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Maas E. Treatment for Childhood Apraxia of Speech: Past, Present, and Future. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024:1-26. [PMID: 38768073 DOI: 10.1044/2024_jslhr-23-00233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
PURPOSE The purposes of this review article were to provide an introduction to and "bird's-eye" overview of the current evidence base for treatment of childhood apraxia of speech (CAS), identify some gaps and trends in this rapidly growing literature, and formulate some future research directions, in order to advance the evidence base and clinical practice for children with CAS. METHOD Following a brief introduction outlining important concepts, a narrative review of the CAS treatment literature is provided, and trends and future directions are identified based on this review. The review is organized around four fundamental treatment research questions: (a) "Does Treatment X work?", (b) "Does Treatment X work better than Treatment Y?", (c) "For whom does Treatment X work?", and (d) "What does 'work' mean, anyway?" RESULTS A wide range of CAS treatments with varying degrees of evidence for efficacy exists. Research is beginning to emerge that compares different treatments and seeks to determine optimal treatment parameters. Few studies to date have explored child-level predictors of treatment response, and the evidence base currently is limited in scope with respect to populations and outcomes studied. CONCLUSIONS A growing evidence base supports the efficacy of a number of treatments for CAS. However, many important gaps in the literature were identified that warrant redoubled and sustained research attention. Research is beginning to emerge that addresses treatment optimization, comparison, candidacy, and outcomes. Suggestions for future research are offered, and the concept of a hypothesized pathway was applied to CAS to illustrate how components of an intervention can effect change in a clinical goal and can help guide development and refinement of treatments for children with CAS.
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Affiliation(s)
- Edwin Maas
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
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Korkalainen MJ, McCabe P, Smidt A, Morgan C. Outcomes of a novel single case study incorporating Rapid Syllable Transition treatment, AAC and blended intervention in children with cerebral palsy: a pilot study. Disabil Rehabil Assist Technol 2024; 19:167-176. [PMID: 35576498 DOI: 10.1080/17483107.2022.2071488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Motor speech and augmentative and alternative communication (AAC) interventions are commonly used with children with cerebral palsy (CP) but there is limited literature comparing the effectiveness of these interventions. The purpose of this study was to investigate the effectiveness of intensive AAC, Rapid Syllable Transition Treatment (ReST), and blended intervention, a combination of motor-speech and AAC, on speech accuracy and sentence length and complexity. METHODS A single case experimental design across participants with repeated measurements across phases (ABACADA design) was used. Four participants aged 8-14 years with CP who used a speech-generating device (SGD) received three 6-week intervention blocks that included ReST, AAC, and blended intervention. Measures were taken during intervention and baseline phases and at maintenance two and four weeks after the last intervention phase. Participants were randomized to starting with either ReST or AAC with the blended intervention delivered last. RESULTS All participants improved their speech accuracy and sentence length and complexity in speech and with their SGD in all three interventions. The data demonstrated overall immediacy of the effect with all interventions and retention of gains across the whole sequence of phases. The order of AAC or ReST interventions or the severity of CP did not impact the intervention gains. CONCLUSION This study suggests that intensive AAC, a multi-modal approach, and ReST improve speech accuracy and sentence length and complexity in children with moderate CP, but all require further investigation.Implications for rehabilitationIn this paper intensive AAC intervention with a speech generating device (SGD), ReST treatment and multimodal blended intervention were effective in improving speech accuracy and sentence length and complexity in both verbal speech and on communication with the SGD.ReST treatment has not been used with children with CP before. This study established a proof of concept for its effectiveness in children with CP. Further research is warranted.
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Affiliation(s)
- Marjut Johanna Korkalainen
- Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Patricia McCabe
- Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Andy Smidt
- Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Child and Adolescent Health, The University of Sydney, Sydney, Australia
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Namasivayam AK, Shin H, Nisenbaum R, Pukonen M, van Lieshout P. Predictors of Functional Communication Outcomes in Children With Idiopathic Motor Speech Disorders. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-16. [PMID: 37672787 DOI: 10.1044/2023_jslhr-23-00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
PURPOSE The purpose of the study was to investigate child- and intervention-level factors that predict improvements in functional communication outcomes in children with motor-based speech sound disorders. METHOD Eighty-five preschool-age children with childhood apraxia of speech (n = 37) and speech motor delay (n = 48) participated. Multivariable logistic regression models estimated odds ratios and 95% confidence intervals for the association between minimal clinically important difference in the Focus on the Outcomes of Communication Under Six scores and multiple child-level (e.g., age, sex, speech intelligibility, Kaufman Speech Praxis Test diagnostic rating scale) and intervention-level predictors (dose frequency and home practice duration). RESULTS Overall, 65% of participants demonstrated minimal clinically important difference changes in the functional communication outcomes. Kaufman Speech Praxis Test rating scale was significantly associated with higher odds of noticeable change in functional communication outcomes in children. There is some evidence that delivering the intervention for 2 times per week for 10 weeks provides benefit. CONCLUSION A rating scale based on task complexity has the potential for serving as a screening tool to triage children for intervention from waitlist and/or determining service delivery for this population.
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Affiliation(s)
- Aravind K Namasivayam
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Speech Research Centre, Toronto, Ontario, Canada
| | - Hyunji Shin
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Speech Research Centre, Toronto, Ontario, Canada
| | - Rosane Nisenbaum
- Applied Health Research Centre, MAP Centre for Urban Health Solutions, St. Michael's Hospital Li Ka Shing Knowledge Institute, Unity Health Toronto, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Margit Pukonen
- The Speech and Stuttering Institute, Toronto, Ontario, Canada
| | - Pascal van Lieshout
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
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Keller S, Maas E. Self-Reported Communication Attitudes of Children With Childhood Apraxia of Speech: An Exploratory Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1806-1824. [PMID: 36630889 PMCID: PMC10561972 DOI: 10.1044/2022_ajslp-22-00163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/08/2022] [Accepted: 10/01/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE Much of the research literature on childhood apraxia of speech (CAS) has focused on understanding, diagnosing, and treating the impairment, rather than examining its functional effect on children's daily lives. This study focuses on the Personal Factors component of the World Health Organization International Classification of Functioning, Disability and Health-Children and Youth Version Framework. Specifically, the purpose was to examine the self-reported communication attitudes of children with CAS. METHOD Two validated communication attitude questionnaires were administered to 12 children with CAS enrolled in an intensive speech-focused intervention (age range: 4-10 years old). Children's scores were compared to the questionnaires' typically developing norms. Descriptive analyses explored relationships between communication attitude and CAS severity, caregiver perceptions of communicative participation, frustration ratings during therapy, and change in communication attitude over a brief time. RESULTS Older (ages 6-10 years) but not younger (ages 4-5;11 [years;months]) children with CAS were more likely to have negative attitudes about their speech. No clear relationships were observed between communication attitudes and caregiver perceptions of communicative participation; small positive relationships were observed between communication attitude and frustration during therapy. For the younger children, there was also a relationship with CAS severity. For most children, no change in communication attitude was observed over a brief period, though one child appeared to develop more negative and one appeared to develop more positive attitudes. CONCLUSIONS These initial findings suggest that older children with CAS may be at greater risk for negative communication attitudes than their peers without CAS. The findings also highlight the need to include more child self-report measures in research. Further implications for CAS assessment and intervention are discussed. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21834432.
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Affiliation(s)
- Sydney Keller
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
| | - Edwin Maas
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
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Wikse Barrow C, Körner K, Strömbergsson S. A survey of Swedish speech-language pathologists' practices regarding assessment of speech sound disorders. LOGOP PHONIATR VOCO 2023; 48:23-34. [PMID: 34581250 DOI: 10.1080/14015439.2021.1977383] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To explore Swedish clinical practice regarding assessment of suspected Speech Sound Disorders (SSD) in children. METHODS A web-based questionnaire, regarding assessment of SSD in children 4;6-6;11 (years; months), was distributed to Swedish speech-language pathologists (SLPs) through social media and online forums. The questions concerned the frequency and manner of assessment for seven assessment components, chosen based on a review of international recommendations for SSD assessment. RESULTS A total of 131 SLPs responded to the questionnaire. The results show that Swedish SSD assessment practices vary with regards to the frequency and manner of assessment for many components. Speech output is frequently assessed while speech perception, phonological awareness and oral-motor function are assessed less frequently. A variety of manners of assessment, for example, standardised tests, non-standardised material, and informal assessment procedures, such as observation, are utilized by respondents. CONCLUSIONS Swedish SSD assessment practices are variable. The present paper reveals areas for development within SLP practice and education programmes, and provides a new perspective on present praxis with regards to the assessment of suspected SSD in Sweden.
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Affiliation(s)
| | - Karin Körner
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Sofia Strömbergsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Korkalainen J, McCabe P, Smidt A, Morgan C. Motor Speech Interventions for Children With Cerebral Palsy: A Systematic Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:110-125. [PMID: 36623233 DOI: 10.1044/2022_jslhr-22-00375] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Dysarthria is common among children with cerebral palsy (CP) and results in poor speech intelligibility and subsequently low communicative participation. Neuroplasticity evidence suggests that adherence to principles of motor learning (PML) improves motor speech intervention outcomes. Motor speech interventions aim to improve speech intelligibility and ultimately facilitate participation, but the effectiveness of these interventions and their inclusion of PML are not clear. Aims are as follows: (a) evaluate the effectiveness motor speech interventions in improving speech intelligibility; (b) summarize the aims, outcome measures, and outcomes relating to the International Classification of Functioning and Disability Child and Youth; and (c) summarize the principles of motor learning used in the intervention. METHOD Eight databases were searched, complemented by a hand search. Studies of any level of evidence were included if they used a motor speech intervention and measured speech in children with CP aged 0-18 years. Studies before 2000 or not in English were excluded. The review was conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was rated using the Single Case Experimental Design Scale and Physiotherapy Evidence Database-P rating scales. The strength of evidence was evaluated with Grading of Recommendations, Assessment, Development and Evaluation. RESULTS Of 1,036 initial articles, 21 were included. Eight interventions were identified including 131 participants aged 3-18 years. All studies aimed to improve speech intelligibility or articulation and reported improvement at sound, word, or sentence level. One study reported improvements in communicative participation. The strength of evidence ranged from very low to moderate for one intervention. Adherence to PML was inconsistent. CONCLUSIONS The quality of evidence is very low to moderate. More research on motor speech interventions that adhere to PML is required. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21817959.
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Affiliation(s)
| | - Patricia McCabe
- The University of Sydney, Camperdown, New South Wales, Australia
| | - Andy Smidt
- The University of Sydney, Camperdown, New South Wales, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Baker E, Masso S, Huynh K, Sugden E. Optimizing Outcomes for Children With Phonological Impairment: A Systematic Search and Review of Outcome and Experience Measures Reported in Intervention Research. Lang Speech Hear Serv Sch 2022; 53:732-748. [PMID: 35394819 DOI: 10.1044/2022_lshss-21-00132] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Reporting of outcome and experience measures is critical to our understanding of the effect of intervention for speech sound disorders (SSD) in children. There is currently no agreed-upon set of measures for reporting intervention outcomes and experiences. In this article, we introduce the Speech Outcome Reporting Taxonomy (SORT), a tool designed to assist with the classification of outcome and experience measures. In a systematic search and review using the SORT, we explore the type and frequency of these measures reported in intervention research addressing phonological impairment in children. Given the integral relationship between intervention fidelity and intervention outcomes, reporting of fidelity is also examined. METHOD Five literature databases were searched to identify articles written or translated into English published between 1975 and 2020. Using the SORT, outcome and experience measures were extracted and categorized. The number of intervention studies reporting fidelity was determined. RESULTS A total of 220 articles met inclusion criteria. The most frequently reported outcome domain was broad generalization measures (n = 142, 64.5%), followed by specific measures of generalization of an intervention target (n = 133, 60.5%). Eleven (5.0%) articles reported measures of the impact of the phonological impairment on children's activity, participation, quality of life, or others. Twenty articles (9.1%) reported on parent, child, or clinician experience or child engagement. Fidelity data were reported for 13.4% of studies of interventions. CONCLUSIONS The measurement of intervention outcomes is challenging yet important. No single type of measure was reported across all articles. Through using tailored measures closely related to intervention targets in combination with a universal set of measures of intelligibility, the impact of phonological impairment on children's lives, and the experience of receiving and providing intervention, researchers and clinicians could work together to progress insights and innovations in science and practice for children with SSD. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19497803.
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Affiliation(s)
- Elise Baker
- School of Health Sciences, Western Sydney University, New South Wales, Australia.,South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Sarah Masso
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia.,Charles Sturt University, Bathurst, New South Wales, Australia
| | - Kylie Huynh
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Ellie Sugden
- School of Health Sciences, Western Sydney University, New South Wales, Australia
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Icht M. Improving speech characteristics of young adults with congenital dysarthria: An exploratory study comparing articulation training and the Beatalk method. JOURNAL OF COMMUNICATION DISORDERS 2021; 93:106147. [PMID: 34461556 DOI: 10.1016/j.jcomdis.2021.106147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/06/2021] [Accepted: 08/16/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION This exploratory study compared the effects of two speech therapy approaches on speech characteristics of young adults with congenital dysarthria resulting from various etiologies: a) articulation training focusing on consonant articulation exercises at various levels (isolation, syllables, and words), and b) the Beatalk method, based on human beatboxing, i.e., producing various instrumental sounds in an a-cappella musical context. Both interventions were designed to increase participants' speech intelligibility. METHODS Twelve adults with congenital dysarthria and reduced speech intelligibility participated in treatment groups for eight weeks. Six participants were assigned to the articulation training group, and six to the Beatalk group. Intelligibility of single words and continuous speech, voice measures, and oral-diadochokinesis rates were measured before and after the treatment. RESULTS The results showed that the Beatalk intervention yielded a significant overall pre- to post-treatment effect. Specifically, it resulted in gains in articulatory accuracy and intelligibility for single words. Improvements were not noted following articulation training. CONCLUSIONS The results present initial evidence of the positive effect of the Beatalk method as an intervention tool for adults with congenital dysarthria. This relatively easy-to-learn technique shows promise, as it involves intense and repetitive production of speech sounds while controlling rhythm and breathing in an enjoyable context.
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Affiliation(s)
- Michal Icht
- Department of Communication Disorders, Ariel University 40700, Israel.
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Namasivayam AK, Huynh A, Bali R, Granata F, Law V, Rampersaud D, Hard J, Ward R, Helms-Park R, van Lieshout P, Hayden D. Development and Validation of a Probe Word List to Assess Speech Motor Skills in Children. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:622-648. [PMID: 33705676 DOI: 10.1044/2020_ajslp-20-00139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The aim of the study was to develop and validate a probe word list and scoring system to assess speech motor skills in preschool and school-age children with motor speech disorders. Method This article describes the development of a probe word list and scoring system using a modified word complexity measure and principles based on the hierarchical development of speech motor control known as the Motor Speech Hierarchy (MSH). The probe word list development accounted for factors related to word (i.e., motoric) complexity, linguistic variables, and content familiarity. The probe word list and scoring system was administered to 48 preschool and school-age children with moderate-to-severe speech motor delay at clinical centers in Ontario, Canada, and then evaluated for reliability and validity. Results One-way analyses of variance revealed that the motor complexity of the probe words increased significantly for each MSH stage, while no significant differences in the linguistic complexity were found for neighborhood density, mean biphone frequency, or log word frequency. The probe word list and scoring system yielded high reliability on measures of internal consistency and intrarater reliability. Interrater reliability indicated moderate agreement across the MSH stages, with the exception of MSH Stage V, which yielded substantial agreement. The probe word list and scoring system demonstrated high content, construct (unidimensionality, convergent validity, and discriminant validity), and criterion-related (concurrent and predictive) validity. Conclusions The probe word list and scoring system described in the current study provide a standardized method that speech-language pathologists can use in the assessment of speech motor control. It can support clinicians in identifying speech motor difficulties in preschool and school-age children, set appropriate goals, and potentially measure changes in these goals across time and/or after intervention.
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Affiliation(s)
- Aravind Kumar Namasivayam
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, Ontario, Canada
| | - Anna Huynh
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Rohan Bali
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Francesca Granata
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Vina Law
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Darshani Rampersaud
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Jennifer Hard
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Roslyn Ward
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia
- School of Allied Health, Curtin University, Bentley, Western Australia, Australia
| | - Rena Helms-Park
- Linguistics, Department of Language Studies, University of Toronto Scarborough, Ontario, Canada
| | - Pascal van Lieshout
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
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Namasivayam AK, Huynh A, Granata F, Law V, van Lieshout P. PROMPT intervention for children with severe speech motor delay: a randomized control trial. Pediatr Res 2021; 89:613-621. [PMID: 32357364 PMCID: PMC7979536 DOI: 10.1038/s41390-020-0924-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/01/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Currently, there is limited information on the intervention efficacy for children with speech motor delay (SMD). This randomized control trial (RCT) study examined the effectiveness of Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) intervention to improve the outcomes in children with SMD. We hypothesized that children with SMD receiving PROMPT intervention would improve more in the measured outcomes than those waitlisted and receiving home training. METHODS Using a two-arm, parallel group, RCT, 49 children with SMD were allocated to either an intervention group (N = 24) that received 45 min of PROMPT intervention two times a week for 10 weeks or were waitlisted for the same duration and received only home training instructions (N = 25). Outcome measures for speech motor control, articulation, speech intelligibility (word and sentence levels), and functional communication were assessed at baseline and at a 10-week follow-up. RESULTS PROMPT intervention was associated with notable improvements in speech motor control, speech articulation, and word-level speech intelligibility. Intervention allocation yielded weak improvements in sentence-level speech intelligibility and functional communication. CONCLUSIONS PROMPT intervention is a clinically effective intervention approach for children with SMD. IMPACT Currently, there is limited information on the intervention efficacy for children with SMD. We report on the findings of a phase III intervention efficacy study on children with SMD using an RCT design. PROMPT intervention is a clinically effective intervention approach for children with SMD. Results of the study will be fundamental to the delivery of effective services for this population. These findings may facilitate the development of an evidence-based care pathway for children with severe speech sound disorders.
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Affiliation(s)
- Aravind K. Namasivayam
- grid.17063.330000 0001 2157 2938Oral Dynamics Laboratory, Department of Speech–Language Pathology, University of Toronto, Toronto, ON Canada ,grid.415526.10000 0001 0692 494XToronto Rehabilitation Institute, Toronto, ON Canada
| | - Anna Huynh
- grid.17063.330000 0001 2157 2938Oral Dynamics Laboratory, Department of Speech–Language Pathology, University of Toronto, Toronto, ON Canada
| | - Francesca Granata
- grid.17063.330000 0001 2157 2938Oral Dynamics Laboratory, Department of Speech–Language Pathology, University of Toronto, Toronto, ON Canada
| | - Vina Law
- grid.17063.330000 0001 2157 2938Oral Dynamics Laboratory, Department of Speech–Language Pathology, University of Toronto, Toronto, ON Canada
| | - Pascal van Lieshout
- grid.17063.330000 0001 2157 2938Oral Dynamics Laboratory, Department of Speech–Language Pathology, University of Toronto, Toronto, ON Canada ,grid.415526.10000 0001 0692 494XToronto Rehabilitation Institute, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Rehabilitation Sciences Institute, University of Toronto, Toronto, ON Canada
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Farquharson K, Tambyraja SR, Justice LM. Contributions to Gain in Speech Sound Production Accuracy for Children With Speech Sound Disorders: Exploring Child and Therapy Factors. Lang Speech Hear Serv Sch 2020; 51:457-468. [PMID: 32160111 DOI: 10.1044/2019_lshss-19-00079] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose The purpose of this study was to explore the extent to which child- and therapy-level factors contribute to gains in speech sound production accuracy for children with speech sound disorders in receipt of school-based services. Method Data were obtained from 126 kindergarten and first- and second-grade children currently in receipt of speech therapy services in their public school setting. Pretest and posttest measures of spontaneous speech production and language ability were collected at the beginning and end of one academic year. Using a spontaneous speech sample, percentage of consonants correct (PCC) was calculated for each child; a gain score was computed by subtracting the pretest PCC score from the posttest PCC score. The children's speech-language pathologist completed weekly therapy logs during business-as-usual therapy, indicating the frequency, duration, and group composition of services throughout the school year. Results Results supported that gain in PCC from pretest to posttest was predicted by several child- and therapy-level variables. Children's initial speech sound severity was negatively related to gains in PCC. Our results also supported that the total number of therapy sessions received in a year was positively predictive of PCC gain. Interestingly, the number of individual therapy sessions was negatively associated with PCC gain. Conclusion Several malleable therapy factors contribute to gains in speech sound accuracy for children with speech sound disorders. Speech-language pathologists should consider how these factors may be manipulated to best tailor treatment to the individual needs of the children on their caseloads.
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Affiliation(s)
- Kelly Farquharson
- School of Communication Sciences and Disorders, Florida State University, Tallahassee
| | - Sherine R Tambyraja
- Crane Center for Early Childhood Research and Policy, The Ohio State University, Columbus
| | - Laura M Justice
- Crane Center for Early Childhood Research and Policy, The Ohio State University, Columbus
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12
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Maas E, Gildersleeve-Neumann C, Jakielski K, Kovacs N, Stoeckel R, Vradelis H, Welsh M. Bang for Your Buck: A Single-Case Experimental Design Study of Practice Amount and Distribution in Treatment for Childhood Apraxia of Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:3160-3182. [PMID: 31425660 DOI: 10.1044/2019_jslhr-s-18-0212] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose The aim of this study was to examine 2 aspects of treatment intensity in treatment for childhood apraxia of speech (CAS): practice amount and practice distribution. Method Using an alternating-treatments single-subject design with multiple baselines, we compared high versus low amount of practice, and massed versus distributed practice, in 6 children with CAS. Conditions were manipulated in the context of integral stimulation treatment. Changes in perceptual accuracy, scored by blinded analysts, were quantified with effect sizes. Results Four children showed an advantage for high amount of practice, 1 showed an opposite effect, and 1 showed no condition difference. For distribution, 4 children showed a clear advantage for massed over distributed practice post treatment; 1 showed an opposite pattern, and 1 showed no clear difference. Follow-up revealed a similar pattern. All children demonstrated treatment effects (larger gains for treated than untreated items). Conclusions High practice amount and massed practice were associated with more robust speech motor learning in most children with CAS, compared to low amount and distributed practice, respectively. Variation in effects across children warrants further research to determine factors that predict optimal treatment conditions. Finally, this study adds to the evidence base supporting the efficacy of integral stimulation treatment for CAS. Supplemental Material https://doi.org/10.23641/asha.9630599.
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Affiliation(s)
- Edwin Maas
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
| | | | - Kathy Jakielski
- Department of Communication Sciences and Disorders, Augustana College, Rock Island, IL
| | - Nicolette Kovacs
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
| | - Ruth Stoeckel
- Department of Speech-Language Pathology, Mayo Clinic, Rochester, MN
| | - Helen Vradelis
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
| | - Mackenzie Welsh
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
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Namasivayam AK, Pukonen M, Goshulak D, Granata F, Le DJ, Kroll R, van Lieshout P. Investigating intervention dose frequency for children with speech sound disorders and motor speech involvement. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:673-686. [PMID: 30941860 DOI: 10.1111/1460-6984.12472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Treatment outcome data for children with severe speech sound disorders with motor speech involvement (SSD-MSI) are derived from Phase I clinical research studies. These studies have demonstrated positive improvements in speech production. Currently there is no research examining the optimal treatment dose frequency for this population. The results of this study, which is the first of its kind, will inform the delivery of effective services for this population. AIMS To investigate optimal treatment dose frequency for the Motor Speech Treatment Protocol (MSTP) for children with SSD-MSI. METHODS & PROCEDURES A total of 48 children (aged 43-47 months) with SSD-MSI participated in the study. Participants received 45-min MSTP intervention sessions either once per week (lower dose frequency) or twice per week (higher dose frequency) for a 10-week period. Blinded outcome assessments were carried out at pre- and post-intervention. OUTCOMES & RESULTS Treatment-related change was assessed at body structures, functions and activities participation level as per the World Health Organization's International Classification of Functioning framework: Children and Youth Version (ICF-CY) framework WHO (2007). These measures are related to articulation, functional communication and speech intelligibility. One-way analysis of variance (ANOVA) revealed that for all variables the baseline scores were not statistically different (p > 0.05) between the two dose-frequency groups. Overall, there was a significant main effect of Time (pre-post) across all variables (p < 0.01). However, repeated-measures ANOVA did not result in any statistical interactions (Time × Dose frequency) for any of the variables tested (p > 0.05). Only marginal clinical advantages (< 4% change in intelligibility) were noted with the 10 extra sessions. CONCLUSIONS & IMPLICATIONS Overall, the MSTP intervention approach in conjunction with home practice led to significant positive changes for all measures in children with SSD-MSI. No statistical differences between high- and low-dose-frequency groups were observed for any of the variables. Clinical effects were examined using effect sizes, as well as changes in articulation, speech intelligibility and functional communication; these differed marginally between the two dose frequencies. This suggests limited benefits of 10 additional sessions per block. Thus, it is recommended that caregivers, speech-language therapists and policy-makers perform a cost-benefit analysis before determining the dose frequency, when considering additional sessions per block.
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Affiliation(s)
- Aravind K Namasivayam
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Margit Pukonen
- The Speech and Stuttering Institute, Toronto, ON, Canada
| | - Debra Goshulak
- The Speech and Stuttering Institute, Toronto, ON, Canada
| | - Francesca Granata
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
| | - D James Le
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
| | - Robert Kroll
- The Speech and Stuttering Institute, Toronto, ON, Canada
| | - Pascal van Lieshout
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, Toronto, ON, Canada
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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14
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Gómez-Vilda P, Palacios-Alonso D, Rodellar-Biarge V, Álvarez-Marquina A, Nieto-Lluis V, Martínez-Olalla R. Parkinson's disease monitoring by biomechanical instability of phonation. Neurocomputing 2017. [DOI: 10.1016/j.neucom.2016.06.092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Shriberg LD, Strand EA, Fourakis M, Jakielski KJ, Hall SD, Karlsson HB, Mabie HL, McSweeny JL, Tilkens CM, Wilson DL. A Diagnostic Marker to Discriminate Childhood Apraxia of Speech From Speech Delay: IV. The Pause Marker Index. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:S1153-S1169. [PMID: 28384662 PMCID: PMC5548089 DOI: 10.1044/2016_jslhr-s-16-0149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/02/2016] [Accepted: 08/21/2016] [Indexed: 05/07/2023]
Abstract
Purpose Three previous articles provided rationale, methods, and several forms of validity support for a diagnostic marker of childhood apraxia of speech (CAS), termed the pause marker (PM). Goals of the present article were to assess the validity and stability of the PM Index (PMI) to scale CAS severity. Method PM scores and speech, prosody, and voice precision-stability data were obtained for participants with CAS in idiopathic, neurogenetic, and complex neurodevelopmental disorders; adult-onset apraxia of speech consequent to stroke and primary progressive apraxia; and idiopathic speech delay. Three studies were completed including criterion and concurrent validity studies of the PMI and a temporal stability study of the PMI using retrospective case studies. Results PM scores were significantly correlated with other signs of CAS precision and stability. The best fit of the distribution of PM scores to index CAS severity was obtained by dividing scores into 4 ordinal severity classifications: mild, mild-moderate, moderate-severe, and severe. Severity findings for the 4 classifications and retrospective longitudinal findings from 8 participants with CAS supported the validity and stability of the PMI. Conclusion Findings support research and clinical use of the PMI to scale the severity of CAS.
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Affiliation(s)
| | | | | | - Kathy J. Jakielski
- Department of Communication Sciences and Disorders, Augustana College, Rock Island, IL
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16
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Murray E, Iuzzini-Seigel J. Efficacious Treatment of Children With Childhood Apraxia of Speech According to the International Classification of Functioning, Disability and Health. ACTA ACUST UNITED AC 2017. [DOI: 10.1044/persp2.sig2.61] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
There is increasing evidence for treatment approaches designed for children with childhood apraxia of speech (CAS). Despite this, no treatment has conclusive evidence to date. The CAS population is heterogeneous, with children presenting with varying symptom profiles, severity levels, and comorbidities. Consequently, treatment planning for children with CAS represents a clinical challenge. To assist clinicians in providing optimal care, this paper uses the International Classification of Functioning, Disability and Health (ICF) as a framework for identifying the body structures and functions, activities, and personal/environmental factors that should be considered when working with children with CAS. Evidence-based interventions are described and resources outlined to help guide the treatment planning process.
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Affiliation(s)
- Elizabeth Murray
- Faculty of Health Sciences, The University of Sydney
Lidcombe NSW, Australia
| | - Jenya Iuzzini-Seigel
- Communication, Movement and Learning Lab, Department of Speech Pathology and Audiology, Marquette University
Milwaukee, WI
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17
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Bressmann T, Harper S, Zhylich I, Kulkarni GV. Perceptual, durational and tongue displacement measures following articulation therapy for rhotic sound errors. CLINICAL LINGUISTICS & PHONETICS 2016; 30:345-362. [PMID: 26979162 DOI: 10.3109/02699206.2016.1140227] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Outcomes of articulation therapy for rhotic errors are usually assessed perceptually. However, our understanding of associated changes of tongue movement is limited. This study described perceptual, durational and tongue displacement changes over 10 sessions of articulation therapy for /ɹ/ in six children. Four of the participants also received ultrasound biofeedback of their tongue shape. Speech and tongue movement were recorded pre-therapy, after 5 sessions, in the final session and at a one month follow-up. Perceptually, listeners perceived improvement and classified more productions as /ɹ/ in the final and follow-up assessments. The durations of VɹV syllables at the midway point of the therapy were longer. Cumulative tongue displacement increased in the final session. The average standard deviation was significantly higher in the middle and final assessments. The duration and tongue displacement measures illustrated how articulation therapy affected tongue movement and may be useful for outcomes research about articulation therapy.
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Affiliation(s)
- Tim Bressmann
- a Department of Speech-Language Pathology , University of Toronto , Toronto , ON , Canada
- b Faculty of Dentistry , University of Toronto , Toronto , ON , Canada
| | - Susan Harper
- a Department of Speech-Language Pathology , University of Toronto , Toronto , ON , Canada
| | - Irina Zhylich
- a Department of Speech-Language Pathology , University of Toronto , Toronto , ON , Canada
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