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Integral Stimulation and Childhood Apraxia <strong>of</strong> Speech To date, there are few treatment approaches for CAS other than <strong>integral</strong> <strong>stimulation</strong> (and Dynamic Temporal and Tactile Cueing [DTTC], which was derived from <strong>integral</strong> <strong>stimulation</strong>) that systematically combine the multimodal cueing systems shown to be efficacious in speech remediation with the principles <strong>of</strong> cognitive motor learning. The ASHA Position Statement (2007) advises SLPs to use treatments based on the principles <strong>of</strong> motor learning and varied multimodal cuing techniques for children with CAS. Small scale studies have begun to mount suggesting <strong>integral</strong> <strong>stimulation</strong> <strong>therapy</strong> as being the most efficacious treatment approach to date. Two single subject studies published in the Journal <strong>of</strong> Medical Speech-Language Pathology reported increases in speech intelligibility for children treated with <strong>integral</strong> <strong>stimulation</strong> <strong>therapy</strong>. Strand and Debertine (2000) evaluated the effectiveness <strong>of</strong> <strong>integral</strong> <strong>stimulation</strong> <strong>therapy</strong> on a 5-year-old girl diagnosed with CAS. Multi modal cueing techniques were used in conjunction with motor learning practice to teach functional phrases over a series <strong>of</strong> short but frequent <strong>therapy</strong> sessions. The results indicated an increase in intelligibility for all speech sound targets. Strand, Stoeckel, and Baas (2006) included 4 children with CAS treated with DTTC, a revised version <strong>of</strong> <strong>integral</strong> <strong>stimulation</strong> <strong>therapy</strong>. This study used short and very frequent <strong>therapy</strong> sessions (2 sessions each day and 5 days per week) for a 6-week period. Three <strong>of</strong> the 4 children demonstrated increased speech intelligibility following the study. Generalization <strong>of</strong> some speech sounds were noted as well. Other research projects and thesis studies have added to the body <strong>of</strong> research suggesting that <strong>integral</strong> <strong>stimulation</strong> <strong>therapy</strong> is an efficacious treatment approach for CAS 24
(Edeal, 2008; Jakielski, et al., 2006; Jensen, 2005). Jensen (2005) used <strong>integral</strong> <strong>stimulation</strong> <strong>therapy</strong> with a 10-year-old boy for 15 weeks. Post-treatment data suggested increased intelligibility for 2 <strong>of</strong> the 3 targeted phonemes and a 5% increase in overall speech intelligibility. Similarly, Jakielski et al. (2006) treated 3 siblings diagnosed with CAS with <strong>integral</strong> <strong>stimulation</strong> <strong>therapy</strong>. At the end <strong>of</strong> the study, all 3 participants showed improved speech accuracy for target sentences. Results showed that the oldest sibling made the most progress while the youngest participant made the least progress. The most recent study <strong>of</strong> <strong>integral</strong> <strong>stimulation</strong> <strong>therapy</strong> was conducted by Edeal in 2008. This study explored the frequency <strong>of</strong> repetition <strong>of</strong> target sounds in the context <strong>of</strong> <strong>integral</strong> <strong>stimulation</strong> <strong>therapy</strong> with three children suspected <strong>of</strong> having CAS. The single subject, alternating treatment design explored the efficacy <strong>of</strong> multimodal cueing approaches with varying amounts <strong>of</strong> speech motor practice opportunities. Two treatment conditions (target phonemes) were chosen for each child. Each condition used all <strong>of</strong> the components <strong>of</strong> <strong>integral</strong> <strong>stimulation</strong> <strong>therapy</strong> (cuing and motor practice), but one demanded less practice (30 to 40 repetitions) <strong>of</strong> speech sounds during treatment sessions and the other required more practice (100 to 150 repetitions) <strong>of</strong> speech sounds. One <strong>of</strong> the participants was withdrawn from the study as his diagnosis <strong>of</strong> CAS and the benefits <strong>of</strong> <strong>integral</strong> <strong>stimulation</strong> treatment were in question. The remaining 2 participants completed the study showing improved motor performance <strong>of</strong> treated sounds (in both treatment conditions) in non trained words. Integral <strong>stimulation</strong> <strong>therapy</strong> that incorporated the higher speech practice condition (100 to 150 repetitions) yielded higher levels <strong>of</strong> in-session accuracy and generalization to novel words than did the condition demanding fewer (30 to 40) repetitions per session. Post treatment results <strong>of</strong> this study illustrate that <strong>integral</strong> 25
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 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 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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