Apraxia

Question 1

What is apraxia?

Answer 1

A neurologic speech disorder that reflects an impaired capacity to plan or program sensorimotor commands necessary for directing movements that result in phonetically and prosodically normal speech.

Question 2

When can apraxia occur?

Answer 2

In the absence of physiologic disturbances associated with dysarthrias and in the absence of disturbance in any component of language.

Question 3

What is the problem presented with apraxia?

Answer 3

Motor programming of speech movements

Question 4

What is the problem presented with dysarthria?

Answer 4

muscles/ movement

Question 5

What is the problem presented with aphasia?

Answer 5

linguistic/language

Question 6

In what disorder are muscle okay? Apraxia or dysarthria?

Answer 6

Apraxia

Question 7

Apraxia doesn’t involve ______ although it often co-occurs with _______ and ________.

Answer 7

language

aphasia and dysarthria

Question 8

_______ does co-occur with aphasia but less often than _____ does.

Answer 8

Dysarthria

apraxia

Question 9

_____ or _____ _____ may co-occur with apraxia of speech.

Answer 9

Oral or limb apraxia

Question 10

Apraxia is almost always due to what?

Answer 10

left cerebral hemisphere damage so helps in localization of the lesion.

Question 11

What are the steps in speaking?

Answer 11

1. Speaker conceptualizes what is going to be said. This is where the message is determined.
2. Speaker formulates the message through selecting semantic, syntactic, morphological, phonological structures for the message.
3. The Motor Speech Programmer programs/plans the movements necessary to produce the needed phonemes. It activates a plan for the motor execution needed.
4. This program is sent through the nervous system to produce muscle movement/motor execution.

Question 12

If difficulties occur in (step 2) the speakers ability to formulate the message through selecting semantic, syntactic, morphological, phonological structures for the message it may be a result of ______.

Answer 12

Aphasia

Question 13

If difficulties occur in (stepp 3) the ability for the motor speech programmer to program/plan the movements necessary to produce the needed phonemes it may be as a result of _______.

Answer 13

apraxia

Question 14

If difficulties occur when (step 4) the program is sent through the nervous system to produce muscle movement/motor execution it may be a result of _______.

Answer 14

dysarthria

Question 15

What are other names for apraxia of speech?

Answer 15

• speech apraxia

- oral verbal apraxia

Question 16

Apraxia of speech is sometimes confused with what?

Answer 16

Broca’s aphasia

Question 17

Why is apraxia of speech confused with Broca’s aphasia?

Answer 17

The phonologic impairment may be similar

Question 18

Broca’s aphasia may include _____ but it involves more than ____.

Answer 18

AOS

Question 19

Individuals with AOS do not have ______ problems that are seen in Broca’s aphasia.

Answer 19

linguistic

Question 20

is the site of lesion for Broca’s aphasia and apraxia the same or different?

Answer 20

Both have similar sites of lesion.

Question 21

Probably some of the speech problems people with Broca’s aphasia have are due to _____ problems and not always linguistic problems.

Answer 21

MSP (motor speech programmer)

Question 22

What do you do when a client is suspected of apraxia and aphasia?

Answer 22

Always evaluate for both since they often co-occur.

Question 23

What is the Motor Speech (MSP) programmer responsible for?

Answer 23

programming speech. It transforms the abstract phonemes to a neural code from which the motor programming can occur. The neural code determines the specific muscle movements needed.

Question 24

Some of the specifics of the programming from the motor speech programmer possibly include:

Answer 24

• duration of movement
• amplitude of movement
• acceleration
• deceleration
• time t peak velocity
• timing of speech events

Question 25

What is theorized about the motor speech plans?

Answer 25

That the motor speech plans are prepared before the muscle movement begins and that they are held in a buffer area. These plans can be modified before movement begins or during movement. This pre-planning is thought to be what allows us to have rapid speech.

Question 26

What is thought to be what allows us to have rapid speech.

Answer 26

Pre-planning

Question 27

Where is the motor speech programmer (MSP) thought to be located?

Answer 27

left cerebral hemisphere

Question 28

The MSP is thought to be located in the left cerebral hemisphere. It is a theoretical system that involves several interacting structures and pathways in the left cerebrum. These structures are primarily located in the ___________ and related_______ ________.

Answer 28

Parietal-frontal | subcotical circuits

Question 29

What do you need to have in order to know what to organize?

Answer 29

linguistic input

Question 30

The linguistic input to the MSP comes mainly from the ________ area in the _____ _____. What does it include?

Answer 30

``` perisylvian left hemisphere temporoparietal cortex, insula basal ganglia thalamus ```

Question 31

What is the insula?

Answer 31

A cortical brain area that is buried within the lateral (sylvan) cerebral fissure.

Question 32

The insula is hidden in the folds and can't be seen unless you separate the ____ and _____ lobes.

Answer 32

temporal | frontal

Question 33

What does the latest research odne by Dr. Robin and Dr. Wambaugh indicate about the insula?

Answer 33

It might not be involved in apraxia.

Question 34

What has Dr. Robin found out?

Answer 34

That Brodman's area 6 (pre-motor area) is an important area in aparxia and that damage in that area is associated with apraxia.

Question 35

Name the specific areas that are thought to be primarily involved with the MSP:

Answer 35

- pre-motor area - parietal lobe somatosensory cortex and supramarginal gyrus. - insula - basal ganglia

Question 36

What is especially important for apraxia in the pre-motor area?

Answer 36

Broca's area

Question 37

Where are the lesions most often found in most people with apraxia?

Answer 37

Broca's area

Question 38

What area is not a common site of lesion for apraxia but may be involved sometimes?

Answer 38

Supplemental motor area

Question 39

What are the pre-motor areas linked to for input?

Answer 39

basal ganglia and cerebellar circuits

Question 40

Where do the pre-motor areas send connections for impulses to be sent on and put into place by the motor speech program?

Answer 40

motor area

Question 41

Why do pre-motor areas send connections to the motor area?

Answer 41

For impulses to be sent on and put into place by the motor speech program.

Question 42

Why are the parietal lobe somatesonsensory cortex and supramarginal gyrus important?

Answer 42

They integrate sensory information that is needed for skilled motor activity.

Question 43

What is an area that is a frequent site of lesion for peole wth apraxia and sometimes the only site of lesion. However, apraxia can occur without lesions in this area.

Answer 43

Insula

Question 44

The importance of the insula for apraxia has been questioned. True or False.

Answer 44

True

Question 45

The basal ganglia is also thought to be important in MSP. Lesions in the striatum, _____ and _____ ____ are common in people with AOS.

Answer 45

putamen | caudate nucleus

Question 46

What are the most common sites of lesion in AOS?

Answer 46

Left posterior frontal lobe area (Broca's) (insula?) and (basal ganglia).

Question 47

What are non-speech characteristics that may accompany AOS and reflect left hemisphere damage?

Answer 47

- some right sided weakness and spasticity - Babinski reflex and hyperactive stretch reflexes - sometimes limb apraxia is present

Question 48

What is limb apraxia associated with?

Answer 48

Left hemisphere pathology although if it is present in both right and left sides but may be masked on the right side by hemiparesis or hemiplegia.

Question 49

Since MSP is thought to be located in the left hemisphere it may influence what?

Answer 49

all motor movement

Question 50

What are the etiologies for apraxia of speech?

Answer 50

- anything that causes dominant hemisphere impairment of structures involved in motor planning. - Tumors - trauma - stroke

Question 51

What are patient's complaints and perception with apraxia of speech?

Answer 51

Can't pronounce words right-they know what they want to say but the words won't come out right. They may indicate it worsens in stress.

Question 52

Patients with AOS alone do not typically have problems with _______. If patients do complain of _____, neuromuscular problems may exist which would implicate ______ as well as _______.

Answer 52

swallowing swallowing dysarthria dysphagia

Question 53

If patients complain of swallowing, nueromuscular problems may exist which implicates what?

Answer 53

dysarthria as well as dysphagia

Question 54

What should be the clinical findings during an oral mechanism for a client with apraxia?

Answer 54

if dysarthria does not co-occur, gag reflex, chewing and swallowing should be WNL. Similarly, there should no pathological oral reflexes or tongue weakness without dysarthria. -note whether oral sensation is impaired.

Question 55

are auditory processing skills affected in patients with AOS?

Answer 55

Auditory processing skills are normal in patients with AOS but direct auditory feedback can cause more severe breakdowns in individuals with AOS and Broca's aphasia than in normal speakers.

Question 56

What kind of voluntary speech tasks are used to elicit AOS?

Answer 56

conversational speech narratives reading

Question 57

What kind of tasks do patients with AOS tend to breakdown?

Answer 57

Tasks that require sequencing of various sounds and syllables such as: sequential motions rate (SMRs) and multisyllabic words and sentences.

Question 58

How can you determine if the problems are due to aphasia or apraxia?

Answer 58

Have the patients do imitation tasks to reduce the need for word retrieval or other kinds of word formulation which may be a problem if aphasia co-exists.

Question 59

patients may do ok with what kind of tasks?

Answer 59

Speech tasks that are over-learned: counting, days of week, familiar phrases. They have become automatic and non-volitional.

Question 60

During a speech assessment in patients with apraxia listen for _______ _______ ______ and watch for ______ of articulators.

Answer 60

false articulatory starts | groping

Question 61

Patients with severe AOS may not be able to do many of speech tasks. What should you do?

Answer 61

Try to elicit any speech response and determine what they can do?

Question 62

What is the primary articulation error for patients with apraxia of speech?

Answer 62

distortion. It may be a perceived substitution but it is actually a distortion.

Question 63

_______ is a key problem with consistent errors occurring in apraxia.

Answer 63

Articulation

Question 64

What is one difference from the paraphasias that occur in aphasia and the articulatory distortions that occur in AOS?

Answer 64

In paraphasias, there is usually no distortion.

Question 65

Aritculation problems in patients with apraxia are greater on _____ than _____ ______.

Answer 65

blends | single consonants

Question 66

____ and ______ problems are very common in AOS?

Answer 66

Rate | prosodic

Question 67

How is fluency affected in patients with apraxia of speech?

Answer 67

It becomes abnormal as individuals start and stop repetitively in attempts to self-correct and produce words correctly.

Question 68

What is the most important diagnostic criteria for apraxia of speech?

Answer 68

- slowed rate of speech-segmentation of syllables (increased interval time between syllables) - sound errors (distortions, consistent, predictable - prosodic abnormalities

Question 69

What may happen with a person who has severe AOS?

Answer 69

May not initially be able to phonate and may be mute. May not last too long, most can phonate after 2 weeks.

Question 70

If muteness lasts longer than 2 weeks in a client with apraxia what should clinician consider?

Answer 70

Another diagnosis such as severe aphasia, anarthria or psychogenic mutism.