Speech Disorders: Childhood Disorders Part 2

Motor Speech Disorders Include: apraxia & dysarthria

Childhood Apraxia of Speech (CAS)

  • neurological speech disorder that affects the planning and programming of the movements necessary for speech.

  • this is a muscle planning disorder that causes difficulty producing sounds, words, & syllables

    • oral non-verbal apraxia (kiss, cough, lip smacks)

      • muscle movement is responsible

      • not at the level of phonological representations

    • not due to muscular weakness (i.e. not dysarthria)

    • not an issue with phonological representations (i.e. not specific language impairments)

  • articulation errors are not consistent

  • this is a motor planning disorder in which a person has the language capacity to talk, but the signals between their brain & mouth muscles are not sent correctly

What Is The Difference Between Speech Planning & Programming

  • speech planning - the process of organizing and structuring the content of a speech, including the selection of appropriate vocabulary, phrasing, and tone

  • speech programming - involves the physical movements required to produce speech, such as the coordination of breathing, vocal fold vibration, and articulation

Childhood Apraxia Of Speech

  • motor plan

    • setting general spatial (where it’s going), temporal (timing), & acoustic goals for the articulators

      • move the tongue to the alveolar ridge after /ka/

  • motor program

    • parameters of movement - which muscles need to contract and how much (how strong)

      • range of motion

      • direction

      • speed

      • force

      • muscle tension

  • both are “automatic” (procedural) in TD (typical development), which enables rapid speech production

Childhood Apraxia Of Speech

  • characteristics

    • difficulty specification of movement parameters required to make appropriate articulatory gestures for production goals

      • inconsistent errors on consonants & vowels in repeated productions of syllables or words

      • lengthened & disrupted transitions between sounds & syllables

      • inappropriate prosody, especially in the realization of word or phrasal stress

        • choppy with the incorrect word or sentence stress (causes speech to be slower)

      • speech groping behaviors (grasping for the right sound - they can hear & try to correct the phoneme)

      • omissions/insertions outside normal phonological processes/patterns

      • difficulty with multisyllabic words into adolescence/adulthood

      • single word productions are generally more accurate than running speech

      • severe ~ initially nonverbal

        • in this case the individual is nonverbal

    • frequent comorbid phonological impairments & expressive language delay

    • normal cognition

      • selective mutism

      • good prognosis

      • poor intelligibility for school-age

      • difficulties with phonological awareness, reading, writing, & spelling

    • phonological impairment: phoneme is stored incorrectly therefore they will produce it wrong (apraxia is wrong sometimes due to motor issues)

    • Inconsistently~ storage of the sound is incorrect

      • this will point you to apraxia

  • Assessment & Treatment

    • diagnosis as early as 3 or 4

    • targets: articulatory gestures or transitions between them

    • requires attention and multiple productions of words

    • no gold standard for assessment

      • strands 10-point checklist

        • screen for apraxia

        • if the kid has 3 or more on the checklist - expected to have apraxia

  • Childhood Apraxia Of Speech ~ Is Not A Medical Diagnosis

Dysarthria

  • motor speech disorder caused by neuromuscular deficits: physical deficits that affect speech

  • affect respiration, phonation, resonance, & articulation

    • types characterized by:

      • lesions location

        • central vs periphery

      • weakness/paralysis

        • ability to move the muscle

      • spasticity/flaccidity

        • contracted vs loose/relaxed

      • poor coordination

        • clumsiness

      • involuntary movements

        • repress inappropriate movements

  • an individual with dysarthria will know exactly what they want to say & the language used but the motor control of the muscles used to generate that speech is affected

    • slur their words

  • the anatomy of the individual is affected


Dysarthria is a problem with the muscles used for speech, while apraxia is a problem with the brain's ability to plan and organize movements needed for speech production (inconsistent errors)

Dysarthria In Cerebral Palsy

  • CP: a permanent neuromotor disorder caused by brain damage that occurred before, during, or shortly after birth: affects movement & balance

    • causes

      • oxygen deprivation to the brain

      • hemorrhages

      • infection

      • malnutrition

      • fetal alcohol spectrum disorders/fetal alcohol syndrome

      • accident/injury

    • damage is not progressive but gross motor symptoms oftentimes are

    • most common etiology of chronic physical disability in pediatric populations

  • Does not progress or pass over to other areas of the brain