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Motor speech disorders
6
ACQ
Volume 12, Number 1 2010
ACQ
uiring knowledge in speech, language and hearing
Angela. T.
Morgan
This article
has been
peer-
reviewed
Keywords
apraxia
brain injury
child
dysarthria
motor speech
speech field to find alternative tools. The following section
considers commercially and non-commercially available
tools.
Commercial assessment tools
There are a number of commercially available standardised
tests that purport to assess “motor speech” in children,
implying that they assess both dysarthria and dyspraxia.
Anecdotally however, clinical observations may lead one to
surmise that the majority of paediatric motor speech
assessments have a particular bent towards childhood
apraxia of speech (CAS). In fact, this CAS bias was recently
confirmed, based on data in a review paper by McCauley
and Strand (2008). The authors evaluated the content and
psychometric characteristics of standardised tests of
nonverbal oral and speech motor performance in children.
Criterion for inclusion of tests for review were that the test
was: a) standardised; b) included young children (at or below
elementary school age), c) addressed non-verbal oral motor/
motor speech function, and d) available in July 2006 through
a commercial source. Tests that were only focused on oral
mechanism structure or sound system analyses were
excluded.
Only six of the 22 identified assessments met criterion:
i)
Apraxia Profile
(Hickman, 1997); ii)
Kaufman Speech
Praxis Test for Children
(Kaufman, 1995); iii)
Oral Speech
Mechanism Screening Examination
3rd Ed. (St Louis &
Ruscello, 2000); iv)
Screening Test for Developmental
Apraxia of Speech
– 2nd Ed. (Blakely, 2001); v) Verbal
Dyspraxia Profile (Jelm, 2001); and vi)
Verbal Motor
Production Assessment for Children
(Hayden & Square,
1999). Even from the titles of these assessments, it is
obvious that four of the six tests focus predominantly, if not
exclusively, on CAS.
Overall conclusions from the review were that the tests
varied markedly in both content and the methods of
test interpretation (McCauley & Strand, 2008). Few tests
documented reliability or validity data, even when this
information may have been generated during the test’s
development (McCauley & Strand, 2008). The VMPAC was
the only assessment to provide “adequately described”
normative data. It also came closest to meeting operational
definitions for test-retest and inter-examiner reliability data,
but did not fully meet them due to a lack of statistical detail.
The VMPAC was also the only test to meet any of the three
operational definitions for validation. Specifically, the VMPAC
The term “acquired brain injury” (ABI)
encompasses many debilitating neurological
aetiologies, including stroke, encephalitis,
traumatic brain injury, and brain tumour.
Dysarthria is one communication impairment
associated with ABI. In contrast with the adult
field, limited data are available on the
incidence, clinical features, and treatment
techniques for acquired dysarthria in
childhood. The aim of the present report is to
provide an overview of current evidence
regarding assessment and treatment of
dysarthria associated with childhood ABI.
A practically oriented discussion of what the
evidence means for clinicians working in
acute or rehabilitative practice is provided.
Assessment and diagnosis
A recent survey of 51 speech-language pathologists from 26
major paediatric rehabilitation centres across Australia, New
Zealand, the United Kingdom, and Ireland explored current
motor speech assessment practices (Morgan & Skeat, in
press). The majority of clinicians (67%) reported that they
were not satisfied with current motor speech assessments
for children with ABI. The most commonly used standardised
assessment tool was the
Frenchay Dysarthria Assessment
(Enderby, 1983) used by 74% of the group. The most
commonly used informal diagnostic approach was the
MAYO clinic diagnostic classification (Darley, Aronson &
Brown, 1975; Duffy, 2005), used by 67% of clinicians
surveyed. The limitations of using these tools with children
are obvious, in that: i) both tools were designed for adults;
and ii) only the Frenchay is standardised, yet based on adult
performances only, making the psychometric data invalid for
extrapolation to a paediatric population. Why are paediatric
clinicians relying on adult-based tests? In short, because
there are no tests available that have been standardised or
developed specifically for children with acquired dysarthria.
Current evidence guiding
assessment approaches
In the absence of an ABI specific paediatric dysarthria
assessment, we must look to the broader paediatric motor
Management of acquired
motor speech disorder
in children
A practical reflection on the evidence
Angela. T. Morgan