motor based SSD

functional vs organic

functional: no known cause

• articulation and phonology

organic: developmental or acquired

• motor/neurological

• structural

• sensory/perceptual

articulation vs phonology

what type of aspects?

articulation: motor aspects

phonology: linguistic aspect

motor/neurological

• execution (dysarthria)

• planning (apraxia)

structural

• cleft palate/other orofacial anomalies

• structural deficits due to trauma or surgery

sensory/perceptual

hearing impairment

praxis vs execution

praxis: planning

execution: movement

breakdown in the ability to plan and program volitional movement

praxis

weakness in decreased range of motion, speed, and force of movement

execution deficits

2 types of pediatric motor speech disorders

1. apraxia

2. dysarthria

pediatric motor speech disorders- apraxia

• Childhood AOS

• praxis problem

pediatric motor speech disorders- dystharthria

• developmental dysarthria

• execution problem

etiologies of developmental dysarthria:

• Pediatric TBI

• Tumors

• Strokes

• Cerebral Palsy (CP)

Congenital disorder resulting from brain damage before, during, or after birth / childhood neurological disorder

CP

types of CP

athetoid, spastic, ataxic, and mixed

__% of individuals with CP have a speech sound disorder

70%

Treatment approaches used with articulation disorders are generally utilized with _________

modifications

treatment considerations:

• Compensatory articulatory postures movement of the child

• Presence of abnormal reflexes

Compensatory articulatory postures movement of the child

• Tongue blade versus tongue tip- they can’t elevate

• Linguadental contact for nasals due to labial weakness

treatment considerations for voicing difficulties

Respiratory support

treatment considerations for prosody

Speech rate (slower=better intelligbility), rhythm, pitch variation

overview of CAS:

• CAS is a ____ not a _____

• focus on the ______, not the ____

• more _____ therapy, improving _______, incorporating ____________

• CAS is a label not a medical dx

• focus on the movement, not the sound

• more frequent therapy, improving motor skills, incorporating principles of motor learning

a neurological childhood (pediatric) speech sound disorder in which the ________ and ____________ underlying speech are impaired in the absence of _________ (e.g., ______, _____)

precision and consistency of movements, neuromuscular deficits (e.g., abnormal reflexes, abnormal tone).

Childhood apraxia of speech (CAS)

CAS may occur as a result of ___________, in association with ___________________ of known or unknown origin, or as an ________ neurogenic speech sound disorder.

known neurological impairment; complex neurobehavioral disorders; idiopathic

The core impairment in _____________________________________ results in errors in speech sound production and prosody

planning and/or programming spatiotemporal parameters of movement sequences, CAS

CAS diagnostic markers: may be discriminative

• Difficulty moving from one articulatory configuration to another

• Errors vary with the complexity of articulatory adjustment

• Difficulty completing a movement gesture for a phoneme in a longer context

• Increase in errors with increased length of utterance

• Connected speech is poorer than isolated word production

• Groping and/or trial and error behavior

• Presence of vowel distortions

• Prosodic errors

• Slow rate

• Prosodic disturbances (rate, stress, pauses, intonation, improper pauses, monotone, etc.)

diagnostic assessments

• Dynamic Evaluation of Motor Speech Skill (DEMSS)

• Verbal Motor Production

• The Orofacial Praxis Test

• Kaufman Speech Praxis Test for children

• Madison Speech Assessment Protocol

the goals for CAS intervention is to improve the individual’s ability to ______, ____, and ____________ for speech

assemble, retrieve, and execute motor plans

Amount of improvement depends on the __________ and ____________

severity of apraxia and frequency of sessions

Treatment focus is on ___________ rather than an isolated sound or class of sounds

movement

CAS focus of treatment

movement vs sound

Focus on __________ in speech (in other words?)

movement transitions (i.e. movement from the lips to the back of the tongue)

Provide _______ support with _____, _____, and ______ models and then fade over time

maximum; visual, tactile, and auditory

Implement the principles of _________

motor learning

key takeway of principles of motor learning

never segment sounds, slower longer practice rather than single sounds

what treatment is the most appropriate for CAS?

No single program is most appropriate, but it needs to incorporate principles of motor learning

Research supports the following principles:

• Focus on movement performance

• Use repetitive practice

• Focus on movement transition versus individual phoneme

• Hierarchy of stimuli

• Use decreased rate and progress to normal

• Provide specific and frequent feedback early

what are the two motor treatment approaches recommended?

DTTC and ReST

appears to be more appropriate for more severe cases

DTTC

ReST is for mild-mod

appears to work better for mild to moderate cases and with children who are 7-10 years old

ReST

Incorporates principles of motor learning

ReST

goal is long term maintenance and generalization of treated speech skills

ReST

Involves intensive practice of multisyllabic pseudowords

ReST

2 components of ReST

• pre-practice

• practice

One type of articulatory approach

DTTC

Involves shaping the movement gestures for speech through adding and fading of cues

DTTC

Hierarchy is constantly changing based on the child’s response on each trial

DTTC

Allows the child to take “increasing responsibility for assembling and retrieving motor plans with progressively less cueing”

DTTC

Emphasizes variation of the temporal relationship between stimulus and response- immediate repetition, delayed repetition

DTTC

Models start with a slow rate and then move to a normal rate and variance in prosody to allow for more flexibility in motor planning

DTTC