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ReST vs. ultrasound pilot RCT for children with CAS (McCabe et al., 2023)

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posted on 2023-02-27, 22:40 authored by Patricia McCabe, Jonathan L. Preston, Pippa Evans, Rob Heard

Purpose: Both Rapid Syllable Transition Treatment (ReST) and ultrasound biofeedback are effective approaches to treating childhood apraxia of speech (CAS). The purpose of the study was to compare outcomes from these two motor-based treatment approaches for school-age children with CAS.

Method: In a single site, single blind randomized control trial, 14 children with CAS ages 6–13 years were randomly assigned to 12 sessions over 6 weeks of either of ultrasound biofeedback treatment (with a speech motor chaining practice structure) or ReST. Treatment was delivered at The University of Sydney by students trained and supervised by certified speech-language pathologists. Transcriptions from blinded assessors were used to compare the two groups on speech sound accuracy (percent phonemes correct) and prosodic severity (lexical stress errors and syllable segregation) in untreated words and sentences at three time points: pretreatment, immediately posttreatment, and 1-month posttreatment (i.e., retention).

Results: Both groups showed significant improvement on treated items indicating a treatment effect. At no time was there a difference between groups. Both groups showed a significant improvement in speech sound accuracy on untreated words and sentences from pre to post and neither group showed an improvement in prosody pre–post. Changes to speech sound accuracy were retained by both groups at 1-month follow-up. Significant improvement in prosodic accuracy was reported at the 1-month follow-up.

Conclusions: ReST and ultrasound biofeedback were equally effective. Either ReST or ultrasound biofeedback may be viable treatment options for school-age children with CAS.

Supplemental Material S1. De-identified data from individual children.

Supplemental Material S2. SPSS data file and the SPSS syntax.

McCabe, P., Preston, J. L., Evans, P., & Heard, R. (2023). A pilot randomized control trial of motor-based treatments for childhood apraxia of speech: Rapid Syllable Transition Treatment and ultrasound biofeedback. American Journal of Speech-Language Pathology, 32(2), 613–628.


This study was funded by a grant from the Childhood Apraxia of Speech Association of North America (Apraxia-Kids). Preston was also supported by National Institutes of Health grant R15DC016426.