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

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part affect the numbers diagnosed as having the disorder. Further, increased interest and information on the subject <strong>of</strong> CAS may be a possible contributor to the apparent increase in diagnosed cases <strong>of</strong> CAS (ASHA, 2007). Many researchers suggest the most plausible factor in the over diagnosis <strong>of</strong> CAS is a “lack <strong>of</strong> diagnostic guidelines” for the disorder (Shriberg, Campbell, Karlsson, Brown, McSweeny, & Nadler, 2003; Shriberg & McSweeny, 2002). Clearly, the variability <strong>of</strong> characteristics and ambiguity <strong>of</strong> defined parameters for CAS leave ample opportunity for inclusion <strong>of</strong> children who may (in the presence <strong>of</strong> clinically agreed upon diagnostic markers) be otherwise excluded from that diagnosis. In short, without clear etiological or large scale diagnostic studies on suspected childhood apraxia <strong>of</strong> speech, the over-diagnosis (and at times under-diagnosis) <strong>of</strong> the disorder seems inevitable. Etiological Characteristics Childhood apraxia <strong>of</strong> speech has been assigned many names since Morely first described the disorder as “articulatory apraxia” in 1954 (Crary, 1993). Since that time CAS has been referred to as dyspraxia, developmental apraxia <strong>of</strong> speech, and childhood verbal apraxia, among others. Many <strong>of</strong> the titles used until recently reflected the etiological viewpoints <strong>of</strong> those who study and work with individuals affected by CAS. The frequently used term developmental apraxia <strong>of</strong> speech (DAS) reflected theories <strong>of</strong> motor-programming impairment and contrasted the disorder with adult acquired apraxia <strong>of</strong> speech (AOS) (Darley, Aaronson & Brown, 1975). The term developmental verbal dyspraxia (DVD) has been used by those who believe the disorder involves both phonological and language processes in addition to motor-programming impairment (Ekelman & Aram, 1983). Recently, the term “childhood apraxia <strong>of</strong> speech” was 8
suggested as a new option for the disorder by the Childhood Apraxia <strong>of</strong> Speech Association <strong>of</strong> North America. The organization’s deliberate exclusion <strong>of</strong> the term “developmental” was a result <strong>of</strong> many insurance companies’ hesitation to cover speechlanguage services for the disorder on the grounds that, by nature <strong>of</strong> its name, the impairment would resolve itself over time without treatment (Velleman, 2003). Many who question whether a “pure” childhood apraxia <strong>of</strong> speech even exists suggest the use <strong>of</strong> “suspected childhood apraxia <strong>of</strong> speech” until a definitive diagnostic criteria for the suspected disorder is developed. Similarly, the term “apraxia” is recommended for use over the alternative word “dyspraxia” as it is assumed to be closely associated (in symptomology) with the acquired form <strong>of</strong> apraxia <strong>of</strong> speech (ASHA, 2007). For the purpose <strong>of</strong> this discussion, the term childhood apraxia <strong>of</strong> speech (CAS) will be used as it has been recommended by the American Speech-Language-Hearing Association (2007). To date, there is no known etiology for CAS. It is thought by many to be a neurologically-based disorder in part because <strong>of</strong> its shared characteristics with acquired apraxia <strong>of</strong> speech (AOS) (Freed, 2000). Many <strong>of</strong> the oral groping and poor sequential movement tasks (diadochokinetic) present in adults with AOS are also present in children demonstrating CAS. AOS is typically regarded as a neurologically-based disorder <strong>of</strong> motor planning. Research using brain-imaging devices identified consistent damage to the left precentral gyrus <strong>of</strong> the insula in patients diagnosed with AOS (Dronkers, 1996). Support for a non-acquired (developmental) form <strong>of</strong> apraxia <strong>of</strong> speech (CAS) has increased as a result <strong>of</strong> several familial studies and gender-related patterns <strong>of</strong> prevalence. It is reported that 75% <strong>of</strong> children diagnosed with CAS are male. This gender 9
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 10 and 11: The committee recognized that ident
Page 12 and 13: melodic support to overcome sound s
Page 14 and 15: Literature Review The differential
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/
Page 72 and 73:
Discussion This discussion examines
Page 74 and 75:
practice his motor speech skills in
Page 76 and 77:
Indicators that motor learning had
Page 78 and 79:
Conclusion The results of</
Page 80 and 81:
A number of sessio
Page 82 and 83:
References American Speech-Language
Page 84 and 85:
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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