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/摘要 尽管《残疾人教育法》（IDEA）确保所有残疾儿童 在提供适当的公共教育时，在提供言论方面越来越不公平- 由于公共语言病理学家（SLP）的严重短缺， 学校设置。远程实践是缓解短缺问题的一种方法。目前可用的远程实践研究 已经进行了小样本和不同的方法的严格性。特别是，迄今为止， 通过远程实践对有腭裂病史的儿童进行了治疗效果研究。 脑瘫修复后的儿童通常会出现代偿性发音模式，这在儿童中并不常见 有语言障碍确定远程练习对修复CP的儿童是否有效是当务之急 来治疗代偿性关节炎在评价代偿性发音错误时，存在两个主要的局限性 在目前的文学。首先，这些错误主要是基于听者的认知-知觉 无需工具分析即可做出判断;第二，言语感知如何在产生中发挥作用 代偿性发音尚未得到充分的研究，尽管有充分的证据表明， 感知和生产技能。 作为一项I期随机对照试验（RCT），本提案响应了NIDCR行为社会学研究（NIDCR Behavioral Social）。 干预性临床试验计划与实施合作协议（UG 3/UH 3）。这一提议符合 NIDCR的战略计划，其目的是开发和测试一种有效的行为干预， 口腔和颅面疾病。我们在UG 3一年规划期内的目标是：（1）完成干预措施 协议，（2）制定操作手册，（3）为数据管理系统开发定制软件， （4）言语知觉实验的刺激和软件开发，以完成一个无偏的 UH 3阶段的RCT设计。我们在UH 3阶段的主要目标是（目标1）确定以下药物的疗效： 对脑瘫修复儿童进行远程训练言语干预，并（目的2）定量定义代偿性 发音错误，使用仪器分析，和（目的3），以确定儿童的言语知觉缺陷 在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医学研究。 决定采用远程实践服务提供模式来治疗患有修复CP的儿童。目标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依据 临床医生治疗脑瘫儿童时的感知缺陷。这项研究的重要性是由 当前的COVID-19疫情。相关的社交距离限制已经强加给学校 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，在本发明中， 拟议研究的结果将满足日益增长的对儿童远程练习效果研究的需求 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.