Apraxia of Speech, which commonly affects children, as well as adults, is a motor speech disorder and falls in the speech sound disorders that involve deficits in motor planning, that subsequently affects the production of speech sounds (Dodd, Gillon, & McNeill, 2009). An individual who suffers from speech apraxia is unable to coordinate muscle movements associated with speech. He knows what to say, but his brain is incapable of harmonizing the speech muscles. In essence, this occurs primarily because brain messages to the mouth are disrupted, which is attributed to planning problems in the brain to effectively move body parts for speech. In effect, the person cannot be able to move the lips or tongue to the right place in order to say the words correctly. In children, the disorder is commonly referred to as childhood apraxia of speech (CAS), and in most occasions, the cause is not known as doctors do not observe any problems with the childs brain, and thus, it is usually associated with injury or neurological conditions, for example, a stroke, infections, genetic disorders, or a traumatic brain injury (Dodd et al., 2009). In adults, it is often attributed to instances of dementia, traumatic brain injury, progressive neurological disorders, brain tumors or a stroke.
Key Criteria of Speech Apraxia
A speech-language pathologist (SLP) plays a vital role in diagnosing and treating speech apraxia, and no single test or factor can be used in diagnosing the disorder. Besides, speech-language experts have not agreed on the specific symptoms that are part of developmental apraxia. Even so, there are various assessments and diagnostic criteria they can use in diagnosing speech apraxia. These include oral-motor, the melody of speech, and speech sound assessments.
An SLP can perform oral-motor assessments, which entails checking muscle weakness in the tongue, jaw, or lips. Among children, SLPs can look into how the child coordinates mouth movements, as well as evaluating the sequencing and coordination of muscle movements for speech while the child performs simple speech tasks, for example, repeating strings of words as fast they can (Dodd et al., 2009). Also, an oral-motor assessment can help examine the rote abilities, usually by testing the skills of the child in real-life or functional situations, and subsequently comparing this to competencies in a pretend or nonfunctional situations, such as licking a lollipop or rather, pretending to lick a lollipop.
Furthermore, SLPs can perform a melody of speech assessment, which entails listening to the child to identify whether he or she is able to stress the syllables she uses in words and words in various sentences appropriately. In essence, when testing for the melody of speech, the SLP determines whether the child can use pitch and pauses to mark a variety of sentences, as well as to mark off different portions of the sentences. As such, this involves testing for whether the child can correctly articulate intonations as used in sentences. Lastly, SLPs can also perform a speech sound assessment, entailing evaluating if the person can correctly use consonant and vowel sounds (Dodd et al., 2009). In addition, the SLP can also check whether the child can say correctly individual words, as well as sound combinations. Besides, the SLP can also assess whether others can understand what he or she is saying when using single words, phrases, as well as conversational speech. However, in the assessments, the SLP must rule out any coexisting problems in other areas of development. Essentially, according to Dodd et al. (2008), SLPs can capitalize on the use of magnetic resonance imaging (MRI) to distinguish acquired speech apraxia from other communication disorders associated with brain damage.
Since there is no specific symptom for diagnosing speech apraxia, SLPs with the help of parents need to observe the speech of the child over time. As for adults, they can gauge whether they have these difficulties with the help of SLPs. The SLPs may take the child or adult through some speech tasks, for example, repeating particular words or list of words severally. For acquired speech apraxia, SLPs can determine the capability of the person to write, read, or perform non-speech movements.
Specific Characteristics of Speech Apraxia
There is no specific symptom associated with speech apraxia. For this reason, SLPs look for the presence of a variety of symptoms. One of the most common is difficulty in putting sounds and syllables together in the correct order to form meaningful words, as well as making inconsistent mistakes while speaking (Gillon & Moriarty, 2006). People suffering from speech apraxia will always seem to be groping or searching for the right word or sound, and in some instances, they may try saying the word severally before they ultimately pronounce it correctly. They often use incorrect use of varying rhythms, inflections, and stresses of speech that are often used in combination to help express meaning. For instance, children with CAS can understand the language better than they can use it in expressing themselves. Other symptoms include incorrect grammar, poor vocabulary, problems with reading, difficulties in chewing and swallowing, as well as problems associated with writing, reading, math, or spelling (Gillon & Moriarty, 2006). As such, motor learning deficit characterize speech apraxia. However, the severity of these symptoms varies from one person to another. Speech apraxia may sometimes be so mild that the person only has trouble with a few speech sounds or pronouncing certain syllables and words. In severe cases, the person may not be able to communicate effectively with speech and may need additional or alternative methods of communication.
Further characterization of speech apraxia entails evaluating the production of speech by analyzing the percent vowels correct (PVC), percent phonemes correct (PPC), and percent process usage (PPU; Gillon & Moriarty, 2006). The SLP has to determine that the person scores very low when testing for PVC, PPC, and PPU. In fact, children and adults with speech apraxia are more likely to encompass vowel and consonant deletion errors. Also, SLP evaluates a personal narrative language sample to assess various features of connected speech, the childs or adults speech abilities in connected compared to single-word contexts, as well as the when the individual is seen groping during connected speech.
Genetic and Environmental Characteristics of Speech Apraxia
Key findings on the association of speech apraxia with genetics emerged from a London family, wee half of the members had orofacial apraxia and a reported speech apraxia, attributed to the mutation of FOXP2 gene located on chromosome 7 that is specifically linked to family members with apraxia. FOXP2 when distributed widely in the brain, specifically both hemispheres, is consistent with speech, language, prosody, and cognitive challenges observed in children with CAS. When the gene is found the two brain hemisphere instead of one, there is some degree of severity and persistence of CAS. Shriberg, Ballard, Tomblin, Duffy, Odell, and Williams (2006) reported CAS in a mother and daughter with a chromosome translocation in a brain region affecting FOXP2. Besides, Zeesman et al. (2006) identified the deficit of FOXP2 in a child with CAS, and thus, a genetic characteristic of CAS is the deficit of FOXP2 or its presence in both brain hemispheres. Besides, environmental characteristics, including exposure to toxins and pollutants before or after birth, as well as nutritional deficits and malabsorption are theorized to cause CAS (The Childhood Apraxia of Speech Association (CASANA), n.d).
Delineation of Treatment Variables
Children with apraxia have more success when they receive intervention measures, for example, intensive and frequent treatment, usually scheduled three to five times weekly in a one-to-one setting. In essence, intervention focus for the disorder is to improve sequencing, coordination, and planning of muscle movements for producing accurate speech. It is derived from the assertion that for the child to improve his or her speech, then practicing speech is paramount. Besides, the use of multi-sensory approach is particularly helpful. For instance, getting feedback from a variety of senses, for example, tactile and visual cues such as watching themselves speak on the mirror and auditory feedback can assist them to make necessary improvement for repeat syllable, sentences, words, as well as longer sentence utterances, which significantly improves speech sequencing and muscle coordination. In cases of severe apraxia, children can be taught how to communicate using other methods such as sign language or use of augmented communication devices. Lastly, practice is important and there is no other place better than at home. Family members can help the child or adult progress in using new communication strategies, which helps realize optimal progress. As such, it can be concluded that treatment of apraxia is possible for as long the child or adult obtasins the necessary help they can get, such as from SLPs and family members.
Dodd, B., Gillon, G., & McNeill, B. (2009). A longitudinal case study of the effects of an integrated phonological awareness program for identical twin boys with childhood apraxia of speech. International Journal of Speech-Language Pathology, 11(6), 482-495.
Gillon, G.T. & Moriarty, B.C. (2006). Phonological awareness intervention for children with childhood apraxia of speech. International Journal of Language and Communication Disorders 41, 713734.
Shriberg, L. D., Ballard, K. J., Tomblin, J. B., Duffy, J. R., Odell, K. H., & Williams, C. A. (2006). Speech, prosody, and voice characteristics of a mother and daughter with a 7; 13 translocation affecting FOXP2. Journal of Speech, Language, and Hearing Research, 49(3), 500-525.
The Childhood Apraxia of Speech Association (CASANA). (n.d). What Causes Childhood Apraxia of Speech and Is It Preventable? Retrieved from http://www.apraxia-kids.org/library/what-causes-childhood-apraxia-of-speech-and-is-it-preventable/
Zeesman, S., Nowaczyk, M. J., Teshima, I., Roberts, W., Cardy, J. O., Brian, J., & Scherer, S. W. (2006). Speech and language impairment and oromotor dyspraxia due to deletion of 7q31 that involves FOXP2. American Journal of Medical Genetics Part A, 140(5), 509-514.s
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