The Impact of Individual-Level Factors on Progress in Speech Therapy for Children with Childhood Apraxia of Speech (CAS)
Committee memberAlpert, Rebecca T. (Rebecca Trachtenberg), 1950-
Coffman, Donna L.
Robin, Donald A.
Childhood apraxia of speech
Speech sound disorder
Permanent link to this recordhttp://hdl.handle.net/20.500.12613/7991
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AbstractChildhood apraxia of speech (CAS) is a motor-based disorder that often results in long-term communication challenges, as well as adverse academic and psychosocial consequences. Response to CAS treatment is variable, with some children achieving slow or limited progress. A better understanding of factors associated with treatment response is needed to generate accurate prognoses and guide future development of efficient, targeted treatments. This dissertation research includes two studies. Study 1 examined speech perception skills among children with CAS using a discrimination (AX) task and a mispronunciation detection (MPD) task. Study 2 examined the association between four individual-level characteristics—age, speech accuracy, inconsistency, and perception—and CAS treatment response. Participants included 27 children (Study 2; subset of 12 children for Study 1) involved in an ongoing clinical trial for CAS (i.e., the “parent trial;” ClinicalTrials.gov ID = NCT03903120). Research questions were addressed using nonparametric correlation and t-tests, as well as multivariable linear regression. Results from Study 1 indicated that speech perception ability (1) did not differ by task, (2) did not differ by consonant and vowel conditions, (3) was positively correlated with age and speech accuracy, and negatively associated with speech inconsistency and nonverbal cognition, and (4) did not change after integral stimulation treatment. Results from Study 2 indicated that speech perception ability was the sole significant predictor of CAS treatment response, such that children with better perceptual skills at baseline made greater treatment gains. Further research is needed to replicate and extend these findings.
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A Systematic Examination of Practice Amount in Childhood Apraxia of Speech (CAS) Treatment Using an Integral Stimulation ApproachMaas, Edwin; Reilly, Jamie; Kohen, Francine (Temple University. Libraries, 2017)The purpose of this study was to examine how a critical principle of motor learning, practice amount (high number of trials versus a low number of trials), affects speech motor learning in childhood apraxia of speech (CAS). It also sought to contribute to the literature base regarding using an integral stimulation approach for these children. Currently, a limited evidence base exists for decision-making regarding practice amount in CAS treatment. Using a single-case experimental design with two participants, three target sets of utterances (High Amount, Low Amount, and Control) received different amounts of treatment. Outcomes were compared in terms of retention. Targets were scored regarding perceptual (prosodic and segmental) accuracy. Effect sizes were computed to quantify the extent of treatment effects. For both participants, results show some evidence suggesting a higher amount of practice is advantageous and leads to greater learning. A low amount of treatment did not show clear differences compared to not receiving any treatment. Caution should be taken when interpreting these findings due to its small sample size and modest effects. Results suggest that the integral stimulation approach may only be effective if provided with a significantly high amount of practice. Further research is needed to examine how the principles of motor learning and the integral stimulation approach should be sensibly and systematically applied to promote best outcomes for this population.
Feedback Control in Treatment for Apraxia of SpeechMaas, Edwin; DeDe, Gayle; Kohen, Francine (Temple University. Libraries, 2020)Apraxia of speech (AOS) is a motor speech disorder associated with an impairment in motor planning and programming. It is therefore a logical step to derive treatment of the disorder from the principles of motor learning. Principles of motor learning refer to relatively predictable benefits of certain practice conditions over others (e.g., random practice enhances learning compared to blocked practice). A number of studies have begun to examine principles of motor learning in treatment for AOS (e.g., Austermann Hula et al., 2008; Katz et al., 2010). The current project aims to continue the investigation of motor learning principles and its application to motor speech disorders. In particular, the primary goal of this study is to examine the role of feedback control in treatment for AOS. Two types of feedback control are typically distinguished: self-controlled feedback and clinician-controlled feedback (Chiviacowsky & Wulf, 2004; Chiviacowsky & Wulf, 2007; Janelle, Barba, Frehlich, Tennant, & Cauraugh, 1997; Wulf, 2007). A secondary goal is then to examine the efficacy of script training for AOS. Youmans et al. (2011) provided promising initial evidence supporting its efficacy for AOS, yet no studies have replicated these findings (Ballard et al., 2015). The results of this study suggest that self-controlled feedback is more efficacious in treating adults with AOS than clinician-controlled feedback. Greater improvements of performance for self-controlled feedback were noted especially in accuracy of productions. There was the potential to impact rate of speech as well. Findings across conditions (treated versus untreated scripts) also indicate that script training is an efficacious method of treating adults with AOS.
The Role of Frustration in Intensive Treatment of Childhood Apraxia of SpeechMaas, Edwin; Caspari, Susan; Alpert, Rebecca T. (Rebecca Trachtenberg), 1950- (Temple University. Libraries, 2021)Purpose: This study primarily investigates the effects and influence of frustration in children with childhood apraxia of speech (CAS) in the setting of intensive treatment. Additionally, the study examines the interrater reliability of the frustration rating scale used in an intensive CAS treatment study. Methods: Frustration and treatment data obtained from 17 participants (between 4;0-9;11 years) with CAS in an intensive treatment research study were retrospectively used to determine potential relationships related to frustration in treatment (target complexity, temporal conditions, session number, CAS severity). Interrater reliability of the frustration rating scale was assessed with 34 randomly selected treatment session videos scored by a blinded second rater and compared to original scores. Results: Interrater reliability of the scale was poor to fair but had relatively close agreement within one scale point. Frustration levels were observed to decrease over the course of the treatment period but were typically greater in the afternoon sessions compared to morning. Participants in the complex target treatment condition with lower frustration also exhibited better outcomes than those with greater frustration. No other relationships were observed. Conclusions: Due to relatively poor interrater reliability of frustration scoring system used to obtain data used in the current study, results of the study should be interpreted cautiously. There may be a relationship between frustration levels in children with CAS and treatment conditions and outcomes, but other factors may influence both variables and further investigation into frustration is necessary to draw stronger conclusions.