Title: FIDELITY: Feasibility of Internet DELivery of Intensive TherapY for children with motor speech disorders and cerebral palsy
Funder: Department of Health (England)

Abstract: Cerebral palsy (CP) can cause a speech disorder, dysarthria, making speech difficult to understand. In UK children receive little therapy to improve speech; the first line of treatment is often articulation therapy[4], which has not been found to be effective in dysarthria[5]. We have shown that a therapy targeting breath control and phonation can increase the speech intelligibility of children with dysarthria and CP and has positive impacts on children’s everyday communication in and out of school[1, 2]. To date the therapy has been delivered face-to-face in school. This study aims to test the feasibility of delivering the therapy over the internet using Skype and inform the design of a randomised controlled trial. Objectives are to: test the feasibility and acceptability of delivering the therapy via Skype; test the feasibility of recruiting children via a range of sources to a trial in which they are randomised to the new therapy or usual local therapy condition; and to refine our estimate of the minimal important change in intelligibility. We will recruit 24 children, aged 7-17 years who have CP and dysarthria, via the NHS, schools and voluntary organisations and randomly allocate them to the new therapy or a usual therapy condition. We will log all activities and time taken to recruit participants. Children in the new therapy condition will receive therapy three times a week via Skype. Six randomly selected therapy sessions from each child’s therapy will be recorded and the conduct of the therapy checked against the therapy protocol. Children and their parents will be interviewed once before, once during and once after the therapy about Skype delivery of the therapy. Children and parents will rate the effectiveness of the therapy at one and six weeks after therapy using a seven point scale. The therapist delivering the intervention will be interviewed once. Parents of children in the usual therapy group will be interviewed about their participation in the study. The speech of all participants will be recorded six weeks and one week before the therapy period, one week and six weeks after its completion. At each point parents and teachers will rate children’s usual communication function at home and school using a validated questionnaire. We will calculate the percentage of words correctly recognised by multiple unfamiliar listeners at one week before and six weeks after therapy. We will compare rate of recruitment from different sources. We will calculate the number of sessions reaching criterion for treatment integrity. We will calculate the mean percentage of words understood by unfamiliar adults before and after therapy. We will use intelligibility data and ratings of therapy effectiveness from this study and previous research[2] to refine our estimate of the minimal important difference in intelligibility. We will conduct thematic analysis of interviews, to understand perceptions of the acceptability of Skype delivery of therapy and study participation. We will develop tools for the collection of costs and pilot their use. We will explore, using a structured review of the literature, what tools suitable for inclusion in an economic evaluation are available to measure the benefits of the alternative treatments. This study will show if access to the therapy could be widened through internet delivery. Results will be used to develop a definitive trial of the intervention to be submitted to NIHR Health Technology Assessment Programme. Potential impacts of therapy targeting speech are substantial. Improved speech intelligibility will increase the speed of interaction and reduce the frequency of communication breakdown, thereby facilitating children’s active involvement in educational and social activities and potentially improving children’s quality of life in a cost-effective way.


Research activity codes: 6.7 PHYSICAL
Health categories: NEUROLOGICAL