Academic journal article International Journal of Child Health and Human Development

Using VML (Verbal Motor Learning) Method Techniques in Treatment of Prosody Disorder Due to Childhood Apraxia of Speech: A Case Study

Academic journal article International Journal of Child Health and Human Development

Using VML (Verbal Motor Learning) Method Techniques in Treatment of Prosody Disorder Due to Childhood Apraxia of Speech: A Case Study

Article excerpt


Communication among people can be expressed in several ways such as through written correspondence, body language picture exchange or visual signals. However, the most powerful communication tool is speech which is unique to humans. Speech is built from verbal structures such as words and sentences and from nonverbal structures. A non-verbal communicative element of speech is the intonation which is produced by a combination of Vocal cord frequency, duration and intensity (1). Intonation is an ability that a child starts to control and develop in the first year of his life. This case study will describe the absence of intonation control in a child with childhood apraxia of speech (CAS) and a VML intervention for intonation control and prosody.

The origin of CAS is debated. Researchers have several approaches to CAS that lead to different treatment approaches (2). There are the motor control models and the psycholinguistic theories (3) that try to define the disorder. The ASHA committee (4) defines CAS as "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 a 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.

One of the diagnostic markers for CAS examines the ability to imitate movements of the three basic systems of speech: articulators (oral imitation), breathing (blowing out a candle, blowing bubbles) and vocal cords (sound production of any kind). The ability to imitate speech means that there is an ability to imitate combined movements of each of these systems. Speech is both the combined and timed work of these three systems.

If there is a problem in imitating movements of one of these systems in the absence of muscle tone deficits, lack of muscle power or anatomic disorder, than the speech problem is probably due to CAS.

One of the deficits in CAS is the lack of intonation. The child has difficulties in delivering a non-verbal message through his speech. Verbal language without intonation becomes poor and robotic. The loss of intonation has been well demonstrated among people after a head injury (5). Without intonation, the non-verbal message is unclear just as reading would be if it was done without punctuation marks. Teaching intonation to a child who doesn't understand how to produce the sound is not an easy task. Very few articles have been written on this subject. Exceptions are Helfrich-Miller (6) who demonstrated the Melodic Intonation Therapy Method which used melody patterns in order to organize speech patterns and Boutsen and Christman (7) who described the prosody issues in apraxia of speech.

Prosody is the patterns of stress and intonation in a language. The term generally covers intonation, rhythm, and focus in speech (8). Acoustically, prosody describes changes in the syllable length, loudness, pitch (frequency of a sound), and certain details of the formant structure of speech sounds. From the speech articulator's perspective, prosody is a result of changes in the velocity and range of motion in articulators like the jaw and tongue, along with change in the air pressure in the trachea and a change in the tension of the laryngeal muscles. Phonologically, prosody is described by tone, intonation, rhythm, and lexical stress (9).

The VML method is a set of Manual techniques, motor learning principles and multi-disciplinary therapeutic guidelines that is aimed at treating apraxia of speech.

The method was developed via field work with children diagnosed with CAS. Based on theory and previous research, the practical techniques framework, and evaluation, analysis and treatment forms were created. …

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