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54

ACQ

Volume 12, Number 1 2010

ACQ

uiring knowledge in speech, language and hearing

of the movement). KP is information about the nature

or quality of the movement. It includes biofeedback and

external feedback provided by an instructor (clinician). The

article draws on extensive literature regarding the nature of

feedback frequency, intensity, and timing.

Having disected this complex theory, the article finally

draws together the above concepts and discusses the

clinical implications when applying it to the people we treat

on a daily basis. It provides a case example and shows how

intervention may be constructed to improve motor speech

outcomes for people with AOS. While I believe there is still

much to learn about the motor speech system and how to

help repair it once it is broken, this article goes a long way

to bridge the divide between principles of learning, practice,

feedback, and attention with motor speech production.

Included below is the “shortlist” of key articles that form

a comprehensive reading list to help unlock the mysteries

behind AOS. I hope you enjoy!

References

Ballard, K.J., Maas, E., & Robin, D. A. (2007) Treating control

of voicing in apraxia of speech with variable practice.

Aphasiology

,

21

(12),1195-1217.

Guadagnoli M.A. & Lee, T.D. (2004). Challenge point: A

framework for conceptualizing the effects of various practice

conditions in motor learning.

Journal of Motor Behavior

,

36

(2), 212–224.

Guenther, F. H. (2006). Cortical interactions underlying the

production of speech sounds.

Journal of Communication

Disorders

,

39

, 350–365.

Schmidt, R. A. (1975). A schema theory of discrete motor

skill learning.

Psychological Review

,

82

, 225–260.

Schmidt, R.A. & Lee, T.D. (1999).

Motor control and

learning: A behavioural emphasis

. (3rd ed.). Champaigne, IL:

Human Kinetics.

Wambaugh, J.L., Duffy J.R., McNeil, M. R., Robin, D. A.,

& Rogers, M. A. (2006). Treatment guidelines for acquired

apraxia of speech: A synthesis and evaluation of the

evidence.

Journal of Medical Speech-Language Pathology

,

14

(2), xv–xxxiii.

Investigating word intelligibility in

Parkinson’s disease

Neel, A. (2009). Effects of loud and amplified speech on

sentence and word intelligibility in Parkinson disease.

Journal

of Speech, Language and Hearing Research

,

52

, 1021–

1033.

Kylie Mulcahy

In management of hypokinetic dysarthria related to

Parkinson’s disease, the effects of increased vocal effort (or

loud speech) as opposed to simple amplification are unclear.

In this study, the authors aim to explain the mechanisms that

contribute to deficits in speech intelligibility by dichotomising

Principles of motor learning

Maas E., Robin, D., Austermann Hula, S.N., Freedman, S. E.,

Wulf, G., Ballard, K. J., & Schmidt, R. A. (2008). Principles of

motor learning in treatment of motor speech disorders.

American Journal of Speech-Language Pathology

,

17

,

277–298.

Erin Godecke

At last! An article that incorporates all you need to know

about treating apraxia of speech (AOS). This tutorial-based

article incorporates a critical review of existing AOS literature

and presents a theoretical framework to better guide clinical

management of the disorder. The authors describe the

founding principles of general motor learning and go on to

apply these principles to speech motor learning. Essential to

the development of the links between speech and general

motor learning is the concept of “learning versus

performance”, which the authors believe to be intimately

associated with the holy grail of all speech intervention,

namely “improved generalisation and carryover”.

The authors draw heavily on the “Schema Theory”

(Schmidt, 1975, 2003; Schmidt & Lee, 2005) which assumes

that in the intact motor learning system, motor programs

are retrieved from memory and subsequently adapted to

a specific situation. The motor programs are shaped and

honed with increased practice and eventually stored as

learned chunks of behaviour. The authors postulate that

the principles of motor learning (Schema Theory) extend

to impaired speech systems, and demonstrate that with

optimal conditions of practice, improved generalisation

and carryover can be achieved. Additionally, the authors

present a synopsis of the “Challenge point framework” by

Guadagnoli and Lee (2004) which augments the theoretical

underpinnings of the Schema Theory and introduces

the concept of optimal (motor) learning environments to

treatment of AOS.

In order to assimilate a large amount of theory, the

authors discuss key issues, including the structure of

practice, attentional focus, movement complexity, and

feedback type. The structure of practice is partitioned into:

1) amount, which refers to the overall time spent practising

the movements; 2) distribution, which is how the practice is

aportioned over time; 3) variability, which describes practice

performed in different variations; and 4) schedule, which

refers to different movements being used to achieve an

unpredictable target. Attentional focus relates to either the

internal focus, which is concentrating on kinetic, kinematic,

and somatosensory information; or the external focus which

describes attention to movement of an object (e.g., golf club)

to achieve a goal. Movement complexity relates directly to

the Challenge point framework and breaks tasks into simple

(part) or whole (complex) movements. Feedback type is

divided into knowledge of results (KR) and knowledge of

performance (KP). KR is information about the movement

outcome, in relation to the goal (provided at the completion

Around the journals

Motor speech disorders