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