AI-Assisted Treatment for Residual Speech Sound Disorders

Overview

The goal of this randomized-controlled trial is to determine how artificial intelligence-assisted home practice may enhance speech learning of the "r" sound in school-age children with residual speech sound disorders. All child participants will receive 1 speech lesson per week, via telepractice, for 5 weeks with a human speech-language clinician. Some participants will receive 3 speech sessions per week with an Artificial Intelligence (AI)-clinician during the same 5 weeks as the human clinician sessions (CONCURRENT treatment order group), whereas others will receive 3 speech sessions per week with an AI-clinician after the human clinician sessions end (SEQUENTIAL treatment order group.

Detailed description

Artificial Intelligence-assisted treatment that detects mispronunciations within an evidence-based motor learning framework could increase access to sufficiently intense, efficacious treatment despite provider shortages. A successful Artificial intelligencesystem that can predict the clinical gold standard of trained listeners' perceptions could not only improve access to clinical care but also mitigate known confounds to accurate clinical feedback, including clinical experience and drift due to increasing familiarity between the speaker and listener. The Artificial intelligence tool used in this study includes a speech classifier trained to predict clinician judgment of American English "r" that is integrated into an existing evidence-based treatment software called Speech Motor Chaining.

Interventions

• Behavioral Speech-Language Pathologist-led Speech Motor Chaining
  Sessions begin with Pre-practice to elicit the /r/ sound. During Structured Practice, the same utterance is practiced several times in a row (with systematic increases in difficulty based on performance). Our web-based software manipulates the principles of motor learning, including feedback prompts for the clinician, the complexity of the utterance, and the variability in the practice trial; the software will analyze the clinician's rating to increase the difficulty of practice when the child i
• Behavioral Artificial Intelligence-led Speech Motor Chaining (CHAINING-AI)
  Sessions include Structured Practice and Randomized Practice using our web-based software with an Artificial Intelligence clinician to address the /r/ sound. Within a practice session, participants speak into a microphone, and the audio file is sent to a server to be analyzed by a classifier, which returns a binary accurate/inaccurate rating of productions in a fashion similar to SLP judgment. Our web-based software manipulates the principles of motor learning, including feedback prompts, the co

Primary outcome measures

• Change in percent correct for the /ɹ/ sound in untreated words, rated by blinded listeners. [Time frame: Before the initiation of treatment and again 5 weeks later.]

Secondary outcome measures (6)

• Retention of percent correct for the /ɹ/ sound in untreated words, rated by blinded listeners. [Time frame: Before the initiation of treatment and again 10 weeks later.]
• Change in percent correct for the /ɹ/ sound in untreated words, rated by blinded listeners. [Time frame: After 5 weeks of treatment and again 10 weeks later.]
• Survey evaluating impacts of speech disorder on participants' social, emotional, and academic well-being. [Time frame: Before the initiation of treatment and again 5 weeks later.]
• Change in percent correct for the /ɹ/ sound in practiced words, rated by blinded listeners. [Time frame: Before the initiation of treatment and again 5 weeks later.]
• Change in percent correct for the /ɹ/ sound in practiced words, rated by blinded listeners. [Time frame: Before the initiation of treatment and again 10 weeks later.]
• Change in percent correct for the /ɹ/ sound in practiced words, rated by blinded listeners. [Time frame: After 5 weeks of treatment and again 10 weeks later.]

Eligibility criteria

Inclusion criteria

• Must speak a rhotic dialect of American English as a dominant language.
• Must have begun learning English by at least the age of 3 years.
• Must be between 9;0 to 17;11 years of age.
• Must have reported difficulty with /ɹ/ production.
• Must have reported hearing within normal limits.
• Must receive a Scaled Score of 5 or above on both the Listening Comprehension and Story Retelling subtests from the Test of Integrated Language \& Literacy Skills (TILLS).
• Must receive a percentile score of 8 or below on the Goldman-Fristoe Test of Articulation-3 (GFTA-3) Sounds in Words subtest.
• Must have 1 scorable response with 5+ consecutive correct /pataka/ with > 3.4 syllables per second in the MRR-Tri task of the Maximum Performance Tasks OR must demonstrate no childhood apraxia of speech (CAS-only) features in BOTH articulatory and rate/prosody domains of the ProCAD.
• Must score <40% accurate based on word-level items from our /ɹ/ probe list.
• Must score >=15% accuracy on /ɹ/ on 45 syllables following Dynamic Assessment.
• Must express interest in changing their /ɹ/ production.
• Must have oral structure and function that are appropriate for /ɹ/ production.
• Must have access to broadband internet with videoconferencing capabilities

Exclusion criteria

• Must have no known history of autism spectrum disorder, Down Syndrome, cerebral palsy, intellectual disability, permanent hearing loss, epilepsy/antiepileptic medication, or brain injury/neurosurgery/stroke.
• Must not have diagnosis of attention deficit disorder, attention deficit hyperactivity disorder, Tourette's, or Obsessive-compulsive disorder.
• Must have no orthodontic appliances that block the roof of the mouth (e.g., palate expanders).
• Must not have current cleft palate, fluency disorder, or voice disorder.
• Must not demonstrate childhood apraxia of speech (CAS-only) features in BOTH articulatory and rate/prosody domains of the ProCAD.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

United States · 1 center

• Syracuse University — Syracuse

Identifiers

NCT: NCT05988515 · 22-426b · 1R01DC020959-01

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗