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Abstract
Background: Buccofacial apraxia (BFA) may be defined as the inability to perform voluntary movements of the larynx, pharynx, mandible, tongue, lips, and cheeks, while automatic or reflexive control of these structures is preserved. BFA frequently co‐occurs with aphasia and apraxia of speech (AOS). The treatment and management of BFA has received little emphasis in the clinical literature. However, recent studies suggest that principles of motor learning may provide an improved means of treating a variety of apraxic disorders, including limb apraxia and AOS. Also, research in our laboratory has suggested that augmented (or extrinsic) feedback provided by an electromagnetic articulograph (EMA) system may lead to improved remediation of place‐of‐articulation errors in talkers with aphasia and AOS. Taken together, the data suggest that treatment based on motor training principles, including the use of augmented kinematic feedback, may be beneficial to individuals with BFA.
This study was supported by Callier Faculty Research Initiative Grant #22517. The authors thank the participant and his family for their help in this study. We also thank Diane Garst and Caroline Nickels for their assistance in data analysis. Portions of this work were reported at the 41st Meeting of the Academy of Aphasia, 2003, Vienna, Austria [Brain and Language, 87, 175–176].
Aims: The aims of the present study were to explore whether BFA may be successfully treated with direct (restitutive) methods, and whether augmented kinematic feedback improves therapy effectiveness and maintenance.
Methods & Procedures: An ABA design with follow‐up probes 6 weeks post‐treatment was used to investigate two types of treatment for non‐verbal oral errors produced by an individual with BFA. Over a 1‐month period, the participant received structured motor practice for a set of oral gestures (“bite your upper lip”, “bite your lower lip”), and motor practice with EMA augmented feedback for a third oral gesture (“touch your upper lip and your lower lip, using your tongue”). Nine untrained oral motor behaviours were also probed throughout the experiment. The sessions were videotaped and later scored by two independent examiners who were unaware of the nature of the experiment.
Outcomes & Results: The main findings were (1) a mixed pattern of improvement with no lasting maintenance for the gestures treated with structured motor therapy, and (2) consistent improvement with maintenance at 6 weeks post‐treatment for the gesture treated with augmented feedback therapy. In general, the observed gains were treatment specific, although possible cases of positive and negative stimulus were also observed.
Conclusions: Augmented feedback provided by an EMA system appears to provide improved treatment effectiveness and maintenance compared to structured motor practice. However, the current preliminary findings should be tested with additional controls and more subjects before any strong conclusions are drawn.
Notes
This study was supported by Callier Faculty Research Initiative Grant #22517. The authors thank the participant and his family for their help in this study. We also thank Diane Garst and Caroline Nickels for their assistance in data analysis. Portions of this work were reported at the 41st Meeting of the Academy of Aphasia, 2003, Vienna, Austria [Brain and Language, 87, 175–176].
1. These principles of motor learning were included to maximise the likelihood of successful EMA training. However, this design involves there being at least two differences between the two treatment types (i.e., the presence/absence of augmented feedback and the nature of that feedback), an issue that must be considered carefully in interpreting the results.