Token‐to‐token variability in developmental apraxia of speech: three longitudinal case studies

Variability in the speech production patterns of children with developmental apraxia of speech (DAS) was investigated in a three‐year longitudinal study of three children with DAS. A metric was developed to measure token‐to‐token variability in repeated word productions from connected speech samples. Results suggest that high levels of total token and error token variability and low levels of word target stability and token accuracy characterize the disorder. Overall levels of variability and patterns of change over time differed between participants. Longitudinal patterns were indicative of decreasing total token variability and increasing token accuracy. However, change was not consistently unidirectional for two of the three children in the study, suggesting day‐to‐day performance differences in addition to within‐session variability.     

Implicit phoneme manipulation for the treatment of apraxia of speech and co‐occurring aphasia

Background: Apraxia of speech (AOS) is a disorder of expressive speech attributed to an impairment at the motor planning and programming phases of speech production. AOS is treated in different ways but the articulatory kinematic approach is usually followed. The intervention described in this study introduces a new approach toward treatment of AOS with aphasia through the use of implicit manipulation of phonemes via rhyming, deletion and alliteration tasks. Theoretical models propose that during lexical retrieval, associated areas responsible for motor planning and the preparation of the utterance are activated. In a similar way, our tasks require a phoneme manipulation that is hypothesised to activate motor planning. The repeated implicit practice of retrieving and internally monitoring sounds in various phonetic contexts may improve the efficiency of the transition between phonological plans and the initial phase of motor planning and the monitoring of that plan. Therefore, if AOS is due to a dysfunction of motor planning, an implicit intervention targeting this phase may improve speech production without the need for overt practice.

Methods and Procedures: This single‐subject multiple baseline intervention used implicit phoneme manipulation tasks in a subject with AOS and mild aphasia. The therapist‐designed computerised program required the subject to perform the implicit practice of rhyming, deletion, and alliteration of phonemes in three sound classes: /?/, /?/, and /s/ clusters in various phonetic contexts. Stimuli were presented on computerised templates requiring the subject to select the target among 3 foils. No overt speech was required however probe word repetitions were necessary to monitor treatment effects.

Outcomes and Results: The effect sizes for the trained words were: /?/ probes d = 4.46, /?/ probes d = 6.02, and /s/ clusters d = 2.54 which represents a small to medium effect for /?/ and /?/. T‐MAC results of 59/87 (68%) at pre‐testing improved to 75/87 (87%) at post‐test (z = 3.08, binomial p < .01, two‐tailed) which suggest generalisation to non‐treatment words. Patterns of change in three probe words over the course of treatment suggest an improvement in speech production. Distortions, disturbed prosody and phonological errors were resolved in these probes by the maintenance session as judged by 5 SLPs.

Conclusions: We conclude that in this participant (1) implicit phoneme manipulation training improved overt speech production; (2) accuracy of trained words, specifically a reduction in sound distortions, phonological errors and improved prosody, were the result of this treatment; and (3) a significant generalisation to non‐treatment words was the result of the intervention.     

The vowel lengthening exaggeration effect in speakers with apraxia of speech: Compensation,artifact, or primary deficit?

Abstract

Vowel duration functions contrastively in English to signal the voicing feature of syllable-final stop consonants. This study examines three hypotheses posited to explain why speakers with apraxia of speech and a concomitant aphasia exhibit an exaggerated vowel lengthening effect relative to speakers with dysarthria, aphasia without apraxia and controls. The investigation addresses the hypotheses that the vowel lengthening exaggeration effect is attributable to: (1) a compensatory strategy, (2) an artifact of slow speaking rate, (3) the concomitant language impairment, or (4) a primary deficit reflecting the underlying nature of the apraxia disorder. The results do not support the first three of these hypotheses. It is hypothesized that the temporal measures most likely to reveal abnormalities which are uniquely characteristic of speakers with apraxia of speech are those which are relational in nature, either with respect to inter-articulator timing or contrastive durations.     

Learning a syllable from its parts: Cross‐syllabic generalisation effects in patients with apraxia of speech

Background: The impairment underlying apraxia of speech (AOS) is usually attributed to the phonetic encoding stage of the speech production process, where speech motor programs are accessed (e.g., Code, 1998 Code, C. 1998. Major review: Models, theories and heuristics in apraxia of speech.. Clinical Linguistics and Phonetics, 12: 47–65. [Crossref], [Web of Science ®] , [Google Scholar]). At this processing stage, Levelt, Roelofs, and Meyer (1999 Levelt, W. J. M., Roelofs, A. and Meyer, A. S. 1999. A theory of lexical access in speech production.. Behavioral and Brain Sciences, 22: 1–75. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) postulate a store of motor patterns for frequently used syllables (“syllabary”). These syllable gestures are assumed to be holistically represented. However, the fact that syllable structure influences the error mechanism of AOS is in conflict with the assumption of holistic syllable gestures.

Aims: This study examined the assumption of holistic syllable‐sized motor programs in apraxia of speech by a learning paradigm. We investigated if training of phonologically simple syllables, which were derived from more complex target syllables, showed a generalisation effect on these target syllables. If the assumption of holistic syllable programs is appropriate, no generalisation effects are expected.

Methods & Procedures: A learning experiment was conducted with four patients with AOS. For each of 24 complex target syllables a set of 15 training syllables was derived by deleting one or two of the onset and/or coda consonants or by assimilating consonantal features. The learning trials comprised repetitions of the training syllables, block‐wise for each target syllable. To assess generalisation effects, segmental errors and disfluencies were counted and syllable durations were measured before and immediately after training, for the target syllables as well as for matched control syllables.

Outcomes & Results: In the patients as a group, the training resulted in significant and specific improvements on the complex target syllables. The strongest effect was found in RK, a patient with pure AOS. This patient additionally exhibited a significant reduction of target but not of control syllable durations.

Conclusions: In this learning study, patients with apraxia of speech showed specific generalisation effects from phonologically simple syllables to more complex syllables. These effects cannot be explained by the assumption of holistically stored syllable programs (Levelt et al., 1999 Levelt, W. J. M., Roelofs, A. and Meyer, A. S. 1999. A theory of lexical access in speech production.. Behavioral and Brain Sciences, 22: 1–75. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). In contrast, the results suggest that syllabic motor programs comprise an internal phonological structure.     

Timing errors in two children with suspected childhood apraxia of speech (sCAS) during speech and music‐related tasks

Impaired speech prosody has been identified as a critical feature of suspected childhood apraxia of speech (sCAS). Lexical stress productions of children with sCAS have been characterized as ‘excessive/equal/misplaced’. This investigation examines two potential explanations of this particular deficit, articulatory difficulty and impaired intrinsic timing. Two children with a diagnosis of sCAS (ages 4 years, 3 months and 9 years, 5 months) and two age‐matched controls were observed during three speech and three music tasks. Acoustic analysis revealed that in all tasks, the performance of the controls was more accurate than that of the children with sCAS. Timing structures and accuracy are discussed with respect to diagnostic status, age, speech and music tasks, and timing unit size.     

The co‐development of speech and gesture in children with autism

Recent interest in gesture has led to an understanding of the development of gesture and speech in typically developing young children. Research suggests that initially gesture and speech form two independent systems which combine together temporally and semantically before children enter the two‐word period of language development. However, little is known about gesture development in children's disordered speech. This paper presents two case studies of young children with autism. The children are under 3 years of age and attend an intervention programme to facilitate their social and communication development. Early indications suggest that whilst both gesture and speech development is delayed in children with Autistic Spectrum Disorders (ASD), the developmental trajectory is the same as for typically developing children.     

A follow-up case study of transitory developmental apraxia of speech: 'L'enfant à voyelles'

It is well known that the acquisition of consonants can be a more difficult developmental process than of vowels. In this study the authors describe a case of 'transitory developmental apraxia of speech' (TDAS) in which a French-speaking child, although he acquired the whole vowel system, showed a significant delay in consonant acquisition and usage. The results of systematic observations and assessments of general cognitive and specific language functioning cover a period of 4 years (age 3:8 to 7:1l), from first clinical assessment to evidence of a good academic achievement. It is argued that this case demonstrates an unusual example of TDAS. The language deficits observed could not be attributed to oromotor, neurological, cognitive or intellectual deficits. The findings here also raise crucial questions concerning the origins of such a speech disorder and why it is transient in nature.     

Models of phonology in the education of speech‐language pathologists

We discuss developments in theoretical phonology and, in particular, at the divide between theories aiming to be adequate accounts of the data, as opposed to those claiming psycholinguistic validity. It would seem that the latter might have greater utility for thye speech‐language pathologist. However, we need to know the dominant models of clinical phonology, in both clinical education and practise, before we can promote other theoretical approaches. This article describes preliminary results from a questionnaire designed to discover what models of phonology are taught in institutions training speech‐language pathologists in the United States. Results support anecdotal evidence that only a limited number of approaches (phonemic, distinctive features, and processes) are taught in many instances. They also demonstrate that some correspondents were unable to distinguish aspects of theoretical phonology from similar sounding (but radically different) models of intervention. This ties in with the results showing that some instructors of phonology courses have little or no background in the subject.     

Non‐pulmonic‐egressive speech in clinical data: A brief review

This review examines the literature on the use of non‐pulmonic egressive sounds in disordered speech. Studies are described that report the use of pulmonic ingressive speech, clicks, ejectives, and implosives. Broad trends are identified linking the use of each type of non‐pulmonic‐egressive airstream use with particular disorders. The importance of including these airstream types in both phonetic theory and practice classes in the training of speech‐language pathologists is stressed.     

Opportunities to say ‘yes’: Rare speech automatisms in a case of progressive nonfluent aphasia and apraxia

We describe the investigation of speech automatisms in a man with progressive nonfluent aphasia and apraxias. Occurrence of the automatisms yes and right, were analysed across a range of speech tasks varying in length, propositionality, lexical and articulatory complexity, whether tasks engaged internal generation or external triggering and articulatory distortions, and while completing pantomimes/gestures. No differences were found in occurrence across most tasks but there was a significant interaction between automatism production and apraxic speech errors and during limb praxic tasks, suggesting that production of the automatism was unrelated to linguistic or lexical variables, but was related to the presence of speech apraxia coupled with disinhibition.     

The influence of visual and auditory information on the perception of speech and non‐speech oral movements in patients with left hemisphere lesions

Patients with lesions of the left hemisphere often suffer from oral‐facial apraxia, apraxia of speech, and aphasia. In these patients, visual features often play a critical role in speech and language therapy, when pictured lip shapes or the therapist's visible mouth movements are used to facilitate speech production and articulation. This demands audiovisual processing both in speech and language treatment and in the diagnosis of oral‐facial apraxia. The purpose of this study was to investigate differences in audiovisual perception of speech as compared to non‐speech oral gestures. Bimodal and unimodal speech and non‐speech items were used and additionally discordant stimuli constructed, which were presented for imitation. This study examined a group of healthy volunteers and a group of patients with lesions of the left hemisphere. Patients made substantially more errors than controls, but the factors influencing imitation accuracy were more or less the same in both groups. Error analyses in both groups suggested different types of representations for speech as compared to the non‐speech domain, with speech having a stronger weight on the auditory modality and non‐speech processing on the visual modality. Additionally, this study was able to show that the McGurk effect is not limited to speech.     

Sensorimotor dysfunction of grasping in schizophrenia: a side effect of antipsychotic treatment?

BACKGROUND: Antipsychotic treatment in schizophrenia is frequently associated with extrapyramidal side effects. Objective behavioural measures to evaluate the severity of extrapyramidal side effects in the clinical setting do not exist. OBJECTIVES: This study was designed to investigate grasping movements in five drug naive and 13 medicated subjects with schizophrenia and to compare their performance with that of 18 healthy control subjects. Deficits of grip force performance were correlated with clinical scores of both parkinson-like motor disability and psychiatric symptom severity METHODS: Participants performed vertical arm movements with a handheld instrumented object and caught a weight that was dropped into a handheld cup either expectedly from the opposite hand or unexpectedly from the experimenter's hand. The scaling of grip force and the temporospatial coupling between grip and load force profiles was analysed. The psychiatric symptom severity was assessed by the positive and negative symptom score of schizophrenia and the brief psychiatric rating scale. Extrapyramidal symptoms were assessed by the unified Parkinson's disease rating scale. RESULTS: Drug naive subjects with schizophrenia performed similar to healthy controls. In contrast, medicated subjects with schizophrenia exhibited excessive grip force scaling and impaired coupling between grip and load force profiles. These performance deficits were strongly correlated with the severity of both extrapyramidal side effects related to antipsychotic therapy and negative symptoms related to the underlying pathology. CONCLUSIONS: These data provide preliminary evidence that deficits of sensorimotor performance in schizophrenia are, at least in part, related to the side effects of antipsychotic treatment. The investigation of grasping movements may provide a sensitive measure to objectively evaluate extrapyramidal side effects related to antipsychotic therapy.     

APOE ε4 influences β-amyloid deposition in primary progressive aphasia and speech apraxia

BackgroundApolipoprotein E ε4 (APOE ε4) is a risk factor for β-amyloid deposition in Alzheimer's disease dementia. Its influence on β-amyloid deposition in speech and language disorders, including primary progressive aphasia (PPA), is unclear.MethodsOne hundred thirty subjects with PPA or progressive speech apraxia underwent APOE genotyping and Pittsburgh compound B (PiB) PET scanning. The relationship between APOE ε4 and PiB status, as well as severity and regional distribution of PiB, was assessed.ResultsForty-five subjects had an APOE ε4 allele and 60 subjects were PiB-positive. The odds ratio for a subject with APOE ε4 being PiB-positive compared with a subject without APOE ε4 being PiB-positive was 10.2 (95% confidence interval, 4.4–25.5; P < .0001). The APOE ε4 allele did not influence regional PiB distribution or severity.ConclusionAPOE ε4 increases the risk of β-amyloid deposition in PPA and progressive speech apraxia but does not influence regional β-amyloid distribution or severity.     

Abnormal patterns of tongue‐palate contact in the speech of individuals with cleft palate

Individuals with cleft palate, even those with adequate velopharyngeal function, are at high risk for disordered lingual articulation. This article attempts to summarize current knowledge of abnormal tongue‐palate contact patterns derived from electropalatographic (EPG) data in speakers with cleft palate. These data, which have been reported in 23 articles published over the past 20 years, have added significantly to our knowledge about cleft palate speech. Eight abnormal patterns of tongue‐palate contact are described and illustrated with data from children and adults with repaired cleft palate. The paper also discusses some of the problems in interpreting EPG data from speakers with abnormal craniofacial anatomy and emphasizes the importance of quantifying relevant aspects of tongue‐palate contact data. Areas of research requiring further investigation are outlined.     

The value of therapeutic communities in the treatment of personality disorder: a suitable place for treatment?

In the United Kingdom, a government program investigating the links between offending and personality disorder has stimulated renewed interest in the treatment of personality disorders. One psychosocial treatment option for patients with personality disorders is the therapeutic community (TC). In 2000, the authors conducted a small qualitative study with a sample of psychiatrists which suggested that TCs were not well understood and that the status of evidence on efficacy might be partly responsible for low referral numbers. This article reviews the evidence for the efficacy and cost-effectiveness of TCs as a treatment for personality disorders and considers which types of disorders are amenable to TC treatment. We conclude that there is a strong case for more rigorous evaluation and that some of the difficulties anticipated in applying randomized clinical trial (RCT) methodology to the study of TCs could be overcome.     

Modifications of apoptosis-related protein levels in lymphocytes of patients with Parkinson’s disease. The effect of dopaminergic treatment

Summary. In this study, we investigated whether changes in the regulatory mechanisms of apoptosis and oxidative stress may be detected, peripherally, in patients with Parkinsons disease (PD). For this purpose, we measured caspase-3 activity, Bcl-2 concentrations, peripheral benzodiazepine receptor (PBR) expression and Cu/Zn superoxide dismutase (SOD) concentrations in lymphocytes of untreated PD patients, patients treated only with L-Dopa or with L-Dopa and dopamine agonists and healthy volunteers. Caspase-3 activity was significantly increased in all PD patient groups. Patients treated with L-Dopa and dopamine agonists showed the lowest values of Bcl-2, coupled with the highest density of PBRs, while increased levels of Cu/Zn SOD were found in the group under monotherapy with L-Dopa. We also found, in PD patients, clear, negative correlations between Bcl-2 levels and both duration and severity of the disease. Our findings point to the existence of changes in the regulatory mechanisms of apoptosis in PD patients – observable outside the central nervous system – which seem to be modulated by the pharmacological treatment with dopaminergic agents.     

The use of hypothermia: a role in the treatment of neonatal asphyxia?

Perinatal asphyxia remains one of the most devastating neurologic processes. Although the understanding of the pathophysiology after perinatal asphyxia is extensive, there are few therapeutic interventions available to prevent or even mitigate the devastating process that unfolds after injury. The search for a safe and efficacious therapy has prompted scientists and clinicians to consider various promising therapies. One such therapy is therapeutic hypothermia. On the basis of adult, pediatric, and animal research, there is increasing evidence to suggest that therapeutic hypothermia may be an effective intervention to lessen the secondary neuronal injury that ensues after a hypoxic-ischemic insult. In this article the historic and modern-day uses of therapeutic hypothermia are first reviewed. The pathophysiology of neonatal asphyxia is examined next, with emphasis on the changes that occur when therapeutic hypothermia is implemented. Potential side-effects of the therapy in the neonate and the debate over systemic vs selective hypothermia are discussed. Lastly, although hypothermia as a potential treatment modality for neonates with hypoxic-ischemic encephalopathy is supported by numerous studies, the need for well-designed multicenter trials with detailed patient entry criteria and therapeutic conditions is emphasized.     

The effect of neuroleptic treatment and of high dosage diazepam therapy onβ-endorphin immunoreactivity in plasma of schizophrenic patients

Summary Synapsin I (Protein I), a neuron-specific phosphoprotein enriched in presynaptic nerve terminals, has been used as a quantitative marker for the density of nerve terminals in five brain regions (caudate nucleus, cingulate gyrus, hippocampus, mesencephalon and putamen) from patients who had suffered from Alzheimer disease/senile dementia of Alzheimer type (AD/ SDAT), from patients with multi-infarct dementia (MID), and from agematched controls. Samples were obtained at autopsy. Lower levels of Synapsin I were observed in the hippocampus of patients with AD/SDAT but not with MID. There were no significant differences in Synapsin I levels between patients and controls in any of the other four brain regions examined.