Academic journal article Journal of Medical Speech - Language Pathology

Using Principles of Motor Learning to Treat Apraxia of Speech after Traumatic Brain Injury

Academic journal article Journal of Medical Speech - Language Pathology

Using Principles of Motor Learning to Treat Apraxia of Speech after Traumatic Brain Injury

Article excerpt

Background: This study examined the effectiveness of a modified version of the Motor Learning Guided (MLG) approach, a treatment protocol to establish functional speech that incorporates principles of motor learning: blocked and random practice schedules, delayed and summary knowledge of response (KR) feedback, and specificity of training.

Methods: A 29-year-old male survivor of traumatic brain injury diagnosed with moderate-severe apraxia of speech (AOS) participated in this protocol. A time-series ABA design measured the participant's production of two sets of five target items, and his ability to maintain accurate productions several months after treatment.

Results: Improvements were seen in the participant's ability to produce both sets of trained items; however, the second set of target items were practiced with more frequency, which may have lead to a greater accuracy of production in less time compared to the first set of five target items.

Conclusions: Application of motor learning principles through the modified MLG approach can lead to increased accuracy and automaticity of trained target items, and the ability to maintain accurate phrase production following cessation of treatment. Adherence to a frequent practice schedule and other motor learning principles is influential to success of this treatment for AOS.

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Everyday tasks such as saying hello, typing without looking at the keyboard, and riding a bicycle without explicitly thinking about each step or component of the task are examples of learned motor programs. The structure of actions is known as the motor program (Wulf, Schmidt, & Deubel, 1993). Much of the empirical evidence for motor programs relates to motor movements of limbs in sport training (Schmidt, 1991) and physical rehabilitation (Buxbaum et al., 2008; Gilmore & Spaulding, 2001; Hesse, 2001; Krakauer, Mazzoni, Ghazizadeh, Ravindran, & Shadmehr, 2006; Langhammer & Stanghelle, 2000; Platz, Denzler, Kaden, & Mauritz, 1994; Smania et al., 2006). Specification of motor programs for speech movements is relatively less documented in the literature, but it appears the standard principles used to form motor programs can be applied to achieve predicted results in speech as well. A recent tutorial article by Maas et al. (2008) summarized practice and feedback conditions most likely to result in formation of new motor programs. A motor program is considered learned when permanent changes in ability to perform motor skills are observed. At this time, it is unclear whether the principles of nonspeech motor learning can be similarly applied to speech motor learning. One way to examine the function of motor principles in speech (re)learning is to test treatment protocols incorporating principles of motor learning (ML) in speech rehabilitation, as was this study's aim.

MOTOR PROGRAMS

Permanent and accurate execution of motor programs is the result of practice or experience (Schmidt, 1991). Several principles of motor learning have been developed to specifically characterize the practice parameters most effective for learning motor programs. According to Schmidt (1991) three main stages are involved in building a motor program: a stimulus identification stage, which detects environmental information; a response selection stage, which resolves uncertainty about what action should be made; and a response-programming stage, which organizes the system for action. These stages together create a motor program for a specific movement, such as swinging a golf club or saying "hello." Motor programs include the relative timing and force of muscle commands for carrying out discrete movements (Austermann Hula, 2007).

Duffy (2005) identified six motor learning tenets of forming motor programs:

1. Drill is essential because repetitive, frequent practice is the first step toward formation of a motor program. Without frequent practice the brain and muscle movements will not be performed with consistency or accuracy. …

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