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.
What safety data exists for Speech Motor Chaining Treatment for speech sound disorders?The available research does not specifically address safety data for Speech Motor Chaining Treatment. However, the tutorial on SMC describes it as a structured and evidence-based intervention for school-age children with speech sound disorders, focusing on successful acquisition and generalization of speech patterns. The study on intervention dose frequency and the quality improvement project suggest that intensive interventions can improve outcomes, but they do not provide specific safety data. Overall, while the effectiveness of SMC is supported, explicit safety data is not detailed in the provided research.367911
Is Intensive Speech Motor Chaining Treatment a promising treatment for Speech Sound Disorder?Yes, Intensive Speech Motor Chaining Treatment is promising because it helps children successfully learn and use new speech patterns. It uses principles of motor learning to improve speech, and most children can practice over 200 times in each session, leading to better speech outcomes.12578
What data supports the idea that Speech Therapy for Speech Sound Disorder is an effective treatment?The available research shows that Speech Therapy for Speech Sound Disorder, specifically using Speech Motor Chaining (SMC), is effective. One study found that most children can achieve over 200 successful speech trials per session, and clinicians can implement the procedure with over 90% accuracy. Another case study demonstrated significant improvements in a child with severe speech sound disorder after intensive therapy, with whole word match increasing from 0% to 39% and other speech measures showing similar improvements. This suggests that frequent and direct therapy is beneficial for children with severe speech sound disorders.456710
Do I need to stop taking my current medications for this trial?The trial protocol does not specify whether you need to stop taking your current medications. It seems focused on speech therapy, so it's unlikely that medications would be affected, but you should confirm with the trial organizers.
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.Treatment Details
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.
2Treatment groups
Experimental Treatment
Group I: Intensive TreatmentExperimental Treatment1 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 TreatmentExperimental Treatment1 Intervention
Speech Motor Chaining will be delivered twice weekly for 8 weeks
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Syracuse UniversitySyracuse, NY
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Who is running the clinical trial?
Syracuse UniversityLead Sponsor
State University of New York - Upstate Medical UniversityCollaborator
National Institute on Deafness and Other Communication Disorders (NIDCD)Collaborator
National Institutes of Health (NIH)Collaborator
References
Research on speech motor control and its disorders: a review and prospective. [2019]This paper reviews issues in speech motor control and a class of communication disorders known as motor speech disorders. Speech motor control refers to the systems and strategies that regulate the production of speech, including the planning and preparation of movements (sometimes called motor programming) and the execution of movement plans to result in muscle contractions and structural displacements. Traditionally, speech motor control is distinguished from phonologic operations, but in some recent phonologic theories, there is a deliberate blurring of the boundaries between phonologic representation and motor functions. Moreover, there is continuing discussion in the literature as to whether a given motor speech disorder (especially apraxia of speech and stuttering) should be understood at the phonologic level, the motoric level, or both of these. The motor speech disorders considered here include: the dysarthrias, apraxia of speech, developmental apraxia of speech, developmental stuttering, acquired (neurogenic and psychogenic) stuttering, and cluttering.
Effects of intensive voice treatment (the Lee Silverman Voice Treatment [LSVT]) on ataxic dysarthria: a case study. [2016]This study examined the effects of intensive voice treatment (the Lee Silverman Voice Treatment [LSVT]) on ataxic dysarthria in a woman with cerebellar dysfunction secondary to thiamine deficiency. Perceptual and acoustic measures were made on speech samples recorded just before the LSVT program was administered, immediately after it was administered, and at 9 months follow-up. Results indicate short- and long-term improvement in phonatory and articulatory functions, speech intelligibility, and overall communication and job-related activity following LSVT. This study's findings provide initial support for the application of LSVT to the treatment of speech disorders accompanying ataxic dysarthria. Potential neural mechanisms that may underlie the effects of loud phonation and LSVT are addressed.
Severe speech sound disorders: an integrated multimodal intervention. [2019]This study introduces an integrated multimodal intervention (IMI) and examines its effectiveness for the treatment of persistent and severe speech sound disorders (SSD) in young children. The IMI is an activity-based intervention that focuses simultaneously on increasing the quantity of a child's meaningful productions of target words and providing supports to shape the quality of natural speech productions of target sounds by systematically incorporating the full range of each child's communicative repertoire, including augmentative and alternative communication (AAC) systems and natural speech and language.
Effects of Treatment Intensity on Outcomes in Acquired Apraxia of Speech. [2019]This investigation was designed to examine the effects of treatment intensity (i.e., dose frequency) on the outcomes of Sound Production Treatment (SPT) for acquired apraxia of speech.
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]Even though there are documented benefits of direct intensive intervention for children with speech sound disorders (SSDs), the intensity given at Swedish Speech Language Pathology services rarely exceeds once a week. Also, indirect therapy approaches are commonly employed. The purpose of the present case study was to investigate the effects of an intensive specialist therapy, based on non-linear phonological analysis and motor learning principles. The participant was a boy aged 4:10 years with severe SSD, who previously had received indirect therapy from age 3 with, very limited results. A single subject ABA design was used. At baseline, whole word match was 0%, Word shape CV match was 39% and PCC was 22, 7%. He had no multisyllabic words, no consonant clusters and no established coronals. Intervention was given 4 days weekly for 3 weeks in two periods with a 7-week intervening break and a post therapy assessments. Therapy was focused on establishing multisyllabic words, iambic stress pattern, clusters and coronals with the principle of using already established elements for targeting new elements. At post therapy assessment, whole word match was 39%, word shape CV match was 71% and PCC 69.1%. Multisyllabic words (86%), coronals (82%) and word initial clusters (80%) were established. Without being targeted, back vowels were also present and segment timing improved. The strong treatment effects of this study demonstrate that at least severe cases of SSD require the clinical knowledge and skills that only a SLP can provide and that frequent direct therapy is both beneficial and needed.
Investigating intervention dose frequency for children with speech sound disorders and motor speech involvement. [2020]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.
Tutorial: Speech Motor Chaining Treatment for School-Age Children With Speech Sound Disorders. [2020]Purpose Operationalized treatments for school-age children with speech sound disorders may result in more replicable and evidence-based interventions. This tutorial describes Speech Motor Chaining (SMC) procedures, which are designed to build complex speech around core movements by incorporating several principles of motor learning. The procedures systematically manipulate factors such as feedback type and frequency, practice variability, and stimulus complexity based on the child's performance. Method The rationale and procedures for SMC are described. Examples are presented of how to design stimuli, deliver feedback, and adapt the approach. Free resources are provided to guide clinicians through implementation of the procedure. Data on fidelity of implementation and dose per session are presented. Clinical and research evidence is provided to illustrate likely outcomes with the procedure. Results SMC is a method that can result in successful acquisition of target speech patterns and generalization to untrained words. Most clinicians can implement the procedure with over 90% fidelity, and most children can achieve over 200 trials per session. Conclusion Clinicians and researchers can use or adapt the operationally defined SMC procedures to incorporate several principles of motor learning into treatment for school-age children with speech sound disorders. Supplemental Material https://osf.io/5jmf9/.
Neuromodulation: A combined-therapy protocol for speech rehabilitation in a child with cerebral palsy. [2022]Transcranial direct current stimulation (tDCS) modulates cortical activity and potentiates functional gains achieved during therapeutic protocols. The aim of Integrative Speech Therapy Protocol is to rehabilitate speech in patients with impairments regarding neuropyschomotor development by combining oral motor stimuli, specific articulatory production, and the stimulation of phonological aspects of language.
Applying evidence to practice by increasing intensity of intervention for children with severe speech sound disorder: a quality improvement project. [2023]Speech sound disorder (SSD) affects up to 25% of UK children and may impact on: effective communication; the development of relationships; school progression and overall well-being. The evidence base shows that intervention for children with SSD is more effective and efficient when provided intensively in relation to the number of target sounds elicited in sessions (dose) and number of sessions per week (frequency). Southern Health and Social Care (HSC) Trust's baseline intensity of speech and language therapy (SLT) intervention was similar to that often found in current practice across the UK,where ~30 target sounds were elicited (dose) in once weekly sessions (frequency) over a 6-week block, followed by a break from therapy. This quality improvement (QI) project aimed to increase intensity of intervention for children with severe SSD within Southern HSC Trust's community SLT service to improve outcomes for children and their parents. QI methods supported accurate identification of ten 4-5 year olds with severe SSD and increased the intensity of their intervention over a 12-week period by measuring a range of data and speech outcomes. Findings showed a sustainable increase of dose (number of targets elicited per session) to levels recommended in the research (≥70). However, it was difficult to sustain increased frequency of appointments (to twice weekly) because of contextual factors such as sickness, etc. Accommodating this, measuring days between appointments captured an overall increase in the number of appointments attended across time. Child speech outcomes improved for direct speech measures and parent ratings of intelligibility. The intensive model of intervention has been implemented for children identified with severe SSD across Southern HSC Trust's community service with ongoing audit and development, and findings have been disseminated.
Cross-Modal Somatosensory Repetition Priming and Speech Processing. [2022]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.
Outcome measures for children with speech sound disorder: an umbrella review protocol. [2023]Speech sound disorder (SSD) describes a 'persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication'. There is a need to establish which care pathways are most effective and efficient for children with SSD. Comparison of care pathways requires clearly defined, evidence-based interventions and agreement on how to measure the outcomes. At present, no list of assessments, interventions or outcomes exists.The objective of this paper is to provide a rigorous and detailed protocol for an umbrella review of assessments, interventions and outcomes that target SSD in children. The protocol details the development of a search strategy and trial of an extraction tool.