Treating Childhood Apraxia of Speech
Condition: Childhood Apraxia of Speech
MeSH terms: Apraxias
Study type: Interventional

Summary: 
      The study will test two modifications to speech therapy for 40 school-age children with
      childhood apraxia of speech to determine how to improve treatment outcomes. The study will
      compare treatment that includes real-time visual feedback of the tongue during speech using
      ultrasound vs traditional therapy that does not include ultrasound visual feedback.
      Additionally, some children will be treated with a traditional schedule of 2 sessions per
      week, whereas others will be provided with treatment that begins with intensive training (10
      hours of therapy in one week) and progresses to a more distributed treatment schedule.
    

Detailed description: 
      Childhood apraxia of speech is a developmental speech sound disorder that may lead to
      persisting speech errors, often despite years of treatment. Such impairments may lead to
      social, academic, and vocational limitations. Thus, there is a need to explore alternate
      treatment approaches. This study will explore how to improve speech sound production in
      school-age children with CAS by modifying a standard speech therapy program. Two adaptations
      to speech therapy will be tested in a 2 x 2 randomized group design.

      In Aim 1, a standard treatment schedule of 2 one-hour sessions per week will be compared
      against a treatment sequence beginning with an intensive therapy schedule (10 hrs of
      treatment in one week), which will then transition to a more distributed practice schedule.
      This treatment modification is intended to minimize erred practice between training sessions
      in the early stages of learning, then foster generalization through increased time between
      practice sessions.

      In Aim 2, a standard treatment that includes only verbal feedback to the client during speech
      practice will be compared against a treatment sequence that initially includes real-time
      ultrasound visual feedback of the tongue during speech, which will be faded over the course
      of treatment. Ultrasound visual feedback is designed to train articulatory movements. It may
      enhance children's understanding of the articulatory goals of speech movement patterns by
      comparing executed tongue movements with intended movements. Prior case reports and single
      subject experimental designs have shown that speech sound production may be enhanced by
      including ultrasound visual feedback, although no prior randomized group studies have been
      conducted.

      Beside these modifications, the other aspects of treatment will be held constant. Outcomes
      will be evaluated by tracking changes in percent consonants correct from a large speech
      sample, scored by individuals who are blind to treatment status. The four groups will be
      compared to determine the extent to which speech sound therapy can be enhanced through a
      treatment sequence that begins with intensive practice and/or with ultrasound visual
      feedback.
    

Intervention name(s): Speech Motor Chaining without Biofeedback; Biofeedback; Distributed Practice; Massed --> Distributed Practice
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral
Intervention description(s): These procedures target sound sequences (consonant-vowel, consonant-consonant, or vowel-consonant). Sessions begin with Pre-practice to elicit the target sounds, with verbal cueing and shaping strategies. The Practice component then includes chaining that is response-contingent. Participants practice in blocks of 6 consecutive trials beginning at the syllable level. If 5/6 are correct, the participant advances to monosyllabic word practice, then multisyllabic word practice, phrase practice, and sentence practice (with the target syllable embedded within each level of complexity). If fewer than 5/6 trials are correct, a different syllable with the target sound pattern is practiced next. Verbal feedback is faded from 5 of 6 trials at the syllable level to only 3 of 6 trials at the sentence level. For more description, see http://speechproductionlab.syr.edu/Resources%20for%20Researchers.html; Real-time images of the tongue are made available using ultrasound placed beneath the chin. Participants practice speech movements and can be cued to modify their tongue shape or position to achieve clearer speech. Practice structure is similar to the Speech Motor Chaining procedures, but with the addition of a visual reference.; 2 sessions per week for 10 weeks; Week 1: 10 hours of treatment Week 2: 3 hours of treatment Week 3: 3 hours of treatment Week 4: 2 hours of treatment Week 5: 2 hours of treatment
Allocation: Randomized
Intervention model: Factorial Assignment
Intervention model description: 2 x 2 design Scheduling: Mass-->Distributed vs. Distributed only Visual feedback: Sequenced Ultrasound Biofeedback vs. No biofeedback
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: speech sound disorder