Developmental Dyspraxia of Speech Larry Burd, Ph.D. Department of Pediatrics 701-780-2477 laburd@medicine.nodak.edu - PowerPoint PPT Presentation

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Developmental Dyspraxia of Speech Larry Burd, Ph.D. Department of Pediatrics 701-780-2477 laburd@medicine.nodak.edu. Presentation. Typical Presentation: slow clumsy speech Often with poor motor coordination Nearly always presents with additional impairments. Cognitive impairment 50%

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Developmental Dyspraxia of Speech Larry Burd, Ph.D. Department of Pediatrics 701-780-2477 laburd@medicine.nodak.edu

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Developmental dyspraxia of speech larry burd ph d department of pediatrics 701 780 2477 laburd medicine nodak edu

Developmental Dyspraxia of SpeechLarry Burd, Ph.D.Department of Pediatrics701-780-2477laburd@medicine.nodak.edu


Presentation

Presentation

  • Typical Presentation: slow clumsy speech

    • Often with poor motor coordination

  • Nearly always presents with additional impairments.

    • Cognitive impairment 50%

    • Cerebral Palsy 20-50%


Neural organization

Neural Organization

  • System Disorder

    • Conceptual and/or Production


Pathways

Pathways

  • Rule out: Sensory impairment

    • Area 4 by age 4 – Voluntary Movement

      • 1 step directions

      • Imitate eating with spoon

      • Coloring

    • Area 6 by age 6 – Multiple Actions

      • 2 step actions

      • 2 simultaneous actions

      • Abstract actions

      • Show comb – point to hair

      • Show sandwhich – imitate eating

      • Pretend to play catch

      • Show picture of toothbrush – brush teeth

      • Pretend of show me licking Popsicle

      • Eating


Pathways1

Pathways

  • Transcoding

    • Response to stimuli or command

      • No motor impairment

      • Imitation

      • Echophenonomena

        • Echolalia

        • Echopraxia


Pathways2

Pathways

  • Rule out:

    • Comprehension deficit

    • Hearing loss

    • Conversation disorder

    • Landeau Kleffner

    • Agnesis corpus collosum

  • Language to Gesture

  • Language to oral response

    • Phonology

    • Prosody

    • Voice


Motor impairment

Motor Impairment

  • Rule Out

    • Low tone

    • Facial paralysis

    • Dystonia

    • Parkinsonism

    • Galactosemia


Motor impairment1

Motor Impairment


Clinical exam

Clinical Exam

  • Recropical smile

  • Imitate or responds to gestures only

  • Responds to commands

Must evaluate separately


Syndromal delineation

Syndromal Delineation

  • Echolalia rules out dyspraxia for production but not conceptual impairment

    • Aphasia vs. conceptual dyspraxia

    • Cerebral palsy

    • Dystonia and focal dystonia

    • Conversation disorder

    • Neuro exam

    • Rarely Parkinsonism – childhood mystenia gravis


Syndromal delineation1

Syndromal Delineation

  • Dyspraxia only is rare

    • Common comorbid conditions

      • Mental retardation

      • Cerebral Palsy

      • Hearing Loss

      • Motor Disorder

      • Dysphasic Syndromes


The conceptual approach to dyspraxia of speech

The conceptual approach to Dyspraxia of Speech


Developmental dyspraxia of speech larry burd ph d department of pediatrics 701 780 2477 laburd medicine nodak edu

Aphasia

Imitation:

Command to Action to speech

Movement Disorder

Clumbsy


Developmental dyspraxia of speech larry burd ph d department of pediatrics 701 780 2477 laburd medicine nodak edu

Plan

  • Do not order any tests without a question - Why?


Developmental dyspraxia of speech larry burd ph d department of pediatrics 701 780 2477 laburd medicine nodak edu

  • False positives and cost

    • Referral to speech language pathology

    • Pediatric neurology – other motor impairment

    • Child psychiatry – conversion disorder

    • Educational assessment – sight word reading

    • Acceptance

    • Cognitive evaluation - IQ


Developmental dyspraxia of speech larry burd ph d department of pediatrics 701 780 2477 laburd medicine nodak edu

Phonology

Syntax

Semantics

Syndrome

Comprehension

Production

Comprehension

Production

Comprehension

Production

Pragmatics

Fluency

1. Verbal auditory agnosia

↓a

2. Semantic-pragmatic

±a

N

N

±

↑a

3. Mixed phonologic-syntactic

±

±

±

N

N

4. Phonologic programming deficit

Na

N

±

N

N

N

±

5a. Fluent autistic

N

N

N

5b. Dysfluent autistic

aN = normal; ↓ = abnormal or decreased; ± = variable; ↑ = increased.

Speech comprehension and production across dysphasic syndromesb (Modiefied from Rapin, 1992)


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