Disorders of Motor Speech: Assessment, Treatment, and Clinical Characterization.

Robin DA, Yorkston KM, Beukelman DR, eds. Baltimore, MD 21285, Paul H Brookes Publishing Co Inc, 1996, hardback, 368 pp, illus, $38.

This book is a compilation of articles written for speech-language clinicians, clinical and basic scientists interested in motor speech control and its disorders, and other health care professionals who need a resource on motor speech disorders. It contains selected papers presented at a 1994 conference on motor speech, which focused on normal motor speech control and motor speech disorders. The featured speaker of the conference was Richard Schmidt, who is well known to physical therapists and others in the area of motor learning. This text represents the fourth publication of papers from the biennial conferences, which began in 1982.

The book is organized into eight sections: "Issues in Motor Learning," "Perspectives on Normal Motor Speech Control," "Intelligibility," "Reliability and Validity Issues in Assessment," "Respiratory Involvement in Dysarthria," "Motor Speech Involvement in Traumatic Brain Injury," "Parkinson's Disease," and "Spasmodic Dysphonia, Inspiratory Airway Compromise, and Apraxia of Speech." The first section, authored by Schmidt and Bjork, presents factors that may have a positive effect on learning and challenges the practitioner to rethink how motor speech disorders should be treated. This chapter is very easy to read and offers interesting examples of how newer ideas about motor learning have been generated.

The second section reviews a new framework in which the input to motor speech programming consists of sequences of goals that are defined in terms of acoustic and articulatory parameters. This theoretical framework hypothesizes that acoustic goals are a part of motor speech programming and that an acoustic goal may be reached in more than one way (ie, motor equivalence). This theory certainly supports assumptions that there may not be a "gold standard" for each motor task. An animal model of motor speech is also presented in this section, as animal models may have potential for contributing to an understanding of normal and disordered regulation of phonation and articulation. As someone who is not a speech language pathologist, I found this section somewhat difficult to follow. For the physical therapy practitioner the section may be confusing.

Section 3 includes three studies on intelligibility in persons with dysarthria. The studies are well done and present important strategies, such as using semantic and syntactic context, gestures, and interword pauses to improve intelligibility in persons with moderate to severe dysarthria.

The fourth section covers new studies on perceptual measures of motor speech disorders and prosody. Each of the three studies in the section poses questions related to reliability and validity of traditional rating methods and scales for voice quality and dysarthria. Clinical suggestions for improving either intrarater or interrater reliability are given at the end of each study. Section 5 focuses on clinical research studies of respiration during speech production. Suggestions are given for intervention strategies for breath control in subjects with dysarthria due to a variety of medical diagnoses.

Sections 6 and 7 of the text may have the most enlightening information for physical therapy practitioners. These two sections address motor speech involvement in patients with traumatic brain injury (closed head injury [CHI]) and Parkinson's disease. Problems were found in laryngeal function and tongue endurance in patients with CHI who also have dysarthria. It is suggested that therapy should be directed toward aberrant behaviors, such as laryngeal hyperfunction and tongue fatigue. In patients with Parkinson's disease, hypokinetic dysarthria and decreased tongue strength were documented. Strategies are presented to assist these patients in improving their speaking effectiveness.

The final section contains information about a variety of different motor speech disorders such as abductor spasmodic dysphonia, inspiratory airway compromise, and apraxia of speech. Chapters in this section represent studies of individuals with these particular diagnoses and clinical findings and provide suggestions for treatment.

The text is well written and easy to read. The inclusion of theoretical papers as well as clinical studies makes the textbook interesting and informative. Each chapter also provides an extensive reference list. The consistent use of non--people-first language throughout the textbook, however, was distracting.

The book's intended audience is speech-language pathologists, and the text serves that intent well. Although some of the background information on motor speech problems in patients with CHI, amyotrophic lateral sclerosis, and Parkinson's disease would be of interest to physical therapists working with these populations, the text has little to offer to the physical therapy practioner. Treatment strategies are given primarily for the speech-language pathologist and not for related health care providers.

Barbara H Connolly, EdD, PT University of Tennessee--Memphis Memphis, Tenn

Ms Connolly specializes in pediatrics and learning disabilities.