Motor Speech Disorders 123speech- language pathologist, her courage and resolve are truly remarkable. What made Karen a
remarkable person was not that she made the sacrifices that many gradu ate students must make,
but that she made them while having to think consciously about the most basic action in life:
breathing. She practiced her beloved profession for nearly 3 de cades before death took this amaz-
ing woman from the special needs students who learned so much from her.
Karen’s resolve and determination were apparent from the day she was born. By all accounts,
she should never have survived the delivery, and she spent most of her first weeks in a neonatal
intensive care unit. Her ability to breathe on her own was always marginal, and when she entered
college to pursue a degree in speech pathology and audiology, dormitory life was not an option.
Karen moved to a nursing home near the university’s speech and hearing department. With the
assistance of an aide, she traveled to and from her phonetics, anatomy, methods, organics, stutter-
ing, and language courses in her wheelchair. During class, she combatted her spastic respiratory
muscles with clavicular breathing, working consciously to counter the reverse abdominal breath-
ing commonly seen in spasticity by lifting and expanding her chest using her upper thoracic and
neck muscles. For several years, she pursued her dream of becoming a speech- language patholo-
gist. Unlike most students who dream of professional accomplishments, Karen’s dreams did not
f loat through her mind in the comfort of a dorm bed.
Karen slept in an iron lung. Because of her compromised respiration, she needed it to breathe
when she slept. The huge lung took up most of the space in the small nursing home room. Made
of galvanized steel, it was 7 feet long and 3 feet wide and was held 4 feet from the f loor by sup-
porting structures. It weighed nearly 500 pounds. When it was operating, there was a hissing
sound of air rushing in and out of the chamber, followed by a low- pitched “clunk” as the main
valve closed.
Karen needed assistance to enter the iron lung. Each night, two nurses’ aides lifted her from
the wheelchair and placed her on a sliding table. With Karen lying on her back, the aides slid the
table into the iron lung until her head was inserted in a circular rubber valve. Then the aides tight-
ened the valve around Karen’s neck until a seal was created. Next, several large locking devices
were engaged and Karen’s lower body was sealed from the atmosphere. One of the aides then
adjusted the control panel, and the iron lung began to breathe for Karen. At regular intervals, air
was pumped in and out of the lung, the frequency and extent of the pumping corresponding to
Karen’s resting oxygen needs. This early iron lung also had a mirror placed above Karen’s face at a
45- degree angle, permitting her to see and be seen by persons standing or sitting behind her. With
the help of the iron lung, Karen did not need to think about breathing.
Case Study 6-4: Apraxia of Speech Without Oral Apraxia
Stephanie took the job as a clerk in the con ve nience store only to save enough money to return
to college and continue pursuing her degree in En glish. The latest round of tuition increases and
the high cost of housing had forced her to drop out and take the full- time, temporary job. Now,
11 years later, Stephanie is the assistant man ag er of the store and a stroke survivor. She also has
apraxia of speech and strug gles daily to program her articulators.