Ballard & McCabe (2013) Table 2: Primary symptoms which may differentiate

between Childhood Apraxia of Speech, dysarthia and phonological disorders.

Phonological Childhood Apraxia of Dysarthria

Disorder Speech
 Normal prosody  Initation errors  Known brain injury,
 Consistent, rule  Difficulty moving from other neurological signs
governed, even if not syllable to syllable  Sound distortions
developmentally (e.g., robotic, staccato  Not generally
typical or very slow speech) influenced by word
 Influenced by word  Influenced by word length
position not length length,  breakdown  Usually consistent
 Rarely any oral signs with  complexity (except spasticity)
 Responsive to  Inconsistent errors  Paralysis, paresis,
phonological feedback  No paralysis or paresis asymmetry
– normal muscle tone  Abnormal resonance,
 Normal resonance, respiration or phonation
respiration & phonation
 Producing speech

Motor
Phonological
Cognitive Semantic Motor Motor execution
thought
encoding/
representation planning programming (say the
assembly
word)

(Levelt, 2002; Nijland et al, 2003; Terband &

Maassen, 2010; van der Merwe, 2009)
Motor sensory circuits
Speech motor Programming
Language planning (coordination, timing)
(in the brain)

Thought Stored plan Transmission

from brain to mouth

Evaluation Sensory
Feedback Execution
(did I get
(hearing & touch) (saying the sounds)
it right)

Duffy (2005) pp 35,57-64.

Bohland, Bullock & Guanter (2009) Neural Representations and Mechanisms for the
Perfomance of Simple Speech Sequences. Journal Of Cognitive Neuroscience
Doi:10.1162/jocn.2009.21306
 Motor sensory circuits
Speech motor cortex (SMA)

Speech motor Programming

Language planning (coordination, timing)
(in the brain)

Cerebellum,
subcortex
Frontal lobe
Thought Stored plan Transmission
from brain to mouth
Speech Motor
Cortex(SMA) Cranial
nerves
Evaluation Sensory
(did I get Feedback Execution
it right) (hearing & touch) (saying the sounds)
Cranial nerves Muscles & nerves of vocal
tract &respiration
Duffy (2005) pp 35,57-64.
Bohland, Bullock & Guanter (2009) Neural Representations and Mechanisms for the
Perfomance of Simple Speech Sequences. Journal Of Cognitive Neuroscience
Doi:10.1162/jocn.2009.21306
Motor learning
“the process of acquiring (and retaining) the capability for
Producing skilled actions” Schmidt & Lee,2011

Acquisition

Short-term Learning
perfomance
Generalisation &
retention

Hong Kong speech and hearing simposium 1-4 november, 2018

Childhood Apraxia of Speech: From Diagnosis to Discharge
Professor Tricia McCabe
Motor learning
• Acquisition = only in the session

• Learning = transfer, generalisation, retention

• Pre-practice (teaching) aims for acquisition

• Practice (training) aims for retention and uses the principles of motor learning (PML)

Hong Kong speech and hearing simposium 1-4 november, 2018

Childhood Apraxia of Speech: From Diagnosis to Discharge
Professor Tricia McCabe
 Pre-practice = acquisition
AIM : Develop an internal reference of correctness
(know what is required)

Practice = learning
AIM : be able to independently use the skill

Hong Kong speech and hearing simposium 1-4 november, 2018

Childhood Apraxia of Speech: From Diagnosis to Discharge
Professor Tricia McCabe
 Acquisition vs Learning
For acquisition
• Blocked presentation of items
• Massed practice
• Constant practice
• Small practice amount
• Low target complexity
• Feedback 100%
• Feedback on technique
• Immediate feedback
• Teach self-evaluation
Mcllwaine, Madill & McCabe, 2010
For learning (PML)
• Random item presentation
• Distributed practice
• Variable practice
• Large practice amount
• High target complexity
• Feedback < 100%
• Feedback on outcome
• Delayed feedback
Maas et al,2008
 A word or two about feedback
“ specific and immediate feedback” – a “traditional” therapy skill
What do you get in conversation ?

PML
- Knowledge of perfomance (KP) – “specific” feedback on whether the movement
was correct or incorrect – technique
- Knowledge of results (KR) – feedback on the outcome – not specific
- KP – aimed at changes in technique
- KR – aimed at self – evaluation and self- correction

Hong Kong speech and hearing simposium 1-4 november, 2018

Childhood Apraxia of Speech: From Diagnosis to Discharge
Professor Tricia McCabe
 Acquisition vs learning
- Treatment which is low intensity, easy targets with high frequency
knowledge of perfomance feedback leads to acquisition – an in- the-
session change

- Treatment which is high intensity, hard targets with low frequency

knowledge of results feedback and leads to long term change in behaviour
– i.e. learning

Applies to all motor learning. Requires resilient clinicians

Hong Kong speech and hearing simposium 1-4 november, 2018

Childhood Apraxia of Speech: From Diagnosis to Discharge
Professor Tricia McCabe