METHOD
12-week program of Cortical Integrative Therapy
RESULTS
At the conclusion of the 12-week treatment program, J.L. showed considerable gains in his ability to understand directions as noted by an independent examiner, a school psychologist. His overall academic performance, as noted by his classroom teachers and parents, was also significantly improved especially in the areas of reading and reading comprehension, listening skills, oral expression, and rhyming ability. Of perhaps greater significance, his speech is easier to understand, if slightly slower and more melodic. In addition, his perceptual motor skills and fine motor coordination seem to have substantially improved. He is much less clumsy.
There were also other documented gains. Subsequent to receiving Cortical Integrative training, at age 7 years, 7 months, J.L. underwent further neuropsychological testing. While his conversational speech remained “somewhat unclear” and he spoke with a slight lisp and often mispronounced words, he received a Verbal IQ score of 76, a Performance IQ score of 74, and a Full Scale IQ of 73, all in the mildly impaired range for others of his age group, but considerably improved from earlier testing. Fluency to a phonemic characteristic was in the low average range, while fluency to a semantic category was average suggesting the J.L. benefits greatly from external structure and support. Recognition memory was average for retention of simple information. His ability to sustain attention to search for a shape was fast and accurate. Immediate recall of stories was in the low average range and improved slightly to the average range over delay. The subsequent testing also revealed a low average ability to use feedback to discover categorical rules and solve novel problems. While J.L.’s deficits are more extensive than being exclusively apraxia-related, his adaptive skills are too high to consider him as mentally retarded. In addition, in separate trials, receptive single-word vocabulary (as demonstrated by his recognition of words by sight) was significantly improved. Showing a newfound predilection for visual scanning, J.L. has gone from recognizing only 3 words on sight to a recognizing at least 146 words, with the ability to reproduce results independently and upon command.
DISCUSSION
Developmental apraxia of speech is often associated with serious impediment to academic success. J.L. had been stymied throughout his academic career by this disability, and his quality of life was severely restricted. But when a multimodal approach using techniques aimed at facilitating inter-hemispheric communication was provided, evidence was produced to indicate that when such techniques are applied, the prospect of indirect neuronal or network modulation occurring as cortical pathways are stimulated becomes a real possibility worthy of further investigation. In addition, there are valuable intangibles effecting quality of life. Prior to participation in Cortical Integrative Therapy, J.L. often grew frustrated with simple homework tasks and academic work. His speech sounded like “babble” and he was reduced to gestures to be understood much of the time. It seems that his speech is now significantly improved, and he is less frustrated while communicating.