Committee memberDeDe, Gayle
Apraxia of Speech
Apraxia of Speech Treatment
Principles of Motor Learning
Speech Language Pathology
Permanent link to this recordhttp://hdl.handle.net/20.500.12613/360
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AbstractApraxia of speech (AOS) is a motor speech disorder associated with an impairment in motor planning and programming. It is therefore a logical step to derive treatment of the disorder from the principles of motor learning. Principles of motor learning refer to relatively predictable benefits of certain practice conditions over others (e.g., random practice enhances learning compared to blocked practice). A number of studies have begun to examine principles of motor learning in treatment for AOS (e.g., Austermann Hula et al., 2008; Katz et al., 2010). The current project aims to continue the investigation of motor learning principles and its application to motor speech disorders. In particular, the primary goal of this study is to examine the role of feedback control in treatment for AOS. Two types of feedback control are typically distinguished: self-controlled feedback and clinician-controlled feedback (Chiviacowsky & Wulf, 2004; Chiviacowsky & Wulf, 2007; Janelle, Barba, Frehlich, Tennant, & Cauraugh, 1997; Wulf, 2007). A secondary goal is then to examine the efficacy of script training for AOS. Youmans et al. (2011) provided promising initial evidence supporting its efficacy for AOS, yet no studies have replicated these findings (Ballard et al., 2015). The results of this study suggest that self-controlled feedback is more efficacious in treating adults with AOS than clinician-controlled feedback. Greater improvements of performance for self-controlled feedback were noted especially in accuracy of productions. There was the potential to impact rate of speech as well. Findings across conditions (treated versus untreated scripts) also indicate that script training is an efficacious method of treating adults with AOS.
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A Systematic Examination of Practice Amount in Childhood Apraxia of Speech (CAS) Treatment Using an Integral Stimulation ApproachMaas, Edwin; Reilly, Jamie; Kohen, Francine (Temple University. Libraries, 2017)The purpose of this study was to examine how a critical principle of motor learning, practice amount (high number of trials versus a low number of trials), affects speech motor learning in childhood apraxia of speech (CAS). It also sought to contribute to the literature base regarding using an integral stimulation approach for these children. Currently, a limited evidence base exists for decision-making regarding practice amount in CAS treatment. Using a single-case experimental design with two participants, three target sets of utterances (High Amount, Low Amount, and Control) received different amounts of treatment. Outcomes were compared in terms of retention. Targets were scored regarding perceptual (prosodic and segmental) accuracy. Effect sizes were computed to quantify the extent of treatment effects. For both participants, results show some evidence suggesting a higher amount of practice is advantageous and leads to greater learning. A low amount of treatment did not show clear differences compared to not receiving any treatment. Caution should be taken when interpreting these findings due to its small sample size and modest effects. Results suggest that the integral stimulation approach may only be effective if provided with a significantly high amount of practice. Further research is needed to examine how the principles of motor learning and the integral stimulation approach should be sensibly and systematically applied to promote best outcomes for this population.
The Active Ingredients of Integral Stimulation Treatment: The Efficacy of Auditory, Visual, and Auditory-Visual Cues for Treatment of Childhood Apraxia of SpeechMaas, Edwin; Kohen, Francine; Caspari, Susan (Temple University. Libraries, 2020)The purpose of this study was to determine the relative efficacy of cueing modalities employed in Integral Stimulation (IS) treatment for childhood apraxia of speech (CAS). Previous literature has supported the use of IS for children with CAS, though there are no studies that evaluate the active ingredients of IS. This study aimed to examine the efficacy of single- and multi-modality cues in IS treatment. The experiment was administered as a single-case, alternating treatments design consisting of three conditions (auditory-only, visual-only, and simultaneous auditory and visual). Two participants with CAS received IS treatment in every condition during each session. Probes were administered prior to starting every other session (once per week), consisting of practiced and control targets that were balanced for complexity and functionality. Perceptual accuracy of productions was rated on a 3-point scale and standardized effect sizes were calculated for each condition. Each participant demonstrated different effects in regard to modality and treatment effects. The visual-only condition yielded the greatest effect for one participant, followed by the auditory-only cues. The other participant displayed no significant effects in any condition nor a treatment effect. The results of this study suggest that single-modality cues may be more beneficial for some children with CAS than the clinically used simultaneous auditory-visual multi-modality cue. The significant effect of the visual-only condition in one participant indicates that visual-only cues may bypass an impaired auditory feedback system and support speech motor learning, though more research is required.
TREATMENT OF CHILDHOOD APRAXIA OF SPEECH: A SINGLE-CASE EXPERIMENTAL DESIGN STUDY OF INTENSITY OF TREATMENTMaas, Edwin; Kohen, Francine; Reilly, Jamie (Temple University. Libraries, 2017)Childhood Apraxia of Speech (CAS) is a pediatric motor-speech disorder which has been controversial due to its difficulty to diagnose and little progress in treatment. The purpose of the present study was to examine a principle of motor learning (PML) within the context of an evidence-based treatment for this disorder, as a way to improve outcomes for children with CAS. In particular, this study examines the role of intensity, specifically, massed versus distributed practice, when treating CAS using a modified form of Dynamic Temporal Tactile Cueing (DTTC; Strand et al., 2006). Two participants with CAS between the ages of 5 and 11 received massed and distributed practice on individualized targets in an single-case alternating treatments design with multiple baselines. Accuracy of speech targets on probe tasks was judged by blinded listeners. Results were interpreted through inspection of graphs and calculation of effect sizes. The results of the study showed that massed practice had a marginal benefit over distributed practice. Implications from this study suggest the importance of continued research examining the role of PML in CAS treatment and the value of using a massed-treatment approach when treating CAS.