Treatment intensity and childhood apraxia of speech

BackgroundIntensive treatment has been repeatedly recommended for the treatment of speech deficits in childhood apraxia of speech (CAS). However, differences in treatment outcomes as a function of treatment intensity have not been systematically studied in this population.AimTo investigate the effects of treatment intensity on outcome measures related to articulation, functional communication and speech intelligibility for children with CAS undergoing individual motor speech intervention.Methods &amp; ProceduresA total of 37 children (32-54 months of age) with CAS received 1x/week (lower intensity) or 2x/week (higher intensity) individual motor speech treatment for 10 weeks. Assessments were carried out before and after a 10-week treatment block to study the effects of variations in treatment intensity on the outcome measures.Outcomes &amp; ResultsThe results indicated that only higher intensity treatment (2x/week) led to significantly better outcomes for articulation and functional communication compared with 1x/week (lower intensity) intervention. Further, neither lower nor higher intensity treatment yielded a significant change for speech intelligibility at the word or sentence level. In general, effect sizes for the higher intensity treatment groups were larger for most variables compared with the lower intensity treatment group.Conclusions &amp; ImplicationsOverall, the results of the current study may allow for modification of service delivery and facilitate the development of an evidence-based care pathway for children with CAS.</p

Motor speech treatment protocol for developmental motor speech disorders

Objective: This study examines the effect of the Motor Speech Treatment Protocol (MSTP), a multi-sensory hybrid treatment approach on five children (mean: 3;3 years; S.D. 0;1) with severe to profound speech sound disorders with motor speech difficulties. Methods: A multiple probe design, replicated over five participants, was used to evaluate the effects of treatment on improving listeners' auditory and visual judgements of speech accuracy. Results: All participants demonstrated significant change between baseline and maintenance conditions, with the exception of KM, who may have had underlying psychosocial, regulation and/or attention difficulties. The training-(practiced in treatment) and test-words (not practiced in treatment) both demonstrated positive change in all participants, indicating generalization of target features to untrained words. Conclusion: These results provide preliminary evidence that the MSTP, which integrates multisensory information and utilizes hierarchical goal selection, may positively impact speech sound production by improving speech motor control in this population.</p

Parent–child interaction in motor speech therapy

<p><b>Purpose:</b> This study measures the reliability and sensitivity of a modified Parent–Child Interaction Observation scale (PCIOs) used to monitor the quality of parent–child interaction. The scale is part of a home-training program employed with direct motor speech intervention for children with speech sound disorders.</p> <p><b>Method:</b> Eighty-four preschool age children with speech sound disorders were provided either high- (2×/week/10 weeks) or low-intensity (1×/week/10 weeks) motor speech intervention. Clinicians completed the PCIOs at the beginning, middle, and end of treatment. Inter-rater reliability (Kappa scores) was determined by an independent speech-language pathologist who assessed videotaped sessions at the midpoint of the treatment block. Intervention sensitivity of the scale was evaluated using a Friedman test for each item and then followed up with Wilcoxon pairwise comparisons where appropriate.</p> <p><b>Results:</b> We obtained fair-to-good inter-rater reliability (Kappa = 0.33–0.64) for the PCIOs using only video-based scoring. Child-related items were more strongly influenced by differences in treatment intensity than parent-related items, where a greater number of sessions positively influenced parent learning of treatment skills and child behaviors.</p> <p><b>Conclusion:</b> The adapted PCIOs is reliable and sensitive to monitor the quality of parent–child interactions in a 10-week block of motor speech intervention with adjunct home therapy.Implications for rehabilitation</p><p>Parent-centered therapy is considered a cost effective method of speech and language service delivery. However, parent-centered models may be difficult to implement for treatments such as developmental motor speech interventions that require a high degree of skill and training.</p><p>For children with speech sound disorders and motor speech difficulties, a translated and adapted version of the parent–child observation scale was found to be sufficiently reliable and sensitive to assess changes in the quality of the parent–child interactions during intervention.</p><p>In developmental motor speech interventions, high-intensity treatment (2×/week/10 weeks) facilitates greater changes in the parent–child interactions than low intensity treatment (1×/week/10 weeks).</p><p>On one hand, parents may need to attend more than five sessions with the clinician to learn how to observe and address their child’s speech difficulties. On the other hand, children with speech sound disorders may need more than 10 sessions to adapt to structured play settings even when activities and therapy materials are age-appropriate.</p><p></p> <p>Parent-centered therapy is considered a cost effective method of speech and language service delivery. However, parent-centered models may be difficult to implement for treatments such as developmental motor speech interventions that require a high degree of skill and training.</p> <p>For children with speech sound disorders and motor speech difficulties, a translated and adapted version of the parent–child observation scale was found to be sufficiently reliable and sensitive to assess changes in the quality of the parent–child interactions during intervention.</p> <p>In developmental motor speech interventions, high-intensity treatment (2×/week/10 weeks) facilitates greater changes in the parent–child interactions than low intensity treatment (1×/week/10 weeks).</p> <p>On one hand, parents may need to attend more than five sessions with the clinician to learn how to observe and address their child’s speech difficulties. On the other hand, children with speech sound disorders may need more than 10 sessions to adapt to structured play settings even when activities and therapy materials are age-appropriate.</p