ASSIST: Child Apraxia Speech Treatment

项目摘要 儿童言语失用症(CAS)是一种儿童运动性言语障碍，它损害了儿童的言语计划 语音清晰所需的动作。CA可能会限制识字率、学术和经济成果 参与社会。在美国，大约有40,000到16,000名10岁以下的儿童患有CAS，超过60% 的在校言语语言病理学家有患有CAS的儿童要处理，平均有3名 每个案件的儿童数量。患有CAS的儿童在标准语言治疗方面通常进展甚微或缓慢，这 导致了密集干预的建议，并呼吁进行系统研究以优化结果。 考虑到临床环境中有限的资源，必须最大限度地发挥这些有限资源对 患有CAS的儿童。这项建议符合NIDCD的战略计划，因为它旨在开发和测试有效的 对明确指出的未充分研究人群的治疗(CAS)。 CAS的治疗方法有多种，并有完整的刺激治疗(看我的，听我的，说 我所说的“)是迄今为止唯一具有独立复制支持的治疗方法。尽管如此， 目前的证据基础在研究质量和范围上都是有限的。在研究质量方面，到目前为止，所有的研究都 研究采用单病例实验设计，样本量小，方法学严格性各不相同。就.而言 范围，现有的研究在重要的治疗参数方面有很大的差异，这些参数可能会至关重要 影响结果。两个如此重要但知之甚少的参数与最佳目标选择和 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 损害水平结果衡量标准，并未包括与以下内容相关的更多功能性结果衡量标准 主动性和参与性。出于这些原因，言语病理学家缺乏足够的信息来做出 为他们的客户做出临床决策。 拟议的研究是一项第一阶段的研究，从理论上测试一种 基于积分刺激的治疗称为ASSIST(语音失用症)系统积分刺激 治疗)。在三项小规模随机分组设计研究中，儿童(每项研究N=20)接受16小时的 个人助攻。这三项研究系统地研究了治疗强度(2周与4周)和2项 目标选择的关键方面：复杂性(简单目标与复杂目标)和词汇性(单词与非单词)。 每项研究还系统地检查治疗对功能结果指标的影响，包括 父母对可理解性和交际参与的评级，以及获得的客观可理解性测量 来自不熟悉的听众。因此，这项研究将为初步疗效的第二阶段试验收集重要信息。 并提供高质量的证据，帮助言语病理学家进行循证临床 决定。这项研究计划的长期目标是开发最有效的治疗方法，以最大限度地 许多CAS患儿及其家庭的预后和沟通生活质量。

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.