Starting Over in Apraxia Research

By Pam Marshalla

Q: I have heard you complain about research in the area of apraxia. Why do you think it is so poor?

Think about this: APRAXIA occurs in the ABSENCE of neuromuscular disorder while DYSARTHRIA occurs in the PRESENCE of neuromuscular disorder.

Now think about this: ALL the research in speech that has been done on apraxic kids since the beginning of time has been done without any assessment of their muscle tone.  Researchers have just been assuming that tone is okay.  Researchers are taking all kids with very severe artic/phono problems and calling them apraxic without ANY evaluation of their tone.

Therefore all the apraxia research done from the beginning of time through today should be thrown out and we should start over.  Researchers in the area of apraxia should be required to have an assessment of client tone done by an OT/PT to qualify the subjects for their research projects.  Those with hypertonicity or hypotonicity should be tossed out.

0 thoughts on “Starting Over in Apraxia Research”

  1. Pam,
    What assessment(s) would you recommend for a second grader if you (highly) suspect dysarthria?
    His mother has told me that he was diagnosed with “low tone” before entering kindergarten. He received OT services prior to entering Kdg. He goes to a private school so OT/PT services are not available. He has had artic therapy 3 times per week for 2 years and 2 times per week this last year. No change on his “artic test” although he works hard, they practice at home but no carryover even at the word level unless he exagerrates and over articulates (which is what we are doing in therapy for sibilants – he lateralizes them- and all R sounds with vowels sometimes “off”).
    Do you have a recommendation on a published test that will help me evaluate speech besides just looking at artic?
    Thank you so much for this website- I refer to it constantly and highly recommend it to my colleagues.

    1. I have no magic test for you. A diagnosis of low tone should automatically assign him a diagnosis of dysarthria. That is what dysarthria is– speech problem the result of neuromuscular disorder.

      Dysarthric kids have all the same artic and phonological problems that everyone else has with the exception that they have more distortion, especially distorted vowels and errors on prosody.

      The diagnosis of apraxia and dysarthria is not an evaluation that arises because of the phonetic and phonological problems. The diagnosis comes when you know the CAUSE of the artic and phono problems.

      The cause of dysarthria is muscle tone disturbance.

  2. Pam, thank you so very much for this site! When you say that an OT/PT should evaluate tone, are you referring specifically to oral/facial tone? Or do you mean overall tone?

    1. In an ideal world, the diagnosis of tone disturbance would come from co-analysis by OT, PT, and Speech. But many of the clients we see are seen by us only, and so we have to do it. Unfortunately, SLPs are not trained to do this. Isn’t that amazing! we are expected to diagnose apraxia but we are not trained to dx muscle tone. Things have got to change in our universities. Students deserve to be trained to do the things they need to do.

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