Tabletop versus microcomputer-assisted speech management: response evocation phase

Optimizing Outcomes for Children With Phonological Impairment: A Systematic Search and Review of Outcome and Experience Measures Reported in Intervention Research

PURPOSE

Reporting of outcome and experience measures is critical to our understanding of the effect of intervention for speech sound disorders (SSD) in children. There is currently no agreed-upon set of measures for reporting intervention outcomes and experiences. In this article, we introduce the Speech Outcome Reporting Taxonomy (SORT), a tool designed to assist with the classification of outcome and experience measures. In a systematic search and review using the SORT, we explore the type and frequency of these measures reported in intervention research addressing phonological impairment in children. Given the integral relationship between intervention fidelity and intervention outcomes, reporting of fidelity is also examined.

METHOD

Five literature databases were searched to identify articles written or translated into English published between 1975 and 2020. Using the SORT, outcome and experience measures were extracted and categorized. The number of intervention studies reporting fidelity was determined.

RESULTS

A total of 220 articles met inclusion criteria. The most frequently reported outcome domain was broad generalization measures (n = 142, 64.5%), followed by specific measures of generalization of an intervention target (n = 133, 60.5%). Eleven (5.0%) articles reported measures of the impact of the phonological impairment on children's activity, participation, quality of life, or others. Twenty articles (9.1%) reported on parent, child, or clinician experience or child engagement. Fidelity data were reported for 13.4% of studies of interventions.

CONCLUSIONS

The measurement of intervention outcomes is challenging yet important. No single type of measure was reported across all articles. Through using tailored measures closely related to intervention targets in combination with a universal set of measures of intelligibility, the impact of phonological impairment on children's lives, and the experience of receiving and providing intervention, researchers and clinicians could work together to progress insights and innovations in science and practice for children with SSD.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19497803.

A Longitudinal Evaluation of Tablet-Based Child Speech Therapy with Apraxia World

Digital games can make speech therapy exercises more enjoyable for children and increase their motivation during therapy. However, many such games developed to date have not been designed for long-term use. To address this issue, we developed Apraxia World, a speech therapy game specifically intended to be played over extended periods. In this study, we examined pronunciation improvements, child engagement over time, and caregiver and automated pronunciation evaluation accuracy while using our game over a multi-month period. Ten children played Apraxia World at home during two counterbalanced 4-week treatment blocks separated by a 2-week break. In one treatment phase, children received pronunciation feedback from caregivers and in the other treatment phase, utterances were evaluated with an automated framework built into the game. We found that children made therapeutically significant speech improvements while using Apraxia World, and that the game successfully increased engagement during speech therapy practice. Additionally, in offline mispronunciation detection tests, our automated pronunciation evaluation framework outperformed a traditional method based on goodness of pronunciation scoring. Our results suggest that this type of speech therapy game is a valid complement to traditional home practice.

Comparing Traditional and Tablet-Based Intervention for Children With Speech Sound Disorders: A Randomized Controlled Trial

Purpose This article reports on the effectiveness of a novel tablet-based approach to phonological intervention and compares it to a traditional tabletop approach, targeting children with phonologically based speech sound disorders (SSD). Method Twenty-two Portuguese children with phonologically based SSD were randomly assigned to 1 of 2 interventions, tabletop or tablet (11 children in each group), and received intervention based on the same activities, with the only difference being the delivery. All children were treated by the same speech-language pathologist over 2 blocks of 6 weekly sessions, for 12 sessions of intervention. Participants were assessed at 3 time points: baseline; pre-intervention, after a 3-month waiting period; and post-intervention. Outcome measures included percentage of consonants correct, percentage of vowels correct, and percentage of phonemes correct. A generalization of target sounds was also explored. Results Both tabletop and tablet-based interventions were effective in improving percentage of consonants correct and percentage of phonemes correct scores, with an intervention effect only evident for percentage of vowels correct in the tablet group. Change scores across both interventions were significantly greater after the intervention, compared to baseline, indicating that the change was due to the intervention. High levels of generalization (60% and above for the majority of participants) were obtained across both tabletop and tablet groups. Conclusions The software proved to be as effective as a traditional tabletop approach in treating children with phonologically based SSD. These findings provide new evidence regarding the use of digital materials in improving speech in children with SSD. Supplemental Material https://doi.org/10.23641/asha.9989816.

Comparison of the computer-aided articulation therapy application with printed material in children with speech sound disorders

OBJECTIVES

The aim of the present study was to develop an iPad application for computer-aided articulation therapy called the Turkish Articulation Therapy Application (TARTU), and make comparisons between the efficacy of TARTU and printed material.

METHOD

A single subject research design, adapted alternating treatments model, was used for this purpose. The study was carried out with 2 children, at the age of 5; 1 and 5; 11, both of whom have a speech sound disorder. The comparison between TARTU and printed material effectiveness was compared for three target sounds (/k/, /ʃ/ and /l/). 12 therapy sessions were carried out three times a week using the behavioural approach. One participant received therapy targeting the sound /k/ using TARTU, while printed material used for the sound /ʃ/. The targeted sounds were switched for the second participant. Sound /l/ was left without any intervention.

RESULT

The target sound met the criterion with TARTU in one participant, and with printed material in the other participant.

CONCLUSION

The presentation type of the materials did not play an important role in the success of the therapy on the participants.

Involvement of parents in intervention for childhood speech sound disorders: a review of the evidence

BACKGROUND

Internationally, speech and language therapists (SLTs) are involving parents and providing home tasks in intervention for phonology-based speech sound disorder (SSD). To ensure that SLTs' involvement of parents is guided by empirical research, a review of peer-reviewed published evidence is needed.

AIMS

To provide SLTs and researchers with a comprehensive appraisal and analysis of peer-reviewed published intervention research reporting parent involvement and the provision of home tasks in intervention studies for children with phonology-based SSD.

METHODS & PROCEDURES

A systematic search and review was conducted. Academic databases were searched for peer-reviewed research papers published between 1979 and 2013 reporting on phonological intervention for SSD. Of the 176 papers that met the criteria, 61 were identified that reported on the involvement of parents and/or home tasks within the intervention. These papers were analysed using a quality appraisal tool. Details regarding the involvement of parents and home tasks were extracted and analysed to provide a summary of these practices within the evidence base.

MAIN CONTRIBUTION

Parents have been involved in intervention research for phonology-based SSD. However, most of the peer-reviewed published papers reporting this research have provided limited details regarding what this involved. This paucity of information presents challenges for SLTs wishing to integrate external evidence into their clinical services and clinical decision-making. It also raises issues regarding treatment fidelity for researchers wishing to replicate published intervention research.

CONCLUSIONS & IMPLICATIONS

The range of tasks in which parents were involved, and the limited details reported in the literature, present challenges for SLTs wanting to involve parents in intervention. Further high-quality research reporting more detail regarding the involvement of parents and home tasks in intervention for SSD is needed.

How to meet the neighbors: Modality effects on phonological generalization

Long-term auditory priming of words from dense neighborhoods has been posited as a learning mechanism that affects change in the phonological structure of children's lexical representations. An apparent confound associated with the modality of priming responsible for structural change has been introduced in the literature, which challenges this proposal. Thus, our purpose was to evaluate prime modality in the treatment of children with phonological delay. Nine children were assigned to auditory-visual, auditory, or visual priming of words from dense neighborhoods prior to the treatment of production as the independent variable. The dependent variable was phonological generalization. Results showed that auditory priming (with or without visual input) promoted greater generalization on an order of magnitude of 3:1. Findings support the theoretical significance of auditory priming for phonological learning and demonstrate the applied utility of priming in clinical treatment.

Intervention efficacy and intensity for children with speech sound disorder

PURPOSE

Clinicians do not have an evidence base they can use to recommend optimum intervention intensity for preschool children who present with speech sound disorder (SSD). This study examined the effect of dose frequency on phonological performance and the efficacy of the multiple oppositions approach.

METHOD

Fifty-four preschool children with SSD were randomly assigned to one of three intervention conditions. Two intervention conditions received the multiple oppositions approach either 3 times per week for 8 weeks (P3) or once weekly for 24 weeks (P1). A control (C) condition received a storybook intervention. Percentage of consonants correct (PCC) was evaluated at 8 weeks and after 24 sessions. PCC gain was examined after a 6-week maintenance period.

RESULTS

The P3 condition had a significantly better phonological outcome than the P1 and C conditions at 8 weeks and than the P1 condition after 24 weeks. There were no significant differences between the P1 and C conditions. There was no significant difference between the P1 and P3 conditions in PCC gain during the maintenance period.

CONCLUSION

Preschool children with SSD who received the multiple oppositions approach made significantly greater gains when they were provided with a more intensive dose frequency and when cumulative intervention intensity was held constant.

Designs and decisions: the creation of informal measures for assessing speech production in children

Speech-language pathologists (SLPs) frequently assess children's speech to diagnose and identify areas of difficulty, then determine appropriate intervention goals. Formal measures are available for assessment; however, many SLPs use informal measures within clinical practice. The purpose of this two-part mixed methods study was to describe informal measures created to assess children's speech. Study 1 involved a systematic review of 39 informal measures identified via journal database and internet searches, scanning of reference lists, and submission by SLPs and researchers. The measures were reviewed in terms of their conceptualization (content and format) and operationalization (evaluation and validation). Common conceptual features included assessment of consonant singletons, single words, computer format, and picture-naming. Few measures provided information addressing operational criteria; in particular, they lacked evaluation of their effectiveness. Study 2 involved an inductive thematic analysis of journal entries from eight creators of informal measures that explored key considerations in the development process. Informal measures were created due to the absence of measures which were sufficiently comprehensive and culturally appropriate, plus a desire to incorporate technology. Considerations in the creation of informal measures included sourcing research and existing measures to inform the measures' development, maximizing children's engagement, and utility. SLPs must be cautious when using informal measures due to their lack of operationalization. However, these measures often address SLPs' needs and so operationalization of informal measures would be beneficial for the profession.

Terapia fonológica com uso de computador: relato de caso

O tema desse artigo aborda as mudanças fonológicas a partir da terapia fonológica com o uso de computador em casos de desvio fonológico. Realizou-se estudo de caso de quatro sujeitos (S1, S2, S3 e S4) com idade entre 4:7 e 5:3, de ambos os gêneros, com desvio fonológico. Realizou-se a Avaliação Fonológica da Criança, Exame Articulatório Repetitivo, Avaliação do Sistema Estomatognático, Teste de Figuras para Discriminação Fonêmica, Prova de Estimulabilidade e avaliação audiológica. Os sujeitos foram divididos em duplas de acordo com a semelhança dos sistemas fonológicos, sendo que um sujeito de cada dupla foi tratado com terapia fonológica padrão e outro com uso de computador como principal recurso terapêutico (terapia experimental). Os dados das avaliações dos sujeitos foram analisados e, após, foram comparados os resultados dos submetidos à terapia padrão (S1 e S2), com os pareados submetidos à terapia experimental, com auxílio do computador, (S3 e S4) por meio do teste Exato de Fisher, considerando significância estatística de 5% (p<0,05). Verificou-se que a evolução dos sujeitos S3 e S4 submetidos à terapia experimental foi maior em relação à evolução de S1 e S2 submetidos à terapia padrão, sendo este resultado estatisticamente significante. Os achados da pesquisa demonstram terem sido favoráveis o uso da terapia experimental no tratamento de crianças com desvio fonológico. Contudo, há necessidade de realização de outros estudos com ampliação casuística para confirmação dos achados.

A pilot exploration of speech sound disorder intervention delivered by telehealth to school-age children

This article describes a school-based telehealth service delivery model and reports outcomes made by school-age students with speech sound disorders in a rural Ohio school district. Speech therapy using computer-based speech sound intervention materials was provided either by live interactive videoconferencing (telehealth), or conventional side-by-side intervention. Progress was measured using pre- and post-intervention scores on the Goldman Fristoe Test of Articulation-2 (Goldman & Fristoe, 2002). Students in both service delivery models made significant improvements in speech sound production, with students in the telehealth condition demonstrating greater mastery of their Individual Education Plan (IEP) goals. Live interactive videoconferencing thus appears to be a viable method for delivering intervention for speech sound disorders to children in a rural, public school setting.

Evidence-Based Practice for Children With Speech Sound Disorders: Part 1 Narrative Review

Purpose

This article provides a comprehensive narrative review of intervention studies for children with speech sound disorders (SSD). Its companion paper (Baker & McLeod, 2011) provides a tutorial and clinical example of how speech-language pathologists (SLPs) can engage in evidence-based practice (EBP) for this clinical population.

Method

Studies reporting speech sound intervention for children with SSDs published from 1979 to 2009 were identified and coded.

Results

One hundred thirty-four intervention studies were identified. Intervention typically was conducted by an SLP in a one-to-one individual format for 30- to 60-min sessions 2 to 3 times per week. Total duration of intervention (from assessment to discharge) was reported for 10 studies and ranged from 3 to 46 months. Most studies were either Level IIb (quasi-experimental studies, 41.5%) or Level III (nonexperimental case studies, 32.6%). Single-case experimental design (29.6%) was the most frequently used experimental research design. There were 7 distinct approaches to target selection and 46 distinct intervention approaches, with 23 described in more than 1 publication. Each approach was associated with varying quantities and levels of evidence, according to research design.

Conclusion

Collaborative research reflecting higher levels of evidence using rigorous experimental designs is needed to compare the relative benefits of different intervention approaches.

Fidelity: an essential component of evidence-based practice in speech-language pathology

PURPOSE

To provide a primer regarding treatment fidelity as it affects evidence-based practice (EBP) for speech-language pathologists.

METHOD

This tutorial defines treatment fidelity, examines the role of treatment fidelity for speech-language pathologists, provides examples of fidelity measurement, and describes approaches for assessing treatment fidelity.

CONCLUSION

Treatment fidelity is a neglected construct in the EBP literature; however, fidelity is a crucial construct for documenting intervention effectiveness and engaging in EBP.

A comparison between computer and tabletop delivery of phonology therapy

This paper reports on the development and evaluation of a software program aimed at assisting children with phonological impairment. An experimental approach was used whereby children's speech output was assessed pre- and post-therapy. Children were randomly assigned to a computer, a tabletop or a no therapy group. Those children receiving the computer therapy were exposed to an experimental software program that mirrored the tabletop activities using interactive computer games. The results showed no significant difference between any of the three groups with regard to change in speech output. These results may relate to the amount and frequency of therapy given and also to the heterogeneous nature of children included in the study. There was considerable variation in individual performance across all three groups and the data were therefore analysed to look for patterns that might predict performance. Stimulability and gender were identified as possible predictors. Female children and those who were able to produce a greater number of consonant speech sounds in isolation were more likely to make progress in their speech output. Future research might use a similar methodology to compare the therapy conditions but with a more homogenous group in terms of stimulability and using a greater intensity of intervention.

Phonological complexity and language learnability

PURPOSE

To extend formal models of language learnability to applications in clinical treatment of children with functional phonological delays.

METHOD

The focus of the narrative review is on phonological complexity. This follows from learnability theory, whereby complexity in the linguistic input to children has been shown to trigger language learning. Drawing from the literature, phonological complexity is defined from epistemic, ontological, and functional perspectives, with specific emphasis on the application of language universals in the selection of target sounds for treatment.

RESULTS

The cascading effects of phonological complexity on children's generalization learning are illustrated, and frequently asked questions about complexity in treatment are addressed.

CONCLUSION

The role of complexity in cognitive development is introduced to demonstrate the apparent robustness of effects.

Treatment efficacy: functional phonological disorders in children

This report addresses the efficacy of treatment for functional phonological disorders in children. The definition of phonological disorders and their incidence and prevalence are first presented. The impact of this disorder on the lives of children and the role that speech-language pathologists play in treating this disorder are then discussed. Evidence of the positive outcome of phonological treatment is reviewed, with particular emphasis on treatment procedures that have been deemed effective, the specific effects of these treatments on improving intelligibility, and comparisons between treatments in facilitating improved sound production.

Not Using a Computer in Language Assessment/Intervention

Clinicians who are not yet making direct use of computer applications with their school-age clients may have good reasons. Factors that hinder the clinical use of computers by school clinicians include limited access to computer resources, lack of training, concern that students will be intimidated by the computer, worry over the amount of time necessary to teach students to use the computer, and doubts regarding the efficacy of computer activities. On the other hand, some computer applications offer benefits that are compelling enough to cause clinicians to overcome these barriers. Clinicians are encouraged to explore such applications, which include use of the computer as a context for conversation, a tool for learning, a tool for linguistic and phonological analysis, a tool for treatment data collection, a treatment materials generator, and a biofeedback device.

The use of different service delivery models for children with phonological disorders

A group of 12 preschool children with phonological process errors was selected, and individual subjects were randomly assigned to one of two treatments that differed in relation to service delivery. Group I received a treatment that was administered exclusively by the clinician. Group II received a combination that included clinician administered treatment and parent administered instruction with the Speech Viewer system. Results indicate that both groups improved significantly, but they did not differ significantly from each other in the degree of change. Implications with respect to the service delivery options and their respective components are discussed.

Speech Normalization in Developmental Phonological Disorders

A two-factor theory is proposed to explain individual differences in intervention outcomes for children with speech delays. Indices of Capability include linguistic measures of a child's comprehension and production phonology and risk factors. Indices of Focus include clinical responses to children's motivation for speech change and level of effort. Retrospective data from clinical records of 75 children who received intervention services in a phonology clinic provide a preliminary test of the proposed two-factor theory. Discriminant function analyses suggest that correlates of Focus are sensitive to factors associated with failure to make progress during intervention. Implications of these findings for prospective predictive research are discussed.

Speech and prosody characteristics of adults with mental retardation

Audio-recorded continuous speech samples from forty 20-50-year-old noninstitutionalized persons with mental retardation were selected from a database of 192 samples. Descriptive data on segmental and suprasegmental characteristics were obtained using close phonetic transcription as input to linguistic analyses software. For this sample of adults with mental retardation, speech and prosody status were not statistically associated with gender or gross level of mental retardation, but were associated with estimated probability of independent living. Speech and prosody analyses and content analyses of transcribers' comments yielded diacritic-level profiles of these speakers' linguistic and paralinguistic behaviors in continuous speech. Additional analyses of the error data tested alternative sources of processing involvement within a four-stage speech production model. A cognitive capacity constraint, which limits the speaker's ability to allocate resources to phonological encoding, is proposed as a sufficient explanation for the obtained pattern of token-to-token inconsistency of articulation. An additional sociolinguistic constraint is hypothesized to account for reduced prosodic and paralinguistic competence in continuous discourse. Both constraints are amenable to intervention programming. Findings fail to support the view that the potential for long-term speech prosody competence in individuals with mental retardation is limited by speech-motor constraints. Discussion includes intervention considerations in the context of current trends in special education.