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

项目摘要/摘要 尽管《残疾人教育法》(IDEA)确保所有残疾儿童 都得到了适当的公众教育，在提供演讲方面的不平等日益加剧- 由于公共场合严重缺乏言语语言病理学家(SLP)，全美的语言服务 学校环境。远程实践是缓解短缺问题的一种方式。目前可用的远程实践研究 以小样本和不同的方法严格性进行了研究。特别是，到目前为止还没有 通过远程练习对有腭裂(CP)病史的儿童进行了疗效研究。 修复脑瘫的儿童通常会出现代偿性发音模式，这在儿童中并不常见 患有语言障碍。确定远程练习对修复的脑瘫儿童是否有效是当务之急 治疗代偿性发音。在评估补偿性发音错误时，存在两个主要限制 在当前的文学作品中。首先，这些错误主要是基于听者的听觉-知觉来检查的 没有工具分析的判断；第二，言语知觉如何在 补偿性发音尚未得到充分研究，尽管大量证据表明 感知和制作技能。 作为一项I期随机对照试验(RCT)，该建议响应了NIDCR行为社会 干预临床试验规划与实施合作协议(UG3/UH3)。这项建议符合 NIDCR的战略计划是，它旨在开发和测试一种有效的行为干预方法，用于治疗患有 口腔和颅面部疾病。我们在UG3一年规划期间的目标是(1)最终确定干预措施 协议，(2)开发操作手册，(3)为数据管理系统开发定制软件， 以及(4)针对语音感知实验的刺激物和软件的开发，以完成无偏 UH3阶段的RCT设计。我们在UH3阶段的主要目标是(目标1)确定 对修复的脑瘫儿童进行远程语音干预，并(目标2)定量定义代偿性 使用仪器分析的发音错误，以及(目标3)确定儿童的言语感知缺陷 有CP。这项研究将具有临床意义，因为Aim 1将帮助临床医生进行循证 决定采用远程实践服务提供模式来治疗修复的脑瘫儿童。AIMS 2-3将提供 使用仪器分析评估言语产生和识别言语的重要临床原理 临床医生治疗儿童脑性瘫痪时的认知缺陷。这项研究的重要性从以下几个方面突显出来 当前的新冠肺炎大流行。相关的社交距离限制已被强加给学校 教师和SLP采用远程实践，同时继续提供教育和治疗服务。因此， 拟议的研究结果将满足对儿童远程实践疗效研究日益增长的需求 患有语言障碍。

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.