Abstract
BackgroundChildhood Apraxia of Speech is an impairment of speech motor planning that manifests as difficulty producing the sounds (articulation) and melody (prosody) of speech. These difficulties may persist through life and are detrimental to academic, social, and vocational development. A number of published single subject and case series studies of speech treatments are available. There are currently no randomised control trials or other well designed group trials available to guide clinical practice.Methods/DesignA parallel group, fixed size randomised control trial will be conducted in Sydney, Australia to determine the efficacy of two treatments for Childhood Apraxia of Speech: 1) Rapid Syllable Transition Treatment and the 2) Nuffield Dyspraxia Programme – Third edition. Eligible children will be English speaking, aged 4–12 years with a diagnosis of suspected CAS, normal or adjusted hearing and vision, and no comprehension difficulties or other developmental diagnoses. At least 20 children will be randomised to receive one of the two treatments in parallel. Treatments will be delivered by trained and supervised speech pathology clinicians using operationalised manuals. Treatment will be administered in 1-hour sessions, 4 times per week for 3 weeks. The primary outcomes are speech sound and prosodic accuracy on a customised 292 item probe and the Diagnostic Evaluation of Articulation and Phonology inconsistency subtest administered prior to treatment and 1 week, 1 month and 4 months post-treatment. All post assessments will be completed by blinded assessors. Our hypotheses are: 1) treatment effects at 1 week post will be similar for both treatments, 2) maintenance of treatment effects at 1 and 4 months post will be greater for Rapid Syllable Transition Treatment than Nuffield Dyspraxia Programme treatment, and 3) generalisation of treatment effects to untrained related speech behaviours will be greater for Rapid Syllable Transition Treatment than Nuffield Dyspraxia Programme treatment. This protocol was approved by the Human Research Ethics Committee, University of Sydney (#12924).DiscussionThis will be the first randomised control trial to test treatment for CAS. It will be valuable for clinical decision-making and providing evidence-based services for children with CAS.Trial RegistrationAustralian New Zealand Clinical Trials Registry: ACTRN12612000744853
Highlights
Childhood Apraxia of Speech is an impairment of speech motor planning that manifests as difficulty producing the sounds and melody of speech
Based on these foundational studies, we are well poised to conduct a larger scale clinical trial of Rapid Syllable Transition Treatment (ReST) treatment against Nuffield Dyspraxia Programme – Third edition (NDP3). Our hypotheses for this planned randomised control trial are: 1) treatment gains from pre-treatment to 1 week post-treatment will be similar for both treatments, 2) ReST treatment will result in greater maintenance of treatment effects at 1 and 4 months post-treatment than NDP3 treatment, and 3) ReST treatment will result in greater generalisation of treatment effects to untrained but related speech behaviours at 1 week, 1 month and 4 months post-treatment than NDP3 treatment
A parallel group, fixed size randomised control trial will be conducted in Sydney, Australia to determine the comparative efficacy of two treatments for Childhood Apraxia of Speech: the Rapid Syllable Transition Treatment (ReST) and the Nuffield Dyspraxia Programme – Third edition (NDP3)
Summary
Potential significance This will be the first randomised control trial to test any treatment for CAS [14]. If the treatments are successful, further work in ensuring time-efficient translation into practice can be pursued in effectiveness studies, knowing the treatments are efficacious and such work is warranted Examples of this may include computer-based delivery of treatment to promote home practice and achieve treatment intensity with fewer faceto-face clinician-directed sessions. As both treatments vary in their application of Principles of Motor Learning, future investigations of the treatments may explore the effects of these differences on long-term outcomes. Clinicians will conduct all treatment sessions with two assigned participants using the ReST treatment for one and the NDP3 treatment for the other They will be required to be trained in and deliver both treatments.
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