1
|
Case J, Caspari S, Aggarwal P, Stoeckel R. A Goal-Writing Framework for Motor-Based Intervention for Childhood Apraxia of Speech. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1590-1607. [PMID: 38754036 DOI: 10.1044/2024_ajslp-24-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
PURPOSE There are multiple frameworks for goal writing that are applicable to the practice of speech-language pathology. Motor-based speech disorders are a subset of speech sound disorders that are thought to require specific elements of intervention that are typically not addressed in the traditional frameworks used in the clinical setting. The purpose of this tutorial is to review general approaches of goal writing and suggest additional elements that may be used to improve the efficiency and effectiveness of treatment for childhood motor speech disorders, specifically childhood apraxia of speech (CAS). METHOD Existing models of goal writing were reviewed to ascertain elements common to most of these models. A basic framework was chosen and modified to include behaviors, conditions, and approaches to goal measurement tailored to the clinical needs of children with CAS. A resource for clinical decision making for children with CAS was developed to inform goal writing at the onset of treatment and adaptations that occur over the course of treatment. Case studies are presented to demonstrate how the presented framework can be applied to writing goals for motor-based treatment for two different children with CAS. DISCUSSION Children with CAS require a specialized approach to intervention, which requires goals to reflect the unique clinical needs of this population. This tutorial offers resources that use the best available research evidence and current understanding of effective treatment practices for CAS to guide clinical decision making for motor-based intervention and goal writing. This tutorial is intended to guide treatment planning across varied settings to facilitate progress and optimize treatment outcomes for children with CAS.
Collapse
Affiliation(s)
- Julie Case
- Department of Speech-Language-Hearing Sciences, Hofstra University, Hempstead, NY
| | - Susan Caspari
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
| | | | | |
Collapse
|
2
|
Alduais A, Alfadda H. Childhood Apraxia of Speech: A Descriptive and Prescriptive Model of Assessment and Diagnosis. Brain Sci 2024; 14:540. [PMID: 38928540 PMCID: PMC11201615 DOI: 10.3390/brainsci14060540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024] Open
Abstract
Childhood apraxia of speech (CAS) represents a significant diagnostic and therapeutic challenge within the field of clinical neuropsychology, characterized by its nuanced presentation and multifactorial nature. The aim of this study was to distil and synthesize the broad spectrum of research into a coherent model for the assessment and diagnosis of CAS. Through a mixed-method design, the quantitative phase analyzed 290 studies, unveiling 10 clusters: developmental apraxia, tabby talk, intellectual disabilities, underlying speech processes, breakpoint localization, speech characteristics, functional characteristics, clinical practice, and treatment outcome. The qualitative phase conducted a thematic analysis on the most cited and recent literature, identifying 10 categories: neurobiological markers, speech motor control, perceptual speech features, auditory processing, prosody and stress patterns, parent- and self-report measures, intervention response, motor learning and generalization, comorbidity analysis, and cultural and linguistic considerations. Integrating these findings, a descriptive and prescriptive model was developed, encapsulating the complexities of CAS and providing a structured approach for clinicians. This model advances the understanding of CAS and supports the development of targeted interventions. This study concludes with a call for evidence-based personalized treatment plans that account for the diverse neurobiological and cultural backgrounds of children with CAS. Its implications for practice include the integration of cutting-edge assessment tools that embrace the heterogeneity of CAS presentations, ensuring that interventions are as unique as the children they aim to support.
Collapse
Affiliation(s)
- Ahmed Alduais
- Department of Human Sciences (Psychology), University of Verona, 37129 Verona, Italy
| | - Hind Alfadda
- Department of Curriculum and Instruction, King Saud University, Riyadh 11362, Saudi Arabia
| |
Collapse
|
3
|
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.
Collapse
Affiliation(s)
- Edwin Maas
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
| |
Collapse
|
4
|
Grigos MI, Case J, Lu Y, Lyu Z. Dynamic Temporal and Tactile Cueing in Young Children With Childhood Apraxia of Speech: A Multiple Single-Case Design. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1042-1071. [PMID: 38512002 PMCID: PMC11005957 DOI: 10.1044/2024_jslhr-23-00415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/12/2023] [Accepted: 01/12/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Childhood apraxia of speech (CAS) is a multivariate motor speech disorder that requires a motor-based intervention approach. There is limited treatment research on young children with CAS, reflecting a critical gap in the literature given that features of CAS are often in full expression early in development. Dynamic Temporal and Tactile Cueing (DTTC) is a treatment approach designed for children with severe CAS, yet the use of DTTC with children younger than 3 years of age has not been examined. METHOD A multiple single-case design was employed to examine the use of DTTC in seven children with CAS (aged 2.5-5 years) over the course of 6 weeks of intervention. Changes in word accuracy were measured in treated words from baseline to posttreatment and from baseline to maintenance (6 weeks posttreatment). Generalization of word accuracy changes to matched untreated words was also examined. A linear mixed-effects model was used to estimate the change in word accuracy for treated and untreated words across all children from baseline to posttreatment and to maintenance. A quasi-Poisson regression model was used to estimate mean change and calculate effect sizes for treated and untreated words. RESULTS Group-level analyses revealed significant changes in word accuracy for treated and untreated words at posttreatment and maintenance. At the child level, six of seven children displayed medium-to-large effect sizes where word accuracy increased in an average of 3.4/5 words across all children. Each child displayed some degree of generalization to untreated targets, specifically for words with the same syllable shape as the treated words. CONCLUSIONS These results demonstrate that DTTC can yield positive change in some young children with CAS. Key differences in each child's performance are highlighted.
Collapse
Affiliation(s)
- Maria I. Grigos
- Department of Communicative Sciences and Disorders, New York University, NY
| | - Julie Case
- Department of Speech-Language-Hearing Sciences, Hofstra University, Hempstead, NY
| | - Ying Lu
- Department of Applied Statistics, Social Science, and Humanities, New York University, NY
| | - Zhuojun Lyu
- Department of Applied Statistics, Social Science, and Humanities, New York University, NY
| |
Collapse
|
5
|
Anastasopoulou I, Cheyne DO, van Lieshout P, Johnson BW. Decoding kinematic information from beta-band motor rhythms of speech motor cortex: a methodological/analytic approach using concurrent speech movement tracking and magnetoencephalography. Front Hum Neurosci 2024; 18:1305058. [PMID: 38646159 PMCID: PMC11027130 DOI: 10.3389/fnhum.2024.1305058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/26/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Articulography and functional neuroimaging are two major tools for studying the neurobiology of speech production. Until now, however, it has generally not been feasible to use both in the same experimental setup because of technical incompatibilities between the two methodologies. Methods Here we describe results from a novel articulography system dubbed Magneto-articulography for the Assessment of Speech Kinematics (MASK), which is technically compatible with magnetoencephalography (MEG) brain scanning systems. In the present paper we describe our methodological and analytic approach for extracting brain motor activities related to key kinematic and coordination event parameters derived from time-registered MASK tracking measurements. Data were collected from 10 healthy adults with tracking coils on the tongue, lips, and jaw. Analyses targeted the gestural landmarks of reiterated utterances/ipa/ and /api/, produced at normal and faster rates. Results The results show that (1) Speech sensorimotor cortex can be reliably located in peri-rolandic regions of the left hemisphere; (2) mu (8-12 Hz) and beta band (13-30 Hz) neuromotor oscillations are present in the speech signals and contain information structures that are independent of those present in higher-frequency bands; and (3) hypotheses concerning the information content of speech motor rhythms can be systematically evaluated with multivariate pattern analytic techniques. Discussion These results show that MASK provides the capability, for deriving subject-specific articulatory parameters, based on well-established and robust motor control parameters, in the same experimental setup as the MEG brain recordings and in temporal and spatial co-register with the brain data. The analytic approach described here provides new capabilities for testing hypotheses concerning the types of kinematic information that are encoded and processed within specific components of the speech neuromotor system.
Collapse
Affiliation(s)
| | - Douglas Owen Cheyne
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Pascal van Lieshout
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
| | | |
Collapse
|
6
|
Gomez M, Purcell A, Jakielski K, McCabe P. A single case experimental design study using an operationalised version of the Kaufman Speech to Language Protocol for children with childhood apraxia of speech. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:194-211. [PMID: 37855390 DOI: 10.1080/17549507.2023.2211750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
PURPOSE A Phase I study was conducted to examine the treatment effectiveness of the Kaufman Speech to Language Protocol using a research-operationalised protocol. It was hypothesised that articulatory accuracy would improve as a result of the treatment and that these improvements would be maintained after treatment was discontinued. METHOD A single case experimental design was used to evaluate the effectiveness of the Kaufman Speech to Language Protocol. Four children with a confirmed childhood apraxia of speech diagnosis were included in this study. Each child received 12 individual 1 hr treatment sessions that each consisted of an approximation setting phase and a practice phase. Probe data was collected during treatment and at post-treatment time points to measure treatment effectiveness and to measure changes in the untreated words. Untreated (control) sounds were included to test whether recorded improvements in articulatory accuracy could be attributed to the Kaufman Speech to Language Protocol. RESULT Two of the four children demonstrated a response to the intervention and maintenance of these changes, while the two remaining children demonstrated some generalisation in the absence of improved target (treatment) words. No specific child factors were clearly associated with positive treatment outcomes. CONCLUSION This study replicated the findings of an earlier pilot study and found that the operationalised protocol for the Kaufman Speech to Language Protocol is effective in improving articulatory accuracy for some children with childhood apraxia of speech. Additional replication with a further refined treatment protocol and a larger sample size is needed to support a recommendation of clinical use of the Kaufman Speech to Language Protocol.
Collapse
Affiliation(s)
- Maryane Gomez
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Alison Purcell
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- School of Health Sciences, Western Sydney University, Sydney, Australia and
| | - Kathy Jakielski
- Communication Sciences and Disorders Department, Augustana College, Rock Island, IL, USA
| | - Patricia McCabe
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
7
|
Neumann K, Kauschke C, Fox-Boyer A, Lüke C, Sallat S, Kiese-Himmel C. Interventions for Developmental Language Delay and Disorders. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:155-162. [PMID: 38377329 DOI: 10.3238/arztebl.m2024.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Approximately 9.9 % of children present with difficulties in language development (DLD), 7.6 % without serious additional impairments and 2.3 % associated with languagerelevant comorbidities, e.g., hearing loss. Notably, in a consensus statement by experts in German-speaking countries, in the guideline presented here, and further in this article, all of these disorders are referred to as "developmental language disorders" (DLD), whereas the international consortium CATALISE only refers to those without comorbidities as DLD. DLDs are among the most commonly treated childhood disorders and, if persistent, often reduce educational and socio-economic outcome. Children in their third year of life with developmental language delay (late talkers, LT) are at risk of a later DLD. METHODS This German interdisciplinary clinical practice guideline reflects current knowledge regarding evidence-based interventions for developmental language delay and disorders. A systematic literature review was conducted on the effectiveness of interventions for DLD. RESULTS The guideline recommends parent training (Hedges g = 0.38 to 0.82) for LTs with expressive language delay, language therapy (Cohen's d = -0.20 to 0.90) for LTs with additional receptive language delay or further DLD risk factors, phonological or integrated phonological treatment methods (Cohen's d = 0.89 to 1.04) for phonological speech sound disorders (SSDs), a motor approach for isolated phonetic SSDs (non-DLD), and for lexical-semantic and morpho-syntactic impairments combinations of implicit and explicit intervention approaches (including input enrichment, modeling techniques, elicitation methods, creation of production opportunities, metalinguistic- approaches, visualizations; Cohen's d = 0.89-1.04). Recom mendations were also made for DLD associated with pragmatic-communicative impairment, bi-/ multilingualism, hearing loss, intellectual disability, autism-spectrum disorders, selective mutism, language- relevant syndromes or multiple disabilities, and for intensive inpatient language rehabilitation. CONCLUSION Early parent- and child-centered speech and language intervention implementing evidence-based intervention approaches, frequency, and settings, combined with educational language support, can improve the effectiveness of management of developmental language delay and disorders.
Collapse
Affiliation(s)
- Katrin Neumann
- Department of Phoniatrics and Pediatric Audiology, University Hospital of Muenster, University of Muenster, Germany; Department of German Linguistics, Clinical Linguistics, University of Marburg, Marburg, Germany; Institute of Health Sciences, University of Luebeck, Germany; Special Education and Therapy in Language and Communication Disorders, University of Wuerzburg, Germany; Department of Pedagogy for Speech and Communication Disorders, Halle, Germany
| | | | | | | | | | | |
Collapse
|
8
|
Eastwood C, McCabe P, Heard R. Unpacking the black box of voice therapy: A clinical application and revision of the Motor Learning Classification Framework (MLCF). INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:68-82. [PMID: 35706389 DOI: 10.1080/17549507.2022.2079723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Voice therapy is a complex behavioural intervention. Understanding its components is integral for continued advancement of voice therapy research, translation of evidence into the clinical setting and improved client care. The Motor Learning Classification Framework (MLCF) offers an excellent opportunity for increasing such knowledge, specifically in relation to identifying variables that affect motor learning (ML), an important mechanism hypothesised to bring about voice change during voice therapy. The MLCF has shown promising results in identifying speech-language pathologists' (SLPs) use of ML variables during experimentally controlled voice therapy contexts. The purpose of this study was to test the feasibility of applying the framework in the clinical context of everyday voice therapy practice. METHOD Data consisted of two video-recorded voice therapy sessions representing usual voice therapy care. Classification of ML variables used by SLPs during the recorded sessions was attempted based on the MLCF. RESULT Several problematic features of the framework were identified. Based on deliberations between the authors of the current paper, the MLCF was revised using an iterative process. This resulted in the construction of an updated version of the framework (MLCF-V2). The MLCF-V2 organises ML strategies into two broad categories: directly observable behaviours and learning processes. The framework incorporates greater consideration of theory and empirical evidence supporting motivational, attentional focus and subjective error estimation influences on ML. Several examples of each ML variable are included as well as an attempt to provide clearer classification instruction. CONCLUSION It is anticipated that the MLCF-V2 will provide a more useful and reliable classification for use in future investigations of SLPs' use of ML variables during usual voice therapy practice.
Collapse
Affiliation(s)
- Clare Eastwood
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Patricia McCabe
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Robert Heard
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
9
|
Nakamura-Palacios EM, Falçoni Júnior AT, Tanese GL, Vogeley ACE, Namasivayam AK. Enhancing Speech Rehabilitation in a Young Adult with Trisomy 21: Integrating Transcranial Direct Current Stimulation (tDCS) with Rapid Syllable Transition Training for Apraxia of Speech. Brain Sci 2024; 14:58. [PMID: 38248273 PMCID: PMC10813810 DOI: 10.3390/brainsci14010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Apraxia of speech is a persistent speech motor disorder that affects speech intelligibility. Studies on speech motor disorders with transcranial Direct Current Stimulation (tDCS) have been mostly directed toward examining post-stroke aphasia. Only a few tDCS studies have focused on apraxia of speech or childhood apraxia of speech (CAS), and no study has investigated individuals with CAS and Trisomy 21 (T21, Down syndrome). This N-of-1 randomized trial examined the effects of tDCS combined with a motor learning task in developmental apraxia of speech co-existing with T21 (ReBEC RBR-5435x9). The accuracy of speech sound production of nonsense words (NSWs) during Rapid Syllable Transition Training (ReST) over 10 sessions of anodal tDCS (1.5 mA, 25 cm) over Broca's area with the cathode over the contralateral region was compared to 10 sessions of sham-tDCS and four control sessions in a 20-year-old male individual with T21 presenting moderate-severe childhood apraxia of speech (CAS). The accuracy for NSW production progressively improved (gain of 40%) under tDCS (sham-tDCS and control sessions showed < 20% gain). A decrease in speech severity from moderate-severe to mild-moderate indicated transfer effects in speech production. Speech accuracy under tDCS was correlated with Wernicke's area activation (P3 current source density), which in turn was correlated with the activation of the left supramarginal gyrus and the Sylvian parietal-temporal junction. Repetitive bihemispheric tDCS paired with ReST may have facilitated speech sound acquisition in a young adult with T21 and CAS, possibly through activating brain regions required for phonological working memory.
Collapse
Affiliation(s)
| | | | - Gabriela Lolli Tanese
- Clinic of Speech-Language Pathology, Eldorado Business Tower, Goiânia 74280-010, GO, Brazil;
| | - Ana Carla Estellita Vogeley
- Department of Speech and Language Pathology, Federal University of Paraíba, João Pessoa 58051-900, PB, Brazil;
| | - Aravind Kumar Namasivayam
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON M5G 1V7, Canada;
- Speech Research Centre Inc., Brampton, ON L7A 2T1, Canada
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Vuolo J. Articulatory and segmental performance in children with and without speech disorder: A multiple case pilot study. CLINICAL LINGUISTICS & PHONETICS 2023; 37:935-957. [PMID: 35971981 PMCID: PMC9931931 DOI: 10.1080/02699206.2022.2108724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/07/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
This multiple case pilot study explored how nonword imitation influences articulatory and segmental performance in children with and without speech disorder. Eight children, ages 4- to 8-years-old, participated, including two children with childhood apraxia of speech (CAS), four children with phonological disorder (PD), and two children with typical development (TD). Tokens included two complexity types and were presented in random order. Minimal feedback was provided and nonwords were never associated with a referent. Kinematic and transcription data were analysed to examine articulatory variability, segmental accuracy, and segmental variability in session 1 and session 5. Descriptive statistics, percent change, effect sizes, and Pearson correlations are reported. In session 1, the two participants with CAS showed high articulatory variability, low segmental accuracy, and high segmental variability compared to the participants with PD and TD. By session 5, both participants with CAS, two with PD, and one with TD showed increased articulatory variability in the lowest complexity nonword. Segmental accuracy remained low and variability remained high for the two participants with CAS in session 5, whereas several participants with PD and TD showed improved segmental performance. Articulatory and segmental variability were not significantly correlated. The results of this study suggest that motor practice with minimal feedback and no assignment of a lexical referent can instantiate positive changes to segmental performance for children without apraxia. Positive changes to segmental performance are not necessarily related to increased articulatory control; these two processing levels can show distinct and disparate learning trajectories.
Collapse
Affiliation(s)
- Janet Vuolo
- Speech and Hearing Science, The Ohio State University, Columbus, USA
| |
Collapse
|
12
|
Lauretta ML, Jarmolowicz A, Amor DJ, Best S, Morgan AT. An Investigation of Barriers and Enablers for Genetics in Speech-Language Pathology Explored Through a Case Study of Childhood Apraxia of Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-15. [PMID: 37713535 DOI: 10.1044/2023_jslhr-22-00714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
PURPOSE Advancements in genetic testing and analysis have allowed improved identification of the genetic basis of childhood apraxia of speech, a rare speech presentation. This study aimed to understand speech-language pathologists' (SLPs') consideration of incorporation of genetics in clinical practice using a theory-informed qualitative approach. METHOD Semistructured interviews were conducted with 12 pediatric SLPs using a behavior change theory (Theoretical Domains Framework [TDF]) within a case study describing a child with complex co-occurring features, including childhood apraxia of speech. Interviews focused on three stages of the patient journey (prereferral, referral, and postreferral). Interviews were analyzed to identify barriers and enablers to considering incorporation of genetics in current clinical practice. Barriers and enablers were grouped and mapped onto a contextually relevant TDF-coded analysis framework. RESULTS Barriers were identified across several TDF domains, through all stages of the patient journey. Lack of confidence, relevance, and level of experience were most common prereferral, and connection to and awareness of genetics services and contextual factors were barriers in the referral stage. Perception of professional role, knowledge, and beliefs about effects on families were barriers postreferral. Associated enablers were also identified, including seeing value in genetic diagnosis, support from other health care professionals, supervision, and relationships with genetics services. CONCLUSIONS Results of this qualitative study highlight barriers and enablers to incorporating genetics into speech-language pathology clinical practice. These findings will assist in the development of theory-informed implementation strategies to support SLPs into the future. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24112800.
Collapse
Affiliation(s)
| | - Anna Jarmolowicz
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - David J Amor
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
- Royal Children's Hospital, Parkville, Victoria, Australia
| | - Stephanie Best
- Australian Genomics, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Angela T Morgan
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
- Royal Children's Hospital, Parkville, Victoria, Australia
- The University of Queensland, St. Lucia, Australia
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Murray E, Velleman S, Preston JL, Heard R, Shibu A, McCabe P. The Reliability of Expert Diagnosis of Childhood Apraxia of Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-18. [PMID: 37642523 DOI: 10.1044/2023_jslhr-22-00677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE The current standard for clinical diagnosis of childhood apraxia of speech (CAS) is expert clinician judgment. The psychometric properties of this standard are not well understood; however, they are important for improving clinical diagnosis. The purpose of this study is to determine the extent to which experts agree on the clinical diagnosis of CAS using two cohorts of children with mixed speech sound disorders (SSDs). METHOD Speech samples of children with SSDs were obtained from previous and ongoing research from video recordings of children aged 3-8 years (n = 36) and audio recordings of children aged 8-17 years (n = 56). A total of 23 expert, English-speaking clinicians were recruited internationally. Three of these experts rated each speech sample to provide a description of the observed features and a diagnosis. Intrarater reliability was acceptable at 85% agreement. RESULTS Interrater reliability on the presence or absence of CAS among experts was poor both as a categorical diagnosis (κ = .187, 95% confidence interval [CI] [0.089, 0.286]) and on a continuous "likelihood of CAS" scale (0-100; intraclass correlation = .183, 95% CI [.037, .347]). Reliability was similar across the video-recorded and audio-only samples. There was greater agreement on other diagnoses (such as articulation disorder) than on the diagnosis of CAS, although these too did not meet the predetermined standard. Likelihood of CAS was greater in children who presented with more American Speech-Language-Hearing Association CAS consensus features. CONCLUSIONS Different expert raters had different thresholds for applying the diagnosis of CAS. If expert clinician judgment is to be used for diagnosis of CAS or other SSDs, further standardization and calibration is needed to increase interrater reliability. Diagnosis may require operationalized checklists or reliable measures that operate along a diagnostic continuum. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23949105.
Collapse
Affiliation(s)
- Elizabeth Murray
- The University of Sydney, New South Wales, Australia
- Remarkable Speech + Movement, Sydney, New South Wales, Australia
| | | | | | - Robert Heard
- The University of Sydney, New South Wales, Australia
| | - Akhila Shibu
- The University of Sydney, New South Wales, Australia
| | | |
Collapse
|
15
|
Case J, Wang EW, Grigos MI. The Multilevel Word Accuracy Composite Scale: A Novel Measure of Speech Production in Childhood Apraxia of Speech. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1866-1883. [PMID: 37195724 PMCID: PMC10561970 DOI: 10.1044/2023_ajslp-22-00166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/23/2022] [Accepted: 03/02/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE The Multilevel word Accuracy Composite Scale (MACS) is a novel whole-word measure of speech production accuracy designed to evaluate behaviors commonly targeted in motor-based intervention for childhood apraxia of speech (CAS). The MACS yields a composite score generated through ratings of segmental accuracy, word structure maintenance, prosody, and movement transition. This study examined the validity of the MACS through comparison to established measures of speech accuracy. Reliability was also examined within and between practicing speech-language pathologists (SLPs). METHOD The MACS was used to rate 117 tokens produced by children with severe CAS. Ratings were performed in the laboratory setting by two expert raters and by practicing SLPs (N = 19). Concurrent validity was estimated through comparison of expert MACS ratings (i.e., MACS score and each component rating) to measures of speech accuracy (percent phoneme correct and the 3-point scale) using correlational analyses. Reliability was examined between expert raters and across SLP raters using the intraclass correlation coefficient to examine interrater reliability of expert ratings, in addition to inter- and intrarater reliability of SLP ratings. RESULTS Correlation analyses between MACS ratings (i.e., MACS score and component ratings) and existing measures of speech accuracy revealed small to large positive correlations between measures. Reliability analyses revealed moderate to excellent reliability for MACS ratings performed by expert raters and between (interrater) and within (intrarater) SLP raters. CONCLUSIONS Analyses of concurrent validity indicate that the MACS aligns with established measures, yet contributes novel elements for rating speech accuracy. Results further support the MACS as a reliable measure for rating speech accuracy in children with severe speech impairment for ratings performed by expert raters and practicing clinicians.
Collapse
Affiliation(s)
- Julie Case
- Department of Speech-Language-Hearing Sciences, Hofstra University, Hempstead, NY
| | - Emily W. Wang
- Department of Communicative Sciences and Disorders, New York University, New York
| | - Maria I. Grigos
- Department of Communicative Sciences and Disorders, New York University, New York
| |
Collapse
|
16
|
Thomas D, Murray E, Williamson E, McCabe P. Weekly Treatment for Childhood Apraxia of Speech With Rapid Syllable Transition Treatment: A Single-Case Experimental Design Study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-22. [PMID: 37536463 DOI: 10.1044/2023_jslhr-22-00665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
PURPOSE The aim of this study was to pilot the efficacy of rapid syllable transition (ReST) treatment when provided once per week for a 50-min treatment session for 12 weeks with five children with childhood apraxia of speech. Of central importance was the children's retention and generalization of gains from treatment as indicators of speech motor learning. METHOD A multiple-baseline across-participant design was employed to investigate (a) treatment effect on the 20 treated pseudowords, (b) generalization to 40 untreated real words and 10 untreated polysyllabic word sentences, and (c) maintenance of any treatment and generalization goals to up to 4 months posttreatment. To investigate any difference between in-session performance and retention, a comparison was made between data collected during treatment and probe sessions. RESULTS Treatment data collected during therapy showed all children improving across their 12 treatment sessions. Three of the five children showed a treatment effect on treated pseudowords in the probe sessions, but only one child showed generalization to untreated real words, and no children showed generalization to sentences. CONCLUSIONS ReST treatment delivered at a dose frequency of once per week was efficacious for only one of the five children. In-session treatment data were not a reliable indicator of children's learning. One session per week of ReST therapy is therefore not recommended. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23751018.
Collapse
Affiliation(s)
- Donna Thomas
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Elizabeth Murray
- Faculty of Medicine and Health, The University of Sydney, Australia
- Remarkable Speech and Movement, Sydney, Australia
| | - Eliza Williamson
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Patricia McCabe
- Faculty of Medicine and Health, The University of Sydney, Australia
| |
Collapse
|
17
|
Grigos MI, Case J, Lu Y, Lyu Z. Dynamic Temporal and Tactile Cueing: Quantifying Speech Motor Changes and Individual Factors That Contribute to Treatment Gains in Childhood Apraxia of Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-18. [PMID: 37379241 DOI: 10.1044/2023_jslhr-22-00658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
PURPOSE Speech motor skill is refined over the course of practice, which is commonly reflected by increased accuracy and consistency. This research examined the relationship between auditory-perceptual ratings of word accuracy and measures of speech motor timing and variability at pre- and posttreatment in children with childhood apraxia of speech (CAS). Furthermore, the degree to which individual patterns of baseline probe word accuracy, receptive language, and cognition predicted response to treatment was explored. METHOD Probe data were collected from seven children with CAS (aged 2;5-5;0 [years;months]) who received 6 weeks of Dynamic Temporal and Tactile Cueing (DTTC) treatment. Using a multidimensional approach to measuring speech performance, auditory-perceptual (whole-word accuracy), acoustic (whole-word duration), and kinematic (jaw movement variability) analyses were conducted on probe words produced pre- and posttreatment. Standardized tests of receptive language and cognition were administered pretreatment. RESULTS There was a negative relationship between auditory-perceptual measures of word accuracy and movement variability. Higher word accuracy was associated with lower jaw movement variability following intervention. There was a strong relationship between word accuracy and word duration at baseline, which became less robust posttreatment. Furthermore, baseline word accuracy was the only child-specific factor to predict response to DTTC treatment. CONCLUSIONS Following a period of motor-based intervention, children with CAS appeared to refine speech motor control in conjunction with improvements in word accuracy. Those who demonstrated the poorest performance at treatment onset displayed the greatest degree of gains. Taken together, these results reflect a system-wide change following motor-based intervention.
Collapse
Affiliation(s)
- Maria I Grigos
- Department of Communicative Sciences and Disorders, New York University, NY
| | - Julie Case
- Department of Speech-Language-Hearing Sciences, Hofstra University, Hempstead, NY
| | - Ying Lu
- Department of Applied Statistics, Social Science, and Humanities, New York University, NY
| | - Zhuojun Lyu
- Department of Applied Statistics, Social Science, and Humanities, New York University, NY
| |
Collapse
|
18
|
Iuzzini-Seigel J, Case J, Grigos MI, Velleman SL, Thomas D, Murray E. Dose frequency randomized controlled trial for Dynamic Temporal and Tactile Cueing (DTTC) treatment for childhood apraxia of speech: protocol paper. BMC Pediatr 2023; 23:263. [PMID: 37226208 DOI: 10.1186/s12887-023-04066-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/10/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Childhood apraxia of speech (CAS) is a pediatric motor-based speech sound disorder that requires a specialized approach to intervention. The extant literature on the treatment of CAS commonly recommends intensive treatment using a motor-based approach, with some of the best evidence supporting the use of Dynamic Temporal and Tactile Cueing (DTTC). To date, a rigorous and systematic comparison of high and low dose frequency (i.e., frequency of therapy sessions) has not been undertaken for DTTC, resulting in a lack of evidence to guide decisions about the optimal treatment schedule for this intervention. The current study aims to fill this gap in knowledge by comparing treatment outcomes when dose frequency is varied. METHODS A randomized controlled trial will be conducted to examine the efficacy of low versus high dose frequency on DTTC treatment outcomes in children with CAS. A target of 60 children, 2;6-7;11 years of age, will be recruited to participate in this study. Treatment will be provided in the community setting by speech-language pathologists who have completed specialized training administering DTTC in a research reliable manner. True randomization with concealed allocation will be used to assign children to either the low or high dose frequency group. Treatment will be administered in 1-h sessions either 4 times per week over a 6-week period (high dose) or 2 times per week over a 12-week period (low dose). To measure treatment gains, probe data will be collected before treatment, during treatment, and 1 day, 1 week, 4 weeks, and 12 weeks post-treatment. Probe data will consist of customized treated words and a standard set of untreated words to assess generalization of treatment gains. The primary outcome variable will be whole word accuracy, encompassing segmental, phonotactic, and suprasegmental accuracy. DISCUSSION This will be the first randomized controlled trial to evaluate dose frequency for DTTC treatment in children with CAS. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT05675306, January 6, 2023.
Collapse
Affiliation(s)
- Jenya Iuzzini-Seigel
- Department of Speech Pathology and Audiology, Marquette University, PO Box 1881, Harriet Barker Cramer Hall, Milwaukee, WI, 53201, USA.
| | - Julie Case
- Speech-Language-Hearing Sciences, Hofstra University, Davison Hall 106B, 110, Hempstead, NY, 11549, USA
| | - Maria I Grigos
- Communicative Sciences and Disorders, New York University, 665 Broadway, 9th floor, New York, NY, 10012, USA
| | - Shelley L Velleman
- University of Vermont, Pomeroy Hall, 489 Main St, Burlington, VT, 05405, USA
| | - Donna Thomas
- University of Sydney, Susan Wakil Health Building, Western Avenue, Camperdown, NSW, 2006, Australia
| | - Elizabeth Murray
- University of Sydney, Susan Wakil Health Building, Western Avenue, Camperdown, NSW, 2006, Australia
- Remarkable Speech and Movement, 52 Anderson Avenue, Panania, NSW, 2213, Australia
| |
Collapse
|
19
|
Gao R, Yuen JTW, Li XX, To CKS. Oral Diadochokinetic Performance on Perceptual and Acoustic Measures for Typically Developing Cantonese-Speaking Preschool Children. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:1445-1466. [PMID: 37040691 DOI: 10.1044/2023_jslhr-22-00426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE This study investigated native Cantonese-speaking preschool children's diadochokinetic performance, including rate, accuracy, and regularity. The second aim of this study was to examine whether language-specific patterns exist by comparing diadochokinetic rates with the average DKK rate for native English speakers. METHOD Sixty-four typically developing preschool children who were native Cantonese speakers participated. The diadochokinetic task administered to the children involved repetitions of monosyllabic, disyllabic, and trisyllabic words and nonsense words. The maximum performance of the children was compared by diadochokinetic rate (number of syllables per second), accuracy (percentage of matched production), and regularity (pairwise variability indexes, known as PVIs). RESULTS Monosyllabic units were produced faster, more accurately, and more regularly than multisyllabic units. Word repetition showed higher accuracy and generally lower regularity than nonsense words but similar rates. Older children were faster and more regular (higher raw PVI of initial consonants) than younger children, but younger children performed as accurately as them. When compared with data from English speakers, the diadochokinetic rates of Cantonese children were generally lower. CONCLUSIONS Developmental progression was evident in terms of rate and regularity. The distinctive accuracy and regularity patterns between word and nonsense word repetition suggest a clinical value for both stimulus types. Language typology plays a role in diadochokinetic rate, supporting the use of language-specific reference data in practice. The typical diadochokinetic profile obtained in this study could serve as a clinical reference for speech motor assessments.
Collapse
Affiliation(s)
- Ran Gao
- Faculty of Education, The University of Hong Kong
| | | | - Xin Xin Li
- Faculty of Arts, Hong Kong Baptist University
| | - Carol K S To
- Faculty of Education, The University of Hong Kong
| |
Collapse
|
20
|
Cassar C, McCabe P, Cumming S. "I still have issues with pronunciation of words": A mixed methods investigation of the psychosocial and speech effects of Childhood Apraxia of Speech in adults. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:193-205. [PMID: 35034534 DOI: 10.1080/17549507.2021.2018496] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE Adolescents with Childhood Apraxia of Speech (CAS) are likely to have persistent speech errors compared to non-CAS peers (Lewis et al., 2018) and may have ongoing psychosocial issues (e.g. Carrigg, Parry, Baker, Shriberg, & Ballard, 2016). Beyond this, little is known about the long-term consequences of CAS in adulthood. This study explored whether adults who were reported to have had CAS as children have ongoing psychosocial or speech impacts. METHOD A cross-sectional descriptive design, with mixed-method analyses of demographic, psychosocial, and speech data was used. Data were collected via a four-part online survey. Part one consisted of questions about demographic information and participants' self-reported performance in speech, language and literacy. Parts two and three investigated the psychosocial impacts of CAS using the Brief Fear of Negative Evaluation Scale - Revised (BFNE- R) and The State-Trait Anxiety Inventory (STAI). Part four collected single word and connected speech data via an online audio recording, which was then transcribed following the Connected Speech Transcription Protocol (CoST-P). Analyses of speech characteristics reported in CAS was completed using Phon software. RESULT There were 17 participants in part one, 16 in parts two and three, and six in part four. Participants reported elevated levels of state (p = 0.01) and trait (p = 0.0001) anxiety compared to normative data. Ongoing segmental and suprasegmental speech errors were observed, with a significant difference between percent phonemes correct in single words versus connected speech (p = 0.03). Participants who provided a speech sample had difficulty with correct stress, use of juncture, and had increased intra- and inter-word segregation. Participants with better speech reported less anxiety. CONCLUSION Psychosocial effects and speech characteristics associated with CAS in childhood appear to persist into adulthood. Confirmation of these results and research to determine treatment and psychosocial support needs past early childhood is warranted.
Collapse
Affiliation(s)
- Courtney Cassar
- The University of Sydney, Camperdown, Australia
- Liverpool Hospital, South West Sydney Local Health District, Liverpool, Australia
| | - Patricia McCabe
- The University of Sydney, Camperdown, Australia
- Liverpool Hospital, South West Sydney Local Health District, Liverpool, Australia
| | | |
Collapse
|
21
|
McCabe P, Preston JL, Evans P, Heard R. A Pilot Randomized Control Trial of Motor-Based Treatments for Childhood Apraxia of Speech: Rapid Syllable Transition Treatment and Ultrasound Biofeedback. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:629-644. [PMID: 36848673 PMCID: PMC10171856 DOI: 10.1044/2022_ajslp-22-00144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/08/2022] [Accepted: 11/29/2022] [Indexed: 05/12/2023]
Abstract
PURPOSE Both Rapid Syllable Transition Treatment (ReST) and ultrasound biofeedback are effective approaches to treating childhood apraxia of speech (CAS). The purpose of the study was to compare outcomes from these two motor-based treatment approaches for school-age children with CAS. METHOD In a single site, single blind randomized control trial, 14 children with CAS ages 6-13 years were randomly assigned to 12 sessions over 6 weeks of either of ultrasound biofeedback treatment (with a speech motor chaining practice structure) or ReST. Treatment was delivered at The University of Sydney by students trained and supervised by certified speech-language pathologists. Transcriptions from blinded assessors were used to compare the two groups on speech sound accuracy (percent phonemes correct) and prosodic severity (lexical stress errors and syllable segregation) in untreated words and sentences at three time points: pretreatment, immediately posttreatment, and 1-month posttreatment (i.e., retention). RESULTS Both groups showed significant improvement on treated items indicating a treatment effect. At no time was there a difference between groups. Both groups showed a significant improvement in speech sound accuracy on untreated words and sentences from pre to post and neither group showed an improvement in prosody pre-post. Changes to speech sound accuracy were retained by both groups at 1-month follow-up. Significant improvement in prosodic accuracy was reported at the 1-month follow-up. CONCLUSIONS ReST and ultrasound biofeedback were equally effective. Either ReST or ultrasound biofeedback may be viable treatment options for school-age children with CAS. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22114661.
Collapse
Affiliation(s)
| | | | - Pippa Evans
- The University of Sydney, New South Wales, Australia
- The University of Queensland, Brisbane, Australia
| | - Rob Heard
- The University of Sydney, New South Wales, Australia
| |
Collapse
|
22
|
Anastasopoulou I, van Lieshout P, Cheyne DO, Johnson BW. Speech Kinematics and Coordination Measured With an MEG-Compatible Speech Tracking System. Front Neurol 2022; 13:828237. [PMID: 35837226 PMCID: PMC9273948 DOI: 10.3389/fneur.2022.828237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Articulography and functional neuroimaging are two major tools for studying the neurobiology of speech production. Until recently, however, it has generally not been possible to use both in the same experimental setup because of technical incompatibilities between the two methodologies. Here we describe results from a novel articulography system dubbed Magneto-articulography for the Assessment of Speech Kinematics (MASK), which we used to derive kinematic profiles of oro-facial movements during speech. MASK was used to characterize speech kinematics in two healthy adults, and the results were compared to measurements from a separate participant with a conventional Electromagnetic Articulography (EMA) system. Analyses targeted the gestural landmarks of reiterated utterances /ipa/, /api/ and /pataka/. The results demonstrate that MASK reliably characterizes key kinematic and movement coordination parameters of speech motor control. Since these parameters are intrinsically registered in time with concurrent magnetoencephalographic (MEG) measurements of neuromotor brain activity, this methodology paves the way for innovative cross-disciplinary studies of the neuromotor control of human speech production, speech development, and speech motor disorders.
Collapse
Affiliation(s)
- Ioanna Anastasopoulou
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
- *Correspondence: Ioanna Anastasopoulou
| | - Pascal van Lieshout
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
| | - Douglas O. Cheyne
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Blake W. Johnson
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
- Blake W. Johnson
| |
Collapse
|
23
|
Ng WL, McCabe P, Heard R, Park V, Murray E, Thomas D. Predicting Treatment Outcomes in Rapid Syllable Transition Treatment: An Individual Participant Data Meta-Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1784-1799. [PMID: 35486543 DOI: 10.1044/2022_jslhr-21-00617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The purpose of this study is to identify predictors of treatment outcomes in Rapid Syllable Transition Treatment (ReST) for childhood apraxia of speech through an individual participant data meta-analysis. METHOD A systematic literature search identified nine ReST studies for inclusion. Individual participant data were obtained, and studies were coded for methodological design, baseline participant characteristics, service delivery factors, and treatment outcomes. Bivariate analyses were conducted to identify potential predictor variables. Multiple linear regressions were then performed to identify predictors of treatment outcomes. RESULTS Data for 36 participants from seven studies were included in the statistical analyses. In multivariate modeling, better performance on treated pseudowords posttreatment was predicted by higher baseline expressive language and Goldman-Fristoe Test of Articulation scores, lower speech inconsistency and percentage of vowels correct, and higher pretreatment accuracy on pseudoword targets. Better performance on untreated real words posttreatment was predicted by higher pretreatment accuracy on real words. Gains in performance and retention of gains were not significantly predicted by any individual variable or combination of variables. CONCLUSIONS Baseline speech and expressive language skills and accuracy on pseudowords and real words were significant predictors of absolute posttreatment performance. Regardless of baseline characteristics, all children were statistically as likely to achieve gains during ReST and retain these gains for up to 4 weeks posttreatment. Large-scale prospective research is required to further examine the effects of dose frequency and co-occurring language impairments on treatment outcomes and the complex co-effects of percentage of vowels correct with other potential predictors. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19611714.
Collapse
Affiliation(s)
- Wei Lin Ng
- The University of Sydney, New South Wales, Australia
| | | | - Rob Heard
- The University of Sydney, New South Wales, Australia
| | - Veronica Park
- The University of Sydney, New South Wales, Australia
| | | | - Donna Thomas
- The University of Sydney, New South Wales, Australia
| |
Collapse
|
24
|
Gomez M, McCabe P, Purcell A. A survey of the clinical management of childhood apraxia of speech in the United States and Canada. JOURNAL OF COMMUNICATION DISORDERS 2022; 96:106193. [PMID: 35151225 DOI: 10.1016/j.jcomdis.2022.106193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 01/19/2022] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Limited information is available about the current practices of generalist speech-language pathologists (SLPs) in relation to their management of childhood apraxia of speech (CAS). This study was designed to investigate four primary questions separately for the US and Canada; 1. What treatment approaches are used by SLP clinicians to treat CAS? 2. What treatment format and intensity are used to deliver CAS treatment? 3. What are the attitudes and perspectives of SLPs to evidence-based practice (EBP) as it pertains to CAS treatment? and 4. What are the perceived barriers to the implementation of EBP in CAS treatment? METHOD An online questionnaire was used to investigate the four primary research questions. The questionnaire was distributed online through social media, some state-based associations and through forums affiliated with national speech-language-hearing associations. RESULTS Most survey respondents reported frequently using an eclectic approach to treat CAS (US 85%; Canada 89%). Although no intervention emerged as the most preferred primary treatment for CAS, US-based clinicians more commonly reported using the Kaufman Speech to Language Protocol (K-SLP) (33%) and Dynamic, Temporal and Tactile Cueing (DTTC) (28%); while clinicians in Canada used PROMPT ® (31%). SLPs demonstrated a positive attitude towards EBP however, they identified a range of perceived barriers that impacted their implementation of EBP. CONCLUSION SLPs in the US and Canada frequently used an eclectic approach to treat CAS which is consistent with previous findings both in the CAS literature and the wider speech disorders literature. The more commonly used primary interventions were the K-SLP and DTTC (US); and PROMPT ® (Canada), with one of the strongest factors that influenced clinicians' choice of intervention being familiarity with the treatment approach. Face to face therapy was preferred by clinicians across both countries, with clinicians in the US providing therapy between 2-5 times per week, while those in Canada delivered therapy up to once per week. Clinicians identified a number of barriers to implementing evidence-based practice, among which, being time poor was most commonly selected across clinicians in both the US and Canada.
Collapse
Affiliation(s)
- Maryane Gomez
- Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Patricia McCabe
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Alison Purcell
- Faculty of Medicine and Health, The University of Sydney, Australia
| |
Collapse
|
25
|
Braden RO, Amor DJ, Fisher SE, Mei C, Myers CT, Mefford H, Gill D, Srivastava S, Swanson LC, Goel H, Scheffer IE, Morgan AT. Severe speech impairment is a distinguishing feature of FOXP1-related disorder. Dev Med Child Neurol 2021; 63:1417-1426. [PMID: 34109629 DOI: 10.1111/dmcn.14955] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 12/21/2022]
Abstract
AIM To delineate the speech and language phenotype of a cohort of individuals with FOXP1-related disorder. METHOD We administered a standardized test battery to examine speech and oral motor function, receptive and expressive language, non-verbal cognition, and adaptive behaviour. Clinical history and cognitive assessments were analysed together with speech and language findings. RESULTS Twenty-nine patients (17 females, 12 males; mean age 9y 6mo; median age 8y [range 2y 7mo-33y]; SD 6y 5mo) with pathogenic FOXP1 variants (14 truncating, three missense, three splice site, one in-frame deletion, eight cytogenic deletions; 28 out of 29 were de novo variants) were studied. All had atypical speech, with 21 being verbal and eight minimally verbal. All verbal patients had dysarthric and apraxic features, with phonological deficits in most (14 out of 16). Language scores were low overall. In the 21 individuals who carried truncating or splice site variants and small deletions, expressive abilities were relatively preserved compared with comprehension. INTERPRETATION FOXP1-related disorder is characterized by a complex speech and language phenotype with prominent dysarthria, broader motor planning and programming deficits, and linguistic-based phonological errors. Diagnosis of the speech phenotype associated with FOXP1-related dysfunction will inform early targeted therapy. What this paper adds Individuals with FOXP1-related disorder have a complex speech and language phenotype. Dysarthria, which impairs intelligibility, is the dominant feature of the speech profile. No participants were receiving speech therapy for dysarthria, but were good candidates for therapy Features of speech apraxia occur alongside persistent phonological errors. Language abilities are low overall; however, expressive language is a relative strength.
Collapse
Affiliation(s)
- Ruth O Braden
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Audiology and Speech Pathology and Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - David J Amor
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Audiology and Speech Pathology and Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.,The Royal Children's Hospital, Parkville, VIC, Australia.,Victorian Clinical Genetics Service, Parkville, VIC, Australia
| | - Simon E Fisher
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, the Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Cristina Mei
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Orygen and Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Candace T Myers
- Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, WA, USA
| | - Heather Mefford
- Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, WA, USA
| | - Deepak Gill
- TY Nelson Department of Neurology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | | | - Lindsay C Swanson
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Himanshu Goel
- Hunter Genetics, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Ingrid E Scheffer
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Audiology and Speech Pathology and Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.,The Royal Children's Hospital, Parkville, VIC, Australia.,Austin Health, Heidelberg, Melbourne, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Angela T Morgan
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Audiology and Speech Pathology and Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.,The Royal Children's Hospital, Parkville, VIC, Australia.,Victorian Clinical Genetics Service, Parkville, VIC, Australia
| |
Collapse
|
26
|
Miller HE, Ballard KJ, Campbell J, Smith M, Plante AS, Aytur SA, Robin DA. Improvements in Speech of Children with Apraxia: The Efficacy of Treatment for Establishing Motor Program Organization (TEMPO SM). Dev Neurorehabil 2021; 24:494-509. [PMID: 34241564 DOI: 10.1080/17518423.2021.1916113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: This study investigated the efficacy of Treatment for Establishing Motor Program Organization (TEMPOSM) in childhood apraxia of speech (CAS).Method: A mixed between- and within-participant design with multiple baselines across participants and behaviors was used to examine acquisition, generalization, and maintenance of skills. TEMPOSM was administered in four one-hour sessions a week over a four-week period for eleven participants (ages 5 to 8), allocated to either an immediate treatment group or a wait-list control group. Acoustic and perceptual variables were measured at baseline, immediate post-treatment, and one-month post-treatment.Results: Children demonstrated significant improvements in specific acoustic measures of segmentation and lexical stress, as well as perceptual measures of fluency, lexical stress, and speech-sound accuracy. Treatment and generalization effects were maintained one-month post-treatment with generalization to untreated stimuli.Conclusion: TEMPOSM was efficacious in improving segmental and suprasegmental impairments in the speech of children with CAS.
Collapse
|
27
|
Landin-Romero R, Liang CT, Monroe PA, Higashiyama Y, Leyton CE, Hodges JR, Piguet O, Ballard KJ. Brain changes underlying progression of speech motor programming impairment. Brain Commun 2021; 3:fcab205. [PMID: 34541532 PMCID: PMC8445394 DOI: 10.1093/braincomms/fcab205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 06/01/2021] [Accepted: 07/23/2021] [Indexed: 11/13/2022] Open
Abstract
Aquired apraxia of speech is a disorder that impairs speech production, despite intact peripheral neuromotor function. Its pathomechanism remains to be established. Neurodegenerative lesion models provide an unequalled opportunity to explore the neural correlates of apraxia of speech, which is present in a subset of patients diagnosed with non-semantic variants of primary progressive aphasia. The normalized pairwise variability index, an acoustic measure of speech motor programming, has shown high sensitivity and specificity for apraxia of speech in cross-sectional studies. Here, we aimed to examine the strength of the pairwise variability index and overall word duration (i.e. articulation rate) as markers of progressive motor programming deficits in primary progressive aphasia with apraxia of speech. Seventy-nine individuals diagnosed with primary progressive aphasia (39 with non-fluent variant and 40 with logopenic variant) and 40 matched healthy controls participated. Patients were followed-up annually (range 1-6 years, median number of visits = 2). All participants completed a speech assessment task and a high-resolution MRI. Our analyses investigated trajectories of speech production (e.g. pairwise variablity index and word duration) and associations with cortical atrophy in the patients. At first presentation, word duration differentiated the nonfluent and logopenic cases statistically, but the range of scores overlapped substantially across groups. Longitudinally, we observed progressive deterioration in pairwise variability index and word duration specific to the non-fluent group only. The pairwise variability index showed particularly strong associations with progressive atrophy in speech motor programming brain regions. Of novelty, our results uncovered a key role of the right frontal gyrus in underpinning speech motor programming changes in non-fluent cases, highlighting the importance of right-brain regions in responding to progressive neurological changes in the speech motor network. Taken together, our findings validate the use of a new metric, the pairwise variability index, as a robust marker of apraxia of speech in contrast to more generic measures of speaking rate. Sensitive/specific neuroimaging biomarkers of the emergence and progression of speech impairments will be useful to inform theories of the pathomechanisms underpinning impaired speech motor control. Our findings justify developing more sensitive measures of rhythmic temporal control of speech that may enable confident detection of emerging speech disturbances and more sensitive tracking of intervention-related changes for pharmacological, neuromodulatory and behavioural interventions. A more reliable detection of speech disturbances has relevance for patient care, with predominance of progressive apraxia of speech a high-risk factor for later diagnosis of progressive supranuclear palsy or corticobasal degeneration.
Collapse
Affiliation(s)
- Ramon Landin-Romero
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Cheng T Liang
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Penelope A Monroe
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Yuichi Higashiyama
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Cristian E Leyton
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - John R Hodges
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Olivier Piguet
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Kirrie J Ballard
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
28
|
Morgan L, Overton S, Bates S, Titterington J, Wren Y. Making the case for the collection of a minimal dataset for children with speech sound disorder. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:1097-1107. [PMID: 34309981 DOI: 10.1111/1460-6984.12649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 05/11/2021] [Accepted: 06/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND NHS case note data are a potential source of practice-based evidence which could be used to investigate the effectiveness of different interventions for individuals with a range of speech, language and communication needs. Consistency in pre- and post-intervention data as well as the collection of relevant variables would need to be demonstrated as a precursor to adopting this approach in future investigations of speech and language therapy intervention. AIMS To explore whether routine clinical data collection for children with speech sound disorder (SSD) could be a potential source for examining the effectiveness of intervention(s). METHODS & PROCEDURES We examined case notes from three UK NHS services, reviewing 174 sets of case notes and 234 blocks of therapy provided for school-age children with SSD. MAIN CONTRIBUTION We found there was significant variation in pre- and post-intervention data and variables collected by the services. The assessment data available in the case notes across all sites were insufficient to be used to compare the effectiveness of different interventions. Specific issues included lack of consistent reporting of pre- and post-intervention data, and use of a variety of both formal and informal assessment tools. CONCLUSIONS & IMPLICATIONS The case notes reviewed were from three sites and may not represent wider clinical practice, nevertheless the findings suggest the sample explored indicates the need for more consistent and contemporaneous collection of data for children with SSD to facilitate the investigation of different interventions in practice. Researchers should work with the clinical community to determine a minimal dataset that includes a core outcome set and potential variables. This should be feasible to collect in clinical practice and provide a dataset for future investigations of clinically relevant research questions. This would provide an invaluable resource to the clinical academic and research communities enabling research questions to be addressed that have the potential to lead to improved outcomes and more cost-effective services. WHAT THIS PAPER ADDS What is already known on the subject While there is some evidence for the efficacy of therapy for children with SSD, studies typically focus on very specific populations who meet strict selection criteria and take place in university clinics or laboratory-style settings which do not reflect typical clinical practice in the UK and elsewhere. An alternative approach to investigating the effectiveness of interventions would be to use NHS case note data. It is not clear from the existing literature whether case note data are sufficiently robust to facilitate such an analysis. What this paper adds to existing knowledge This study found that case note data, in particular assessment data, were highly variable across services and would be insufficient to compare different interventions for this population. Agreement on what should be included in a minimal dataset for children with SSD is required to maximize the potential for NHS clinical case notes to become a resource for future research. What are the actual or potential clinical implications of this work? This study indicates that current clinical practice in SLT for children with SSD is inconsistent with regards to the reporting of pre- and post-intervention assessment data and other important variables in case notes. We make the case for agreeing a minimal dataset with a need for clinicians to work with researchers to determine core outcomes and additional relevant data, which can be feasibly collected in clinical practice.
Collapse
Affiliation(s)
- Lydia Morgan
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - Sarah Overton
- Oxford University Hospitals, Spires Cleft Centre Offices, Children's Hospital, John Radcliffe Hospital, Oxford, UK
| | - Sally Bates
- University of St Mark and ST John, Speech and Language Therapy, School of Sport, Health and Wellbeing, Plymouth, UK
| | - Jill Titterington
- University of Ulster, Speech and Language Therapy, School of Health Sciences, Jordanstown, Newtownabbey, UK
| | - Yvonne Wren
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| |
Collapse
|
29
|
Bahar N, Namasivayam AK, van Lieshout P. Telehealth intervention and childhood apraxia of speech: a scoping review. SPEECH, LANGUAGE AND HEARING 2021. [DOI: 10.1080/2050571x.2021.1947649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nilgoun Bahar
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
| | - Aravind K. Namasivayam
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
- Speech Research Centre, Toronto, Canada
| | - Pascal van Lieshout
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute, Toronto, Canada
| |
Collapse
|
30
|
Micheletti S, Galli J, Scaglioni V, Renzetti S, Scarano E, Foresti V, Fazzi E. Promoting Language Skills in Children With Neuromotor and Intellectual Disorders: Telepractice at the Time of SARS-CoV-2. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1866-1879. [PMID: 34232698 DOI: 10.1044/2021_ajslp-20-00222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose The aim of this pilot study is to gather preliminary results on the effectiveness of intensive, parent-oriented, telepractice-based intervention to improve language skills in preschool children with neuromotor and intellectual disorders. Method Nine preschool children (M = 63 months, SD = 8.7 months) underwent a telepractice program 4 times a week designed to promote speech, lexical, and syntactic skills. Families were remotely connected from home with the therapists, who controlled the rehabilitation procedures from the hospital. The number of stable phonemes, of understood and repeated words, and of understood and repeated sentences were evaluated as outcome measures 3 months (prebaseline) and 1 week (baseline) before the intervention, immediately after the intervention (T1) and at a 3-month follow-up (T2). Results An increase in the number of stable phonemes was detected after the treatment, even if it was not statistically significant. After the intervention program, there was a significant increase in the number of understood words (ratio T1 vs. baseline: 1.33; 95% CI [1.03, 1.71]) and repeated words (ratio T1 vs. baseline: 1.39; 95% CI [1.00, 1.92]), as well as of understood sentences (ratio T1 vs. baseline: 1.80; 95% CI [1.24, 2.35]) and repeated sentences (ratio T1 vs. baseline: 4.23; 95% CI [1.96, 9.12]). No significant differences were found when comparing all the outcome measures at prebaseline and at baseline. Conclusion An intensive, parent-oriented, telepractice-based intervention has the potential to increase scores of lexical and syntactic tasks in children with neuromotor and intellectual disorders.
Collapse
Affiliation(s)
- Serena Micheletti
- Child Neurology and Psychiatry Unit, ASST Spedali Civili of Brescia, Italy
| | - Jessica Galli
- Child Neurology and Psychiatry Unit, ASST Spedali Civili of Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Vera Scaglioni
- Child Neurology and Psychiatry Unit, ASST Spedali Civili of Brescia, Italy
| | - Stefano Renzetti
- Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Italy
| | - Elisa Scarano
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Valentina Foresti
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Elisa Fazzi
- Child Neurology and Psychiatry Unit, ASST Spedali Civili of Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| |
Collapse
|
31
|
Case J, Grigos MI. The Effect of Practice on Variability in Childhood Apraxia of Speech: A Multidimensional Analysis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1477-1495. [PMID: 33826355 DOI: 10.1044/2021_ajslp-20-00167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose Variability has been interpreted in differing ways according to context (e.g., development, speech impairment, and learning). A challenge arises when interpreting variability in the context of learning for children with speech impairment characterized by high movement variability, as in childhood apraxia of speech (CAS). The objective of this study is to investigate changes in variability in CAS with practice in comparison to patterns seen in children with non-CAS speech sound disorders (SSD) and typical development. Method Speech production variability was examined in 24 children (5-6 years of age) with CAS, non-CAS SSD, and typical development in production of nonwords of varied motoric complexity. Multidimensional analyses were performed using measures of token-to-token speech consistency (percent word consistency), acoustic variability (acoustic spatiotemporal index), and movement variability (lip aperture spatiotemporal index). Changes in variability were examined in each group of children by comparing the first half to the last half of nonword tokens in the same data collection session. The impact of token complexity on practice effects was also explored across groups of children. Results All children displayed increased speech consistency within this practice period (p = .01). Only children with CAS displayed increased movement variability following practice (p = .01). Differences in acoustic and kinematic variability were observed across complexity levels in all groups, though these did not interact with practice effects. Discussion These findings suggest that increased movement variability in children with CAS might be facilitating perceptual consistency. It is believed that this finding reflects an inefficient strategy adapted by children with CAS in the absence of motor-based cueing and feedback to guide speech performance with practice.
Collapse
Affiliation(s)
- Julie Case
- Department of Speech-Language-Hearing Sciences, Hofstra University, Hempstead, NY
| | - Maria I Grigos
- Department of Communicative Sciences and Disorders, New York University, New York City
| |
Collapse
|
32
|
Scarcella I, Michelazzo L, McCabe P. A Pilot Single-Case Experimental Design Study of Rapid Syllable Transition Treatment for Italian Children With Childhood Apraxia of Speech. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1496-1510. [PMID: 33830791 DOI: 10.1044/2021_ajslp-20-00133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background The Rapid Syllable Transition (ReST) treatment is an effective intervention designed to address the planning and programming disorder found in childhood apraxia of speech. To date, no study has considered its use with children who speak languages other than English. Aim This pilot study aimed to examine the use of ReST treatment with Italian children. We hypothesized that the ReST approach would improve the overall accuracy of the targeted behaviors of lexical stress, smoothness, and phonemic accuracy, whereas phonemic and phonetic accuracy of untreated items would remain stable. Method Two monolingual Italian-speaking children with childhood apraxia of speech received therapy in 12 one-hour sessions, 2-3 times per week, using a single-case experimental design. The treatment procedures used in English were replicated in Italian with one change: In English, two stress patterns are treated. Italian commonly uses three stress patterns; therefore, the stimuli were modified accordingly. Accuracy of articulation, lexical stress, and smoothness were assessed at pretreatment and 1 day, 1 week, and 4 months posttreatment in treated and untreated pseudowords and in real words and sentences. Results Both children improved on treated pseudowords and real words with moderate effect sizes, but only one child generalized to untreated pseudowords. Maintenance of treatment results was observed in both participants. Articulation of control phonemes did not change. Conclusions ReST treatment in Italian is feasible, and a treatment effect was found, showing that its use may be valid in languages other than English. Further research is required. Supplemental Material https://doi.org/10.23641/asha.14348060.
Collapse
Affiliation(s)
- Ilaria Scarcella
- The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Patricia McCabe
- The University of Sydney, Camperdown, New South Wales, Australia
| |
Collapse
|
33
|
Beiting M, Maas E. Autism-Centered Therapy for Childhood Apraxia of Speech (ACT4CAS): A Single-Case Experimental Design Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1525-1541. [PMID: 33684309 DOI: 10.1044/2020_ajslp-20-00131] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose A subset of children with autism spectrum disorder (ASD) has speech sound disorders, including childhood apraxia of speech (CAS). To date, virtually all speech treatment studies consider ASD an exclusionary criterion, resulting in little scientific evidence for treatment of CAS for children who also have ASD. This study proposes and tests a novel approach, Autism-Centered Therapy for Childhood Apraxia of Speech (ACT4CAS), as a theoretically and clinically informed speech treatment option for this population. Method Using a multiple-baseline design within and across participants, three children with co-occurring ASD and CAS received 11-18 treatment sessions. Treatment targets were individually designed and matched with untreated control words. Probes were administered at the start of each session to assess speech production accuracy perceptually. Changes in production accuracy were examined through visual inspection and quantified with effect sizes. Results Findings were mixed, with one child showing significant gains for half of the treated targets at follow-up and two children showing no clear improvement. Conclusions Preliminary evidence suggests potentially positive treatment effects for ACT4CAS when implemented as intended, although treatment intensity and disorder severity likely influence treatment outcome. Replication and comparison of ACT4CAS to other speech treatments is needed. Supplemental Material https://doi.org/10.23641/asha.14110445.
Collapse
Affiliation(s)
- Molly Beiting
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
| | - Edwin Maas
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
| |
Collapse
|
34
|
Iuzzini-Seigel J. Procedural Learning, Grammar, and Motor Skills in Children With Childhood Apraxia of Speech, Speech Sound Disorder, and Typically Developing Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:1081-1103. [PMID: 33784194 DOI: 10.1044/2020_jslhr-20-00581] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose This case-control study sought to determine if (a) children with childhood apraxia of speech (CAS), other speech sound disorders (SSDs), and typical development would perform differently on a procedural learning assessment and (b) whether grammatical ability would impact group differences. Method Communication, motor, and procedural learning abilities were assessed in 48 children with CAS (n = 13), SSD (n = 20), and typical development (n = 15), between 43 and 97 months of age (M = 66 months, SD = 12 months). Results On average, children with CAS demonstrated grammatical and motor impairments and required an increased number of exposures to the visuospatial sequence to demonstrate procedural learning, compared to peers with SSD or typical development. A subset of children from each group demonstrated an unanticipated procedural learning pattern wherein they evidenced an uptick in reaction time during the second sequenced block. Children with CAS with this pattern still evidenced procedural learning gains by the fifth sequenced block. In contrast, children with SSD and typical development with this pattern showed poor procedural learning outcomes and were characterized by lower scores on language and motor assessments as well. Conclusions This research provides partial support for the procedural learning deficit hypothesis in children with CAS and for a subset of children with SSD as well. Future research should examine the role of a serial reaction time task in identifying children at risk of multisystem communication and motor deficits. Supplemental Material https://doi.org/10.23641/asha.14173532.
Collapse
Affiliation(s)
- Jenya Iuzzini-Seigel
- Department of Speech Pathology and Audiology, Marquette University, Milwaukee, WI
| |
Collapse
|
35
|
Hair A, Ballard KJ, Markoulli C, Monroe P, Mckechnie J, Ahmed B, Gutierrez-Osuna R. A Longitudinal Evaluation of Tablet-Based Child Speech Therapy with Apraxia World. ACM TRANSACTIONS ON ACCESSIBLE COMPUTING 2021. [DOI: 10.1145/3433607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Digital games can make speech therapy exercises more enjoyable for children and increase their motivation during therapy. However, many such games developed to date have not been designed for long-term use. To address this issue, we developed Apraxia World, a speech therapy game specifically intended to be played over extended periods. In this study, we examined pronunciation improvements, child engagement over time, and caregiver and automated pronunciation evaluation accuracy while using our game over a multi-month period. Ten children played Apraxia World at home during two counterbalanced 4-week treatment blocks separated by a 2-week break. In one treatment phase, children received pronunciation feedback from caregivers and in the other treatment phase, utterances were evaluated with an automated framework built into the game. We found that children made therapeutically significant speech improvements while using Apraxia World, and that the game successfully increased engagement during speech therapy practice. Additionally, in offline mispronunciation detection tests, our automated pronunciation evaluation framework outperformed a traditional method based on goodness of pronunciation scoring. Our results suggest that this type of speech therapy game is a valid complement to traditional home practice.
Collapse
Affiliation(s)
- Adam Hair
- Texas A&M University, College Station, Texas, USA
| | | | | | | | | | | | | |
Collapse
|
36
|
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.
Collapse
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
| | | |
Collapse
|
37
|
Murray E, Iuzzini-Seigel J, Maas E, Terband H, Ballard KJ. Differential Diagnosis of Childhood Apraxia of Speech Compared to Other Speech Sound Disorders: A Systematic Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:279-300. [PMID: 33151751 DOI: 10.1044/2020_ajslp-20-00063] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The aim of this study was to determine the discriminative features that might contribute to differentiation of childhood apraxia of speech (CAS) from other speech sound disorders (SSDs). Method A comprehensive literature search was conducted for articles or doctoral dissertations that included ≥ 1 child with CAS and ≥ 1 child with SSD. Of 2,071 publications screened, 53 met the criteria. Articles were assessed for (a) study design and risk of bias; (b) participant characteristics and confidence in diagnosis; and (c) discriminative perceptual, acoustic, or kinematic measures. A criterion was used to identify promising studies: American Academy of Neurology study design (Class III+), replicable participant descriptions and adequate confidence in diagnosis (≥ 3), and ≥ 1 discriminative and reliable measure. Results Over 75% of studies were retrospective, case-control designs and/or assessed English-speaking children. Many studies did not fully describe study design and quality. No studies met the Class I (highest) quality rating according to American Academy of Neurology guidelines. CAS was mostly compared to speech delay/phonological disorder. Only six studies had diagnostic confidence ratings of 1 (best). Twenty-six studies reported discriminative perceptual measures, 14 reported discriminative acoustic markers, and four reported discriminative kinematic markers. Measures were diverse, and only two studies directly replicated previous findings. Overall, seven studies met the quality criteria, and another eight nearly met the study criteria to warrant further investigation. Conclusions There are no studies of the highest diagnostic quality. There are 15 studies that can contribute to further diagnostic efforts discriminating CAS from other SSDs. Future research should utilize careful diagnostic design, support replication, and adhere to standard reporting guidelines. Supplemental Material https://doi.org/10.23641/asha.13158149.
Collapse
Affiliation(s)
- Elizabeth Murray
- The University of Sydney, New South Wales, Australia
- Remarkable Speech + Movement, New South Wales, Australia
| | | | | | - Hayo Terband
- Utrecht Institute of Linguistics OTS, Utrecht University, the Netherlands
| | | |
Collapse
|
38
|
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: 9] [Impact Index Per Article: 3.0] [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.
Collapse
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
| |
Collapse
|
39
|
Oliveira AMD, Nunes I, Cruz GSD, Gurgel LG. Métodos de avaliação da apraxia de fala na infância: revisão sistemática. AUDIOLOGY - COMMUNICATION RESEARCH 2021; 26. [DOI: 10.1590/2317-6431-2021-2524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
RESUMO Objetivos Revisar sistematicamente os protocolos e/ou avaliações que contribuem para o diagnóstico de apraxia de fala na infância (AFI) e classificá-los de acordo com a dimensão clínica avaliada. Estratégia de pesquisa Estudo de revisão sistemática da literatura nas bases de dados MEDLINE (acessado via PubMed), LILACS, Scopus e SciELO, com os descritores Apraxias, Childhood apraxia of speech, Evaluation, Assessment, Validation Studies, Evaluation Studies, Language Therapy, Rehabilitation of Speech and Language Disorders, Child e Child, Preschool. Critérios de seleção A busca nas bases de dados foi conduzida por três pesquisadores independentes. Foram incluídos estudos que avaliavam, de forma clara, sujeitos com suspeita ou diagnóstico de AFI. Os revisores realizaram a coleta de dados no que diz respeito às características metodológicas, intervenções e desfechos dos estudos, por meio de planilhas previamente elaboradas especificamente para o presente estudo. O dado principal coletado foi referente aos procedimentos de avaliação da AFI para crianças. Resultados A maior parte dos estudos (14 dos 21 incluídos) realizou a associação entre a avaliação de habilidades motoras e/ou articulatórias e segmentais. Cinco realizaram avaliação de todos os aspectos elencados: motor e/ou articulatória, segmental e suprassegmental e dois realizaram apenas avaliação motora e/ou articulatória. A idade dos sujeitos variou de 3 a 12 anos. Conclusão A maioria das pesquisas considerou a associação entre habilidades motoras e/ou articulatórias e segmentais para avaliação da apraxia de fala na infância. Sugere-se a realização de mais estudos, a fim de buscar evidências de validade.
Collapse
|
40
|
McLeod S, Ballard KJ, Ahmed B, McGill N, Brown MI. Supporting Children With Speech Sound Disorders During COVID-19 Restrictions: Technological Solutions. ACTA ACUST UNITED AC 2020. [DOI: 10.1044/2020_persp-20-00128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose“Children are the hidden victims of the COVID-19 pandemic” (United Nations Children's Fund, 2020). Timely and effective speech intervention is important to reduce the impact on children's school achievement, ability to make friends, mental health, future life opportunities, and government resources. Prior to the coronavirus disease (COVID-19) pandemic, many Australian children did not receive sufficient speech-language pathology (SLP) services due to long waiting lists in the public health system. COVID-19 restrictions exacerbated this issue, as even children who were at the top of lengthy SLP waiting lists often received limited services, particularly in rural areas. To facilitate children receiving speech intervention remotely during the COVID-19 pandemic, evidence from randomized controlled trials regarding three technological solutions are examined: (a) Phoneme Factory Sound Sorter (Sound Start Study), (b) Waiting for Speech Pathology website, and (c) Apraxia World.ConclusionsFor the first two technological solutions, there were similar gains in speech production between the intervention and control groups, whereas, for the third solution, the average magnitude of treatment effect was comparable to face-to-face SLP therapy. Automated therapy management systems may be able to accelerate speech development and support communication resilience to counteract the effects of the COVID-19 restrictions on children with speech sound disorders. Technology-based strategies may also provide a potential solution to the chronic shortage of SLP services in rural areas into the future.
Collapse
Affiliation(s)
- Sharynne McLeod
- Charles Sturt University, Bathurst, New South Wales, Australia
| | | | - Beena Ahmed
- University of New South Wales, Sydney, Australia
| | - Nicole McGill
- Charles Sturt University, Bathurst, New South Wales, Australia
| | | |
Collapse
|
41
|
Case J, Grigos MI. A Framework of Motoric Complexity: An Investigation in Children With Typical and Impaired Speech Development. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:3326-3348. [PMID: 32946304 DOI: 10.1044/2020_jslhr-20-00020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Introduction The current work presents a framework of motoric complexity where stimuli differ according to movement elements across a sound sequence (i.e., consonant transitions and vowel direction). This framework was then examined in children with childhood apraxia of speech (CAS), other speech sound disorders (SSDs), and typical development (TD). Method Twenty-four children (CAS, n = 8; SSD, n = 8; TD, n = 8), 5-6 years of age, participated in this study. The children produced words that varied in motoric complexity while transcription, acoustic, and kinematic data were collected. Multidimensional analyses were conducted to examine speech production accuracy, speech motor variability, and temporal control. Results Analyses revealed poorer accuracy, longer movement duration, and greater speech motor variability in children with CAS than TD (across all measures) and other SSDs (accuracy and variability). All children demonstrated greater speech motor variability and longer duration as movement demands increased within the framework of motoric complexity. Diagnostic grouping did not mediate performance on this task. Conclusions Results of this study are believed to reveal gradations of complexity with increasing movement demands, thereby supporting the proposed framework of motoric complexity. This work also supports the importance of considering motoric properties of sound sequences when evaluating speech production skills and designing experimental and treatment stimuli.
Collapse
Affiliation(s)
- Julie Case
- Department of Speech-Language-Hearing Sciences, Hofstra University, Hempstead, NY
| | - Maria I Grigos
- Department of Communicative Sciences and Disorders, New York University, New York
| |
Collapse
|
42
|
McKechnie J, Ahmed B, Gutierrez-Osuna R, Murray E, McCabe P, Ballard KJ. The influence of type of feedback during tablet-based delivery of intensive treatment for childhood apraxia of speech. JOURNAL OF COMMUNICATION DISORDERS 2020; 87:106026. [PMID: 32693310 DOI: 10.1016/j.jcomdis.2020.106026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/11/2020] [Accepted: 05/18/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE One of the key principles of motor learning supports using knowledge of results feedback (KR, i.e., whether a response was correct / incorrect only) during high intensity motor practice, rather than knowledge of performance (KP, i.e., whether and how a response was correct/incorrect). In the future, mobile technology equipped with automatic speech recognition (ASR) could provide KR feedback, enabling this practice to move outside the clinic, supplementing speech pathology sessions and reducing burden on already stretched speech-language pathology resources. Here, we employ a randomized controlled trial design to test the impact of KR vs KP feedback on children's response to the Nuffield Dyspraxia Programme 3, delivered through an android tablet. At the time of testing, ASR was not feasible and so correctness of responses was decided by the treating clinician. METHOD Fourteen children with CAS, aged 4-10 years, participated in a parallel group design, matched for age and severity of CAS. Both groups attended a university clinic for 1-hr therapy sessions 4 days a week for 3 weeks. One group received high frequency feedback comprised of both KR and KP, in the style of traditional, face-to-face intensive intervention on all days. The other group received high frequency KR + KP feedback on 1 day per week and high frequency KR feedback on the other 3 days per week, simulating the service delivery model of one clinic session per week supported by tablet-based home practice. RESULTS Both groups had significantly improved speech outcomes at 4-months post-treatment. Post-hoc comparisons suggested that only the KP group showed a significant change from pre- to immediately post-treatment but the group difference had dissipated by 1-month post-treatment. Heterogeneity in response to intervention within the groups suggests that other factors, not measured here, may be having a substantive influence on response to intervention and feedback type. CONCLUSION Mobile technology has the potential to increase motivation and engagement with therapy and to mitigate barriers associated with distance and access to speech pathology services. Further research is needed to explore the influence of type and frequency of feedback on motor learning, optimal timing for transitioning from KP to KR feedback, and how these parameters interact with task, child and context-related factors.
Collapse
Affiliation(s)
- Jacqueline McKechnie
- Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia; Faculty of Health, University of Canberra, Bruce, ACT, Australia.
| | - Beena Ahmed
- Texas A&M University at Qatar, Doha, Qatar; Faculty of Engineering, University of New South Wales, Sydney, NSW, Australia
| | | | - Elizabeth Murray
- Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
| | - Patricia McCabe
- Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
| | - Kirrie J Ballard
- Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
| |
Collapse
|
43
|
Madill C, McIlwaine A, Russell R, Hodges NJ, McCabe P. Classifying and Identifying Motor Learning Behaviors in Voice-Therapy Clinician-Client Interactions: A Proposed Motor Learning Classification Framework. J Voice 2020; 34:806.e19-806.e31. [DOI: 10.1016/j.jvoice.2019.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/22/2019] [Accepted: 03/22/2019] [Indexed: 11/29/2022]
|
44
|
Case J, Grigos M. How the Study of Speech Motor Control Can Inform Assessment and Intervention in Childhood Apraxia of Speech. ACTA ACUST UNITED AC 2020. [DOI: 10.1044/2020_persp-19-00114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose
The study of speech motor control has led to great advancements in the current understanding of childhood apraxia of speech (CAS). There remains a significant need to bridge the gap between theory and practice to fully understand the clinical implications of past research.
Method
This review article reviews the speech motor control research in CAS and discusses how these works have offered key information about the underlying motor deficits (Grigos et al., 2015; Terband et al., 2019), the influence of structured practice on speech performance (Case & Grigos, 2016; Grigos & Case, 2018), and the role of task complexity (Case, 2019; Case & Grigos, 2016; Grigos & Case, 2018). We highlight salient points from this existing literature and clinical implications to the assessment and treatment of CAS.
Conclusion
The study of speech motor control has shed light on a number of key factors related to CAS. Even within perceptually accurate speech, children with CAS display differences in movement patterning and timing control. Assessment must aim to more directly tax speech motor skills to obtain a thorough and accurate illustration of production deficits. Intervention is challenged with the task of not only improving production accuracy but also facilitating more efficient motor planning and programming. Motor-based intervention that applies motor learning principles and introduces variability across motor, phonetic, and prosodic contexts is believed to achieve this goal, though research is needed to better understand changes in speech motor control with treatment.
Collapse
Affiliation(s)
- Julie Case
- Department of Speech-Language-Hearing Sciences, Hofstra University, Hempstead, NY
| | - Maria Grigos
- Department of Communicative Sciences and Disorders, New York University, New York
| |
Collapse
|
45
|
McCabe P, Thomas DC, Murray E. Rapid Syllable Transition Treatment—A Treatment for Childhood Apraxia of Speech and Other Pediatric Motor Speech Disorders. ACTA ACUST UNITED AC 2020. [DOI: 10.1044/2020_persp-19-00165] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose
Childhood apraxia of speech (CAS) is a speech disorder that many generalist speech-language pathologists feel underqualified to treat. For children with CAS, this may result in ad hoc interventions resulting in slower progress. Research evidence for various CAS treatments is primarily limited to single-case experimental design studies; however, two treatments (Rapid Syllable Transition Treatment [ReST] and the Nuffield Dyspraxia Programme, Third Edition) have been compared in a single randomized controlled trial.
Conclusion
This tutorial describes one of those treatments: ReST which was designed to address the three consensus core features of CAS simultaneously: consistency and accuracy of sounds, sequencing, and prosody. The treatment uses nonwords to help children build and store accurate motor plans and programs using principles of motor learning. Treatment data are described, and commonly reported clinical issues are discussed. Recommendations for which children may be suitable for ReST and for evidence-based practice are described.
Collapse
Affiliation(s)
- Patricia McCabe
- Discipline of Speech Pathology, Sydney School of Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia
| | - Donna Claire Thomas
- Discipline of Speech Pathology, Sydney School of Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia
| | - Elizabeth Murray
- Discipline of Speech Pathology, Sydney School of Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia
| |
Collapse
|
46
|
Miller HE, Guenther FH. Modelling speech motor programming and apraxia of speech in the DIVA/GODIVA neurocomputational framework. APHASIOLOGY 2020; 35:424-441. [PMID: 34108793 PMCID: PMC8183977 DOI: 10.1080/02687038.2020.1765307] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/03/2020] [Indexed: 05/24/2023]
Abstract
BACKGROUND The Directions Into Velocities of Articulators (DIVA) model and its partner, the Gradient Order DIVA (GODIVA) model, provide neurobiologically grounded, computational accounts of speech motor control and motor sequencing, with applications for the study and treatment of neurological motor speech disorders. AIMS In this review, we provide an overview of the DIVA and GODIVA models and how they explain the interface between phonological and motor planning systems to build on previous models and provide a mechanistic accounting of apraxia of speech (AOS), a disorder of speech motor programming. MAIN CONTRIBUTION Combined, the DIVA and GODIVA models account for both the segmental and suprasegmental features that define AOS via damage to (i) a speech sound map, hypothesized to reside in left ventral premotor cortex, (ii) a phonological content buffer hypothesized to reside in left posterior inferior frontal sulcus, and/or (iii) the axonal projections between these regions. This account is in line with a large body of behavioural work, and it unifies several prior theoretical accounts of AOS. CONCLUSIONS The DIVA and GODIVA models provide an integrated framework for the generation and testing of both behavioural and neuroimaging hypotheses about the underlying neural mechanisms responsible for motor programming in typical speakers and in speakers with AOS.
Collapse
Affiliation(s)
- Hilary E. Miller
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA
| | - Frank H. Guenther
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA
- Department of Biomedical Engineering, Boston University, Boston, MA
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA
| |
Collapse
|
47
|
Randazzo M. A Survey of Clinicians With Specialization in Childhood Apraxia of Speech. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1659-1672. [PMID: 31487474 DOI: 10.1044/2019_ajslp-19-0034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Little is known about how clinicians develop expertise in childhood apraxia of speech (CAS), a rare speech disorder with heterogeneous presentation. The purpose of this survey study was to examine the beliefs and practices of clinicians specializing in CAS. Method Speech-language pathologists who self-identify as having expertise in CAS (n = 165) completed an online survey regarding influences on clinical practice and beliefs about CAS. Practice patterns and perspectives regarding CAS were analyzed for respondents who self-identify as having expertise in CAS, across 4 experience bands (1-5, 6-10, 11-15, and 15+ years). Results A majority of the respondents to this survey provide treatment to preschool-age children with CAS. Respondents report features used in differential diagnosis aligned with the American Speech-Language-Hearing Association's (2007) technical report, with inconsistency as a key feature. Results suggest that continuing education courses are highly influential in the perceived development of expertise and perspectives regarding CAS. Respondents expressed uncertainty about comorbidity of CAS with other communication disorders. Overall, beliefs and practices are relatively uniform across levels of clinical experience. Conclusions Practices and perspectives of clinicians who self-identify as having expertise with CAS are influenced by factors noted in previous literature. Results of this survey highlight the need for research on the development of expertise in the clinical management of CAS, updated consensus statements that reflect advances in current research, clarification regarding comorbidity of CAS with other communication disorders, and evaluation of continuing education opportunities. Supplemental Material https://doi.org/10.23641/asha.9755459.
Collapse
Affiliation(s)
- Melissa Randazzo
- Department of Communication Sciences and Disorders, Adelphi University, Garden City, NY
| |
Collapse
|
48
|
Rvachew S, Matthews T. An N-of-1 Randomized Controlled Trial of Interventions for Children With Inconsistent Speech Sound Errors. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:3183-3203. [PMID: 31479383 DOI: 10.1044/2019_jslhr-s-18-0288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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 test the hypothesis that children with inconsistent speech errors would respond differentially to 1 of 3 specific interventions depending on their primary underlying impairment: Children with deficient motor planning were expected to respond best to an auditory-motor integration (AMI) intervention, and children with deficient phonological planning were expected to respond best to a phonological memory and planning (PMP) intervention. Method Twelve participants were diagnosed with a motor planning (n = 7) or phonological planning (n = 5) deficit based on a comprehensive assessment, which included the Syllable Repetition Task as an important source of diagnostic evidence. An N-of-1 randomized controlled trial was used. Each child experienced all 3 interventions: AMI, PMP, and control (CTL); however, these interventions were randomly allocated to sessions within weeks (3 sessions per week × 6 weeks for 18 sessions). The AMI intervention procedures targeted knowledge of the acoustic-phonetic target and integration of auditory and somatosensory feedback during speech practice. The PMP intervention procedures targeted segmenting and recompiling the phonological plan for each word. The CTL intervention was standard drill practice. The child was taught 5 pseudowords in a meaningful context in each intervention condition. Results Same-day (SD) probes assessed transfer from taught pseudowords to untaught real words, and next-day (ND) probes assessed retention of that learning. Nonparametric resampling tests with pooling of p values across children with the same diagnosis were used to assess the results. Pooled p values indicated a significant benefit of AMI over PMP for the group with a motor planning deficit (p = 2.01E-04 for SD probes and 2.97E-03 for ND probes) and a significant benefit of PMP over AMI for the group with a phonological planning deficit (p = 1.22E-02 for SD probes and 1.32E-02 for ND probes). Response to the CTL intervention was variable within groups. Conclusion In this study, the child's underlying psycholinguistic deficit helped to predict response to intervention.
Collapse
Affiliation(s)
- Susan Rvachew
- School of Communication Sciences and Disorders, McGill University, Montréal, Québec, Canada
| | - Tanya Matthews
- School of Communication Sciences and Disorders, McGill University, Montréal, Québec, Canada
| |
Collapse
|
49
|
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.
Collapse
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
| |
Collapse
|
50
|
Gomez M, McCabe P, Purcell A. Clinical management of childhood apraxia of speech: A survey of speech-language pathologists in Australia and New Zealand. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:295-304. [PMID: 31122069 DOI: 10.1080/17549507.2019.1608301] [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: 07/18/2018] [Revised: 03/14/2019] [Accepted: 04/11/2019] [Indexed: 06/09/2023]
Abstract
Purpose: A number of studies have been published that have investigated the practices of speech-language pathologists in relation to speech sound disorder intervention; however, specific research about the treatment of childhood apraxia of speech is not available. This study aimed to describe the treatment approaches being used by speech-language pathologists, explore their perspectives of evidence-based practice and identify perceived barriers to implementing empirical research recommendations. Method: An online survey was distributed to speech-language pathologists in Australia and New Zealand. In total, 109 valid surveys were completed by participants who answered a series of multiple choice, yes/no, short answer and Likert-scaled questions. Result: Speech-language pathologists demonstrated a strong preference for eclectic interventions to treat childhood apraxia of speech. When asked to identify the primary treatment approach they used (whether as a stand-alone; or as the primary approach within an eclectic intervention), the most frequently used intervention was the Nuffield Dyspraxia Programme. Many speech-language pathologists reported valuing empirical research evidence, despite identifying a range of barriers that impact their ability to implement evidence-based practice in childhood apraxia of speech treatment. Conclusion: Although many speech-language pathologists use the Nuffield Dyspraxia Programme as their primary intervention, most clinicians use it as part of an eclectic/hybrid intervention. The effectiveness of eclectic interventions for childhood apraxia of speech has not been empirically evaluated.
Collapse
Affiliation(s)
- Maryane Gomez
- a Faculty of Health Sciences , University of Sydney, Lidcombe, NSW , Australia
| | - Patricia McCabe
- a Faculty of Health Sciences , University of Sydney, Lidcombe, NSW , Australia
| | - Alison Purcell
- a Faculty of Health Sciences , University of Sydney, Lidcombe, NSW , Australia
| |
Collapse
|