1. APPLICATION OF MOTOR LEARNING TO DEVELOPMENTAL APRAXIA OF SPEECH Melissa M. Mueller, B.A. Carlin F. Hageman, Ph.D. Angela N. Burda, Ph.D. Ken M. Bleile, Ph. D. University of Northern Iowa Presented at ICPLA 2003

2. Literature Review Treatment of DAS continues to be difficult. Progress toward successful communication is slow and laborious. One hypothesis is that children with DAS have difficulties with speech motor programs. Motor Programs: programs that are capable of being carried out in the absence of sensory feedback. Presented at ICPLA 2003

3. Literature Review Motor learning has been studied extensively for controlling limb movements. Variables that affect Motor Learning: Random vs. blocked practice High number of trials within practice session Frequency of feedback (50-60% vs. 100% of trials) Type of feedback (KR vs. KP) Knowledge of Results: information given about the end result of movement Knowledge of Performance: augmented feedback about actual movements Presented at ICPLA 2003

4. Purpose of Study Few studies applying motor learning theory to speech treatment have been completed. Those that have been done have been applied to adults. The purpose of this study was to examine the application of a specific practice hierarchy modeled on motor learning principles to the treatment of DAS. Presented at ICPLA 2003

5. Methods Single-subject experimental study using a multiple-baseline design 8;3 year-old female Had been receiving speech services since she was 3-years-old 18 fifty-minute sessions (2 per week) Practice hierarchy also implemented by child’s school clinician 18 twenty-minute sessions (2 per week) Stimuli: 80 sentences (4-9 words in length) “Learning” measured once per week at the beginning of session using 10 different stimuli Presented at ICPLA 2003

6. Model Hierarchy for Apraxia of Speech Treatment (Hageman, 2003, in press) Step #1The clinician and client produce the target utterance simultaneously. Client attempts utterance without assistance. (No feedback) Client produces utterance 5 times with 3-second pause between each attempt. After 5 attempts, clinician repeats/models the utterance, waits 3 seconds, and then provides KR. (Step 1 continues for a block of 5 stimulus items.) Presented at ICPLA 2003

7. Model Hierarchy for Apraxia of Speech Treatment (Hageman, 2003, in press) Step #2The clinician produces the utterance, waits 3 seconds, and the utterance is elicited from a written stimulus card in random order. Client attempts utterance without assistance. (No feedback) Client produces utterance 5 times with 3-second pause between each attempt. After 5 attempts, clinician repeats/models the utterance, waits 3 seconds, and then provides KR. (Step 2 continues for a block of 5 stimulus items.) Presented at ICPLA 2003

8. Model Hierarchy for Apraxia of Speech Treatment (Hageman, 2003, in press) Step #3The utterance is elicited from a written stimulus card in random order. Client attempts utterance without assistance. (No feedback) Client produces utterance 5 times with 3-second pause between each attempt. After 5 attempts, clinician repeats/models the utterance, waits 3 seconds, and then provides KR. (Step 3 continues for a block of 5 stimulus items. A short break may take place after Step 3.) Presented at ICPLA 2003

9. Model Hierarchy for Apraxia of Speech Treatment (Hageman, 2003, in press) Step #4 Repeat steps 1-3 with another block of 5 stimulus items. Presented at ICPLA 2003

10. Model Hierarchy for Apraxia of Speech Treatment (Hageman, 2003, in press) Step #5 After 20 utterances, the utterances are randomly elicited from written stimulus cards. Client attempts utterance without assistance. (No feedback) Client produces utterance 5 times with 3-second pause between each attempt. After 5 attempts, clinician repeats/models the utterance, waits 3 seconds, and then provides KR. Presented at ICPLA 2003

11. Model Hierarchy for Apraxia of Speech Treatment (Hageman, 2003, in press) Step #6 To be imbedded into Step #5 only when warranted for difficult articulatory sequences. (LaPointe, 2000) Isolate the error Indicate, explain the nature of the error Model the corrected version Client produces corrected response Repetition-Stabilization Transition to volitional control Re-Stimulate in original form Presented at ICPLA 2003

12. Results Bankson-Bernthal Test of Phonology Presented at ICPLA 2003

13. Results Peabody Picture Vocabulary Test—3 rd ed. Presented at ICPLA 2003

14. Results Clinical Evaluation of Language Fundamentals—4 th ed. Presented at ICPLA 2003

15. Results Kaufman Assessment Battery for Children (Nonverbal Subtest) Presented at ICPLA 2003

16. Results Naturalness Rating Scale Presented at ICPLA 2003

17. Results Presented at ICPLA 2003

18. Discussion With 9 weeks of treatment targeting both consonants and vowels, the client showed a meaningful performance change as deemed by both standardized and informal assessments. One week after treatment, the client displayed retention of correct articulation. These results are impressive considering the client had been receiving articulation therapy for 5 years previous to this study. Presented at ICPLA 2003

19. Implications for Further Research This is the 1 st study of its kind—more research participants are needed to determine the reliability of the application of a motor learning approach to the treatment of DAS. Different aged participants are also needed to determine feasibility. A follow-up study is needed to further determine retention of learning. Presented at ICPLA 2003