Total Motor Score (TMS): A Theoretical Framework for Speech Motor Complexity

The Total Motor Score (TMS) is a theoretical, kinematically informed framework designed to support clinical reasoning in motor speech intervention for individuals with Childhood Apraxia of Speech (CAS), Acquired Apraxia of Speech (AOS), and related motor planning disorders.

TMS is not a diagnostic tool or standardized assessment. It is a clinical reasoning model and heuristic intended to help clinicians and caregivers think more precisely about the relative motor planning and sequencing demands of speech targets.

The framework is based on a core assumption: speech is a motor task. Different words place different demands on jaw control, tongue–jaw coordination, articulatory movement trajectories, and sequencing across syllables. TMS models these demands to estimate relative motor load, helping explain why a longer word may sometimes be easier to produce than a shorter one.

The Total Motor Score provides a numeric estimate of relative motor complexity and is paired with qualitative progression rules that guide target selection and sequencing in therapy. The value of the score lies in comparison rather than absolute numbers, and clinical judgment remains essential.

This framework is grounded in principles from motor learning theory, articulatory phonetics, and evidence-based intervention for motor speech disorders. The specific scoring system is theoretical and has not yet been empirically validated using direct kinematic measures. It should be used as a guide to support intervention planning, not as a prescriptive rule set.

All theoretical foundations, scoring logic, worked examples, clinical implications, and limitations are presented in a full article, which is linked on this page for readers who wish to explore the model in detail.

Practical tools based on the TMS framework are currently in development. Flashcards designed to help clinicians, parents, and caregivers select and practice therapy targets based on relative motor load will be released soon.

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