Ax of CAS Flashcards
(41 cards)
1
Q
General case history qs
A
- Babbling
- Use of gesture
- Feeding, swallowing
- Family history, including academic
- Motor development, self-help skills
- Socialization
2
Q
Non-speech motor function in case history
A
- General sensorimotor organisation
- Oral sensorimotor organisation
3
Q
General sensorimotor organisation
A
- Posture and gait, movement
patterns - Gross and fine motor coordination
4
Q
Oral sensorimotor organisation
A
- Overt paresis, asymmetry
- Mouth posture, saliva control
5
Q
ICF components
A
Body functions and structures, activity, participation, environmental factors, personal factors
6
Q
body structure
A
- CAS is associated with functional impairment rather than structural impairment
- Comorbidity? - DLD/hearing impairment as well?
- Oro-motor examination
- Onward referral e.g. ENT is needed
7
Q
body function (11)
A
- Vowel error
- Consonant distortion
- Stress errors
- Syllable segregation
- Groping
- Intrusive schwa
- Voicing error
- Slow rate
- Increased difficulty with multisyllabic words
- Resonance or nasality disturbance
- Difficulty achieving initial articulatory configurations or transitional movement gestures
8
Q
Vowel errors
A
- obvious sign of apraxia
- Iuzzini-Siegel et al., 2017: 100% of participants with CAS (n=20) had vowel errors, only 10% of children with speech delay
9
Q
vowel errors implication
A
ensure vowels are assessed in single word pronunciation and in imitation
10
Q
Consonant deletion
A
- not a defining feature
- Precision is impaired, but
phonological knowledge is present
11
Q
consonant deletion implication
A
ensure data sample
includes range of target sounds in single word and connected speech
12
Q
stress errors
A
- Can only be identified in contexts that contain contrastive syllable stress.
- Difficulties with lexical stress (Murray et al., 2015)
- Difficulties with sentential stress (Shriberg et al., 2011)
13
Q
stress errors implication
A
Must assess using multi-syllable words and phrases
14
Q
Syllable segregation
A
- Equalization of stress, duration, intensity and pitch across syllables; stress
may not vary appropriately - 5% of children with CAS vs 30% of children with other SSD
- Moderately sensitive and specific feature
15
Q
Syllable segregation implication
A
include varying stress in stimuli, diacritics are important
16
Q
Groping
A
- Long established
- Compensatory or core?
- Murray et al., (2015): groping
accurately identified 54% of
preschool participants with CAS - Consistent with CAS, but not
mandatory - May be specific, but not sensitive
17
Q
Intrusive schwa
A
- Schwa insertion (epenthesis) within cluster
- Common error in SSD
- Consistent with CAS, but also with many other disorders
18
Q
Intrusive schwa implication
A
careful transcription
19
Q
Voicing errors
A
- Common error, but may persist far longer in children with CAS
- Lewis et al. (2004): 90% of preschool and 40% of school aged children with CAS; IzzuniSiegel et al. :17/20 persisted with voice errors
20
Q
voicing errors implication
A
single word and connected speech
21
Q
Slow rate
A
- Core or compensatory
- Consistent with CAS but also with many other SSD
- Only 18% accurate in predicting expert
diagnosis
22
Q
Slow rate implication
A
Consider speech rate
23
Q
Increased difficulty with multisyllable words
A
- Occurs across many SSD
- Requires careful assessment and balancing of stimuli
- Questionable
24
Q
Increased difficulty with multisyllable words implication
A
careful selection of target multisyllable words in assessment
25
Resonance or nasality disturbance
- Inconsistent resonance patterns
- May be difficult to assess reliably
- If persistent, consider referral to ENT
- Motor rather than structural explanation
26
Resonance or nasality disturbance implication
collect data over time; record and evaluate
27
Speech sound inconsistency
- Extent of inconsistency is relevant: at the phonemic level
- Children with high inconsistency (18% or higher) also presented
vowel and voicing errors: convergence of features
- Phonemic inconsistency may be more sensitive than lexical
inconsistency
- “buy Bobby a puppy” x 5
28
3 key areas that suggest CAS over other SSDs:
1. Inconsistent errors on consonants and vowels in repeated productions of syllables and words.
2. Lengthened and disrupted coarticulatory transitions between sounds and syllables (e.g. pauses in inappropriate places, sounds jerky).
3. Inappropriate prosody, especially in lexical or phrasal stress.
29
Comprehensive ax includes: (6)
Case history
Oral-motor skills, including DDK rates
Speech assessment with repeated attempts
Repetitions of multi-syllabic words
Connected speech sample
Receptive and expressive language assessment
30
What is DEMSS?
Dynamic Evaluation of Motor Speech Skill
31
What is the DEMSS scoring like?
Articulatory accuracy
◼ 0=correct on first attempt
◼ 1=consistent developmental substitution error
◼ 2=correct after first cued attempt
◼ 3=correct after two or three additional cued attempts
◼ 4=not correct after all cued attempts
Vowel accuracy
◼ 0=correct
◼ 1=mild distortion
◼ 2=frank distortion
32
What does DEAP stand for?
Diagnostic Evaluation of Articulation and Phonology
33
What does the DEAP consist of?
- Diagnostic screen
- Articulation Ax
- Oro-motor Ax
- Inconsistency Ax
34
DEAP diagnostic screen procedure
If the child cannot imitate sounds that 90% of children their age can imitate, the Articulation and Oro-Motor assessments need to be administered. If the child has an inconsistency
rating of 50% or more, administer the Inconsistency and Oro-Motor assessments.
35
DEAP Articulation Ax procedure
Compare the child’s consonant errors to the norms on P.11 of the Irish Standardisation manual (90% of children) to determine if a speech difficulty is present. Any vowel errors are considered a sign of an articulation difficulty.
36
DEAP oro-motor Ax procedure
Calculate the standard scores and percentile ranks for DDK, Isolated movement and Sequenced movement in the Irish manual. Standard Scores of 7-13 denote typical performance.
37
DEAP Inconsistency Ax procedure
A score of 40% or more suggests either an inconsistent phonological disorder or CAS
38
Differential Diagnosis between Developmental Verbal Disorder
(CAS) and Inconsistent Phonological Disorder, according to DEAP Manual:
DVD
- Poor Oro-motor Ax
- Worse word prod. in imitation than spontaneous speech
- Difficulty with speech sounds in isolation and may have C&V distortions
- Slow laboured speech with atypical intonation patterns
Inconsistent disorder:
- Normal Oro-motor Ax
- Word prod. better in imitation than spontaneous speech
- Can produce most speech sounds in isolation
Fluent speech with normal intonation patterns despite lack of intelligibility
39
Nuffield Dyspraxia Ax: elicit __ (2) by imitation?
- Elicit consonants and vowels by imitation
- Elicit phrases and sentences by imitation, supported by pictures.
40
Nuffield Dyspraxia Ax: elicit __ (5) by picture naming?
- Elicit CV and VC words by picture naming.
- Elicit C5)VC words by picture naming.
- Elicit CVCV words by picture naming.
- Elicit complex and multisyllabic words by picture naming.
- Elicit consonant cluster words by picture naming.
41
Nuffield Dyspraxia Ax: other tools
- Record a sample of typical spontaneous connected speech in conversation or a story-retelling task.
- Oro-motor assessment: Lips and Jaw, Tongue, Airstream, Voice, Palate.
- DDK assessment: Syllables and words.
- Throughout there are questions such as “Are sounds joined smoothly?” “Any voice/prosodic features to comment on?”
