Academic journal article International Journal of Child Health and Human Development

The Influence of Initial Phoneme Cue Technique on Word Formation: A Case Study of a Child with Apraxia of Speech and Autism

Academic journal article International Journal of Child Health and Human Development

The Influence of Initial Phoneme Cue Technique on Word Formation: A Case Study of a Child with Apraxia of Speech and Autism

Article excerpt


Initial phoneme cue (IPC) is a technique that is used for word formation among patients with Childhood Apraxia of Speech (CAS). Not many such techniques have been examined objectively in order to prove their usefulness in treatment of CAS in general let alone in the Hebrew language. An objective investigation of the IPC technique may provide clinical knowledge of the efficiency of the technique and may help in improving the technique's protocol. The purpose of this study was to assess the effect of the IPC technique of the Verbal Motor Learning (VML) method in teaching word formation among children diagnosed with CAS and Autism. I will begin by defining the CAS condition and scanning different techniques for treating difficulties in word formation and then concentrate on the IPC technique.

Childhood apraxia of speech (CAS) is a motor- speech disorder that occurs among children. This disorder is different from apraxia of speech (AOS) that occurs among adults after a head injury or cerebral vascular accident (1). The updated definition of CAS according to the ASHA (American Speech- Language-Hearing Association) is:

"Childhood apraxia of speech (CAS) is a neurological childhood (pediatric) speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits (e.g., abnormal reflexes, abnormal tone). CAS may occur as a result of known neurological impairment, in association with complex neurobehavioral disorders of known or unknown origin, or as an idiopathic neurogenic speech sound disorder. The core impairment in planning and/or programming spatiotemporal parameters of movement sequences results in errors in speech sound production and prosody"

Levelt et al (2) distinguish between three different stages of speech and their pathologies, 1) impairments of lexical access to the word form (classic anomia), 2) phonological encoding (post lexical phonological disorder), and 3) phonetic encoding (apraxia of speech). CAS causes deficits in the production of consonants, vowels and the formation of words. Pronouncing a word built from two open familiar syllables can be a difficult task for a child with CAS (3). A common characteristic of word imitation among children diagnosed with CAS is a difficulty in pronouncing the first syllable of the word (4).

Shriberg et al (4) identified segmental and supra- segmental characteristics of CAS. The segmental characteristics include (a) an articulatory struggle (groping) particularly on word onsets, (b) trans positional (metathetic) substitution errors reflecting sequencing constraints on adjacent sounds, (c) marked inconsistencies on repeated tokens of the same word type, (d) proportionally increased sound and syllable deletions relative to overall severity of involvement and (e) proportionally increased vowel/diphthong errors relative to overall severity of involvement. The supra-segmental characteristics include (a) inconsistent realization of stress (i.e. prominence on syllables or words), (b) inconsistent realization of temporal constraints on both speech and pause events and (c) inconsistent oral-nasal gestures underlying the percept of nasopharyngeal resonance. All of these characteristics of CAS effects word formation.

Techniques for treating difficulties in word formation

A number of approaches and techniques have been introduced in the literature to deal with word formation. Tomlin (5) suggested forming words by practicing monosyllabic words and when the severity of the apraxia condition decreases the therapist should proceed to practicing multi-syllabic words. Tomlin (5) started teaching pronunciation by increasing phoneme control up to an 80% success rate of pronunciation. She argued that when the client starts to produce the phoneme correctly he/she will begin to understand the tactile/kinesthetic pattern of the phoneme.

Another approach is the cycles approach (6) which combines various phonological theories including cognitive psychology principles, phonological acquisition research and clinical phonology research. …

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