Apraxia, a disorder of higher motor cognition, is a frequent and outcome-relevant sequel of left hemispheric stroke. Deficient pantomiming of object use constitutes a key symptom of apraxia and is assessed when testing for apraxia. To date the neural basis of pantomime remains controversial. We here review the literature and perform a meta-analysis of the relevant structural and functional imaging (fMRI/PET) studies. Based on a systematic literature search, 10 structural and 12 functional imaging studies were selected. Structural lesion studies associated pantomiming deficits with left frontal, parietal and temporal lesions. In contrast, functional imaging studies associate pantomimes with left parietal activations, with or without concurrent frontal or temporal activations. Functional imaging studies that selectively activated parietal cortex adopted the most stringent controls. In contrast to previous suggestions, current analyses show that both lesion and functional studies support the notion of a left-hemispheric fronto-(temporal)-parietal network underlying pantomiming object use. Furthermore, our review demonstrates that the left parietal cortex plays a key role in pantomime-related processes. More specifically, stringently controlled fMRI-studies suggest that in addition to storing motor schemas, left parietal cortex is also involved in activating these motor schemas in the context of pantomiming object use. In addition to inherent differences between structural and functional imaging studies and consistent with the dedifferentiation hypothesis, the age difference between young healthy subjects (typically included in functional imaging studies) and elderly neurological patients (typically included in structural lesion studies) may well contribute to the finding of a more distributed representation of pantomiming within the motor-dominant left hemisphere in the elderly.

BACKGROUND: Some children referred to ENT physicians suffer from severe and seemingly therapy-resistant impairment of the articulation of speech. Apart from classical symptoms of specific language impairment (SLI), such as a delay in the acquisition of syntax or poor lexical competence, these children's speech is sometimes practically incomprehensible. Describing the disorder as SLI although not correct would nevertheless be inappropriate. The term childhood apraxia of speech (CAS) has been coined for such impairment. In this article the background, symptoms, diagnostics and therapy of CAS are reviewed. METHOD: For this systematic review a selective literature search in PubMed was conducted. RESULTS: The etiology of CAS is not well known and genetic factors, neurological diseases and metabolic imbalances are assumed. Symptoms differ significantly among individuals as well as intraindividually. CAS is defined as impairment in planning and controlling articulatory movements, which has a severe impact on the sound production. DISCUSSION: For ENT specialists it is important to be aware that CAS symptoms may lead to a severe impediment of verbal communication and subsequently also interfere with the normal socio-emotional development of an affected child. Thus, an intensive therapy regimen is mandatory. Studies with a high level of evidence concerning the sensitivity and specificity of diagnostic tools, as well as studies regarding the effectiveness and efficiency of therapeutic approaches are needed.

ANTECEDENTES: La apraxia es un trastorno cognoscitivo que puede ocurrir después de un accidente cerebrovascular. Impide que una persona realice un movimiento aprendido. Se han utilizado diversas estrategias para tratar la apraxia pero no existen pruebas suficientes de su beneficio. OBJETIVOS: Determinar qué intervenciones terapéuticas que tengan como objetivo la apraxia motriz pueden reducir la discapacidad. ESTRATEGIA DE BÚSQUEDA: Se hicieron búsquedas en el Registro Especializado de Ensayos Controlados del Grupo Cochrane de Accidentes Cerebrales Vasculares (Cochrane Stroke Group) (última búsqueda noviembre 2006). Además, se hicieron búsquedas en las siguientes bases de datos: Registro Cochrane Central de Ensayos Controlados (Cochrane Central Register of Controlled Trials, CENTRAL) ( número 3, 2006), MEDLINE (1966 hasta noviembre 2007), EMBASE (1980 hasta noviembre 2006), CINAHL (1982 hasta noviembre 2006), PsycINFO (1974 hasta noviembre 2006), el Research Index of the Occupational Therapy Journal (búsqueda noviembre 2006), REHABDATA (1956 hasta noviembre 2006), el National Research Register (búsqueda noviembre 2006) y Current Controlled Trials Register (búsqueda noviembre 2006). Se comprobaron las listas de referencias de todos los artículos que se identificaron como relevantes. Se realizaron esfuerzos para encontrar ensayos tanto publicados como no publicados al escribir a los autores y las revistas claves. CRITERIOS DE SELECCIÓN: Ensayos controlados aleatorios de intervención terapéutica para la apraxia motriz en el accidente cerebrovascular. RECOPILACIÓN Y ANÁLISIS DE DATOS: Un revisor buscó los títulos, los resúmenes y las palabras claves. Cuatro autores de la revisión extrajeron y analizaron la calidad de los ensayos. Si fue necesario, se contactó con los investigadores para obtener detalles adicionales de los ensayos. RESULTADOS PRINCIPALES: Tres ensayos con un total de 132 participantes fueron incluidos en la revisión. Hubo pruebas de un efecto terapéutico pequeño y de corta duración en los dos estudios que informaron el cambio en la actividades cotidianas (102 participantes), pero este hecho no se consideró clínicamente significativo y no persistió durante el período de seguimiento de mayor duración. CONCLUSIONES DE LOS AUTORES: No existen pruebas suficientes para apoyar o refutar la efectividad de las intervenciones terapéuticas específicas para la apraxia motriz posterior al accidente cerebrovascular. Se requiere más investigación de alta calidad. Debido a que no se evaluó si los pacientes con apraxia tuvieron beneficios con la facilitación de rehabilitación en general, estos pacientes deben continuar recibiendo servicios de rehabilitación general después del accidente cerebrovascular.

ANTECEDENTES: La apraxia del habla es un trastorno de comunicación que puede afectar a los pacientes con accidente cerebrovascular. En este grupo de pacientes, los terapeutas del habla y lenguaje aplican varias estrategias de intervención diferentes. OBJETIVOS: Evaluar si las intervenciones terapéuticas mejoran el habla funcional en los pacientes con accidente cerebrovascular y apraxia del habla y qué intervenciones terapéuticas individuales son eficaces. ESTRATEGIA DE BÚSQUEDA: Se realizaron búsquedas en el Registro Especializado de Ensayos Controlados del Grupo Cochrane de Accidentes Cerebrovasculares (Cochrane Stroke Group Trials Register) (última búsqueda: mayo de 2004). Además, se realizaron búsquedas en las siguientes bases de datos: Registro Cochrane Central de Ensayos Controlados (CENTRAL)(The Cochrane Central Register of Controlled Trials) ( Número 4, 2003); MEDLINE (1966 a abril de 2004); EMBASE (1980 a abril de 2004); CINAHL (1982 a abril 2004); PsycINFO (1974 a abril de 2004); el National Research Register (búsqueda de abril de 2004); y el Current Controlled Trials Register (búsqueda de mayo de 2004). Se revisaron las listas de referencias de los artículos pertinentes y se estableció contacto con los autores y los investigadores para identificar ensayos publicados y no publicados. CRITERIOS DE SELECCIÓN: Se procuró incluir ensayos controlados aleatorios de las intervenciones no-farmacológicas para los adultos con apraxia del habla posterior a un accidente cerebrovascular donde la medida de resultado primaria era el habla funcional a los 6 meses de seguimiento. OBTENCIÓN Y ANÁLISIS DE LOS DATOS: Un autor buscó los títulos, los resúmenes y las palabras clave. Dos autores examinaron los resúmenes que posiblemente cumplieran con los criterios de inclusión. Cuatro autores estaban disponibles para evaluar la calidad del ensayo y para extraer los datos de los estudios elegibles. RESULTADOS PRINCIPALES: No se identificaron ensayos. CONCLUSIONES DE LOS AUTORES: No hay pruebas derivadas de los ensayos aleatorios para apoyar o refutar la efectividad de las intervenciones terapéuticas para la apraxia del habla. Es necesario realizar ensayos aleatorios de alta calidad en esta área.

BACKGROUND: The diagnosis of Childhood Apraxia of Speech (CAS) remains heavily debated, and there is no agreement upon the etiology for the disorder. Whilst there is some consensus on the potential broad array of presenting features of children with CAS, only three key features are recognised as ubiquitous for diagnosis: 1) inconsistent error production on both consonants and vowels across repeated productions of syllables or words; 2) lengthened and impaired coarticulatory transitions between sounds and syllables; and 3) inappropriate prosody. Despite the typically severe and complex presentation of CAS, there is little evidence reported on intervention approaches for the disorder, perhaps as a result of the ongoing deliberation over etiology and diagnosis. OBJECTIVES: The aim of this paper was to assess the efficacy of intervention delivered by Speech and Language Pathologists(s)/Speech and Language Therapists targeting CAS in children and adolescents. METHOD: Several electronic databases were searched up to January 2007. The review considered randomised controlled trials (RCTs) and quasi-randomised studies of children aged 3 to 16 years with CAS, grouped by treatment types (e.g., perceptual and instrumentally-based biofeedback treatment techniques). Two authors independently assessed references identified from the searches and obtained full text versions of all potentially relevant articles. RESULTS: Of 825 titles and abstracts searched, only 31 abstracts appeared to meet inclusion criteria. The remaining 794 papers were excluded predominantly on the basis of not including participants with CAS (e.g., focused on other developmental speech disorders or adult acquired apraxia of speech), or for not being intervention studies (i.e. being diagnostic or descriptive). All 31 full text articles obtained were excluded following evaluation as they did not meet inclusion criteria on design. CONCLUSION: The review demonstrates a critical lack of well controlled treatment studies addressing treatment efficacy for CAS, making it impossible for conclusions to be drawn about which interventions are most effective for treating CAS in children or adolescents.

PURPOSE: To present a systematic review of single-case experimental treatment studies for childhood apraxia of speech (CAS). METHOD: A search of 9 databases was used to find peer-reviewed treatment articles from 1970 to 2012 of all levels of evidence with published communication outcomes for children with CAS. Improvement rate differences (IRDs) were calculated for articles with replicated (n > 1), statistically compared treatment and generalization evidence. RESULTS: Forty-two articles representing Phase I and II single-case experimental designs (SCEDs; n = 23) or case series or description studies ( n = 19) were analyzed. Six articles showed high CAS diagnosis confidence. Of the 13 approaches within the 23 SCED articles, treatments were primarily for speech motor skills ( n = 6), linguistic skills ( n = 5), or augmentative and alternative communication ( n = 2). Most participants responded positively to treatment, but only 7 of 13 approaches in SCED studies reported maintenance and/or generalization of treatment effects. Three approaches had preponderant evidence (Smith, 1981). IRD effect sizes were calculated for Integral Stimulation/Dynamic Temporal and Tactile Cueing, Rapid Syllable Transition Treatment, and Integrated Phonological Awareness Intervention. CONCLUSIONS: At least 3 treatments have sufficient evidence for Phase III trials and interim clinical practice. In the future, efficacy needs to be established via maintenance and generalization measures.

BACKGROUND: Intensive treatment has been repeatedly recommended for the treatment of speech deficits in childhood apraxia of speech (CAS). However, differences in treatment outcomes as a function of treatment intensity have not been systematically studied in this population. AIM: To investigate the effects of treatment intensity on outcome measures related to articulation, functional communication and speech intelligibility for children with CAS undergoing individual motor speech intervention. METHODS & PROCEDURES: A total of 37 children (32-54 months of age) with CAS received 1×/week (lower intensity) or 2×/week (higher intensity) individual motor speech treatment for 10 weeks. Assessments were carried out before and after a 10-week treatment block to study the effects of variations in treatment intensity on the outcome measures. OUTCOMES & RESULTS: The results indicated that only higher intensity treatment (2×/week) led to significantly better outcomes for articulation and functional communication compared with 1×/week (lower intensity) intervention. Further, neither lower nor higher intensity treatment yielded a significant change for speech intelligibility at the word or sentence level. In general, effect sizes for the higher intensity treatment groups were larger for most variables compared with the lower intensity treatment group. CONCLUSIONS & IMPLICATIONS: Overall, the results of the current study may allow for modification of service delivery and facilitate the development of an evidence-based care pathway for children with CAS.

The objective was to assess effectiveness of apraxia treatments using a systematic review. In contrast to previous reviews, each study was rated as to its applicability to occupational therapy practice and its focus on occupational performance using the FAME rating system (defined by four categories: Feasibility, Appropriateness, Meaningfulness, Effectiveness). This systematic review included eight studies: four randomized controlled trials (level 1 evidence) and four pre-post designs (level 3 evidence). Three treatment approaches were reported: errorless learning with training of details; gesture training; and strategy training. FAME scores ranged from A to C. All studies reported significant treatment effects, but only one demonstrated an impact on observed occupational performance that transferred from clinic to home.

BACKGROUND: Telerehabilitation is the remote delivery of rehabilitation services via information technology and telecommunication systems. There have been a number of studies that have used videoconferencing to assess speech and language skills in people with acquired neurogenic communication disorders. However, few studies have focused on cases of apraxia of speech. In order to perform accurately differential diagnosis via the telerehabilitation medium, it is important that validation of the assessment of apraxia of speech be established as part of the overall evidence base for telerehabilitation communication assessment protocols. AIMS: To determine if valid and reliable assessment of apraxia of speech using a standardized assessment tool was feasible via telerehabilitation. METHODS & PROCEDURES: Eleven participants with an acquired apraxia of speech were assessed simultaneously via telerehabilitation and face-to-face methods on the Apraxia Battery for Adults - 2 (ABA-2). A custom-built telerehabilitation system developed at the University of Queensland enabled real-time telerehabilitation assessment over a 128 kbit/s internet connection. Data analysis included tests of significant difference between raw scores using the Wilcoxon signed rank statistic and analysis of the degree of agreement between the two methods using weighted Kappa statistics. Inter- and intra-rater reliabilities were also examined for the telerehabilitation-led assessments. OUTCOMES & RESULTS: Results revealed no significant differences between the subtest scores of the ABA-2 obtained in the telerehabilitation and face-to-face test environments (p = 0.06-0.68). Weighted Kappa statistics indicated moderate to very good agreement (0.59-1.00) between the two environments for the subtests of the ABA-2. The reliability study was hampered by small sample size; however, the data were suggestive of reasonable reliability. Participants reported high overall satisfaction, comfort level, and audio and visual quality in the telerehabilitation environment. The speech-language pathologists (SLP) reported some difficulties assessing participants with severe apraxia of speech via the telerehabilitation system. CONCLUSIONS & IMPLICATIONS: This study suggests that valid assessment of apraxia of speech using the ABA-2 over the internet is feasible. The reliability study on the telerehabilitation assessments was encouraging with results suggesting that telerehabilitation assessment using the ABA-2 could be reliable. Findings from the participant satisfaction questionnaire were favourable. However, comments from the SLP suggested that participants exhibiting severe apraxia of speech might be better suited to face-to-face assessment. These findings may have implications for the development of evidence-based guidelines for the use of telerehabilitation in the assessment of apraxia of speech. The authors propose that future research should include larger sample sizes with a range of participant severity levels and be conducted over higher bandwidth connections to explore further the validity and reliability of telerehabilitation assessment of apraxia of speech.

Este artículo no tiene resumen