“I was a smart kid, and had a lot to say, but I just couldn’t say it. It would just haunt me. I never thought I would be able to sit and talk to someone like I’m talking to you right now”. Emily Blunt, an actress and winner of a Golden Globe Award, grew up with a speech impediment. Blunt grew up insecure of her voice, so she did not talk unless spoken to. With the help of a speech pathologist, Emily Blunt overcame her stuttering disorder and became an awarding winning, successful actress. This portrays how beneficial speech pathologists can be.
To become a speech language pathologist, one must receive a master’s degree in the program of study by the American-Speech-Language-Hearing Association (ASHA) and must also receive a credential. Throughout the United States, the ASHA is the association for speech-language pathologists, hearing experts, and language scientists. Speech-language pathologists are professionally trained to diagnose and treat many different types of speech and language disorders (Laberge). Speech-language pathologists are considered experts in communication. There are a number of reasons a person would need to see a speech pathologist. For children, a
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speech language pathologist can help with clear speech/flexibility skills, speaking using expressive thoughts, receptive language, fluency, stuttering, social language, and swallowing issues. Speech pathologists may also help elderly people who have or may have suffered from aphasia, dementia, dysarthria, apraxia, and dysphagia. In some cases, speech-language pathologist may work with patients who can barely speak or cannot speak at all. When this happens, they may use an alternative method such as sign language or an automated contrivance like a computer (Field). There are a number of different work settings that a speech-language pathologist may work in. Depending on the age group the speech-language pathologist is working with, they may work in primary schools, high schools, hospitals, nursing homes, rehabilitation centers, or private practices. In order to be a speech-language pathologist, certain characteristics are imperative. Good communication skills are consequential because they have to handle test results, diagnoses, and treatments in an understandable manner. Speech-language pathologists are surrounded by patients often, so it is important that they are able to work well with others while being patient and sensitive (Field). There are many different types of disorders that speech-language pathologists work to treat such as speech disorders, language disorders, social communication disorders, cognitive-communication disorders, and swallowing disorders. Throughout my paper, I will look at the different strategies and methods that speech-language pathologists use for children diagnosed with Childhood Apraxia of Speech.
One of the conditions that speech-language pathologists help diagnose and treat is Childhood Apraxia of Speech (CAS). Childhood Apraxia of Speech is a speech disorder in in
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children that causes difficulty in the child’s brain to coordinate oral movements that are needed to create sounds into syllables, syllables into words, and words into phrases (Farmer). CAS is not that common. It occurs in approximately one to two children per thousand (Zuk). In most cases, the cause of CAS cannot be determined. In a few cases, Childhood Apraxia of Speech is a result of traumatic brain injuries. Children also might develop CAS as a symptom of a genetic disorder or galactosemia. This condition does not insist that the speech muscles are weak, but the brain struggles to direct the movement which causes the speech muscles to not function properly. These children also struggle with forming letters when writing, drawing, gesture movements, and in some cases eating. To diagnose this condition, the child must be undergoing symptoms.
Depending on the age and how intense their speech problems may be, children with Childhood Apraxia of Speech may have many symptoms. It is an approximate calculation that Childhood Apraxia of Speech may account for 3% to 5% of speech sound disorder cases, but the number of incipient cases of CAS appears to have incremented over the past decade and more precise prevalence data are needed (Zipoli). One of the symptoms may include a delay in speaking first words, a restricted amount of words spoken, or limited to form only a few syllables or vowel sounds. Those symptoms may be recognized between eighteen months and two years. Symptoms like voicing errors and vowel distortions may be recognized in children from ages two to four. An example of this would a child saying “lie” when they are trying to say “hi”. This is because children with childhood apraxia of speech have difficulty getting the correct position to make a sound from their jaws, lips, and tongues. The difficulty causes them
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to have fluency issues. Most children with this condition have a reduced vocabulary, find it difficult to form sentences and struggle with placing words in order. Now I know what you are thinking. These symptoms relate to other symptoms of many other speech and language disorders. How do they differ? There are a few characteristics that CAS have that distinguish that it is not another disorder. Fluency issues, voicing errors, and vowel distortions are particularly associated with Childhood Apraxia of Speech. The symptoms that children with apraxia of speech have that can be associated with other speech and language problems are speaking first words late, speaking a reduced quantity of vowels, and struggling to understand speech.
According to the American-Speech-Hearing Learning Association, the treatment for Childhood Apraxia of Speech is often very intense and includes repetitive practices. Children with CAS appear to remain in jeopardy of reading failure even after their verbalization has become more intelligible (Zipoli). Many of the treatment options encourage the child’s family members to be in attendance so that they can help the child outside of the treatment facility. The vast majority of treatment options focus on the difference between movement patterns and sound patterns. The speech-language pathologist will have their patient watch them speak and focus on their mouth movements as they make certain sounds and syllables (Raymer). According to Meghan Gourley, “The therapist uses tactile, auditory, and visual feedback to direct the brain to move the muscles used during speech.” If a patient is extremely impaired to the point where communication and speech aren’t possible, speech-language pathologists will use an alternative communication system. This method uses a computer that “speaks” what
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the patient is directing it to say. Researchers have perpetually stressed the consequentiality of identifying these students with CAS, proximately monitoring their language and reading skills, and providing preventative intervention (Zipoli).
Katrina Haley, from the University of North Carolina at Chapel Hill University Research Council, conducted a study to find the discrepancies in the results of error consistency that will help determine the appropriate diagnosis. For this experiment, she analyzed fourteen speech samples from left-hemisphere stroke survivors who have been diagnosed with Apraxia of Speech. The contributors were asked to produce three multisyllabic words five times. Phonetic transcriptions, which is the visual representation of sounds, were coded for the regularity of error location. For the unit of analysis, she used the word, its syllables, and sound segments. Uniformity of error type varied systematically with the unit of analysis, exhibiting progressively more preponderant consistency as the analysis unit transmuted from the word to the syllable and then to the sound segment. In conclusion to this study, low to mitigate consistency of error type at the word level attests pristine diagnostic accounts of verbalization output and sound errors in Apraxia of Speech as variable in form. The mean of the participants that had incorrect sounds per word was 3.33. When Haley tested the participants for the incorrect syllables per word, the mean was 2.05. Lastly, when Haley tested the participants for the percentage of words incorrect, the mean was 82.44%. Moderate to high error type consistency at the syllable and verbalization level designate that phonetic errors are taking place. The results are matching and sensibly harmonious with each other (Haley).
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Richard Zipoli, an assistant professor at Southern Connecticut State University, and Donna D. Merritt, a speech-language pathologist and consultant at Southern Connecticut State University, made some evaluations on young children with Apraxia of Speech. Five researchers followed ten preschool students who have Childhood Apraxia of Speech. When these students were between the ages of eight and ten, they were tested with standardized measures of word reading, spelling, comprehension, and spoken languages. Entirely, the students displayed impaired decoding of authentic and nonsense words, substandard spelling, decreased reading comprehension, and indisposed expressive and receptive language skills. To note, eight of ten students had amended articulation scores, advocating that many students in this sample experienced perpetual difficulties with reading and oral language in spite of development in verbalization and sound production (Zipoli). Zipoli and Merritt concluded that children with Apraxia of Speech persistently have an incremated risk of reading difficulties even after clinical manifestations of verbalization or speech impairment have diminished and speech-language accommodations have been terminated. Student Support Teams are enheartened to discuss the attainability of implementing for proximately identifying, monitoring, and fortifying students with a history of verbalization or language impairment who are in peril of reading obstacles. These procedures will avail Student Support Teams to minimize the jeopardy of reading failure among these children (Zipoli).
In the final clinical focus, I will be analyzing the study conducted by Julie Wambaugh, a Research Career Scientist Award winner, as she looks at the effects of treatment intensity on outcomes in acquired Apraxia of Speech. The purpose of this investigation was to look at
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people with chronic cases of Apraxia of Speech and examine the effects of treatment intensity on the outcomes of Sound Production Treatment (SPT). Wambaugh used a method that involved five people undergoing intense SPT for three hours a day and three hours a week. These same patients also had to receive a less intense method that took place for one hour a day and three times a week. Every treatment was applied discretely to a certain set of experimental words. Only one treatment was applied at a time. Each phase of treatment was conducted over a span of twenty-seven sessions. During the process of the investigation, the precision of target sounds within treated and untreated words was quantified. For the first participant, 46.48 treated items were learned from the intense STP treatment and for the less intense treatment the participant had 51.67 treated items. Participant two had 43.88 treated items from the intense treatment and 37.24 treated items from the less intense treatment. Participant three conquered 12.44 treated items from the intense treatment and 8.84 treated items for the less intense treatment. From the intense treatment, participant four had 32.76 treated items and 22.37 treated items from the alternative treatment. Lastly, participant five only conquered 8.93 items from the intense treatment and 21.17 treated items from the less intense treatment (Wambaugh). Fortunately, both treatment intensities caused the participants to improve their speech. Surprisingly, the less intense SPT treatment that took place for only one hour a day showed more improvement in articulatory accuracy.
To conclude, there are many different treatment options for a speech-language pathologist to use for a child struggling with Apraxia of Speech. All of the treatment options are helpful and will help the child with not only their speech, but it will boost their confidence as
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well. Ralph Waldo Emerson spoke, “speech is power: speech is to persuade, to convert, to compel”. Although Childhood Apraxia of Speech is not the most common speech disorder, it should be recognized because it can greatly affect a child’s learning.