Therapy Outcome of Combined Treatment Approach In Childhood Apraxia of Speech (CAS)

Abstract

Background: Childhood apraxia of speech (CAS) is a neurological childhood speech disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits. CAS is a controversial disorder in terms of diagnosis and intervention approaches. Purpose: Due to heterogeneity of children with CAS, a speech language pathologist faces methodological challenges to administer any single therapy approach. Absence of any single effective CAS oriented therapy approach leads to a critical need for research on a use of reliable and effective treatment protocols together through eclectic approach and its validation. Objectives: To assess the effectiveness of Nuffield dyspraxia program (NDP) with incorporation of melodic intonation therapy (MIT) and multisensory approach for CAS. Methods: A Hindi speaker child age 8years/male had difficulties in achieving initial articulatory configurations and transitioning into and out of these configurations during speech and non-speech task. Single subject experimental design with multiple baselines across behaviours e.g. non speech motor task, speech production abilities, prosody, speech perception, language skills was used. NDP therapy steps were followed along with the use of MIT and multisensory input. Results: After 1hour sessions, twice a week for 7 months of treatment, improvement in automaticity and flexibility of articulatory movement was found in non-speech and speech motor task. Child achieved 80% target stimuli with 90% accuracy on naming task (Appendix-I). Language domains i.e., Syntax, semantics, and pragmatic was rated as Brown stage 3, 5 year and 5-7years respectively. These language domains were also evaluated on 18th, 36th and 54th session of treatment. Conclusion: Incorporation of these approaches would help in tailor made therapy plan and its replication would increase its external validity.