Childhood Apraxia of Speech Treatment Quiz

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Questions and Answers

What is the primary focus when beginning treatment for a child with CAS?

Ensure initial success in treatment (correct)

Start with complex sound combinations

Focus solely on voiced sounds first

Address auditory discrimination skills

Which technique involves using diagrams and physical tools to aid sound production?

Contrastive Stress Drills

Phonetic Placement Techniques (correct)

Shaping/Progressive Assimilation

Auditory Discrimination Techniques

What sequence should treatment targets follow regarding sound difficulty?

Start with affricates, then move to vowels

Begin with voiceless sounds, progress to voiced sounds (correct)

Tackle complex clusters before simpler sounds

Start with consonant-ending words

What strategy is recommended for giving breaks during therapy sessions?

Incorporate short breaks to prevent fatigue Signup and view all the answers

Which of the following is emphasized as an initial treatment focus in CAS therapy?

Selecting a core vocabulary of meaningful words Signup and view all the answers

Which statement about reinforcement in CAS therapy is true?

Constant reinforcement is necessary to maintain progress Signup and view all the answers

Which method involves using non-speech gestures or sounds to facilitate speech production?

Shaping/Progressive Assimilation Signup and view all the answers

What aspect does Contrastive Stress Drills primarily teach?

The stress and rhythm of spoken language Signup and view all the answers

Which characteristic is NOT associated with cerebral palsy?

Progressive neurological disease Signup and view all the answers

What is the primary cause of cerebral palsy?

Non-progressive defect or lesion Signup and view all the answers

Which of the following classifications includes impairment of all four limbs but with legs more affected than arms?

Diplegia Signup and view all the answers

What is a common associated condition with cerebral palsy?

Mental retardation Signup and view all the answers

Which statement about early signs of cerebral palsy is true?

Altered tone is a significant indicator Signup and view all the answers

What is NOT classified under the functional classifications of cerebral palsy?

Class 2 - Moderate limitation Signup and view all the answers

Which of the following is an abnormal motor performance sign to watch for in early detection of cerebral palsy?

Toe walking Signup and view all the answers

What type of reflex persistence might indicate cerebral palsy during early development?

Asymmetrical tonic reflex Signup and view all the answers

Which posture is commonly recommended for most individuals to aid in respiration?

Sitting upright Signup and view all the answers

What is a primary goal of the Lee Silverman Voice Therapy (LSVT)?

Increasing intelligibility and loudness Signup and view all the answers

Which technique is emphasized in LSVT to improve vocal fold adduction?

Maximizing impact on intelligibility Signup and view all the answers

What strategy can be employed to improve resonance during speech?

Utilizing intra-oral pressure Signup and view all the answers

Which statement accurately reflects a concept of LSVT?

Calibration helps establish appropriate effort levels. Signup and view all the answers

What is a characteristic of the focus on 'high effort' in LSVT?

Pushing patients to new effort levels Signup and view all the answers

Which breathing approach is suggested to establish diaphragmatic breathing?

Using hands on the diaphragm Signup and view all the answers

What is the benefit of 'sustained phonation' in voice therapy?

Improves breath control Signup and view all the answers

What is the nature of cerebral palsy (CP) in terms of progression over time?

Its symptoms can improve with therapy. Signup and view all the answers

How does cerebral palsy affect individuals?

It affects individuals uniquely depending on various factors. Signup and view all the answers

What is the primary goal of treatment for speech production in individuals with motor speech disorders (MSD)?

To improve motor aspects of speech production. Signup and view all the answers

What does the term 'generalization' refer to in the context of treatment effectiveness?

Transfer of learning to other contexts and partners. Signup and view all the answers

Which of the following best describes the recommended focus when treating motor speech disorders?

Addressing impaired subsystems and relevant speech tasks. Signup and view all the answers

What is one approach that should NOT be used in the treatment of motor speech disorders based on the provided content?

Strengthening articulators through oral motor activities. Signup and view all the answers

What does 'acquisition' mean in the context of treatment for motor speech disorders?

Temporary improvements during treatment. Signup and view all the answers

Which of the following statements about the treatment strategies for motor speech disorders is true?

Compensatory strategies can be helpful. Signup and view all the answers

What is a common characteristic of apraxia of speech?

Voluntary speech is more affected than automatic speech Signup and view all the answers

What kind of therapy is typically required for individuals with severe apraxia of speech?

Intensive one-on-one speech-language therapy Signup and view all the answers

Which of the following methods might help individuals with severe apraxia of speech express themselves?

Sign language and written communication methods Signup and view all the answers

Which characteristic of speech errors is NOT typically associated with apraxia of speech?

Complete loss of speech ability Signup and view all the answers

What is the primary goal of treatment for apraxia of speech?

Functional speech development Signup and view all the answers

What is a crucial aspect of speech therapy for individuals with apraxia of speech?

Repetitive drill and controlled sequencing of phonemes Signup and view all the answers

Which of the following approaches is used for treating more severe cases of apraxia of speech?

Melodic Intonation Therapy (MIT) Signup and view all the answers

What is a potential benefit of using assistive communication methods for children with apraxia of speech?

Stimulating areas of the brain related to language and literacy Signup and view all the answers

What is the primary focus of therapy for patients with dysarthria?

Increasing speech accuracy and communication efficacy Signup and view all the answers

Which approach is NOT typically used in the treatment of AOS?

Increasing speech rate Signup and view all the answers

How should the SLP work with the family and friends of a patient with dysarthria?

Help them learn methods to converse and understand the patient Signup and view all the answers

What treatment goal is associated with flaccid dysarthria?

Increase tone and strength Signup and view all the answers

Which of the following is a common sign of dysarthria?

Changes such as hoarseness or breathiness in voice Signup and view all the answers

What is one possible approach for treating speech issues in dysarthria?

Using visual aids for speech production Signup and view all the answers

In AOS treatment, what does 'progressive complexity' refer to?

Starting with the easiest tasks and gradually increasing difficulty Signup and view all the answers

What might be a goal for respiration therapy tied to speech production?

To establish a correct breathing pattern Signup and view all the answers

Study Notes

Cerebral Palsy Overview

Chronic neurological disorder originating in the central nervous system
Characterized by abnormal movement and posture
Appears in early life; not a progressive disease

Definition of Cerebral Palsy

Persistent but not unchanging movement, tone, and posture impairments
Caused by non-progressive defects or lesions in the immature brain (fetal life, infancy, childhood)
Often associated with developmental disabilities, including mental retardation (60%), epilepsy (33%), visual/hearing impairments (10%), and speech defects, strabismus (50% incidence), cognitive dysfunction, and emotional/behavioral problems

Excluding and Including Conditions

Excludes progressive pathology and lesions of the spinal cord
Includes non-progressive genetic or congenital malformations

Classifications of Cerebral Palsy

Monoplegia: One limb affected (most often an arm)
Hemiplegia: Upper motor neuron lesion affecting one side of the body
Double Hemiplegia: Bilateral upper motor neuron lesion
Diplegia: Upper motor neuron lesion affecting all four limbs, but legs more affected than arms
Quadriplegia: Equal involvement of all four limbs
Paraplegia: Lower parts of the body affected

Functional Classifications (GMFCS)

CLASS 1: No limitation of activity
CLASS 2: Slight limitation
CLASS 3: Moderate limitation
CLASS 4: No useful physical activity

Early Signs of Cerebral Palsy

Birth History: Prematurity, seizures, intracranial hemorrhage, periventricular leukomalacia
Delayed Milestones: Difficulty achieving developmental milestones
Abnormal Motor Performance: Handedness, abnormal crawling (reptilian crawl), toe walking (spastic diplegia)
Altered Tone: Changes in muscle tone
Persistence of primitive reflexes: Asymmetrical tonic reflex
Abnormal posturing

Early Markers of Cerebral Palsy

Slow head growth
Poor head control
Eye: Roving eyes, poor hand regard, persistent squint
Ear: Lack of auditory response
Irritability, seizures, poor suck, poor quality of sleep
Extreme sensitivity to light
Scissoring of lower limbs
Toe walking
Abnormal tone
Stereotypic abnormal movements
Lack of alertness

Body Stiffness Patterns in Cerebral Palsy

Normal body movement
Floppy/Hypotonic body characteristics (child hangs in a 'U')
Stiffening/Spasticity
Various body postures and stiffening/spasms when prompted to stand

Athetoid or Dyskinetic Cerebral Palsy

Characterized by involuntary, slow, writhing movements, particularly in the hands and face

Ataxic Cerebral Palsy

Results from damage to the cerebellum, the brain's major center for balance
Characterized by unsteady walking and balance problems

Mixed Cerebral Palsy

Individuals have more than one type of CP

Incidence and Factors

Higher incidence of CP in low-birth-weight babies (2.5-4kg)
Prevalence higher in boys (58%)
Associated with the lowest socio-economic groups
Maternal age may be a risk factor

Assessment of Cognitive Disabilities

Mental retardation is the most common cognitive impairment in children with CP
Standard intelligence tests may give inaccurate results because of movement and communication deficits
Age-appropriate non-verbal intelligence tests must be used.

Assessment of Vision and Hearing

Hearing impairments may be associated with microcephaly and congenital heart disease
Sensorineural hearing loss due to iodine deficiency is common in endemic regions

Assessment of Speech and Language

Often due to hearing impairment or cognitive deficits
Difficulties in communication (verbal/non-verbal) further complicate behavior
Language difficulties and oral motor challenges, dysfunctions should be assessed

Comprehensive Multidisciplinary Assessment

Neuro-developmental pediatrician (team leader)
Physiotherapist
Occupational therapist
Clinical psychologist
Speech pathologist
Orthopedic surgeon
ENT
Ophthalmologist
Teacher
Play therapist
Social worker
Assessment ideally within a centralized location

Treatment of Cerebral Palsy

Cerebral palsy cannot be cured, but interventions can improve quality of life
Early intervention increases the success rate
Many children lead near normal adult lives with proper management
A comprehensive coordinated treatment plan is key
Involvement of various specialists/therapists is essential

Treatment and Caregivers

Treatment involves a multidisciplinary team, with physicians, surgeons, occupational and physical therapists
Occupational therapists are trained to provide advise on daily living activities such as feeding, bathing, and dressing

Speech Therapists

Speech therapists work to improve speech function
Therapists may use remedies, treatment, and counseling
Therapy can involve emotional wellbeing and cognitive evaluation of school placement

Prognosis of Cerebral Palsy

CP does not always cause profound disabilities
Some children with mild CP require very little or no support
Treatments, such as medications or surgery, may improve motor skills and communication

Conclusion and Considerations

Affected limbs can experience pain, heat, cold, and pressure sensations
Individuals with CP may not have verbal ability but can still communicate in other ways

Cerebral Palsy: Questions & Answers

Does cerebral palsy get worse over time? No. Cerebral palsy is not a progressive disorder; the brain damage occurs during pregnancy or childbirth and does not worsen over time. Effective treatment can improve symptoms.
Does CP affect everyone the same way? No. CP can manifest in many different forms and affects individuals differently depending on the specific cause and type of CP. Individuals may be categorized by the type of movement disorder and/or the number of limbs affected.

Motor Speech Disorders (MSD) Treatment

Focuses on re-learning motor aspects of speech production, requiring acquisition, retention and generalization
Acquisition: Temporary improvements during treatment
Retention: Lasting performance enhancements
Generalization: Improvement in related or targeted behaviors in varied contexts, tasks, or settings
Treatment targets use of complex tasks; avoiding nonspeech tasks (e.g., tongue movements), for treatment
Two treatment approaches: Primary strategies (improving the impaired subsystem) and Compensatory strategies (for the affected individual, environment, or communication partners)
Contextual assessment (e.g., speech production in multiple tasks and with different conversational partners) is important to assess generalization

Apraxia of Speech Diagnosis and Treatment

Diagnosis via formal speech testing includes repeating words or phrases of increasing length (love, loving, lovingly)
Treatment focuses on repetition, practice, and visual cues (e.g., mirror)
Characteristics: articulation errors, inconsistent errors, errors of placement, anticipatory errors, perseverative errors, metathetic errors, longer sequences causing more errors, voluntary speech affected more than automatic, slow rate, equal stress, and often mono-pitch
Treatment approaches may include spontaneous recovery, intensive one-on-one therapy, and use of alternative forms of communication (e.g., sign language, communication devices).

Treatment Approaches for Children with CAS

The treatment plan considers pre-practice considerations such as memory, attention, motivation, and goal setting
Treatment focuses on intensive repetitive drill, controlled sequencing of phonemes and ultimately functional speech.
Specific programs for treating more severe CAS include Restructuring Oral Muscular Phonetic Targets (PROMPT), and Melodic Intonation Therapy (MIT)
Mild cases may use the Rosenbek Hierarchy of Apraxia Drills 8-step continuum
General therapy tends to follow a sequential organization, progressing from simpler to more complex tasks (CV/VC combinations, CVC, syllable shapes, words, phrases, sentences, conversational speech)
General Principles: success in treatment requires a multi-modality approach: consideration of the child's experiences and any difficulties initially experienced or any dominant vowel errors; auditory discrimination is not important (treatment focuses on speech production, not auditory discrimination). Sounds should be approached using an order based on their increasing phonetic difficulty (vowels to affricates), first focusing on voiceless sounds and then progressing to voiced sounds. Training starts with sounds in the word-initial position; short breaks and repeated trials (to program muscle memory) are necessary; a core vocabulary of words is useful in initial treatment.
Specific Techniques:
Phonetic Placement
Shaping/Progressive Assimilation
Contrastive Stress Drills

Dysarthria

Signs: Slurred or mumbled speech, slow or fast speech, speaking softly, difficulty moving tongue, lips, and jaw, robotic or choppy speech, voice changes (e.g., hoarse, breathy, nasal), perceptual judgment
Treatment: Slowing speech rate, increasing breath support, strengthening mouth muscles, clear pronunciation practice, augmentation and alternative communication (AAC)
Important issue: SLP needs to collaborate with families and friends to help them communicate effectively with the patient. General Principles of Therapy: The focus and goals of therapy are determined by the specific affected subsystems and the underlying neurological damage. Goals focus on improving tone and strength (flaccid dysarthria), decreasing tone and increasing range of motion (spastic dysarthria), increasing range of motion and strength (hypokinetic dysarthria), and increasing control (hyperkinetic/ataxic dysarthria).

Respiration - Goals and Strategies

Establish correct breathing patterns
Increase vital capacity
Facilitate control of inhalation/exhalation
Improve strength and coordination of respiratory muscles
WHY: to provide breath support for speech production
STRATEGIES: Modify posture for some, including sitting, standing, or lying down for some overweight patients. Establish diaphragmatic breathing with hands on the diaphragm to feel breathing patterns. Exercise slow, deep breathing, and sustained phonation. Monitor breaths during connected speech.

Phonation - Goals and Lee Silverman Voice Therapy (LSVT)

Establish good coordination
Appropriate vocal onset
Control loudness
Comfortable pitch and inflection
Appropriate resonance
LSVT (Lee Silverman Voice Therapy) : Intensive behavioral treatment (at least 3-4 times per week) for other neurological disorders (initially for Parkinson's)
Concept 1: Increasing/improving VF adduction (think loud - think shout)
Concept 2: High effort (pushing speech effort - puts more load on larynx)
Concept 3: Extensive/intensive practice; maximizing daily increment of effort; maintain motivation and carry-over
Concept 4: Calibration (establishing right effort/results; patient feedback is needed to reach desired intensity)

Articulation

Increase power (force + speed)
Increase/decrease tone
Increased range of motion (ROM)
Improves speech coordination and accuracy
Increase co-articulatory coordination
Therapy approaches: Strengthening, ROM/reduce tone (stretches, massage of tongue, lips, and face), articulatory precision (over articulation exercises, speech drills to improve difficulty), pacing techniques, use of visual/auditory/tactile cues.

Intelligibility & Comprehensibility

Intelligibility within specific contexts (clinic, with spouse, with strangers, in noise, on phone)
Self-monitoring and clarification strategies
Approaches include pacing boards, overarticulation, increasing effort, modifications to environment (background noise), contextual cues, train listeners, nonverbal communication strategies, and augmentative devices

Pacing Boards

Aid in speech pacing for those with verbal apraxia, motor planning, dysarthria, cluttering, fluency, and articulation disorders (even autism and articulation processing differences)
Breaks down sentences into syllables for slow communication
Used with alphabet boards to increase listener understanding

Prosody

Goals: Improve emotive stress, linguistic stress, produce natural speech melody
Approaches: Pitch control, loudness control, imitation of stress patterns, production of specified stress patterns, question inflection, intra-word stress affecting meaning, and context/situational training

Tips for Patients with Communication Challenges

Speak one word or phrase before starting a sentence (provides context).
Speak slowly and loudly
Avoid speaking when fatigued
Use alternative methods such as pointing, writing, or drawing
Provide specific auditory/vocal cues (with reinforcement) to strengthen areas affected or affected speech processes

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Test your knowledge on the treatment approaches for Childhood Apraxia of Speech (CAS). This quiz covers initial treatment focuses, techniques for sound production, and strategies for effective therapy sessions. Ideal for speech-language pathologists and students in related fields.