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Case Study 1

Case Study: Apraxia
03/18/2002 Meridian Developmental Center

This study involves a five-year-old female diagnosed with Apraxia. She has mild motor Apraxia and severe Broca’s language Apraxia. Katie, as we will call her, came to our center in September of 2001, referred by her family Doctor a general practitioner in the Midwest. Katie had received traditional speech and language therapy for three years prior to being seen for EEG Biofeedback. In September, Katie was tested using the PPVT-III revised as a pre-test baseline. She earned a raw score of 18 indicating a mental age equivalent of 1 year and 9 months. Behaviorally Katie had little ability to focus or concentrate, leaving a task after only several seconds of involvement. She had an explosive temper usually being activated after being exposed to abrupt noise such as at church as the entire congregation would sing at one time, or at a birthday party with loud noise or group singing. She seemed to have a “hyper-sensitivity” to noise and particular sounds. The parental concerns at the beginning of her traaining were her sleeping patterns, attention span, volatile behavior, low cognitive skills, and her actual speech production. Katie had a sleeping pattern of restlessness, accompanied with being an early riser, which made her “grouchy” as though she hadn’t gotten enough sleep. Katie’s academic abilities included being able to identify and discriminate between primary colors; red, yellow, green and blue, and the primary shapes; square, circle, and triangle. She was able to identify a letter “K” (as in her name) in upper case and in isolation, identify the number 1 consistently and count to 3 without assistance. She had little fine motor ability, was able to hold a pencil with an immature grasp while only cutting by using the gross motor movement of the entire arm. Katie had very little intelligible verbal utterances or expressions. She was able to identify Mom and Dad and Sister Amanda with an approximation of their names. Katie was unable use spontaneous language in context. She had developed a pattern with her family allowing the concept, idea or question to be expressed through other family members. 
The revised protocol used with Katie at the Cognitive Connections was developed by Dr. Valdeane Brown and is called the Period 3 approach. The instrumentation used was the NeurOptimal. Katie started her training as follows:
  • 2 times a day for 1 week = 14 sessions
  • 1 time a day for 2 weeks = 14 sessions
  • 3 times a week for 5 weeks = 15 sessions
  • 2 times a week for the remainder of the protocol = 12 sessions
  • Total = 55 sessions
A fractionation between SMR & low Beta were used as Period I alternating between the two frequencies in 5 minutes intervals for approximately the first 8-10 sessions. The premise was to work with her sleep patterns in the beginning in hopes that her attention would change due to the better sleep. Katie then was introduced to Period III presenting her with the screens of a low beta fractionating with a sheer beta or sometimes called gamma. She usually received three rotations of five minutes of each of these screens while a second therapist followed through on cognitive processing activities. It was our intention to increase her processing abilities in terms of deductive thinking, reasoning, and problem solving skills while developing an age appropriate vocabulary, organizational skills, patterning and discrimination skills in both the auditory and visual modes.
The results are impressive. The testing was once again given at session #31 and at session # 55. The results are as follows:
Raw Score Age Equivalent
  • Session #1          1.9 years of age
  • Session # 31        2.11 years of age
  • Session # 55        3.9 years of age
Katie has continued with her training. She completed her training on session # 85 and is going through her testing once again. Her vocabulary has increased tremendously as she is even using spontaneous speech with inflection and periodically using slang. Katie has developed a sense of humor and is continually growing with her problem solving skills. She is able to sequence items visually as well as up to three items auditorially. She is now able to see patterns in activities and develop strategies because of these patterns.

Katie is now sleeping without problems while occasionally she may request her mother in the morning help her to the restroom but most of the time she is independent. She sleeps through the night and wakes rested enough that she is not “grouchy” during the day. Katie’s hypersensitivity to sound has also decreased. She is singing with the group while having a birthday party and is able to sit through church without becoming upset. 

The cognitive skills have definitely improved over the past seven months developing two full years in this time. While we have all agreed neurofeedback will not “cure” a person of Apraxia, Katie has demonstrated the efficacy for this process within this population. The characteristic increases in maturity, cognition and behavior have certainly shown evidence of improvement using the process of Neurofeedback, NeurOptimal and Cognitive Rehabilitation techniques.