Effectiveness of Dynamic Tactile Temporal Cueing in improving speech and communicative participation in children with cerebral palsy: An exploratory sequential mixed methods study

Dynamic Tactile Temporal Cuing (DTTC) is a motor speech intervention designed for young children with severe motor speech disorders including childhood apraxia of speech (CAS), a similar condition to dysarthria in cerebral palsy. DTTC focuses on learning to move the muscles required for speaking while learning to say words. DTTC involves stimulation techniques of “look at me, listen to me, say what I say”. A set of 20 meaningful target words that contain sounds that the child already can produce and those sounds that are emerging are practiced in intensive drill. The speech pathologist systematically works toward independent (non-imitated) production of the words by fading cues in a cueing hierarchy. The cues include slow speaking rate, the length of time between clinician model and child’s response, and tactile cues to demonstrate articulatory configurations (the movements and placement of the tongue, cheeks, and lips). Rapid reinforcers (feedback on the correctness of the production and on how to produce the word/ phrase) are used to maximize the number of practice trials per session. Cues are individual to the child and the clinician moves along the cuing hierarchy to facilitate accurate production while moving towards independent production. DTTC intervention will be provided three times a week for six weeks by speech pathologists trained in DTTC intervention. Each session runs for one hour. The sessions will be in-person at a Cerebral Palsy Alliance site closest to the participant's home. All treating speech pathologists will undergo training for DTTC a minimum of one month before the commencement of the intervention. The following training will take place: 1. Complete DTTC online training https://childapraxiatreatment.org/dttc/. 2. Complete a three-hour training on the implementation of DTTC, delivered over two or three sessions depending on the speech pathologist’s availability. The CI or the other speech pathologists in the research team will provide the training individually to each speech pathologist or in groups of two online or in-person. A standardized DTTC intervention manual will be developed and used in the training. 3. The CI or the other speech pathologists in the team will observe the treating clinician’s first or the second treatment session with their first participant after which they will provide coaching feedback to the speech pathologist. Adherence to DTTC intervention will be monitored by the Chief Investigator (CI) and the other speech pathologists in the research team. In addition to the initial clinician observation, the CI or the other speech pathologists will also observe three more randomly selected treatment sessions to observe fidelity to the DTTC intervention. If Fidelity drops below 90%, the speech pathologist will be provided with further training and support by the Chief Investigator or other speech pathologists in the research team. The length of baselines: Following the pre-treatment assessment, children will be randomized to complete 3, 4 or 5 pre-treatment probe assessments during baseline period. Children will be randomized to one of the following conditions: - 3 pre-treatment probes: 2 x on 1 week before treatment and 1x on the first week of treatment - 4 pre-treatment probes: 1 x on 2 weeks before treatment, 2 x 1 week before treatment, 1 x 1 on the first week of treatment. - 5 pre-treatment probes: 2 x on 2 weeks before treatment, 2 x 1 week before treatment, 1 x 1 on the first week of treatment