[CAS – S001] Nuffield Dyspraxia Programme

2016年飛咗去London，就係為咗上呢個course。兩日course，上得我勁興奮，90%內容都係關於CAS，理論、應用、研究、臨床技巧咩都有，正到我上完都仲興奮咗一段好長嘅時間。要提醒下，以上內容全部係我私人感情，私人感情，私人感情（因為真係好重要，所以講三次）。如果你對CAS 興趣不大，你應該會覺得個course 只係一般嘅學嘢course，無咩特別。

Nuffield Dyspraxia Programme- Third Edition (Williams & Stephens, 2004) 嚟到第三個Edition，所以佢最新係叫NDP3。第一、二個edition，係1985 同 1992 完成嘅，已經30幾年歷史。Founder 係Pam Williams，英國嘅Speech and Language Therapist。話說佢年紀都唔細，仲喺2017年喺University of Sheffield 完成咗PhD，宜家係Dr. Williams。佢嘅Supervisor，就係Professor Joy Stackhouse 同 Professor Bill Wells。你話幾咁犀利。

講返個NDP， 用嚟CAS 小朋友身上非常有效。全世界第一個CAS 嘅RCT 研究，就係用NDP 同另一個programme 比較，發現兩個Programme 都同樣有效嘅，詳見 Murray, McCabe, & Ballard (2015)。研究發現NDP 係有效嘅，個人嚟講，NDP嘅好，係佢涵蓋嘅範圍好闊。有assessment，亦有treatment。Treatment 入面，由單音砌到上connected speech，好有系統。Treatment planning 同implementation亦都非常簡單而有彈性。喺手頭嘅case 上是但點一個，都可以跟佢嘅方法plan 好treatment，非常user friendly。不過，佢唯一唔好嘅地方，就係個programme 係需要狂drill嘅，對於一啲專注能力或有行為問題嘅小朋友，就好難跟足個programme 嚟做。但又不過呢，ST 有嘅係flexibility，只要plan 好，implementation 就一定唔係問題，只係需要用多啲力啫～～

總結，如果你對CAS 好有興趣，我好建議大家去上NDP 嘅course，個course每年5月同11月都會喺London 攪一次，上完course 仲可以留英國玩幾日，正呀喂！

網頁如下： https://www.ndp3.org/

References: Murray, E., McCabe, P., & Ballard, K. J. (2015). A randomized controlled trial for children with childhood apraxia of speech comparing Rapid Syllable Transition treatment and the Nuffield Dyspraxia Programme- Third Edition. Journal of Speech, Language, and Hearing Research, 58(3), 669-686.

Williams, P., & Stephens, H. (2004). Nuffield dyspraxia programme (3rd ed.). Windsor: The Miracle Factory.

[CAS --R001] Language-neutral assessment of motor speech (LAMS)

This is a poster presentation in APCSLH2017. LAMS is a play-based assessment tool for children motor speech skills, including both non-speech and speech abilities (Velleman, Andrianopoulos & Rupela, 2017). The highlight of this tool is its regardlessness of language background and administration on pre-verbal children. Though the validity and reliability have not yet be demonstrated, there are several studies support that LAMs is effective for differentiating motor speech skills of different groups (e.g., ASD, Down Syndrome).

This is one of the studies using LAMS for assessment.

Rupela, V., Velleman, S. L., & Andrianopoulos, M. V. (2016). Motor speech skills of children with Down Syndrome: a descriptive study. International Journal of Speech and Language Pathology, 18(5), 483-92. doi:10.3109/17549507.2015.1112836.

access website: https://www.ncbi.nlm.nih.gov/m/pubmed/27063682/

Reference: Velleman, S. L., Andrianopoulos, M. V., & Rupela, V. (2017). Language-neutral assessment of motor speech (LAMS). Paper presented at the Asia Pacific Conference of Speech, Language and Hearing 2017, Narita, Japan.

[CAS -- C001] 究竟點先知小朋友係咪CAS？

間中都會同啲ST同工討論下個案。通常講完少少小朋友嘅表現之後，就會問我覺唔覺得佢係CAS。不如今日就分享下我點樣睇一個小朋友係咪CAS。

「三歲小朋友，語言理解能力好好，但口語表達好少，好多時都用動作做表達。」

聽到呢度，好多人都會諗個仔係咪CAS。但我呢就會再追問一個問題。小朋友多唔多babbling。Velleman & Strand (1994) 提及過，CAS 嘅小朋友對點樣運用不同syllable structure (音節結構) 有明顯嘅困難，意思係佢地唔識點樣將不同嘅phoneme 組合成一個音節結構，所以佢地唔能夠發出/ba/、/ma/等成為babbling。如果小朋友無呢種canonical babbling，咁較難嘅variegated babbling 就更少喇。如果小朋友真係好少babbling，呢個係一個好重要嘅特徵，顯示佢排序能力真係好弱。

「佢真係無babbling 架，但小朋友好多時都只係用一個單音，例如/a/ 作表達。無inconsistent error ，亦無groping，咁仲係唔係CAS?」

呢個問題好有趣。如果小朋友口語能力咁弱，只係講到一個元音，當然唔會有inconsistent error 啦。Inconsistent error 其實同variability 好有關係，小朋友嘅motor plan and programme 入面越多野，講野時嘅variability先越大， inconsistent error 先會出現。只係得一個音嘅plan and programme，又點會有inconsistent 嘅情況呢。其次，CAS 同大人嘅AOS 好唔同，有groping當然反映到motor plan and programme 問題，但無亦唔一定唔係CAS。始終groping 唔係個個CAS 小朋友都有。

「咁點先知佢係咪CAS?」

我會建議做多少少motor speech 嘅評估。首先，如果小朋友有兩個或以上嘅元音，就要做下DDK，睇下佢排列已有元音嘅能力。做法其實好簡單，如果小朋友有/a/ 同/u/，就用一隻動物代表/a/，另一隻動物代表/u/，然後請小朋友輪流講/a/ 同/u/，重覆三至五次，就會睇到佢有冇排序困難。真係CAS 嘅小朋友，佢地會做得好慢，停頓位會好奇怪，或者入面會有好多addition/deletion errors，元音變異(vowel distortion)亦會有。

第二，要攞佢最少10分鐘嘅speech sample，因為CAS小朋友自發嘅口語表達，同模仿係有分別嘅。而且，speech sample 入面可以知道小朋友最常用嘅phoneme 同 音節結構，對於治療，係非常重要嘅資料。

「咁如果個小朋友無speech，咁佢係咪CAS?」

如果無speech，根本唔可以話佢喺CAS。因為你睇唔到佢motor speech 嘅能力。一定要佢有口語表達，先可以診斷為CAS。

「咁如果佢模仿唔到元音，咁又點？」

如果模仿唔到，就要睇佢點解模仿唔到。係因為唔明個task? 唔attend? 定係因為motor speech 嘅問題？如果你已確定小朋友係motor speech 問題摸仿唔到，呢個時候就要出cues 喇，visual、tactile、auditory cues 咩都要出，睇下佢喺咩情況下做到，對於你計劃治療，非常有用。我嘅經驗，如果係CAS 嘅小朋友，有一種叫simultaneous cue 係非常有效。即係同個小朋友同時講一個音或字。CAS 權威 Edythe Strand 亦喺 「Management of motor speech disorders in children and adults 」一書入面提過呢個係有效嘅提示方法。而呢個方法，喺 Guehther, Ghosh & Tourville (2006) 提及的Directions Into Velocities of Articulators (DIVA) Model 入面係解釋到架。因為CAS 嘅小朋友非常依賴auditory feedback 幫佢地建立feedforward system。詳細關於DIVA Model，遲下再講。

其實口語表達能力咁有限嘅小朋友，做評估係困難嘅，要診斷佢係CAS就更困難。除咗以上嘅資料，仲有一啲其他需要注意事項，例如小朋友整體嘅general motor behaviours、sensory integration、oral motor behaviours、speech perception等等等等，下次再分享呀～

Reference:

Guenther, F.H., Ghosh, S.S., & Tourville, J.A. (2006). Neural modeling and imaging of the cortical interactions underlying syllable production. Brain and Language, 96, pp280-301.

Velleman, S., & Strand, K. (1994). Developmental verbal dyspraxia. In J. E. Bernthal & N. W. Bankson (Eds.), Child phonology: Characteristic, assessment and intervention with special populations (pp. 110-139). New York: Thieme.

Yorkston, K. M., Beukelman, D. R., Strand, E. A., & Hakel, M. (2010). Management of motor speech disorders in children and adults. Austin, TX: PRO-ED.

#有咩意見歡迎留言inbox

#childhoodapraxiaofspeech #speechtherapy #CAS #CantoneseCAS #言語治療 #言語治療師 #兒童言語失用症