Speech Intervention via Telepractice for Children with Repaired Cleft Palate : Randomized Controlled Trial and Assessment of Speech Production and Perception Skills

项目总结/文摘

PROJECT SUMMARY/ABSTRACT Although the Individuals with Disabilities Education Act (IDEA) ensures that all children with disabilities are provided with appropriate public education, there is an increasing inequity in the provision of speech- language services across the U.S. due to the critical shortage of speech-language pathologists (SLPs) in public school settings. Telepractice is one way to mitigate the shortage issue. Currently available telepractice studies have been conducted with small sample sizes and varying methodological rigor. In particular, to date no treatment efficacy studies via telepractice have been conducted on children with a history of cleft palate (CP). Children with repaired CP often develop compensatory articulation patterns which are not common in children with speech disorders. It is imperative to identify whether telepractice is efficacious for children with repaired CP to treat compensatory articulation. In evaluation of compensatory articulation errors, two major limitations exist in the current literature. First, these errors are mainly examined based on the listener's auditory-perceptual judgement without instrumental analysis; second, how speech perception plays a role in production of compensatory articulation has not been fully investigated although ample evidence suggests interplay between perception and production skills. As a Phase I randomized controlled trial (RCT), this proposal responds to the NIDCR Behavioral Social Intervention Clinical Trial Planning & Implementation Cooperative Agreement (UG3/UH3). This proposal fits with NIDCR's Strategic Plan in that it aims to develop and test an effective behavioral intervention for children with oral and craniofacial disorders. Our aim during the UG3 one-year planning period is to (1) finalize the intervention protocols, (2) develop the Manual of Operations, (3) develop custom software for the data management system, and (4) stimuli and software development for the speech perception experiment in order to complete an unbiased RCT design for the UH3 phase. Our primary aims during the UH3 phase are (Aim 1) to establish the efficacy of telepractice speech intervention for children with repaired CP, and (Aim 2) to quantitatively define compensatory articulation errors using instrumentation analyses, and (Aim 3) to determine speech perception deficits in children with CP. This research will be clinically significant because Aim 1 will assist clinicians to make evidence-based decisions to adopt a telepractice service delivery model to treat children with repaired CP. Aims 2-3 will provide important clinical rationales to evaluate speech production using instrumental analyses and to identify speech perception deficits when clinicians treat children with CP. The importance of this study is highlighted by the current COVID-19 pandemic. The associated social-distancing restrictions have been imposed upon school teachers and SLPs to adopt telepractice while continuing to provide educational and therapeutic services. Thus, the results of the proposed study will meet an increasing demand for telepractice efficacy studies for children with speech disorders.