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Namasivayam AK, Shin H, Nisenbaum R, Pukonen M, van Lieshout P. Predictors of Functional Communication Outcomes in Children With Idiopathic Motor Speech Disorders. J Speech Lang Hear Res 2023:1-16. [PMID: 37672787 DOI: 10.1044/2023_jslhr-23-00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
PURPOSE The purpose of the study was to investigate child- and intervention-level factors that predict improvements in functional communication outcomes in children with motor-based speech sound disorders. METHOD Eighty-five preschool-age children with childhood apraxia of speech (n = 37) and speech motor delay (n = 48) participated. Multivariable logistic regression models estimated odds ratios and 95% confidence intervals for the association between minimal clinically important difference in the Focus on the Outcomes of Communication Under Six scores and multiple child-level (e.g., age, sex, speech intelligibility, Kaufman Speech Praxis Test diagnostic rating scale) and intervention-level predictors (dose frequency and home practice duration). RESULTS Overall, 65% of participants demonstrated minimal clinically important difference changes in the functional communication outcomes. Kaufman Speech Praxis Test rating scale was significantly associated with higher odds of noticeable change in functional communication outcomes in children. There is some evidence that delivering the intervention for 2 times per week for 10 weeks provides benefit. CONCLUSION A rating scale based on task complexity has the potential for serving as a screening tool to triage children for intervention from waitlist and/or determining service delivery for this population.
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Affiliation(s)
- Aravind K Namasivayam
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Speech Research Centre, Toronto, Ontario, Canada
| | - Hyunji Shin
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Speech Research Centre, Toronto, Ontario, Canada
| | - Rosane Nisenbaum
- Applied Health Research Centre, MAP Centre for Urban Health Solutions, St. Michael's Hospital Li Ka Shing Knowledge Institute, Unity Health Toronto, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Margit Pukonen
- The Speech and Stuttering Institute, Toronto, Ontario, Canada
| | - Pascal van Lieshout
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
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Namasivayam AK, Pukonen M, Goshulak D, Granata F, Le DJ, Kroll R, van Lieshout P. Investigating intervention dose frequency for children with speech sound disorders and motor speech involvement. Int J Lang Commun Disord 2019; 54:673-686. [PMID: 30941860 DOI: 10.1111/1460-6984.12472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Treatment outcome data for children with severe speech sound disorders with motor speech involvement (SSD-MSI) are derived from Phase I clinical research studies. These studies have demonstrated positive improvements in speech production. Currently there is no research examining the optimal treatment dose frequency for this population. The results of this study, which is the first of its kind, will inform the delivery of effective services for this population. AIMS To investigate optimal treatment dose frequency for the Motor Speech Treatment Protocol (MSTP) for children with SSD-MSI. METHODS & PROCEDURES A total of 48 children (aged 43-47 months) with SSD-MSI participated in the study. Participants received 45-min MSTP intervention sessions either once per week (lower dose frequency) or twice per week (higher dose frequency) for a 10-week period. Blinded outcome assessments were carried out at pre- and post-intervention. OUTCOMES & RESULTS Treatment-related change was assessed at body structures, functions and activities participation level as per the World Health Organization's International Classification of Functioning framework: Children and Youth Version (ICF-CY) framework WHO (2007). These measures are related to articulation, functional communication and speech intelligibility. One-way analysis of variance (ANOVA) revealed that for all variables the baseline scores were not statistically different (p > 0.05) between the two dose-frequency groups. Overall, there was a significant main effect of Time (pre-post) across all variables (p < 0.01). However, repeated-measures ANOVA did not result in any statistical interactions (Time × Dose frequency) for any of the variables tested (p > 0.05). Only marginal clinical advantages (< 4% change in intelligibility) were noted with the 10 extra sessions. CONCLUSIONS & IMPLICATIONS Overall, the MSTP intervention approach in conjunction with home practice led to significant positive changes for all measures in children with SSD-MSI. No statistical differences between high- and low-dose-frequency groups were observed for any of the variables. Clinical effects were examined using effect sizes, as well as changes in articulation, speech intelligibility and functional communication; these differed marginally between the two dose frequencies. This suggests limited benefits of 10 additional sessions per block. Thus, it is recommended that caregivers, speech-language therapists and policy-makers perform a cost-benefit analysis before determining the dose frequency, when considering additional sessions per block.
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Affiliation(s)
- Aravind K Namasivayam
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Margit Pukonen
- The Speech and Stuttering Institute, Toronto, ON, Canada
| | - Debra Goshulak
- The Speech and Stuttering Institute, Toronto, ON, Canada
| | - Francesca Granata
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
| | - D James Le
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
| | - Robert Kroll
- The Speech and Stuttering Institute, Toronto, ON, Canada
| | - Pascal van Lieshout
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, Toronto, ON, Canada
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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Abstract
PURPOSE This study measures the reliability and sensitivity of a modified Parent-Child Interaction Observation scale (PCIOs) used to monitor the quality of parent-child interaction. The scale is part of a home-training program employed with direct motor speech intervention for children with speech sound disorders. METHOD Eighty-four preschool age children with speech sound disorders were provided either high- (2×/week/10 weeks) or low-intensity (1×/week/10 weeks) motor speech intervention. Clinicians completed the PCIOs at the beginning, middle, and end of treatment. Inter-rater reliability (Kappa scores) was determined by an independent speech-language pathologist who assessed videotaped sessions at the midpoint of the treatment block. Intervention sensitivity of the scale was evaluated using a Friedman test for each item and then followed up with Wilcoxon pairwise comparisons where appropriate. RESULTS We obtained fair-to-good inter-rater reliability (Kappa = 0.33-0.64) for the PCIOs using only video-based scoring. Child-related items were more strongly influenced by differences in treatment intensity than parent-related items, where a greater number of sessions positively influenced parent learning of treatment skills and child behaviors. CONCLUSION The adapted PCIOs is reliable and sensitive to monitor the quality of parent-child interactions in a 10-week block of motor speech intervention with adjunct home therapy. Implications for rehabilitation Parent-centered therapy is considered a cost effective method of speech and language service delivery. However, parent-centered models may be difficult to implement for treatments such as developmental motor speech interventions that require a high degree of skill and training. For children with speech sound disorders and motor speech difficulties, a translated and adapted version of the parent-child observation scale was found to be sufficiently reliable and sensitive to assess changes in the quality of the parent-child interactions during intervention. In developmental motor speech interventions, high-intensity treatment (2×/week/10 weeks) facilitates greater changes in the parent-child interactions than low intensity treatment (1×/week/10 weeks). On one hand, parents may need to attend more than five sessions with the clinician to learn how to observe and address their child's speech difficulties. On the other hand, children with speech sound disorders may need more than 10 sessions to adapt to structured play settings even when activities and therapy materials are age-appropriate.
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Affiliation(s)
- Aravind Kumar Namasivayam
- a Department of Speech-Language Pathology , University of Toronto , Toronto , Ontario , Canada.,b Toronto Rehabilitation Institute , Toronto , Ontario , Canada
| | - Vibhuti Jethava
- a Department of Speech-Language Pathology , University of Toronto , Toronto , Ontario , Canada
| | - Margit Pukonen
- c The Speech & Stuttering Institute , Toronto , Ontario , Canada
| | - Anna Huynh
- a Department of Speech-Language Pathology , University of Toronto , Toronto , Ontario , Canada
| | - Debra Goshulak
- c The Speech & Stuttering Institute , Toronto , Ontario , Canada
| | - Robert Kroll
- c The Speech & Stuttering Institute , Toronto , Ontario , Canada
| | - Pascal van Lieshout
- a Department of Speech-Language Pathology , University of Toronto , Toronto , Ontario , Canada.,b Toronto Rehabilitation Institute , Toronto , Ontario , Canada.,d Department of Psychology , University of Toronto , Ontario , Canada.,e Institute of Biomaterials and Biomedical Engineering, University of Toronto , Toronto , Canada.,f Rehabilitation Sciences Institute , University of Toronto , Toronto , Canada
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Abstract
OBJECTIVE This study examines the effect of the Motor Speech Treatment Protocol (MSTP), a multi-sensory hybrid treatment approach on five children (mean: 3;3 years; S.D. 0;1) with severe to profound speech sound disorders with motor speech difficulties. METHODS A multiple probe design, replicated over five participants, was used to evaluate the effects of treatment on improving listeners' auditory and visual judgements of speech accuracy. RESULTS All participants demonstrated significant change between baseline and maintenance conditions, with the exception of KM, who may have had underlying psychosocial, regulation and/or attention difficulties. The training- (practiced in treatment) and test-words (not practiced in treatment) both demonstrated positive change in all participants, indicating generalization of target features to untrained words. CONCLUSION These results provide preliminary evidence that the MSTP, which integrates multi-sensory information and utilizes hierarchical goal selection, may positively impact speech sound production by improving speech motor control in this population.
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Affiliation(s)
- Aravind Namasivayam
- a Department of Speech-Language Pathology , University of Toronto , Toronto , Ontario , Canada
| | - Margit Pukonen
- b The Speech & Stuttering Institute , Toronto , Ontario , Canada
| | - Jennifer Hard
- a Department of Speech-Language Pathology , University of Toronto , Toronto , Ontario , Canada
| | - Rene Jahnke
- b The Speech & Stuttering Institute , Toronto , Ontario , Canada
| | - Elaine Kearney
- a Department of Speech-Language Pathology , University of Toronto , Toronto , Ontario , Canada
| | - Robert Kroll
- b The Speech & Stuttering Institute , Toronto , Ontario , Canada
| | - Pascal van Lieshout
- a Department of Speech-Language Pathology , University of Toronto , Toronto , Ontario , Canada .,c The Toronto Rehabilitation Institute , Toronto , Ontario , Canada .,d Department of Psychology , University of Toronto , Toronto , Ontario , Canada .,e Institute of Biomaterials and Biomedical Engineering, University of Toronto , Toronto , Ontario , Canada , and.,f Graduate Department of Rehabilitation Science , University of Toronto , Toronto , Ontario , Canada
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Namasivayam AK, Pukonen M, Goshulak D, Hard J, Rudzicz F, Rietveld T, Maassen B, Kroll R, van Lieshout P. Treatment intensity and childhood apraxia of speech. Int J Lang Commun Disord 2015; 50:529-546. [PMID: 25581372 DOI: 10.1111/1460-6984.12154] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 11/18/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Intensive treatment has been repeatedly recommended for the treatment of speech deficits in childhood apraxia of speech (CAS). However, differences in treatment outcomes as a function of treatment intensity have not been systematically studied in this population. AIM To investigate the effects of treatment intensity on outcome measures related to articulation, functional communication and speech intelligibility for children with CAS undergoing individual motor speech intervention. METHODS & PROCEDURES A total of 37 children (32-54 months of age) with CAS received 1×/week (lower intensity) or 2×/week (higher intensity) individual motor speech treatment for 10 weeks. Assessments were carried out before and after a 10-week treatment block to study the effects of variations in treatment intensity on the outcome measures. OUTCOMES & RESULTS The results indicated that only higher intensity treatment (2×/week) led to significantly better outcomes for articulation and functional communication compared with 1×/week (lower intensity) intervention. Further, neither lower nor higher intensity treatment yielded a significant change for speech intelligibility at the word or sentence level. In general, effect sizes for the higher intensity treatment groups were larger for most variables compared with the lower intensity treatment group. CONCLUSIONS & IMPLICATIONS Overall, the results of the current study may allow for modification of service delivery and facilitate the development of an evidence-based care pathway for children with CAS.
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Affiliation(s)
| | - Margit Pukonen
- The Speech and Stuttering Institute, Toronto, ON, Canada
| | - Debra Goshulak
- The Speech and Stuttering Institute, Toronto, ON, Canada
| | - Jennifer Hard
- ErinoakKids Centre for Treatment and Development, Mississauga, ON, Canada
| | - Frank Rudzicz
- Toronto Rehabilitation Institute, Toronto, ON, Canada
| | | | - Ben Maassen
- University of Groningen, Groningen, the Netherlands
| | - Robert Kroll
- The Speech and Stuttering Institute, Toronto, ON, Canada
| | - Pascal van Lieshout
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
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Yu VY, Kadis DS, Oh A, Goshulak D, Namasivayam A, Pukonen M, Kroll R, De Nil LF, Pang EW. Changes in voice onset time and motor speech skills in children following motor speech therapy: Evidence from /pa/ productions. Clin Linguist Phon 2014; 28:396-412. [PMID: 24446799 PMCID: PMC4885741 DOI: 10.3109/02699206.2013.874040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study evaluated changes in motor speech control and inter-gestural coordination for children with speech sound disorders (SSD) subsequent to Prompts for Restructuring Oral and Muscular Phonetic Targets (PROMPT) intervention. We measured the distribution patterns of voice onset time (VOT) for a voiceless stop (/p/) to examine the changes in inter-gestural coordination. Two standardized tests were used (Verbal Motor Production Assessment for Children (VMPAC), GFTA-2) to assess the changes in motor speech skills and articulation. Data showed positive changes in patterns of VOT with a lower pattern of variability. All children showed significantly higher scores for VMPAC, but only some children showed higher scores for GFTA-2. Results suggest that the proprioceptive feedback provided through PROMPT had a positive influence on speech motor control and inter-gestural coordination in voicing behavior. This set of VOT data for children with SSD adds to our understanding of the speech characteristics underlying speech motor control. Directions for future studies are discussed.
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Affiliation(s)
- Vickie Y. Yu
- Neurosciences and Mental Health, Sick Kids Research Institute, 555 University Avenue, Toronto, Ontario, M5G 1X8
- Division of Neurology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8
| | - Darren S. Kadis
- Division of Neurology and Pediatric Neuroimaging Research Consortium, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH
| | - Anna Oh
- Neurosciences and Mental Health, Sick Kids Research Institute, 555 University Avenue, Toronto, Ontario, M5G 1X8
| | - Debra Goshulak
- The Speech & Stuttering Institute, 2-150 Duncan Mill Road, Toronto, Ontario M3B 3M4
| | - Aravind Namasivayam
- The Speech & Stuttering Institute, 2-150 Duncan Mill Road, Toronto, Ontario M3B 3M4
| | - Margit Pukonen
- The Speech & Stuttering Institute, 2-150 Duncan Mill Road, Toronto, Ontario M3B 3M4
| | - Robert Kroll
- The Speech & Stuttering Institute, 2-150 Duncan Mill Road, Toronto, Ontario M3B 3M4
| | - Luc F. De Nil
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7
| | - Elizabeth W. Pang
- Neurosciences and Mental Health, Sick Kids Research Institute, 555 University Avenue, Toronto, Ontario, M5G 1X8
- Division of Neurology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8
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Kadis DS, Goshulak D, Namasivayam A, Pukonen M, Kroll R, De Nil LF, Pang EW, Lerch JP. Cortical thickness in children receiving intensive therapy for idiopathic apraxia of speech. Brain Topogr 2013; 27:240-7. [PMID: 23974724 PMCID: PMC3921462 DOI: 10.1007/s10548-013-0308-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/10/2013] [Indexed: 11/30/2022]
Abstract
Children with idiopathic apraxia experience difficulties planning the movements necessary for intelligible speech. There is increasing evidence that targeted early interventions, such as Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT), can be effective in treating these disorders. In this study, we investigate possible cortical thickness correlates of idiopathic apraxia of speech in childhood, and changes associated with participation in an 8-week block of PROMPT therapy. We found that children with idiopathic apraxia (n = 11), aged 3–6 years, had significantly thicker left supramarginal gyri than a group of typically-developing age-matched controls (n = 11), t(20) = 2.84, p ≤ 0.05. Over the course of therapy, the children with apraxia (n = 9) experienced significant thinning of the left posterior superior temporal gyrus (canonical Wernicke’s area), t(8) = 2.42, p ≤ 0.05. This is the first study to demonstrate experience-dependent structural plasticity in children receiving therapy for speech sound disorders.
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Affiliation(s)
- Darren S Kadis
- Division of Neurology, Pediatric Neuroimaging Research Consortium (PNRC), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Namasivayam AK, Pukonen M, Goshulak D, Yu VY, Kadis DS, Kroll R, Pang EW, De Nil LF. Relationship between speech motor control and speech intelligibility in children with speech sound disorders. J Commun Disord 2013; 46:264-280. [PMID: 23628222 DOI: 10.1016/j.jcomdis.2013.02.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 02/06/2013] [Accepted: 02/12/2013] [Indexed: 06/02/2023]
Abstract
UNLABELLED The current study was undertaken to investigate the impact of speech motor issues on the speech intelligibility of children with moderate to severe speech sound disorders (SSD) within the context of the PROMPT intervention approach. The word-level Children's Speech Intelligibility Measure (CSIM), the sentence-level Beginner's Intelligibility Test (BIT) and tests of speech motor control and articulation proficiency were administered to 12 children (3:11 to 6:7 years) before and after PROMPT therapy. PROMPT treatment was provided for 45 min twice a week for 8 weeks. Twenty-four naïve adult listeners aged 22-46 years judged the intelligibility of the words and sentences. For CSIM, each time a recorded word was played to the listeners they were asked to look at a list of 12 words (multiple-choice format) and circle the word while for BIT sentences, the listeners were asked to write down everything they heard. Words correctly circled (CSIM) or transcribed (BIT) were averaged across three naïve judges to calculate percentage speech intelligibility. Speech intelligibility at both the word and sentence level was significantly correlated with speech motor control, but not articulatory proficiency. Further, the severity of speech motor planning and sequencing issues may potentially be a limiting factor in connected speech intelligibility and highlights the need to target these issues early and directly in treatment. LEARNING OUTCOMES The reader will be able to: (1) outline the advantages and disadvantages of using word- and sentence-level speech intelligibility tests; (2) describe the impact of speech motor control and articulatory proficiency on speech intelligibility; and (3) describe how speech motor control and speech intelligibility data may provide critical information to aid treatment planning.
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