Interventions for childhood apraxia of speech

BACKGROUND: Childhood apraxia of speech (CAS) affects a child's ability to produce sounds and syllables precisely and consistently, and to produce words and sentences with accuracy and correct speech rhythm. It is a rare condition, affecting only 0.1% of the general population. Consensus has been reached that three core features have diagnostic validity: (1) inconsistent error production on both consonants and vowels across repeated productions of syllables or words; (2) lengthened and impaired coarticulatory transitions between sounds and syllables; and (3) inappropriate prosody (ASHA 2007). A deficit in motor programming or planning is thought to underlie the condition. This means that children know what they would like to say but there is a breakdown in the ability to programme or plan the fine and rapid movements required to accurately produce speech. Children with CAS may also have impairments in one or more of the following areas: non-speech oral motor function, dysarthria, language, phonological production impairment, phonemic awareness or metalinguistic skills and literacy, or combinations of these. High-quality evidence from randomised controlled trials (RCTs) is lacking on interventions for CAS. OBJECTIVES: To assess the efficacy of interventions targeting speech and language in children and adolescents with CAS as delivered by speech and language pathologists/therapists. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, eight other databases and seven trial registers up to April 2017. We searched the reference lists of included reports and requested information on unpublished trials from authors of published studies and other experts as well as information groups in the areas of speech and language therapy/pathology and linguistics. SELECTION CRITERIA: RCTs and quasi-RCTs of children aged 3 to 16 years with CAS diagnosed by a speech and language pathologist/therapist, grouped by treatment types. DATA COLLECTION AND ANALYSIS: Two review authors (FL, AM) independently assessed titles and abstracts identified from the searches and obtained full-text reports of all potentially relevant articles and assessed these for eligibility. The same two authors extracted data and conducted the 'Risk of bias' and GRADE assessments. One review author (EM) tabulated findings from excluded observational studies (Table 1). MAIN RESULTS: This review includes only one RCT, funded by the Australian Research Council; the University of Sydney International Development Fund; Douglas and Lola Douglas Scholarship on Child and Adolescent Health; Nadia Verrall Memorial Scholarship; and a James Kentley Memorial Fellowship. This study recruited 26 children aged 4 to 12 years, with mild to moderate CAS of unknown cause, and compared two interventions: the Nuffield Dyspraxia Programme-3 (NDP-3); and the Rapid Syllable Transitions Treatment (ReST). Children were allocated randomly to one of the two treatments. Treatments were delivered intensively in one-hour sessions, four days a week for three weeks, in a university clinic in Australia. Speech pathology students delivered the treatments in the English language. Outcomes were assessed before therapy, immediately after therapy, at one month and four months post-therapy. Our review looked at one-month post-therapy outcomes only. We judged all core outcome domains to be low risk of bias. We downgraded the quality of the evidence by one level to moderate due to imprecision, given that only one RCT was identified. Both the NDP-3 and ReST therapies demonstrated improvement at one month post-treatment. A number of cases in each cohort had recommenced usual treatment by their speech and language pathologist between one month and four months post-treatment (NDP-3: 9/13 participants; ReST: 9/13 participants). Hence, maintenance of treatment effects to four months post-treatment could not be analysed without significant potential bias, and thus this time point was not included for further analysis in this review. There is limited evidence that, when delivered intensively, both the NDP-3 and ReST may effect improvement in word accuracy in 4- to 12-year-old children with CAS, measured by the accuracy of production on treated and non-treated words, speech production consistency and the accuracy of connected speech. The study did not measure functional communication. AUTHORS' CONCLUSIONS: There is limited evidence that, when delivered intensively, both the NDP-3 and ReST may effect improvement in word accuracy in 4- to 12-year-old children with CAS, measured by the accuracy of production on treated and non-treated words, speech production consistency and the accuracy of connected speech. The study did not measure functional communication. No formal analyses were conducted to compare NDP-3 and ReST by the original study authors, hence one treatment cannot be reliably advocated over the other. We are also unable to say whether either treatment is better than no treatment or treatment as usual. No evidence currently exists to support the effectiveness of other treatments for children aged 4 to 12 years with idiopathic CAS without other comorbid neurodevelopmental disorders. Further RCTs replicating this study would strengthen the evidence base. Similarly, further RCTs are needed of other interventions, in other age ranges and populations with CAS and with co-occurring disorders

Patterns of physical activity among preschoolers in a childcare setting: a pilot study

The rates of children’s physical activity (PA) have declined over the past several decades in the U.S. While the increased number of women entering the workforce has led to more children than ever before attending childcare centers, studies examining PA have largely focused on school-aged children so far. Currently, there is some knowledge in the existing literature on the amount of PA among preschoolers, but the knowledge is so far very limited. The main purpose of this study was to assess the amount and specific patterns of PA of preschool-aged children in a childcare setting. The second purpose of the study was to examine personal, environmental, and policy factors that have been proposed to influence PA in a childcare setting. A list of 98 five-star childcare centers in Guilford County was compiled and three childcare centers were randomly selected for potential participation in the study (1 agreed to participate). The amount and patterns of children’s PA were measured using accelerometers. The multi-level factors related to PA within the childcare setting were assessed using the Environmental Policy Assessment and Observation tool (EPAO), in-depth interviews with the center director and informal interviews with teachers (guided by the Social Cognitive Theory). An Actigraph GT3x accelerometer was placed on each child upon arrival and removed during pickup from the childcare center to measure total PA. Sixty-eight percent of children met the recommendation of at least 60 minutes of moderate-to-vigorous PA a day (MVPA). The childcare center’s PA environment was scored at 18.7/20, indicating a very positive PA environment. Using a manual content analysis, several themes emerged from the interview with the center’s director: 1) awareness of PA importance on learning, growth, and health; 2) importance of buy-in from parents and teachers/staff; 3) the need for PA policy to be in place; 4) knowledge of PA recommendations; 5) lack of gym access perceived as a main barrier. The field interviews with teachers generated the following themes: 1) strong awareness of the importance of PA for children’s learning, growth and overall health; 2) equipment, space and time perceived as the major facilitators of PA; 3) focus on safety perceived as major barrier to teacher participation in PA with children; 4) low PA among teachers due to lack of time in their schedules; and 5) confusion about current PA recommendations for young children. Most children in the sample met the minimum PA recommendations. Our findings highlight the importance of a positive environment, with childcare staff being aware of the importance of PA for children during the day. Further studies should assess both the PA environment and the social climate related to PA across childcare centers in order to make individualized improvements and thus optimize children’s PA across childcare centers

Looking for Laveau: the mythology of Marie Laveau in and out of the archive

The purpose of this work is to engage with the proliferation of the myth of Marie Laveau, the nineteenth-century Voodoo figure of New Orleans, Louisiana and its multiple potentialities as both a tool of investment in whiteness as a form of intellectual property as well as a subject for myth as uplift, refusal, and resistance in terms of southern black womanhood and the critically imaginary. In this work, I create a trajectory of work that has endeavored to “recover” Laveau within institutionalized forms of knowing, specifically taking to task projects of recovery that attempt to present Laveau as a figure of strong leadership for women through institutionalized spaces and forms of knowledge, such as the archive while simultaneously dismissing other, “nonacademic” proliferations of the Laveau myth. This thesis serves to decenter the research, reading, and writing of the Laveau mythology as within the academy, which ostensibly serves white and normative generated and centered ways of knowing, identifying, and articulating, in favor of a methodology that accounts for cultural forms of mythologies that center memory, lineage, and communal identification. Through this critical work, I hope to supply a critical imaginary of what a Creole/Cajun southern feminism would look like, and how it is deeply intertwined with gendered and racialized nuances that are specific to region and community

Spatial dynamics in painting achieved through plane manipulation

In order to understand the thesis, a clear definition of terms is necessary. The idea of space as considered by the artist may consist of two concepts. One might deal with the greatly expanded space revealed in our contemporary action and thought. The other is definitely limited to the painting surface, whereon a small segment of a world, imagined or real, may be presented; or, the immensity of a universe boldly suggested. The modern painter can use pure space of controlled size (the painting surface), to create space of vast dimensions if he chooses. Or, as one critic, Aaron Berkman, says, "The canvas, too, is space. Within itself it is infinite; and the painter is a creator in the picture-space universe."

Pairing cognitive training and exercise

The research on the cognitive benefits of exercise has shown that regular participation in physical activity can improve performance for cognitive activities. Recently, animal research has shown that combining physical activity (PA) with cognitive training concomitantly, produces greater increases in cognitive performance than either done alone. The human research that has been designed to explore the effects of combined exercise and cognitive training has implemented the training on separate days and in separate locations. Thus, the human research has not looked at combining PA and cognitive engagement during exercise in the same way the animal research has. Therefore, the current study investigated the cognitive benefits of a cognitive training protocol performed during an exercise task as compared to cognitive training or exercise training alone. Participants (N = 24) were randomized to one of three groups that engaged in a 6-day training protocol. There was a bike group that exercised at a moderate intensity, a game group that engaged in an interactive learning software protocol, and a both group that completed the interactive learning software protocol while simultaneously exercising. All participants were tested before and after the 6 day training session on the Wonderlic Personnel Test, the Stroop Test, the Trail Making Tests A and B (TMTA, TMTB) and the Paced Auditory Serial Addition Test (PASAT). The results of the Repeated Measures ANOVA for the Stroop test showed there was a significant interaction of time x test x group, p < .05 indicating that while the two exercise groups (bike and both) had improvements in scores on all subtests over time, the game group did improve on the color subtest but did not improve on the word and color-word subtests. Analysis of the Stroop interference score also showed a significant time x group interaction, p < .05. Examination of the means showed that the bike group and the both group reduced their time to completion from pretest to posttest, but the game group increased their completion time and therefore performed worse at posttest. An examination of the set-switch score for the TMT indicated that the interaction of time x group approached significance, p = .062. Examination of the means indicated that the bike group and the both group reduced their time to completion from pretest to posttest, but the game group increased their completion time from pretest to posttest. The findings suggest that combining exercise and a cognitive training protocol can produce significant results on cognitive measures after a 6-day intervention

Interspecific Competition Affects Avian Personality, Assortative Mating, and Reproductive Success

Animal personality is thought to influence monogamous relationships by better allowing mates to coordinate territory defense and parental care behaviors. Aggressive territorial defense and boldness to potential predators are often important and ecologically relevant animal personality traits; however, the effects of heterogeneous social environments on the expression of assortative mating, personality, and behavioral syndromes are poorly understood. Eastern bluebirds are secondary cavity nesting birds that are facing a changing social environment in western NC. Tree swallows are expanding their range southward and have been in the field site for < 40 years. Tree swallows are highly aggressive and compete with bluebirds for limited nesting cavities. This new selection pressure may interfere with otherwise adaptive personality traits. This thesis aims to understand the ways that interspecific competition with a highly aggressive species may shape individual behavior and affect reproductive success in cavity nesting birds. Here, I examined how interspecific competition with tree swallows affects the propensity of paired male and female Eastern bluebirds to mate assortatively for behavior and how that may affect reproductive success. Furthermore, I examined how interspecific competition may affect behavior in an attempt to understand how the environment plays a role in shaping animal personality and plasticity

Zirconia poems

This thesis consists of twenty-eight poems in four sections. Poems in the first section, DREAM, are short sequences of imagery aimed at disturbing or energizing the imagination and inner consciousness of the reader. The logic is emotion logic and the rhythms are intended to mesmerize or jerk the reader into a poetic world which I believe is only one version of reality. The following section, ZIRCONIA, contains poems about a specific locale familiar to me. Here I attempt to expand the world of the imagination to include both past and present, both the physical world and (for me) the mythic

The effect of timbre and pitch-pattern difficulty on the pitch perceptions of elementary-aged users of cochlear implants

The purpose of this study was to examine the effects of timbre and pitch-pattern difficulty on perceptions of same-difference between paired pitch patterns, altered and unaltered by timbre and pattern difficulty, among elementary-aged users of cochlear implants. Three null hypotheses were tested to determine the significance of these variables and their interaction on the pitch perceptions of children aged five through twelve, who used cochlear implants. Secondary purposes of the study included the examination of the relationships, if any, between age, age at implantation, and whether there were significant differences between participants' speech processor and pitch perceptions. The Adapted Musical Background Questionnaire was completed by each participant/parent(s)/guardian(s) and used to collect information about each participants' hearing history and musical experiences. The Pitch Discrimination Test, (PDT) was a researcher-developed, 36-item data collection instrument used to measure pitch perceptions of participants. Three timbres were used as stimuli, including the soprano voice, piano, and violin. Thirteen participant responses to the PDT were recorded individually. Results were analyzed using IBM© SPSS© Statistics Version 22. Results of the study revealed no effect of timbre (p = .511), or pitch-pattern difficulty (p = .971) on pitch perceptions. A significant interaction between timbre and pitch-pattern difficulty, however, was found (p = .046). Additional analyses revealed that there were significant differences between mean scores of PDT test items presented by violin and soprano voice for difficult patterns (p = .041), and items presented by soprano and piano for patterns with moderate difficulty (p = .041). The participants discriminated difficult patterns more accurately when the PDT items were presented by soprano voice than piano, but participants discriminated moderate patterns more accurately when the PDT items were presented piano than by soprano voice. There were no significant positive or negative correlations between age or age at implantation and PDT scores. Additionally, there were no significant differences between participant scores on the PDT and the type of speech processor used. Participants who used CochlearTM devices, however, had higher average scores than participants who used MED-EL® devices. Recommendations were suggested for future research and instruction of children who use cochlear implants in the elementary general music classroom

Undue burdens: the Black woman subject in June Medical Services LLC. V. Russo : and, “Will you test your strength out on me?”: comic disruptions and the rhetorical memoir

Examining the US Supreme Court case June Medical Services LLC V. Russo, I draw on the complicated trajectory of Louisiana law and Alexander Weheliye’s theorization of the assemblage of the nonhuman to argue that Black women in Louisiana face particular legal barriers and forms of criminalization that speak to a longer history of rendering Black women’s bodies as simultaneously invisible and hypervisible. By emphasizing the impossibility of a Black female subject in the legal imaginary, I critique the positioning of Act 620, a law that would refuse abortion providers to practice without having admitting privileges to a hospital within thirty miles of the location of the procedure, which would result in the reduction of abortion providers in Louisiana to only one. I use the historical and contemporary legal legacy of the state to enact rhetorical practices of invisibility and hypervisibility to both criminalize Black women as well as refuse or create obstacles to a multitude of social services. I highlight how the particular Russo Supreme Court case is part of a larger trajectory and history of refusing Black women legal subjecthood through individualist and paternalist rhetoric, which both shapes and takes place in law and its enforcement. AND I look at six pieces by comedians, three stand-up specials and three memoirs, to examine comedy as a form of rhetorical response that emerges from a situation that is rooted in personal, embodied experience. I critique Lloyd F. Bitzer’s and Richard E. Vatz’s oppositional writing on the rhetorical situation and its being rooted in either a distant, generalized event or the language used to articulate such an event as the primary factors in eliciting a response. Instead, I privilege Jacqueline Jones Royster’s intervention on the tension between “subject matter” and “subjectivity” as well as Sarah Ahmed’s work on phenomenology to assert that when bodies that make up and are directly implicated in events or situations become those that speak on and address them, another form of rhetorical agency is possible. Looking at comedians who are women of color and/or queer, I illustrate how stand-up comedy, when performed by Other bodies, is an accessible and strategic means of persuasion as well as enacting change on both a personal and social level