Speech Intervention Effect for Childhood Apraxia of Speech: Quality Appraisal of Systematic Reviews

Alisha Springle, Amber Breeden, & Anastasia Raymer
Summary by Alisha Springle

A number of studies have examined the effects of speech interventions on outcomes in childhood apraxia of speech (CAS).  Clinicians searching for the most effective way to treat their clients with CAS need an efficient way to identify the strongest evidence-based practices. One useful approach to support evidence-based practice is for the clinician to identify systematic reviews (SR) or meta-analyses (MA) aligned with practice needs. Systematic reviews represent a rigorous process of identifying and synthesizing the results of the breadth of research studies on a topic, including an analysis of the methodologic quality of the research evidence (Grant & Booth, 2009). A meta-analysis is a systematic review that identifies consistent outcome measures across studies to conduct a quantitative synthesis of the research evidence. Most systematic reviews include all studies on a topic to encompass both the quantity and quality of evidence (Gough, 2007).  Yet without acceptable rigor, SRs/MAs may be biased in their recommendations.  We appraised the quality of existing SRs for CAS treatment using a tool developed within epidemiology, the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews; Shea et al., 2017).

A search of five databases to identify published SRs that coalesced treatment research for CAS revealed six systematic reviews that met inclusion criteria. Two examiners coded each article with the AMSTAR-2 to rate the methodologic rigor of the SRs and extracted summary data.  The number of studies summarized in six identified systematic reviews varied widely, from zero (Morgan & Vogel, 2009) to 42 studies (Murray et al., 2014).  One rigorous systematic review included only one randomized controlled trial (Morgan et al., 2018). A second moderately rigorous review (Murray et al., 2014) examined multiple single participant research designs.  These two reviews summarized multiple types of treatments, including linguistic, motor-programming, and alternative and augmentative communication approaches (Koehlinger, 2015; Murray et al., 2014).  The schedule for reviewed treatments varied by study, but most identified hour-long sessions delivered one to three times weekly.  Five of the six reviews reported improvement in speech production for at least some targeted speech behaviors following treatments for CAS.  Better outcomes were reported for high intensity motor programming treatment schedules that applied a high dose (number of responses) and higher dose frequency (days per week) during training (Kaipa & Peterson, 2016).

Although most  CAS treatment studies incorporate less rigorous study designs, recent well-done systematic reviews, such as the work of  Murray et al. (2014), report that the preponderance of the evidence suggests that motor programming treatments lead to the best speech production outcomes in CAS.  Among these approaches are Rapid Syllable Transition Treatment (ReST; McCabe et al., 2017), Dynamic Temporal and Tactile Cueing (DTTC, Strand et al., 2006), and Nuffield Dyspraxia Program (Murray, McCabe, & Ballard, 2015; Williams & Stephens, 2010). Descriptions of these treatment approaches can be found in various online resources (e.g., apraxia-kids.org; asha.org; sydney.edu.au/health-sciences/rest/; ndp3.org/).  Additional professional training can be beneficial to effectively administer these treatment protocols and are available through these and other websites (e.g., childapraxiatreatment.org; utdallas.edu/calliercenter/events/CAS/; sydney.edu.au/health-sciences/rest/training-package/).  Some supporting treatment materials and training are provided by the researcher/developers free of charge, while others require purchase.

Please see the full article for listed references.

ASHA Perspectives Sig 2, June, 2020

https://doi.org/10.1044/2020_PERSP-19-00019

Alisha Springle, Amber Breeden, & Anastasia Raymer
Summary by Alisha Springle

A number of studies have examined the effects of speech interventions on outcomes in childhood apraxia of speech (CAS).  Clinicians searching for the most effective way to treat their clients with CAS need an efficient way to identify the strongest evidence-based practices. One useful approach to support evidence-based practice is for the clinician to identify systematic reviews (SR) or meta-analyses (MA) aligned with practice needs. Systematic reviews represent a rigorous process of identifying and synthesizing the results of the breadth of research studies on a topic, including an analysis of the methodologic quality of the research evidence (Grant & Booth, 2009). A meta-analysis is a systematic review that identifies consistent outcome measures across studies to conduct a quantitative synthesis of the research evidence. Most systematic reviews include all studies on a topic to encompass both the quantity and quality of evidence (Gough, 2007).  Yet without acceptable rigor, SRs/MAs may be biased in their recommendations.  We appraised the quality of existing SRs for CAS treatment using a tool developed within epidemiology, the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews; Shea et al., 2017).

A search of five databases to identify published SRs that coalesced treatment research for CAS revealed six systematic reviews that met inclusion criteria. Two examiners coded each article with the AMSTAR-2 to rate the methodologic rigor of the SRs and extracted summary data.  The number of studies summarized in six identified systematic reviews varied widely, from zero (Morgan & Vogel, 2009) to 42 studies (Murray et al., 2014).  One rigorous systematic review included only one randomized controlled trial (Morgan et al., 2018). A second moderately rigorous review (Murray et al., 2014) examined multiple single participant research designs.  These two reviews summarized multiple types of treatments, including linguistic, motor-programming, and alternative and augmentative communication approaches (Koehlinger, 2015; Murray et al., 2014).  The schedule for reviewed treatments varied by study, but most identified hour-long sessions delivered one to three times weekly.  Five of the six reviews reported improvement in speech production for at least some targeted speech behaviors following treatments for CAS.  Better outcomes were reported for high intensity motor programming treatment schedules that applied a high dose (number of responses) and higher dose frequency (days per week) during training (Kaipa & Peterson, 2016).

Although most  CAS treatment studies incorporate less rigorous study designs, recent well-done systematic reviews, such as the work of  Murray et al. (2014), report that the preponderance of the evidence suggests that motor programming treatments lead to the best speech production outcomes in CAS.  Among these approaches are Rapid Syllable Transition Treatment (ReST; McCabe et al., 2017), Dynamic Temporal and Tactile Cueing (DTTC, Strand et al., 2006), and Nuffield Dyspraxia Program (Murray, McCabe, & Ballard, 2015; Williams & Stephens, 2010). Descriptions of these treatment approaches can be found in various online resources (e.g., apraxia-kids.org; asha.org; sydney.edu.au/health-sciences/rest/; ndp3.org/).  Additional professional training can be beneficial to effectively administer these treatment protocols and are available through these and other websites (e.g., childapraxiatreatment.org; utdallas.edu/calliercenter/events/CAS/; sydney.edu.au/health-sciences/rest/training-package/).  Some supporting treatment materials and training are provided by the researcher/developers free of charge, while others require purchase.

Please see the full article for listed references.

ASHA Perspectives Sig 2, June, 2020

https://doi.org/10.1044/2020_PERSP-19-00019



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