Treating Childhood Apraxia of Speech: Role of Biofeedback & Practice Distribution

儿童言语失用症是一种发育性语音障碍，可能导致 持续的言语错误，通常尽管多年的治疗。这种损伤可能会导致社会， 学术和职业限制。因此，有必要探索替代治疗方法。 本研究将探讨如何通过以下方法改善学龄期CAS儿童的言语发声： 修改一个标准的语言治疗程序两个适应语言治疗将在一个2x测试 2随机分组设计。 在目标1中，我们将比较每周2次一小时疗程的标准治疗方案与 治疗顺序从强化治疗方案开始（一周内治疗10小时）， 然后将过渡到更加分散的练习时间表。这种治疗方法旨在 在学习的早期阶段，尽量减少培训课程之间的错误练习，然后培养 通过增加练习课之间的时间来概括。 在目标2中，我们将比较一个标准的治疗方法，其中只包括对客户的口头反馈 在语音练习期间与最初包括实时超声视觉的治疗序列相比 舌头在说话时的反馈，这将在治疗过程中消失。超声 视觉反馈被设计用于训练发音运动。它可以增强孩子们对 言语运动模式的发音目标，通过比较执行舌头运动与 预期的运动。先前的病例报告和单一受试者实验设计表明， 可以通过包括超声视觉反馈来增强语音声音产生，尽管没有先前的方法 进行了随机分组研究。 除了这些修改之外，治疗的其他方面将保持不变。成果将 通过跟踪大量语音样本中辅音正确率的变化进行评估， 对治疗状态视而不见的人。将对这四组进行比较，以确定 该语音声音治疗可以通过治疗序列来增强， 实践和/或超声视觉反馈。 最后，作为R15机制的一部分，本科生和研究生将参与 临床导向研究。他们将通过接触科学的关键方面来发展科学素养， 科学过程，包括研究设计、行为研究方案的实施、设盲， 可靠性、忠诚度监测和研究中的伦理考虑。

Childhood apraxia of speech is a developmental speech sound disorder that may lead to persisting speech errors, often despite years of treatment. Such impairments may lead to social, academic, and vocational limitations. Thus, there is a need to explore alternate treatment approaches. This study will explore how to improve speech sound production in school-age children with CAS by modifying a standard speech therapy program. Two adaptations to speech therapy will be tested in a 2 x 2 randomized group design. In Aim 1, we will compare a standard treatment schedule of 2 one-hour sessions per week vs. a treatment sequence beginning with an intensive therapy schedule (10 hrs of treatment in one week), which will then transition to a more distributed practice schedule. This treatment modification is intended to minimize erred practice between training sessions in the early stages of learning, then foster generalization through increased time between practice sessions. In Aim 2, we will compare a standard treatment that includes only verbal feedback to the client during speech practice vs. a treatment sequence that initially includes real-time ultrasound visual feedback of the tongue during speech, which will be faded over the course of treatment. Ultrasound visual feedback is designed to train articulatory movements. It may enhance children’s understanding of the articulatory goals of speech movement patterns by comparing executed tongue movements with intended movements. Prior case reports and single subject experimental designs have shown that speech sound production may be enhanced by including ultrasound visual feedback, although no prior randomized group studies have been conducted. Beside these modifications, the other aspects of treatment will be held constant. Outcomes will be evaluated by tracking changes in percent consonants correct from a large speech sample, scored by individuals who are blind to treatment status. The four groups will be compared to determine the extent to which speech sound therapy can be enhanced through a treatment sequence that begins with intensive practice and/or with ultrasound visual feedback. Finally, as part of the R15 mechanism, undergraduate and graduate students will be involved in clinically oriented research. They will develop scientific literacy by being exposed to critical aspects of the scientific process including research design, operationalization of behavioral research protocols, blinding, reliability, fidelity monitoring, and ethical considerations in research.