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Master Title

The Use of Non-Speach Oral Motor Exercises in Improving Expressive Language in Children with Speech Apraxia Disorder

Master Abstract

Summary I. Introduction: Speech production is a complex process that requires a range of sensorimotor functions. Humans are distinguished by their ability to speak, utilizing various articulatory organs such as the tongue, lips, teeth, uvula, palate, and mandible. These organs are coordinated through neural commands transmitted from the brain via specialized nerves, resulting in speech production. Some individuals may experience disorders in the central nervous system (brain) that disrupt the neural programming necessary to generate these commands, leading to speech difficulties known as childhood apraxia of speech (CAS). CAS is characterized by impaired ability to position muscles, plan, and perform sequential muscle movements to achieve intentional speech goals. This motor performance issue is not attributed to muscle weakness, slowness, or incoordination. It manifests as an inability to control articulatory movements despite intact musculature, difficulty producing words correctly, and errors such as omissions, additions, or substitutions of sounds within words (A?fal Al-Khalij Forum, 2022). Non-speech oral motor exercises (NSOMEs) are defined as activities designed to stimulate or improve speech production and treat children with specific speech errors without requiring the child to produce speech sounds (Gibbon & Lee, 2015). The use of NSOMEs may contribute to improved expressive language in children with CAS. Typically, non-speech oral motor training is integrated into various treatment protocols, emphasizing the motor component of expressive language production. This training can be conducted with or without the production of speech sounds (Alhaidary, 2021). Based on the above, the researcher posits that expressive language in children with CAS can be improved through a program based on NSOMEs. Therefore, this study aimed to develop a program based on NSOMEs to improve expressive language in children with CAS. II. Statement of the Problem: The central research question of this study is: What is the effectiveness of using non-speech oral motor exercises to improve expressive language in children with childhood apraxia of speech? This question is further explored through the following sub-questions: 1. What are the differences between the post-test scores of the experimental and control groups on the expressive language measure? 2. What are the differences between the pre-test and post-test scores of the experimental group on the expressive language measure? 3. What are the differences between the post-test and follow-up test scores of the experimental group on the expressive language measure? 4. What are the differences between the pre-test and post-test scores of the experimental group on the Childhood Apraxia of Speech Scale? III. Objectives of the Study: This study aimed to achieve the following objectives: 1. To examine the effectiveness of using Non-Speech Oral Motor Exercises (NSOMEs) on expressive language in children with childhood apraxia of speech. 2. To examine the effectiveness of using Non-Speech Oral Motor Exercises (NSOMEs) on childhood apraxia of speech. 3. To provide information and data related to Non-Speech Oral Motor Exercises (NSOMEs). 4. To offer suggestions that may be beneficial for professionals regarding the use of Non-Speech Oral Motor Exercises (NSOMEs). 5. To assess the long-term effectiveness of the program after its completion and during the follow-up period. IV. Significance of the Study: The significance of this study lies in the following aspects: A. Theoretical Significance: 1. The study is characterized by its contemporary focus, directly addressing childhood apraxia of speech in children, a topic with limited research in Arabic contexts. 2. It provides a theoretical grounding for the variable of Non-Speech Oral Motor Exercises (NSOMEs), a relatively new concept in the Arabic-speaking environment (to the researcher's knowledge). 3. There is a scarcity of previous studies in the Arabic-speaking environment that have addressed the use of NSOMEs with children with childhood apraxia of speech (to the researcher's knowledge). 4. It raises awareness among parents, teachers, and professionals about the importance of early intervention for cases of apraxia. B. Practical Significance: 1. The study's findings can be used to develop effective treatment programs for children with childhood apraxia of speech by integrating NSOMEs into traditional treatment approaches. 2. It contributes to a deeper understanding of the impact of NSOMEs on expressive language in children with apraxia, aiding in the identification of best practice treatment methods. 3. It enables the design of a specialized training program for children with childhood apraxia of speech that relies on NSOMEs, with the goal of improving their expressive language skills. V. Definitions of Terms: 1. Childhood Apraxia of Speech: Defined by Violet Ibrahim and Nani Awad Allah (2021, 4) as a disorder affecting voluntary movements for producing sounds, syllables, words, and sentences. It is not caused by weakness or impairment in speech muscles but by a deficiency in organizing, coordinating, and sequencing speech articulators such as the lips, jaw, and tongue. The child knows what they want to say but experiences difficulty coordinating the muscle movements necessary for speech, as measured by the scale used in the current research. 2.Expressive Language: Operationally defined as the ability to use words, sentences, and phrases correctly and appropriately to convey the intended meaning. 3.Non-Speech Oral Motor Exercises (NSOMEs): Non-speech activities designed to stimulate sensation or manipulate oral structures to affect physiological mechanisms and improve the function of these structures. Many types of NSOMEs focus on building strength, range of motion, stability, and respiratory support. For example, passive manipulation of structures (biting, chewing, massage, applying heat and cold) is used in various ways and often, but not always, in conjunction with speech practice (McCauley & Strand, 2008). 4.Training Programs: Operationally defined by the researcher as a series of planned and structured sessions aimed at providing a range of non-speech oral motor exercises to address difficulties in coordination and sequencing between the central nervous system and the muscles responsible for speech production, which are experienced by children with CAS. The program relies on strategies such as modeling, repetition, imitation, role-playing, homework, and feedback to improve the child's expressive language skills and achieve the program's objectives successfully. VI. Limitations of the Study: 1.Methodological Limitations: a. Research Design: A quasi-experimental design with two groups (experimental and control) was adopted to determine the effect of using non-speech oral motor exercises (independent variable) on improving expressive language (dependent variable) in children with childhood apraxia of speech. b. Research Sample: The primary sample consisted of 10 children with childhood apraxia of speech, aged between 4 and 7 years. The sample was randomly divided into two equal groups: • Experimental Group: 5 children • Control Group: 5 children c. Research Instruments: • Stanford-Binet Intelligence Scales, Fifth Edition (Arabic adaptation and standardization by Mahmoud Abu El-Nil et al., 2011). • The Arabic adaptation of the Preschool Language Scale (PLS) (prepared by Ahmed Abu Hassiba, 2011). • Verbal Apraxia Disorder Scale (prepared by Violet Fouad and Nani Awad Allah, 2021). • The Economic, Social, and Cultural Level Scale(Prepared by: Mohamed Ahmed Saafan & Doaa Mohamed Khattab, 2016). • Training program based on non-speech oral motor exercises (prepared by the researcher). d. Statistical Analysis: To analyze the data and evaluate the hypotheses, a set of non-parametric statistical methods were used due to the nature of the collected data. These methods include: • Mann-Whitney U test • Wilcoxon signed-rank test 2.Spatial Limitations: The study instruments were implemented in: • Al-Rashedin Center in Ihnasia • Awladna Association in Bayad Al-Arab • Capabilities Center of the Al-Hayaa Association in Ashmant, Beni Suef Governorate • Communication Center in Mallawi, Minya Governorate 3.Temporal Limitations: The study instruments were administered during the period of 2024 – 2025. VII. Hypotheses: In light of the previous studies, the following hypotheses can be formulated as possible answers to the study questions raised in the statement of the problem: 1. There is a statistically significant difference between the mean rank scores of children in the experimental and control groups in the post-test on the Expressive Language Scale, favoring the experimental group. 2. There is a statistically significant difference between the mean rank scores of children in the experimental group in the pre-test and post-test on the Expressive Language Scale, favoring the post-test. 3. There is no statistically significant difference between the mean rank scores of children in the experimental group in the post-test and follow-up test on the Expressive Language Scale. 4. There is a statistically significant difference between the mean rank scores of children in the experimental group in the pre-test and post-test on the Childhood Apraxia of Speech Scale, favoring the post-test. VIII. Results: The study results showed: 1. There is a statistically significant difference between the mean rank scores of children in the experimental and control groups in the post-test on the Expressive Language Scale, favoring the experimental group. 2. There is a statistically significant difference between the mean rank scores of children in the experimental group in the pre-test and post-test on the Expressive Language Scale, favoring the post-test. 3. There is a statistically significant difference between the mean rank scores of children in the experimental group in the post-test and follow-up test on the Expressive Language Scale. 4. There is a statistically significant difference between the mean rank scores of children in the experimental group in the pre-test and post-test on the Childhood Apraxia of Speech Scale, favoring the post-test

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