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During the discovery phase of the trial, the attorneys representing the obstetrician asserted
that motor speech disorders ran in Shantell’s family. They noted that Shantell’s father had been
in special education as a youngster for a speech disorder and that her brother, Ron, required
therapy for a motor speech disorder. The obstetrician’s experts stated that Shantell suffered from
verbal apraxia, a speech disorder that ran in the family. The defense attorneys wanted to show
that Shantell’s communication disorder was inherited to limit the obstetrician’s liability. The issue
became whether Shantell suffered from verbal apraxia and whether her father and brother also had
this motor speech programming disorder.
As is often the case in medical malpractice trials, expert witnesses for each side provided evalu-
ations, documents, and depositions. The first issue involved the definition of apraxia of speech.
Shantell and Ron were evaluated by an in de pen dent speech- language pathologist. As the defense
attorneys proposed, the evaluation showed that Ron did indeed suffer from apraxia of speech.
Although the therapists treating him labeled the disorder in vari ous ways, it involved motor
conceptualizing, programming, and executing purposeful speech acts. Several research articles
showing that developmental apraxia of speech has an inherited component were also submitted.
The plaintiffs conceded that Shantell’s brother had apraxia of speech and that there might be a
ge ne tic predisposition to it, but they stated that Shantell had spastic dysarthria and that a history
of apraxia of speech in Shantell’s family was irrelevant.
Shantell had classic speech symptoms of spastic dysarthria. The first and most obvious symp-
tom was spastic paraplegia. Shantell had increased bilateral muscular tone and exaggerated ten-
don ref lexes. The neurologist’s report clearly stated a diagnosis of spastic paraplegia. The speech
evaluation also showed spasticity of the speech muscles, with consequent imprecise production
of consonants and prosodic disturbances. In addition, Shantell’s voice had a strained- strangled
quality. An issue arising during discovery was whether spastic dysarthria could be considered an
aspect of apraxia of speech. The defense claimed that in a broad definition of apraxia of speech,
upper motor neuron damage and the resulting speech symptoms could be considered an apraxia
and that Shantell’s spasticity involved execution of the motor act.
Apparently, the defense ultimately deci ded that their case for an inherited apraxia of speech
and their claim that spastic dysarthria is, in fact, an aspect of impaired motor speech program-
ming would not convince a judge and jury. A com pany that determined the costs of habilitation
and related expenses for birth defects projected how much it would cost to care for, train, and
educate Shantell throughout her life. Days before the case went to trial, the parties settled out of
court. Although the attorneys did not disclose the terms of the settlement, the parties to the case
were told that Shantell would receive the care she required.
Case Study 6-3: Cerebral Palsy and Clavicular Breathing
People talk about the courage and resolve of persons with disabilities, but few understand the
challenges and obstacles many of them must face in an ordinary day. When a person with severe
ce re bral palsy manages to attain the academic and clinical requirements to become a certified