 | | | | | | | | | | | | | | | This is an exciting newsletter for the staff at www.aphasiatoolbox.com as we are introducing our new, innovative program for treating acquired apraxia that utilizes motor reconnect principles (MRP). These MRP take advantage of the powerful potential of brain plasticity. We are experiencing excellent success using these motor reconnect principles to help our clients speak and converse again, even those with severe speech impairments related to apraxia. | | Traditionally, speech pathologists have used motor learning principles (MLP) in working with apraxia of speech due to stroke or brain injury. We do know that these principles play a key role in the successful treatment of childhood apraxia of speech (CAS) in children who have not acquired the motor speech skill necessary for speaking ( McGlothlin, 2011, Strand, 2005. While MLP provide valuable guidance and information, it may well, however, be a misguided interpretation to strictly apply MLP to clients with acquired apraxia. It is important to remember that MLP have emerged from studies that involved, “…nonspeech motor tasks largely performed by individuals with intact motor systems.” ( Mass, et al, 2008). The literature on how motor learning principles apply to impaired motor systems is unsettled at this time. This raises a number of issues related to using motor learning principles to drive treatment for acquired apraxia: - First it is unknown whether speech motor control is sensitive to the same principles as nonspeech motor control. In other words, should we teach people to use rapid, rhythmic movements of the articulators in spoken syllables in the same manner as teaching them to juggle 3 balls? Do the same learning principles apply?
- Secondly, we have not defined clearly how the principles of motor learning affect speech versus nonspeech learning. Is it safe to assume that MLP apply equally to speech and nonspeech treatment?
- Thirdly, if clients do already know how to talk, shouldn’t we be taking advantage of neuroplasticity by utilizing activities that facilitate reconnection of the established, albeit damaged, neural pathways?
- Since, “…motor control impairment of AOS extends beyond speech and is manifest in nonspeech movements of the oral structures.” (Ballard, 2000) and the vocal folds, separation of the neural controls for the larynx, jaw and tongue/lips is a necessity for successful acquired apraxia treatment.
- Nearly all people with acquired apraxia that limits their voice and speech control, also experience phonemic and linguistic and most probably cognitive (e.g., attention; working memory; mental resource allocation) problems (Ballard, 2000, Burns, 2011). This would not be true of non-impaired subjects used in MLP studies.
It is clear that critical differences exist between learning a new motor skill and reacquiring or re-accessing previously mastered motor skills. For example, if a one takes a 5 year hiatus from golfing, he/she still knows how to golf; how to swing and grip a club, the rules of play, etc. He/she does not need to learn to golf; he/she just need to get reoriented and to reactivate motor memory of movement patterns. He/she may want to take his/her golf swing apart and learn new skills but the basic motor pattern knowledge remains. Given this, we have developed the motor reconnect principles for acquired apraxia that affects speech and voice. We incorporate these into our Viking Program for Apraxia (VPA). VPA uses both those components MLP that apply to the expanded MRP. This program not only separates and truly treats acquired apraxia as a movement disorder, but also then effectively threads the phonological and language components into practice (Burns, 2011, Hicks, 2010). Carryover into conversation happens naturally as our clients simultaneously engage other clients in group activities such as the Aphasia Communication Cafe (http://www.aphasiatoolbox.com/?q=smallgroup ). | | | | | | | | | | | Table comparing and contrasting MLP with MRP Motor Learning Principles for CAS Motor Reconnect Principles for acquired apraxia | GOAL: to help brain reorganize itself with new neural connections | GOAL: to help brain reorganize itself with renewed and new neural connections | | A. Exploiting neuroplasticity: 1. Increase sensory input; 2. Provide many opportunities for specific input; 3. Modulate in lifelike contexts; 4. “Watch my face.” | A. Exploiting neuroplasticity: 1. Moderate/reduce sensory input; 2. Provide more opportunities for intrinsic focus; 3. Modulate in phrase and sentence contexts; 4. “feel- think” | | B. Acquisition of performance is not a good index of retention | B. Reacquisition of performance is a good index of retention | | C. Random practice is superior to blocked practice. Avoid repetitive trials with a predictable time pattern. | C. Blocked practice can play a bigger role. Utilize repeated rhythmic flows of a self-generated nature (not repetitious) | | D. Intent to improve movement is critical. | D. Intent to improve movement is critical. Intent is thought. | | E. Focus on individual phonemes should not be in the treatment plan. | E. Focus on individual vowel phonemes should be the treatment plan with early transition to syllable stimuli structure. | | F. Focus on vowels a great deal. | F. Focus on vowels a great deal especially to reestablish jaw control. | | G. Ongoing practice: blocked early for accuracy toward more random practice. | G. Ongoing practice: blocked early for accuracy toward more random practice. | | H. Ongoing practice: lots and lots in context it will be used. | H. Ongoing practice: lots and lots combined with work on phonological, lexical and semantic as appropriate. (Hicks, 2010) | | I. Make the ‘feel’ of the movement salient. | I. Make the ‘feel’ of the movement salient, salient, salient. | | J. Utilize tactile and proprioceptive feedback. | J. Minimize tactile and maximize proprioceptive feedback. | | K. Focus on function, core vocabulary. | K. Reconnect to vocabulary. (sub, pronouns, conjugate) | | L. Segment syllables, not phonemes | L. Segment syllables, not phonemes (compounds, tripounds; increasing syllable words) | | M. Fold in prosody early. | M. Fold in prosody early. (scatpraxia; OMC) | | N. Focus on extrinsic feedback encourage visual and tactile feedback moving toward more intrinsic. | N. Minimize extrinsic feedback; focus on intrinsic feedback. | | (adapted from McGlothlin, 2011, Strand, 2005) | | Stay tuned : - ) . Our next newsletter will describe and discuss in more detail our treatment program for acquired apraxia. References: Ballard, Kirrie, Granier, Jay and Robin, Donald, Understanding the nature of apraxia of speech: Theory, analysis, and treatment, APHASIOLOGY, 2000, VOL. 14, NO. 10 Burns, Martha, Apraxia of Speech in Children and Adolescents: Applications of Neuroscience to Differential Diagnosis and Intervention, Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders 21 15-32 April 2011 Hickok, GregoryThe role of mirror neurons in speech perception and action word semantics, Language and Cognitive Processes, 25: 6, 749 — 776, First published on: 29 March 2010 (iFirst) Mass, Edwin, Robin, Donald, Austermann, Sharon, Wulf, Gabrile, Ballard, Kirie, Schmidt, Principles of Motor Learning in Treatment of Motor Speech Disorders, American Journal of Speech-Language Pathology • Vol. 17 • 277–298 • August 2008 • A American Speech-Language-Hearing Association McGlothlin, Jenny, Utilizing Motor Learning Principles in Treatment of Childhood Apraxia of Speech, Advance Magazine Presentation, http://speech-language-pathology-audiology.advanceweb.com/ 2011 Strand, Edith, The Relationship of Practice and Repetition to Motor Learning for Speech in Children with Apraxia, http://www.apraxia-kids.org/site/apps/nl/content3.asp?c=chKMI0PIIsE&b=788447&ct=464503 , 2005 | | SLP: If you would like to refer a client for online treatment or to consult with us in collaborative therapy, contact Bill Connors at bill@aphasiatoolbox.com or 724.494.2534 . PERSON WITH APHASIA or CAREGIVER: if you would like to set up an online consutation or for more information contact Bill Connors at bill@aphasiatoolbox.com or 724.494.2534 . | | | | | | | | | | | | © 2011 Aphasia Center of Innovative Treatment | | |
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