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Treatment #2 for CAS

Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT)

  • Involves tactile cues from the clinician to the client
  • Manipulates articulators into correct speech sound positions
  • Involves special training for the clinician
  • Process used a bottom-up hierarchy with seven speech stages

Conclusion

"There is not perfect treatment plan and that's ok!"

  • Even though our hypothesis was proven wrong, our study was still beneficial
  • Pondering new thoughts
  • Maybe the treatment plan itself was not the most important aspect of therapy
  • Maybe any treatment plan can be beneficial and even successful if it is implemented by a skilled and experienced clinician
  • Technology of ultrasound biofeedback
  • Beneficial but not a necessity
  • Do not sacrifice budget, but use if you have the resources
  • Implement ultrasound biofeedback into a treatment plan for CAS along with other strategies
  • Choose treatment strategies you are personally skilled and experienced with as a clinician
  • The treatment strategy is not as important as the clinician providing the therapy services

Treatment #3 for CAS

Rapid Syllable Transition (ReST)

  • Motor learning with high frequency of number of sessions
  • Involve many repetitions of pseudo words in random order
  • Practice the movements of speech sounds in different contexts

Results

  • Significant Differences between the 6 research studies:
  • Different number of patients
  • Sessions had different lengths and meeting times
  • Individualized targets
  • Treatment-specific reinforcement and guides
  • Significant Similarities between the 6 research studies:
  • Every participant improved, all yielding a similar amount of gain
  • All therapy services were conducted by skilled and experienced SLPs
  • SLPs were skilled and experienced in the specific treatment strategy they were using
  • Hypothesis was NOT supported
  • Ultrasound Biofeedback was not proven to be a more significant treatment plan for CAS when compared to PROMPT and ReST
  • All treatments gave similar, positive, results

Treatment #1 for CAS:

Ultrasound Biofeedback

Article #4

"Treatment Speech Subsystems in Childhood Apraxia of Speech with Tactie Input: PROMPT Approach" (Phillip, Dale, and Hayden)

  • New and portable untrasound instrument
  • Allows clients to see a real-time image of the articulators inside of their mouth
  • Gives a new perspective and understanding on what correct pronunciations feel and look like
  • Especially helpful with speech sounds that are usually not visible
  • Equipment itself is not client-specific and can be used universally
  • 4 participants, ranging from 3 to 4 years old
  • A total of 16, 50 minute sessions
  • Tactile kinesthetic proprioceptive (TKP) cues 80% accuracy
  • Targets: 15 target phonemes
  • Results: All participants benefitted
  • Evidence that TKP cues add to PROMPT's effectiveness

Article #3

"Effects of PROMPT Therapy of Speech Motor Function in a Person with Aphasia and Apraxia of Speech" (Bose, Square, Schlosser and Van Lieshout)

Article #6

"A Comparison of Two Treatments for Childhood Apraxia of Speech: Methods and Treatment Protocol for a Parallel Group Randomized Control Trial" (Murray, McCabe, and Ballard)

What is Childhood Apraxia of Speech (CAS)?

  • Case study of one individual, 30 years old
  • 50 minute sessions
  • Targets: 30 short phrases
  • Used PROMPT therapy the entire length of the sessions
  • Results: Positive changes when producing simple sentences
  • Speech sound disorder with the absense of speech motor problems
  • Difficulty producing specific sounds, syllables, and words
  • Difficulty formulating a correct speech plan
  • Language skills are intact
  • CAS is challenging to diagnose and requires a differential diagnosis approach from skilled clinicians.
  • 20 participants ranging from age 4-12
  • Total of 12, 60 minute sessions
  • Targets: 292 pseudo words, with 90% accuracy
  • Performed ReST therapy throughout the entire session
  • Results: Study proved ReST to be an effective strategy for CAS, with high frequency of feedback during pre-practice and low frequency of feedback during regular practice

The Purpose of Our Research:

We were both initially interested in Childhood Apraxia of Speech, but we wanted to know more. We wanted to know if there was a treatment for CAS that was more effective than other approaches. We were specifically intrigued when we came across the new approach of ultrasound biofeedback.

How Does Ultrasound Biofeedback Compare as a Treatment Strategy for CAS Against PROMPT or ReST?

Article #2

"Enhancing Generalization in Biofeedback Intervention Using a Challenge Point Framework" (Hitchcock and Byun)

Article #5

"Rapid Syllable Transitions (ReST) Treatment for Childhood Apraxia or Speech: The Effect of Lower Dose - Frequency" (Thomas, McCabe, and Ballard)

  • Case study of one individual, 11 years old
  • A total of 11, 30-45 minute sessions
  • Targets: Single words containing vocalic and consonantal /r/, with 90% accuracy
  • Used ultrasound biofeedback the entire session
  • Results:
  • Word level, gained 77% for the consonantal /r/
  • Sentence level, gained 10% for vocalic /r/ and 100% for cononantal /r/
  • 4 participants from ages 4 to 8
  • Total of 12, 60 minute sessions
  • Targets: 120 items with different sound patterns, 80% accuracy
  • Used ReST 35 minutes of each session
  • Results: All participants improved in segmentation accuracy, stress, and generalization

Article #1

"Ultrasound Biofeedback Treatment for Persisting Childhood Apraxia of Speech"

(Preston, Brick and Landi)

  • 6 participants ages 9-15
  • A total of 18, 60 minute sessions
  • Targets: Monosyllabic and multisyllabic words with 80% accurary
  • Used ultrasound biofeedback for 30 minutes per session
  • Results: 23/31 treated sound sequences met 80% accuracy

Methods

  • Literature Review
  • Analyzed 6 peer reviewed articles
  • 2 articles for ultrasound biofeedback therapy for CAS
  • 2 articles for PROMPT therapy for CAS
  • 2 articles for ReST therapy for CAS
  • Gathered data entered into a table

How Does Ultrasound Biofeedback Compare as a Treatment Strategy for CAS Against PROMPT or ReST?

By: Taylor Lowe & Megan Patton

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