Speech Therapy for Speech Sound Disorder

(iChain Trial)

Overseen By Nina Benway, PhD

Age: < 18

Sex: Any

Trial Phase: Phase 1 & 2

Sponsor: Syracuse University

Disqualifiers: Autism, Down Syndrome, Cerebral palsy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 16

Duration: 4-8 weeks

84 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores the best way to help children improve their speech sounds, specifically focusing on the "r" and "s" sounds. It compares two schedules: one with sessions spaced out over eight weeks and another with more frequent sessions over four weeks. The aim is to determine which schedule better aids children in learning these sounds. Children who might benefit from this trial speak American English and have ongoing difficulty pronouncing "r" or "s" sounds. Participants should also be interested in improving their speech through Intensive Speech Motor Chaining Treatment. As a Phase 1/Phase 2 trial, this research aims to understand how the treatment works and measure its effectiveness in an initial, smaller group of children, offering a unique opportunity to contribute to advancements in speech therapy.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that these treatment schedules are safe for children with speech sound disorders?

Research has shown that the Intensive Speech Motor Chaining Treatment is generally well-tolerated. Although specific details from past studies aren't provided, the trial's early stage means researchers are still carefully assessing the treatment's safety. Early-phase trials primarily focus on safety and help identify any possible side effects.

Speech therapy methods like this are usually considered safe because they don't involve drugs or surgery. Any side effects are likely minor, such as fatigue from the intensive sessions. Participants will be closely monitored to ensure they remain healthy throughout the process. If any issues arise, the research team can address them promptly. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Speech Motor Chaining Treatment for Speech Sound Disorder because it offers a new approach to therapy by focusing on the motor aspects of speech production. Unlike traditional treatments that might involve less frequent therapy sessions, this method can be delivered intensively, providing multiple sessions per week, which could speed up progress. The treatment is also adaptable, with options for both distributed and intensive schedules, allowing it to be tailored to individual needs. This flexibility and focus on motor skills could lead to more effective and faster improvements in speech sound disorders compared to standard therapies.

What evidence suggests that this trial's treatments could be effective for speech sound disorder?

Research has shown that Speech Motor Chaining (SMC) can help children with speech sound disorders learn new speech patterns and apply them in words. This method builds complex speech by practicing basic movements. Early findings suggest that starting with more frequent sessions may improve results by reducing mistakes between sessions. This approach might help children remember and learn correct speech sounds faster. The trial tests both frequent (Intensive Treatment) and spaced-out (Distributed Treatment) practice schedules to determine which is more effective. ^{1 2 3 5 6}

Who Is on the Research Team?

Jonathan Preston, PhD

Principal Investigator

Syracuse University

Are You a Good Fit for This Trial?

This trial is for American English-speaking children aged 9 to 17 with speech sound disorders, specifically difficulty with /ɹ/ and /s/ sounds. They must have started learning English by age 3, pass a hearing test, score adequately on language understanding tests, and want to improve their speech. Children with cleft palate, voice disorders, autism spectrum disorder, Down Syndrome, cerebral palsy, intellectual disability or brain injury are excluded.

Inclusion Criteria

Must have reported difficulty with /ɹ/ and/or /s/ production

Must receive a percentile score of 5 or below on the Goldman-Fristoe Test of Articulation-3 (GFTA-3) Sounds in Words subtest

Must pass pure tone hearing screening at 25 dB at 1000, 2000, and 4000 Hz

Exclusion Criteria

Must have no known history of autism spectrum disorder, Down Syndrome, cerebral palsy, intellectual disability, permanent hearing loss, or brain injury

Must not have current cleft palate or voice disorder

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive Speech Motor Chaining treatment. Distributed schedule: 2 sessions per week for 8 weeks. Intensive schedule: 16 sessions over 4 weeks.

4-8 weeks

16 sessions total

Follow-up

Participants are monitored for speech sound learning and social, emotional, and academic impacts after treatment

10 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Intensive Speech Motor Chaining Treatment

Trial Overview The study compares two different schedules of Speech Motor Chaining treatment: a 'Distributed' schedule (2 sessions per week for 8 weeks) versus an 'Intensive' schedule (16 hours of treatment over 4 weeks). The aim is to see which schedule better helps school-age children learn correct speech sounds in cases of residual speech sound disorder.

How Is the Trial Designed?

Group I: Intensive Treatment Experimental Treatment 1 Intervention

Speech Motor Chaining will be delivered in an intensive fashion. Week 1: 8 sessions (2 sessions per day on 4 different days) Week 2: 3 sessions (1 per day on 3 different days) Week 3: 3 sessions (1 per day on 3 different days) Week 4: 2 sessions (1 per day on 2 different days)

Group II: Distributed Treatment Experimental Treatment 1 Intervention

Speech Motor Chaining will be delivered twice weekly for 8 weeks

Who Is Running the Clinical Trial?

Syracuse University

Lead Sponsor

Trials

54

Recruited

118,000+

State University of New York - Upstate Medical University

Collaborator

Trials

176

Recruited

27,600+

National Institute on Deafness and Other Communication Disorders (NIDCD)

Collaborator

Trials

377

Recruited

190,000+

National Institutes of Health (NIH)

Collaborator

Trials

2,896

Recruited

8,053,000+

Published Research Related to This Trial

A case study involving a child with cerebral palsy showed that combining transcranial direct current stimulation (tDCS) with integrative speech therapy led to significant improvements in speech, including an increase in the percentage of correct consonants and the ability to produce two- and three-syllable words.

The therapy involved two phases of tDCS targeting different brain areas, resulting in a notable increase in phoneme production, suggesting that tDCS can enhance the effectiveness of speech rehabilitation in children with speech impairments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neuromodulation: A combined-therapy protocol for speech rehabilitation in a child with cerebral palsy. Lima, VLCC., Cosmo, C., Lima, KB., et al.[2022]

The study found that somatosensory inputs to oro-facial structures significantly improved speech processing for low-frequency words, indicating that these sensory cues can enhance lexical access and speech production accuracy.

In contrast, stimulation applied to non-speech areas (forehead) did not produce any significant effects, reinforcing the idea that targeted somatosensory interventions can effectively influence motor speech treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cross-Modal Somatosensory Repetition Priming and Speech Processing. Namasivayam, AK., Yan, T., Bali, R., et al.[2022]

Speech Motor Chaining (SMC) is an effective treatment method for school-age children with speech sound disorders, promoting the acquisition of target speech patterns and generalization to untrained words.

Clinicians can implement SMC with over 90% fidelity, allowing children to complete more than 200 trials per session, which supports the method's practicality and potential for positive outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tutorial: Speech Motor Chaining Treatment for School-Age Children With Speech Sound Disorders. Preston, JL., Leece, MC., Storto, J.[2020]

Intensive therapy for a 4-year-old boy with severe speech sound disorders, conducted 4 days a week for 3 weeks, led to significant improvements in speech, including a 39% increase in whole word match and the establishment of multisyllabic words and consonant clusters.

The results highlight that severe cases of speech sound disorders benefit greatly from frequent, direct intervention by a speech-language pathologist, suggesting that current practices of less frequent therapy may not be sufficient.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A shift of treatment approach in speech language pathology services for children with speech sound disorders - a single case study of an intense intervention based on non-linear phonology and motor-learning principles. Lundeborg Hammarström, I., Svensson, RM., Myrberg, K.[2020]

Speech motor control involves complex systems that manage how we plan and execute speech movements, which is crucial for understanding communication disorders like motor speech disorders.

There is ongoing debate about whether disorders such as apraxia of speech and stuttering should be viewed primarily through the lens of motor control or phonologic processes, highlighting the need for a comprehensive approach to treatment and understanding.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Research on speech motor control and its disorders: a review and prospective. Kent, RD.[2019]

This study aims to create a comprehensive protocol for an umbrella review that will identify effective assessments, interventions, and outcomes for treating speech sound disorders (SSD) in children, addressing a significant gap in current research.

The review will include studies of children with SSD of unknown origin and will follow established guidelines to ensure a rigorous evaluation of existing care pathways, ultimately aiming to improve treatment strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcome measures for children with speech sound disorder: an umbrella review protocol. Harding, S., Burr, S., Cleland, J., et al.[2023]

The Lee Silverman Voice Treatment (LSVT) led to significant short- and long-term improvements in speech functions, including phonation, articulation, and overall communication in a woman with ataxic dysarthria due to cerebellar dysfunction from thiamine deficiency.

The study suggests that LSVT may be an effective treatment for speech disorders associated with ataxic dysarthria, with potential neural mechanisms linked to the benefits of loud phonation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of intensive voice treatment (the Lee Silverman Voice Treatment [LSVT]) on ataxic dysarthria: a case study. Sapir, S., Spielman, J., Ramig, LO., et al.[2016]

A study involving 48 children with severe speech sound disorders (SSD-MSI) found that both once and twice weekly treatment sessions using the Motor Speech Treatment Protocol (MSTP) led to significant improvements in speech production over 10 weeks.

However, there were no significant differences in outcomes between the two treatment frequencies, suggesting that increasing the number of sessions may not provide substantial additional benefits, and a cost-benefit analysis is recommended for determining optimal treatment frequency.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Investigating intervention dose frequency for children with speech sound disorders and motor speech involvement. Namasivayam, AK., Pukonen, M., Goshulak, D., et al.[2020]

The integrated multimodal intervention (IMI) effectively improved both the quantity and quality of speech in three young boys (ages 4 to 8) with moderate to severe speech sound disorders, who were using speech-generating AAC systems.

By combining natural speech practices with AAC support, the IMI led to significant positive changes in communication abilities, suggesting that this approach can enhance traditional speech therapy methods for children with speech sound disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Severe speech sound disorders: an integrated multimodal intervention. King, AM., Hengst, JA., DeThorne, LS.[2019]

A quality improvement project increased the intensity of speech and language therapy for children with severe speech sound disorder (SSD) from an average of 30 target sounds to over 70 per session, aligning with research recommendations.

Despite challenges in increasing the frequency of therapy sessions to twice a week, improvements were observed in children's speech outcomes and parent ratings of intelligibility, demonstrating the effectiveness of a more intensive intervention model.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Applying evidence to practice by increasing intensity of intervention for children with severe speech sound disorder: a quality improvement project. McFaul, H., Mulgrew, L., Smyth, J., et al.[2023]

In a study involving five men with chronic apraxia of speech, both intense and traditional Sound Production Treatment (SPT) improved articulation, but the traditional method showed better long-term retention of gains.

The less intense SPT (1 hour per day) led to superior maintenance of accuracy for untreated words compared to the more intense SPT (3 hours per day), suggesting that a distributed approach may be more effective for lasting improvements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Treatment Intensity on Outcomes in Acquired Apraxia of Speech. Wambaugh, JL., Wright, S., Boss, E., et al.[2019]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT05929859

Intensive Speech Motor Chaining Treatment for Residual ... The goal of this randomized-controlled trial is to compare distributed treatment schedules and intensive treatment schedules in 84 school-age children with ...

2. reporter.nih.gov reporter.nih.gov/project-details/10796960

Intensive Speech Motor Chaining Treatment and Artificial ... The theoretical rationale is that increasing intensity early in treatment will mitigate erred prac- tice between sessions, improving outcomes relative to more ...

3. trialx.com trialx.com/clinical-trials/listings/221995/intensive-speech-motor-chaining-treatment-for-residual-speech-sound-disorders/

Intensive Speech Motor Chaining Treatment for Residual ... The goal of this randomized-controlled trial is to compare distributed treatment schedules and intensive treatment schedules in 84 school-age ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6802861/

Tutorial: Speech Motor Chaining Treatment for School-Age ... This tutorial describes Speech Motor Chaining (SMC) procedures, which are designed to build complex speech around core movements by incorporating several ...

5. withpower.com withpower.com/trial/phase-speech-sound-disorder-9-2023-1b4a8

Speech Therapy for Speech Sound Disorder (iChain Trial) Research shows that Speech Motor Chaining (SMC) can help children with speech sound disorders successfully learn new speech patterns and apply them to words ...

6. chaining.syr.edu chaining.syr.edu/

Speech Motor Chaining - Index The Speech Motor Chaining web application is designed for speech-language clinicians who treat motor-based speech sound disorders.