Apraxia World: An interactive technology-based therapy tool for childhood apraxia of speech.

Introduction: Our team have developed a system called Apraxia World that includes speech­driven games for tablets to deliver speech therapy exercises remotely, and speech processing algorithms required to extract disorder-specific variables for use in controlling gameplay and accurately monitoring therapy progress. The system enables true remote speech therapy by 1) including automated speech-processing capabilities to evaluate a child’s speech production attempts and provide the child with feedback on their performance accuracy, 2) providing feedback on the child’s performance to the speech-language pathologist (SLP) via a secure server, allowing SLPs to review progress made and manage multiple children remotely, and 3) enabling children to practice and learn new skills expeditiously via a tablet without having to schedule intensive and expensive therapy sessions. The images and vocabulary programmed into the table are based on the Nuffield Dyspraxia Programme Edition 3, which has been shown an efficacious approach for CAS (1-3). We will clinically validate the use of remote speech therapy as an effective medium for intervention in CAS with this intervention effectiveness trial conducted through the University of Sydney. This study will test the integrated Apraxia World system (games + tablet interface + clinician interface) in the field, evaluating (1) the child’s adherence to therapy and amount of practice completed using the system (data recorded through the system), (2) the child’s and parent’s experiences and satisfaction with the system (survey), and (3) the SLPs experiences and satisfaction with the system (survey). Method: Up to 10 private SLPs from the local community in Sydney will be recruited via advertisements. SLPs who contact the research team will be enrolled in the study, provided with a recruitment flyer targeted to families of children with CAS, and asked to post the flyer in their waiting room. The flyer directs interested families to contact the research team; at that time the research team will identify which private SLP the family are seeing and inform the SLP that their client is enrolling. The SLPs will be trained on the system and the intervention approach by the research team, although most will be familiar with the intervention approach already. Training will involve familiarisation with the server-clinician interface, gameplay in the app, and the Nuffield Dyspraxia Program; and will be set up with accounts for themself and their enrolled clients. This training should take about 1 hr in the SLPs clinic, with technical support offered by phone/email throughout the trial. The research team will contact the SLPs weekly to check for issues/progress. The SLP will be asked to identify the speech behaviours that are appropriate for their client(s) to work on in therapy. This information will be used to select the appropriate therapy exercises on the tablet for each child. Following this, the SLP will train the child and parent(s) to ensure that they can navigate the tablet and understand the structure, purpose and goals of each of their assigned exercises (1 hr); researchers will be available to assist with/do this if requested by the SLP and family. The SLP will provide individual face-to-face therapy for the child in the clinic or the child’s home (as was occurring before the trial began), at their current frequency (typically 1 session of 1 hr / week), using the system, and prescribing homework activities for other days (as is customary). The family will be given the tablet for 12 weeks and instructed to continue their weekly sessions with the SLP and do a total of at least 45 minutes of practice a day for 4 days a week on the tablet-based exercises prescribed by the SLP. For all sessions undertaken by the child, speech attempts will be recorded, uploaded to the server­clinician interface, and automatically analyzed for key speech features (i.e., lexical stress, and speech sound accuracy). The SLP will be asked to view the recordings and/or data at least 1 – 2 times a week to track adherence, ensure the exercises are not too difficult, and replace old exercises with new ones once a skill / skill level is mastered. Weekly contact will be made with the SLPs to collect recordings and data and ensure the trial is on track. (1) Nuffield Dyspraxia Programme. Available: http://www.ndp3.org/dyspraxia-therapy-overview.html (2) Williams P. and H. Stephens, "Nuffield Centre Dyspraxia Programme," in Interventions for Speech Sound Disorders in Children, A. L. Williams, et al., Ed., ed: Brookes Pub., 2010. (3) Murray, E., McCabe, P., & Ballard, K.J. (2015). A randomized controlled trial for children with childhood apraxia of speech comparing Rapid Syllable Transition Treatment and the Nuffield Dyspraxia Programme- Third Edition). Journal of Speech, Language, and Hearing Research, 58(3), 669-686. doi:10.1044/2015_JSLHR-S-13-0179.