Childhood Apraxia of Speech (exam 2)

Question 1

What is apraxia of speech (AOS)?

Answer 1

A disorder of volitional speech motor planning and programming resulting in inefficient translation and sequencing of phonological codes into motor plans.

Question 2

Typical target for articulation disorder vs a typical target for AOS:

Answer 2

Typical target for articulation disorder:
Correct production of /t/ in initial, medial, and/or final position of word.
Ex: tall, kitten, bat

Typical target for AOS:
Correct production of entire sequence of target string.
Ex: /t/ -> /a/ -> /l/

• You’re not just cueing placement of a sound, you’re cueing place, manner, voicing, and coarticulation
• Artic: sometimes a single target sound; AOS: a single target word with re-train ongoing coordination throughout words
• AOS kids have difficulty with motor coordination on and BETWEEN sounds

Question 3

AOS Assessment Tasks:

Answer 3

1. Oral motor exam
   With “puh.tuh.kuh” at comfortable and fast rates
   – estimate their “comfortable rate”; examine breakdown at faster rates – also looking for muscle weakness – dysarthria can co-occur
2. Articulation testing
   – Consonant/vowel distortions (and distorted substitutions), consistency of errors (at least vowels), stress assignment (to some degree)
3. Repeated multisyllabic words (Dabul, 2000)
   - Consistency of errors!
4. Connected speech sample
   - intelligibility testing (% words understood by unfamiliar listener), C or V distortions and distorted substitutions, consistency of errors
5. Intelligibility testing

Question 4

Primary Diagnostic Criteria for AOS:

Answer 4

Slowed speech rate due to prolongation of or between sounds or syllables
“happy” -> “awwpi”

Consonant and/or vowel distortions
“Zachary” -> ”sokawee”
“Matthew” -> “tawtup”
“move back” -> “mu bawk”

Distorted sounds perceived as substitutions
“Sammy” -> sounds like “shammy” with a distorted “sh” sound

Abnormal stress or generally equal stress
“Teresa” -> “Tesa”

Inconsistent error types
“round and round” -> “wa wa WAN” “wa wa WUTH”

Question 5

Secondary Diagnostic Criteria

Answer 5

May be present (in conjunction with primary features) but not discriminative.

1. Articulation groping
   - Noticeable struggle to form sounds
2. Preservative errors
   - “black boxes” -> “black bloxes”
3. Increasing errors with word length
   - Multisyllabic words less intelligible
4. Difficulty initiating speech
   - Long pause before starting to speak
5. Awareness of errors
   - Self-correction / frustration
6. Automatic speech better than propositional speech
   - yes/no, counting, singing
7. “Islands” of error free speech
   - Not ALL speech is unintelligible; well-learned or “safe” strings of words

Question 6

Exclusionary Diagnostic Criteria

Answer 6

1. Fast speech rate + intelligible
2. Normal speech rate + intelligible
3. Typical stress assignment

Question 7

All-in-one Perceptual Assessment: 7-point rating system

Answer 7

1. Imprecise consonants
2. Distorted vowels
3. Prolonged intervals
4. Excess and equal stress
5. Slow rate
6. Fast or normal rate (exclusionary)
7. Pitch

Question 8

Treatment for AOS is typically:

Answer 8

Systematic
Incremental
Drill-based

Question 9

Suggested dosage of treatment for AOS is typically:

Answer 9

3-5x/week, typically 3+ years

Question 10

Factors of Treatment

Answer 10

Selection of target
- High frequency errors
- At level of breakdown (sound, word, or phrase)
- Functional words
- Complexity of targets
Some suggest more complex targets generalize to simpler targets, but not vice versa (Williams, 2010; Jacks & Robin, 2012)

Nature of feedback
-Modality
May begin with all sensory modalities (auditory, visual, tactile, kinematic) then fade with progress

-Verbal feedback
Knowledge of performance - specific verbal descriptions of the patient’s attempt
Knowledge of results - correct or incorrect

-Timing of feedback
Infrequent better than frequent
Delayed better than immediate

Organization of practice
- Sequence of feedback
Model -> Mime -> Simultaneous -> Immediate Repetition -> Delayed Production -> Spontaneous Production

-Sequence of targets
Blocked practice
Practice the same sounds repeatedly in different contexts
-Random practice
Practice the certain sounds with different sounds intermixed in practice

Knock et al. (2000): initial progress facilitated by blocked practice, retention facilitated by random practice

Question 11

Articulatory kinematics

Answer 11

MAIN GOAL: correcting misplacement and sequencing of sounds

Most evidence-based positive outcomes

Directly address motor aspects of speech production

Began with Rosenbek’s “8-step continuum”…

Question 12

What is Rosenbek’s 8-step Continuum? What is the key to this system that makes it successful?

Answer 12

1) Simultaneous production: Child and SLP produce target; maintain auditory or visual stimuli
2) Immediate repetition: SLP provides aud model, client repeats watching therapist mouth gesture
3) Immediate repetition: Same as above, but no SLP mime
4) Delayed repetition: SLP produces target, inserts 1-5 sec delay before imitation, child repeats target several times without aud or visual stimuli
5) Target elicited by question: Child responds

Basically, all other therapy techniques are a variation of this. Key – SLP is varying the temporal relationship between stim and response, intitially providing max cues, then gradually fading cues

Question 13

What alternative treatment is used for severe cases of AOS?

Answer 13

AAC devices. The goal is to replace or supplement oral speech production with electronic or physical device