Enhanced Speech Development Through Combined Speech Therapy Massage and Augmentative Alternative Communication: A Randomized Controlled Trial of Preschool Children
DOI:
https://doi.org/10.71637/tnhj.v25i1.966Keywords:
Augmentative Alternative Communication, combined intervention, speech delay, neuroplasticity, Speech Therapy MassageAbstract
Background: Speech delay affects 5–10% of preschool-aged children and has significant implications for cognitive, social, and emotional development. Traditional speech therapy is often inadequate for achieving long-term outcomes. This study aimed to evaluate the efficacy of combining Speech Therapy Massage (STM) with Augmentative Alternative Communication (AAC) compared to each method independently in enhancing speech abilities in children.
Methods: This research utilised a randomised controlled trial (RCT) design involving 120 children aged 2–6 years, allocated into three intervention groups: STM, AAC, and combined STM-AAC. The intervention was conducted over a nine-month period, with speech development assessed using the Communication and Symbolic Behaviour Scales (CSBS) and Ages and Stages Questionnaires (ASQ). Data analysis comprised ANOVA with post-hoc Tukey tests to compare efficacy across groups.
Results: The STM-AAC combination group demonstrated significant improvements in CSBS (37%) and ASQ scores (41%) compared to the STM (24%, 27%) and AAC groups (22%, 23%), respectively (p < 0.01). The most substantial advancements were observed in constructing simple sentences (75%) and utilising two-word phrases (80%) within the combination group. Parental adherence to therapy protocols was also the highest in this group (95%).
Conclusion: The combination of STM and AAC yielded superior outcomes compared with single-method interventions, supporting the efficacy of a multimodal neuroplasticity-based approach in speech therapy. These findings significantly contribute to the development of comprehensive intervention strategies for children with speech delay. Further studies are warranted to assess the long-term impacts and neurophysiological mechanisms underlying these results.
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References
1. Liang WHK, Gn LWE, Tan YCD, Tan GH. Speech and language delay in children: a practical framework for primary care physicians. Singapore Med J. 2023 Nov 29;64(12):745–50.
2. Usha GP, Alex JSR. Speech assessment tool methods for speech impaired children: a systematic literature review on the state-of-the-art in Speech impairment analysis. Multimed Tools Appl. 2023 Sep 1;82(22):35021–58.
3. Lorang E, Maltman N, Venker C, Eith A, Sterling A. Speech-Language Pathologists’ Practices in Augmentative and Alternative Communication during Early Intervention. Augment Altern Commun. 2022 Mar;38(1):41–52.
4. Marzola P, Melzer T, Pavesi E, Gil-Mohapel J, Brocardo PS. Exploring the Role of Neuroplasticity in Development, Aging, and Neurodegeneration. Brain Sci. 2023 Nov 21;13(12):1610.
5. Attwell GA, Bennin KE, Tekinerdogan B. A Systematic Review of Online Speech Therapy Systems for Intervention in Childhood Speech Communication Disorders. Sensors. 2022 Jan;22(24):9713.
6. Brittlebank S, Light JC, Pope L. A scoping review of AAC interventions for children and young adults with simultaneous visual and motor impairments: Clinical and research Implications. Augment Altern Commun. 2024 Sep;40(3):219–37.
7. Bean A, Harris K, Kim H, DiGiovine C, Sonntag AM. A scoping review of communication outcomes measures in augmentative and alternative communication. Assistive Technology. 2023;1–22.
8. Archer Anwar R, Hart Barnett JE. AAC in AACtion: Collaborative Strategies for Special Education Teachers and Speech-Language Pathologists. Intervention in School and Clinic. 2024 Nov 1;60(2):96–107.
9. Larsen B, Sydnor VJ, Keller AS, Yeo BTT, Satterthwaite TD. A critical period plasticity framework for the sensorimotor-association axis of cortical neurodevelopment. Trends Neurosci. 2023 Oct;46(10):847–62.
10. Walsh M, Harman I, Manning P, Ponza B, Wong S, Shaw B, et al. Including People Who Use Augmentative and Alternative Communication in Qualitative Research: Can You Hear Us? International Journal of Qualitative Methods. 2024 Jan 1;23:16094069241234190.
11. Giorgetti M, Bombacigno R, Toraldo A, Lorusso ML. STM-Suite, an Online Platform for the Assessment of Memory Functions Discriminates among Subgroups of Children with Different Types of Specific Learning Disorders. Applied Sciences. 2024 Jan;14(13):5891.
12. Wilkinson KM, Brittlebank S, Barwise A, Zimmerman TO, Light J. Visual fixation patterns to AAC displays are significantly correlated with motor selection for individuals with Down syndrome or individuals on the autism spectrum. Augmentative and Alternative Communication. 2024 Jul 2;40(3):155–67.
13. Schworer EK, Voth K, Hoffman EK, Esbensen AJ. Short-term memory outcome measures: Psychometric evaluation and performance in youth with Down syndrome. Research in Developmental Disabilities. 2022 Jan 1;120:104147.
14. Shea K, St-Cyr O, Chau T. Ecological Design of an Augmentative and Alternative Communication Device Interface. Journal of Cognitive Engineering and Decision Making. 2021 Dec 1;15(4):175–97.
15. Gilroy SP, McCleery JP, Leader G. A delayed intervention start randomized controlled trial of high- and low-tech communication training approaches for school-age autistic children with co-occurring intellectual disability. J Appl Behav Anal. 2023 Jun;56(3):593–606.
16. Griffiths T, Clarke M, Price K. Augmentative and alternative communication for children with speech, language and communication needs. Paediatrics and Child Health. 2022 Aug 1;32(8):277–81.
17. Crowe B, Machalicek W, Wei Q, Drew C, Ganz J. Augmentative and Alternative Communication for Children with Intellectual and Developmental Disability: A Mega-Review of the Literature. J Dev Phys Disabil. 2022;34(1):1–42.
18. Weismer G. Oromotor Nonverbal Performance and Speech Motor Control: Theory and Review of Empirical Evidence. Brain Sci. 2023 May 6;13(5):768.
19. University of Central Florida. Building Sentences With Preschoolers Who Use AAC [Internet]. clinicaltrials.gov; 2024 Jan [cited 2024 Nov 25]. Report No.: NCT03538925. Available from: https://clinicaltrials.gov/study/NCT03538925
20. Yunilda E, Gunardi H, Medise BE, Oswari H. The Indonesian version of Ages and Stages Questionnaire III accuracy compared to Bayley Scales of Infant Development III. Infant and Child Development [Internet]. 2023 [cited 2024 Nov 25];32(1). Available from: http://www.scopus.com/inward/record.url?scp=85142182435&partnerID=8YFLogxK
21. Supit DM. Universitas Indonesia Library. Fakultas Kedokteran Universitas Indonesia; 2019 [cited 2024 Nov 25]. Uji kesahihan dan keandalan communication and symbolic behavior scales developmental profile (CSBS DP) infant/ toddler checklist Bahasa Indonesia sebagai alat uji penapisan gangguan komunikasi pada anak usia 6-24 bulan = Validity and reliability of communication and symbolic behavior scales developmental profile (CSBS DP) infant/ toddler checklist Indonesian version as a screening tool for communication disorders in 6-24 months old children. Available from: https://lib.ui.ac.id
22. Impulss. Impulss - Speech therapy massage [Internet]. 2023 [cited 2024 Nov 25]. Available from: https://impulss.eu/methods/speech-therapy-massage
23. Zhang L fang. Erikson’s Theory of Psychosocial Development. In: Wright JD, editor. International Encyclopedia of the Social & Behavioral Sciences (Second Edition) [Internet]. Oxford: Elsevier; 2015 [cited 2024 Nov 25]. p. 938–46. Available from: https://www.sciencedirect.com/science/article/pii/B9780080970868232005
24. Poole S, Snarey J. Erikson’s Stages of the Life Cycle. In: Goldstein S, Naglieri JA, editors. Encyclopedia of Child Behavior and Development [Internet]. Boston, MA: Springer US; 2011 [cited 2024 Nov 25]. p. 599–603. Available from: https://doi.org/10.1007/978-0-387-79061-9_1024
25. Rorije M, Damen S, Janssen MJ, Minnaert A. Applying Erikson’s theory of psychosocial development to understand autonomy development in children and youths with deafblindness: a systematic literature review. Front Educ [Internet]. 2023 Oct 12 [cited 2024 Nov 25];8. Available from: https://www.frontiersin.org/journals/education/articles/10.3389/feduc.2023.1228905/full
26. Gallagher MW. Self-Efficacy. In: Ramachandran VS, editor. Encyclopedia of Human Behavior (Second Edition) [Internet]. San Diego: Academic Press; 2012 [cited 2024 Nov 25]. p. 314–20. Available from: https://www.sciencedirect.com/science/article/pii/B9780123750006003128
27. Lippke S. Self-Efficacy Theory. In: Zeigler-Hill V, Shackelford TK, editors. Encyclopedia of Personality and Individual Differences [Internet]. Cham: Springer International Publishing; 2020 [cited 2024 Nov 25]. p. 4722–7. Available from: https://doi.org/10.1007/978-3-319-24612-3_1167
28. Schunk DH, DiBenedetto MK. Chapter Four - Self-efficacy and human motivation. In: Elliot AJ, editor. Advances in Motivation Science [Internet]. Elsevier; 2021 [cited 2024 Nov 25]. p. 153–79. (Advances in Motivation Science; vol. 8). Available from: https://www.sciencedirect.com/science/article/pii/S2215091920300158
29. Poluektova O, Kappas A, Smith CA. Using Bandura’s Self-Efficacy Theory to Explain Individual Differences in the Appraisal of Problem-Focused Coping Potential. Emotion Review. 2023 Oct 1;15(4):302–12.
30. Attwood AI. A Conceptual Analysis of the Semantic Use of Multiple Intelligences Theory and Implications for Teacher Education. Front Psychol. 2022 Jun 16;13:920851.
31. Ghaznavi N, Haddad Narafshan M, Tajadini M. The Implementation of a Multiple Intelligences Teaching Approach: Classroom engagement and physically disabled learners. Caputi M, editor. Cogent Psychology. 2021 Dec 31;8(1):1880258.
32. Deci EL, Ryan RM. The “What” and “Why” of Goal Pursuits: Human Needs and the Self-Determination of Behavior. Psychological Inquiry. 2000 Oct 1;11(4):227–68.
33. Manninen M, Dishman R, Hwang Y, Magrum E, Deng Y, Yli-Piipari S. Self-determination theory based instructional interventions and motivational regulations in organized physical activity: A systematic review and multivariate meta-analysis. Psychology of Sport and Exercise. 2022 Sep 1;62:102248.
34. Martin KC, Ketchabaw WT, Turkeltaub PE. Plasticity of the language system in children and adults. Handb Clin Neurol. 2022;184:397–414.
35. Scott HK, Cogburn M. Piaget. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Nov 8]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK448206/
36. Sarmiento-Campos NV, Lázaro-Guillermo JC, Silvera-Alarcón EN, Cuellar-Quispe S, Huamán-Romaní YL, Apaza OA, et al. A Look at Vygotsky’s Sociocultural Theory (SCT): The Effectiveness of Scaffolding Method on EFL Learners’ Speaking Achievement. Education Research International. 2022;2022(1):3514892.
37. Fernyhough C, Borghi AM. Inner speech as language process and cognitive tool. Trends in Cognitive Sciences. 2023 Dec 1;27(12):1180–93.
38. Lv YB, Cheng W, Wang MH, Wang XM, Hu YL, Lv LQ. Multimodal integrated intervention for children with attention-deficit/hyperactivity disorder. World J Clin Cases. 2023 Jun 26;11(18):4267–76.
39. Donner P, Lundström S, Heikkilä M. A case study of young children’s play negotiations in free play. Early Years. 2024 May 26;44(3–4):889–902.
40. Arnott L. Play, adventure and creativity: unearthing the excitement and fun of learning. International Journal of Early Years Education. 2023 Apr 3;31(2):305–8.
41. Fisher C. The role of abstract syntactic knowledge in language acquisition: a reply to Tomasello (2000). Cognition. 2002 Jan 1;82(3):259–78.
42. Bress KS, Cascio CJ. Sensorimotor regulation of facial expression – An untouched frontier. Neuroscience & Biobehavioral Reviews. 2024 Jul 1;162:105684.
43. Tang D lan, Niziolek CA, Parrell B. Modulation of somatosensation by transcranial magnetic stimulation over somatosensory cortex: a systematic review. Exp Brain Res. 2023 Apr;241(4):951–77.
44. Wani PD. From Sound to Meaning: Navigating Wernicke’s Area in Language Processing. Cureus. 2024;16(9):e69833.
45. Elsahar Y, Hu S, Bouazza-Marouf K, Kerr D, Mansor A. Augmentative and Alternative Communication (AAC) Advances: A Review of Configurations for Individuals with a Speech Disability. Sensors (Basel). 2019 Apr 22;19(8):1911.
46. May KE, Kana RK. Frontoparietal Network in Executive Functioning in Autism Spectrum Disorder. Autism Res. 2020 Oct;13(10):1762–77.
47. Dubinsky JM, Hamid AA. The neuroscience of active learning and direct instruction. Neuroscience & Biobehavioral Reviews. 2024 Aug 1;163:105737.
48. Grøver V, Snow CE, Evans L, Strømme H. Overlooked advantages of interactive book reading in early childhood? A systematic review and research agenda. Acta Psychologica. 2023 Sep 1;239:103997.
49. Gonzales Martinez R, Wells J, Anand P, Pelto G, Dhansay MA, Haisma H. Community Participation and Multidimensional Child Growth: Evidence from the Vietnam Young Lives Study. Current Developments in Nutrition. 2022 Apr 1;6(4):nzac022.
50. Burney V, McCann CM, Arnold-Saritepe A. Parent Engagement in Child-Focused Interventions: A Systematised Review of Qualitative Allied Health Literature. Child Youth Care Forum. 2024 Dec 1;53(6):1451–86.
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