A Randomized Controlled Trial of Treatment Distribution and Biofeedback Effects on Speech Production in School-Age Children With Apraxia of Speech.
A Randomized Controlled Trial of Treatment Distribution and Biofeedback Effects on Speech Production in School-Age Children With Apraxia of Speech.
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DOI：
10.1044/2023_jslhr-22-00622
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发表时间：
2023-08
期刊：
影响因子：
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通讯作者：
J. Preston;Nicole F Caballero;Megan C. Leece;Dongliang Wang;Benedette M Herbst;Nina R. Benway
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文献类型：
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作者：
J. Preston;Nicole F Caballero;Megan C. Leece;Dongliang Wang;Benedette M Herbst;Nina R. Benway
本研究旨在探讨超声生物反馈和强化治疗分布如何影响循证治疗过程中的语音声音概括，言语运动链，与儿童言语失用症（CAS）相关的持续言语错误的儿童。方法在一项2 × 2析因随机对照试验中，将符合CAS标准的9-17岁儿童随机接受（a）分布式治疗（20次，每周两次，共10周）或强化治疗（5周20小时，第1周10小时）和（B）有或无生物反馈治疗。由于COVID大流行，部分参与者仅被随机分配至分布式/密集远程实践治疗。主要结果是未处理短语的目标声音正确率（即，在第10周时间点时的一般化。超过50，000个狭义的音标被分析。结果48名参与者完成了治疗。强化治疗显著增加泛化在所有时间点。生物反馈的效果在治疗开始后5周时显著，但在最初的10周时间点不显著。然而，当在20小时治疗结束后立即比较各组时，强化治疗的泛化显著大于分散治疗，超声治疗的泛化显著大于非超声治疗（超声强化治疗的显著相互作用）。治疗结束后5周，只有强化治疗的优势仍然显著。面对面和远程练习方式之间没有显着差异。结论：当治疗小时数固定时，强化的言语运动链训练计划比分布式训练计划更有利于改善。超声波生物反馈最初加速了学习，但随着治疗的继续或结束，这种好处可能会消失。
PURPOSE This study examines how ultrasound biofeedback and intensive treatment distribution affect speech sound generalization during an evidence-based treatment, Speech Motor Chaining, for children with persisting speech errors associated with childhood apraxia of speech (CAS). METHOD In a 2 × 2 factorial randomized controlled trial, children ages 9-17 years meeting CAS criteria were randomized to receive (a) a distributed treatment (20 sessions twice weekly over 10 weeks) or intensive treatment (20 hr in 5 weeks, with 10 hr in Week 1) and (b) treatment with or without biofeedback. Due to the COVID pandemic, some participants were randomized to distributed/intensive telepractice treatment only. The primary outcome was percent target sounds correct on untreated phrases (i.e., generalization) at the 10-week time point. More than 50,000 narrow phonetic transcriptions were analyzed. RESULTS Forty-eight participants completed treatment. Intensive treatment significantly increased generalization at all time points. The effect of biofeedback was significant at 5 weeks from the start of treatment but not significant at the primary 10-week time point. However, when comparing each group immediately after their 20 hr of treatment finished, generalization was significantly greater in intensive over distributed treatment and greater in ultrasound over no-ultrasound treatment (with a significant interaction favoring intensive treatment with ultrasound). Only the advantage of intensive treatment remained significant 5 weeks after groups finished treatment. There was no significant difference between face-to-face and telepractice modalities. CONCLUSIONS When the number of treatment hours is fixed, an intensive schedule of Speech Motor Chaining facilitated greater improvement than a distributed schedule. Ultrasound biofeedback initially accelerated learning, but the benefits may dissipate as treatment continues or after it ends.