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Children with childhood apraxia of speech (CAS) are likely to experience severe and persistent spoken and written language disorder. There is a scarcity of intervention research, however, investigating techniques to improve the speech and literacy outcomes of this population. The series of 5 experiments reported in this thesis investigated phonological awareness and early reading development in children with CAS and trialled a new intervention designed to advance the spoken and written language development of those affected. In the first experiment (presented in Chapter 2), a comparison of 12 children with CAS, 12 children with inconsistent speech disorder (ISD), and 12 children with typical speech-language development (TD) revealed that children with CAS may be particularly susceptible to phonological awareness and reading deficits. There was no difference in the articulatory consistency and speech severity of the CAS and ISD groups, and no difference in the receptive vocabulary of the CAS, ISD, and TD groups. The children with CAS exhibited poorer phonological awareness scores than the comparison groups and had a greater percentage of participants performing below the expected range for their age on letter knowledge, real word decoding, and phonological awareness normative measures. The children with CAS and ISD performed inferiorly than the children with TD on a receptive phonological representation task. The results showed that the children with CAS had a representational component to their disorder that needed to be addressed in intervention. In the second experiment (presented in Chapter 3), a follow-up pilot study was conducted to examine the long-term effects of a previously conducted intensive integrated phonological awareness programme (7 hours of intervention over 3 weeks) on 2 children with CAS. The children aged 7;3 and 8;3 at follow-up assessment had previously responded positively to the intervention. Results showed that the children were able to maintain their high accuracy in targeted speech repeated measures over the follow-up period. One child was also able to maintain her high accuracy in phonological awareness repeated measures. The children performed superiorly on a standardised phonological awareness measure at follow-up than at pre-intervention. Non-word reading ability showed a sharp increase during the intervention period, while minimal gains were made in this measure over the follow-up period. The findings suggested that an integrated intervention was a potential therapeutic approach for children with CAS. In the third experiment (presented in Chapter 4), the effectiveness of an integrated phonological awareness programme was evaluated for the 12 children (identified in the first experiment) aged 4 to 7 years with CAS. A controlled multiple single-subject design with repeated measures was employed to analyse change in trained and untrained speech and phoneme segmentation targets. A comparative group design was used to evaluate the phonological awareness, reading, and spelling development of the children with CAS compared to their peers with TD over the intervention. The children participated in two 6- week intervention blocks (2-sessions per week) separated by a 6-week withdrawal block. Seven children with CAS made significant gains in their production of trained and untrained speech words with 7 of these children demonstrating transfer of skills to connected speech for at least one target. Ten children showed significant gains in phoneme awareness, and 8 of these children demonstrated transfer of skills to novel phoneme awareness tasks. As a group, the children with CAS demonstrated accelerated development over the intervention period in letter knowledge, phonological awareness, word decoding, and spelling ability compared to their peers with typical development. In the fourth experiment (presented in Chapter 5), the speech, phonological awareness, reading, and spelling skills of children with CAS and TD were re-evaluated 6- months following completion of the intervention programme. A measure of reading accuracy and reading comprehension in a text reading task was administered to the children with CAS. There was no difference in the performance of the children with CAS in post-intervention and follow-up assessments. The children with CAS and children with TD presented with similar relative change in phonological awareness, reading, and decoding measures over the follow-up period. The connected reading performance of children with CAS mirrored their phonological awareness and decoding skills. The findings demonstrated that children with CAS were able to maintain gains achieved during the intervention but may need further support to promote sustained development in written language. In the fifth experiment (presented in Chapter 6), the long-term effects of the integrated phonological awareness programme for identical twin boys who participated in the research intervention at pre-school were examined. The study examined Theo and Jamie's spoken language, phonological awareness, reading, and spelling development during their first year of schooling. The results pointed to the benefit of providing phonological awareness within a preventative framework for children with CAS. Theo and Jamie experienced continued growth in speech and phonological awareness skills. They exhibited age-appropriate reading and spelling development during their first year of formal literacy instruction. It was concluded from this series of experiments that children with CAS are particularly vulnerable to phonological awareness and early reading difficulty, and that an integrated phonological awareness intervention is an effective means of developing speech, phonological awareness, reading, and spelling skills in most children with CAS. The intervention appears to target processes underlying spoken and written language development in this population. The results are discussed within a phonological representation deficit hypothesis of CAS and clinical implications of the findings are highlighted.

This thesis provides new insights about how the brain controls skilled movements, through the study of limb apraxia in two major neurological disorders: Stroke and Corticobasal Syndrome (CBS). Limb apraxia is a cognitive-motor deficit characterized by impairment in the performance of skilled movement. The Conceptual-Production systems model, used as framework in this thesis, proposes that skilled movement is under the control of three systems: a sensory/perceptual system, a conceptual system and a production system. Deficits in any of these systems produce limb apraxia, and depending on which system is affected, a distinct pattern of apraxia emerges. This information processing approach was used to evaluate performance levels, study brain asymmetries and discern patterns of deficits in each population. In addition, longitudinal assessments in sample subsets revealed patterns of recovery after stroke and of progression in CBS. The first study examined acute-subacute and chronic stroke patients with left (LHD) and right hemisphere damage (RHD) for their ability to pantomime and imitate transitive and intransitive gestures. The results indicated that LHD and acute-subacute were more severely impaired. Concurrent deficits in pantomime and imitation were most common, especially after LHD. Since acute-subacute patients were more severely impaired, in the absence of any therapies, it is likely that some degree of recovery occurs over time. The second study study examined longitudinal recovery in a series of transitive gestures tasks among stroke patients and indicated that patients significantly recovered in all tasks, except in Action Identification, a conceptual apraxia task which probes knowledge of actions. Finally, two comparative studies were conducted in CBS, a neurodegenerative disorder in which apraxia is common, making this one of the first studies that evaluated patient performance on a complete limb apraxia battery. The first study found that patients were often impaired on all gesture production tasks, while conceptual knowledge of gestures and tools was usually preserved. A case series constituted the second study, which documented the progression of apraxia in CBS demonstrating that, while deficits in gesture production usually are present at first examination, deficits in conceptual knowledge are infrequent and in many cases do not develop at all. Study limitations were discussed and it was suggested that future research should expand on our findings for recovery in stroke and progression in CBS.

El objetivo de este estudio, fue identificar si existe relación entre la apraxia constructiva y el rendimiento académico en estudiantes del tercer año de tres escuelas académicas de la Universidad Nacional del Santa; para lo cual, se aplicó el Test de praxia constructiva tridimensional de Benton y Fogel, versión española de Rivera Benavides, es una prueba que permite revelar déficits viso-constructivos, que no habían aparecido en tareas de diseño más simples y, a la vez, se estableció la relación con el rendimiento académico de los estudiantes de las tres escuelas académicas expresadas en promedios ponderados correspondientes a los cuatro primeros ciclos concluidos; encontrándose que los resultados obtenidos mediante el estadístico chi-cuadrado indican que si existe relación entre apraxia constructiva y rendimiento académico en el nivel de Educación Superior tanto en cada una de las facultades como en los alumnos en general. Lo que permite inferir que el rendimiento académico podría estar obedeciendo a la presencia de apraxia constructiva; puesto que no es el único factor que influye en el rendimiento académico de los estudiantes de las tres escuelas académicas objeto de nuestro estudio. Palabras clave: apraxia constructiva, rendimiento académico. / Tesis

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Speech perception is a unique audiovisual experience in part because timing of the speech signal is influenced by simultaneous overlapping gestures in coarticulation. Apraxia of speech (AOS) is a motor planning disorder that impairs coarticulation. Imaging studies show that brain regions damaged in AOS are critical to audiovisual speech perception. Although AOS is a motor planning disorder, individuals with AOS may have a disruption to the perceptual system for speech gestures. To evaluate this hypothesis we investigated audiovisual mismatch negativity (MMN) brain responses in adults with damage to Broca’s area (n =5) compared to a healthy age-matched comparison group (n = 5). We utilized the McGurk effect, in which incongruent auditory and visual information alters perception. Participants viewed videos of a speaker articulating the syllable /ba/ (standard) for 80% trials and /ga/ (deviant) for 20% of the trials while the auditory stimulus /ba/ remained consistent throughout. Responses to this McGurk audiovisual condition were compared to an inverse McGurk audiovisual condition in which the visual stimulus remained constant while the auditory stimulus changed, and a visual-only condition without sound to control for evoked activity from changes to the visual stimulus. Incongruent McGurk deviants elicited an MMN over left hemisphere electrodes in the comparison group, while the AOS group exhibited a later, attention-based response, a P300. The AOS group similarly responded to inverse McGurk deviants, which do not require fusion of the percept, with a P300 response, indicating that auditory and visual aspects of the incongruent McGurk deviants were not integrated. In the visual-only control condition, the AOS group showed a left-lateralized MMN, suggesting greater influence of visual processing when confronted with conflicting multisensory information compared to the comparison group. Overall, the comparison group’s responses were indicative of early and automatic audiovisual integration of incongruent McGurk percepts while the responses of the AOS group showed contributions of both attentional and visual processing. The timing of the response in the AOS group was correlated with speech production characteristics of apraxia, as well as performance on taxing motor speech tasks. Results of this study support the hypothesis that AOS is a disorder beyond motor planning, with implications for higher-level linguistic and cognitive systems.

This study examines facilitated communication as it was experienced by three people who were affected by acquired brain injury. Facilitated communication is a type of augmentative communication purported to allow persons with a severe communication impairments to communicate. The assumption is made that people with global apraxia can communicate if given physical support. The technique usually involves a facilitator providing physical support to the arm, hand or elbow of the person with the severe communication impairment to assist them to point to objects, pictures, printed letters and words or to a keyboard. Facilitated communication is a controversial method because it is difficult to establish the existence, or extent of the facilitator's influence in the communication of the person with a disability. Although much of the research on facilitated communication has been conducted with people with intellectual or developmental disabilities, research on the use of the technique with people with brain injury offers several advantages. Firstly, most people with brain injury were known to be competent communicators prior to the brain injury. Secondly, many recover sufficiently to allow a retrospective examination of the issues that faced them when they were using the technique. Thirdly, there can be a large amount of data available about the person's diagnosis, their prognosis and the course of their history following the event. Consequently, the current study uses a case study methodology to explore the application of facilitated communication with people with brain injury and draws on personal recollections of people with brain injury, interviews with families and medical and therapist reports. The three people interviewed in the study displayed varying language and memory abilities. They indicated a preference for independent communication techniques and they reported frustrations with using facilitated communication. They quickly rejected the method when speech began to appear even though their speech was inadequate for communication purposes, for two of them, for an extended period. One of the interviewees reported that facilitator influence was overwhelming at times but not always present. Two of the interviewees felt that facilitated communication gave them a start in their recovery process. Two of the interviewees reported that meaningful exchanges with others occurred only with speech. In addition to these findings the study, although not experimental, was able to shed light on some of the contentious issues surrounding facilitated communication. The method is reported to be designed to overcome the motor difficulties of the disabled communicator by providing physical assistance to individuals with poor fine motor control thus breaking the perseveration cycle that can be present . However the task of coping with facilitator influence may actually require some motor skills. Also, the physical effort involved in using facilitated communication for some individuals may have been underestimated by its supporters. However the study has shown that some individuals with severe communication impairments felt that facilitated communication had some merit but saw their ability to communicate independently as the significant achievement in their recovery.

Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2008. / Title from first page of PDF file (viewed July 10, 2008). Available via ProQuest Digital Dissertations. Vita. Includes bibliographical references (p. 332-356).

This report investigates the efficacy of using constraint-induced language therapy (CILT) for treating acquired apraxia of speech (AOS). CILT is a treatment method used with individuals with aphasia in which communication is restricted to verbal output in order to isolate the damaged language areas of the brain and reactivate impaired neural connections (Pulvermuller et al., 2001). CILT employs repetitive, massed practiced stimuli and structured shaping of expressive output within the confines of verbal expression (Pulvermuller et al., 2001). Kirmess and Maher (2010) indirectly discovered that two patients with aphasia and apraxia of speech made gains in both language output and articulatory accuracy after receiving intensive CILT, suggesting possible efficacy for the use of CILT with patients with AOS. / text

Purpose: The Everyday Speech Production Assessment Measure (E-SPAM) is a novel test for assessing changes in clients‟ speech production skills after intervention. This study provides information on reliability and validity for the test and overviews its clinical application. Method & Procedures: E-SPAM, oral reading, and sequential motion rate tasks were administered to 15 participants with motor speech disorders (MSDs). E-SPAM responses were scored using a 5-point system by four graduate students to assess inter-scorer and temporal reliability and to determine validity for E-SPAM. Results: Findings of this study indicate that the E-SPAM can be scored with sufficient reliability for clinical use, yields stable scores on repeat administrations, and that its results correlate highly with other accepted measures of speech production ability, specifically sentence intelligibility and severity. Conclusions: While the results of this study must be considered preliminary because of the small sample size, it does appear that the E-SPAM can provide information about aspects of speech production such as intelligibility, efficiency, and speech naturalness, that are important when treatment focuses on improving speech. The E-SPAM also appears to be a “clinician-friendly” test as it is quick to administer and score and can be administered to patients across the severity continuum.