap"><dt>1</dt><dd><div id="chd4.tab3_1"><p class="no_margin">95% CI of the effect estimate includes one MID threshold</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="chd4.tab3_2"><p class="no_margin">Downgraded for indirectness – the participants were older children with mean age 14 years.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchd4tab4"><div id="chd4.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Summary clinical evidence profile: comparison 2: supplemented versus habitual speech</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578077/table/chd4.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd4.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chd4.tab4_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_chd4.tab4_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_chd4.tab4_1_1_1_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Illustrative comparative risks (95% CI)</th><th id="hd_h_chd4.tab4_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_chd4.tab4_1_1_1_3" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_chd4.tab4_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_chd4.tab4_1_1_1_4" style="text-align:left;vertical-align:bottom;">No of Participants (studies)</th><th id="hd_h_chd4.tab4_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_chd4.tab4_1_1_1_5" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th></tr><tr><th headers="hd_h_chd4.tab4_1_1_1_2" id="hd_h_chd4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Assumed risk with habitual speech</th><th headers="hd_h_chd4.tab4_1_1_1_2" id="hd_h_chd4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Corresponding risk Supplemented versus habitual speech</th></tr></thead><tbody><tr><td headers="hd_h_chd4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Participation - not reported</td><td headers="hd_h_chd4.tab4_1_1_1_2 hd_h_chd4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab4_1_1_1_2 hd_h_chd4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td></tr><tr><td headers="hd_h_chd4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Function: Intelligibility (% of words understood) - Topic cues</p>
|
|
<p>Scale from: 0 to 100.</p>
|
|
</td><td headers="hd_h_chd4.tab4_1_1_1_2 hd_h_chd4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean intelligibility with habitual speech was</p>
|
|
<p>39.79 %</p>
|
|
</td><td headers="hd_h_chd4.tab4_1_1_1_2 hd_h_chd4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean intelligibility with topic cues was</p>
|
|
<p>2.55 higher</p>
|
|
<p>(22.48 lower to 27.58 higher)</p>
|
|
</td><td headers="hd_h_chd4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>5</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_chd4.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low<sup>1</sup></td></tr><tr><td headers="hd_h_chd4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Function: Intelligibility (% of words understood) - Alphabet cues</p>
|
|
<p>Scale from: 0 to 100.</p>
|
|
</td><td headers="hd_h_chd4.tab4_1_1_1_2 hd_h_chd4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean intelligibility with habitual speech was</p>
|
|
<p>39.79 %</p>
|
|
</td><td headers="hd_h_chd4.tab4_1_1_1_2 hd_h_chd4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean intelligibility with alphabet cues was</p>
|
|
<p>32.11 higher</p>
|
|
<p>(7.7 to 56.52 higher)</p>
|
|
</td><td headers="hd_h_chd4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>5</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_chd4.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low<sup>2</sup></td></tr><tr><td headers="hd_h_chd4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Function: Intelligibility (% of words understood) - Combined cues</p>
|
|
<p>Scale from: 0 to 100.</p>
|
|
</td><td headers="hd_h_chd4.tab4_1_1_1_2 hd_h_chd4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean intelligibility with habitual speech was</p>
|
|
<p>39.79 %</p>
|
|
</td><td headers="hd_h_chd4.tab4_1_1_1_2 hd_h_chd4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean intelligibility with combined cues was</p>
|
|
<p>36.4 higher</p>
|
|
<p>(13.17 to 59.63 higher)</p>
|
|
</td><td headers="hd_h_chd4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>5</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_chd4.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low<sup>2</sup></td></tr><tr><td headers="hd_h_chd4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Independence - not reported</td><td headers="hd_h_chd4.tab4_1_1_1_2 hd_h_chd4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab4_1_1_1_2 hd_h_chd4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td></tr><tr><td headers="hd_h_chd4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Health related quality of life - not reported</td><td headers="hd_h_chd4.tab4_1_1_1_2 hd_h_chd4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab4_1_1_1_2 hd_h_chd4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td></tr><tr><td headers="hd_h_chd4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Satisfaction: Listener’s attitude - Topic cues</p>
|
|
<p>Scale from: 1 to 7.</p>
|
|
</td><td headers="hd_h_chd4.tab4_1_1_1_2 hd_h_chd4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The mean listener’s attitude to habitual speech was 2.39</td><td headers="hd_h_chd4.tab4_1_1_1_2 hd_h_chd4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean listener’s attitude to speech using topic cues</p>
|
|
<p>0.42 higher</p>
|
|
<p>(1.28 lower to 2.12 higher)</p>
|
|
</td><td headers="hd_h_chd4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>7</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_chd4.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low<sup>1</sup></td></tr><tr><td headers="hd_h_chd4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Satisfaction: Listener’s attitude - Alphabet cues</p>
|
|
<p>Scale from: 1 to 7.</p>
|
|
</td><td headers="hd_h_chd4.tab4_1_1_1_2 hd_h_chd4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The mean listener’s attitude to habitual speech was 2.39</td><td headers="hd_h_chd4.tab4_1_1_1_2 hd_h_chd4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean listener’s attitude to speech using alphabet cues</p>
|
|
<p>1.71 higher</p>
|
|
<p>(0.08 lower to 3.5 higher)</p>
|
|
</td><td headers="hd_h_chd4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>7</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_chd4.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low<sup>2</sup></td></tr><tr><td headers="hd_h_chd4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Satisfaction: Listener’s attitude - Combined cues</p>
|
|
<p>Scale from: 1 to 7.</p>
|
|
</td><td headers="hd_h_chd4.tab4_1_1_1_2 hd_h_chd4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The mean listener’s attitude to habitual speech was 2.39</td><td headers="hd_h_chd4.tab4_1_1_1_2 hd_h_chd4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean listener’s attitude to speech using combined cues was</p>
|
|
<p>2.35 higher</p>
|
|
<p>(0.6 to 4.1 higher)</p>
|
|
</td><td headers="hd_h_chd4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_chd4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>7</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_chd4.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low<sup>2</sup></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">CI: confidence interval; MID: minimally important difference.</p></div></dd></dl><dl class="bkr_refwrap"><dt>1</dt><dd><div id="chd4.tab4_1"><p class="no_margin">95% confidence interval of effect estimate includes both MID thresholds</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="chd4.tab4_2"><p class="no_margin">95% confidence interval of the effect estimate includes one MID value</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchd4appbtab1"><div id="chd4.appb.tab1" class="table"><h3><span class="label">Table 6</span><span class="title">Last searched on 22 March 2018</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578077/table/chd4.appb.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd4.appb.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">#</th><th id="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Searches</th></tr></thead><tbody><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Cerebral Palsy/ use prmz</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp cerebral palsy/ use oemezd</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((cerebral or brain or central) adj2 (pal* or paralys#s or pares#s)).tw.</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cerebral palsy.ti,ab.</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">little? disease.tw.</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((hemipleg* or dipleg* or tripleg* or quadripleg* or unilateral*) adj5 spastic*).tw.</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((hemipleg* or dipleg* or tripleg* or quadripleg* or unilateral*) adj3 ataxi*).tw.</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1–7</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 8 to english language</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 9 to (adult <18 to 64 years> or aged <65+ years>) use oemezd [Limit not valid in Ovid MEDLINE(R),Ovid MEDLINE(R) In-Process; records were retained]</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 9 to “all adult (19 plus years)” [Limit not valid in Embase; records were retained]</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 use prmz</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/10,12</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Community Participation/ or exp Social Participation/ or exp “Activities of Daily Living”/ or exp Independent Living/ or exp Vocational Education/ or exp “Quality of Life”/ or exp Hearing Aids/ or exp Wheelchairs/ or exp Needs Assessment/ or exp Disability Evaluation/ or exp Self-Help Devices/ or exp Sickness Impact Profile/ or exp Sensory Aids/ or exp “Prostheses and Implants”/ or exp Orthotic Devices/ or exp Equipment Design/ or exp User-Computer Interface/ or exp communication aids for disabled/ or exp speech disorder/rh or exp Exercise/ or exp Rehabilitation/mt or exp Sports/ or exp Exercise Therapy/ or exp Orthopedic Procedures/ or exp Physical Therapy Modalities/</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14 use prmz</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">social behavior/ or exp social adaptation/ or exp social participation/ or exp social interaction/ or exp community integration/ or exp community living/ or exp daily life activity/ or exp independent living/ or exp vocational education/ or exp “quality of life”/ or exp hearing aid/ or exp wheelchair/ or exp needs assessment/ or exp disability/ or exp self help device/ or exp Sickness Impact Profile/ or exp sensory aid/ or exp “prostheses and orthoses”/ or exp orthosis/ or exp implant/ or exp equipment design/ or exp computer interface/ or exp exercise/ or exp rehabilitation/ or exp self help/ or exp assistive technology/ or exp vocational guidance/ or exp communication aid/ or exp facilitated communication/ or exp eye tracking/ or exp sport/ or exp kinesiotherapy/ or exp orthopedic surgery/ or exp physiotherapy/</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16 use oemezd</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(participat* or (daily adj activit*) or (independen* adj5 liv*) or age* or aging or gender or motivat* or preference* or limitation* or restriction* or capacit* or performance* or (handl* adj5 object*) or assistive technolog* or (social adj5 interaction*) or employ* or vocation* or occupat* or educat* or profession* or isolat* or leisure activit* or mobil* or communicat* or eat* or dining or drink* or dress* or interact* or ((assistive or adaptive) adj5 (technolog* or device* or system*)) or home or school or work* or communit* or play* or eye tracking or sporting activit* or swim* or aqua* or upper limb training or bony procedure* or (neuro-developmental adj (treatment* or therap* or training)) or NDT or (muscle adj (tissue or tone)) or ((strength* or endurance) adj5 (program* or training*)) or ((tendon* or muscle*) adj (length* or stretch*)) or treadmill* or weight*).tw.</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(augmentative or alternative communication or AAC or voice synthesizer* or accommodation* or sign language or gestur* or manual language board* or high?tech or touch screen* or speech?generating* or electronic keyboard* or phone* or iPad* or laptop* or computer* or modificat* or modify* or adapt* or custom* or tailor* or assist* or ((walking or hearing) adj aid*) or (communication adj (device* or system* or board*))).ti,ab.</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 or 17 or 18 or 19</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13 and 20</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">conference abstract.pt. use oemezd</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or LETTER/ use oemezd</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Letter/ use prmz</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">EDITORIAL/ use prmz</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt. use oemezd</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NEWS/ use prmz</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp HISTORICAL ARTICLE/ use prmz</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt. use oemezd</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ANECDOTES AS TOPIC/ use prmz</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">COMMENT/ use prmz</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CASE REPORT/ use prmz</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CASE REPORT/ use oemezd</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CASE STUDY/ use oemezd</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment* or abstracts).ti.</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/22–35</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RANDOMIZED CONTROLLED TRIAL/ use prmz</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RANDOMIZED CONTROLLED TRIAL/ use oemezd</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">random*.ti,ab.</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/37–39</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36 not 40</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ANIMALS/ not HUMANS/ use prmz</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ANIMAL/ not HUMAN/ use oemezd</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp ANIMALS, LABORATORY/ use prmz</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp ANIMAL EXPERIMENTATION/ use prmz</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp MODELS, ANIMAL/ use prmz</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp RODENTIA/ use prmz</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NONHUMAN/ use oemezd</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp ANIMAL EXPERIMENT/ use oemezd</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp EXPERIMENTAL ANIMAL/ use oemezd</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ANIMAL MODEL/ use oemezd</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp RODENT/ use oemezd</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/41–53</td></tr><tr><td headers="hd_h_chd4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55</td><td headers="hd_h_chd4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21 not 54</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchd4appbtab2"><div id="chd4.appb.tab2" class="table"><h3><span class="label">Table 7</span><span class="title">Last searched on 22 March 2018</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578077/table/chd4.appb.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd4.appb.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Hits</th><th id="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Search</th></tr></thead><tbody><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Cerebral Palsy] explode all trees and with qualifier(s): [Physiopathology - PP, Rehabilitation - RH]</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((cerebral or brain or central) N2 (pal* or paralys?s or pare?s))</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((hemipleg* or dipleg* or tripleg* or quadripleg* or unilateral*) N5 spastic*)</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((hemipleg* or dipleg* or tripleg* or quadripleg* or unilateral*) N3 ataxi*)</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1 or #2 or #3 or #4</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Social Behavior] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Social Participation] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Interpersonal Relations] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Community Integration] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Independent Living] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#11</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Activities of Daily Living] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#12</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Vocational Education] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#13</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Quality of Life] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#14</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Hearing Aids] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#15</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Wheelchairs] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#16</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Needs Assessment] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#17</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Disability Evaluation] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#18</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Self-Help Devices] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#19</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Sickness Impact Profile] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#20</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Sensory Aids] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#21</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Prostheses and Implants] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#22</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Orthotic Devices] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#23</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Equipment Design] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#24</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [User-Computer Interface] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#25</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Exercise] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#26</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Rehabilitation] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#27</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Vocational Guidance] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#28</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Communication Aids for Disabled] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#29</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Eye Movements] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#30</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Sports] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#31</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Exercise Therapy] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#32</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Orthopedic Procedures] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#33</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Physical Therapy Modalities] explode all trees</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#34</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">sporting activit* or swim* or aqua* or upper limb training or bony procedures or Neuro-developmental near (Treatment* or therap* or training) or NDT or muscle tissue or muscle tone or strength* or endurance or length* or stretch* or treadmill* or weight*</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#35</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">participat* or independent liv* or age or aging or limitation* or restriction* or capacit* or performance* or Assistive technolog* or augmentative communication or alternative communication or AAC or employ* or vocation* or occupat* or educat* or profession* or leisure activit* or interaction* or home or school or work* or communit* or play* or accommodation* or sign language or gestur* or manual language board* or high?tech or touch screen* or speech?generating* or electronic keyboard* or phone* or iPad* or laptop* or computer or eye tracking or modif* or adapt* or custom* or tailor* or assist* or walking aid* or hearing aid*</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#36</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">{or #6–#35}</td></tr><tr><td headers="hd_h_chd4.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#37</td><td headers="hd_h_chd4.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5 and #36</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchd4appbtab3"><div id="chd4.appb.tab3" class="table"><h3><span class="label">Table 8</span><span class="title">Last searched on 22 March 2018</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578077/table/chd4.appb.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd4.appb.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_chd4.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3</th><th id="hd_h_chd4.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2 AND #1 AND LANGUAGE: (English)</th></tr></thead><tbody><tr><td headers="hd_h_chd4.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2</td><td headers="hd_h_chd4.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ts=Social Behavior or ts=Social Participation or ts=Interpersonal Relations or ts=Community Integration or ts=Independent Living or ts=Activities of Daily Living or ts=Vocational Education or ts=Quality of Life or ts=Hearing Aid* or ts=Wheelchair* or ts=Disability Evaluation or ts=Needs Assessment or ts=Self-Help Device* or ts=Sensory Aid* or ts=Prostheses or ts=Implant* or ts=Orthotic Device* or ts=Equipment Design or ts=User-Computer Interface or ts=Exercise* or ts=Rehabilitation or ts=Vocational Guidance or ts=Sport* or ts=Exercise Therap* or ts=Orthopedic Surgery or ts=Physiotherapy OR TS=Assistive technolog* or TS=augmentative communication or TS=alternative communication or TS=AAC OR TS=manual language board* or TS=high?tech or TS=touch screen* or TS=speech?generating* or TS=electronic keyboard* or TS=phone* or TS=iPad* or TS=laptop* or TS=eye tracking</td></tr><tr><td headers="hd_h_chd4.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1</td><td headers="hd_h_chd4.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ts=Cerebral Palsy</td></tr></tbody></table></div></div></article><article data-type="fig" id="figobchd4appcfig1"><div id="chd4.appc.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201.%20Flow%20diagram%20of%20clinical%20article%20selection%20for%20interventions%20to%20promote%20communication.&p=BOOKS&id=578077_chd4appcf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK578077/bin/chd4appcf1.jpg" alt="Figure 1. Flow diagram of clinical article selection for interventions to promote communication." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 1</span><span class="title">Flow diagram of clinical article selection for interventions to promote communication</span></h3></div></article><article data-type="fig" id="figobchd4appefig1"><div id="chd4.appe.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%202.%20Before%20versus%20after%20intensive%20speech%20and%20language%20therapy%20-%20intelligibility%20of%20single%20words%20(range%20of%20scores%3A%200%20to%20100%3B%20better%20indicated%20by%20higher%20values).&p=BOOKS&id=578077_chd4appef1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK578077/bin/chd4appef1.jpg" alt="Figure 2. Before versus after intensive speech and language therapy - intelligibility of single words (range of scores: 0 to 100; better indicated by higher values)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 2</span><span class="title">Before versus after intensive speech and language therapy - intelligibility of single words (range of scores: 0 to 100; better indicated by higher values)</span></h3><div class="caption"><p>CI: confidence interval; IV: inverse variance; SD: standard deviation; SLT: speech and language therapy</p></div></div></article><article data-type="fig" id="figobchd4appefig2"><div id="chd4.appe.fig2" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%203.%20Before%20versus%20after%20intensive%20speech%20and%20language%20therapy%20-%20intelligibility%20of%20connected%20words%20(range%20of%20scores%3A%200%20to%20100%3B%20better%20indicated%20by%20higher%20values).&p=BOOKS&id=578077_chd4appef2.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK578077/bin/chd4appef2.jpg" alt="Figure 3. Before versus after intensive speech and language therapy - intelligibility of connected words (range of scores: 0 to 100; better indicated by higher values)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 3</span><span class="title">Before versus after intensive speech and language therapy - intelligibility of connected words (range of scores: 0 to 100; better indicated by higher values)</span></h3><div class="caption"><p>CI: confidence interval; IV: inverse variance; SD: standard deviation; SLT: speech and language therapy</p></div></div></article><article data-type="fig" id="figobchd4appefig3"><div id="chd4.appe.fig3" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%204.%20Supplemented%20versus%20habitual%20speech%20%02013%20intelligibility%20(range%20of%20scores%3A%200%20to%20100%3B%20better%20indicated%20by%20higher%20values).&p=BOOKS&id=578077_chd4appef3.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK578077/bin/chd4appef3.jpg" alt="Figure 4. Supplemented versus habitual speech – intelligibility (range of scores: 0 to 100; better indicated by higher values)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 4</span><span class="title">Supplemented versus habitual speech – intelligibility (range of scores: 0 to 100; better indicated by higher values)</span></h3><div class="caption"><p>CI: confidence interval; IV: inverse variance; SD: standard deviation</p></div></div></article><article data-type="fig" id="figobchd4appefig4"><div id="chd4.appe.fig4" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%205.%20Supplemented%20versus%20habitual%20speech%20-%20attitudes%20of%20listeners%20(range%20of%20scores%3A%201%20to%207%3B%20better%20indicated%20by%20higher%20values).&p=BOOKS&id=578077_chd4appef4.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK578077/bin/chd4appef4.jpg" alt="Figure 5. Supplemented versus habitual speech - attitudes of listeners (range of scores: 1 to 7; better indicated by higher values)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 5</span><span class="title">Supplemented versus habitual speech - attitudes of listeners (range of scores: 1 to 7; better indicated by higher values)</span></h3><div class="caption"><p>CI: confidence interval; IV: inverse variance; SD: standard deviation</p></div></div></article><article data-type="table-wrap" id="figobchd4appltab1"><div id="chd4.appl.tab1" class="table"><h3><span class="label">Table 13</span><span class="title">Research recommendation rationale</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578077/table/chd4.appl.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd4.appl.tab1_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chd4.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Research question</th><th id="hd_h_chd4.appl.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Are augmentative and alternative communication systems effective and cost-effective in promoting communication for adults with cerebral palsy who have communication difficulties?</th></tr></thead><tbody><tr><td headers="hd_h_chd4.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Importance to ‘patients’ or the population</td><td headers="hd_h_chd4.appl.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Ensure access to effective approaches</p>
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<p>Reduce costs of ineffective treatment</p>
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</td></tr><tr><td headers="hd_h_chd4.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relevance to NICE guidance</td><td headers="hd_h_chd4.appl.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ability to clearly define effective systems in promoting communication for adults with cerebral palsy with communication difficulties</td></tr><tr><td headers="hd_h_chd4.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relevance to the NHS</td><td headers="hd_h_chd4.appl.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Reduce costs of therapy</p>
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<p>Ensure access to services already available</p>
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</td></tr><tr><td headers="hd_h_chd4.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">National priorities</td><td headers="hd_h_chd4.appl.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Reduce variation in treatment</p>
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<p>Guidance for commissioning AAC services and equipment, NHS England, 2016</p>
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<p>Augmentative and Alternative Communication (AAC) Services Standards, Communication Matters, 2012</p>
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</td></tr><tr><td headers="hd_h_chd4.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Current evidence base</td><td headers="hd_h_chd4.appl.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Current evidence found support for two different types of interventions and each were graded as very low quality</td></tr><tr><td headers="hd_h_chd4.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Equality</td><td headers="hd_h_chd4.appl.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Applies to all adults with cerebral palsy and communication difficulties over the age of 25</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">AAC: Alternative or Augmentative Communication; NHS: National Health Service.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchd4appltab2"><div id="chd4.appl.tab2" class="table"><h3><span class="label">Table 14</span><span class="title">Research recommendation modified PICO table</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578077/table/chd4.appl.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd4.appl.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chd4.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Criterion</th><th id="hd_h_chd4.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Explanation</th></tr></thead><tbody><tr><td headers="hd_h_chd4.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</td><td headers="hd_h_chd4.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adults aged 18 and over with cerebral palsy and communication difficulties</td></tr><tr><td headers="hd_h_chd4.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</td><td headers="hd_h_chd4.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l355"><li id="lt993" class="half_rhythm"><div>Interventions to improve expressive communication</div></li><li id="lt994" class="half_rhythm"><div>Intensive speech and language therapy</div></li><li id="lt995" class="half_rhythm"><div>Alternative and Augmentative Communication</div></li><li id="lt996" class="half_rhythm"><div>Alternative Communication</div></li></ul></td></tr><tr><td headers="hd_h_chd4.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparator</td><td headers="hd_h_chd4.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l356"><li id="lt997" class="half_rhythm"><div>Each other</div></li><li id="lt998" class="half_rhythm"><div>No intervention</div></li></ul></td></tr><tr><td headers="hd_h_chd4.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcome</td><td headers="hd_h_chd4.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Critical</b>
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<ul id="l357"><li id="lt999" class="half_rhythm"><div>Participation</div></li><li id="lt1000" class="half_rhythm"><div>TOMS</div></li><li id="lt1001" class="half_rhythm"><div>Function (expressive and receptive communication)</div></li><li id="lt1002" class="half_rhythm"><div>Independence (communication in different situations)</div></li><li id="lt1003" class="half_rhythm"><div>Important outcomes</div></li><li id="lt1004" class="half_rhythm"><div>Health related quality of life</div></li><li id="lt1005" class="half_rhythm"><div>Patient satisfaction</div></li></ul>
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Regular utilisation of AAC in practice</td></tr><tr><td headers="hd_h_chd4.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</td><td headers="hd_h_chd4.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multicentre large observational cohort study</td></tr><tr><td headers="hd_h_chd4.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Timeframe</td><td headers="hd_h_chd4.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 years</td></tr><tr><td headers="hd_h_chd4.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Additional information</td><td headers="hd_h_chd4.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Need to stratify by:
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<ul id="l358"><li id="lt1006" class="half_rhythm"><div>Severity of speech impairment</div></li><li id="lt1007" class="half_rhythm"><div>Presence and severity of learning disability</div></li></ul></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">AAC: Alternative or Augmentative Communication; TOMS: Therapy Outcome Measures-Swallowing.</p></div></dd></dl></dl></div></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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