Describe apraxia. What kind of disorder is it? What is impaired? What is it caused by? What is it marked by? What is it not the result of?
- A motor planning disorder
- Impaired sequencing of muscle movements for volitional actions
- Caused by damage to cortical structures that sequence movements
- Marked by inconsistency of productions
- NOT the result of muscle weakness, slowness or discoordination
What are the types of apraxia?
- Limb Apraxia
- Oral Apraxia
- Apraxia of Speech
Describe ideational apraxia. What is it? What is it due to? What is the damage to? Does it last a long time?
- The inability to make use of an object or gesture due to lost idea of the action
- Due to “lost knowledge” of the function of the object/gesture
- Left parietal damage, often resolve quickly
- Eg. using a fork as straw
Describe ideomotor apraxia. What is it? What are they able to do/not do? What does it impact? What is easier than spontaneous production?
•Inability to use an object or make a gesture due to loss of the motor movements
• Able to approximate the movement, but not sequence the steps to complete it.
- Eg. Brushing teeth
•Impacts volitional movements more than automatic ones
- Eg. Waving goodbye
•Imitation is easier than spontaneous production
More common, more persistent
Describe ideomotor, limb apraxia. What is it? What does it interfere with? Would it impact writing?
•Inability to sequence movements using hands, arms, legs,
•Interferes with activities of daily living (dressing, eating)
•Would this impact writing?
- Yes, because motor plan is inaccurate
Crossed wires ex., groping
Describe ideomotor, oral apraxia. What is it? What may they have difficulty with? WHat may it be accompanied by? What may they have trouble doing on command? What may they still be able to do? Will oral apraxia have a big impact on functioning?
•Inability to sequence oral movements not related to speech
•May have difficulty on an oral motor exam
•May be accompanied by
- Incomplete or partially complete actions
•May have trouble coughing/swallowing on command (eg “Cough”)
•May still be able to swallow while eating, laugh at jokes etc.
•This set of symptoms alone has little impact on functioning, Only important when it co-occurs with Apraxia of Speech.
Stick tongue out - do other things, eventually get there
Describe apraxia of speech. What is it? What may it co-occur with? What is it typically caused by? What is it likely to occur with? What is it primarily a disorder of?
•Impaired motor sequencing for speech tasks
•May co-occur with other apraxias
•Typically caused by Left frontal lobe lesions
•Like to co-occur with aphasia and dysarthria
•While apraxia can impact a number of subsystems it is primarily a disorder of
What is the motor speech programmer?
•A theorize structure in the brain that receives input from linguistic, motor, sensory, and emotional centers and plans precise muscular contractions.
•Theorized to reside near Broca’s area
Describe articulation and apraxia or speech. What types of errors can there be? What is there more difficulty with? Are the errors consistent?
•Most common errors
•Errors can be of any type:
- Placement, manner, voicing
- Substitutions, distortions, omissions, additions, repetitions
- Anticipatory (Llama -> Mama) or perseverative (Viking -> viving)
•More difficulty with multisyllabic words, or complex sequences
•Errors may be consistent or inconsistent
Describe prosody and apraxia of speech
•Slow rate of speech
•Reduced variation of pitch and loudness
Describe respiration, resonance and phonation with apraxia of speech
•Other speech systems are less significantly impacted:
•Respiration: difficulty with voluntary respiratory tasks
•Resonance: Rarely a significant issue
•Phonation: Errors usually tied to articulation
Describe assessment with apraxia of speech. What tasks are done?
•Oral motor exam, and purposeful oral movements
•Words of increasing length
Differentiate between apraxia and dysarthria:
Respiration, Phonation, Resonance
Muscle Weakness, Slowness
Involuntary tasks (swallowing)
Tasks that are voluntary, volitional
Initiation of Movements
Errors can be
Struggle and groping behaviors
What are some general principles of apraxia treatment?
•May look similar to aphasia therapy
•Emphasis on modeling and minimize explaining
•Repetitive drill work is essential
•Focus of functionality as early as possible.
Describe motor practice. What approach is taken? Describe what full support would look like.
•Begin with full support
- Speaking in unison
- Exaggerated mouth movements
•Repetition, Repetition, Repetition
Describe functional phrases. What are they? What is the goal? What do you begin with? What do you move to?
•Emphasize phrases that the client will use in real life
•Tailored to each person’s needs
•Goal is to communicate functionally. Phrases don’t have to be perfect.
•Begin with blocked practice
- Repeat, repeat, repeat
•Once established move to random practice
- Repeat, repeat, repeat
4 or 5, then build repertiore
What are facilitative contexts?
•Pairing words and sounds that help elicit the target sound. (other sounds around helo to produce sound)
•Eg. “King Kong” (k for ing - tongue already placed)
•Fading paired words
•Repeat, repeat, repeat
What are some new treatments for apraxia of speech?
Differentiate between aphasia and apraxia
A disorder of…
Errors are a break down in…
Lesion is typically…