Treatment approach one—Multiple Input Phoneme Therapy (MIPT)
The approach
Understanding Severe Apraxia of Speech and Verbal Motor Loops
Understanding Severe Apraxia of Speech and Verbal Motor Loops
An evidence-based approach designed for patients with severe apraxia of speech who are caught in verbal motor loops, helping them create new neural pathways for effective communication.
Understanding Severe Apraxia of Speech and Verbal Motor Loops
Understanding Severe Apraxia of Speech and Verbal Motor Loops
Understanding Severe Apraxia of Speech and Verbal Motor Loops
Severe apraxia of speech often traps patients in frustrating verbal motor loops where they produce stereotypic utterances—repetitive, invariant phrases that aren't contextually appropriate. These patients typically have limited functional vocabulary and minimal phrase production ability.
Neuroplasticity Foundations
Understanding Severe Apraxia of Speech and Verbal Motor Loops
Neuroplasticity Foundations
MIPT harnesses the brain's neuroplasticity to create new neural pathways for speech production. By systematically using existing stereotypic utterances as a foundation, therapists help patients build bridges to new, functional speech patterns.
This approach recognizes that even damaged brains can form new connections when presented with consistent, structured sensory input across multiple modalities
Neural Pathway Creation
Neural Pathway Creation
Neuroplasticity Foundations
Treatment steps
Neural Pathway Creation
Treatment steps
Document and Model
Write down the patient's stereotypic utterance and model it while providing gestural and prosodic cues. Repeat 6-10 times to establish pattern recognition.
Fade Cues
Gradually reduce verbal prompts until you're silently modeling with gestures only. Patient should follow your mime while producing the utterance.
Introduce New Targets
Select new target words that share the same initial phoneme as the stereotypic utterance, creating a phonological bridge to functional vocabulary.
Increase Complexity
Systematically ramp up challenges by increasing target word count, introducing multisyllabic words, and building toward phrases and sentences.
The evidence
Neural Pathway Creation
Treatment steps
Stevens and Glaser (1983) conducted a cohort study (N=5) with stroke patients aged 49-73, demonstrating significant gains in verbal expression and reduction of perseverative utterances at the single word level.
While initial research supports MIPT's effectiveness, the field would benefit from additional studies with larger sample sizes and diverse patient populations. Current evidence suggests MIPT is particularly valuable for patients who have not responded to traditional apraxia treatments.
Treatement approach two- 8-Step Continuum Treatment
Approach
The 8-Step Continuum is an articulatory kinematic approach concentrating on improving the timing and placement of speech movements through modeling, positioning, and repetition. Integral stimulation—where patients watch the clinician's face during word production—serves as a foundational element, enhancing the patient's ability to produce target sounds by engaging multiple sensory modalities simultaneously.
Originally Designed for Severe Cases
Initially developed for individuals with more severe forms of apraxia of speech requiring comprehensive intervention.
Adaptable for Milder Presentations
The protocol has proven effective for patients with milder apraxia through selective application of specific steps
The Progression: Steps of the Continuum
Step 1: Guided Co-Production
Patient watches and listens as the clinician produces the target word, then they produce it together simultaneously.
Step 2: Silent Modeling
Patient observes the clinician's production again, then produces the target word while the clinician silently mouths it.
Step 3: Initial Independent Production
After watching and listening to the clinician, the patient independently repeats the target word.
Step 4: Multiple Independent Repetitions
Following clinician modeling, the patient repeats the word multiple times independently to build consistency.
Step 5: Visual Word Reinforcement
Clinician presents the written target word, and the patient produces it while viewing the written form.
Step 6: Delayed Visual Cue
After briefly viewing the written word, the paper is removed and the patient produces the target from memory.
Step 7: Question Response
Patient produces the target word in response to a clinician's prompt question, adding functional context.
Step 8: Conversational Role Play
Clinician and patient engage in role play scenarios where the target word is used in natural conversation.
Evidence
Rosenbek's (1973) initial testing with three individuals with severe and profound apraxia demonstrated positive changes in articulation and speech sequencing abilities.
Follow-Up Studies
Deal and Florance (1978) modified and further validated the approach with four severe apraxia cases, successfully restoring communicative ability and developing effective home programs based on the continuum.
Wambaugh (2002) noted that Rosenbek's emphasis on regaining points of articulation and sequencing remains the foundation for subsequent apraxia treatments, highlighting the approach's enduring influence.
Treatment approach 3- Speech Motor Treatment
Speech motor treament -the approach
Speech motor treament -the approach
Speech motor treament -the approach
Speech Motor Learning Treatment for Apraxia of Speech
A systematic approach to addressing motor speech disorders through targeted consonant and vowel rehearsal, progressing from nonwords to functional communication.
Core Principles
Speech motor treament -the approach
Speech motor treament -the approach
The speech motor learning treatment addresses the underlying inability to plan and program speech motor targets in varying phonetic contexts and utterances longer than single words.
This approach is specifically designed for individuals with childhood apraxia of speech (CAS) or acquired apraxia of speech (AOS) following neurological injury.
How it works
Treatment progression
Stimulus Complexity Progression
Treatment Stimuli and Staging
Begins with personalized assessment of sound production ease
Uses nonwords constructed from target consonants and vowels
Gradually increases complexity of phonetic contexts
Transitions from imitation to self-initiated production
Treatment Stimuli and Staging
Stimulus Complexity Progression
Treatment Stimuli and Staging
Initial Assessment
Rating of production ease for all speech sounds from the client's perspective serves as the foundation for treatment planning.
Target Selection
3-4 consonants and 3-5 vowels with greatest ease of production are selected as the first target set and introduced simultaneously.
Staged Progression
Each addition of new, more difficult sounds marks a new stage in treatment, with consonant sets typically expanded before vowel sets.
Stimulus Complexity Progression
Stimulus Complexity Progression
Stimulus Complexity Progression
Treatment follows a systematic progression of increasing phonetic complexity:
CVCV Nonwords
Initial treatment begins with simple consonant-vowel-consonant-vowel nonwords using the easiest sounds for the client (e.g., "paba").
CVC Structures
Progress to consonant-vowel-consonant structures, increasing articulatory challenge (e.g., "pam").
CVCVC/CVCVCVC
Advanced stages incorporate longer nonwords (e.g., "patik" or "patikam"), preparing for real word transition.
Functional Words
Final stages integrate real words and phrases containing practiced phonetic elements until mastery criteria are met.
Research evidence
Strengths and limitations
Stimulus Complexity Progression
Van der Merwe's Studies
Acquired Apraxia of Speech (2011)
"Rationale and effects of intervention with an adult with acquired apraxia of speech"
Childhood Apraxia of Speech (2018)
"Positive effects of the speech motor learning approach"
Therapy outcomes
Strengths and limitations
Strengths and limitations
Surface vs. Underlying Improvements
Research indicates clients may improve sound production and appear to make steady gains, yet increases in consonant/vowel accuracy alone may not reflect changes in underlying movement patterns.
Refined Articulatory Control
Advanced motor learning techniques are required to maintain and generalize improved speech patterns beyond the clinical setting.
Automatic Speech Benefits
The approach has demonstrated effectiveness in improving automatic speech production, reducing the cognitive load required for communication.
Strengths and limitations
Strengths and limitations
Strengths and limitations
Strengths
- Systematic progression from simple to complex
- Individualized starting point based on client's abilities
- Research-validated approach for both children and adults
- Targets underlying motor planning deficits directly
Current Limitations
"We don't know how motor learning can address limitations in activity/participation"
Research is still needed to determine how improvements in speech motor control translate to functional communication outcomes and quality of life measures.