Introdução: A articulação da fala é um dos aspectos fonoaudiológicos mais comprometidos na doença de Parkinson (DP). Pacientes com DP apresentam risco de manifestar apraxia não verbal e verbal. A apraxia não verbal ocorre quando há um déficit na habilidade de sequencialização dos movimentos voluntários não verbais da língua, lábios, mandíbula e outras estruturas orofaciais associadas, e a apraxia verbal é definida como um déficit na habilidade de sequencializar os controles motores necessários para o posicionamento correto dos articuladores durante a produção voluntária da fala. A prevalência com que apraxia da fala ocorre na DP não está bem estabelecida, sendo um distúrbio pouco explorado nesses pacientes. É um estudo inédito, até onde temos conhecimento, quanto à identificação dos erros práxicos verbais na DP. Objetivo: avaliar a prevalência da praxia não verbal e verbal em pacientes com doença de Parkinson, correlacionandoas com idade, escolaridade, tempo de doença e estadiamento da DP (Hoehn e Yahr), assim como correlacionar a apraxia não verbal com a apraxia verbal e identificar os erros práxicos verbais. Método: Estudo quantitativo, observacional, descritivo e de prevalência. Foram avaliados 45 pacientes acometidos pela DP, que realizaram seguimento clínico no ambulatório de Distúrbios do Movimento do Hospital de Clínicas de Porto Alegre, Brasil, através da aplicação do Protocolo de Avaliação da Apraxia da Fala, e o estadiamento da DP foi controlado através da escala de Hoehn e Yahr (H&Y). Resultados: A prevalência de apraxia não verbal e verbal nos pacientes com DP foi de 24,4%. Não houve significância entre apraxia não verbal com idade, escolaridade, tempo de doença, estadiamento da DP (H&Y) e gênero. A correlação entre apraxia verbal e escolaridade foi significante (p≤0,05), mas não houve significância com idade, tempo de doença, estadiamento da DP (H&Y) e gênero. Os tipos de erros práxicos verbais mais frequentes foram as omissões (70,8%). Quanto ao ponto e modo articulatório os fonemas mais alterados foram os dentoalveolares (92%) e os vibrantes (57,7%), consecutivamente. Conclusão: Os pacientes com DP apresentaram apraxia não verbal e verbal com manifestação de muitos erros práxicos verbais, estando a apraxia verbal correlacionada com a escolaridade. / Introduction: The speech articulation is one of the aspects most impaired in Parkinson's disease (PD). Patients PD present risk of expressing nonverbal and verbal apraxia. The nonverbal apraxia occurs when there is a deficit in the sequencing ability of nonverbal voluntary movements of the tongue, lips, jaw and other associated orofacial structures, while the verbal apraxia is defined as a deficit in the ability of sequencing the necessary motor controls in order to place the articulators correctly during the voluntary speech production. The predominance with which apraxia of speech occurs in PD is not well established and rarely explored in these patients. As far as we know, it is an unprecedented study regarding the identification of verbal praxic errors in PD. Objective: To assess the prevalence of nonverbal and verbal apraxia in patients with Parkinson's disease, correlating them with age, education, duration of disease and PD stage (Hoehn e Yahr), as well as to correlate nonverbal with verbal apraxia and identify the verbal praxic errors. Method: Quantitative, observational, descriptive and prevalence study. Forty-five patients with PD were evaluated. They were submitted to the clinical follow-up in the Movement Disorders Clinic of the Cinical Hospital of Porto Alegre, Brazil, through the application of the Speech Apraxia Assessment Protocol. Additionally, the PD stage was controlled through the Hoehn and Yahr scale (H&Y). Results: The prevalence of nonverbal and verbal apraxia in patients with PD was 24.4%. There was no significance between the nonverbal apraxia with age, education, duration of disease, PD stage (H&Y), and genre. The correlation between verbal apraxia and education was significant (p ≤ 0.05), but there was no significance with age, duration of disease, PD stage (H&Y) and genre. Omissions were the most frequent kinds of verbal praxic errors with (70.8 percent). Regarding the place and mode of articulation, the most changed phonemes were the dentoalveolar (92%)and the vibrants (57.7%), consecutively. Conclusion: Patients with PD presented nonverbal and verbal apraxia with manifestation of many verbal praxic errors and verbal apraxia correlated with education levels.

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

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.

<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>

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. 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)? och 2. 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)? 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 &lt;. 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. / 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. 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)? and 2. 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)? 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 &lt;. 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.

Talapraxi är en talmotorikstörning som drabbar planeringen och programmeringen av talet, vilket visar sig som avvikelser i artikulation och prosodi. I dag finns inget svenskt test för utredning av talapraxi. Syftet med studien var därför att utforma ett testbatteri på svenska som är känsligt även för lindriga grader av talapraxi. Detta test pilotnormerades på 50 friska deltagare.  För att kunna studera hur kön, ålder och utbildningsnivå kan inverka på prestationen i testbatteriet, eftersträvades en jämn fördelning när det gäller dessa demografiska bakgrundsvariabler. Uppgifterna konstruerades baserat på tidigare forskning gällande de typiska perceptuella dragen vid talapraxi och på testuppgifter som tidigare har visat sig vara känsliga för talapraxi. Deltagarnas prestation varierade mellan testbatteriets olika uppgifter. På några uppgifter hade en stor andel av deltagarna alla rätt, medan andra uppgifter visade sig vara utmanande även för friska personer. Inga signifikanta könsskillnader fanns för prestationerna på någon av uppgifterna i testbatteriet. Utbildningsnivå och ålder påverkade däremot prestationen på vissa uppgifter. Generellt var effektstyrkorna för utbildningsnivå större än för ålder. Testbatteriet bör i framtiden kunna ge ett bra underlag för bedömning av huruvida talapraxi föreligger eller inte. Det bör också kunna användas vid bedömning av talapraxins svårighetsgrad. För att gå vidare med utvecklingen av testbatteriet bör man fortsätta normeringen på ett större antal personer samt kliniskt validera det på personer med diagnostiserad talapraxi. / Apraxia of speech (AOS) is a motor speech disorder that affects the planning and programming of speech, resulting in articulatory and prosodic distortions. To this date there is no available test in Swedish for assessment of AOS. Therefore, the aim of this study was to construct a test battery that enables the assessment of level of severity of the disorder, including mild AOS. A pilot standardization was performed on 50 healthy speakers. In order to determine whether the performance on the test battery is affected by sex, age or level of education, the selection of participants was stratified by these variables. The tasks were constructed based on previous research regarding the perceptual characteristics of AOS, taking into account also the types of tasks that have proved to be challenging for patients with AOS. The performance varied between different tasks of the test battery. On some tasks a high portion of the participants got very high scores, while other tasks were shown to be challenging even for healthy speakers. No significant sex differences were found on any of the tasks. However, age and level of education significantly affected the performance on some of the tasks. Overall, the effect sizes for level of education were larger than for age. In the future, the test battery should be able to determine the presence or absence and severity of AOS. For further development of the test battery, the standardization should continue using a larger sample. A clinical validation on patients with diagnosed AOS is also of great importance.

Die vorliegende Studie untersucht die zugrunde liegende Frage, ob die Sprechapraxie und die aphasisch-phonologische Störung anhand phonetischer Entstellungen und phonematischer Paraphasien bei Diphthongen und Monophthongen voneinander unterschieden werden können. Ergänzend werden messphonetische Daten wie Vokal- und Wortdauern, der erste und zweite Vokalformant und die Voice Onset Time bei stimmlosen Plosiven im Silbenanlaut vergleichend herangezogen. Dazu werden drei Gruppen à vier Probanden untersucht: Gruppe SAX (mit Sprechapraxie), Gruppe APH (mit aphasisch-phonologischer Störung) und Gruppe NOM (sprachgesunde Kontrollgruppe). Es wird ein Nachsprechtest von 104 deutschen, meist monomorphematischen, einsilbigen Nomina, 52 einfache (CVC) und 52 komplexe (CCVC und CVCC) Silben, durchgeführt. Jeder Vokal wird durch acht meist unterschiedliche Wörter überprüft. Die Reaktionen werden mit dem phonetischen Analyseprogramm „Praat“ (Version 5.2.22, Boersma & Weenink, 1992–2011) segmentiert sowie ohren- und messphonetisch analysiert. Die statistische Auswertung erfolgt mit R (R Foundation) und R Studio (Version 0.98.1103, 2009–2014). Die Ergebnisse liefern Hinweise auf störungsspezifische Fehler bzw. Pathomechanismen der Sprechapraxie. Die Gruppe SAX produziert signifikant mehr phonetische Entstellungen bei Monophthongen und Diphthongen sowie signifikant längere Wortdauern als die Gruppe APH. In der Gruppe SAX sind einige Vokale nur teilweise entstellt, wie z. B. initial atypisch behauchte oder gerundete Vokale. Auch zeigen sich die Formantwerte in der Gruppe SAX variabler als in der Gruppe APH und der Gruppe NOM. Die Ergebnisse verweisen auf ein angenommenes Timing-Defizit bei der Planung und Kontrolle sprechmotorischer Bewegungen der Sprechapraxie. / This study analyses the underlying question if it is possible to distinguish apraxia of speech (SAX) and phonemic aphasia (APH) by phonetic distortions and phonological paraphasia of monophthongs and diphthongs. Phonetic measurements like the duration of vowels and words, the Voice Onset Time of voiceless plosives in the onset of syllables and the first and second formant will be analyzed as well. Three groups of four subjects are studied: Group SAX (no/mild aphasia), group APH (without apraxia of speech), group NOM (without any speech disorder). A repetition task comprising 104 German mostly monomorphemic, monosyllabic nouns, 52 simple (CVC) and 52 complex (CCVC and CVCC) syllables, is performed. Each of the vowels is tested in eight mostly different words. The reactions will be segmented, phonetically measured, and analyzed by ear with the help of the program “Praat” (Version 5.2.22, Boersma & Weenink, 1992–2011). The statistical analysis is conducted with R (The R Foundation), within the “R-Studio” software suite (Version 0.98.1103, 2009–2014). The results show some indications of failures and pathological mechanisms of apraxia of speech. Group SAX produces significantly more phonetic distorted monophthongs and diphthongs and significantly longer word durations than group APH. Some vowels are just partly distorted, for example, in form of atypical initial aspirated or rounded monophthongs. Also the formants show greater variability in group SAX than in groups APH and NOM. The results suggest a timing deficit during planning and control of speech movements in apraxia of speech.

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