Sep 28, 1985 - Lexington Public Schools. Lexington, Massachusetts. ..... and staff, and the panicip:~ting children of the Bridge School in Lexington ...
The Relationsh~ Between ~rticufation Disorders and Motor Coorhtion in Chldren i
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any occupational therapists are involved in remediating problems in motor coordination and dyspraxia in children (Ayres, 1972; Cermak, Coster, & Drake, 1980; Conrad, Cermak, & Drake, 1983). A high incidence of articulation problems has consistently been noted in these children (Abbie, Douglas, & Ross, 1978; Ayres, 1972; Gubbay, 1975). Conversely, speech therapists working with children w h o have articulation problems have noted Sharon A. Cermak, Elizabeth A. Ward, that these children have more motor problems than Ward . Lorraine M. . . d o their peers (Bilto, 1941; Jenkins & Lohr, 1964). . . . - . . .. . . . - . . ...... . . . . . . . . . . . .-. . . . .. . . - . . : _ i T h i s apparent relationship between deficits in articu. . . . . . . . . . . . . . . . . . .;_ .... -lation and deficits in motor coordination has been Key Words: dyspraxia apraxia .sensory examined by a number of investigators (Bernthal & integration . . . . . . . . . ..: .... . . . . . . : Bankson, 1981) and s o m e studies have indeed found . . . . . . . . a relationship between severe articulation problems (referred to as developmental apraxia of speech) and . - 2 h i s study was designed to examine-the -relationship-problems in motor coordination (sometimes referred between articulation disorders,,soJtneurological to as motor dyspraxia) (Bilto, 1941; Jenkins 8r Lohr, signs, and motor abilities. FiJteen children with ar1964; Prins, 1962). Unfortunately, other studies have . ticulation problems, as measu-redb)! the _Tetnplitr- -.-I - --indicated that there is no relationship (Aram & Hor. . ~ Darley Articulation Screening Test and a conwitz, 1983; Reid, 1947). In addition, children with nected speech sample, were compared with a normotor dyspraxia as well as children with developmal control group (matched for sex and age) on the mental apraxia of speech have been shown to have a Quick Neurological Screening Test, the Imitation of higher incidence of soft neurological signs (Kornse, Postures test (from the Southern CaliJornia Sensory Manni, & Rubenstein, 1981; Rosenbek & Wertz, 1972; Integration Tests), and the 1984 version of the Stott Yoss & Darley, 1974), even though o n e study did not Test ofMotor Impairment that has been reuised by Henderson. A sign $cant d~yererzcewas foic?rd beconcur with this outcome (Williams, Ingham, & Rotween the groups on the Motor Impairme?rt Test and senthal, 1981). Since children are typically identified the Quick Neurological Screening Test, sitpportirzg and treated earlier for speech deficits than they are the hjpotl~esisthat the articltlation disorder chilfor motor coordination deficits (Gubbay, 1979; Wildren woitld haue more motor coordination probliams, Ingham, 8r Rosenthal, 1981), the relationship lems and soft neurological signs than t l ~ enormal between these problems ought to b e of major concern children in the controlgroilp. TI~erewas no beto occupational therapists because more than 1.3 miltween-group drfferetice on the Imitation of Postures - -- lion children have functional articulation problems ---...- test,-szcggesting that as a group; children with artic.--(Yoss 8r Darley, 1974) and are unable to correctly ulatiorr deficits are not djsprauic. This stud)?sitppronounce sounds although they d o not display paports other researchfindings stating a relationsl~ip ralysis, weakness, or deformities (Reid, 1947). If a between articitlation problems and rnotor irnpairment, but it also indicates that this motor impairrelationship between articulation deficits and probment is not necessarily djlspraxia. lems in motor coordination exists, many of the children being seen for articulation problems should also b e screened for motor problems and considered for occupational therapy services. Various theories have been proposed to explain functional articulation problems in children. At o n e Sharon A. Cermak. EdD, OTR, FAOTA, is Associate Profestime articulation problems in children were thought sor of Occupational Thempy, Boston University, Sargent to b e similar to the expressive aphasias seen in adults College, 1 University Road, Boston, Massachusetts 02215. with lesions to Broca's area (Rosenbek 8r Wertz, She is also a Faculty Member of Sensory Integntion Inter. 1972). However, it has been shown that articulation national. problems in children are not the result of specific At the time of this study, Elimbeth A. Ward was an occupalesions of the left hemisphere (Kornse, Manni, & tional thenpy graduate student in a master of science deRubenstein, 1981; Rosenbek & Wertz, 1972). It apgree program, Boston University, Sargent College. pears that the praxis centers for speech movement Lorraine M. Ward, MA, is a speech-language pathologist, may b e diffuse in the child's brain, whereas the conLexington Public Schools. Lexington, Massachusetts. trol of speech is localized in the adult. Thus, the .
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understanding of adult brain lesions has not provided in each group. All subjects were free from obvious answers to apraxia in children (Rosenbek & Wertz, physical limitations such as deformities, paralysis, and i weakness. No child in either group was diagnosed as ! 1972). .. .. . . L~ M o t o r dyspraxia also has an unknown etiology. being learning disabled. i Gubbay (1975, 1979) has hypothesized a multifactoi i . rial etiology to explain motor dyspraxia, which may Instrumentation .--. -. i{ include perinatal influences and alterations of cereTemplin-Darley Articulation Test. The 50-item bra1 organization. Ayres (1972, 1980a) believes that screening subtest of the Templin-Darley Articulation I motor dyspraxia is the result of a disorder of sensory Test was used to assess the general accuracy of the integration. Both motor dyspraxia and developmental subjects' articulation. The stimuli are line drawings, apraxia of speech seem to be sensitive to interfer. and subjecls are-asked to identify items in the draw_-.__-._: . -- ---. ing. The subjects' total number of correctly identified -.enc.es..fr~mi a u e u n i d e n t i f i e d .sources-(Jenkins=.&:= Lohr, 1964). items was compared with the mean number of items This study is designed to further examine the_-- .-produced by children of the same age in the standard... . relationship between articulation deficits, soft neu. . . ization sample. A standard deviation score was calcurological signs, impairments in motor coordination, j lated for each subject. and motor dyspraxia. It is hypothesized that children Connected Speech Sample. Conversational . -.-with -articulation--problems . . .. will score ~.. . --. ~-more .. -- poorly... t -speech was elicited to assess articulation with stanI .r . than children without articulation problems on the dard questions asked of the child about his or her 1 Quick Neurological Zcreenig-TTst ( ~ u t t i Sterling,, ---address; dassroom, and family. The child also named - ~...!.- . . '-.- - & Sp . _,_ _ . aiding;-1978);-and on tests of motor coordination some numbers and colors. The conversational speech and planning, specifically the Test of Motor Impairwas tape-recorded, with the first 50 words being evalment (Stott, Moyes, & Henderson, 1984), and the uated for articulation disorders. The percentage of 'Imitation of Postures test (Ayres, 1980b). incorrect words in the sample was calculated for each subject. 1 Method ! Peabody Picture Vocabulay Test-Revised Form I Subjects hl. This test assesses receptive vocabulary using single The subjects were 30 children from a middle- to'upper A raw score is converted to a language quotient words. middle-income suburban public school in Massachurelated to the age of the subject. setts. They ranged in age from 5 to 8 years. Fifteen Quick Neurological Screelzing Test. This is a 15subjects had functional articulation problems, and 15 item screening test, which relates neurological intesubjects (the control group) did not have functional gration to learning. The test aids in the identification articulation problems. of children with learning disorders. Scores were toAll subjects in the articulation disorder group taled for each subject in accordance with the instrucwere jdentified by the speech and language patholotions in the test manual. In addition;scores were -- - - gist in their school as having articulation problems. categorized as normal, suspiciorrs, o r impaired. A In addition, they scored below the -1 standard deviascore of 25 or less is considered normal, scores tion score on the Templin-Darley Articulation Screenbetween 25 and 50 are considered suspiciorts, and ing Test (Templin & Darley, 1964) and/or demonscores above 50 indicate that a subject is inrpaireci. strated 10% or more misarticulated words in a speech Prior to categorization, scores were recalculated to sample of 50 connected words. The mean standard take the subjects' age into account. score on the Templin-Darley was -1.86 (SD = 1.98), and the mean word error score on the connected Test of hlotor Impairnret~t-Revised 1984. This speech sample was 24.80% (SD = 19.25%). All chiltest is based on the Oseretsky Tests of Motor ProfiI dren in the articulation group had normal receptive ciency (Doll, 1946). It is a screening test designed to language skills (standard scores equal to or greater detect impairment of motor function. Eight items for than 85) as assessed by the revised Peabody picture each age level are presented. These items include vocabulary test (Dunn & Dunn, 1981). The mean ball skills (catching and throwing), unimanual and score o n the Peabody was 114 (SD = 12.7). bimanual dexterity, and static and dynamic balance. The control group was matched with the articuEach item is scored with zero points for passing, one lation disorder group by sex and age (within G point for borderline performance and two points for months). The mean age (and standard deviation) for a performance that has been determined to represent the control and articulation disorder groups was 82.6 failure. Thus the range of scores is 0-16. Scores are months (11.7 months), and 82.7 months (11.7 categorized as inlpaired (4 + points) o r tzotzinlpaired months), respectively. There were 9 boys and 6 girls (0-3.5 points) motor performance. I
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The America~z]ozrr~zal of Occzrpcltiorral Tl~erapj~
Table 1 Imitatiotz of Postures Test. This test is one of the Mean and Standard Deviation of Articulation Disorder tests of the Southern California Sensory Integration and Normal Control Subjects on Three Tests Tests (Ayres, 1980b). "It requires the child to assume Tests a series of positions and/or postures demonstrated by the examiner, a process that requires motor planning QNST TMI IP (raw (no. of (standard or programming a skilled or nonhabitual motor act" Group score) errors) score) (Ayres, 1980b, p. 5). The test is used to assess motor Articulation disorder 31.07 4.23 -0.29 dyspraxia. Scoring is based on completion or partial SD 9.82 3.40 0.69 completion of the posture, or the inability to assume Normal control X 20.47 1.83 -0.11 SD 8.26 1.32 0.89 the posture, and the time it takes to assume the Note. QNST = Quick Neurological Screening Test (Mutti, Sterling, posture. Raw scores are converted to standard scores & Spalding, 1978); TMI = Test of Motor Impairment (Stott, Moyes according to the age of the subject. &Henderson. 1984); I P = Imitation of Postures test (Ayres, 1980b). Procedures. Subjects were tested on the TemplinDarley Articulation Screening Test and a sample of .02, showing a significant difference between the connected speech. If the subject's standard deviation on .the-Quick.Neurological Screening Test scores were less than -1.0 on - the Templin-Darley .--:groups categories (p < .05). and/or they made 10% or more errors on the words Between-group analyses were performed on the in the connected speech sample, they were placed in Imitation of Postures test scores. The between-group -- the articulation disorder group. Then all subjects with difference was not significant [F(1,28)
