ASSIST: Child Apraxia Speech Treatment

协助：儿童失用症言语治疗

• 批准号: 10383670
• 负责人: Edwin Maas
• 金额: $ 38.23万
• 依托单位: TEMPLE UNIV OF THE COMMONWEALTH
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-15 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10383670
• 关键词: Address; Affect; Apraxias; Area; Child; Childhood; Client; Clinical; Complex; Control Groups; Developmental apraxia; Experimental Designs; Family; Genetic Transcription; Goals; Healthcare Systems; Hour; Impairment; Individual; Intervention; Language; Learning; Measures; Methodology; Methods; Motivation; Motor; Motor Skills; Movement; National Institute on Deafness and Other Communication Disorders; Neuronal Plasticity; Outcome; Outcome Measure; Parents; Pathologist; Phase; Population; Prevalence; Quality of life; Randomized; Recommendation; Reporting; Research; Research Design; Resources; Sample Size; Schools; Selection for Treatments; Series; Social Development; Social Functioning; Societies; Speech; Speech Disorders; Speech Intelligibility; Speech Therapy; Strategic Planning; Testing; Translating; base; clinical decision-making; comparative; design; economic outcome; effective therapy; efficacy trial; evidence base; functional outcomes; lexical; literacy; motor learning; optimal treatments; phase 1 study; phase II trial; phase III trial; primary outcome; programs; speech accuracy; success; treatment effect; treatment group; treatment program; treatment response; virtual

Project Summary Childhood apraxia of speech (CAS) is a pediatric motor speech disorder that impairs the planning of movements needed for intelligible speech. CAS may limit literacy, academic and economic outcomes and participation in society. Approximately 40,000 to 160,000 children under 10 have CAS in the US, and over 60% of school-based speech-language pathologists have children with CAS on their caseload, with on average 3 children per caseload. Children with CAS often show little or slow progress in standard speech therapy, which has led to recommendations for intensive intervention and calls for systematic research to optimize outcomes. Given the limited resources in clinical settings, it is imperative to maximize impact of these limited resources for children with CAS. This proposal fits with NIDCD’s Strategic Plan in that it aims to develop and test an effective treatment for an explicitly noted understudied population (CAS). Various treatment approaches for CAS exist, with integral stimulation treatment (“watch me, listen to me, say what I say”) being the only treatment method to date with independently replicated support. Nevertheless, the current evidence base is limited both in study quality and scope. In terms of study quality, all studies to date have involved single-case experimental designs with small sample sizes and varying methodological rigor. In terms of scope, the extant studies vary considerably with respect to important treatment parameters that may critically impact outcomes. Two such important yet poorly understood parameters relate to optimal target selection and optimal treatment intensity. Another limitation of scope is that virtually all studies have relied exclusively on impairment-level outcome measures, and have not included more functional outcome measures related to activity and participation. For these reasons, speech-language pathologists lack adequate information to make clinical decisions for their clients. The proposed research is a Phase I study that tests initial efficacy and optimal parameters of a theoretically based integral stimulation treatment called ASSIST (Apraxia of Speech Systematic Integral Stimulation Treatment). In three small randomized group design studies, children (N=20 per study) receive 16 hours of individual ASSIST. The three studies systematically investigate treatment intensity (2 vs. 4 weeks) and two critical aspects of target selection: complexity (simple vs. complex target) and lexicality (words vs. nonwords). Each study also systematically examines the effect of treatment on functional outcome measures, including parent ratings of intelligibility and communicative participation, and objective intelligibility measures obtained from unfamiliar listeners. Thus, this research will gather vital information for a Phase II trial of preliminary efficacy and contribute high-quality evidence that will help speech-language pathologists make evidence-based clinical decisions. The long term goal of this research program is to develop optimally effective treatments to maximize outcomes and communicative quality of life for the many children with CAS and their families.

项目摘要 儿童言语失用症（CAS）是一种儿童运动性言语障碍， 为了清晰的语言所需要的动作。CAS可能会限制识字，学术和经济成果， 参与社会。在美国，大约有40，000到160，000名10岁以下的儿童患有CAS， 的学校言语语言病理学家在他们的病例中有CAS儿童，平均3 儿童人数。患有CAS的儿童在标准的语言治疗中通常表现出很少或缓慢的进展， 已导致建议进行密集干预，并呼吁进行系统研究以优化结果。 鉴于临床环境中的资源有限，必须最大限度地发挥这些有限资源的影响， 儿童CAS这项建议符合NIDCD的战略计划，因为它旨在制定和测试一项有效的 明确指出的研究不足人群（CAS）的治疗。 CAS存在各种治疗方法，包括整体刺激治疗（“看我，听我说，说 我说什么”）是迄今为止唯一具有独立复制支持的治疗方法。但 目前的证据基础在研究质量和范围上都是有限的。就研究质量而言，迄今为止的所有研究都 涉及小样本量和不同方法的严格性的单例实验设计。方面 范围，现存的研究在重要的治疗参数方面差异很大，这些参数可能是关键的 影响结果。两个重要但知之甚少的参数涉及最佳目标选择， 最佳处理强度范围的另一个限制是，几乎所有的研究都完全依赖于 损伤水平结局指标，未纳入更多与以下相关的功能结局指标 活动和参与。出于这些原因，言语语言病理学家缺乏足够的信息来做出判断 为客户做出临床决策。 拟议的研究是一项I期研究，测试理论上的初始疗效和最佳参数。 ASSIST（Apraxia of Speech Systematic Integral Stimulation） 治疗）。在三项小型随机分组设计研究中，儿童（每项研究N=20）接受16小时的 个别协助。这三项研究系统地研究了治疗强度（2周与4周）， 目标选择的关键方面：复杂性（简单与复杂目标）和词汇性（单词与非单词）。 每项研究还系统地检查了治疗对功能结局指标的影响，包括 父母对可懂度和交流参与度的评分，以及获得的客观可懂度测量结果 来自不熟悉的听众。因此，这项研究将为初步疗效的II期试验收集重要信息 并提供高质量的证据，帮助语言病理学家进行循证临床研究。 决策这项研究计划的长期目标是开发最有效的治疗方法， 结果和沟通生活质量的许多儿童与CAS及其家庭。