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There is no cure for DVD/CAS, but with appropriate, intensive intervention, people with the disorder can improve significantly.
DVD/CAS requires various forms of therapy which varies with the individual needs of the patient. Typically, treatment involves one-on-one therapy with a speech language pathologist (SLP). In children with DVD/CAS, consistency is a key element in treatment. Consistency in the form of communication, as well as the development and use of oral communication are extremely important in aiding a child's speech learning process.
Many therapy approaches are not supported by thorough evidence; however, the aspects of treatment that do seem to be agreed upon are the following:
- Treatment needs to be intense and highly individualized, with about 3-5 therapy sessions each week
- A maximum of 30 minutes per session is best for young children
- Principles of motor learning theory and intense speech-motor practice seem to be the most effective
- Non-speech oral motor therapy is not necessary or sufficient
- A multi-sensory approach to therapy may be beneficial: using sign language, pictures, tactile cues, visual prompts, and Augmentative and Alternative Communication (AAC) can be helpful.
Although these aspects of treatment are supported by much clinical documentation, they lack evidence from systematic research studies. In ASHA's position statement on DVD/CAS, ASHA states there is a critical need for collaborative, interdisciplinary, and programmatic research on the neural substrates, behavioral correlates, and treatment options for DVD/CAS.
In cases of acute AOS (stroke), spontaneous recovery may occur, in which previous speech abilities reappear on their own. All other cases of acquired AOS require a form of therapy; however the therapy varies with the individual needs of the patient. Typically, treatment involves one-on-one therapy with a speech language pathologist (SLP). For severe forms of AOS, therapy may involve multiple sessions per week, which is reduced with speech improvement. Another main theme in AOS treatment is the use of repetition in order to achieve a large amount of target utterances, or desired speech usages.
There are various treatment techniques for AOS. One technique, called the Linguistic Approach, utilizes the rules for sounds and sequences. This approach focuses on the placement of the mouth in forming speech sounds. Another type of treatment is the Motor-Programming Approach, in which the motor movements necessary for speech are practiced. This technique utilizes a great amount of repetition in order to practice the sequences and transitions that are necessary in between production of sounds.
Research about the treatment of apraxia has revealed four main categories: articulatory-kinematic, rate/rhythm control, intersystemic facilitation/reorganization treatments, and alternative/augmentative communication.
- Articulatory-kinematic treatments almost always require verbal production in order to bring about improvement of speech. One common technique for this is modeling or repetition in order to establish the desired speech behavior. Articulatory-kinematic treatments are based on the importance of patients to improve spatial and temporal aspects of speech production.
- Rate and rhythm control treatments exist to improve errors in patients’ timing of speech, a common characteristic of Apraxia. These techniques often include an external source of control like metronomic pacing, for example, in repeated speech productions.
- Intersystemic reorganization/facilitation techniques often involve physical body or limb gestural approaches to improve speech. Gestures are usually combined with verbalization. It is thought that limb gestures may improve the organization of speech production.
- Finally, alternative and augmentative communication approaches to treatment of apraxia are highly individualized for each patient. However, they often involve a "comprehensive communication system" that may include "speech, a communication book aid, a spelling system, a drawing system, a gestural system, technologies, and informed speech partners".
One specific treatment method is referred to as PROMPT. This acronym stands for Prompts for Restructuring Oral Muscular Phonetic Targets, and takes a hands on multidimensional approach at treating speech production disorders. PROMPT therapists integrate physical-sensory, cognitive-linguistic, and social-emotional aspects of motor performance. The main focus is developing language interaction through this tactile-kinetic approach by using touch cues to facilitate the articulatory movements associated with individual phonemes, and eventually words.
One study describes the use of electropalatography (EPG) to treat a patient with severe acquired apraxia of speech. EPG is a computer-based tool for assessment and treatment of speech motor issues. The program allows patients to see the placement of articulators during speech production thus aiding them in attempting to correct errors. Originally after two years of speech therapy, the patient exhibited speech motor and production problems including problems with phonation, articulation, and resonance. This study showed that EPG therapy gave the patient valuable visual feedback to clarify speech movements that had been difficult for the patient to complete when given only auditory feedback.
While many studies are still exploring the various treatment methods, a few suggestions from ASHA for treating apraxia patients include the integration of objective treatment evidence, theoretical rationale, clinical knowledge and experience, and the needs and goals of the patient
One technique that is frequently used to treat DVD/CAS is integral stimulation. Integral stimulation is based on cognitive motor learning, focusing on the cognitive motor planning needed for the complex motor task of speech. It is often referred to as the "watch me, listen, do as I do" approach and is founded on a multi-step hierarchy of strategies for treatment. This hierarchy of strategies allows the clinician to alter treatment depending upon the needs of the child. It uses various modalities of presentation, emphasizing the auditory and visual modes. Experts suggest that extensive practice and experience with the new material is key, so hundreds of target stimuli should be elicited in a single session. Furthermore, distributed (shorter, but more frequent) and random treatment, which mix target and non-target utterances, produces greater overall learning.
The 6 steps of the hierarchy upon which integral stimulation therapy for children is loosely organized are:"
- The child watches and listens and simultaneously produces the stimulus with the clinician.
- The clinician models, then the child repeats the stimulus while the clinician simultaneously mouths it.
- The clinician models and provides cues and the child repeats.
- The clinician models and the child repeats with no cues provided.
- The clinician elicits the stimulus without modeling, such as by asking a question, with the child responding spontaneously.
- The child produces stimuli in less-directed situations with clinician encouragement, such as in role-play or games".
There is no cure for the condition. Management is through therapy.
Many researchers are investigating the characteristics of apraxia of speech and the most effective treatment methods. Below are a couple of the recent findings:
Sound Production Treatment:
Articulatory-kinematic treatments have the strongest evidence of their use in treating Acquired Apraxia of Speech. These treatments use the facilitation of movement, positioning, timing, and articulators to improve speech production. Sound Production Treatment (SPT) is an articulatory-kinematic treatment that has received more research than many other methods. It combines modeling, repetition, minimal pair contrast, integral stimulation, articulatory placement cueing, and verbal feedback. It was developed to improve the articulation of targeted sounds in the mid-1990s. SPT shows consistent improvement of trained sounds in trained and untrained words. The best results occur with eight to ten exemplars of the targeted sound to promote generalization to untrained exemplars of trained sounds. In addition, maintenance effects are the strongest with 1–2 months post-treatment with sounds that reached high accuracy during treatment. Therefore, the termination of treatment should not be determined by performance criteria, and not by the number of sessions the client completes, in order to have the greatest long-term effects. While there are many parts of SPT that should receive further investigation, it can be expected that it will improve the production of targeted sounds for speakers with apraxia of Speech.
Repeated Practice & Rate/Rhythm Control Treatments:
Julie Wambaugh’s research focuses on clinically applicable treatments for acquired apraxia of speech. She recently published an article examining the effects of repeated practice and rate/rhythm control on sound production accuracy. Wambaugh and colleagues studied the effects of such treatment for 10 individuals with acquired apraxia of speech. The results indicate that repeated practice treatment results in significant improvements in articulation for most clients. In addition, rate/rhythm control helped some clients, but not others. Thus, incorporating repeated practice treatment into therapy would likely help individuals with AOS.
Developmental verbal dyspraxia is a developmental inability to motor plan volitional movement for the production of speech in the absence of muscular weakness. Research has suggested links to the FOXP2 gene.
Dysarthria is the reduced ability to motor plan volitional movements needed for speech production as the result of weakness/paresis and/or paralysis of the musculature of the oral mechanism needed for respiration, phonation, resonance, articulation, and/or prosody.
Developmental coordination disorder (DCD), also known as developmental dyspraxia or simply dyspraxia, is a chronic neurological disorder beginning in childhood. It is also known to affect planning of movements and co-ordination as a result of brain messages not being accurately transmitted to the body. Impairments in skilled motor movements per a child's chronological age which must interfere with activities of daily living. A diagnosis of DCD is then reached only in the absence of other neurological impairments like cerebral palsy, muscular dystrophy, multiple sclerosis or Parkinson's disease. According to CanChild in Canada, this disorder affects 5 to 6 percent of school-aged children; however this disorder does progress towards adulthood, therefore making it a lifelong condition.
The Lance Armstrong doping case was a doping investigation that led to American former professional road racing cyclist Lance Armstrong being stripped of his seven Tour de France titles and his eventual admission to the doping.
Doping in Russian sports has a systemic nature. Russia has had 51 Olympic medals stripped for doping violations – the most of any country, four times the number of the runner-up, and more than a third of the global total. From 2011 to 2015, more than a thousand Russian competitors in various sports, including summer, winter, and Paralympic sports, benefited from a cover-up.
Counter-jihad or Counterjihad or Counter-jihad movement is a political current loosely consisting of authors, bloggers, think tanks, street movements and campaign organisations all linked by a common belief that the Western world is being subjected to takeover by Muslims. Several academic accounts have presented conspiracy theory as a key component of the counter jihad movement.
While the roots of the movement go back to the 1980s, it did not gain significant momentum until after the September 11 attacks in 2001 and the 7 July 2005 London bombings. As far back as 2006, online commentators such as Fjordman were identified as playing a key role in forwarding the nascent counter-jihad ideology. The movement received considerable attention following the 2011 Breivik murders whose manifesto extensively reproduced the writings of prominent counter-jihad bloggers, and following the emergence of prominent street movements such as the English Defence League (EDL). The movement has been variously described as pro-Israel, anti-Islamic, Islamophobic, inciting hatred against Muslims, or far-right.
The movement has adherents both in Europe and in North America, which according to some vary in tone. The European wing is more focused on the alleged cultural threat to European traditions stemming from immigrant Muslim populations, whereas the American wing emphasizes an alleged external threat, essentially terrorist in nature.
Inert gas asphyxiation is a form of asphyxiation which results from breathing a physiologically inert gas in the absence of oxygen, or a low amount of oxygen, rather than atmospheric air (which is largely composed of nitrogen and oxygen). Examples of physiologically inert gases, which have caused accidental or deliberate death by this mechanism, are: argon, helium, nitrogen and methane. The term "physiologically inert" is used to indicate a gas which has no toxic or anesthetic properties and does not act upon the heart or hemoglobin. Instead, the gas acts as a simple diluent to reduce oxygen concentration in inspired gas and blood to dangerously low levels, thereby eventually depriving all cells in the body of oxygen.
According to the U.S. Chemical Safety and Hazard Investigation Board, in humans, "breathing an oxygen deficient atmosphere can have serious and immediate effects, including unconsciousness after only one or two breaths. The exposed person has no warning and cannot sense that the oxygen level is too low." In the US, at least 80 people died due to accidental nitrogen asphyxiation between 1992 and 2002. Hazards with inert gases and the risks of asphyxiation are well established.
An occasional cause of accidental death in humans, inert gas asphyxia with gases including helium, nitrogen, methane, and argon, has been used as a suicide method. Inert gas asphyxia has been advocated by proponents of euthanasia, using a gas-retaining plastic hood device colloquially referred to as a suicide bag.
Nitrogen asphyxiation has been suggested by a number of lawmakers and other advocates as a more humane way to carry out capital punishment. In April 2015, the Oklahoma Governor Mary Fallin signed a bill authorizing nitrogen asphyxiation as an alternative execution method in cases where the state's preferred method of lethal injection was not available as an option.
Diving animals such as mink and burrowing animals, such as rodents and rats, are sensitive to low-oxygen atmospheres and (unlike humans) will avoid them, making purely hypoxic techniques possibly inhumane for them. For this reason, the use of inert gas (hypoxic) atmospheres (without CO) for euthanasia, is also species-specific.
For much of his career, Lance Armstrong faced persistent allegations of doping, but until 2006 no official investigation was undertaken. The first break in the case came in 2004, when SCA Promotions, a Dallas-based insurer, balked at paying a $5 million bonus to Armstrong for winning his sixth consecutive Tour. SCA president Bob Hamman had read "L.A. Confidentiel", a book by cycling journalists Pierre Ballester and David Walsh which detailed circumstantial evidence of massive doping by Armstrong and members of his U.S. Postal Service Pro Cycling Team. In 2006, an arbitration panel ruled that SCA had to pay. However, Hamman's real goal was to force an investigation by sporting authorities. He believed that if someone in a position to investigate the matter found that Armstrong had indeed doped, he could be stripped of his Tour victories--allowing SCA to get its money back. His hunch proved correct; officials from the United States Anti-Doping Agency (USADA) asked to review the evidence Hamman had gleaned.
Counter-jihad is a transatlantic "radical right" wing movement which, via "the sharing of ideas between Europeans and Americans and daily linking between blogs and websites on both sides of the Atlantic" "calls for a counterjihad against the supposed Islamisation of Europe".
While the roots of the movement go back to the 1980s, it did not gain significant momentum until after the September 11 attacks in 2001.
The authors of "Right-Wing Populism in Europe: Politics and Discourse" describe the movement as heavily relying on two key tactics. "The first is arguing that the most radical Muslims – men like Osama bin Laden – are properly interpreting the Quran, while peaceful moderate Muslims either do not understand their own holy book or are strategically faking their moderation. The second key tactic is to relentlessly attack individuals and organizations that purport to represent moderate Islam...painting them as secret operatives in a grand Muslim scheme to destroy the West."
Benjamin Lee describes the "counter-jihad scene" as one where "Europe and the United States are under threat from an aggressive and politicized Islamic world that is attempting to take over Europe through a process of "Islamification" with the eventual aim of imposing Sharia law. In this process, the threat is characterized by the perceived removal of Christian or Jewish symbols, the imposition of Islamic traditions, and the creation of no-go areas for non-Muslims. The construction of mosques in particular is seen as continued reinforcement of the separation of the Muslim population from the wider populous. As strong as the threatening practices of Muslims in descriptions of the counter jihad are images of a powerless Europe in decline and sliding into decadence, unable to resist Islamic takeover. The idea that European culture in particular is in a state of decline, while a spiritually vigorous East represented by Islam is in the ascendancy in civil society, is a common sentiment in some circles."
Two central Counter-jihad themes have been identified:
- the notion that Islam poses a threat to "Western civilisation" with a particular focus on "Muslims living in Europe", that is, within the European Counterjihad Movement (ECJM), "seen predominantly in terms of immigration" particularly Muslim immigration.
- a lack of trust in regional, political and economic "elites", with a particular focus against the European Union (EU).
According to British journalist Andrew Jennings, a KGB colonel stated that the agency's officers had posed as anti-doping authorities from the International Olympic Committee to undermine doping tests and that Soviet athletes were "rescued with [these] tremendous efforts". On the topic of the 1980 Summer Olympics, a 1989 Australian study said "There is hardly a medal winner at the Moscow Games, certainly not a gold medal winner, who is not on one sort of drug or another: usually several kinds. The Moscow Games might as well have been called the Chemists' Games."
Documents obtained in 2016 revealed the Soviet Union's plans for a statewide doping system in track and field in preparation for the 1984 Summer Olympics in Los Angeles. Dated prior to the country's decision to boycott the Games, the document detailed the existing steroids operations of the program, along with suggestions for further enhancements. The communication, directed to the Soviet Union's head of track and field, was prepared by Dr. Sergei Portugalov of the Institute for Physical Culture. Portugalov was also one of the main figures involved in the implementation of the Russian doping program prior to the 2016 Summer Olympics.