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Questions and Answers
Which of the following indicators could suggest motor involvement in a child?
In the context of a Motor Speech Examination, which technique is used for assessing speed and coordination?
Which structural-functional examination movement parameters focus on the muscular ability to vary tension?
Which of the following is most likely associated with childhood apraxia of speech (CAS)?
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What assessment method can be used to determine a child's phonetic repertoire?
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How are items organized in the Kaufman Speech Praxis Test for Children?
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What type of format does the Kaufman Speech Praxis Test for Children utilize?
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Which of the following best describes apraxia?
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What is NOT a characteristic of motor sequencing?
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Which aspect is NOT considered a component of apraxia?
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Childhood apraxia of speech primarily affects which of the following areas?
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Which type of apraxia affects the ability to produce speech through muscle positioning and sequencing?
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Oral apraxia allows a person to volitionally protrude the tongue and smack the lips with ease.
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Verbal apraxia primarily affects motor programming necessary for speech production.
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Spatial-temporal coordination is unimportant for fluent adult-rate speech-language production.
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Limb apraxia is associated with volitional movements of the facial muscles.
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Apraxia can be attributed to basic impairments in strength and coordination.
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Oral apraxia affects a person's ability to perform volitional movements of the tongue and lips.
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Motor sequencing refers to the random ordering of gestures that constitute a motor plan.
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Verbal apraxia is characterized by difficulty in the positioning and sequencing of muscles for speech production.
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Spatial-temporal coordination does not play a significant role in the development of speech-motor control.
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Match the following characteristics of Childhood Apraxia of Speech (CAS) with their descriptions:
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Match the specific symptoms associated with Childhood Apraxia of Speech (CAS) with their implications:
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Match the age indicators of Childhood Apraxia of Speech (CAS) with their implications:
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Match the following features of CAS with their definitions:
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Match the terminologies with their corresponding descriptions related to speech disorders:
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Match the characteristics of Childhood Apraxia of Speech (CAS) with their descriptions:
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Match the known etiologies of Childhood Apraxia of Speech (CAS) with their explanations:
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Match the assessment tools for Apraxia of Speech (AOS) with their descriptions:
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Match the components of a diagnostic battery for AOS with their focus:
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Match the tasks related to apraxia with the characteristics they assess:
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Study Notes
Neuromuscular Status
- Focus on overall physical and neuromuscular status to develop hypotheses regarding the child's speech motor system.
- Not intended for medical diagnosis.
- Indicators of motor involvement include:
- Clumsy gait.
- Muscle mass asymmetry.
- Low tone leading to open mouth posture, droopy eyes, and facial muscle dysfunction.
- Adventitious movements.
- Variations in strength and coordination in non-speech movement patterns.
- Medical reports of pathological reflexes associated with dysarthria.
Diagnostic Battery
- Structural-Functional Examination assesses five movement parameters:
- Range of motion.
- Speed.
- Strength.
- Ability to vary muscular tension.
- Coordination.
Motor Speech Examination
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Involves connected speech samples:
- Conversation.
- Picture description.
- Narrative.
-
Diadochokinesis measures:
- Alternating Motion Rates (AMR).
- Sequential Motion Rates (SMR).
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Hierarchical utterance tasks include:
- Vowels in isolation (e.g., /i, o, ai/).
- Consonant-vowel (CV) and vowel-consonant (VC) combinations.
- Consonant-vowel-consonant (CVC) combinations.
- Words with matching initial and final sounds (e.g., mom, pop).
- Words with different initial and final sounds (e.g., pad, cat).
- Increasing word lengths (e.g., come, computer).
- Multisyllabic word and phrase repetition.
- Sentences of increasing length (e.g., I want more milk).
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Kaufman’s hierarchy may employ various levels of support:
- Direct imitation.
- Modeling with visual/auditory cues.
- Tactile/gestural cues.
- Phonetic placement cues.
Sound System Description
- Independent analysis includes phonetic repertoire and syllable/word shapes.
- Relational analysis differentiates developmental and non-developmental processes.
- Developmental processes are common in typical development and most speech disorders.
- Non-developmental processes are rare and include issues like favorite sound usage and vowel errors.
- Degraded performance across trials is indicative of further testing for developmental apraxia of speech.
- Key areas of focus: prosody, verbal sequencing, and articulation.
Kaufman Speech Praxis Test for Children (KSPT)
- Developed by Nancy R. Kaufman for ages 2:0 to 5:11.
- Takes 5-15 minutes to administer based on disorder severity.
- Norm-referenced, providing standard scores and percentiles.
- Assists in diagnosing and treating developmental apraxia of speech.
- Identifies breakdown levels in speech production to guide treatment.
- Test administration is straightforward, measuring imitative responses and locating speech system breakdowns.
Sound System Analysis
- Consistency across word production should be analyzed in repetitions of spontaneous and imitated tokens.
- Children without developmental apraxia of speech (DAS) typically improve in trials, while those with DAS often show performance degradation.
- Prosody issues in children with childhood apraxia of speech (CAS) include:
- Excessive or misplaced stress.
- Omission of weak syllables.
Apraxia Profile
- Created by Lori A. Hickman for assessing developmental verbal apraxia.
- Administered over 25-35 minutes for children ages 3 to 13.
- Aids in differential diagnosis of developmental verbal apraxia and identifies oral apraxia.
- Documents child's oral-motor sequencing deficits and achievements to inform parents and professionals.
STDAS-2: Screening Test for Developmental Apraxia of Speech – Second Edition
- Identifies children aged 4 to 12 with atypical speech-language issues and oral performance.
- Includes four subtests to assess expressive language discrepancies by comparing expressive and receptive language age.
Praxis and Apraxia
- Praxis: The ability to generate voluntary movement patterns essential for actions, involving selection, planning, organization, and initiation of motor patterns.
- Apraxia: A disorder in executing or learning complex movements, not due to issues with strength, coordination, sensation, or attention.
Types of Apraxia
- Limb Apraxia: Difficulty with voluntary movements of arms and legs.
- Oral Apraxia: Inability to perform oral-facial movements on command, such as tongue protrusion or lip smacking.
- Verbal Apraxia: Difficulty in motor programming required for speech production, including positioning and sequencing muscles for phoneme production.
Childhood Apraxia of Speech (CAS)
- CAS refers to difficulty in motor programming for speech, previously known as developmental apraxia of speech or developmental verbal dyspraxia.
- Early signs include limited babbling, first words emerging after 18 months, and reliance on pointing or grunting for communication.
Early Signs and Symptoms of CAS
- Difficulty producing a variety of consonants and vowels, often limited to a few sounds.
- Greater clarity in imitating sounds in isolation than when combining phonemes.
- Increased errors with longer phrases and difficulty articulating beyond one word.
- Use of a single word or sound to convey multiple meanings.
- Presence of verbal preservation and groping for articulatory positions.
Key Characteristics of CAS
- Limited vowel repertoire and more vowel production errors compared to typically developing peers.
- Variability in speech errors, which tend to worsen with increased utterance complexity.
- Difficulty initiating speech in a voluntary manner compared to automatic speech.
- Impaired diadochokinetic tasks (rapid, alternating movements of speech organs) suggest motor planning deficits.
Etiology of CAS
- Influenced by genetic factors such as FOXP2 gene, prenatal issues, variability in neurological development, and existing neurological disorders.
Assessment of CAS
- Standardized tests include:
- Verbal Motor Production Assessment for Children (VMPAC)
- The Apraxia Profile
- STDAS–2: Screening Test for Developmental Apraxia of Speech
- Kaufman Speech Praxis Test for Children.
Diagnostic Battery Components
- Comprehensive assessments involve medical and developmental history, neuromuscular status, structural-functional examination, and motor speech evaluation.
- Measures gauge consistency in word production and prosody comparison, documenting intelligibility and phonological analysis.
The Apraxia Profile
- Assists in identifying developmental verbal apraxia and tracking a child's oral-motor progress over time for ages 3 to 13 years.
STDAS-2 Overview
- Targeted at children aged 4 to 12, identifying atypical speech-language issues linked with oral performance. Key factors include expressive-receptive language discrepancies, prosody, verbal sequencing, and articulation assessments.
Kaufman Speech Praxis Test Highlights
- Suitable for ages 2 to 5, the test differentiates levels of breakdown in speech abilities, using a straightforward and structured approach to track treatment effectiveness and improvement.
Praxis - Definition
- Praxis involves the ability to generate voluntary movement patterns for actions.
- Essential for selecting, planning, organizing, and initiating motor patterns.
- Critical for fluent speech development, especially between ages 0-6.
- Speech-motor control execution speed increases gradually from ages 3-11.
- Segment duration adapts to the linguistic content of utterances.
Motor Sequencing
- Involves ordering individual gestures in a motor plan and coordinating them.
- Requires determining the sequence and the method of transitions between elements.
Apraxia Overview
- Defined as difficulty in executing complex movements without elementary disturbances.
- Categories of impairment include:
- Volitional movement
- Spatial-temporal coordination
- Motor sequencing
Types of Apraxia
- A person may exhibit multiple types of apraxia simultaneously.
- Major types include:
- Limb Apraxia: Involves voluntary movement of arms and legs.
- Oral Apraxia: Difficulty in performing oral movements like tongue protrusion.
- Verbal Apraxia: Challenges in motor programming for speech production.
Childhood Apraxia of Speech (CAS)
- Preferred term for developmental apraxia of speech.
- Early signs may include:
- Limited or absent babbling in infancy.
- First words missing or replaced by gestures.
- Groping movements when trying to speak.
- Delayed vocabulary development, with significant consonant restrictions.
- Simplification or substitution of phonemes in speech.
Symptoms of CAS
- Words articulated well in isolation, but combining them is challenging.
- Higher comprehension than expressive language ability.
- Persistence in using single words to convey multiple meanings.
- Verbal preservation: repeating or getting stuck on previous utterances.
Neuromuscular Status
- Assessment looks at overall physical/neuromuscular condition for speech motor hypothesis.
- Key indicators include:
- Gait clumsiness
- Muscle asymmetry or low tone
- Unusual strength and coordination in movement.
Diagnostic Battery
- Involves a structural-functional examination focused on:
- Range of motion
- Speed
- Strength
- Coordination
Motor Speech Examination
- Assesses connected speech samples, diadochokinesis, and utterance hierarchies.
- Uses various imitative tasks for vowels and consonant-vowel combinations.
- Includes repetition tasks of words and sentences with increasing complexity.
Sound System Description
- Involves independent and relational analysis of phonetic repertoire and error patterns.
- Children with CAS may show more persistent developmental patterns.
- Focus on consistency of word production across trials.
Intelligibility and Prosody
- Prosody in CAS may include misplaced stress or omission of weak syllables.
- Intelligibility is measured using rating scales to assess speech clarity.
Assessment Tools
- The Apraxia Profile: Used to diagnose developmental verbal apraxia; evaluates progress over time.
- STDAS-2: Screens for developmental apraxia in children aged 4-12, focused on language discrepancy and oral performance.
- Kaufman Speech Praxis Test for Children: Norm-referenced tool assessing developmental apraxia; identifies breakdowns in speech ability and guides treatment.
Praxis Definition
- Praxis involves generating voluntary movement patterns, critical for executing specific actions.
- It includes the ability to select, plan, organize, and initiate motor patterns as foundational elements.
Spatial-Temporal Coordination
- Essential for fluent, adult-rate speech-language production, particularly during the first six years of life.
- Execution speed of motor programs gradually increases from ages 3 to 11.
- Segment durations adapt based on the linguistic content of utterances.
Motor Sequencing
- Requires ordering individual gestures that constitute a motor plan and their coordination.
- Involves determining the sequence of elements and transitions between gestures.
Understanding Apraxia
- Characterized by difficulty in executing complex movements that cannot be attributed to basic strength, coordination, or comprehension issues.
- Involves disorders of volitional movement, spatial-temporal coordination, motor sequencing, and accommodation to context.
Types of Apraxia
- Includes limb apraxia (volitional movements of arms and legs), oral apraxia (difficulty with facial movements like tongue protrusion), and verbal apraxia (motor programming disorder for speech).
Terminology
- Preferred term for this disorder is Childhood Apraxia of Speech (CAS).
- Other terms include Developmental Apraxia of Speech and Developmental Verbal Dyspraxia.
Early Signs & Symptoms of CAS
- Limited or no babbling as an infant, often lacking consonants.
- First words may be absent, with grunting or pointing as communication.
- Difficulty performing oral movements on command despite being able to eat normally.
- Delayed first word approximations (after 18 months) and lack of simple vocabulary by age 2.
- Groping or scanning in speech attempts, and limited consonant use.
Characteristics of CAS
- Vowel repertoire is limited with errors in production; variability in errors noted.
- Errors escalate with longer or complex utterances.
- Struggle with self-initiated speech versus over-learned phrases.
- Observations of groping or difficulty achieving articulatory positions may occur.
Etiologies of CAS
- Genetic factors (e.g., FOXP2 gene), prenatal complications, differences in myelination, neurological disorders, and developmental delays.
Assessment of Apraxia
- Utilizes standardized tests like Verbal Motor Production Assessment for Children (VMPAC), The Apraxia Profile, STDAS-2, and Kaufman Speech Praxis Test.
- Comprehensive diagnostic battery includes medical and developmental histories and assessment of communication and motor skills.
Diagnostic Measures
- Assessment Link Between Phonology and Articulation-Revised and Khan-Lewis Phonological Analysis assist in evaluating sound system and phonological patterns.
- Intelligibility rates and the consistency of word production are key metrics for diagnosing CAS.
The Apraxia Profile
- Developed by Lori A. Hickman, this tool identifies developmental verbal apraxia and tracks progress.
- Suitable for children aged 3 to 13, aiding in diagnosing and documenting oral-motor sequencing issues.
STDAS-2 Screening Test
- Screens children aged 4 to 12 for atypical speech-language problems and related oral performance.
- Consists of subtests focusing on expressive language discrepancies and articulation.
Kaufman Speech Praxis Test
- Designed for preschool children (aged 2 to 5) to assess and diagnose apraxia.
- Facilitates tracking of treatment progress and identifies breakdowns in speech production.
- Items progress from simple to complex movements with a focus on meaningful speech for assessment.
Terminology
- Preferred terminology for the disorder is Childhood Apraxia of Speech (CAS).
- Other terms include Developmental Apraxia of Speech and Developmental Verbal Dyspraxia.
Early Signs & Symptoms of CAS
- Limited babbling in infancy, lacking diverse consonants.
- First words may be absent; communication may include pointing and grunting.
- Motor control of the mouth (opening, closing) is present, but not when directed.
- First word approximations may occur past 18 months; no development of vocabulary by age 2.
- Oral groping may occur; children may continuously grunt and point beyond age 2.
- Children may have a very limited consonant repertoire (e.g., /b, m, p, t, d, h/).
- Phonemes can be imitated in isolation, but combining them is difficult.
- Simplifications in words may involve deleting or replacing sounds.
- Receptive language abilities may surpass expressive language abilities.
- Single words may serve multiple meanings beyond age 2.
- Verbal preservation indicates getting "stuck" on previously uttered words.
- Difficulty in purposeful tongue movements may be observed; “pop-outs” may occur.
Key Characteristics of CAS
- Children may exhibit a reduced vowel repertoire and difficulty differentiating vowel productions.
- Variability and increased errors in longer or more complex utterances are common.
- More challenges seen in self-initiated speech compared to automatic speech.
- Observable stress or struggle for articulatory accuracy may be present.
- Diadochokinetic tasks (AMR & SMR) may show impaired rate and accuracy.
- Children may struggle with non-speech movements, indicating possible oral apraxia.
Etiologies of CAS
- Genetic influences, including variants like FOXP2.
- Prenatal issues and differences in brain myelination.
- Neurological disorders and developmental delays may pertain.
Assessment of CAS
- Standardized tests for assessing CAS include:
- Verbal Motor Production Assessment for Children (VMPAC)
- The Apraxia Profile
- STDAS-2: Screening Test for Developmental Apraxia of Speech
- Kaufman Speech Praxis Test for Children.
Diagnostic Battery Components
- Comprehensive assessment includes a medical history, developmental history, and psychosocial skills assessment.
- Neuromuscular status includes evaluation of physical and motor capabilities.
- Structural-functional examinations assess movement parameters like range, speed, and coordination.
- Motor speech examinations involve connected speech samples and diadochokinesis tasks.
Sound System Description
- Independent analysis of phonetic repertoire and word shapes is critical.
- Relational analysis identifies developmental and non-developmental processing patterns.
- Consistency in word production across trials is assessed to distinguish CAS.
- Prosodic characteristics may show excessive or misplaced stress patterns.
Apraxia Profile
- Developed for ages 3 to 13 years to identify and document developmental verbal apraxia.
- Allows tracking of a child's oral-motor sequencing capabilities and difficulties.
STDAS-2 Overview
- Identifies children aged 4 to 12 with atypical speech-language issues.
- Includes essential subtests: Expressive Language Discrepancy, Prosody, Verbal Sequencing, and Articulation.
Kaufman Speech Praxis Test for Children
- Target age range: 2 to 5 years, with administration time of 5-15 minutes.
- Norm-referenced for developmental apraxia assessment, focusing on breakdowns in speech production.
- Organized from simple to complex motor movements, facilitating treatment and tracking progress.
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Description
This quiz focuses on understanding the neuromuscular status of children, examining various indicators such as clumsy gait and asymmetry in muscle mass. Explore the implications of these indicators on a child's speech motor system. It is essential to differentiate between observations for hypothesis development and formal medical diagnoses.
