Sargenti 2011.

Methods	Randomised controlled trial comparing 1 intervention group (oral motor therapy and articulation therapy) and 1 control group (articulation therapy only). Conducted from January to March 2011
Participants	4 children (all boys) aged 7.01 to 9.06 years; mean age was 8.02 years. All participants had normal hearing and showed delayed motor control. 1 participant in the intervention group was diagnosed as "communication impaired", and 1 participant in the control group was classified as "multiply disabled (communication impaired, Attention Deficit Hyperactivity Disorder, Tourette Syndrome, and Obsessive‐Compulsive Disorder)". The other 2 participants had "normal academic and language abilities" (p 17). All participants showed "distorted production of the phonemes /s/ and /z/ and exhibited an interdental (frontal) or lateral lisp" (p 17)
Interventions	The 4 participants were randomly assigned to 1 of the 2 groups by means of a random number table Intervention group (n = 2) 16 × 30‐minute therapy sessions, with the first 10 minutes on oral motor therapy and the following 20 minutes on articulation therapy Oral placement therapy (OPT) for /s/ and /z/, developed by Rosenfeld‐Johnson (Rosenfeld‐Johnson 2009), was used for oral motor therapy. This treatment protocol includes exercises for the jaw, lips and tongue, using the following tools ‐ Talk Tools Jaw Grading Bite Blocks, Talk Tools Bubble Kit and Talk Tools Horn Kit ‐ as well as a sensory programme using Talk Tools Vibrator/Toothettes. Exercises used in the intervention were selected on the basis of results of the Initial Speech System Evaluation (which comes with this treatment package) of individual participants. Hence, participant 1 went through the following exercises during the course of intervention: bite block exercises level #2 to #7, blow bubble exercises level #3 to #5 and blow horn exercises level #2 to #12, whereas participant 2 went through bite block exercises level #4 to #7 and blow horn exercises level #9 to #12. Results of the Initial Speech System Evaluation revealed that both participants had "hypo‐sensitivity/responsivity" (p 22). Thus, the sensory programme was administered to participants at the start of each therapy session "to increase awareness" before oral motor therapy (p 26). The programme started with rubbing both sides of the buccal cavity, the upper and lower gum ridges, the surface and lateral margins of the tongue and the hard palate of the participant with a dampened Talk Tools Toothette; the procedure was repeated using a Talk Tools Vibrator. The sensory programme took about 1 to 2 minutes to complete Control group (n = 2) 16 × 30‐minute therapy sessions with articulation therapy, targeting /s/ at different word positions The frequency of therapy sessions was the same for both intervention and control groups ‐ 2 therapy sessions per week over 8 weeks. Total therapy time was 8 hours for each participant. All therapy sessions were conducted as individual therapy. All participants were "given specific articulation homework assignments biweekly" (p 38) and "specific (oral motor therapy) homework assignments were given biweekly" to participants in the Intervention group (p 30)
Outcomes	Assessment of Oral‐Motor Functions During Non‐Speech Tasks (Mackie 1996) and Goldman‐Fristoe Test of Articulation Second Edition (Goldman 2000) were conducted on all participants 1 week before the intervention and 1 week after the final therapy session. 3 sets of probes (each of which includes 4 words that contain /s/ and 4 words that contain /z/) were developed for tracking treatment progress of /s/ and generalisation of treatment effect to /z/. Probe 1 was conducted on all participants at the start of the first therapy session to determine the initial level of performance; probe 2 was used to record performance at the end of the first therapy session; and probe 3 was used to document performance at the end of the second therapy session. Performance at the end of the remaining therapy sessions was assessed by alternating use of the 3 probes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	"A random number table was used to randomly assign subjects to one of two groups" (p 18)
Allocation concealment (selection bias)	Unclear risk	The method used to conceal allocation was not described
Blinding of participants and personnel (performance bias) All outcomes	High risk	Blinding of participants and personnel was not possible
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Outcome assessor was not identified
Incomplete outcome data (attrition bias) All outcomes	Low risk	All participants completed the 16 therapy sessions
Selective reporting (reporting bias)	Low risk	The study appears to be free of selective reporting bias
Other bias	Low risk	The study appears to be free of other bias

IEP = individualised education plan; PPVT‐III = Peabody Picture Vocabulary Test Third Edition; SPAT‐D = Structured Photographic Articulation Test ‐ Dudsberry.