[CAS – C014] MPT & SRT

雖然我經常說診斷兒童言語失用症的最普遍方法是用checklist （可參考連結內容：https://www.facebook.com/CantoneseCAS/posts/739350419905925及https://www.facebook.com/CantoneseCAS/posts/283139915526980），但其實一直都有一些較為客觀的方法可以協助診斷的。今次要介紹兩種方法：Maximum Performance Tasks (MPT; Thoonen, Maassen, Gabreels, & Schreuder, 1999)及Syllable Repetition Task (SRT; Shriberg, Lohmeier, Campbell, Dollaghan, Green & Moore, 2009)。

MPT有很多不同的項目，其中有seqeuntial motor rate (SMR)，即是快速地重覆/pʌtʌkʌ/。 Thoonen et al. (1999) 發佈了有關MPT的validity的報告，說明此方法有89-100% 的sensitivity 及 specificity作CAS診斷。CAS兒童比起正常發展兒童及患有運動性構音障礙的兒童需要更多嘗試、會產生更多錯誤及在速度上更慢。我相信大家在臨床工作上都有做過。

至於SRT，是美國研究團隊針對MPT 的不足而設計的。Shriberg et al. (2009)認為， /pʌtʌkʌ/對於有限口語兒童來說未必可行，所以利用兒童語音發展中較早期的聲音，如/m/、/d/ 及 /a/等設計nonword stimuli，讓兒童模仿，再分析表現。Shriberg Lohmeier, Strand, & Jakielski (2012) 表示CAS 兒童在SRT中表現明顯低分，是反應了他們在motorplanning and/or programming of speech 中的缺失。但暫時未有有關validity 的報告。不過臨床使用是有被推薦過的 (Rvachew & Matthews, 2017)。

除了以上兩種方法，其實還有其他客觀評估的方法。日後會再跟大家分享。

#兒童#言語失用症#客觀#評估#方法#言語治療#語言治療#MPT#SRT

Reference:

Rvachew, S. & Matthew, T. (2017). Using the syllable repetition task to reveal underlying speech processes in childhood apraxia of speech: A tutorial. Canadian Journal of Speech-Language Pathology and Audiology, 41, 106-126.

Shriberg, L. D., Lohmeier, H. L., Campbell, L. T., Dollaghan C. A., Green, J. R., & Moore, C. A. (2009). A nonword repetition task for speakers with misarticulations: The syllable repetition task (SRT). Journal of Speech, Language, and Hearing Research, 52(5), 1189-1212.

Shriberg, L. D., Lohmeier, H. L., Strand, E. A., & Jakielski, K. J. (2012). Encoding, memory, and transcoding deficits in childhood apraxia of speech. Clinical Linguistics & Phonetics, 26(5), 445-482.

Thoonen, G., Maassen, B., Gabreels, F., & Schreuder, R. (1999). Validity of maximum performance tasks to diagnoses motor speech disorders in children. Clinical Linguistics, & Phonetics, 13, 1-23.

[CAS — R023] The applicability of English childhood apraxia of speech to Cantonese

[拍手] 我的第一份期刊文章發布了。這是一項問卷研究。十位來自香港不同學前/在學言語治療服務單位的言語治療師參與了此研究，提出廣東話兒童言語失用症的臨床表徵。

約有八成臨床表徵與英語文獻一致。三項英語臨床表徵未有被提出，包括 1. Lexical stress errors 2. Voicing errors 3. Intrusive schwa

另外有三項與廣東話語音相關的臨床表徵被提出，包括： 1. Difficulty in producing aspirated sound (deaspiration) 2. Weak tone perception or identification 3. Difficulty in producing Cantonese tone

研究結果暗示英語與廣東話兒童言語失用症都有著相同的主要表徵及其他表徵。此文討論了六項不為英語及廣東話兒童言語失用症共同擁有的臨床表徵，及建議了將來可研究不同語言及不同語言之間的兒童言語失用症。

感謝所有參與此研究的人士，不單是研究中的言語治療師，還有期刊的編輯及同儕。

——————————————————————————— My first article is finally published in a peer-reviewed journal. This is a survey study, in which 10 experienced STs from representative clinical settings with pre-school or school-aged speech therapy services in Hong Kong were asked to raise the clinical features of Cantonese CAS.

About 80% of the identified clinical features were consistent with English literature. Three English features were not identified, including 1. Lexical stress errors 2. Voicing errors 3. Intrusive schwa

Three features specifically related to Cantonese phonology were identified, including 1. Difficulty in producing aspirated sound (deaspiration) 2. Weak tone perception or identification 3. Difficulty in producing Cantonese tone

The results imply that core- and possible co-occurring features are shared between English and Cantonese CAS. The six features that were not common in both languages were discussed. Further investigation of CAS in and between different languages is recommended.

Thank you very much for all the participants who contributed to this article. Not only the STs, but also the reviewers and editor of the journal.

Reference:

Wong, E. C. H., Lee, K. Y. S., & Tong, M. C. F. (2020). The applicability of the clinical features of English childhood apraxia of speech to Cantonese: A modified Delphi survey. American Journal of Speech and Language Pathology. https://doi.org/10.1044/2019_AJSLP-19-00118.

#廣東話 #言語失用症 #兒童言語失用症 #研究 #言語治療 #失用症 #語言治療 #臨床表徵 #CantoneseCAS #CAS #childhood #apraxia #apraxiaofspeech #speechtherapy #clinicalfeature

[CAS — R022] Telepractice of CAS treatment

武漢/新冠肺炎疫情下，家長都會擔心帶小朋友到診所/訓練中心。在這種情況下，telepractice 可行嗎？

Telepractice 在香港言語治療服務中，未算是十分普及，但在英語世界，都已經有不少証據支持其成效 (Molini-Avejonas, Rondon-Melo, Amato, & Samelli, 2015)。有關言語（speech) 的研究是在眾多範疇中佔據第二位（第一位是聽力[hearing])。

至於有關CAS的telepractice，暫時只有Rapid Syllable Transitions (ReST) 一種得到證據支持的治療課程 (Thomas, McCabe, Ballard, & Lincoln, 2016). Thomas et al. (2016) 為五位5-11歲的兒童提供ReST，連續三星期，每星期4次視象課堂。結果顯示telehealth 同 face-to-face delivery 對於兒童有著相似的結果，是一項有效的治療。在疫情影響下，我都把clients的課堂改成視象課堂，需要準備的都正在準備，或許稍後可以跟大家多作分享。

P.S. 不知道在澳門/台灣/馬來西亞/其他亞洲地區的言語治療師，您們有進行telepractice嗎？可以分享一下你們的做法嗎？

Reference: Molini-Avejonas, D. R., Rondon-Melo, S., Amato, C. A., & Samelli, A. G. (2015). A systematic review of the use of telehealth in speech, language and hearing sciences. Journal of Telemedicine and Telecare, 21(7), 367-376.

Thomas, D. C., McCabe, P., Ballard, K. J., & Lincoln, M. (2016). Telehealth delivery of Rapid Syllable Transitions (ReST) treatment for childhood apraxia of speech. International Journal of Language and Communication Disorders, 51(6), 654-671.

#言語治療 #語言治療 #telepractice #遙距治療 #言語 #失用症 #兒童