Content area
Full text
Purpose: This randomized controlled trial compared the experimental Rapid Syllable Transition (ReST) treatment to the Nuffield Dyspraxia Programme-Third Edition (NDP3; Williams & Stephens, 2004), used widely in clinical practice in Australia and the United Kingdom. Both programs aim to improve speech motor planning/programming for children with apraxia of speech (CAS), but they differ in types of stimuli used, level of stimulus complexity at initiation of treatment, and the principles of motor learning that they apply.
Method: Treatment was delivered to 26 children with mild to severe CAS aged 4-12 years through trained and supervised speech-language pathology students in 1-hr sessions, 4 days a week for 3 weeks at a university clinic. Articulation and prosodic accuracy were assessed at pretreatment, 1 week, 1 month, and 4 months posttreatment using blinded independent assessors to compare treatment, maintenance, and generalization effects.
Results: The ReST and NDP3 treatments demonstrated large treatment effects. ReST maintained treatment gains from 1-week to 4-months posttreatment more effectively than the NDP3. Significant generalization to untreated stimuli was observed for both ReST and NDP3.
Conclusions: ReST and NDP3 have strong evidence of treatment and generalization gains in children with CAS when delivered intensively. Overall, ReST has greater external evidence from multiple sources but both treatments have support for clinical use.
Idiopathic childhood apraxia of speech (CAS; known in the United Kingdom as developmental verbal dyspraxia) is currently considered a motor speech disorder of planning and/or programming (e.g., American Speech-Language-Hearing Association [ASHA], 2007; Nijland, Maassen, & van der Meulen, 2003). Although there is no validated assessment procedure available for CAS, there is consensus on three features of the disorder: ?(a) inconsistent errors on consonants and vowels in repeated productions of syllables or words, (b) lengthened and disrupted co-articulatory transitions between sounds and syllables, and (c) inappropriate prosody, especially in the realization of lexical or phrasal stress? (ASHA, 2007).1 Longitudinal studies suggest that idiopathic CAS is persistent throughout childhood and potentially into adulthood, frequently disrupting development of literacy skills (e.g., learning lettersound relationships for decoding new words), social communication, and academic and vocational potential (e.g., Jacks, Marquardt, & Davis, 2006; Lewis, Freebairn, Hansen, Iyengar, & Taylor, 2004; Stackhouse & Snowling, 1992). The three consensus-based diagnostic features are thought to reflect impaired motor control; therefore, efficacious treatment...