ACQ Vol 12 no 1 2010

met the operational definition for adequate content validity, but not for criterion-related or construct validity (McCauley & Strand, 2008). Hence, using assessment tool selection criteria based on psychometric properties, it appears that the VMPAC is the superior option for the assessment of motor speech impairment in children three to 12 years of age. Current paediatric motor speech assessment tools (including those reviewed by McCauley & Strand, 2008) largely measure impairment . They provide little consideration of the child’s everyday functional speech performance. Attempts to capture more functional aspects of speech performance are largely based on measuring intelligibility. Two commercially available standardised tools in the broader developmental speech field (i.e., not specifically designed for children with motor speech impairment) include the Children’s Speech Intelligibility Measure (CSIM; (Wilcox & Morris, 1999) and the recent Test of Children’s Speech Plus – Sentence Measure (TOCS+ SM; Hodge, 2008). The CSIM assesses intelligibility at a single word level, whereas the TOCS+ SM is based on sentences. Unfortunately, to the author’s knowledge, a more naturalistic standardised assessment of spontaneous speech is not available. Non-commercial assessment tools The McCauley and Strand (2008) study reviewed only commercial assessment tools still available for purchase in mid-2006. This criterion is understandable because it would ensure that the tools of interest were still readily available to clinicians, and that they were not outdated. It is possible, however, that useful non-commercial assessment tools may exist. For example, the non-commercial but standardised Oral and Speech Motor Control Protocol (OSMCP; Robbins & Klee, 1987). While the OSMCP was reported in 1987, references to its use still appear in the clinical-research literature to date, including in speech genetic studies where strong phenotyping or behavioural descriptions of children’s speech performance is required (e.g., Miscimarra et al., 2007; Stein et al., 2006). The OSMCP was normed on 90 children, with 10 children included for each 6 month age band from 2;6 to 6;11 years. There is overlap in the particular tasks required of the child in the OSMCP and the VMPAC. One difference between the two assessments is that the OSMCP is explicit in associating structure or function with specific cranial nerves. The OSMCP may be useful for a clinician working on an acute ward who seeks a systematic tool to document cranial nerve function in children within this age range. There are multiple formal or informal non-speech oral motor or cranial assessments available, however to the author’s knowledge, none have such extensive psychometric data (i.e., the OSMCP is standardised, and has examined test reliability, and inter-rater agreement). Implications for clinical practice The preceding review focused on oral motor or motor speech assessment tools that may be appropriate for use with children with acquired dysarthria. At a minimum however, childhood speech disorders call for a differential diagnosis of three key areas. Specifically, it is critical to determine whether and to what degree, i) structural anatomical, ii) developmental and/or iii) neurologically-based oral motor and motor speech factors are involved in the presenting speech impairment; see box 1 for an example of an assessment protocol.

Treatment Treatment for acquired dysarthria aims to effect sustained improvement in the speech system following brain injury, utilising principles of neural plasticity. 1 Current evidence guiding treatment approaches Recently, a Cochrane Collaboration review evaluated the efficacy of treatments for dysarthria associated with ABI in children aged three to 16 years (Morgan & Vogel, 2008). The review systematically identified that there are only 2 empirically driven studies in this field to date: 1) a single case ABAB study design focused on respiratory-based treatment for dysarthria (box 2; Murdoch et al., 1999), and 2) a case series ABA study design focused on an articulatory-based treatment (box 3; Morgan et al., 2007). 3. Motor speech examination • Oral motor/non-speech function (e.g., selected non-speech items in VMPAC Global motor control, Focal motor control, Sequencing subtests; or selected non-speech items in OSMCP) • Motor speech production (e.g., selected speech items in VMPAC or OSMCP) • Functional speech measure (e.g., CSIM, TOCS+ SM) Box 2. Treatment example summary A (Murdoch et al., 1999) • Participant: 12.5 year old with TBI post MVA • Time post-injury: 2.5 years • Speech diagnosis: mixed spastic-ataxic flaccid dysarthria (with severely impaired respiratory function) • Study design: single case ABAB design • Key therapy goals: i) increase control of inhalation and exhalation; ii) improve co-ordination of phonation and exhalation • Treatment technique: B1: Traditional therapy (included non- speech and speech tasks focused on establishing appropriate sub-glottal air pressure and enhancing the participant’s inhalation and exhalation control); B2: Visual biofeedback (included using a Respitrace plethysmograph to provide visual feedback of speech breathing while performing similar tasks to those in B1) • Treatment dose: B1: 8 x 30-45 minute sessions of traditional therapy across 2 weeks followed by a 10 week withdrawal period; B2: 8 x 30 minute sessions of respitrace (with visual biofeedback) over 2 weeks • Post-treatment result: real-time continuous biofeedback treatment was effective and superior to traditional therapy for modifying speech breathing patterns in this case TBI: traumatic brain injury, MVA: motor vehicle accident; ABAB: A = assessment, B = treatment Box 1. Example protocol for assessment of motor speech (dysarthria) in ABI 1. Oro-facial structural exam (e.g., OSMCP; selected items from OSMCP or VMPAC) 2. Developmental speech production , i.e., articulation and phonology (e.g., Goldman Fristoe Test of Articulation – 2, Goldman & Fristoe, 2000; Diagnostic Evaluation of Articulation and Phonology , Dodd, Hua, Crosbie, Holm, & Ozanne, 2006)

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ACQ Volume 12, Number 1 2010

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