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Diagnosis Destinations 
Apraxia
Treatment:
Some General Principles
Excerpted from an article by Niklas Miller, "Acquired Speech Dyspraxia" Published in Disorders of Communication: The Science of Intervention, Margaret M. Leahy, c. 1989. Reproduced with permission.
Use of Off-the-Shelf Speech Therapy Programs Off-the-peg programmes linked to particular medical-model syndromes will not necessarily address the needs of the individual client, other than by default. Pinpointing nodes of breakdown within a speech-production model framework indicates which processes in speech production are leading to the identified breakdowns in intelligibility and, in turn, shape the content and form of therapeutic tasks. Several works deal in a general way with the objective design of intervention (McReynolds and Kearns, 1983, Dworkin, 1991). There are also several exemplary approaches to speech dyspraxia which illustrate the systematic construction and monitoring of therapeutic tasks and change (Wertz et al., 1984; articles in Square Storer 1989; Dworkin, Abkarian and Johns, 1988). Other carefully designed routine clinic-based studies of speech dyspraxia therapy include Lambier etal. (1989), Rau and Golper (1989), Square-Storere and Hayden (1989),and E. Stevens (1989). Intervention Relative to Severity Intervention varies with severity of the disorder. The person may be mute and efforts will be directed towards eliciting any sound and establishing some (alternative) communication channel (Coelho and Durry, 1990; Fawcus, 1990). Methods include stimulation via so-called automatic actions (singing, humming, over-learned material and series); via paralinguistic and non-verbal gestures (tut-tut, yawning, blowing a kiss); by physical placement of the articulators by the therapist; through imitation (with/without verbal); and by following static or moving pictograms/articulograms. Emphasis will be on looking, feeling, and listening as much as on speaking. As soon as a sound is possible it should be given a use. Elicitation and control techniques must also be taught to the family. Less severe cases may manage approximations to sounds. The above techniques can be used to stabilize and extend the repertoire. Once a sound is stable it can be used to derive other position/sounds, and to stand in contrast with another element. Choosing Target Sounds Which sound do you start with? Group data suggest a gradient of difficulty rising through vowels, plosives, nasals, laterals, and fricatives to affricates. Individual people do not necessarily conform. Hence the need to establish each individual's pattern. For instance, /o/ in English is visible, feelable, manipulable, and occurs frequently -- but it is limited in the number of other sounds it stands in minimal contrast with. Consequently choosing /o/ in favour of say /s/ or /t/ would not normally be a recommendation. Programmes employing nonsense syllables (e.g. Deal and Florance, 1978) aim to tackle the actual motor speech dysfunction more directly, therapy progresses through increasing syllabic complexity, moving from familiar single-syllable words in predictable, habitual circumstances to uncommon (for the person) polysyllabic words in simple, and then complex, grammatical utterances, in situations of increasing propositionality and decreasing external (visual, tactile, contextual, etc.) support. Contrastive Stress Drills Contrastive stress drills take a phrase and practise it with alternative stress and intonational patterns, e.g. 'BUY him a red shirt', 'buy HIM a red shirt', 'buy him a RED shirt', 'buy him a red SHIRT'. There is evidence that contrastive stress exercises may not (Liss and Weismer, 1994) be equally successful with all speaker groups. In some cases intelligibility may be improved simply by concentration on suprasegmental features (Hargrove and McGarr, 1994). Prosodic Teaching Model As an especial difficulty in speech dyspraxia is smooth transition from syllable to syllable, techniques are useful which ease this by teaching with coarticulation incorporated; modifying transitional complexity; or permitting a degree of distortion. These strategies are dealt with more by Millerand Docherty (1995). Movement Towards Prepositional Language From Less Volitional Another method of deriving connected speech is by movement towards prepositional language from less volitional. An often cited example is fried egg from Friday. Others would be want to from 1, 2. Relearned or intact 'chunks' can serve as carrier phrases for these or other words. Frequency and Intensity The work of LaPointe and Dworkin demonstrated improvement and the patients in the report by Wertz improved if they received motor speech training, but not as a result of general language therapy. Given the controlled conditions stipulated in the studies, it is clear that speech dyspraxia can respond to therapy. All approaches involved an intensive pattern of therapy. Even if not seen daily by a therapist, patients carried out daily practice. The studies also re-emphasize the need for objective, principled structuring of therapy steps and the assessments that monitor them -- establishing baselines and controls, systematically manipulating variables (input, response demands, etc.) and monitoring which mode and combination of therapies are proving most effective for the individual. Co-Existing Disorders It has further been emphasized that speech dyspraxia may be a motor disorder, but it exists within a linguistic framework, which inturn exists within social interaction. Hence dyspraxia may beinfluenced by, and simultaneously itself influence, co-existing language and dysarthric disorders. Nick Miller PhD Department of Speech George VI Building University of Newcastle Newcastle upon Tyne NE1 7RU Great Britain phone: +44 191 222 5603 fax : +44 191 222 6518 e-mail Nicholas.Miller@Newcastle.ac.uk http://www.ncl.ac.uk/speech |
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Speechville Express is a resource for families, educators, and medical professionals, offering information about language development in children, helping those who care for toddlers and young children who are late talkers, and connecting you with others who have been down this road. Language disorders and communication impairments included are apraxia, stuttering, pervasive developmental disorder, dysarthria, and aphasia, among others.
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