Authors: Dworkin JP, Abkarian GG
Title: Treatment of phonation in a patient with apraxia and dysarthria secondary to severe closed head injury
Source: Journal of Medical Speech Language Pathology 1996 4(2): 105-115
Year: 1996
Research Design: Single Case Design

This study involved a young adult male who suffered a closed head injury and diffuse encephalopathy. He exhibited profound dysphonia and moderate degrees of articulatory imprecision, hypernasality, and prosodic insuffficiency. The diagnosis rendered included a mixture of apraxia of phonation, apraxia of speech, and unilateral upper motor neuron dysarthria. Although he was not aphasic, he had moderate cognitive and profound short-term memory difficulties. At the time of referral, 14 months post-trauma, he was unable to initiate and sustain phonation and primitive vocalizations were unintelligible; he used a computer typewriter to communicate. This paper describes the first phase of speech intervention, which focused exclusively on facilitating voice output. The regimen employed a hierarchy of voice-motor activities that were paced with a metronome. At the conclusion of this phase of treatment, the patient demonstrated clinically significant phonatory improvements, enabling subsequent therapeutic focus on other speech subsystems. The reasons why this treatment approach was successful when previous speech therapy had failed are explored, and the benefit of the external pacing technique is addressed.

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