Predictors of Functional Communication Outcomes in Children With Idiopathic Motor Speech Disorders.

PURPOSE: The purpose of the study was to investigate child- and intervention-level factors that predict improvements in functional communication outcomes in children with motor-based speech sound disorders. METHOD: Eighty-five preschool-age children with childhood apraxia of speech (n = 37) and speech motor delay (n = 48) participated. Multivariable logistic regression models estimated odds ratios and 95% confidence intervals for the association between minimal clinically important difference in the Focus on the Outcomes of Communication Under Six scores and multiple child-level (e.g., age, sex, speech intelligibility, Kaufman Speech Praxis Test diagnostic rating scale) and intervention-level predictors (dose frequency and home practice duration). RESULTS: Overall, 65% of participants demonstrated minimal clinically important difference changes in the functional communication outcomes. Kaufman Speech Praxis Test rating scale was significantly associated with higher odds of noticeable change in functional communication outcomes in children. There is some evidence that delivering the intervention for 2 times per week for 10 weeks provides benefit. CONCLUSION: A rating scale based on task complexity has the potential for serving as a screening tool to triage children for intervention from waitlist and/or determining service delivery for this population.

Cross-Modal Somatosensory Repetition Priming and Speech Processing.

BACKGROUND: Motor speech treatment approaches have been applied in both adults with aphasia and apraxia of speech and children with speech-sound disorders. Identifying links between motor speech intervention techniques and the modes of action (MoA) targeted would improve our understanding of how and why motor speech interventions achieve their effects, along with identifying its effective components. The current study focuses on identifying potential MoAs for a specific motor speech intervention technique. OBJECTIVES: We aim to demonstrate that somatosensory inputs can influence lexical processing, thus providing further evidence that linguistic information stored in the brain and accessed as part of speech perception processes encodes information related to speech production. METHODS: In a cross-modal repetition priming paradigm, we examined whether the processing of external somatosensory priming cues was modulated by both word-level (lexical frequency, low- or high-frequency) and speech sound articulatory features. The study participants were divided into two groups. The first group consisted of twenty-three native English speakers who received somatosensory priming stimulation to their oro-facial structures (either to labial corners or under the jaw). The second group consisted of ten native English speakers who participated in a control study where somatosensory priming stimulation was applied to their right or left forehead as a control condition. RESULTS: The results showed significant somatosensory priming effects for the low-frequency words, where the congruent somatosensory condition yielded significantly shorter reaction times and numerically higher phoneme accuracy scores when compared to the incongruent somatosensory condition. Data from the control study did not reveal any systematic priming effects from forehead stimulation (non-speech related site), other than a general (and expected) tendency for longer reaction times with low-frequency words. CONCLUSIONS: These findings provide further support for the notion that speech production information is represented in the mental lexicon and can be accessed through exogenous Speech-Language Pathologist driven somatosensory inputs related to place of articulation.

PROMPT intervention for children with severe speech motor delay: a randomized control trial.

BACKGROUND: Currently, there is limited information on the intervention efficacy for children with speech motor delay (SMD). This randomized control trial (RCT) study examined the effectiveness of Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) intervention to improve the outcomes in children with SMD. We hypothesized that children with SMD receiving PROMPT intervention would improve more in the measured outcomes than those waitlisted and receiving home training. METHODS: Using a two-arm, parallel group, RCT, 49 children with SMD were allocated to either an intervention group (N = 24) that received 45 min of PROMPT intervention two times a week for 10 weeks or were waitlisted for the same duration and received only home training instructions (N = 25). Outcome measures for speech motor control, articulation, speech intelligibility (word and sentence levels), and functional communication were assessed at baseline and at a 10-week follow-up. RESULTS: PROMPT intervention was associated with notable improvements in speech motor control, speech articulation, and word-level speech intelligibility. Intervention allocation yielded weak improvements in sentence-level speech intelligibility and functional communication. CONCLUSIONS: PROMPT intervention is a clinically effective intervention approach for children with SMD. IMPACT: Currently, there is limited information on the intervention efficacy for children with SMD. We report on the findings of a phase III intervention efficacy study on children with SMD using an RCT design. PROMPT intervention is a clinically effective intervention approach for children with SMD. Results of the study will be fundamental to the delivery of effective services for this population. These findings may facilitate the development of an evidence-based care pathway for children with severe speech sound disorders.

Investigating intervention dose frequency for children with speech sound disorders and motor speech involvement.

BACKGROUND: Treatment outcome data for children with severe speech sound disorders with motor speech involvement (SSD-MSI) are derived from Phase I clinical research studies. These studies have demonstrated positive improvements in speech production. Currently there is no research examining the optimal treatment dose frequency for this population. The results of this study, which is the first of its kind, will inform the delivery of effective services for this population. AIMS: To investigate optimal treatment dose frequency for the Motor Speech Treatment Protocol (MSTP) for children with SSD-MSI. METHODS & PROCEDURES: A total of 48 children (aged 43-47 months) with SSD-MSI participated in the study. Participants received 45-min MSTP intervention sessions either once per week (lower dose frequency) or twice per week (higher dose frequency) for a 10-week period. Blinded outcome assessments were carried out at pre- and post-intervention. OUTCOMES & RESULTS: Treatment-related change was assessed at body structures, functions and activities participation level as per the World Health Organization's International Classification of Functioning framework: Children and Youth Version (ICF-CY) framework WHO (2007). These measures are related to articulation, functional communication and speech intelligibility. One-way analysis of variance (ANOVA) revealed that for all variables the baseline scores were not statistically different (p > 0.05) between the two dose-frequency groups. Overall, there was a significant main effect of Time (pre-post) across all variables (p < 0.01). However, repeated-measures ANOVA did not result in any statistical interactions (Time × Dose frequency) for any of the variables tested (p > 0.05). Only marginal clinical advantages (< 4% change in intelligibility) were noted with the 10 extra sessions. CONCLUSIONS & IMPLICATIONS: Overall, the MSTP intervention approach in conjunction with home practice led to significant positive changes for all measures in children with SSD-MSI. No statistical differences between high- and low-dose-frequency groups were observed for any of the variables. Clinical effects were examined using effect sizes, as well as changes in articulation, speech intelligibility and functional communication; these differed marginally between the two dose frequencies. This suggests limited benefits of 10 additional sessions per block. Thus, it is recommended that caregivers, speech-language therapists and policy-makers perform a cost-benefit analysis before determining the dose frequency, when considering additional sessions per block.

Linguistic and emotional-valence characteristics of reading passages for clinical use and research.

Purpose: Fluency assessment in people who stutter (PWS) includes reading aloud passages. There is little information on properties of these passages that may affect reading performance: emotional valance, arousal, word familiarity and frequency and passage-readability. Our first goal was to present an extensive examination of these factors in three commonly used ("traditional") passages. The second goal was to compare a traditional passage to a new passage, designed to minimize the impact of these properties. Methods: Content words were rated (129 participants) on arousal, valence and familiarity. Other linguistic features were analyzed based on available datasets. This information was used to assess traditional passages, and to construct a new well-balanced passage, made of neutral, low-arousal and highly-familiar words. Readability for all passages was tested using formula-based and CLOZE tests (31 participants). Finally, 26 PWS were evaluated on fluency comparing the commonly used "Rainbow" passage with the novel one. Results: The three traditional passages contain a share of emotionally valenced (22-34%), high arousal (15-18%), lower familiarity (6-8%) and polysyllabic (5-9%) content words. Readability was highest for the novel passage (on formula-based scales). Average disfluencies percent for the Rainbow and our novel passage were not significantly different. Yet half of the individuals in this sample showed a large difference between the two passages. Conclusion: We provide detailed information on potential sources of variance using the traditional passages. Knowledge about these characteristics can inform clinical practice (and research). We suggest a combined procedure, using more than one passage to assess stuttering in individual cases.

Quality of statistical reporting in developmental disability journals.

Null hypothesis significance testing (NHST) dominates quantitative data analysis, but its use is controversial and has been heavily criticized. The American Psychological Association has advocated the reporting of effect sizes (ES), confidence intervals (CIs), and statistical power analysis to complement NHST results to provide a more comprehensive understanding of research findings. The aim of this paper is to carry out a sample survey of statistical reporting practices in two journals with the highest h5-index scores in the areas of developmental disability and rehabilitation. Using a checklist that includes critical recommendations by American Psychological Association, we examined 100 randomly selected articles out of 456 articles reporting inferential statistics in the year 2013 in the Journal of Autism and Developmental Disorders (JADD) and Research in Developmental Disabilities (RDD). The results showed that for both journals, ES were reported only half the time (JADD 59.3%; RDD 55.87%). These findings are similar to psychology journals, but are in stark contrast to ES reporting in educational journals (73%). Furthermore, a priori power and sample size determination (JADD 10%; RDD 6%), along with reporting and interpreting precision measures (CI: JADD 13.33%; RDD 16.67%), were the least reported metrics in these journals, but not dissimilar to journals in other disciplines. To advance the science in developmental disability and rehabilitation and to bridge the research-to-practice divide, reforms in statistical reporting, such as providing supplemental measures to NHST, are clearly needed.

Treatment intensity and childhood apraxia of speech.

BACKGROUND: Intensive treatment has been repeatedly recommended for the treatment of speech deficits in childhood apraxia of speech (CAS). However, differences in treatment outcomes as a function of treatment intensity have not been systematically studied in this population. AIM: To investigate the effects of treatment intensity on outcome measures related to articulation, functional communication and speech intelligibility for children with CAS undergoing individual motor speech intervention. METHODS & PROCEDURES: A total of 37 children (32-54 months of age) with CAS received 1×/week (lower intensity) or 2×/week (higher intensity) individual motor speech treatment for 10 weeks. Assessments were carried out before and after a 10-week treatment block to study the effects of variations in treatment intensity on the outcome measures. OUTCOMES & RESULTS: The results indicated that only higher intensity treatment (2×/week) led to significantly better outcomes for articulation and functional communication compared with 1×/week (lower intensity) intervention. Further, neither lower nor higher intensity treatment yielded a significant change for speech intelligibility at the word or sentence level. In general, effect sizes for the higher intensity treatment groups were larger for most variables compared with the lower intensity treatment group. CONCLUSIONS & IMPLICATIONS: Overall, the results of the current study may allow for modification of service delivery and facilitate the development of an evidence-based care pathway for children with CAS.

Physiological effects of an 8-week mechanically aided resistance facial exercise program.

This paper describes a study that for the first time addresses the physiological effects of an 8-week mechanically aided facial exercise program, using the Facial-Flex device (Facial Concepts, Inc., Blue Bell, PA) with four healthy individuals with no motor, speech, language, or hearing problems. For a variety of non-speech and speech tasks, upper and lower lip muscle activity (EMG) and upper and lower lip movements were recorded at two baseline sessions (separated by 1 week) and immediately after an 8-week training period. The results indicate that after the training period, all four subjects showed an increase in the number of task repetitions and the duration of isometric contraction using the Facial-Flex device with a fixed resistance (Linebaugh tests). However, with respect to physiological changes as related to the exercise program, the results were mixed. Only one subject showed the expected significant increase in normalized EMG activity. This response was mirrored in a significant overall increase in movement range and peak velocity after the 8-week training period. Regarding the other three subjects, one subject showed no systematic training effect at all, whereas the remaining two subjects showed a significant increase in movement duration. Non-speech and speech tasks were found to be clearly different in their overall physiological characteristics; speech related movements were found to be more clearly defined in terms of larger amplitudes, shorter durations, higher peak velocities, and less variable movement cycles. The apparent discrepancy between the results of the Linebaugh tests and the physiological measures on specific oro-motor tasks warrants some caution in drawing conclusions on changes in the oro-motor system based on general performance measures. Further studies with well-defined clinical populations are needed to assess the usefulness of this device as an aid in the treatment of speech disorders based on motor system impairments.