Assessment and Therapy in Childhood Apraxia of Speech: A Review


Atila Çağlar N., Noyan Erbaş A.

Dil, Konuşma ve Yutma Araştırmaları Dergisi, vol.6, no.3, pp.380-405, 2023 (Peer-Reviewed Journal)

Abstract

Purpose Childhood apraxia of speech (CAS) is a neurological speech sound disorder not accompanied by neuromuscular deficits, characterized by disorders in the planning and/or programming of spatio-temporal parameters of movement sequences. Both congenital and acquired CAS can occur in association with known neurological events, as primary or secondary symptoms of complex neurobehavioral disorders, or as idiopathic neurogenic speech sound disorder. Many of the behaviors and symptoms associated with CAS are also found in children with other speech sound disorders, so differential diagnosis is very important. For the differential diagnosis of CAS, the features specified by ASHA (2007) (inconsistent vowel and consonant errors in repeated productions of syllables or words, inappropriate prosody and/or impaired and prolonged coarticulation transitions between sounds and syllables) and Strand's 10-item clinical checklist are frequently used. After the diagnosis of CAS, it is very important to choose the appropriate assessment and intervention methods for these children. This review aims to present speech and language assessment methods and evidence-based intervention methods applied to children with CAS. Method: In this study, the traditional review method was used. A literature review was conducted regarding speechlanguage assessment and intervention methods applied to children with CAS. Results: A comprehensive CAS assessment should include both formal assessments and informal tasks to accurately address the children's speech motor system. Assessment of a children with suspected CAS; include case history, oral examination, speech analysis, assessment of suprasegmental features, stress, rhythm, pauses, tone of voice, stimulability and cues, as well as language, literacy assessment. Formal tests that can be used in the assessment of CAS are Apraxia Profile, Dynamic Evaluation of Motor Speech Skill, Kaufman Speech Praxis Test, Verbal Motor Production Assessment for Children, Orofacial Praxis Test, Madison Speech Assessment Protocol. Since the age ranges and areas evaluated differ in each formal test, the speech and language therapist should take these factors into consideration when choosing appropriate assessment tools for children. After speech and language evaluations are completed, an individualized intensive intervention program is required for children. The starting point and progression of therapy are shaped depending on the assessment data received from the children. Speech and language therapy in children with CAS progresses systematically, in a hierarchical manner, becoming increasingly difficult. Therapeutic approaches used for children with CAS fall under three headings: motor-based approaches, linguistic-based approaches and multi-modal communication approaches. Evidence-based therapy methods for children with CAS in the field of speech and language therapy are Dynamic Temporal and Tactile Cueing, Rapid Syllable Transitions Therapy, Nuffield Dyspraxia Programme, Integrated Phonological Awareness Intervention. Conclusion: Speech and language therapists should have comprehensive knowledge and experience about different assessment and therapy methods used for children with CAS and choose the most appropriate therapy method for a child diagnosed with CAS.

Amaç: Çocukluk çağı konuşma apraksisi (ÇÇKA), hareket sıralamalarının uzamsal-zamansal parametrelerinin planlanması ve/veya programlanmasındaki bozukluklar ile karakterize nöromüsküler defisitlerin eşlik etmediği nörolojik bir konuşma sesi bozukluğudur. Bu derleme ile, ÇÇKA’ lı çocuklarda uygulanan dil ve konuşma değerlendirme yöntemlerini ve kanıta dayalı müdahale yöntemlerini sunmak amaçlanmaktadır.

Yöntem: Bu çalışmada geleneksel derleme yöntemi kullanılmıştır. ÇÇKA’ lı çocuklarda uygulanan dil-konuşma değerlendirme ve müdahale yöntemlerine ilişkin alan yazın taraması yapılmıştır.

Bulgular: ÇÇKA şüphesi olan bir çocuğun değerlendirmesi; vaka öyküsünü, oral muayeneyi, konuşma analizini, suprasegmental özellikleri, vurgu, ritim, duraklamalar, ses tonu, uyarılabilirlik ve ipuçlarının değerlendirilmesini ve ayrıca dil, okuryazarlık değerlendirmesini içermektedir. ÇÇKA değerlendirmesinde kullanılabilecek formal testler, Apraksi Profili (Apraxia Profile), Motor Konuşma Becerisinin Dinamik Değerlendirmesi (Dynamic Evaluation of Motor Speech Skill), Kaufman Konuşma Praksis Testi (Kaufman Speech Praxis Test), Çocuklar için Sözel Motor Üretim Değerlendirmesi (Verbal Motor Production Assessment for Children), Orofasiyal Praksis Testi (Orofacial Praxis Test), Madison Konuşma Değerlendirme Protokolü (Madison Speech Assessment Protocol) şeklindedir. Dil ve konuşma terapisi alanında ÇÇKA’ lı çocuklar için kanıta dayalı terapi yöntemleri ise, Dinamik Temporal ve Taktil İpucu (Dynamic Temporal and Tactile Cueing), Hızlı Hece Geçişleri Terapisi (Rapid Syllable Transitions Therapy), Nuffield Dispraksi Programı (The Nuffield Dyspraxia Programme), Entegre Fonolojik Farkındalık Müdahalesi (Integrated Phonological Awareness) şeklindedir.

Sonuç: Dil ve konuşma terapistlerinin, ÇÇKA’ lı çocuklarda uygulanan farklı değerlendirme ve terapi yöntemleri hakkında kapsamlı bilgi ve deneyime sahip olması ve ÇÇKA tanısı konan bir çocuk için en uygun terapi yöntemini seçmesi gerekmektedir.