A Systematic Examination of Practice Amount in Childhood Apraxia of Speech (CAS) Treatment Using an Integral Stimulation Approach
Committee memberReilly, Jamie
Childhood Apraxia of Speech
Motor Speech Disorders
Principles of Motor Learning
Speech Sound Disorders
Permanent link to this recordhttp://hdl.handle.net/20.500.12613/3809
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AbstractThe 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.
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Feedback Control in Treatment for Apraxia of SpeechMaas, Edwin; DeDe, Gayle; Kohen, Francine (Temple University. Libraries, 2020)Apraxia 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.
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.
Intensive treatment with ultrasound visual feedback for speech sound errors in childhood apraxiaPreston, JL; Leece, MC; Maas, E (2016-08-30)© 2016 Preston, Leece and Maas. Ultrasound imaging is an adjunct to traditional speech therapy that has shown to be beneficial in the remediation of speech sound errors. Ultrasound biofeedback can be utilized during therapy to provide clients with additional knowledge about their tongue shapes when attempting to produce sounds that are erroneous. The additional feedback may assist children with childhood apraxia of speech (CAS) in stabilizing motor patterns, thereby facilitating more consistent and accurate productions of sounds and syllables. However, due to its specialized nature, ultrasound visual feedback is a technology that is not widely available to clients. Short-term intensive treatment programs are one option that can be utilized to expand access to ultrasound biofeedback. Schema-based motor learning theory suggests that short-term intensive treatment programs (massed practice) may assist children in acquiring more accurate motor patterns. In this case series, three participants ages 10-14 years diagnosed with CAS attended 16 h of speech therapy over a 2-week period to address residual speech sound errors. Two participants had distortions on rhotic sounds, while the third participant demonstrated lateralization of sibilant sounds. During therapy, cues were provided to assist participants in obtaining a tongue shape that facilitated a correct production of the erred sound. Additional practice without ultrasound was also included. Results suggested that all participants showed signs of acquisition of sounds in error. Generalization and retention results were mixed. One participant showed generalization and retention of sounds that were treated; one showed generalization but limited retention; and the third showed no evidence of generalization or retention. Individual characteristics that may facilitate generalization are discussed. Short-term intensive treatment programs using ultrasound biofeedback may result in the acquisition of more accurate motor patterns and improved articulation of sounds previously in error, with varying levels of generalization and retention.