Effects of integral stimulation therapy on speech - Portland State ...

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The committee recognized that identification <strong>of</strong> diagnostic features and efficacious treatments for the speech disorder is particularly difficult because characteristics <strong>of</strong> CAS may change significantly over the course <strong>of</strong> a child’s development and treatment history. Characterization <strong>of</strong> CAS first appeared as a result <strong>of</strong> similarities that were noted between the childhood form <strong>of</strong> apraxia and the acquired adult form <strong>of</strong> apraxia <strong>of</strong> speech (AOS) (Morley,1972). Acquired Apraxia <strong>of</strong> Speech involves cortical damage (most <strong>of</strong>ten associated with strokes or other neurological insults) resulting in difficulty with volitional motor sequencing <strong>of</strong> speech movements (Chapey, 2001). Like AOS, childhood apraxia <strong>of</strong> speech’s core deficit is believed to involve the disruption <strong>of</strong> motor planning and/or motor execution processes (Caruso & Strand, 1999; Nijland, Maassen & van der Meulen, 2003). However, there has been no definitive delineation linking the neurological etiology <strong>of</strong> AOS with CAS. In addition to motor deficits, implications <strong>of</strong> core deficits in language processing have been suggested by many in the field <strong>of</strong> speech-language sciences (Aram & Nation, 1982; Crary, 1984; Dewey, 1995; Velleman & Strand, 1994). There is disagreement as to whether the linguistic symptoms associated with CAS should be considered a core deficit <strong>of</strong> the disorder, or whether linguistic impairments arise as a result <strong>of</strong> underlying sensory motor impairment (Hall, Jordan, & Robin, 1993). Lewis, Freebairn, Hansen, Iyengar, and Taylor, (2004) found that children diagnosed with CAS are likely to present with expressive and receptive language deficits and experience impaired academic performance in areas <strong>of</strong> reading, spelling, and written expression. 2
The scarcity <strong>of</strong> large scale research on the differential diagnosis, treatment, and etiology <strong>of</strong> CAS has left many clinicians discontent with their abilities to provide efficacious and appropriate intervention to clients who present with the symptoms associated with CAS. Effective treatment, thus far, has been driven largely by research and case studies conducted for CAS’s adult counterpart, acquired apraxia <strong>of</strong> speech (AOS). Although the two disorders differ on many accounts, there are numerous motorrelated characteristics shared by the disorders that appear to be responsive to treatments based on cognitive motor learning principles that implement visual, tactile, and auditory hierarchical cueing systems (Jakielski, Webb, & Gilbraith, 2006; Rosenbek, Hansen, Baughman, & Lemme, 1974; Shea & Morgan 1979; Strand & Debertine, 2000). Motor learning is defined by Schmidt and Lee (1999) as: “a set <strong>of</strong> processes associated with practice or experience leading to relatively permanent changes in the capability for movement” (p. 346). The results <strong>of</strong> research in the area <strong>of</strong> motor learning suggest that cognitive processes during motor practice play an important role in the acquisition <strong>of</strong> motor skills (Schmidt & Lee, 1999; Shea & Morgan, 1979). Further, motor learning is enhanced by variables <strong>of</strong> practice such as frequency, intensity, and variability that promote cognitive effort from a learner. Speech is a complex motor skill that when impaired, as in CAS, can be improved by systematic, hierarchical, and repetitive practice <strong>of</strong> speech movements (Rosenbek, et al., 1974; Strand & Debertine, 2000). Many treatment approaches for CAS employ strategies shown to be efficacious to improved motor speech performance. They may provide visual, auditory, and tactile/gestural cues to facilitate greater articulatory accuracy. Some utilize rhythmic and 3
Page 1 and 2: EFFECTS OF INTEGRAL STIMULATION THE
Page 3 and 4: stimulation <stron
Page 5 and 6: Table of Contents
Page 7: List of Figures Fi
Page 12 and 13: melodic support to overcome sound s
Page 14 and 15: Literature Review The differential
Page 16 and 17: part affect the numbers diagnosed a
Page 18 and 19: discrepancy suggests the probabilit
Page 20 and 21: neuromuscular impairment (Caruso &
Page 22 and 23: execute smooth and accurate speech.
Page 24 and 25: Table 1. Rosenbek et al.’s Hierar
Page 26 and 27: methodologies have yielded less con
Page 28 and 29: associated with the practice or exp
Page 30 and 31: very nature of spe
Page 32 and 33: Integral Stimulation and Childhood
Page 34 and 35: stimulation <stron
Page 36 and 37: period of no treat
Page 38 and 39: diagnosis of moder
Page 40 and 41: Table 3. Summary of</strong
Page 42 and 43: Table 4. Summary of</strong
Page 44 and 45: Word Shapes Simple word shapes such
Page 46 and 47: Hearing Hearing evaluations were co
Page 48 and 49: target sounds would allow CP a mana
Page 50 and 51: adjective, and a noun or verb (see
Page 52 and 53: welcomed from CP’s parents who we
Page 54 and 55: simultaneously with the child, prov
Page 56 and 57: to restart the mental processes nee
Page 58 and 59: Analysis of speech
Page 60 and 61:
Results This study examined the eff
Page 62 and 63:
Post-Treatment Results for /s/ Clus
Page 64 and 65:
Data Results for Labiodentals Frica
Page 66 and 67:
Data Results for Affricates: /ȴ/ &
Page 68 and 69:
Data Results for Interdental Fricat
Page 70 and 71:
Figure 4. Percent correct for /θ/
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Discussion This discussion examines
Page 74 and 75:
practice his motor speech skills in
Page 76 and 77:
Indicators that motor learning had
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Conclusion The results of</
Page 80 and 81:
A number of sessio
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References American Speech-Language
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Delaney, A.L., & Kent, R.D. (2004,
Page 86 and 87:
Powell, T. W. (1996). Stimulability
Page 88 and 89:
Strand, E. A. (1995). Treatment <st
Page 90 and 91:
for regular treatment are determine
Page 92:
Appendix C -Data Tracking Form TX T
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