Purpose: Both Rapid Syllable Transition Treatment (ReST) and ultrasound biofeedback are effective approaches to treating childhood apraxia of speech (CAS). The purpose of the study was to compare outcomes from these two motor-based treatment approaches for school-age children with CAS. Method: In a single site, single blind randomized control trial, 14 children with CAS ages 6–13 years were randomly assigned to 12 sessions over 6 weeks of either of ultrasound biofeedback treatment (with a speech motor chaining practice structure) or ReST. Treatment was delivered at The University of Sydney by students trained and supervised by certified speech-language pathologists. Transcriptions from blinded assessors were used to compare the two groups on speech sound accuracy (percent phonemes correct) and prosodic severity (lexical stress errors and syllable segregation) in untreated words and sentences at three time points: pretreatment, immediately posttreatment, and 1-month posttreatment (i.e., retention). Results: Both groups showed significant improvement on treated items indicating a treatment effect. At no time was there a difference between groups. Both groups showed a significant improvement in speech sound accuracy on untreated words and sentences from pre to post and neither group showed an improvement in prosody pre–post. Changes to speech sound accuracy were retained by both groups at 1-month follow-up. Significant improvement in prosodic accuracy was reported at the 1-month follow-up. Conclusions: ReST and ultrasound biofeedback were equally effective. Either ReST or ultrasound biofeedback may be viable treatment options for school-age children with CAS. Supplemental Material: https://doi.org/10.23641/asha.22114661

PURPOSE This systematic review aims to summarize and evaluate the available literature on speech and language therapy interventions for acquired apraxia of speech since 2012. METHOD A systematic search in six electronic databases was performed from 2013 to 2020. The following primary outcomes were summarized: (a) improvement in targeted behaviors, (b) generalization, and (c) maintenance of outcomes. Moreover, studies were evaluated for the level of evidence and the clinical phase. RESULTS Of the 3,070 records identified, 27 studies were included in this review. The majority of the studies (n = 22) used articulatory kinematic approaches followed by intersystemic facilitation/reorganization treatments (n = 4) and other approaches (n = 1). According to the classes defined in Clinical Practice Guideline Process Manual (Gronseth et al., 2017), one was Class II, 10 were Class III, 10 were Class III-b (fulfill Class III criteria except for independence of assessors' criterion), and five were Class IV. In terms of clinical phase, one study classified as Phase III, 10 as Phase II, and 15 as Phase I. CONCLUSIONS Among the interventions for apraxia of speech, articulatory kinematic treatments have become prominent over the last 8 years. Focusing on self-administrated therapies, use of technology for therapy administration and development of treatments that focus on apraxia of speech and aphasia simultaneously were identified as new advancements in the apraxia of speech literature. The methodological quality, clinical phase, and level of evidence of the studies have improved within the past 8 years. Large-scale randomized controlled trials for articulatory kinematic approaches and future studies on other treatment approaches are warranted. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22223785.

To present a systematic review of single-case experimental treatment studies for childhood apraxia of speech (CAS). A search of 9 databases was used to find peer-reviewed treatment articles from 1970 to 2012 of all levels of evidence with published communication outcomes for children with CAS. Improvement rate differences (IRDs) were calculated for articles with replicated (n > 1), statistically compared treatment and generalization evidence. Forty-two articles representing Phase I and II single-case experimental designs (SCEDs; n = 23) or case series or description studies ( n = 19) were analyzed. Six articles showed high CAS diagnosis confidence. Of the 13 approaches within the 23 SCED articles, treatments were primarily for speech motor skills ( n = 6), linguistic skills ( n = 5), or augmentative and alternative communication ( n = 2). Most participants responded positively to treatment, but only 7 of 13 approaches in SCED studies reported maintenance and/or generalization of treatment effects. Three approaches had preponderant evidence (Smith, 1981). IRD effect sizes were calculated for Integral Stimulation/Dynamic Temporal and Tactile Cueing, Rapid Syllable Transition Treatment, and Integrated Phonological Awareness Intervention. At least 3 treatments have sufficient evidence for Phase III trials and interim clinical practice. In the future, efficacy needs to be established via maintenance and generalization measures.

<h4>Background</h4>Parents of children with moderate-to-severe speech sound disorder presenting to clinic want to understand prognosis for their child; however, there is unclear evidence as to the specific long-term speech outcomes in this group.<h4>Aim</h4>To review long-term speech outcomes in children with moderate-to-severe speech sound disorders.<h4>Method</h4>A systematic review identified 3697 papers; 21 papers containing 15 unique studies (six had overlapping data) met inclusion criteria for moderate-to-severe speech sound disorder with at least one follow-up speech assessment unrelated to intervention outcomes. Studies were appraised for quality.<h4>Main contribution</h4>Overall, 9 cohort studies, and 6 case studies of children aged 2y3m-to-11y9m at initial assessment were included. Most (11/15) had two-to-three follow-up time points, and 80% (12/15) specified speech diagnosis or subtype. The most prominent moderate-to-severe speech diagnosis that reached criteria for inclusion was Childhood Apraxia of Speech. Speech outcomes reported in case studies included word (7/15), syllable (7/15), consonant (11/15), and vowel (5/15) accuracy, phonological patterns (9/15, prosody (2/15), consistency (1/15), and intelligibility (2/15). Case studies revealed reduced error frequency and improved single-word accuracy and intelligibility, but persistent error types over time (e.g. token-to-token inconsistency). Cohort studies mostly reported on overall gross improvement, such as 'resolved' or 'persistent' disorder; however, the severity of the 'persistent' subgroup was not delineated. Study quality was generally good, with limitations mostly related to confounding factors such as influence of therapy, or poor or absent specification of the specific speech subtype at time zero.<h4>Conclusions</h4>While case studies indicated reduced error frequency over time, larger-scale data are needed to confirm findings. In the current context of health service demands for speech therapy, longitudinal speech outcome data, measuring meaningful speech outcomes are critically needed to identify predictors of longer-term outcomes and inform prioritisation for treatment.<h4>What this paper adds</h4>What is already known about this subject Despite mounting evidence on the prognosis and history of mild-to-moderate speech and language disorder, longitudinal cohort studies of children with moderate-to-severe speech sound disorders are rare. This gap is notable given emerging data that severe speech sound disorders are more pervasive and pose greater risk to academic achievement and mental health. What this paper adds to existing knowledge There are no larger cohort studies with clear granular data from which to draw conclusions. Longitudinal case studies show reduced error frequency but persistent error type in children and adolescents with childhood apraxia of speech. There are no cohort studies addressing longitudinal data for other severe speech sound disorders, such as dysarthria or fluency disorders. What are the potential or actual clinical implications of this work? Longitudinal prospective data, with a pre-established goal to systematically evaluate speech outcomes over time in a severe speech cohort, are critically needed to identify accurate predictors of longer-term outcomes and inform treatment prioritisation for children with severe speech sound disorders.

<h4>Objectives</h4>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To examine the effectiveness of speech and language interventions for children and adolescents with Childhood Apraxia of Speech (CAS) as delivered by speech and language pathologists/therapists or by other personnel under the direction of a speech and language pathologist/therapist.

To date, new advances in technology have already shown the effectiveness of non-invasive brain stimulation and, in particular, of transcranial direct current stimulation (tDCS), in enhancing language recovery in post-stroke aphasia. More recently, it has been suggested that the stimulation over the spinal cord improves the production of words associated to sensorimotor schemata, such as action verbs. Here, for the first time, we present evidence that transpinal direct current stimulation (tsDCS) combined with a language training is efficacious for the recovery from speech apraxia, a motor speech disorder which might co-occur with aphasia. In a randomized-double blind experiment, ten aphasics underwent five days of tsDCS with concomitant treatment for their articulatory deficits in two different conditions: anodal and sham. In all patients, language measures were collected before (T0), at the end (T5) and one week after the end of treatment (F/U). Results showed that only after anodal tsDCS patients exhibited a better accuracy in repeating the treated items. Moreover, these effects persisted at F/U and generalized to other oral language tasks (i.e. picture description, noun and verb naming, word repetition and reading). A further analysis, which compared the tsDCS results with those collected in a matched group of patients who underwent the same language treatment but combined with tDCS, revealed no differences between the two groups. Given the persistency and severity of arti

Speech and language impairment are basic categories that might be drawn in issues of communication involve hearing, speech, language, and fluency. A speech Speech and language impairment are basic categories that might be drawn in issues of communication involve hearing, speech, language, and fluency. A speech impairment is characterized by difficulty in articulation of words. Examples include stuttering or problems producing particular sounds. Articulation refers to the sounds, syllables, and phonology produced by the individual. An example may incl Developmental verbal dyspraxia refers specifically to a motor speech disorder. This is a neurological disorder. Individuals with developmental verbal apraxia encounter difficulty saying sounds, syllables, and words. The difficulties are not due to weakness of muscles, but rather on coordination between the brain and the specific parts of the body. Apraxia of speech is the acquired form of this disorder caused by brain injury, stroke or dementia. Interventions are more effective when they occur individually at first, and between three and five times per week. With improvements, children with apraxia may be transitioned into group therapy settings. Therapeutic exercises must focus on planning, sequencing, and coordinating the muscle movements involved in speech production. Children with developmental verbal dyspraxia must practice the strategies and techniques that they learn to improve. In addition to practice, feedback can be helpful to improve apraxia of speech. Tactile feedback (touch), visual feedback (watching self in mirror), and verbal feedback are all important additions. Biofeedback has also been cited as a possible therapy. Biofeedback…

dyspraxia (DVD), also known as childhood apraxia of speech (CAS) and developmental apraxia of speech (DAS), is a motor speech disorder in which an individual has Developmental verbal dyspraxia (DVD), also known as childhood apraxia of speech (CAS) and developmental apraxia of speech (DAS), is a motor speech disorder in which an individual has problems saying sounds, syllables and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The individual know Developmental verbal dyspraxia (DVD), also known as childhood apraxia of speech (CAS) and developmental apraxia of speech (DAS), is a motor speech disorder in which an individual has problems saying sounds, syllables and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The individual knows what they want to say, but their brain has difficulty coordinating the muscle movements necessary to say those words. The exact cause of this disorder is usually unknown. Many observations suggest a genetic cause of DVD, as many with the disorder have a family history of communication disorders. The gene FOXP2 has been implicated in many studies of the condition, and when this is the cause, the condition is inherited in an autosomal dominant manner, however, roughly 75% of these cases are de novo. There is no cure for DVD, but with appropriate, intensive intervention, people with the condition can improve significantly.