Treating Childhood Apraxia of Speech

NCT03238677 | Completed Results DMC

• 2 other identifiers: 17-177R15DC016426
• Study Type: interventional
• Target: 56
• Locations: 1 country
• Sites: 1

Brief 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.

Conditions

Childhood Apraxia of Speech

Keywords

speech sound disorder

Outcome Measures

Primary Outcomes (1)

• Speech Sound Accuracy

  Percent consonants correct for target sounds: The primary outcome measure was percent correct for each participant's target sound-positions in untreated phrase. Participants imitated 20 pre-recorded phrases, each containing the target sound pattern 2 times per stimulus (e.g., for /l/ onset, "leave the location"), resulting in 40 attempts at each sound-position. For each session, 3 transcribers independently transcribed in Phon software (Hedlund \& Rose, 2022) and accuracy was averaged across transcribers. Instances where IPA symbols for the Actual transcription differed from the Target transcription was scored as incorrect.

  10 weeks from the start of treatment

Study Arms (4)

Biofeedback, Massed->Distributed

EXPERIMENTAL

Sequenced biofeedback Mass Practice--\> Distributed Scheduling

Behavioral: Biofeedback; Behavioral: Massed --> Distributed Practice

No Biofeedback, Distributed

ACTIVE COMPARATOR

Speech Motor Chaining with no biofeedback. 2 sessions/wk for 10 weeks

Behavioral: Speech Motor Chaining without Biofeedback; Behavioral: Distributed Practice

Biofeedback, Distributed

EXPERIMENTAL

Sequenced biofeedback, 2 sessions/wk for 10 weeks

Behavioral: Biofeedback; Behavioral: Distributed Practice

No Biofeedback, Massed-> Distributed

EXPERIMENTAL

Speech Motor Chaining with no biofeedback. Mass Practice--\> Distributed Scheduling

Behavioral: Speech Motor Chaining without Biofeedback; Behavioral: Massed --> Distributed Practice

Interventions

Speech Motor Chaining without Biofeedback BEHAVIORAL

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

No Biofeedback, Distributed; No Biofeedback, Massed-> Distributed

Biofeedback BEHAVIORAL

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.

Biofeedback, Distributed; Biofeedback, Massed->Distributed

Distributed Practice BEHAVIORAL

2 sessions per week for 10 weeks

Biofeedback, Distributed; No Biofeedback, Distributed

Massed --> Distributed Practice BEHAVIORAL

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

Biofeedback, Massed->Distributed; No Biofeedback, Massed-> Distributed

Eligibility Criteria

• Age: 9 Years - 17 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Native English speakers who hear English as the dominant language in their home setting.
• Must pass a hearing screening.
• Score at or better than -2 standard deviations from the mean on the Matrix Reasoning Task of the Wechsler Abbreviated Scale of Intelligence - 2nd Edition (WASI-2; t-score ≥ 30), Peabody Picture Vocabulary Test - 4th Edition (PPVT-4; standard score ≥ 70), and the Following Directions subtest of the Clinical Evaluation of Language Fundamentals - 5th Edition (CELF-5; scaled score ≥ 3).
• Goldman-Fristoe Test of Articulation - 3rd Edition (GFTA-3) percentile ≤ 5th).
• A diagnosis of CAS will be verified based on a polysyllable picture naming task, diadochokinetic task (puh-tuh-kuh), and syllable repetition task.

You may not qualify if:

• Parent report or direct evaluation reveals oral-facial structural abnormalities (e.g., cleft palate).
• Parental report of neurobehavioral disorders (e.g., autism spectrum disorders, ADHD, obsessive-compulsive disorder), or vision problems that are corrected with glasses/contacts.

Sponsors & Collaborators

• Syracuse University: lead
• National Institute on Deafness and Other Communication Disorders (NIDCD): collaborator

Study Sites (1)

Syracuse University

Syracuse, New York, 13244, United States

Location

Related Publications (2)

• Preston JL, Leece MC, Maas E. Intensive Treatment with Ultrasound Visual Feedback for Speech Sound Errors in Childhood Apraxia. Front Hum Neurosci. 2016 Aug 30;10:440. doi: 10.3389/fnhum.2016.00440. eCollection 2016.

  PMID: 27625603 BACKGROUND

• Preston JL, Leece MC, McNamara K, Maas E. Variable Practice to Enhance Speech Learning in Ultrasound Biofeedback Treatment for Childhood Apraxia of Speech: A Single Case Experimental Study. Am J Speech Lang Pathol. 2017 Aug 15;26(3):840-852. doi: 10.1044/2017_AJSLP-16-0155.

  PMID: 28715554 BACKGROUND

Related Links

• Speech Motor Chaining Procedural manual

MeSH Terms

Conditions

Apraxias; Speech Sound Disorder

Interventions

Biofeedback, Psychology

Condition Hierarchy (Ancestors)

Psychomotor Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Communication Disorders; Neurodevelopmental Disorders; Mental Disorders

Intervention Hierarchy (Ancestors)

Mind-Body Therapies; Complementary Therapies; Therapeutics; Behavior Therapy; Psychotherapy; Behavioral Disciplines and Activities; Feedback, Psychological

Limitations and Caveats

The interruptions due to the COVID-19 pandemic resulted an imbalance in participants in the Ultrasound vs No Ultrasound conditions, which limits statistical power. Participants were not randomized to telepractice vs face-to-face. Also, the treatment emphasizes speech sound accuracy. There is not a direct focus on teaching other features such as lexical stress. Other approaches, such as Rapid Syllable Transition Training would be more appropriate to address other elements of speech production.

Results Point of Contact

• Title: Jonathan Preston
• Organization: Syracuse University

jopresto@syr.edu

3154433143

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Individuals who conduct the phonetic transcriptions that will be used for the primary outcome data will be blinded as to whether the recordings were collected before or after treatment, and also blinded as to the group assignment of the participant.
• Purpose: TREATMENT
• Intervention Model: FACTORIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Model Details: 2 x 2 design Scheduling: Mass--\>Distributed vs. Distributed only Visual feedback: Sequenced Ultrasound Biofeedback vs. No biofeedback

Study Record Dates

• First Submitted: August 1, 2017
• First Posted: August 3, 2017
• Study Start: August 1, 2017
• Primary Completion: May 9, 2022
• Study Completion: June 7, 2022
• Last Updated: June 22, 2023
• Results First Posted: June 22, 2023

Record last verified: 2023-05

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)