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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. / Communication Sciences

The purpose of the present study was to compare feature retention patterns between children developing speech typically (TD) and children with phonological impairment (PI) and to discuss these findings in terms of characteristics, severity, and implication for the identification of developmental apraxia of speech (DAS). A second purpose was to determine if a relationship exists between phonological knowledge and feature retention. This study consisted of a PI group and a TD group of children, ages four to six. A 245-item speech sample was collected from each subject. Feature retention percentages as well as percent correct underlying representation (PCUR) were calculated for each child. Both PI and TD groups retained place the least, voice the most, with manner falling in between. These patterns corresponded with what past researchers found in studies of children with phonological impairment and children diagnosed with DAS. No significant correlation was found between PCUR and feature retention.

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. / Public Health

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. / Communication Sciences

Thesis (MEd)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Even though dyspraxia is a fairly new and unknown disorder, especially in South Africa, a fair amount of research has been conducted on what this condition entails, its causes and symptoms, as well as the resources available to deal with children with dyspraxia. However, research on the emotions, frustrations and concerns of the parents of children with dyspraxia is not as readily available. Bronfenbrenner’s bio-ecological perspective was used as it identifies the family’s diferrent systems where-in it functions. This can possibly identify and bring to attention the existing support systems within the family’s community. The research methodology of this study is qualitative research within the interpretive paradigm. The researcher made use of two case studies as this research explored a specific phenomenon. Through purposive sampling, four parents of children with dyspraxia was identified as participants. The research question guiding this study explores the personal experiences of the parents regarding their children’s dyspraxia. Individual semi-structured interviews and reflective journals were used as methods of data collection. According to existing literature, parents of children with disorders experience their children’s disorders on an emotional, physical as well as social level. The data analysis have shown that parents of children with dyspraxia also experience their children’s condition on these three levels. From this study, it was concluded that parents’ knowledge of dyspraxia, their living environment, the measure of support and resources available, as well as the number of children in the family are all factors that influence their experiences across the three aforementioned levels. The research provides insight into the parents’ experiences and the importance of adequate support for parents, and should promote general awareness and acknowledgement of dyspraxia as a significant barrier in a child’s development. / AFRIKAANSE OPSOMMING: Alhoewel dispraksie veral in Suid-Afrika nog ’n betreklik nuwe en onbekende versteuring is, is daar al heelwat navorsing gedoen oor wat dié toestand behels, hoe dit ontstaan, met watter simptome dit gepaardgaan, en die beskikbare hulpbronne om ʼn kind met dispraksie te hanteer. Tog is navorsing oor die emosies, frustrasies en bekommernisse van die ouers van kinders met dispraksie nie ewe geredelik beskikbaar nie. Bronfenbrenner se bio-ekologiese teorie is gebruik, omdat dit die gesin se verskeie sisteme identifiseer waarbinne hulle funksioneer. Sodoende kan moontlike ondersteuning in die gesin se gemeenskap geïdentifiseer en bewerkstellig word. Die navorsingsmetodologie van hierdie studie is kwalitatiewe navorsing binne ʼn interpretatiewe paradigma. ʼn Spesifieke fenomeen is ondersoek en die navorser het gebruik gemaak van twee gevallestudies. Die deelnemers, soos geïdentifiseer deur ʼn doelgerigte steekproef, is vier ouers van kinders met dispraksie. Die navorsingsvraag wat hierdie studie lei handel oor die ouers se ervarings en persoonlike belewings rakende hul kinders se dispraksie. Individuele, semi-gestruktureerde onderhoude, sowel as reflektiewe joernale, is as metodes van data-insameling gebruik. Volgens bestaande literatuur beleef ouers van ʼn kind met ʼn versteuring hul kinders se toestand op ʼn emosionele, fisiese én sosiale vlak. Die data analise het gedui dat ook ouers van kinders met dispraksie hul kinders se toestand op hierdie drie vlakke ervaar. Die studie het ook daarop gedui dat ouers se kennis van dispraksie, die omgewing waar hulle woon, die mate van ondersteuning en hulpbronne waaroor hulle beskik, sowel as die getal kinders in die gesin, alles faktore is wat hul ervarings op voormelde drie vlakke beïnvloed. Die navorsing bied insig in die ouers se ervarings en die noodsaaklikheid van genoegsame ondersteuning vir ouers, en behoort algemene bewustheid en erkenning van dispraksie as ʼn hindernis vir ʼn kind se ontwikkeling te bevorder.

Les troubles praxiques font partie des critères d’inclusion decertaines pathologies neurodégénératives et sont de nature à réduirel'autonomie de ces patients. Pourtant, les rares travaux dans cedomaine prennent rarement en compte les spécificités liées auxpathologies dégénératives (e.g., évolution, lésions diffuses,phénotypes différents), sans compter qu’il n’existe pas de consensusthéorique sur l’apraxie. Les troubles d'utilisation des outils ontlongtemps été expliqués par la perte de représentations stockées (e.g.,connaissances sur les objets ou les gestes) mais des modèles récentssuggèrent de distinguer l’utilisation proprement dite de l’usagecommunément admis. De même, l’apraxie est fréquemment mise enrapport avec la perte d’une représentation du corps mais une mise enperspective historique de la littérature permet de constater qu'il s'agitd'un postulat tout à fait récent. La présente thèse émet une propositionalternative en opposant à la notion de représentation corporelle desprocessus plus dynamiques et neurologiquement ancrés tels quel’intégration sensorielle. Au plan théorique, la présente thèse proposeainsi une mise en perspective historique et une revue critique de lalittérature, ainsi qu’une réflexion épistémologique opposant savoir etraisonnement, permettant de distinguer des troubles spécifiques dugeste et des répercussions "dans le geste" d'autres niveaux deperturbations. Au plan clinique, ce travail de neuropsychologieclinique et expérimentale examine ces différents niveaux dans uneperspective différentielle et montre que les dissociations envisagéessont cliniquement opérantes. / Apraxia is a diagnostic criterion for neurodegenerativediseases and can reduce autonomy in these patients. Yet, the fewstudies that have been done in this domain rarely take into accountspecificities of dementia (e.g., evolution, diffuse lesions, differentphenotypes) and there is no theoretical consensus on apraxia. Tooluse disorders are mainly explained by the loss of stored knowledge(e.g., about tools or gestures) but recent models suggest to distinguishthe actual use of tools from common usage. Likewise, apraxiai sfrequently linked with the loss of body representations but a historicalperspective of the literature demonstrates that it is a relatively recentassumption. The present doctoral thesis submits an alternativeproposal by opposing body representation and more dynamic andneurological processes, that is, sensory integration. Thus, at thetheoretical level this work proposes a historical perspective and acritical review of existing literature, as well as an epistemologicalreflection that contrasts knowledge and reasoning, and that makes adistinction between specific gesture disorders and consequences ofother cognitive impairments on gesture production. At a clinical level,this neuropsychological research examines these different levels ofimpairments in patients through a differential approach. Results showthat the aforementioned theoretical considerations are clinicallyvalidated.

Notre but de comprendre les mécanismes constitutifs de la déficience intellectuelle et de la dyspraxie verbale, deux pathologies qui affectent les performances aux tests psychométriques. Nous avons sélectionné plusieurs processus pouvant contribuer à l’explication de ces troubles : la vitesse de traitement de l’information et la mémoire travail pour la déficience intellectuelle ; et l’apprentissage procédural pour la dyspraxie verbale. Dans une première étude, nous avons montré que dans la population « tout venant » d’enfants non déficients, la vitesse de traitement augmente avec l’âge. Notre seconde expérience a montré que des patients déficients intellectuels avaient la même vitesse de traitement que des enfants plus jeunes appariés sur l’âge mental. Par ailleurs, nous avons montré que ce ralentissement est similaire dans le syndrome de l’X-Fragile et dans la Trisomie 21. Inversement, la vitesse de traitement des enfants dyspraxiques verbaux est préservée. Ces résultats viennent discuter les deux modèles théoriques de l’intelligence que nous avons choisis comme référence, le modèle en cascade de Fry & Hale (1996) et le modèle d’Anderson (1992). Dans le second volet de nos recherches, nous avons mis en évidence un apprentissage procédural implicite comparable dans deux groupes d’enfants d’âges chronologiques différents malgré des temps de réaction plus importants chez les plus jeunes. La seconde étude montre une préservation de l’apprentissage procédural implicite dans le syndrome de l’X-Fragile et une altération spécifique dans la Trisomie 21. Cela démontre que ce processus est indépendant du QI et varie selon les syndromes. Notre dernière étude montre un trouble important de l’apprentissage procédural implicite dans la dyspraxie verbale, confortant notre hypothèse de départ. L’ensemble de ces résultats est discuté au regard des travaux antérieurs et des modèles théoriques afin de proposer des ouvertures tant théoriques que cliniques. / Our aim is to understand previous process in mental retardation and childhood apraxia of speech (CAS). There are both neurodevelopmental disorders which affect psychometric assessment. We have selected several processes which could explain these disorders such has speed of information processing, working memory for mental retardation and implicit procedural learning for childhood apraxia of speech. In our first study, we have demonstrated within two groups of typical children without disorders that speed of processing increased with chronological age. In the second study, our results have demonstrated the same speed of processing between a group with mental retardation and with mental age matched control group. Moreover, Down and Fragile X syndrome have the same speed of information processing. On the contrary, in our third study, children with CAS and chronological age matched control group have the same speed as process visual information. All results are important to discuss both theories of intelligence we have chosen: the cascade model (Fry and Hall, 1990) and the minimal cognitive architecture (Anderson, 1992). In the second experimental part, our first results have shown a different reaction time between the two groups of young children but both have learned the sequence in a serial reaction time task (implicit procedural learning test). The second study have demonstrated preserved implicit learning in Fragile X but altered learning in Down syndrome. The difference between to these two genetics syndromes is a proof of implicit sequence learning is independent of IQ. The latest results have shown severe implicit procedural learning impairment in CAS. We conclude that this is the cause of CAS.Our discussion is about all results and links between intelligence and disorders with regard to previous studies. Those results aim for both theorical and clinical openings.

While dyspraxia has been studied from the neuro-anatomical aspects, few studies have explored the experience of adults with dyspraxia in the course of their everyday activities. This study reveals the unique and complex experiences of five adults as they struggle to live with dyspraxia.The research is underpinned by the phenomenological perspective. Participants were filmed performing everyday activities of their choice and were interviewed on their experiences of dyspraxia with everyday activities.The stories and videos reveal the struggle participants have with their unknowing and unwilling bodies, puzzled thinking, unfamiliar surroundings, and unhandy tools. Despite the enormity of their struggles, participants persevere, using individual strategies to overcome obstacles. The findings show that the lived-experience of dyspraxia tends to remain hidden from the person, as well as the clinician. Much of what is taken for granted during everyday activities is shattered in the lives of people with dyspraxia. The automatic, smooth, unconscious way activities are done, tools are handled and the world is experienced is altered. The path to recovery remains unclear as dyspraxia makes itself known one day and not the next. Sheer determination and a hope for the future helps participants carry on with trying to reclaim the person they lost as a result of the dyspraxia.The importance for understanding, by clinicians of the impact of dyspraxia on people's everyday lives cannot be underestimated. Implications for practice are discussed, as these relate to formal definitions of dyspraxia, client-centred practice, as well as diagnosis, assessment, intervention, and education.

<p>Syftet med denna studie är att undersöka hur en grupp typiskt utvecklade, svenska barn, i åldrarna fyra till tio år presterar på tre deltest i VMPAC, för att därmed skapa ett underlag för en referens för svenska barn i bedömningen av avvikande utveckling. Studiens frågeställningar är: 1. <em>Hur presterar en grupp typiskt utvecklade, svenska barn, i åldrarna fyra till tio år, på tre deltest i VMPAC (Focal Oromotor Control, Sequencing Maintenance Control och Connected Speech and Language Control)? </em>och 2. <em>Förekommer det några skillnader mellan en grupp typiskt utvecklade, svenska barn, jämfört med den amerikanska normeringen i VMPAC och barn med verbal dyspraxi (CAS) undersökta inom ramen för en magisteruppsats (Björelius-Hort, 2009)?</em> Oral- och talmotorisk förmåga hos 23 svenska barn i åldrarna fyra till tio år, som åldersmatchats mot barn med verbal dyspraxi (Björelius-Hort, 2009), testades med deltest två, tre och fyra ur VMPAC. Prövning av inter- och intrabedömarreliabiltet visade statistiskt signifikanta resultat, r =. 923 respektive r =. 913, med p <. 001 i båda fallen. Utifrån resultatet kan följande slutsatser dras: 1. att de studerade barnen, generellt presterade över 80 % på deltest två, tre och fyra i VMPAC, oavsett ålder, 2. att skillnaderna mellan den amerikanska normeringen i VMPAC och studiens deltagare är små och 3. att barnen med verbal dyspraxi generellt presterar sämre än den studerade gruppen på samtliga deltest.</p> / <p>The study investigates speech and oral motor skills in typically developed children at different ages. The results are intended to serve as a basis for future reference in the assessment of atypical development in Swedish children. The questions addressed within the study are: 1. <em>How does a group of typically developed, Swedish children, in the ages four to ten years, perform on three subtests in VMPAC (Focal Oromotor Control, Sequencing Maintenance Control and Connected Speech and Language Control)?</em> and 2. <em>Are there any differences in performance between a group of typically developed, Swedish children, and the American standardization in VMPAC and also with the children with childhood apraxia of speech (CAS) from the study by Björelius-Hort (2009)?</em> Speech and oral motor abilities were assessed using subtests two, three and four in VMPAC. The participants were 23 Swedish children, aged four to ten years old, who had been age-matched based on the children with CAS from the study by Björelius-Hort (2009). Inter- and intra-rater reliability showed statistically significant results, r =. 923 and r =. 913, with p <. 001, in both cases. From the results of the study the following conclusions can be drawn: 1. that the investigated group of children in general performed over 80 % on subtests two, three and four in VMPAC independent of age, 2. that the differences between the American standardization in VMPAC and the participants in this study were almost nonexistent and 3. that children with CAS in general performed poorer than the investigated group of children in all subtests.</p>