Action Observation for Neurorehabilitation in Apraxia

Neurorehabilitation and brain stimulation studies of post-stroke patients suggest that action-observation effects can lead to rapid improvements in the recovery of motor functions and long-term motor cortical reorganization. Apraxia is a clinically important disorder characterized by marked impairment in representing and performing skillful movements [gestures], which limits many daily activities and impedes independent functioning. Recent clinical research has revealed errors of visuo-motor integration in patients with apraxia. This paper presents a rehabilitative perspective focusing on the possibility of action observation as a therapeutic treatment for patients with apraxia. This perspective also outlines impacts on neurorehabilitation and brain repair following the reinforcement of the perceptual-motor coupling. To date, interventions based primarily on action observation in apraxia have not been undertaken

Translating novel findings of perceptual-motor codes into the neuro-rehabilitation of movement disorders

The bidirectional flow of perceptual and motor information has recently proven useful as rehabilitative tool for re-building motor memories. We analyzed how the visual-motor approach has been successfully applied in neurorehabilitation, leading to surprisingly rapid and effective improvements in action execution. We proposed that the contribution of multiple sensory channels during treatment enables individuals to predict and optimize motor behavior, having a greater effect than visual input alone. We explored how the state-of-the-art neuroscience techniques show direct evidence that employment of visual-motor approach leads to increased motor cortex excitability and synaptic and cortical map plasticity. This super-additive response to multimodal stimulation may maximize neural plasticity, potentiating the effect of conventional treatment, and will be a valuable approach when it comes to advances in innovative methodologies

An Overview of Speech-Language Pathologists’ Current Practices for Bilingual Children with Childhood Apraxia of Speech

Purpose: This study aimed to explore and describe current practices of speech-language pathologists (SLPs) who presently work or have worked with bilingual children with Childhood Apraxia of Speech (CAS) in diverse settings. Exploration of this topic may contribute to the need for more knowledge in the Speech-Language Pathology field regarding evidence-based practices for the target population. The primary aims addressed in this study were: 1) To describe the assessment procedures currently used by speech-language pathologists to diagnose bilingual children with Childhood Apraxia of Speech, 2) To describe the intervention approaches currently used by speech-language pathologists to treat bilingual children with Childhood Apraxia of Speech, 3) to describe diversity training provided to SLPs who treat bilingual children with Speech Sound Disorders (SSDs) across regions. Method: This study followed a qualitative research approach utilizing a descriptive, questionnaire-based survey design. An online survey of speech-language pathologists working with bilingual children with SSDs and CAS was distributed through e-mail and snowball sampling. The survey requested information regarding the clinicians\u27 background and work setting, the composition of caseloads, diversity training, current assessment procedures used in the field, current intervention approaches used in the field, and service delivery challenges. Results: Seven surveys were received and analyzed. Monolingual and bilingual participants from Colorado, Texas, and Virginia participated in the study. Of the total participants, six reported providing services to bilingual children with SSDs, and only four participants indicated currently providing services to bilingual children with Childhood Apraxia of Speech. Between 10-25% of the participants\u27 total caseload comprised bilingual children with SSDs between ages 4-12, and less than 10% of children in their total caseload were identified as bilinguals with CAS between the ages 5-12. All participants reported being competent and comfortable at assessing and treating individuals from a cultural or racial background other than their own, even though 57.1% of SLPs reported that service bilingual children do not speak a second language. In addition, all participants indicated that they do not utilize the services of interpreters/translators when assessing and treating bilingual children aligning with the lack of coursework received on working with an interpreter throughout their carrier and the ongoing challenge faced by these participants on the lack of interpreters who speak the necessary languages to provide services. Speech-language pathologists employ a combination of formal and informal methods to assess bilingual children with Childhood Apraxia of Speech. These methods are modifications of monolingual English assessment and treatment approaches as they have not yet been explored and are not supported by evidence to be employed with the target group. Conclusions: Results confirm the ongoing growth diversity of the population in our country and the lack and limited resources to provide best-practice to bilingual children with SSDs and Childhood Apraxia of Speech. Clinicians are trying to closely follow the American Speech-Language-Hearing Association\u27s (ASHA) recommended guidelines when providing services to bilingual children. However, despite the increase and improvement of training opportunities, a large proportion of SLP professionals still lack confidence in serving the bilingual Hispanic population due to insufficient training in this area. Currently, SLPs rely on various modifications of monolingual English assessment and treatment approaches, which may yield uneven or erroneous outcomes as they may not consider cultural and linguistic variables. Hence, the need for specialized skills and the ability to recognize individual differences, given the child\u27s linguistic background and the nuances of bilingual language development, is highly necessary when serving bilingual children with Childhood Apraxia of Speech. The urgent need for more study in this field has been established, particularly on the best effective evaluation technique and treatment method to utilize with this population. Continued descriptions of developmental norms in culturally and linguistically diverse groups, evidence-based screening and assessment techniques, and research-based intervention methods should be included in future studies. Hence, based on these findings, recommendations are to conduct further studies that contribute to developing evidence-based practice guidelines and ensure the best quality of services to culturally and linguistically diverse children with Childhood Apraxia of Speech

Intervention strategies and psychosocial factors for a client with Broca’s aphasia and apraxia of speech: A case study

The purpose of this case study was to explore the intervention techniques and psychosocial factors present throughout a person with aphasia’s treatment which promoted consistent improvement while attending speech-language therapy across eleven years. The participants in the case study included: a 60-year-old male post onset of a left hemisphere cardiovascular accident (CVA) resulting in moderate-severe Broca’s Aphasia and verbal Apraxia of Speech (AOS); his spouse; and his primary speech-language pathologist. A comprehensive review of speech-language pathology files and in-depth interviews with each participant were completed and analyzed to gather quantitative and qualitative data to determine factors which contributed to the participant with aphasia’s consistent improvement. Analysis of the data was completed using a narrative format. The results revealed documented improvements in formal and informal assessments across time and common psychosocial themes across three interviews

Motor Learning Guided Treatment for Acquired Apraxia of Speech: Factors That Influence Treatment Outcomes

Purpose: The purpose of this study was to examine factors that might influence the treatment effectiveness of motor learning guided (MLG) treatment approach for apraxia of speech (AOS). Specifically, this study examined the effects home practice and the stimuli selection on speech production. Method: This is a case study across two treatment cycles involving a 52 year-old male five months post left CVA (due to a carotid artery dissection). Each treatment cycle used three conditions of practice to investigate the influence of practice frequency on treatment outcomes. The personal relevance of stimuli within and across treatment conditions differed in the treatment cycles to investigate stimuli selection influence on treatment outcomes. Results: Changes in speech motor learning occurred in all conditions of practice only after therapy began. Phrases practiced in therapy and at home met criterion for mastery in fewer sessions than therapy only and untrained phrases. The content of the stimuli did not appear to have a direct influence on speech motor learning. Conclusion: This case study contributes to the growing evidence on the effectiveness of MLG treatment for acquired AOS. Future studies using an experimental design are needed to advance and strengthen the evidence for MLG

Motor Learning Guided Treatment for Acquired Apraxia of Speech

Purpose: The purpose of this study was to expand the evidence on the effectiveness of motor learning guided approach for the treatment of acquired apraxia of speech. This study investigated the influence of practice frequency and number of targets per practice set on transfer of speech motor learning. Method: This is a multiple baseline single-case study across two treatment cycles involving two individuals with chronic acquired apraxia of speech. Treatment Cycle 1 investigated the influence of self-controlled practice on speech motor learning through two conditions of practice. Treatment Cycle 2 investigated the influence of number of targets on transfer of learning. Results: There was a treatment effect for both participants in both treatment cycles. In Treatment Cycle 1, both participants demonstrated speech motor learning on treated stimuli in all practice conditions and no transfer of learning to untrained phrases. In Treatment Cycle 2, the number of targets was reduced. A change in speech motor learning was demonstrated by both participants on the trained phrases as well as a transfer of learning as measured by performance on untrained set of phrases. Conclusion: The outcomes of this study contribute to the growing evidence supporting the effectiveness of motor learning guided treatment for acquired apraxia of speech

Long-term recovery from apraxia and its relation to severe apraxic-aphasic disorder in left hemisphere stroke - a systematic review

Background: Left hemisphere stroke often causes a severe communication disorder that is usually attributed to aphasia. While aphasia refers to linguistic problems, communication is also accomplished by voluntarily articulate and gestural movements, which may be compromised due to apraxia. Along with aphasia, apraxia is a common disorder in left hemisphere stroke, which in severe cases can limit the use of verbal and nonverbal communication methods. The discussion about apraxia from a communicative perspective is still scarce, although the disorder is regularly experienced among left hemisphere stroke patients with aphasia. The rehabilitation of the disorder in severe apraxia-aphasia is challenging and recovery is slow. Aims: The purpose of this study is to provide an overview of the research on long-term recovery from apraxia and to discuss the meaning of these findings in observing the recovery of communication abilities in a person with a severe apraxia-aphasia. The search was not restricted to any specific type of apraxia, as this review assumes that communication may be influenced by apraxia in its different manifestations. The review is based on a systematic literature search, which includes English-language studies retrieved from the databases of Ovid Medline, PsycINFO, and Scopus. Main Contribution: Seven long-term follow-up studies of apraxia were found; one case study of apraxia of speech (AOS), four group studies of ideomotor apraxia (IMA), one case study of IMA (and aphasia), and one group study of limb apraxia. Conclusions: The reviewed group studies of patients with left hemisphere stroke indicate that apraxia is a persistent disorder, but the steepest recovery occurs within the first few months post-stroke. Imitation skills and actions involving real-tool use in activities of daily functions show the best recovery. Real-tool use also continues to improve longer, while recovery of gesturing after verbal command may not show clear signs of recovery in the chronic stage post-stroke. There is some evidence that the pace of recovery from oral apraxia and limb apraxia is comparable, and recovery from apraxia and aphasia would not correlate. Some of the studies used only imitation to assess changes in gesturing, which cannot be regarded as an ecologically valid measure to compare gesturing in natural communicative situations or even gesturing after verbal command. Finally, no follow-up studies were found that would have discussed apraxia from a communicative perspective. Overall, the field is lacking research on long-term follow-up of patients with apraxic-aphasic disorder.Peer reviewe

Rapid Syllable Transition treatment for Childhood Apraxia of Speech: exploring treatment efficacy in three service-delivery contexts

Many children are unable to access speech pathology treatment at the recommended intensity. To address this problem, clinicians use a range of strategies: modifying treatment intensity, mode or delivery agent. Accessing sufficient speech pathology treatment for children with childhood apraxia of speech (CAS) is particularly difficult because treatment should be delivered face-to-face, by a clinician, 3–5 times per week. One relatively new treatment for CAS, rapid syllable transition (ReST) treatment has demonstrated significant acquisition and generalisation effects when delivered intensively, face-to-face, by a clinician. This thesis uses three separate single-case experimental studies to investigate the efficacy of ReST treatment when provided via alternative service-delivery approaches. Lower dose-frequency, telehealth delivery, and a combined clinician–parent delivery model were explored. The studies showed that both lower dose-frequency and telehealth delivery were efficacious. Combined clinician–parent delivery was efficacious for fewer than half the children. Parental experiences of telehealth and of the combined clinician–parent delivery models were investigated qualitatively. The parents reported positive experiences of telehealth, finding it convenient and time-efficient. They had concerns about the combined clinician-parent delivery model, reporting discomfort in the role of therapist, and low levels of confidence and competence in delivering treatment. This thesis supports implementation of both lower dose-frequency and telehealth delivery of ReST treatment. Despite the intuitive appeal of parent-delivered treatment for overcoming access barriers, this thesis does not support clinical application of parent-delivered ReST treatment. This thesis argues for further investigation of intensity variables in CAS treatment and methods for improving parent-delivered treatment efficacy, and the need to ensure clients receive sufficient service provisio