Speech Therapy for Speech Sound Disorder

(iChain Trial)

Recruiting in Palo Alto (17 mi)

Overseen by Jonathan Preston, PhD

Age: < 18

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 1 & 2

Recruiting

Sponsor: Syracuse University

Disqualifiers: Autism, Down Syndrome, Cerebral palsy, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

This trial is testing two different schedules for speech therapy in children with persistent speech problems. One schedule spreads sessions over a longer period, while the other packs them into a shorter time. The idea is that more frequent sessions might help children learn correct speech sounds better by reducing mistakes between sessions.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Intensive Speech Motor Chaining Treatment for Speech Sound Disorder?

Research shows that Speech Motor Chaining (SMC) can help children with speech sound disorders successfully learn new speech patterns and apply them to words they haven't practiced. Clinicians can implement this method effectively, and children can achieve a high number of practice trials per session, leading to improved speech outcomes. ^{1 2 3 4 5}

Is Speech Motor Chaining Treatment safe for children with speech sound disorders?

The available research does not specifically address safety concerns for Speech Motor Chaining Treatment, but it is generally used in clinical settings for children with speech sound disorders without reported safety issues. ^{1 5 6 7 8}

How is the Intensive Speech Motor Chaining Treatment different from other treatments for speech sound disorders?

The Intensive Speech Motor Chaining Treatment is unique because it focuses on building complex speech patterns around core movements using principles of motor learning, such as feedback manipulation and practice variability, which helps children generalize learned speech patterns to new words. ^{1 4 9 10 11}

Research Team

Jonathan Preston, PhD

Principal Investigator

Syracuse University

Eligibility Criteria

This trial is for American English-speaking children aged 9 to 17 with speech sound disorders, specifically difficulty with /ɹ/ and /s/ sounds. They must have started learning English by age 3, pass a hearing test, score adequately on language understanding tests, and want to improve their speech. Children with cleft palate, voice disorders, autism spectrum disorder, Down Syndrome, cerebral palsy, intellectual disability or brain injury are excluded.

Inclusion Criteria

Must have reported difficulty with /ɹ/ and/or /s/ production

Must receive a percentile score of 5 or below on the Goldman-Fristoe Test of Articulation-3 (GFTA-3) Sounds in Words subtest

Must pass pure tone hearing screening at 25 dB at 1000, 2000, and 4000 Hz

Exclusion Criteria

Must have no known history of autism spectrum disorder, Down Syndrome, cerebral palsy, intellectual disability, permanent hearing loss, or brain injury

Must not have current cleft palate or voice disorder

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive Speech Motor Chaining treatment. Distributed schedule: 2 sessions per week for 8 weeks. Intensive schedule: 16 sessions over 4 weeks.

4-8 weeks

16 sessions total

Follow-up

Participants are monitored for speech sound learning and social, emotional, and academic impacts after treatment

10 weeks

Treatment Details

Interventions

• Intensive Speech Motor Chaining Treatment (Behavioral Intervention)

Trial Overview The study compares two different schedules of Speech Motor Chaining treatment: a 'Distributed' schedule (2 sessions per week for 8 weeks) versus an 'Intensive' schedule (16 hours of treatment over 4 weeks). The aim is to see which schedule better helps school-age children learn correct speech sounds in cases of residual speech sound disorder.

Participant Groups

Group I: Intensive Treatment Experimental Treatment 1 Intervention

Speech Motor Chaining will be delivered in an intensive fashion. Week 1: 8 sessions (2 sessions per day on 4 different days) Week 2: 3 sessions (1 per day on 3 different days) Week 3: 3 sessions (1 per day on 3 different days) Week 4: 2 sessions (1 per day on 2 different days)

Group II: Distributed Treatment Experimental Treatment 1 Intervention

Speech Motor Chaining will be delivered twice weekly for 8 weeks

Who Is Running the Clinical Trial?

Syracuse University

Lead Sponsor

Trials

54

Recruited

118,000+

State University of New York - Upstate Medical University

Collaborator

Trials

176

Recruited

27,600+

Dr. Amy Tucker

State University of New York - Upstate Medical University

Chief Medical Officer

MD, MHCM

Dr. Robert J. Corona

State University of New York - Upstate Medical University

Chief Executive Officer since 2019

DO from New York Institute of Technology College of Osteopathic Medicine, MBA from University of Massachusetts at Amherst

National Institute on Deafness and Other Communication Disorders (NIDCD)

Collaborator

Trials

377

Recruited

190,000+

Joshua M. Levy

National Institute on Deafness and Other Communication Disorders (NIDCD)

Chief Medical Officer

MD, MPH, MS

Debara L. Tucci

National Institute on Deafness and Other Communication Disorders (NIDCD)

Chief Executive Officer since 2019

MD, MS, MBA

National Institutes of Health (NIH)

Collaborator

Trials

2,896

Recruited

8,053,000+

Dr. Jeanne Marrazzo

National Institutes of Health (NIH)

Chief Medical Officer

MD from University of California, Los Angeles

Dr. Jay Bhattacharya

National Institutes of Health (NIH)

Chief Executive Officer

MD, PhD from Stanford University

Findings from Research

Speech Motor Chaining (SMC) is an effective treatment method for school-age children with speech sound disorders, promoting the acquisition of target speech patterns and generalization to untrained words.

Clinicians can implement SMC with over 90% fidelity, allowing children to complete more than 200 trials per session, which supports the method's practicality and potential for positive outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tutorial: Speech Motor Chaining Treatment for School-Age Children With Speech Sound Disorders. Preston, JL., Leece, MC., Storto, J.[2020]

In a study involving five men with chronic apraxia of speech, both intense and traditional Sound Production Treatment (SPT) improved articulation, but the traditional method showed better long-term retention of gains.

The less intense SPT (1 hour per day) led to superior maintenance of accuracy for untreated words compared to the more intense SPT (3 hours per day), suggesting that a distributed approach may be more effective for lasting improvements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Treatment Intensity on Outcomes in Acquired Apraxia of Speech. Wambaugh, JL., Wright, S., Boss, E., et al.[2019]

The study found that somatosensory inputs to oro-facial structures significantly improved speech processing for low-frequency words, indicating that these sensory cues can enhance lexical access and speech production accuracy.

In contrast, stimulation applied to non-speech areas (forehead) did not produce any significant effects, reinforcing the idea that targeted somatosensory interventions can effectively influence motor speech treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cross-Modal Somatosensory Repetition Priming and Speech Processing. Namasivayam, AK., Yan, T., Bali, R., et al.[2022]

Intensive therapy for a 4-year-old boy with severe speech sound disorders, conducted 4 days a week for 3 weeks, led to significant improvements in speech, including a 39% increase in whole word match and the establishment of multisyllabic words and consonant clusters.

The results highlight that severe cases of speech sound disorders benefit greatly from frequent, direct intervention by a speech-language pathologist, suggesting that current practices of less frequent therapy may not be sufficient.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A shift of treatment approach in speech language pathology services for children with speech sound disorders - a single case study of an intense intervention based on non-linear phonology and motor-learning principles. Lundeborg Hammarström, I., Svensson, RM., Myrberg, K.[2020]

A study involving 48 children with severe speech sound disorders (SSD-MSI) found that both once and twice weekly treatment sessions using the Motor Speech Treatment Protocol (MSTP) led to significant improvements in speech production over 10 weeks.

However, there were no significant differences in outcomes between the two treatment frequencies, suggesting that increasing the number of sessions may not provide substantial additional benefits, and a cost-benefit analysis is recommended for determining optimal treatment frequency.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Investigating intervention dose frequency for children with speech sound disorders and motor speech involvement. Namasivayam, AK., Pukonen, M., Goshulak, D., et al.[2020]

This study aims to create a comprehensive protocol for an umbrella review that will identify effective assessments, interventions, and outcomes for treating speech sound disorders (SSD) in children, addressing a significant gap in current research.

The review will include studies of children with SSD of unknown origin and will follow established guidelines to ensure a rigorous evaluation of existing care pathways, ultimately aiming to improve treatment strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcome measures for children with speech sound disorder: an umbrella review protocol. Harding, S., Burr, S., Cleland, J., et al.[2023]

The integrated multimodal intervention (IMI) effectively improved both the quantity and quality of speech in three young boys (ages 4 to 8) with moderate to severe speech sound disorders, who were using speech-generating AAC systems.

By combining natural speech practices with AAC support, the IMI led to significant positive changes in communication abilities, suggesting that this approach can enhance traditional speech therapy methods for children with speech sound disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Severe speech sound disorders: an integrated multimodal intervention. King, AM., Hengst, JA., DeThorne, LS.[2019]

A quality improvement project increased the intensity of speech and language therapy for children with severe speech sound disorder (SSD) from an average of 30 target sounds to over 70 per session, aligning with research recommendations.

Despite challenges in increasing the frequency of therapy sessions to twice a week, improvements were observed in children's speech outcomes and parent ratings of intelligibility, demonstrating the effectiveness of a more intensive intervention model.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Applying evidence to practice by increasing intensity of intervention for children with severe speech sound disorder: a quality improvement project. McFaul, H., Mulgrew, L., Smyth, J., et al.[2023]

A case study involving a child with cerebral palsy showed that combining transcranial direct current stimulation (tDCS) with integrative speech therapy led to significant improvements in speech, including an increase in the percentage of correct consonants and the ability to produce two- and three-syllable words.

The therapy involved two phases of tDCS targeting different brain areas, resulting in a notable increase in phoneme production, suggesting that tDCS can enhance the effectiveness of speech rehabilitation in children with speech impairments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neuromodulation: A combined-therapy protocol for speech rehabilitation in a child with cerebral palsy. Lima, VLCC., Cosmo, C., Lima, KB., et al.[2022]

The Lee Silverman Voice Treatment (LSVT) led to significant short- and long-term improvements in speech functions, including phonation, articulation, and overall communication in a woman with ataxic dysarthria due to cerebellar dysfunction from thiamine deficiency.

The study suggests that LSVT may be an effective treatment for speech disorders associated with ataxic dysarthria, with potential neural mechanisms linked to the benefits of loud phonation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of intensive voice treatment (the Lee Silverman Voice Treatment [LSVT]) on ataxic dysarthria: a case study. Sapir, S., Spielman, J., Ramig, LO., et al.[2016]

Speech motor control involves complex systems that manage how we plan and execute speech movements, which is crucial for understanding communication disorders like motor speech disorders.

There is ongoing debate about whether disorders such as apraxia of speech and stuttering should be viewed primarily through the lens of motor control or phonologic processes, highlighting the need for a comprehensive approach to treatment and understanding.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Research on speech motor control and its disorders: a review and prospective. Kent, RD.[2019]

References

1. United States pubmed.ncbi.nlm.nih.gov

Tutorial: Speech Motor Chaining Treatment for School-Age Children With Speech Sound Disorders. [2020]

2. United States pubmed.ncbi.nlm.nih.gov

Effects of Treatment Intensity on Outcomes in Acquired Apraxia of Speech. [2019]

3. Singapore pubmed.ncbi.nlm.nih.gov

Cross-Modal Somatosensory Repetition Priming and Speech Processing. [2022]

4. England pubmed.ncbi.nlm.nih.gov

A shift of treatment approach in speech language pathology services for children with speech sound disorders - a single case study of an intense intervention based on non-linear phonology and motor-learning principles. [2020]

5. United States pubmed.ncbi.nlm.nih.gov

Investigating intervention dose frequency for children with speech sound disorders and motor speech involvement. [2020]

6. England pubmed.ncbi.nlm.nih.gov

Outcome measures for children with speech sound disorder: an umbrella review protocol. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

Severe speech sound disorders: an integrated multimodal intervention. [2019]

8. England pubmed.ncbi.nlm.nih.gov

Applying evidence to practice by increasing intensity of intervention for children with severe speech sound disorder: a quality improvement project. [2023]

9. United States pubmed.ncbi.nlm.nih.gov

Neuromodulation: A combined-therapy protocol for speech rehabilitation in a child with cerebral palsy. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Effects of intensive voice treatment (the Lee Silverman Voice Treatment [LSVT]) on ataxic dysarthria: a case study. [2016]

11. United States pubmed.ncbi.nlm.nih.gov

Research on speech motor control and its disorders: a review and prospective. [2019]