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Elevating Childhood Apraxia of Speech: Integrating Theory, Research and Practice
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- Author / Creator
- Fleming, Cassidy Ley
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BackgroundChildhood apraxia of speech (CAS) has attracted controversy in the field of speech-language pathology for decades. There is some agreement that CAS is a neurological speech sound disorder that impairs a child’s ability to plan and/or program the precise and sequential movements required for speech. However, despite the proliferation of CAS research over the last several decades, the accumulating body of evidence offers limited information regarding the cause and underlying mechanism of CAS and inconclusive evidence and inconsistent guidance to support and guide SLPs’ clinical decision-making and management of CAS. A step toward advancing our current understanding of CAS and elevating SLP services requires the explicit integration of theory, research, and practice.ObjectiveThis doctoral dissertation had three specific objectives: (a) to describe and examine current SLP services and practices in Canada for CAS, (b) to provide an orientation to the use of theory in clinical practice, and (c) to offer a theory-based rationale and protocol for a clinical trial of somatosensory and auditory disruptions in children with and without CAS.MethodsFor the first objective, fifty-six (N=56) Canadian SLPs’ were surveyed on their diagnostic, assessment, and treatment practices with children with CAS. For the second objective, I provided a clinically focused overview of theory and highlighted how theory can be applied to all aspects of clinical practice, using CAS as an example. For the third objective, a detailed clinical trial protocol was developed that will be the first to examine predictions regarding the cause of CAS within the context of the Directions Into Velocities of Articulators (DIVA) model, and related print-to-speech model, by systematically comparing the independent and combined contributions of the auditory and somatosensory feedback systems during speech production and reading.ResultsTogether, these interconnected studies advance our understanding of current practices for CAS. The findings indicated that despite growth and advances in CAS, there is still an immense gap between research and practice, with insufficient attention paid to theory. Moreover, the accumulating body of evidence offers limited information regarding the cause and underlying mechanism of CAS. These knowledge gaps restrict efforts to improve the quality, efficacy, and effectiveness of CAS services. The clinical trial proposed may help move us closer to an understanding of the core deficit in CAS, and help to inform the development of high-quality assessment, diagnostic and treatment procedures that directly target the underlying impairment.ConclusionThis doctoral dissertation advances our understanding of the current practices in Canada for CAS and highlights the gaps/challenges in the clinical management of CAS. These studies highlight a number of needs in our approach to CAS and offer an immediate solution (i.e., employing theory more explicitly) as well as avenues in need of further exploration, such as focusing attention on closing the research-practice gap and expanding our examination of possible causal mechanisms underlying CAS. The systematic integration of theory, research and practice are necessary to reduce the controversy around CAS and improve our efficacy and efficiency in the diagnosis and management of this complex disorder.
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- Graduation date
- Fall 2021
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- Type of Item
- Thesis
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- Degree
- Doctor of Philosophy
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- License
- This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.