A randomized control trial of motor-based intervention for childhood apraxia of speech

基于运动的干预儿童言语失用症的随机对照试验

• 批准号: 10376848
• 负责人: Maria Irene Grigos
• 金额: $ 45.24万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-20 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10376848
• 关键词: Acoustics; Address; Aftercare; Articulation; Articulators; Behavior; Child; Clinical Trials; Complex; Control Groups; Data; Decision Making; Development; Developmental apraxia; Effectiveness; Foundations; Future; Gestures; Goals; Individual; Intervention; Lead; Lip structure; Literature; Maintenance; Measures; Methods; Motion; Motor; Movement; Outcome; Outcome Measure; Participant; Pattern; Phase; Policies; Population; Prediction of Response to Therapy; Predictive Factor; Prevalence; Production; Randomized Controlled Trials; Research; Sampling; Speech; Speech Delay; Speech Intelligibility; Tactile; Testing; Therapeutic; Underserved Population; Work; aged; base; clinical practice; design; digital; efficacy study; efficacy testing; evidence base; evidence based guidelines; improved; individual variation; innovation; jaw movement; kinematics; motor control; motor deficit; motor disorder; motor learning; multimodality; phase 1 study; phase 3 study; phonology; primary outcome; public health relevance; research based treatment; response; secondary outcome; service delivery; skills; treatment duration; treatment guidelines; treatment research; treatment response; trial design

CAS is a complex, multivariate speech motor disorder characterized by difficulty planning and programming movements of the speech articulators. Despite the profound impact that CAS can have on a child’s ability to communicate, there is a paucity of treatment research involving this population. The planned research is a Phase II Randomized Control Trial designed to examine the outcomes of Dynamic Temporal and Tactile Cuing (DTTC), a dynamic, multimodal approach to improving speech production, in children with childhood apraxia of speech (CAS). The long-term goal is to provide evidence based guidelines for treatment in children with CAS. The overall objectives of this application, which will be the largest randomized control trial on CAS to date, are (i) to test the efficacy of DTTC in 72 young children with CAS by examining the impact of DTTC on treated words, generalization to untreated words and post-treatment maintenance, and (ii) to examine how individual patterns of speech motor variability impact response to DTTC. The central hypothesis is that DTTC will refine speech motor control and lead to longstanding change in speech production accuracy. The rationale for this work is that research on the efficacy of DTTC will provide a strong scientific foundation for future treatment research on CAS whereby Phase III studies can be conducted. It will also enhance our theoretical understanding of speech motor learning in this underserved population. The central hypothesis will be tested by pursuing three specific aims: 1) Quantify the effects of DTTC on improved speech production (perceptual ratings) in treated words that are maintained post-treatment and generalized to untreated words in children with CAS; 2) Quantify the effects of DTTC on refined speech motor control (kinematic/acoustic measures) in treated words that are maintained post-treatment and generalized to untreated words in children with CAS; and 3) Characterize the effects of speech motor variability (within-subject) at baseline as a predictor of DTTC efficacy in children with CAS. The first aim will be studied by documenting the accuracy and intelligibility of treated words, maintenance post-treatment and generalization to untreated words. The second aim will be studied by measuring the duration and variability of treated words, maintenance post-treatment and generalization to untreated words. For aim three, measures of speech motor variability at baseline will be compared to word accuracy and intelligibility post-treatment. The proposed work is innovative, as it will study the efficacy of a motor-based treatment for CAS (DTTC) in a large sample of young children, use objective measures (kinematic & acoustic) to support evidence-based decision-making and provide new evidence about participant factors that predict response to treatment. These contributions will be significant because they are expected to have a substantial impact on clinical practice by provide strong scientific justification for continued motor based treatment research for children with CAS. There is important

CAS是一种复杂的、多变量的言语运动障碍，其特征是难以规划和编程 发音器官的运动。尽管CAS对孩子的能力有着深远的影响， 由于缺乏沟通，涉及这一人群的治疗研究很少。计划中的研究是 旨在检查动态时间和触觉提示结局的II期随机对照试验 （DTTC），一种动态的，多模式的方法，以改善语音产生，在儿童失用症的儿童， 演讲（CAS）。长期目标是为CAS儿童的治疗提供循证指南。 这项申请的总体目标是，这将是迄今为止最大的CAS随机对照试验， (i)通过检查DTTC对治疗后的CAS的影响， 词，概括为未经处理的话和治疗后的维护，以及（ii）检查个人如何 言语运动变异的模式影响对DTTC的反应。核心假设是，DTTC将完善 并导致言语产生准确性长期变化。这样做的理由 研究DTTC的疗效将为未来的治疗提供强有力的科学基础 研究CAS，从而可以进行III期研究。这也将增强我们的理论 了解这个服务不足的人群的语言运动学习。中心假设将被检验 通过追求三个具体目标：1）量化DTTC对改善语音产生（感知）的影响 在治疗后保持的治疗单词中，并推广到儿童中未治疗的单词 2）量化DTTC对精细言语运动控制（运动学/声学测量）的影响， 在CAS儿童中，治疗后保持的治疗单词和推广到未治疗单词;以及 3)描述基线时言语运动变异性（受试者内）作为DTTC预测因子的影响 CAS儿童的疗效。第一个目标将通过记录的准确性和可理解性进行研究， 处理词、维护后处理和泛化到未处理词。第二个目标是 研究通过测量治疗的话，维持治疗后的持续时间和变化， 对未处理的词的概括。对于目标三，基线时的言语运动变异性测量将是 与处理后的单词准确度和可懂度相比。拟议的工作是创新的，因为它将研究 在大样本幼儿中，以运动为基础的CAS治疗（DTTC）的疗效，使用目的 措施（运动学和声学），以支持基于证据的决策，并提供新的证据， 预测治疗反应的参与者因素。这些贡献将是重要的，因为它们是 通过提供强有力的科学依据，预计将对临床实践产生重大影响， CAS儿童的运动治疗研究。有着重要