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Principles of motor learning in treatment for apraxia of speech

Edwin Maas1*
  • 1 Temple University, Communication Sciences and Disorders, United States

Speech production involves a number of complex planning stages, including lexical retrieval, phonological planning, and speech motor planning (e.g., Bohland, Bullock, & Guenther, 2010; Dell, 1986). Apraxia of speech (AOS) represents a disruption of speech motor planning (Maas, Robin, Wright, & Ballard, 2008; Mailend & Maas, 2013; McNeil, Robin, & Schmidt, 2009, and is characterized by speech sound distortion errors, slow and effortful speech, and abnormal prosody (McNeil et al., 2009; Wambaugh, Duffy, McNeil, Robin, & Rogers, 2006). A recent systematic review indicated that treatment for AOS can be effective (Ballard et al., 2015) but treatment progress can be slow and resources (time, money) are often limited. As such, research is needed to determine ways to maximize treatment outcomes for individuals with AOS. Over the last 15-20 years, one particular line of research has sought to maximize treatment outcomes by examining the relevance of so-called principles of motor learning to treatment for AOS. This line of research is grounded on the following premises: (a) speech production is a motor skill, (b) AOS reflects an impairment of speech motor skills, (c) treatment should be guided by an understanding of speech motor learning, and (d) the literature on motor skill learning can provide insight into speech motor skill learning. A large literature in the motor skill learning domain has shown that certain practice conditions (e.g., random practice) can enhance learning compared to other conditions (e.g., blocked practice), effects referred to as principles of motor learning (Maas et al., 2008; Schmidt & Lee, 2005). An important finding from this literature is that factors that enhance performance during practice are not necessarily the most beneficial for retention and generalization (learning). Although most of this evidence comes from the learning of nonspeech tasks (e.g., learning to play golf), these findings may hold relevance for rehabilitation of motor speech disorders such as AOS. In this presentation, we will first briefly outline important theoretical and practical concepts in understanding motor learning, including the notion that motor learning involves determining relations between motor commands, sensory outcomes, movement goals, and initial conditions. Next, we will review the literature and discuss recent evidence regarding the applicability of principles of motor learning to the speech domain, with a particular focus on evidence from treatment studies with speakers with AOS. The factors studied to date include practice schedule, practice intensity, target complexity, feedback frequency, and feedback delay, and most of this evidence comes from single-case experimental design studies, typically alternating treatments designs. Although the evidence base is still limited, there is some emerging support for the applicability of these principles in facilitating speech motor learning in AOS.

References

Ballard, K. J., Wambaugh, J. L., Duffy, J. R., Layfield, C., Maas, E., Mauszycki, S., & McNeil, M. R. (2015). Treatment for acquired apraxia of speech: A systematic review of intervention research between 2004 and 2012. American Journal of Speech-Language Pathology, 24, 316-337.
Bohland, J. W., Bullock, D., & Guenther, F. H. (2010). Neural representations and mechanisms for the performance of simple speech sequences. Journal of Cognitive Neuroscience, 22, 1504–1529.
Dell, G. S. (1986). A spreading-activation theory of retrieval in sentence production. Psychological Review, 93, 283-321.
Maas, E., Robin, D. A., Austermann Hula, S. N., Freedman, S. E., Wulf, G., Ballard, K. J., & Schmidt, R. A. (2008). Principles of motor learning in treatment of motor speech disorders. American Journal of Speech-Language Pathology, 17, 277-298.
Maas, E., Robin, D. A., Wright, D. L., & Ballard, K. J. (2008). Motor programming in apraxia of speech. Brain and Language, 106, 107-118
Mailend, M.-L., & Maas, E. (2013). Speech motor planning in apraxia of speech: Evidence from a delayed picture-word interference task. American Journal of Speech-Language Pathology, 22, S380-S396.
McNeil, M. R., Robin, D. A., & Schmidt, R. A. (2009). Apraxia of speech: Definition and differential diagnosis. In M. R. McNeil (Ed.), Clinical Management of Sensorimotor Speech Disorders (2nd Edition) (pp. 249–268). New York: Thieme.
Schmidt, R. A., & Lee, T. D. (2005). Motor Control and Learning: A Behavioral Emphasis (4th Ed). Champaign, IL: Human Kinetics.
Wambaugh, J. L., Duffy, J. R., McNeil, M. R., Robin, D. A., & Rogers, M. A. (2006). Treatment guidelines for acquired apraxia of speech: A synthesis and evaluation of the evidence. Journal of Medical Speech-Language Pathology, 14, xv-xxxiii.

Keywords: apraxia of speech, Principles of motor learning, Treatment, Rehabilitation, Speech motor learning

Conference: Academy of Aphasia 55th Annual Meeting , Baltimore, United States, 5 Nov - 7 Nov, 2017.

Presentation Type: symposium

Topic: Aphasia

Citation: Maas E (2019). Principles of motor learning in treatment for apraxia of speech. Conference Abstract: Academy of Aphasia 55th Annual Meeting . doi: 10.3389/conf.fnhum.2017.223.00094

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Received: 19 Apr 2017; Published Online: 25 Jan 2019.

* Correspondence: PhD. Edwin Maas, Temple University, Communication Sciences and Disorders, Philadelphia, PA, 19122, United States, emaas@temple.edu