Tools for the assessment of childhood apraxia of speech.

PURPOSE: This study systematically reviews the literature on the main tools used to evaluate childhood apraxia of speech (CAS). RESEARCH STRATEGY: The search strategy includes Scopus, PubMed, and Embase databases. SELECTION CRITERIA: Empirical studies that used tools for assessing CAS were selected. DATA ANALYSIS: Articles were selected by two independent researchers. RESULTS: The search retrieved 695 articles, out of which 12 were included in the study. Five tools were identified: Verbal Motor Production Assessment for Children, Dynamic Evaluation of Motor Speech Skill, The Orofacial Praxis Test, Kaufman Speech Praxis Test for Children, and Madison Speech Assessment Protocol. There are few instruments available for CAS assessment and most of them are intended to assess praxis and/or orofacial movements, sequences of orofacial movements, articulation of syllables and phonemes, spontaneous speech, and prosody. CONCLUSION: There are some tests for assessment and diagnosis of CAS. However, few studies on this topic have been conducted at the national level, as well as protocols to assess and assist in an accurate diagnosis.

Instrumentos para avaliação de apraxia de fala infantil / Tools for the assessment of childhood apraxia of speech

RESUMO Objetivo: Revisar sistematicamente na literatura os principais instrumentos utilizados para avaliação da apraxia de fala infantil. Estratégia de pesquisa: Realizou-se busca nas bases Scopus, PubMed e Embase Critérios de seleção: Foram selecionados estudos empíricos que utilizaram instrumentos de avaliação da apraxia de fala infantil. Análise dos dados: A seleção dos artigos foi realizada por dois pesquisadores independentes. Resultados: Foram encontrados 695 resumos. Após a leitura dos resumos, foram selecionados 12 artigos completos. Foi possível identificar cinco instrumentos: Verbal Motor Production Assessment for Children, Dynamic Evaluation of Motor Speech Skill , The Orofacial Praxis Test , Kaufman Speech Praxis Test for children e o Madison Speech Assessment Protocol . São poucos os instrumentos utilizados para identificação da apraxia de fala infantil e a maioria destina-se à avaliação da realização de praxias e/ou movimentos orofaciais, sequências de movimentos orofaciais, articulação de fonemas simples, fonemas complexos e sílabas, fala espontânea, além da adequação da prosódia. Conclusões: Percebe-se que existem instrumentos que se propõem a avaliar e diagnosticar a apraxia de fala infantil. No entanto, ainda são escassos os estudos sobre esse tema em nível nacional, bem como protocolos padronizados e validados para a população brasileira que avaliem e ajudem em um diagnóstico preciso.

ABSTRACT Purpose: This study systematically reviews the literature on the main tools used to evaluate childhood apraxia of speech (CAS). Research strategy: The search strategy includes Scopus, PubMed, and Embase databases. Selection criteria: Empirical studies that used tools for assessing CAS were selected. Data analysis: Articles were selected by two independent researchers. Results: The search retrieved 695 articles, out of which 12 were included in the study. Five tools were identified: Verbal Motor Production Assessment for Children, Dynamic Evaluation of Motor Speech Skill, The Orofacial Praxis Test, Kaufman Speech Praxis Test for Children, and Madison Speech Assessment Protocol. There are few instruments available for CAS assessment and most of them are intended to assess praxis and/or orofacial movements, sequences of orofacial movements, articulation of syllables and phonemes, spontaneous speech, and prosody. Conclusion: There are some tests for assessment and diagnosis of CAS. However, few studies on this topic have been conducted at the national level, as well as protocols to assess and assist in an accurate diagnosis.

Effects of video modelling on emerging speech in an adult with traumatic brain injury: preliminary findings.

PRIMARY OBJECTIVE: Research has shown that traumatic brain injury (TBI) can affect a person's ability to perform previously learned skills. Dysexecutive syndrome and inattention, for example, alongside a number of other cognitive and behavioural impairments such as memory loss and lack of motivation, significantly affect day-to-day functioning following TBI. This study examined the efficacy of video modelling in emerging speech in an adult male with TBI caused by an assault. RESEARCH DESIGN: In an effort to identify functional relations between this novice intervention and the target behaviour, experimental control was achieved by using within-system research methodology, overcoming difficulties of forming groups for such an highly non-homogeneous population. METHODS AND PROCEDURES: Across a number of conditions, the participant watched a videotape in which another adult modelled a selection of 19 spoken words. When this modelled behaviour was performed in vivo, then generalization across 76 other words in the absence of a videotape took place. MAIN OUTCOMES AND RESULTS: It was revealed that video modelling can promote the performance of previously learned behaviours related to speech, but more significantly it can facilitate the generalization of this verbal behaviour across untrained words. CONCLUSIONS: Video modelling could well be added within the rehabilitation programmes for this population.

Development of an assessment tool for motor praxis ability in children aged 5-8 years.

OBJECTIVES: To develop a Motor Praxis Ability Test (MPAT) and examine its psychometric properties. METHODS: The study consisted of two phases: items and scoring criteria of MPAT were developed in phase I. Content validity was clarified by the expert panel discussion method. The preliminary psychometric properties of the MPAT were examined in phase II. Data were collected with two samples consisting of typically-developing children and dyspraxic children. RESULTS: The results revealed high internal consistency reliability. The inter-rater and test-retest reliability for the total score of both sample groups were excellent. The results also revealed that the MPAT was able to discriminate between typical children and dyspraxic children. CONCLUSION: The current study concluded that the MPAT is a highly valid and reliable assessment tool. It can be also used as an appropriate assessment tool for screening and evaluating dyspraxia in children aged 5-8 years.

A motor speech assessment for children with severe speech disorders: reliability and validity evidence.

PURPOSE: In this article, the authors report reliability and validity evidence for the Dynamic Evaluation of Motor Speech Skill (DEMSS), a new test that uses dynamic assessment to aid in the differential diagnosis of childhood apraxia of speech (CAS). METHOD: Participants were 81 children between 36 and 79 months of age who were referred to the Mayo Clinic for diagnosis of speech sound disorders. Children were given the DEMSS and a standard speech and language test battery as part of routine evaluations. Subsequently, intrajudge, interjudge, and test-retest reliability were evaluated for a subset of participants. Construct validity was explored for all 81 participants through the use of agglomerative cluster analysis, sensitivity measures, and likelihood ratios. RESULTS: The mean percentage of agreement for 171 judgments was 89% for test-retest reliability, 89% for intrajudge reliability, and 91% for interjudge reliability. Agglomerative hierarchical cluster analysis showed that total DEMSS scores largely differentiated clusters of children with CAS vs. mild CAS vs. other speech disorders. Positive and negative likelihood ratios and measures of sensitivity and specificity suggested that the DEMSS does not overdiagnose CAS but sometimes fails to identify children with CAS. CONCLUSIONS: The value of the DEMSS in differential diagnosis of severe speech impairments was supported on the basis of evidence of reliability and validity.

Toward a quantitative basis for assessment and diagnosis of apraxia of speech.

PURPOSE: We explored the reliability and validity of 2 quantitative approaches to document presence and severity of speech properties associated with apraxia of speech (AOS). METHOD: A motor speech evaluation was administered to 39 individuals with aphasia. Audio-recordings of the evaluation were presented to 3 experienced clinicians to determine AOS diagnosis and to rate severity of 11 speech dimensions. Additionally, research assistants coded 11 operationalized metrics of articulation, fluency, and prosody in the same speech samples and in recordings from 20 neurologically healthy participants. RESULTS: Agreement among the 3 clinicians was limited for both AOS diagnosis and perceptual scaling, but inter-observer reliability for the operationalized metrics was strong. The relationships between most operationalized metrics and mean severity ratings for corresponding perceptual dimensions were moderately strong and statistically significant. Both perceptual scaling and operationalized quantification approaches were sensitive to the presence or absence of AOS. CONCLUSIONS: Perceptual scaling and operationalized metrics are promising quantification techniques that can help establish diagnostic transparency for AOS. However, because satisfactory reliability cannot be assumed for scaling techniques, effective training and calibration procedures should be implemented. Operationalized metrics show strong potential for enhancing diagnostic objectivity and sensitivity.

Comprehensive assessment of gesture production: a new test of upper limb apraxia (TULIA).

BACKGROUND: Only few standardized apraxia scales are available and they do not cover all domains and semantic features of gesture production. Therefore, the objective of the present study was to evaluate the reliability and validity of a newly developed test of upper limb apraxia (TULIA), which is comprehensive and still short to administer. METHODS: The TULIA consists of 48 items including imitation and pantomime domain of non-symbolic (meaningless), intransitive (communicative) and transitive (tool related) gestures corresponding to 6 subtests. A 6-point scoring method (0-5) was used (score range 0-240). Performance was assessed by blinded raters based on videos in 133 stroke patients, 84 with left hemisphere damage (LHD) and 49 with right hemisphere damage (RHD), as well as 50 healthy subjects (HS). RESULTS: The clinimetric findings demonstrated mostly good to excellent internal consistency, inter- and intra-rater (test-retest) reliability, both at the level of the six subtests and at individual item level. Criterion validity was evaluated by confirming hypotheses based on the literature. Construct validity was demonstrated by a high correlation (r = 0.82) with the De Renzi-test. CONCLUSION: These results show that the TULIA is both a reliable and valid test to systematically assess gesture production. The test can be easily applied and is therefore useful for both research purposes and clinical practice.

An extended drawing test for the assessment of arm and hand function with a performance invariant for healthy subjects.

Impaired hand motor function resulting from neurological, psychiatric or orthopaedic disorders affects patients of all ages. Existing hand function assessment methods, e.g. rating scales, accelerometers and electromyographical devices, are often time-consuming to administer, subjective in interpretation and/or expensive. Graphonomic tests are gaining popularity as a way of avoiding these drawbacks while relating directly to writing and drawing. Here we present a computerized Extended Drawing Test (EDT), which improves on an earlier Drawing Test for stroke patients in three ways. First, it assesses isolated proximal arm movement using a graphics pen in a puck-like pen holder, and in addition combined arm and finger dexterity in movements using a normal writing grip. Secondly, we calibrated our test against 186 healthy subjects (3-70 years), finding significant age- and handedness-related differences in both speed and accuracy of drawing. Thirdly, to simplify assessment we devised an overall performance measure using a variant of Fitts' Law combining speed and accuracy, which we found to be age-independent for healthy subjects above 3 years of age. This result enables us to provide age-independent performance norms using both hands, with and without the pen holder. These norms may assist quantification of specific arm dysfunction by comparing patient performance with the healthy norms, and also by comparing within-patient performance in the dominant and non-dominant hands with and without the pen holder. Using our freely available software, this new test will allow clinicians to rapidly assess arm and hand function across a wide range of patient categories and ages.

Cognitive approach to the assessment of limb apraxia.

A new instrument for the assessment of the different levels of gesture processing, as identified by recent cognitive models of apraxia, is presented. The battery comprises thirteen tasks -- eight assess the production of meaningful gestures both on command and on imitation, four tasks assess the ability to recognize and identify gestures, and one task assesses imitation of meaningless gestures. The battery encompasses a novel test of gesture production on visual command. A total of 60 healthy British volunteers were tested with the entire battery. On the whole, participants made more errors with pantomimes than with other tasks. Their scores served as norms.

Cognitive and motor assessment in autopsy-proven corticobasal degeneration.

OBJECTIVE: To investigate the clinical features of autopsy-proven corticobasal degeneration (CBD). METHODS: We evaluated symptoms, signs, and neuropsychological deficits longitudinally in 15 patients with autopsy-proven CBD and related these observations directly to the neuroanatomic distribution of disease. RESULTS: At presentation, a specific pattern of cognitive impairment was evident, whereas an extrapyramidal motor abnormality was present in less than half of the patients. Follow-up examination revealed persistent impairment of apraxia and executive functioning, worsening language performance, and preserved memory. The motor disorder emerged and worsened as the condition progressed. Statistical analysis associated cognitive deficits with tau-immunoreactive pathology that is significantly more prominent in frontal and parietal cortices and the basal ganglia than temporal neocortex and the hippocampus. CONCLUSION: The clinical diagnosis of corticobasal degeneration should depend on a specific pattern of impaired cognition as well as an extrapyramidal motor disorder, reflecting the neuroanatomic distribution of disease in frontal and parietal cortices and the basal ganglia.

Development of an assessment for ideational praxis.

OBJECTIVE: This study developed an assessment of ideational praxis, examined its psychometric properties, and analyzed age and gender trends in children who were typically developing. METHOD: Part 1 developed items and scoring criteria of the Test of Ideational Praxis (TIP) and examined interrater reliability and internal consistency. Part 2 studied performance of 80 typically developing children between ages 5 and 8 years. RESULTS: The TIP demonstrated acceptable interrater reliability (ICC = .85) and internal consistency (coefficient alpha = .74). Children who were typically developing demonstrated age and gender trends. Girls scored higher than boys, and older children scored higher than younger children. CONCLUSION: The TIP is the first objective assessment for identification of ideational abilities and is a reliable assessment tool. Further research is needed to validate the construct of ideation and examine the TIP's ability to discriminate between children with and without ideational difficulties.

Clumsiness, dyspraxia and developmental co-ordination disorder: how do health and educational professionals in the UK define the terms?

At the turn of the century, the idea that there might be a discrete childhood syndrome, which had 'clumsiness' of movement as its defining symptom, began to emerge. Since then numerous labels have been applied to the syndrome. In spite of recent attempts to standardise the terminology used, variation continues to compromise inter-professional communication and interpretation of research. The aim of this study was to determine how the three terms 'Clumsy', 'Dyspraxia' and 'Developmental Co-ordination Disorder (DCD)' are viewed by health and educational professionals in the UK. Two hundred and thirty-four adults (57% from the health professions and 43% from education) provided a written definition of each term. Content analysis of the 702 definitions was used to determine: (1) the extent to which the terms were familiar/acceptable to the respondents; and (2) to capture differences in the meaning of the term being defined. The results indicated that the terms 'DCD' and 'Dyspraxia' were less familiar than the term 'clumsy' which was, however, least acceptable. Amongst those professionals who were familiar with all three terms, there was general agreement that all were used to describe some sort of overall movement difficulty. Beyond that point, divergence of understanding and inter-professional differences in emphasis emerged. The implications of these differences for clinical and educational practice, research and policy making are discussed.

The assessment of limb apraxia: an investigation of task effects and their cause.

To test the effects of variations in the structure of tasks used to assess limb apraxia, eight tasks--differing in their modes of elicitation (tactile, verbal, visual, imitation) and/or types of movement elicited (transitive, intransitive, meaningless)--were administered to 25 carefully selected subjects with idiomotor limb apraxia. When standardized scores (based on the performance of 10 nonneurologically impaired control subjects) were used to measure the differences between tasks, no clinically significant task effects were found. Additional investigation was made of two causal hypotheses regarding the processes underlying limb apractic performance. The results of factor analyses and a search for double dissociations among individual subjects were consistent with the (severity) hypothesis that differences in task performances (raw scores) reflect degrees of task difficulty; and they failed to support the (disconnection) hypothesis that posits separate and independent neural/mental processes underlying task performances.

Return to work after stroke. A follow-up study.

BACKGROUND AND PURPOSE: Few studies have reported the longitudinal trend of return to work after stroke. The purpose of our study was to evaluate the longitudinal trend of proportion of patients who return to work after stroke and further to examine the predictors of return to work while taking follow-up periods into consideration. METHODS: We conducted a retrospective cohort study on the association between characteristics of stroke patients at admission and return to work after first stroke, taking length of follow-up period into consideration (n = 183). The patients were all younger than 65 years and were working at the time of their stroke. A follow-up questionnaire evaluated return to work and related information. Data were analyzed using the Kaplan-Meier method for curves of the proportion of return to work and Cox's proportional hazards model for odds ratios of return to work. RESULTS: The curve of proportion of return to work had two steep slopes, and the proportion was at a maximum at 18 months from patient admission. The adjusted odds ratios of return to work for patients with normal muscle strength versus severe weakness, without apraxia versus with apraxia, and with white-collar versus blue-collar occupations were 5.16 (P < .05), 4.16 (P < .05), and 1.43 (.05 < P < .10), respectively. CONCLUSIONS: The increase of proportion of return to work after stroke was nonlinear, and this trend was referable to the social security systems available to the patients included in this study. Normal muscle strength and absence of apraxia were significant predictors of return to work after stroke. White-collar occupation showed a tendency to promote return to work.