Apraxia Related to Articulation and Phonological Disorders/Intervention - Term Paper Example

Apraxia related to Articulation and Phonological Disorders/Intervention Abstract Apraxia is a disorder that is often misunderstood, but which affects enough people to warrant attention. It is considered to be a rare disorder, and one that presents significant challenges in prevention and management. Apraxia is often closely associated (many a times confused) with phonological and articulation disorders. It presents itself in two ways: as childhood apraxia of speech (commonly abbreviated as CAS and limited to children, particularly those between the ages of 1 and 10) and as acquired apraxia (limited to adults). This paper will explore the relationship between apraxia and articulation and phonological disorders, as well as the various interventions available for all three disorders. The objective is to establish whether there is indeed a connection between apraxia, articulation disorders, and phonological disorders. Key words Apraxia, acquired apraxia, childhood apraxia of speech (CAS), articulation disorders, phonological disorders. Connection between Apraxia and Articulation/Phonological Disorders This is an area that has been explored extensively by psychologists, psychiatrists, speech-language professionals, and speech-language therapists, but which has not been well dissected yet. The reason for this is that it is punctuated by similarities and differences that make it difficult to comb it as well as it should. As it stands however, there is sufficient evidence to show that apraxia (whether acquired or developmental), articulation disorders, and phonological disorders, have little or no connection except in the presentation of symptoms. That is all there is to it. Apart from some similarities in diagnoses and presentation of symptoms, the three disorders are different in their causes and explanations, two areas which are fundamental in telling diseases apart. In order to emphasize the argument being presented here, it is important that all three disorders are discussed in detail. This will bring out the apparent little or no connection between them. Apraxia is caused by a defect in one’s ability to produce the motor programming necessary for speech movements. Apraxia is not a defect in the relay of messages between the brain and the speech musculature. It is not a movement defect like dysarthria, but a programming/planning problem (Baker & McLeod, 2004). It is characterized by an impairment in the gathering the correct sequence of movements to support speech production or the implementation of the right serial ordering of speech sounds, and is primarily an inability to plan articulatory motion. This disorder develops as a result of lesions in the central nervous system, and is a cortical defect. It affects one’s ability to program, execute, and arrange the movements of the mouth that support intelligible speech. This may include coordination and planning of movements of the lips, tongue, palate, and jaw that are fundamental in speech intelligibility. CAS is more prevalent in boys than girls and affects one in ten children out of 10,000 reported cases. CAS can be (and is often) confused with childhood expressive language/speech delay, but it is good to know the difference (Hardcastle, Barry, & Clark, 1987). A true childhood expressive speech delay is caused by the existent of a huge gap between weak expressive speech abilities which are normally lower than age expectations and stronger receptive speech abilities (Crosby, Holm & Dodd, 2005). In other words, a child can comprehend the language but finds it hard to express his/her thoughts and ideas. Children suffering from apraxia possess good (intact) receptive language abilities with weak expressive language/speech abilities. Speech-language professionals (SLPs) have shown that apraxia is treatable, and errors in apraxia are not only inconsistent but also unpredictable. Different patterns of error are evident in spontaneous speech against repetition. Learners’ spontaneous speech has fewer errors compared to speech in repetition questions. For instance, learners will speak more clearly when producing automatic material. The most prevalent type of errors is substitutions, while marked phonemes may also be approximated. Other common apraxic errors include omissions, additions, distortions, repetitions, transpositions, and prolongations. These errors are often considered to be perseveratory. Just like in stuttering, anticipating errors leads to dysfluent speech. Apraxic speech is heavily punctuated with trial and error forms of articulatory motion along with groping, which is caused by error anticipation (Baker & McLeod, 2004). Apraxic people find it easier to produce vowels than consonants. Resonance and voice problems are not associated with this disorder. Phonological disorders are difficulties with the “patterns” or “rules” for integrating intelligible sounds during speech. These patterns include syllabic reduction, consonant deletion, and reduplication. There are many patterns used to analyze children’s speech based on phonological processes models, and all the patterns are also common in developing children.  It however becomes a problem when majority of children are developing their production patterns and one child is not (Hardcastle, Barry, & Clark, 1987).  For instance, eventual consonant deletion usually disappears between two and a half to three years of age.  It would be considered “atypical” or “disordered” if a child is still leaving out final consonants by age 3, since by that age most of his/her peers have progressed to a more mature/complex pattern. Children with only phonological disorders display developing language, meaning their utterance length and vocabulary are at par with their peers, but they keep on displaying patterns similar to younger children’s speech errors (Forrest, Dinnsen & Elbert, 1997). Articulation disorders are characterized by the addition, omission, substitution, distortion, and/or wrong sequencing of sounds of speech. These errors are motorically-based and are normally consistent. The sounds produced are usually classified as phonetic because they are distinctly different from normal productions. Articulation defects can be organic or functional in etiology. Functional ones are occur without any clear cause and are closely related to deficiencies in peripheral process that are, to an extent, peripheral. Examples include but are not limited to tendencies to distort “r”, and interdental or lateral lisps, etc. (Forrest, Dinnsen & Elbert, 1997). Articulation errors may also be caused by organic or physical conditions like cleft palate, cerebral palsy, and/or hearing defects or they may be caused by TBI or other syndromes/conditions. A small number of articulation disorders may be classified under the ‘developmental dysarthria’ category. Dysarthric speech is typified by omissions and sound distortions that are consistent regardless of speaking tasks. In all positions, consonants are affected more than vowels and are inaccurate with identical production impairments. Rate and prosody are aspects of speech that are also affected (Hardcastle, Barry, & Clark, 1987). Fundamental Diagnostic Differences between Apraxia and Articulation/Phonological Disorders 1. Vowel Sounds Apraxic children substitute, or in some instances leave out, vowel sounds (Hardcastle, Barry, & Clark, 1987).  On the other hand, children with phonological disorders use precise vowel sounds on a consistent basis. 2. Consistency in Errors Children with phonological disorders exhibit consistency in their errors, while children with apraxia are consistently inconsistent with their errors (Baker & McLeod, 2004). Also, children with phonological disorders display patterns in their errors. Apraxic children rarely do. 3. Language Skills. Apraxic children always exhibit late expressive language/speech skills (particularly prior to therapy). Their utterance length and vocabulary size are below their peers’. On the other hand, children with phonological disorders may possess expressive language/speech skills that are closer or within the normal range (Crosby, Holm & Dodd, 2005).    4. Other Speech Characteristics A look at children with apraxia reveals a tendency to “grope” for words (Dagenais, 1995). On the other hand, children with phonological disorders do not display such a problem. 5. Verbal Imitation Apraxic children have huge difficulties repeating or imitating what one has said (particularly after commencement of therapy). Children with phonological disorders are able to repeat or imitate, but they may not be accurate with words (Hardcastle, Barry, & Clark, 1987). 6. Oral Imitation Apraxic children find it hard to use their mouths to perform, talk, or imitate specific movements when asked to do so (Dagenais, 1995). This is however not the case in “automatic” activities, and activities like eating. Children with phonological disorders show more consistency in what they are able or unable to perform with their mouths. Interventions a) Phonological Contrast Therapy This involves identifying (targeting) error patterns based on analyses of phonological evaluation data (Crosby, Holm & Dodd, 2005). An error pattern is then chosen for intervention according to the following procedure: identifying non-developmental sequences prior to developmental; frequency and consistency of use of the selected error pattern; impact on intelligibility of positive remediation; and ability to stimulate required speech sounds (Dagenais, 1995). Each error pattern is normally targeted in 4 stages; these are: auditory evaluation; assessment of the ability to produce single words; assessment of the ability to produce phrases (set followed by spontaneous); and assessment of the ability to produce sentences within conversations. b) Core Vocabulary Therapy This involves targeting consistency in the production of words. A list of words (up to 50) that are functionally powerful to children is selected by them, their parents and their teachers. Every week 10 words are randomly picked from the list of target words, and the therapist then establishes children’s best production of every target word (Hardcastle, Barry, & Clark, 1987). Best production was realized by sound-by-sound teaching of words, using examples like cued articulation, syllable segmentation, and imitation. c) Electropalatography (EPG) This type of therapy has been employed in research for almost 40 years to gain an understanding of the production of normal speech sounds in many languages (Baker & McLeod, 2004). It has also employed in the exploration of poor sound production in wide range of conditions and ages. It has proved to be very useful in treating and assessing wide range of speech-related defects, including: fluency, phonological disorders, CAS, dysarthria, cleft-palate, developmental articulation, cochlear implants and hearing impairment. Children, adults and adolescents have been assessed and treated successfully using this therapy (Dagenais, 1995). Conclusion Apraxia, articulation disorders and phonological disorders do not exhibit a close connection except in the presentation of some symptoms. Apraxia is an oral-motor disorder, while the other two are speech disorders. Individuals (especially children) suffering from any one of these disorders require support, encouragement and love from parents, teachers and society in general so that they can learn how to accept and live positively with their conditions. School-going children are particularly vulnerable to bullying, taunting and other forms of mistreatment, which leads to low self-esteem and confidence. As a result, we must be vigilant in protecting those in the society that are handicapped by these disorders. References Baker, E. and McLeod, S. (2004). Evidence based management of phonological impairment in children. Child Language Teaching and Therapy, 20, 261–285. Crosby, S., Holm, A., & Dodd, B. (2005). Intervention for children with severe speech disorder: A comparison of two approaches. International Journal of Language and Communication Disorders, 40(4), 467-491. Dagenais, P. (1995). Electropalatography in the treatment of articulation/phonological disorders. Journal of Communication Disorders, 28, 303-329. Forrest, K., Dinnsen, D. and Elbert, M. (1997). Impact of substitution patterns on phonological learning by misarticulating children. Clinical Linguistics and Phonetics, 11, 63–76. Hardcastle, W., Barry, R., & Clark, C. (1987). An instrumental phonetic study of lingual activity in articulation-disordered children. Journal of Speech and Hearing Research, 30, 171-184. Read More