Part Three: The Movement Pattern Generalization Theory
Have I ever mentioned how much I love working with children with Apraxia??? It fills me with a great amount of passion – the kind of passion that leaves me sitting awake quietly at night thinking, pondering, and praying for inspiration and guidance about how to treat it better.
These late night brain storming sessions have led me to what I call the Movement Pattern Generalization Theory. While lying in bed one night I started thinking about kids with articulation and phonological disorders and comparing them to kids with apraxia. One of the main differences I have noticed about kids with artic/phonological disorders and kids with apraxia is the “generalization” of skills. It seems to me that kids with artic/phono disorders don’t necessarily have to be taught how to say a sound in every possible articulatory context to learn how to use the sound correctly. They could be taught how to use a sound in a few contexts, with increasing difficulty, and that skill would generalize to other contexts. For example – if a child with articulation/phonological concerns could say the sound /b/ and could say the sound /eI/ it is highly likely that they would be able to say the word /beI/ (“bay”). But what about a child with apraxia??? A child with apraxia may be able to say the sound /b/ in one word, and the sound /eI/ in another word – but might still struggle putting those two sounds together to form the word /beI/ or “bay”.
So my next question was why???
Well, I wasn’t sure. So – I read a bunch of research on apraxia – anything I could find (disappointingly there is not much out there). And I couldn’t find an answer. But what I did find was a deeper clarification into the definition of the disorder itself. So – I ask you – what is apraxia of speech???
Well, the definition is extensive, and to be honest – a little confusing. But – one thing stood out to me time and time again. We all know that apraxia is a motor speech disorder – right. But what does that mean? For me it works best if I change the word motor to movement. Apraxia is a MOVEMENT disorder. So it makes sense that we should be targeting the movement – not just the sounds themselves. But how???
Well, my initial thoughts totally overwhelmed me. I began thinking that since generalization is so limited in children with apraxia I was going to have to target every single word in existence in order for these children to speak. This literally made me cry. How would this be possible. It would take forever. And I really wished for a better way.
Then – and this was during another sleepless night – it hit me. With this theory and these questions in my mind – I developed a systematic way to view and treat this disorder.
So – this is the way I view apraxia now. For typical speech kiddos we just have to teach the sounds and the kids fill in the stuff in between (the coarticulatory movement or movement pattern). We teach them how to produce Point A (/b/) and Point B (/eI/) – and they fill in the dots between the two to make a word (/beI/). But for kids with apraxia we have to teach not only Point A and Point B – but we also (and most importantly) have to teach them how to produce the dots in between the two points. We are literally teaching the MOVEMENT. It is not so much about the sounds we are targeting – but the movement between the sounds. So, we don’t necessarily have to explicitly target and teach every single word in existence. We just have to target the movement from one sound to every possible other sound. Take /b/ for example, we need to teach kids with apraxia how to move into a /b/ from every possible sound, and move out of a /b/ into every possible sound.
Since there are 35 pure consonants and vowels in the English language this means that in order to produce /b/ correctly in every word possible, there are 70 total coarticulatory contexts to target (35 _b targets and 35 b_ targets). Targeting all 70 contexts would ensure success producing the sound in any word in the English language.
If you are still confused – let me break it down for you a little more. Let’s take the word “baby” (/beIbi/. The word would be targeted by drilling each movement pattern found within it. Each movement pattern consists of two pure speech sounds and the movement between them. So… the word “baby” has 3 movement patterns: /b~eI/, /eI~b/, /b~i/.
But here came the biggest question. If I targeted each of these 3 movement patterns individually and separately – would they generalize to the overall production of the word (without the specific word being taught)?
So I put my theory to the test.
I worked with one of my clients with severe apraxia of speech – focusing on individual movement patterns (2 pure speech sounds with the movement in-between). I taught these movement patterns individually and separately. After my client had demonstrated success on the individual movement patterns I then presented words/pictures that combined multiple movement patterns I had targeted. And guess what… he could produce them. They generalized!!! I didn’t have to prompt or help him. It was awesome!!!
Now the next step in my “quest” (I guess you could call it) is to take it even further. I wonder if drilling only VV, CV, VC, and CC movement patterns would generalize to all syllable shapes/words/sentences/etc.
If so – this would mean we would not have to target every possible word in existence, just every possible movement pattern. And in so doing – every possible movement pattern would generalize into the correct production of every word/phrase/sentence/etc. So far I have seen drilling only CV and VC movement patterns generalize to CVC, CVCV, CVCVCV, VCV, VCVC, and VCVCVC syllable shapes/words. So… I plan to continue testing out this theory (so long as it is clinically appropriate – and shown to be effective). I also plan on updating you on the progress I see and changes I make. So don’t forget to FOLLOW ME in my 7 post journey through Apraxia.